O objetivo deste estudo foi verificar se diferentes estratégias de reabilitação oral protética acarretam modificações nos achados clínicos e videoendoscópicos da deglutição em idosos. Métodos: participaram da pesquisa 42 idosos saudáveis com desempenho cognitivo adequado (26 mulheres e 16 homens, 60-82 anos), desdentados totais ou parciais, separados em três grupos segundo avaliação odontológica prévia: próteses parciais fixas ou removíveis (PP) (n = 15); próteses totais removíveis superior e inferior (PTR) (n = 15); e próteses totais removíveis superior e próteses totais fixas implanto-suportadas inferior (PTFIS) (n = 12). O grupo controle foi constituído de 15 idosos dentados totais (DT) (6 homens e 9 mulheres, 60-80 anos) que atenderam aos critérios de inclusão na amostra. Avaliaram-se as consistências sólida (pão), pastosa (10 ml) e líquida (10 ml). Para a avaliação clínica propôs-se uma classificação da gravidade da disfunção da deglutição orofaríngea, distribuída em cinco níveis. Na avaliação instrumental, da qual participaram 37 idosos, realizou-se teste de sensibilidade laringofaríngea, e classificou-se a gravidade do distúrbio de deglutição, de acordo com a escala de comprometimento funcional (gravidade) da deglutição após a VED, ordenada em graus de 0 à III. Para a análise comparativa entre os grupos em ambas as avaliações, e para comparação entre os níveis de comprometimento da deglutição, utilizou-se o Teste de Kruskal-Wallis, adotando-se o nível de significância inferior a 5%. Resultados: Os achados clínicos e videoendoscópicos da deglutição demonstraram não haver diferenças estatisticamente significantes (p>0,05) entre os grupos estudados, nas três consistências ofertadas. Especificamente na avaliação clínica, para a consistência pastosa o grupo DT apresentou maior prevalência de deglutição funcional, enquanto a disfagia orofaríngea moderada foi o padrão de maior ocorrência no grupo PTR (p<0,01). Para o sólido, os grupos de reabilitação oral demonstraram predomínio das disfagias (p<0,01) em relação à deglutição normal e funcional, sendo predominante a disfagia orofaríngea moderada para o grupo PTR (p<0,01). A VED demonstrou, para todos os grupos, que na deglutição de líquido houve distribuição semelhante entre os níveis, enquanto nas consistências sólida e pastosa encontrou-se predomínio de disfagia (p<0,01), havendo maior ocorrência da disfagia orofaríngea moderada (p<0,01) para o grupo PTR na consistência pastosa. O teste de sensibilidade laringofaríngea demonstrou que 19 (51,35%) indivíduos apresentaram alteração da sensibilidade, sendo 6 (40%) do grupo PP, 7 (63,63%) do grupo PTR e 6 (54,54%) do grupo PTFIS. Conclusão: Idosos saudáveis podem apresentar diferentes níveis de deglutição, havendo maior ocorrência de disfagia orofaríngea para as consistências pastosa e sólida, sendo que diferentes estratégias de reabilitação oral não resultam em modificações no padrão de deglutição desses sujeitos. / This study investigated if different strategies of prosthetic oral rehabilitation cause changes in the clinical and videoendoscopic findings of swallowing in elderly individuals. Methods: The study was conducted on 42 healthy elderly subjects with adequate cognitive performance (26 women and 16 men, 60-82 years), completely or partially edentulous, divided in three groups according to the previous dental evaluation: wearing fixed or removable partial dentures (RPD) (n = 15); wearing maxillary and mandibular removable complete dentures (RCD) (n =15); and wearing maxillary removable complete dentures and mandibular implant-supported fixed complete dentures (ISFCD) (n = 12). The control group was composed of 15 completely dentate elderly individuals (DT) (6 men and 9 women, 60-80 years) who met the inclusion criteria. Solid (bread), paste (10 ml) and liquid (10 ml) food textures were analyzed. Clinical evaluation was performed by classification of the severity of dysfunction of oropharyngeal swallowing, divided in five scores. The instrumental evaluation was applied to 37 elderly individuals, comprising the laryngopharyngeal sensitivity test for classification of the severity of the swallowing disorder according to the scale of functional impairment (severity) of swallowing after the VED, divided in scores 0 to III. Comparison between groups in both evaluations and between the scores of impairment of swallowing was performed using the Kruskal-Wallis test, at a significance level below 5%. Results: The clinical and videoendoscopic findings of swallowing revealed no statistically significant differences (p>0.05) between the study groups, for the three textures. Specifically with regard to the clinical evaluation for the paste texture, the DT group exhibited higher prevalence of functional swallowing, while the RCD group presented higher occurrence of moderate oropharyngeal dysphagia (p<0.01). With regard to the solid texture, the groups of oral rehabilitation presented predominance of dysphagia (p<0.01) in relation to normal and functional swallowing, with predominance of moderate oropharyngeal dysphagia for the RCD group (p<0.01). The VED demonstrated, for all groups, that the swallowing of liquid had a similar distribution between scores, while for the solid and paste textures there was predominance of dysphagia (p<0.01), with higher occurrence of moderate oropharyngeal dysphagia (p<0.01) for the RCD group for the paste texture. The laryngopharyngeal sensitivity test demonstrated that 19 (51.35%) individuals presented alterations in sensitivity, being 6 (40%) in the RPD group, 7 (63.63%) in the RCD group and 6 (54.54%) in the ISFCD group. Conclusion: Healthy elderly individuals may present different scores of swallowing, with higher occurrence of oropharyngeal dysphagia for the paste and solid textures; different strategies of oral rehabilitation did not cause changes in the pattern of swallowing of these individuals.

