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PURPOSE: To assess the effects of tilted external hexagon implants and splinted restorations in terms of stress distribution on the bone tissue, implants, and prosthetic screws, using three-dimensional finite element analysis. MATERIALS AND METHODS: Six models were used to simulate a posterior maxilla bone block (type IV) from the first premolar to the first molar. Each model included three 4.1-mm-diameter external hexagon implants with varying inclinations (0°, 17°, and 30°) and crown designs (splinted and nonsplinted restorations). The forces applied were as follows: 400 N axially (50 N for each slope of the cusp) and 200 N obliquely (45° only on the buccal slope of the cusp). Stress distribution on the implants and prosthetic screw was evaluated using Von Mises stress, while the maximum principal stress was used to evaluate the stress distribution in the bone tissue. RESULTS: The oblique load increased the stress on all the structures in all the models. Increased inclination of the implants resulted in higher stress concentration in the bone tissue, implants, and prosthetic screws. However, splinted restorations contributed to reduction of the stress for the oblique loading, mainly in the bone tissue and prosthetic screw of the first molar, as the stress was shared between the first and second premolar restorations. CONCLUSIONS: Tilted implants increased proportionally the stress on bone tissue and prosthetic screws of models. Additionally, splinting restorations reduced the stress concentration area in the simulated bone tissue, implants, and prosthetic screws in the first molar, as the stress was shared with the adjacent implants.

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STATEMENT OF PROBLEM: Whether providing an occlusal device for a patient with bruxism and an implant-supported fixed dental prosthesis leads to improved biomechanics is unclear. PURPOSE: The purpose of this 3D finite element analysis (FEA) study was to evaluate the biomechanical behavior of 3-unit implant-supported prostheses under parafunctional forces with and without an occlusal device. MATERIALS AND METHODS: Eight 3D models consisting of a posterior (type IV) maxillary bone block with 3 external hexagon implants (Ø4.0×7.0 mm) and 3-unit implant-supported prostheses with different crown connections (splinted or unsplinted) and an occlusal device under functional and parafunctional loading were simulated. The abutment screws were evaluated by von Mises stress maps, and the bone tissue by maximum principal stress and microstrain maps by using a finite element software program. RESULTS: An occlusal device improved the biomechanical behavior of the prostheses by reducing stress in the abutment screws and stress and strain in the bone tissue. However, the use of an occlusal device was not sufficiently effective to negate the biomechanical benefit of splinting. CONCLUSIONS: The use of splinted crowns in the posterior maxillary region with an occlusal device was the most effective method of reducing stress in the abutment screws and stress and strain in the bone tissue when parafunction was modeled.

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AIM AND OBJECTIVE: This study aimed to determine whether the use of complete dentures has an influence on the respiratory capacity, assessed by the spirometry examination. MATERIALS AND METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis and registered in the International Prospective Register of Systematic Reviews (CRD42021255224). The PICO question (population/exposure/comparison/outcome) was "Does the use of complete dentures influence the respiratory capacity of a toothless subject?" A search strategy was adapted for the PubMed/MEDLINE, The Cochrane Library, OpenGrey, Lilacs, Scopus, and Embase databases. Inclusion criteria were prospective and retrospective studies. The new castle ottawa (NOS) scale and the Methodological Index for Non-randomized studies were selected to assess the quality of the included studies. RESULTS: Four studies were selected, totalizing the evaluation of 242 participants, aged ranging from 40 to 73 years old. Two studies concluded that the use of complete dentures can negatively affect the respiratory capacity. One study stated that it did not interfere regardless of its use during spirometric measurements, and the other reported that dental prosthesis was required in cases of evaluation of the extrathoracic airways. CONCLUSION: The use of complete dentures did not represent relevant changes from the reference values for pulmonary function in the spirometry test. Considering the results of this review, it is not yet possible to establish a clinical protocol for the use of complete dentures during the test. CLINICAL SIGNIFICANCE: Oral rehabilitation with conventional complete dentures is widely used for the treatment of edentulism, especially in elderly patients. In addition, with aging, many complex changes in immunity and respiratory function contribute to the increase in the development of lung diseases. Therefore, it is important to establish a guidance regarding the use or not of the removable dental prostheses in the respiratory capacity test through spirometry examination.

