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PURPOSE: The purpose of this diagnostic study was to assess the accuracy and time efficiency of a digital method to draw the denture foundation extension outline on preliminary casts compared with the conventional technique. MATERIALS AND METHODS: A total of 28 preliminary edentulous casts with no anatomical landmarks were digitized using a laboratory scanner. The outlining of the entire basal seat of the denture was performed on preliminary casts and digitized. Casts with no extension outline were digitized and outlines were drawn using software (DWOS, Straumann). The accuracy of the extension outlined between both techniques was evaluated in the software (GOM Inspect; GOM GmbH) by file superimposition. Specificity and sensitivity tests were applied to measure accuracy. The paired t-test (95% CI) was used to compare the mean total area and the working time. RESULTS: The accuracy ranged from 0.57 to 0.92. The buccal and labial frenulum showed a lower value in the maxilla (0.57); while the area between the retromolar pad and buccal frenulum (0.64) showed a lower score in the mandible. The maxillary denture foundation and the working time for both arches were significantly longer for the digital method (P < .001). CONCLUSION: The denture foundation extension outline exhibited a sufficiently excellent accuracy for the digital method, except for the maxillary anterior region. However, the digital method required a longer working time.

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Este estudo objetivou identificar os fatores que influenciam na decisão de substituir uma prótese total convencional mandibular pelo tratamento com implantes dentários, assim como avaliar a satisfação, qualidade de vida e performance mastigatória (PM) após reabilitação com sobredentaduras com implante único (SIU) em pacientes adaptados e não-adaptados a prótese total convencional (PT) mandibular. Inicialmente, foi realizado um estudo transversal com 117 usuários de PTs bimaxilares, avaliados quanto aos desfechos relacionados à prótese (número de PTs mandibulares usadas previamente, tempo de uso e profissional que confeccionou a prótese atual, e quanto ao uso regular ou não da prótese mandibular) e aspectos centrados no paciente (período de edentulismo mandibular, altura óssea mandibular e interesse do paciente em se submeter a terapia com implantes). Do total da amostra, 78 pacientes manifestaram interesse na terapia implantossuportada, e desses apenas 22 foram selecionados e reabilitados com novas PTs bimaxilares. Após critérios de elegibilidade, foram alocados após pareamento em 2 grupos: adaptados à prótese mandibular (Grupo PTA - "adaptados à PT mandibular", n:10) e não adaptados (Grupo PTN - "não adaptados à PT mandibular", n:12). Em cada paciente, foi instalado um único implante na linha média e após o período de osseointegração as próteses mandibulares foram convertidas em sobredentaduras. O desempenho mastigatório foi avaliado pelo método das tamises, a altura óssea mandibular por medição em radiografia panorâmica, satisfação por escala quantitativa com questionário validado e o impacto da saúde oral na qualidade de vida pelo questionário OHIP-Edent-19. O teste Qui-quadrado foi utilizado para análise dos dados e as razões de prevalência ajustadas por meio da regressão multivariada de Poisson no primeiro estudo; para o segundo, a análise estatística em cada grupo e entre grupos foi baseada nos testes não-paramétricos de Wilcoxon e Mann-Whitney. O intervalo de confiança para os testes foi de 95%. A amostra foi predominantemente do sexo feminino, com 66,7% (n=78) dos participantes interessados em PT mandibular implantossuportada e com idade média de 65,68±6,38 anos. A PM não influenciou a escolha pela reabilitação com implantes. A preferência pela PT implantossuportada mandibular foi associada significativamente com maior experiência prévia com PT mandibular (p=0,021) e à insatisfação quanto à retenção (p=0,005). Após a intervenção com implante, todos os pacientes não adaptados passaram a condição de adaptados. Não houve diferença entre PTA e PTN para OHIP-Edent (p=0,276) e PM (p=0,222), a satisfação foi significativa apenas para o critério "conforto em arco inferior" (p=0,043). Para comparações pré e pós-tratamento com sobredentadura, a mediana do OHIP-Edent total diminuiu significativamente em ambos os grupos. Na comparação intragrupo, essa redução foi significativa em PTA apenas para a "limitação funcional" (p=0,026), e em PTN em quase todos os domínios, exceto "disfunção social" e "incapacidade" (p>0,05). Houve aumento estatisticamente significativo para a satisfação geral de 75,41 para 90,25 (p=0,012) em PTN e de 76,10 para 90,50 (p=0,007) em PTA. Os parâmetros "mastigação", "adaptação", "retenção" e "conforto" em arco inferior foram diferentes com significância em ambos os grupos, e "gustação", "fonação" e "dor" em arco inferior foram significativos apenas para o grupo não adaptado (p<0,05). Houve diferença significativa para PM em PTN (p=0,002) e PTA (p=0,047) ao se comparar tipo de reabilitação. Não houve correlação entre PM e OHIP antes e após a reabilitação (p>0,05). Pode-se concluir que a experiência prévia com PT mandibulares convencionais e a insatisfação com a retenção dessas, influenciam o interesse pela reabilitação com sobredentadura implantossuportada mandibular, assim como, a reabilitação com sobredentadura sobre implante único apresenta-se como alternativa aos pacientes não adaptados a PT convencional mandibular, auxiliando na aceitação do uso da prótese mandibular, assim como, comprovando efeito positivo na satisfação, qualidade de vida e performance mastigatória (AU).