A higienização das próteses removíveis é fundamental para a longevidade do tratamento e prevenção de patologias orais. O objetivo deste estudo foi avaliar o efeito de higienizadores de imersão nas superfícies da liga metálica e resina acrílica termopolimerizável de Prótese Parcial Removível (PPR), simulando 180 dias. Discos (12 mm x 3 mm) foram confeccionados com ligas metálicas de cobalto-cromo para PPR: Vera PDI® (VP) e DeguDent® (DD). Cada disco metálico foi incluído em mufla previamente preparada por matrizes de teflon (38 mm x 18 mm x 4 mm), incorporando-se o disco metálico à resina acrílica termopolimerizável. Os espécimes (n= 5) foram imersos nas seguintes soluções: água destilada (grupo controle - AD), hipoclorito de sódio 0,05% (HS), Cepacol® (cloreto de cetilpiridínio 0,005% - CE), Periogard® (digluconato de clorexidina 0,12% - PE), Corega Tabs® (peróxido alcalino e enzima - CT), Polident® (peróxido alcalino e enzima - PO) e Medical Interporous Dentures® (ácido cítrico - MI). Foram realizadas análise da estabilidade de cor por meio de espectrocolorímetro, análise visual da presença de manchas no metal, análise da perda de massa em balança de alta precisão e análise da rugosidade por meio de rugosímetro. Como estudo complementar, foram realizadas análises quantitativas da liberação de íons (cobalto e cromo) em cada solução com espectrômetro de massas e análises ópticas e qualitativas com microscópio eletrônico de varredura (MEV) e espectrometria de energia dispersiva de Raios-X (EDS). Os resultados de rugosidade, alteração de cor e massa apresentaram distribuição normal e homogênea, tendo sido submetidos à ANOVA e teste de Tukey (p< 0,05). Quanto à rugosidade (Ra&micro;m), não houve diferença estatisticamente significante entre as soluções e ligas tanto para o metal quanto para a resina. Com relação à alteração de cor da resina acrílica termopolimerizável (&Delta;E), houve diferença estatisticamente significante entre as ligas, soluções e na interação liga x solução. As soluções AD, CE e PE propiciaram menores valores que as demais. A resina associada à DD apresentou maior alteração de cor do que quando associada à VP (1,06 ± 0,51 e 0,51 ± 0,28, respectivamente). Com relação à presença de manchas no metal, o HS propiciou manchamento em 100% dos espécimes. O grupo MI/DD propiciou em 60% e o MI/VP em 40% dos espécimes. Quando avaliada a alteração de massa (g), as soluções CT e MI propiciaram maiores valores. Entre as ligas, a VP apresentou maior perda de massa. Com relação à liberação de íons cobalto e cromo, a solução de HS e a MI propiciaram maior liberação e quando comparadas as ligas, VP apresentou maior liberação de íons. Com o MEV pôde-se verificar que houve corrosão generalizada com o HS e por pites com a MI. Concluiu-se que as soluções CE, PE e PO não apresentaram efeitos deletérios podendo ser auxiliares à escovação para higienização de PPR. / The hygiene care of the removable dentures is required for the longevity of the treatment and prevention of oral diseases. The aim of this study was to evaluate the effect of denture cleansers on the surfaces of the alloys and heat-polymerized acrylic resin for removable partial denture (RPD), simulating a period of 180 days. Circular specimens (12 mm x 3 mm) had been fabricated with cobalt-chromium alloys: Vera PDI&trade; (VP) and DeguDent&trade; (DD). The cast specimens were centered in the moulds previously prepared by matrices of teflon (38 mm x 18 mm x 4 mm) and the acrylic resin was inserted. The specimens (n= 5) had been immersed in the following solutions: distilled water (control - DW), sodium hypochlorite 0.05% (SH), Cepacol&trade; (cetilpiridinium chloride 0.005% - CE), Periogard&trade; (chlorexidine gluconate 0.12% - PE), Corega Tabs&trade; (alkaline peroxide and enzyme - CT), Polident&trade; (alkaline peroxide and enzyme - PO) and Medical Interporous Dentures&trade; (citric acid - MI). The color stability was analyzed using a colorimeter, and the presence of tarnishes on the metal was performed by a visual analysis. The weight loss was measured with a precision balance and the surface roughness was analyzed with a surf-test analyzer. As complementary analyzes a quantitative study of ions release (cobalt and chromium) using inductively mass spectrometry and optical and qualitative analyses with scanning electron microscopy (SEM) associated to dispersive energy spectrometry were performed. The results of roughness, color stability and weight loss presented normal and homogeneous distribution and were submitted to ANOVA (p &le; 0.05) and Tukey test. There was no significant difference among the solutions and between the alloys for both metal and resin roughness (Ra &micro;m). The acrylic resin color stability (&Delta;E) was analyzed and showed significant difference among the solutions, alloys and interaction. AD, CE and PE solutions presented the lowest values of color changes. The resin associated to DD presented higher color change than when associated with the VP (1.06 ± 0.51 and 0.51 ± 0.28, respectively). The HS caused tarnishes on 100% of specimens. The MI/DD group provided 60% and the MI/VP in 40% of specimens. When was analyzed the mass loss (g), the solutions CT and MI had the higher values. Between the alloys VP presented higher weight loss. HS and MI presented greater ionic release and between the alloys, VP presented greater release. With the SEM it was possible observe the presence of widespread corrosion in the HS group and pites corrosion in the MI group. It was concluded that CE, PE, CT and PO solutions had no deleterious effects on the compounds of RPD and may be indicate as auxiliaries to brushing in the RPD hygiene care.