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PURPOSE: To verify the prevalence of sleep disorders in temporomandibular disorders (TMD) subjects in a Brazilian population-based, cross-sectional survey (N = 1,643). MATERIALS AND METHODS: Patients were assessed with the Research Diagnostic Criteria for TMD (RDC/TMD) Axes I and II and the Sleep Assessment Questionnaire. Student t test and Pearson chi-square test were used for continuous and categorical data analyses, respectively. RESULTS: TMD subjects had significantly worse sleep disorders than controls (Graded Chronic Pain Severity categories I through IV vs 0, respectively) in RDC/TMD Axis II variables. Sleep disorders were also worse in the Axis I TMD groups (myofascial pain and arthralgia/osteoarthritis/osteoarthrosis), with the exception of disc displacements. CONCLUSION: TMD subjects had worse sleep disorders, mainly in Axis I TMD groups, with higher pain/disability levels.

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The purpose of this in vitro study was to measure the vertical, positive-horizontal, and negative-horizontal misfit (VM, PHM, and NHM, respectively) of the zirconia three-element prosthetic framework, fabricated using different methods, and compare them with conventional fabrication methods (lost-wax casting). Furthermore, this study aimed to evaluate the influence of the misfit values on the biomechanical behavior of the 3-unit fixed prosthetic frameworks using three-dimensional finite element analysis (3D-FEA). Forty frameworks (n = 10) were fabricated as follow: G1, Cerec Bluecam; G2, iTero; G3, 3Series; and G4, conventional method. The samples were randomized to measure marginal misfit using a high-precision three-dimensional (3D)-optical microscope. The results were submitted to analysis of variance (ANOVA), with the significance level set at 5%. The mean VM values of each group were used in creating the models by 3D-FEA with the misfit found in optical microscopy. The programs used were the InVesalius, Rhinoceros, SolidWorks, FEMAP and NEiNastran. The von Mises map was plotted for each model. The G4 showed the lowest mean VM value (16.73 µm), followed by G3 (20.71 µm), G2 (21.01 µm), and G1 (41.77 µm) (p < 0.001). G2 was more accurate than G1 (p < 0.05) and similar to G3 (p = 0.319). For PHM, G4 was the most accurate and did not present overextended values. With regard to NHM, the computer-aided design and computer-aided manufacturing (CAD-CAM) systems were more accurate (-61.91 µm) than G4 (-95.36 µm) (p = 0.014). In biomechanical analysis, stress concentration caused by oblique loading is greater than caused by axial loading. In axial loading, G4 was the most favorable while G1 was the least favorable, biomechanically, in oblique loading, similar stress patterns were observed in all the models. The prosthetic screw was the most overloaded structure, but the material did not influence the stress distribution. The misfit prostheses showed a greater degree of stress than the controls (without misfit). The manufacturing method influenced the marginal misfit of the frameworks, with the conventional method being the most accurate and the Cerec Bluecam System (closed system) the least accurate. Biomechanically, fitting prostheses were more favorable than misfit prostheses.

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PURPOSE: To assess the impact of temporomandibular disorders (TMD) on general health quality of life in a Brazilian population-based cross-sectional survey. MATERIALS AND METHODS: A total of 1,643 patients were assessed using the World Health Organization Quality of Life Bref (WHOQOL-Bref) and the Research Diagnostic Criteria for Temporomandibular Disorders Axes I and II (RDC/TMD). Cross-tabulation of the data was carried out to compare TMD subjects to controls in all domains of the WHOQOL-Bref and the RDC/TMD. RESULTS: TMD subjects had significantly worse quality of life than controls in Axes I and II of the RDC/TMD and in all WHOQOL-Bref domains except for disc displacement. Osteoarthrosis was significantly different only in the WHOQOL-Bref physical domain. CONCLUSION: TMD subjects had worse general health quality of life, particularly in Axis I groups with higher pain/disability levels (muscle disorders/arthralgia/arthritis).