This study aimed to identify the factors that influence the decision to replace a conventional mandibular complete denture by treatment with dental implants, as well as to evaluate satisfaction, quality of life and masticatory performance (MP) after rehabilitation with overdentures with a single implant in patients adapted and not adapted to conventional mandibular complete denture (CD). Initially, a cross-sectional study was carried out with 117 users of bimaxillaries CDs, who were evaluated for outcomes related to the denture (number of previous mandibular CDs, time of use and professional who made the current denture, and regarding regular use of the mandibular denture) and aspects centered patients (period of mandibular edentulism, mandibular bone height and the patient's willingness to undergo implant therapy). From the total sample, 78 patients expressed interest in implant-supported therapy, and of these, only 22 were selected and rehabilitated with new bimaxillary CDs. After eligibility criteria, they were allocated after pairing into 2 groups: adapted to mandibular prosthesis (PTA Group - "adapted to mandibular CD", n:10) and non-adapted (PTN Group - " not adapted to mandibular CD", n:12). In each patient, a single implant was installed in the midline and after the osseointegration period, the mandibular prostheses were converted into overdentures. Masticatory performance was evaluated by the sieve method, mandibular bone height by paranoid radiographic measurement, satisfaction by quantitative scale with a validated questionnaire and the impact of oral health on quality of life by the OHIP-Edent-19 questionnaire. The chi-square test was used for data analysis and the prevalence ratios adjusted by means of multivariate Poisson regression in the first study; on the second, the statistical analysis in each group and between groups was based on the non-parametric-Wilcoxon and Mann-Whitney tests. The confidence interval for the tests was 95%. The sample was composed predominantly by women, with 66.7% (n=78) of the participants interested in implantsupported mandibular CD, with mean age 65.68±6.38 years. MP was not influenced by the choice by dental implants rehabilitation. Preference for mandibular implant-supported CD was significantly associated with longer previous experience in mandibular CD (p=0.021) and with dissatisfaction regarding retention (p=0.005). After the implant intervention, all non-adapted patients became adapted. There was no difference between PTA and PTN for OHIP-Edent (p=0.276) and MP (p=0.222), satisfaction was significant only for the criteria "comfort in the lower arch" (p=0.043). For pre- and post-treatment comparisons with overdentures, the median total OHIP-Edent decreased significantly in both groups. In the intragroup comparison, this reduction was significant in PTA only for "functional limitation" (p=0.026), and in PTN in almost all domains, except "social dysfunction" and "disability" (p>0.05). There was a statistically significant increase in overall satisfaction from 75.41 to 90.25 (p=0.012) in PTN and from 76.10 to 90.50 (p=0.007) in PTA. The parameters "chewing", "adaptation", "retention" and "comfort" in the lower arch were significantly different in both groups, and "gustation", "phonation" and "pain" in the lower arch were significant only for the group not adapted (p<0.05). There was a significant difference for MP in PTN (p=0.002) and PTA (p=0.047) when comparing the type of rehabilitation. There was no correlation between MP and OHIP before and after rehabilitation (p>0.05). It can be concluded that the previous experience with conventional mandibular CD and the dissatisfaction with the retention of these, influence the rehabilitation with mandibular implant-supported overdenture, as well as the rehabilitation with overdenture on single implant presents itself as an alternative for patients not adapted to mandibular conventional CD, helping to accept the use of mandibular prosthesis, as well as proving a positive effect on satisfaction, quality of life and masticatory performance (AU).