Philosophiae Doctor - PhD / Rehabilitation of edentulous jaws without the option of osseointegrating implants will remain the only treatment option within reach of many older patients for the foreseeable future. Many routine prosthodontic procedures are based on dogmas, because no high-level scientific evidence exists to either accept or reject them, among these is the “neutral zone” (NZ) concept. In spite of paucity of evidence using approved patient-based outcome instruments, it is generally agreed that the NZ should be respected when constructing complete dentures. The purpose of this research project was to determine how shapes of conventional and NZ mandibular dentures differ, and if the two different types of dentures impact differently on oral health–related quality of life by using an accepted oral health-related quality of life instrument as a patient-based outcome. Thirty nine edentulous patients were selected for this prospective, randomised, cross-over, single-blinded clinical trial. Two sets of complete dentures were made for each patient. One denture set was made following conventional biometric guidelines for determining the position of the mandibular posterior denture teeth in relation to the ridge; another set was made following a functional impression of the potential denture space. Each set of dentures was worn for at least two months. A similar number of types of dentures were delivered first. Widths of residual ridges and mandibular denture arches were measured using digital measuring software. Position of denture teeth was related to the ridge. Denture dimensions were compared by means of analysis of variance using the mixed procedure. Using formula of parabola, arch-widths were compared using paired t-tests. Pre- and post-treatment patient feedback was obtained by means of the 20-item Oral Health Impact Profile (OHIP-20) and a preference score. Treatment effect size (ES) was established based on the OHIP-20 scores. Relevant associations among denture dimensions, OHIP-20 scores, preference, age, gender, marital status, education, income, period of edentulousness, and quality of denture-bearing tissue were done using the generalised linear model and correlation analysis. For all statistical analysis, level of significance was determined at p<0.05. The mean age of the sample was 62.3 years. Twenty four patients were female. Mean period of edentulousness was 31 years and mean number of denture sets worn prior to the trial was 2.5. Except for the canine region, NZ dentures were statistically wider than anatomic dentures. The difference in mean widths between the two types of dentures was larger for female patients. Older patients had smaller differences in denture dimensions. More unfavourable denture-bearing tissue was associated with a larger difference in the two types of dentures. Both types of mandibular dentures significantly improved the OHRQoL of patients. Both types of dentures had a high treatment ES. The OHIP-20 instrument could not distinguish a statistical difference in impact on OHRQoL between the two treatment options. There was a minute difference in treatment ES between the two types of treatment. The only domain representing a small clinical benefit between NZ and anatomic dentures was “physical pain”, with the NZ dentures scoring better. There was no correlation between pre- and post-treatment scores for both types of dentures. No significant associations were found between post-treatment OHIP- 20 scores on the one hand and tissue scores, gender, age, education, marital status, period of edentulousness and denture dimension differences on the other hand. Based on OHIP-20 scores, there was a significant association between denture preference and NZ dentures, but not for the other preferences. No significant associations were found between denture preferences on the one hand and tissue scores, gender, age, period of edentulousness and denture dimension differences on the other hand. Even though no significant relationship was found between preference and gender, the majority of female patients preferred the NZ denture and the majority of male patients did not express a preference. Providing new complete dentures improved OHRQoL of edentulous patients. The majority of female patients preferred the NZ compared over the ANA denture. The NZ technique appeared to have a higher positive impact on OHRQoL of female patients compared to male patients.

