Análise da eficiência mastigatória, força máxima de mordida e autopercepção da saúde bucal para próteses totais e overdentures implantorretidas com diferentes padrões oclusais
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Data
2019-06-26
Autores
Rocha, Cibele Oliveira de Melo
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O posicionamento e forma oclusal dos dentes posteriores, assim como a utilização de implantes dentários, podem contribuir com uma adequada função mastigatória de usuários de próteses totais. Neste contexto, os objetivos do estudo clínico randomizado cruzado foram: (1) avaliar a eficiência mastigatória (EM), força máxima de mordida (FM) de portadores de próteses totais duplas e portadores de prótese total no arco superior e overdenture retida por um implante no arco inferior, confeccionadas com oclusão balanceada bilateral e lingualizada e (2) avaliar a autopercepção da saúde bucal destes indivíduos. Vinte e seis pacientes receberam próteses totais duplas, com dentes intercambiáveis na prótese inferior, permitindo a troca dos padrões oclusais. Posteriormente, cada paciente recebeu um implante na região de sínfise mandibular e as próteses totais inferiores foram convertidas em overdentures implantorretidas. A EM foi realizada através da mastigação de cubos de silicone de condensação e mensurada pelo método das peneiras, enquanto que a FM foi mensurada pela utilização de um gnatodinamômetro. Para avaliação da autopercepção de saúde bucal foi utilizado o índice de determinação da saúde bucal geriátrica (GOHAI). Os resultados mostram que não houve diferença estatística para EM (p=0,813) e FM (p=0,074) em usuários de próteses totais convencionais quando comparados diferentes padrões oclusais. Para overdentures mandibulares, em relação aos padrões oclusais, também não foram obtidos resultados significantes para EM (p=0,437) e FM (p=0,834). Quando comparados os tipos de prótese independente do padrão oclusal, foram encontradas diferenças estatísticas tanto para a EM (p≤0,001), como para FM (p≤0,001), com melhores resultados para overdentures. Em relação a autopercepção da saúde bucal, melhores resultados foram encontrados para overdentures mandibulares quando comparadas com as próteses totais. Pode-se concluir que o uso de um implante em região de sínfise mandibular melhora a eficiência mastigatória em indivíduos portadores de próteses totais convencionais, além de aumentar a força de mordida e autopercepção de saúde bucal. Por outro lado, o padrão oclusal (balanceada bilateral ou lingualizada) não teve influência.
The positioning and occlusal design of posterior teeth, as well as the use of dental implants, may contribute with an adequate masticatory function of removable complete denture wearers. In this context, the aims of this randomized crossover clinical trial were: (1) evaluate the masticatory efficiency (ME) and maximum bite force (BF) of wearers of maxillary and mandibular removable complete dentures and wearers of maxillary complete denture and single-implant mandibular overdenture, made with bilateral balanced occlusion and lingualized balanced occlusion, (2) evaluate the self-perception of these. Twenty six patients received maxillary and mandibular removable complete dentures, with interchangeable teeth in the mandibular prosthesis, allowing the exchange of occlusal patterns. Subsequently, each patient received an implant in the mandibular symphysis region and the mandibular complete dentures were converted into implant retained overdentures. ME was performed by the chewing of condensation silicone cubes and measured by sieve method, while the BF was measured with a gnathodynamometer. To evaluate the self-perception of oral health the General Oral Health Assessment Index (GOHAI) was used. The results show that there was no statistical difference for ME (p = 0.813) and BF (p=0.074) in wearers of removable complete dentures when different occlusal patterns were compared. For mandibular overdentures, in relation to occlusal patterns, no significant results were also obtained for ME (p=0.437) and BF (p=0.834). When comparing the types of prosthesis independent of the occlusal pattern, statistical differences were found for both ME (p≤0.001) and BF (p≤0.001), with better results for overdentures. Regarding self-perception of oral health, better results were found to mandibular overdentures when compared to conventional complete dentures. there was an improvement after the second rehabilitation in both types of prosthesis, and this was higher in individuals with overdenture. It can be concluded that the use of an implant in the mandibular symphysis region improves masticatory efficiency in individuals with conventional complete dentures, in addition to increasing bite force and self-perception of oral health. On the other hand, the occlusal pattern (balanced bilateral or lingualized) had no influence.
The positioning and occlusal design of posterior teeth, as well as the use of dental implants, may contribute with an adequate masticatory function of removable complete denture wearers. In this context, the aims of this randomized crossover clinical trial were: (1) evaluate the masticatory efficiency (ME) and maximum bite force (BF) of wearers of maxillary and mandibular removable complete dentures and wearers of maxillary complete denture and single-implant mandibular overdenture, made with bilateral balanced occlusion and lingualized balanced occlusion, (2) evaluate the self-perception of these. Twenty six patients received maxillary and mandibular removable complete dentures, with interchangeable teeth in the mandibular prosthesis, allowing the exchange of occlusal patterns. Subsequently, each patient received an implant in the mandibular symphysis region and the mandibular complete dentures were converted into implant retained overdentures. ME was performed by the chewing of condensation silicone cubes and measured by sieve method, while the BF was measured with a gnathodynamometer. To evaluate the self-perception of oral health the General Oral Health Assessment Index (GOHAI) was used. The results show that there was no statistical difference for ME (p = 0.813) and BF (p=0.074) in wearers of removable complete dentures when different occlusal patterns were compared. For mandibular overdentures, in relation to occlusal patterns, no significant results were also obtained for ME (p=0.437) and BF (p=0.834). When comparing the types of prosthesis independent of the occlusal pattern, statistical differences were found for both ME (p≤0.001) and BF (p≤0.001), with better results for overdentures. Regarding self-perception of oral health, better results were found to mandibular overdentures when compared to conventional complete dentures. there was an improvement after the second rehabilitation in both types of prosthesis, and this was higher in individuals with overdenture. It can be concluded that the use of an implant in the mandibular symphysis region improves masticatory efficiency in individuals with conventional complete dentures, in addition to increasing bite force and self-perception of oral health. On the other hand, the occlusal pattern (balanced bilateral or lingualized) had no influence.
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Palavras-chave
Força de mordida, Mastigação, Implantes dentários, Bite force, Mastication, Dental implants