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OBJECTIVE: To investigate the incidence and risk factors for non-adaptation of the conventional mandibular complete denture (CMCD). MATERIALS AND METHODS: A total of 108 edentulous patients were rehabilitated with complete dentures (CDs) and followed up at 3- and 6-month intervals. Adaptation was confirmed based on chewing, phonetics, and comfortable swallowing with the CDs. The risk factors among sociodemographic and patient-centered factors were analyzed. Statistical analyses included the chi-square test and then a multivariate analysis. RESULTS: After 3 months, 38.0% of patients showed non-adaptation to CMCDs. Non-adaptation was significantly associated with the absence of previous mandibular denture experience (p = 0.042), ulcerations after 15 days of rehabilitation (p < 0.001), and a reduced posterior mandibular ridge (p = 0.035). After 6 months, this incidence decreased to 14.1%. The factors associated with non-adaptation were ulcerative lesions after 15 (p < 0.001) and 30 (p < 0.001) days of the delivery of CDs and the non-regular use of mandibular CDs (p < 0.001). CONCLUSION: The incidence of non-adaptation was higher after 3 months, with reduction after 6 months. Sociodemographic variables did not influence the adaptation. After 3 months, the absence of previous experience, traumatic ulcers, and reduced mandibular ridges hindered the adaptation of patients to mandibular CDs. After 6 months, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation. CLINICAL RELEVANCE: A considerable number of patients have difficulties in adapting to the mandibular dentures. Identifying the factors of non-adaptation of the dentures will contribute to increasing the predictability of this critical adaptation period.

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STATEMENT OF PROBLEM: Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear. PURPOSE: The purpose of this systematic review and meta-analysis of in vitro studies was to determine the best surface treatment protocols for the repair of PICs and RNCs. MATERIAL AND METHODS: The PubMed, Scopus, and Web of Science electronic databases were searched to select in vitro studies in English up to March 2020. Studies with fewer than 5 specimens, those that did not evaluate the BS of PICs or RNCs, and those with aging for fewer than 30 days and 5000 cycles were excluded. Data sets were extracted, and the mean differences were analyzed by using a systematic review software program. RESULTS: Among 284 potentially eligible studies, 21 were selected for full-text analysis, and 9 were included in the systematic review, of which 6 were used in the meta-analysis. The meta-analyses were performed for each treatment surface versus their respective control group and their combinations according to material: RNCs and PICs. For RNCs, airborne-particle abrasion with aluminum oxide (Al2O3) treatment was statistically higher than tribochemical silica airborne-particle abrasion (CoJet) (P=.02, I2=90%) and that in the hydrofluoric acid (HF) (P<.001, I2=0%) groups and was statistically similar to diamond rotary instrument grinding (P=.40, I2=54%). For PICs, the treatment with hydrofluoric acid (HF) was statistically significantly higher than with CoJet (P=.03, I2=62%) and airborne-particle abrasion with Al2O3 (P<.001, I2=98%). CONCLUSIONS: The best surface treatment protocol for repair varied according to the restorative material. HF followed by silanization is suggested for PICs, and airborne-particle abrasion with Al2O3 or preparation with a diamond rotary instrument for RNCs.

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OBJECTIVE: The aim of this study was to evaluate the factors influencing edentulous patients' willingness about mandibular implant-supported complete denture. MATERIALS AND METHODS: A cross-sectional study was carried out with 117 bimaxillary edentulous patients wearing removable complete dentures (CDs). Patients were assessed concerning denture-related items (number of previous mandibular CDs, previous denture wearing period, dentures maker professional, and regular wearing of previous mandibular dentures) and individual-related aspects, such as mandibular edentulousness period, mandibular bone height, and willingness to the use of mandibular implant-supported complete denture. Masticatory performance was evaluated by the median particle diameter. Mandibular bone height and satisfaction were assessed using a validated method. The Chi-square test was used for data analysis and prevalence ratios were adjusted by using multivariate Poisson regression, both with 95% confidence interval. RESULTS: A total of 78 participants (66.7%) were interested in mandibular implant-supported overdenture (mean age 65.33 ± 9.49). Masticatory performance was not influenced by choosing mandibular implant-supported complete denture. The preference about mandibular implant-supported complete denture was correlated with longer mandibular complete denture experience (p = 0.021) and it was significantly associated with dissatisfaction about retention (p = 0.005). CONCLUSION: Previous experience with mandibular complete dentures and dissatisfaction about retention influence the willingness about mandibular implant-supported overdenture. CLINICAL RELEVANCE: Many factors are associated with rehabilitation preferences for edentulous patients and mandibular implant-supported complete denture is one of the available alternatives. Therefore, this study has demonstrated the factors influencing the decision to replace a mandibular conventional complete denture by dental implant treatment based on patient's outcomes. Such finding may be considered as a relevant aspect towards shared decision-making for prosthodontic rehabilitation of edentulous patients.