O objetivo deste estudo foi avaliar a eficiência mastigatória de usuários de prótese parcial removível (PPR) classe I inferior e prótese total (PT) superior, da cidade de Porto Velho - Rondônia, e comparar os resultados obtidos com os descritos na literatura, utilizando a mesma metodologia. Dez indivíduos (cinco do gênero feminino e cinco do gênero masculino) totalmente dentados foram selecionados para o grupo controle. Vinte e sete indivíduos, de ambos os gêneros, receberam 17 cubos de Optocal (simulador de alimento) os quais foram mastigados em vinte ciclos (golpes) mastigatórios. O mesmo procedimento foi repetido posteriormente, desta vez com quarenta ciclos. Os fragmentos foram passados por oito peneiras granulométricas calibradas (5,6; 4,0; 2,8; 2,0; 1,4; 1,0; 0,71 e 0,5 mm) e depositado em um coletor sem perfurações. O material triturado, retido em cada peneira e no coletor, foi secado em estufa e pesado. Os valores foram tabulados em tabela e analisados. Após a mastigação, os indivíduos responderam um questionário para qualificar o alimento utilizado quanto à natureza, consistência, influência do sabor e grau de dificuldade de mastigação. Os resultados mostram melhor eficiência mastigatória em pacientes totalmente dentados, com quarenta ciclos mastigatórios e que, para compensar o fraco desempenho mastigatório das próteses removíveis, os pacientes devem realizar mais golpes mastigatórios. / The aim of this study was evaluate the masticatory efficiency of removable partial denture (RPD) of wearers class I mandibular and complete denture maxillar in Porto Velho, Rondônia. Ten completely dentate subjects (five women and five men) were selected to the control group. Twenty seven subjects both gender were selected and received 17 Optocal cubes (food simulator) that were chewed in twenty chewing strokes. The same procedure was used on late with forty chewing strokes. The fragments of Optocal were sieved on stacks of eight sieves, with apertures from 5,6 decreasing to 0,5 mm (5,6; 4,0; 2,8; 2,0; 1,4; 1,0; 0,71 e 0,5 mm), and a bottom plate. The amount of test food on each sieve and on the bottom plate was dried and measured. The results were tabled and analyzed. After the chewing test, the subjects answer a questionnaire to qualify the test food in relation to hardness, consistency and difficulty to chew. The results show better masticatory efficiency in subjects completely dentates with 40 chewing strokes and that, to compensate the removable denture low performance, the patients must do extra masticatory bites.

Philosophiae Doctor - PhD / Rehabilitation of edentulous jaws without the option of osseointegrating implants will remain the only treatment option within reach of many older patients for the foreseeable future. Many routine prosthodontic procedures are based on dogmas, because no high-level scientific evidence exists to either accept or reject them, among these is the “neutral zone” (NZ) concept. In spite of paucity of evidence using approved patient-based outcome instruments, it is generally agreed that the NZ should be respected when constructing complete dentures. The purpose of this research project was to determine how shapes of conventional and NZ mandibular dentures differ, and if the two different types of dentures impact differently on oral health–related quality of life by using an accepted oral health-related quality of life instrument as a patient-based outcome. Thirty nine edentulous patients were selected for his prospective, randomised, cross-over, single-blinded clinical trial. Two sets of complete dentures were made for each patient. One denture set was made following conventional biometric guidelines for determining the position of the mandibular posterior denture teeth in relation to the ridge; another set was made following a functional impression of the potential denture space. Each set of dentures was worn for at least two months. A similar number of types of dentures were delivered first. Widths of residual ridges and mandibular denture arches were measured using digital measuring software. Position of denture teeth was related to the ridge. Denture dimensions were compared by means of analysis of variance using the mixed procedure. Using formula of parabola, arch-widths were compared using paired t-tests. Pre- and post-treatment patient feedback was obtained by means of the 20-item Oral Health Impact Profile (OHIP-20) and a preference score. Treatment effect size (ES) was established based on the OHIP-20 scores. Relevant associations among denture dimensions, OHIP-20 scores, preference, age, gender, marital status, education, income, period of edentulousness, and quality of denture-bearing tissue were done using the generalised linear model and correlation analysis. For all statistical analysis, level of significance was determined at p<0.05. The mean age of the sample was 62.3 years. Twenty four patients were female. Mean period of edentulousness was 31 years and mean number of denture sets worn prior to the trial was 2.5. Except for the canine region, NZ dentures were statistically wider than anatomic dentures. The difference in mean widths between the two types of dentures was larger for female patients. Older patients had smaller differences in denture dimensions. More unfavourable denture-bearing tissue was associated with a larger difference in the two types of dentures. Both types of mandibular dentures significantly improved the OHRQoL of patients. Both types of dentures had a high treatment ES. The OHIP-20 instrument could not distinguish a statistical difference in impact on OHRQoL between the two treatment options. There was a minute difference in treatment ES between the two types of treatment. The only domain representing a small clinical benefit between NZ and anatomic dentures was “physical pain”, with the NZ dentures scoring better. There was no correlation between pre- and post-treatment scores for both types of dentures. No significant associations were found between post-treatment OHIP- 20 scores on the one hand and tissue scores, gender, age, education, marital status, period of edentulousness and denture dimension differences on the other hand. Based on OHIP-20 scores, there was a significant association between denture preference and NZ dentures, but not for the other preferences. No significant associations were found between denture preferences on the one hand and tissue scores, gender, age, period of edentulousness and denture dimension differences on the other hand. Even though no significant relationship was found between preference and gender, the majority of female patients preferred the NZ denture and the majority of male patients did not express a preference.Providing new complete dentures improved OHRQoL of edentulous patients. The majority of female patients preferred the NZ compared over the ANA denture. The NZ technique appeared to have a higher positive impact on OHRQoL of female patients compared to male patients.