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PURPOSE: To assess the prevalence of depression and somatization in patients with temporomandibular disorders (TMD) in a Brazilian population-based cross-sectional survey. MATERIALS AND METHODS: A total of 1,643 subjects were assessed for TMD using the Research Diagnostic Criteria for Temporomandibular Disorders Axes I and II and were assessed for depression and somatization using the Graded Chronic Pain Scale. The data were cross-tabulated for comparison between TMD subjects and controls. RESULTS: TMD subjects had significantly worse depression and somatization levels than controls in the RDC/TMD Axis II. The levels were also worse in most Axis I TMD groups (muscle disorders and arthralgia/osteoarthritis/osteoarthrosis). CONCLUSION: TMD subjects had worse depression and somatization, particularly in diagnostic groups with higher pain/disability levels.

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Bariatric surgery is the most effective treatment for morbid obesity, but it can cause numerous adverse effects. This systematic review and meta-analysis aimed to evaluate whether bariatric surgery changes patient salivary flow. We searched for articles in the Web of Science, Pubmed/MEDLINE, and Scopus databases using the search terms "oral health AND bariatric surgery OR gastrectomy OR obesity surgery." We recovered 845 articles. After the removal of duplicates and exclusions, eight studies remained. Of them, five showed no significant difference in salivary flow values, two showed an increase in flow rate, and one showed a reduction in flow rate (p < 0.05). The results of the included studies showed no significant alteration in salivary flow rate for up to 24 months after bariatric surgery.

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A systematic review was performed to evaluate whether whitening toothpastes promote tooth whitening when compared to the use of conventional (nonbleaching) dentifrices. This review was registered at PROSPERO (CRD42017065132) and is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic systematic searches of PubMed/MEDLINE, Scopus, and the Cochrane Library were conducted for published articles. Only randomized clinical trials in adults that compared the use of so-called whitening dentifrices to the use of nonwhitening dentifrices were selected. The outcome was tooth color change. Twenty-two articles from 703 data sources met the eligibility criteria. After title and abstract screening, 16 studies remained, after which a further five studies were excluded. In total, nine studies were qualitatively analyzed. Significant differences in tooth color change were found between the groups using whitening dentifrices and those using nonwhitening dentifrices. Within the limitations of this study, the evidence from this systematic review suggests that bleaching dentifrices have potential in tooth whitening. However, although many whitening dentifrices have been introduced into the dental market for bleaching treatments, it is important to analyze tooth surface and color changes when performing home bleaching.

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AIM: To discuss important characteristics of the use of dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE (PubMed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations (bone quantity and density), radiographic techniques, implant selection (number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

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The purpose of this literature review was to describe the main features of phantom eye syndrome in relation to their possible causes, symptoms, treatments, and influence of eye amputation on quality of life of anophthalmic patients. For this, a bibliographical research was performed in Pubmed database using the following terms: "eye amputation," "eye trauma," "phantom eye syndrome," "phantom pain," and "quality of life," associated or not. Thirteen studies were selected, besides some relevant references contained in the selected manuscripts and other studies hallowed in the literature. Thus, 56 articles were included in this review. The phantom eye syndrome is defined as any sensation reported by the patient with anophthalmia, originated anophthalmic cavity. In phantom eye syndrome, at least one of these three symptoms has to be present: phantom vision, phantom pain, and phantom sensations. This syndrome has a direct influence on the quality of life of the patients, and psychological support is recommended before and after the amputation of the eyeball as well as aid in the treatment of the syndrome. Therefore, it is suggested that, for more effective treatment of phantom eye syndrome, drug therapy should be associated with psychological approach.

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OBJECTIVES: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School. METHODS: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007. RESULTS: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps. CONCLUSION: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.

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