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OBJECTIVE: To investigate the influence of different finishing/polishing techniques and in situ aging on the flexural strength (σ), surface roughness, and Candida albicans adherence of 5 mol% yttria-stabilized zirconia (ultratranslucent zirconia). MATERIALS AND METHODS: A total of 120 zirconia bars (Prettau Anterior, Zirkonzahn) with dimensions of 8 × 2 × 0.5 mm were divided into 8 groups (n = 15) according to two factors: "in situ aging" (non-aged and aged (A)) and "finishing/polishing" (control (C), diamond rubber polishing (R), coarse grit diamond bur abrasion (B), and coarse grit diamond bur abrasion + diamond rubber polishing (BR)). Half of the samples from each group were subjected to a 60-day in situ aging by fixing the bars into cavities prepared in the posterior region of the base of complete or partial dentures of 15 patients. The samples were then subjected to the mini flexural (σ) test (1 mm/min). A total of 40 zirconia blocks (5 × 5 × 2 mm) were prepared and subjected to roughness (Ra) analyses and fungal adherence and complementary analyses (X-ray diffraction (XRD) and scanning electron microscopy (SEM)). The data of mean σ (MPa) and roughness Ra (µm) were statistically analyzed by two-way and one-way ANOVA, respectively, and Tukey's test. The Weibull analysis was performed for σ data. The fungal adhesion (Log CFU/mL) data were analyzed by Kruskal-Wallis tests. RESULTS: For flexural resistance, the "finishing/polishing" factor was statistically significant (P = 0.0001); however, the "in situ aging" factor (P = 0.4458) was not significant. The non-aged (507.3 ± 115.7 MPa) and aged (487.6 ± 118.4 MPa) rubber polishing groups exhibited higher mean σ than the other techniques. The non-aged (260.2 ± 43.3 MPa) and aged (270.1 ± 48.8 MPa) bur abrasion groups presented lower σ. The coarse-grit diamond bur abrasion group (1.82 ± 0.61 µm) presented the highest roughness value (P = 0.001). Cell adhesion was not different among groups (P = 0.053). Group B presented the most irregular surface and the highest roughness Ra of 0.61 m. CONCLUSIONS: The finishing of ultratranslucent zirconia might be preferably done with a diamond rubber polisher. Moreover, the protocols used did not interfere with Candida albicans adhesion. CLINICAL RELEVANCE: Coarse-grit diamond burs might be avoided for finishing ultratranslucent monolithic zirconia, which might be preferably performed with a diamond rubber polisher.

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A reabilitação de pacientes parcialmente edêntulos com desgaste dentário severo e dimensão vertical de oclusão reduzida é desafiadora e complexa. Objetivo: Descrever o restabelecimento da dimensão vertical de oclusão e parâmetros estéticos com uma prótese parcial removível do tipo overlay (PPRO) com auxílio de um JIG estético modificado. Relato de caso: Paciente do sexo masculino, 58 anos de idade, procurou serviço odontológico queixando-se de insatisfação com a estética do sorriso e perda dos dentes posteriores. Ao exame clínico, foram observados desgaste dentário excessivo e edentulismo parcial nas arcadas superior e inferior. Então, foi proposto tratamento em 2 etapas (provisória e definitiva) com PPRO em maxila. O JIG estético foi usado como guia de referência para incrementos em resina composta fotopolimerizável e o restabelecimento da dimensão vertical de oclusão foi determinado a partir de métodos métrico, fonético e estético. Os dentes desgastados foram aumentados e os dentes ausentes substituídos por dentes artificiais a partir de uma PPRO provisória. Após 2 meses de adaptação, a reabilitação final com PPRO definitiva foi conduzida baseando-se na reabilitação com a PPRO provisória. Conclusão: O paciente relatou satisfação com a estética e desempenho funcional com o tratamento. Portanto, o JIG estético beneficia o planejamento e o tratamento para restabelecer a dimensão vertical de oclusão. Além disso, a PPRO é uma alternativa reversível, de baixo custo, para reabilitar a estética e a função de pacientes com desgaste severo e perda parcial dos dentes.