O presente estudo in vitro objetivou avaliar a longo prazo o potencial antimicrobiano residual e a citotoxicidade de soluções químicas de limpeza de prótese quando incorporadas à resina acrílica termopolimerizável após sucessivos ciclos de imersão noturna diária. Discos (10mm x 1mm) de resina acrílica termopolimerizável para base de prótese (Lucitone 550) foram submetidos a três ciclos diários de desinfecção (8h/cada) em hipoclorito de sódio a 1% (NaClO), digluconato de clorexidina a 2% (CLX) ou água destilada (controle) durante 91 (T91) ou 183 dias (T183), simulando o período de 9 meses ou 1,5 ano de imersão noturna diária realizada pelo paciente. Inicialmente, foi utilizado o método de concentração inibitória mínima em caldo para determinar o possível efeito residual (incorporação) das soluções à resina acrílica. Metade dos discos imersos em cada agente de limpeza em um dos tempos de imersão (n=5) foi inoculada (1x107cels/mL) com um dos patógenos associados à estomatite protética: Candida albicans (Ca) e Staphylococcus aureus (Sa). Os discos foram incubados a 37oC para análise em espectrofotômetro após 24h, 7 e 14 dias. Os valores de absorbância foram convertidos em porcentagens de inibição microbiana. Confirmada a ação antimicrobiana residual dos agentes de limpeza incorporados à resina acrílica, foi então analisada sua citotoxicidade in vitro sobre fibroblastos gengivais humanos (L929). Os efeitos citotóxicos foram avaliados por meio do ensaio colorimétrico MTT [brometo de 3-(4,5-dimetiltiazol-2-yl)-2,5-difeniltetrazólio] para a determinação da viabilidade celular, após as células serem expostas por 24h às amostras de cada condição experimentais (n=18) previamente imersas em uma das soluções por um dos períodos avaliados (T91 ou T183). A citotoxicidade foi determinada com base na atividade mitocondrial em relação a corpos de prova não submetidos à imersão nas soluções testadas. Os resultados do ensaio do MTT foram analisados estatisticamente por ANOVA-1 fator seguida pelo teste post-hoc de Tukey HSD (a=0,05). Para os períodos T91 e T183, não houve inibição microbiana com a imersão em água (controle) em até 14 dias de incubação. A CLX inibiu progressivamente o crescimento microbiano ao longo dos 14 dias para ambos os períodos de imersão (Ca: 19 a 73,58%; Sa: 0 a 87,08%), sendo observada maior ação antimicrobiana em T183. O NaClO apresentou discreta inibição microbiana apenas no período de 14 dias tanto em T91 (Ca: 0%; Sa: 2,70%) quanto em T183 (Ca: 8,50%; Sa: 15,08%). De acordo com os resultados do teste de MTT, as soluções químicas de limpeza testadas apresentaram uma redução significativa da viabilidade celular quando comparado às células controles propagadas apenas em meio de cultura (p<0,002). A CLX resultou na menor viabilidade celular em ambos os períodos de imersão (p<0,018). As amostras de resina acrílica imersas em água ou NaClO em T91 e T183 apresentaram viabilidade celular estatisticamente similar às amostras não imersas (p>0,05). Pode-se concluir que a CLX incorporada à resina acrílica para base de prótese apresentou um efeito antimicrobiano residual em ambos os períodos de imersão noturna, o que não foi observado com o NaClO. Por outro lado, a CLX residual resultou em efeito intensamente citotóxico aos fibroblastos gengivais humanos quando comparada ao NaClO e à agua destilada, que se apresentaram discretamente citotóxicos. Esses resultados sugerem precaução na seleção de agentes de limpeza para prótese como meio de prevenção e tratamento adjunto da estomatite protética, pois mesmo em concentrações baixas, recomendadas para imersão noturna, podem apresentar algum grau de toxicidade às mucosas de suporte protético. / This in vitro study aimed to evaluate the long-term residual antimicrobial activity and cytotoxicity of chemical denture cleansers incorporated into a heat-polymerized acrylic resin after successive cycles of daily overnight soaking. Discs (10mm x 1mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and submitted to three daily immersion (8h/each) in 1% sodium hypochlorite (NaClO), chlorhexidine digluconate 2% (CHX) or distilled water (control) for 91 days (T91) or 183 days (T183), simulating the period of 9 months or 1.5 year of nocturnal immersion performed by the patient. Initially, the method of minimum inhibitory concentration in broth was used to determine the possible residual effect (incorporation) of the acrylic resin solution. Half of the disks immersed in each cleaning agent for one of the period immersion (n=5) was inoculated (1x107cells/mL) with pathogens associated with denture stomatitis: Candida albicans (Ca) or Staphylococcys aureus (Sa). The disks were incubated at 37oC for analysis in a spectrophotometer after 24h, 7 and 14 days. The absorbance values were expressed as percentages of microbial inhibition. Confirmed the residual antimicrobial action of cleaning agents incorporated into the acrylic resin, its cytotoxicity was analyzed in vitro on human gingival fibroblasts (L929). Cytotoxic effects were evaluated by the colorimetric assay MTT [3- (4,5- dimethylthiazol-2-yl) -2,5-diphenyl tetrazolium bromide] to determine cellular viability after the cells were exposed for 24h to the samples of each experimental condition (n=18) previously immersed in one of the solutions for the evaluation periods (T91 or T183). Cytotoxicity was determined based on mitochondrial activity compared to the specimens not subjected to immersion in the solutions. The MTT assay results were 1-way ANOVA followed by Tukey\'s HSD post-hoc test (a=0.05). For the periods T91 and T183, no microbial inhibition was observed with immersion in water (control) for up to 14 days of incubation. The CHX progressively inhibited microbial growth over the 14 days for both immersion times (Ca: 19 to 73.58%, Sa: 0 to 87.08%); with greater antimicrobial activity in T183. The NaClO showed a slight microbial inhibition only in the 14-day period in both T91 (Ca: 0%; Sa: 2.70%) and T183 (Ca: 8.50%; Sa: 15.08%). According to the results of the MTT assay, the chemical cleaning solutions tested showed a significant reduction in cell viability when compared to the control cells propagated in normal culture medium (p<0.002). The CHX resulted in the lowest cell viability in both immersion periods (p<0.018). The acrylic samples immersed in water or NaClO in T91 and T183 showed cell viability statistically similar to nonimmersed samples (p>0.05). CHX incorporated into the acrylic resin denture base had a residual antimicrobial effect on both immersion periods, which was not observed with NaClO. On the other hand, the residual CHX were severely cytotoxic to human gingival fibroblasts compared to NaClO and distilled water which were slightly cytotoxic. These results suggest caution in selecting denture cleaning agents as a method of prevention and adjunct treatment of denture stomatitis because even at low concentrations recommended for overnight immersion, they may exhibit some degree of toxicity to the denture bearing mucosa.

Objectives: The primary objective was to assess the impact of two denture fabrication techniques, conventional and CAD/CAM, on oral health-related quality of life (OHRQoL) and patient satisfaction in complete denture wearers. The secondary objective was to compare the level of microorganisms present on complete dentures from the two fabrication techniques. Methods: Twenty-eight completely edentulous subjects (16 men and 21 women, age range from 49 to 87 years old.), who had been edentulous for at least 6 months, were wearing ill-fitting complete dentures, or unsatisfied with their existing complete dentures were recruited. Subjects were randomized to conventional and computer-aided design/ computer-aided manufacturing (CAD/CAM) treatment groups. Subjects in both groups were given the OHIP-EDENT (Oral Health Impact Profile for Edentulous Patients) and patient satisfaction questionnaires to record the data at baseline and at 1 month post-delivery of the new prostheses. Plaque samples were collected from intaglio surfaces of maxillary complete dentures at 1 month post-delivery to culture for any colonization of bacteria and/or yeasts. Results: There was a significant reduction in OHIP-EDENT scores within both treatment groups at the 1 month follow-up (p < 0.05). There was also a significant reduction in almost all OHIP-EDENT domains scores at 1 month. Gender was significantly associated with OHIP-EDENT score at baseline (p = 0.0419) and at 1 month (p = 0.0152). Female subjects tend to have higher OHIP-EDENT scores than male subjects. There was no significant difference in patient satisfaction between treatment groups both at baseline and at the 1 month visit for almost all aspects of satisfaction (p> 0.05). Appearance of maxillary denture was the only significant difference in patient satisfaction across treatment groups (p = 0.0213). The comparisons of microbial counts showed no significant difference between treatment groups. Conclusions: There were no significant difference on oral health-related quality of life (OHRQoL) and patient satisfaction between two treatment groups at baseline and 1 month. There was no significant difference in microbial counts between two treatment groups.