The rehabilitation of partially edentulous patients with severe tooth wear and reduced occlusal vertical dimension is challenging and complex. Objective: To describe the reestablishment of occlusal vertical dimension and aesthetic parameters with an overlay re-movable partial denture (ORPD) with the aid of a modified aesthetic JIG. Case report: A 58-year-old man sought dental service complaining of dissatisfaction with the aesthetics of his smile and a loss of posterior teeth. At clinical examination, excessive tooth wear and partially edentulism in the lower and upper arches were observed. A two-step treatment (interim and definitive) with an ORPD in the upper arch was proposed. The aesthetic JIG was used as a reference guide for the increments in light-curing resin composite, and the reestablishmentthe occlusal vertical dimension was determined using aesthetic, phonetic, and metric methods. The worn teeth were increased, and the missing natural teeth were replaced by artificial teeth using a temporary ORPD. After two months of adaptation, de-finitive rehabilitation with a definitive ORPD was performed based on the interim ORPD. Conclusion: The patient reported satisfaction with the esthetic and functional performance of this treatment. Therefore, the aesthetic JIG benefits the planning and treatment of reduced vertical dimension. Moreover, the ORPD is a reversible and lower-cost alternative to rehabilitate the aesthetics and function of patients with severe teeth wear and partial teeth loss.

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To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE: Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS: The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS: Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.

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To investigate the impact of radiotherapy on surface properties of restorative dental materials. A conventional resin composite-CRC (Aura Enamel), a bulk-fill resin composite-BFRC (Aura Bulk-fill), a conventional glass ionomer cement-CGIC (Riva self cure), and a resin-modified glass ionomer cement-RMGIC (Riva light cure) were tested. Forty disc-shaped samples from each material (8 mm diameter × 2 mm thickness) (n = 10) were produced according to manufacturer directions and then stored in water distilled for 24 h. Surface wettability (water contact angle), Vickers microhardness, and micromorphology through scanning electron microscopy (SEM) before and after exposition to ionizing radiation (60 Gy) were obtained. The data were statistically evaluated using the two-way ANOVA and Tukey posthoc test (p < 0.05). Baseline and post-radiation values of contact angles were statistically similar for CRC, BFRC, and RMGIC, whilst post-radiation values of contact angles were statistically lower than baseline ones for CGIC. Exposition to ionizing radiation statistically increased the microhardness of CRC, and statistically decreased the microhardness of CGIC. The surface micromorphology of all materials was changed post-radiation. Exposure to ionizing radiation negatively affected the conventional glass ionomer tested, while did not alter or improved surface properties testing of the resin composites and the resin-modified glass ionomer cement tested.

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The objective of this study was to evaluate the influence of hydrofluoric acid (HF) concentration, etching time, and application of phosphoric acid (PA) followed by neutralization with sodium bicarbonate on the bond strength between a feldspar ceramic and resin cement. Thus, 80 blocks (10 x 12 x 2 mm) of glass ceramic (VM - Vita Mark II - Vita Zahnfabrik) were made and randomly assigned to eight groups (n = 10) according to the factors: HF concentration (5 and 10%), etching time (60 and 120 s), and use of phosphoric acid (PA) (with and without). According to the experimental group, 37% PA (Condac, FGM) was applied after HF etching for 60s. Afterwards, samples were immersed in sodium bicarbonate for 1 min then in an ultrasonic bath in distilled water (5 min) for cleaning. After surface bonding treatment, cylinders (Ø = 2 mm; h = 2 mm) of dual resin cement (AllCem / FGM) were made in the center of each block. The samples were then stored in water (37ºC) for 90 days and submitted to the shear bond test (50 KgF, 1 mm/min). Failure analysis was performed by stereomicroscope and scanning electron microscopy. Data (MPa) were analyzed with 3-way ANOVA and Tukey's test. Only the factor "HF concentration" was significant (p = 0.02). Most failures were of cohesive in ceramic (40%) and mixed types (42.5%). The 10% HF resulted in higher shear bond strength value than the 5% HF. Surface cleaning with phosphoric acid followed by sodium bicarbonate and HF time (60 or 120 seconds) did not influence the resin bond strength to feldspar ceramic.

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