O presente estudo in vitro objetivou avaliar a longo prazo o potencial antimicrobiano residual e a citotoxicidade de soluções químicas de limpeza de prótese quando incorporadas à resina acrílica termopolimerizável após sucessivos ciclos de imersão noturna diária. Discos (10mm x 1mm) de resina acrílica termopolimerizável para base de prótese (Lucitone 550) foram submetidos a três ciclos diários de desinfecção (8h/cada) em hipoclorito de sódio a 1% (NaClO), digluconato de clorexidina a 2% (CLX) ou água destilada (controle) durante 91 (T91) ou 183 dias (T183), simulando o período de 9 meses ou 1,5 ano de imersão noturna diária realizada pelo paciente. Inicialmente, foi utilizado o método de concentração inibitória mínima em caldo para determinar o possível efeito residual (incorporação) das soluções à resina acrílica. Metade dos discos imersos em cada agente de limpeza em um dos tempos de imersão (n=5) foi inoculada (1x107cels/mL) com um dos patógenos associados à estomatite protética: Candida albicans (Ca) e Staphylococcus aureus (Sa). Os discos foram incubados a 37oC para análise em espectrofotômetro após 24h, 7 e 14 dias. Os valores de absorbância foram convertidos em porcentagens de inibição microbiana. Confirmada a ação antimicrobiana residual dos agentes de limpeza incorporados à resina acrílica, foi então analisada sua citotoxicidade in vitro sobre fibroblastos gengivais humanos (L929). Os efeitos citotóxicos foram avaliados por meio do ensaio colorimétrico MTT [brometo de 3-(4,5-dimetiltiazol-2-yl)-2,5-difeniltetrazólio] para a determinação da viabilidade celular, após as células serem expostas por 24h às amostras de cada condição experimentais (n=18) previamente imersas em uma das soluções por um dos períodos avaliados (T91 ou T183). A citotoxicidade foi determinada com base na atividade mitocondrial em relação a corpos de prova não submetidos à imersão nas soluções testadas. Os resultados do ensaio do MTT foram analisados estatisticamente por ANOVA-1 fator seguida pelo teste post-hoc de Tukey HSD (a=0,05). Para os períodos T91 e T183, não houve inibição microbiana com a imersão em água (controle) em até 14 dias de incubação. A CLX inibiu progressivamente o crescimento microbiano ao longo dos 14 dias para ambos os períodos de imersão (Ca: 19 a 73,58%; Sa: 0 a 87,08%), sendo observada maior ação antimicrobiana em T183. O NaClO apresentou discreta inibição microbiana apenas no período de 14 dias tanto em T91 (Ca: 0%; Sa: 2,70%) quanto em T183 (Ca: 8,50%; Sa: 15,08%). De acordo com os resultados do teste de MTT, as soluções químicas de limpeza testadas apresentaram uma redução significativa da viabilidade celular quando comparado às células controles propagadas apenas em meio de cultura (p<0,002). A CLX resultou na menor viabilidade celular em ambos os períodos de imersão (p<0,018). As amostras de resina acrílica imersas em água ou NaClO em T91 e T183 apresentaram viabilidade celular estatisticamente similar às amostras não imersas (p>0,05). Pode-se concluir que a CLX incorporada à resina acrílica para base de prótese apresentou um efeito antimicrobiano residual em ambos os períodos de imersão noturna, o que não foi observado com o NaClO. Por outro lado, a CLX residual resultou em efeito intensamente citotóxico aos fibroblastos gengivais humanos quando comparada ao NaClO e à agua destilada, que se apresentaram discretamente citotóxicos. Esses resultados sugerem precaução na seleção de agentes de limpeza para prótese como meio de prevenção e tratamento adjunto da estomatite protética, pois mesmo em concentrações baixas, recomendadas para imersão noturna, podem apresentar algum grau de toxicidade às mucosas de suporte protético. / This in vitro study aimed to evaluate the long-term residual antimicrobial activity and cytotoxicity of chemical denture cleansers incorporated into a heat-polymerized acrylic resin after successive cycles of daily overnight soaking. Discs (10mm x 1mm) were prepared from heat-polymerized acrylic resin (Lucitone 550) and submitted to three daily immersion (8h/each) in 1% sodium hypochlorite (NaClO), chlorhexidine digluconate 2% (CHX) or distilled water (control) for 91 days (T91) or 183 days (T183), simulating the period of 9 months or 1.5 year of nocturnal immersion performed by the patient. Initially, the method of minimum inhibitory concentration in broth was used to determine the possible residual effect (incorporation) of the acrylic resin solution. Half of the disks immersed in each cleaning agent for one of the period immersion (n=5) was inoculated (1x107cells/mL) with pathogens associated with denture stomatitis: Candida albicans (Ca) or Staphylococcys aureus (Sa). The disks were incubated at 37oC for analysis in a spectrophotometer after 24h, 7 and 14 days. The absorbance values were expressed as percentages of microbial inhibition. Confirmed the residual antimicrobial action of cleaning agents incorporated into the acrylic resin, its cytotoxicity was analyzed in vitro on human gingival fibroblasts (L929). Cytotoxic effects were evaluated by the colorimetric assay MTT [3- (4,5- dimethylthiazol-2-yl) -2,5-diphenyl tetrazolium bromide] to determine cellular viability after the cells were exposed for 24h to the samples of each experimental condition (n=18) previously immersed in one of the solutions for the evaluation periods (T91 or T183). Cytotoxicity was determined based on mitochondrial activity compared to the specimens not subjected to immersion in the solutions. The MTT assay results were 1-way ANOVA followed by Tukey\'s HSD post-hoc test (a=0.05). For the periods T91 and T183, no microbial inhibition was observed with immersion in water (control) for up to 14 days of incubation. The CHX progressively inhibited microbial growth over the 14 days for both immersion times (Ca: 19 to 73.58%, Sa: 0 to 87.08%); with greater antimicrobial activity in T183. The NaClO showed a slight microbial inhibition only in the 14-day period in both T91 (Ca: 0%; Sa: 2.70%) and T183 (Ca: 8.50%; Sa: 15.08%). According to the results of the MTT assay, the chemical cleaning solutions tested showed a significant reduction in cell viability when compared to the control cells propagated in normal culture medium (p<0.002). The CHX resulted in the lowest cell viability in both immersion periods (p<0.018). The acrylic samples immersed in water or NaClO in T91 and T183 showed cell viability statistically similar to nonimmersed samples (p>0.05). CHX incorporated into the acrylic resin denture base had a residual antimicrobial effect on both immersion periods, which was not observed with NaClO. On the other hand, the residual CHX were severely cytotoxic to human gingival fibroblasts compared to NaClO and distilled water which were slightly cytotoxic. These results suggest caution in selecting denture cleaning agents as a method of prevention and adjunct treatment of denture stomatitis because even at low concentrations recommended for overnight immersion, they may exhibit some degree of toxicity to the denture bearing mucosa.

<p><span style="font-size: 8pt / " text-align:="" font-family:="" color:="">The edentulous jaw is a common feature in elderly patients that had lost their teeth during life due to local reasons such as poor oral hygiene and dental caries as well as periodontal disease. Hence these patients are the victims of biological phenomenona that lead to difficulties in different aspects of patient comfort with dentures. Clinicians are always concerned to minimize these difficulties and increase patient comfort through manufacturing a proper prosthesis to substitute for the loss of the natural teeth as well as the surrounding structures for optimum satisfaction and improved quality of life of the patient. The aim of this study was to evaluate patient satisfaction regarding function and aesthetics with conventional mandibular dentures and implant retained mandibular overdentures in denture wearers.</span></p>

O presente trabalho se propôs a fazer uma avaliação da higiene e saúde orais de pacientes geriátricos portadores de próteses totais. Devido ao crescimento da população idosa houve um aumento do número de pacientes que passaram a usar algum tipo de prótese (total, removível ou implantes). Espera-se que as próteses totais restituam as funções estéticas, mastigatórias e fonéticas, no entanto sua instalação não representa o final da reabilitação protética, existindo a necessidade da realização de controles periódicos. Um dos fatores essenciais para o sucesso do tratamento odontológico é a higienização eficiente, capaz de remover o biofilme das próteses. Em casos de estomatite protética associada à Cândida ssp, as medidas terapêuticas mais eficientes são os controles efetivos da higiene oral, assim como das próteses (HEARTWELL; RAHN, 1993). Partindo desse raciocínio, o índice de placa nas faces interna e externa das próteses totais maxilares foi avaliado, neste trabalho, através do uso de evidenciadores. Esse procedimento foi realizado em próteses novas tendo-se a preocupação de orientar, no momento da instalação, os portadores das mesmas sobre cuidados de higienização da cavidade oral e das próteses. Foi realizado ainda exame citológico do palato desses mesmos pacientes a fim de verificar a presença de Cândida albicans. Os resultados encontrados não mostraram diminuição dos índices de biofilme depositados nas próteses totais maxilares tanto dos pacientes do grupo experimental como dos pacientes do grupo controle, sendo que se procurou avaliar também distúrbios cognitivos. Estes resultados sugerem que o método de motivação não foi eficiente e que fatores psicológicos, sociais e culturais influenciam a motivação dos pacientes em relação a hábitos de saúde oral. / This research intended to evaluate hygiene and oral health in geriatric patients using complete dentures. Because the elderly population has increased fast much more people uses today some kind of prostheses (complete, removable or implants). It’s expected that complete dentures should replace facial expression, mastigatory function and speech as well. However this is not always possible because patients are supposed to accept the inconvenience and responsibility of taking care of their own prostheses. A very important step is to perform a good hygiene intending to control biofilm development on tooth surface as well as over the prostheses. In Candida-associated denture stomatites the most important therapeutic measure is institution of effective oral and denture hygiene (HEARTWELL; RAHN, 1993). Based on what was mentioned before it was analyzed by means of staining, the biofilm index in the internal and external faces of complete dentures. Such procedures were performed in the new prostheses after instructing the patient how to clean them. It was also performed a cytologic exam of the palatal mucosa to verify if Candida albicans were present, or not. The results did not show any diminution of the biofilm index accumulate in the maxillary prostheses of both groups: control and experimental with or without deficit of cognition. Such results suggest that the motivation method was not efficient and also that psychologic, social and cultural factors do influence the patient’s motivation when we deal with oral health.