Influência da altura do rebordo mandibular na adaptação funcional com próteses totais convencionais
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2020-02-07
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Universidade Estadual Paulista (Unesp)
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O período de adaptação funcional com as próteses totais novas envolve uma série de problemas transitórios, e este período está diretamente relacionado com o sucesso ou falha do tratamento. O objetivo deste estudo foi avaliar a influência da altura do rebordo mandibular no padrão de movimentos mandibulares, na máxima força de mordida oclusal, na função mastigatória, na ingestão de nutrientes e na satisfação dos pacientes em diferentes estágios após a instalação de próteses totais convencionais novas. Vinte e oito indivíduos desdentados totais (RN, n=14, rebordos mandibulares normais; RR, n=14, rebordos mandibulares reabsorvidos) receberam novas próteses totais convencionais. Um cinesiógrafo foi utilizado para registrar os movimentos mandibulares durante a abertura e fechamento e a mastigação de um alimento teste. A máxima força oclusal foi mensurada com o auxílio de um gnatodinamômetro digital, o desempenho mastigatório foi avaliado por meio do método dos tamises e a habilidade mastigatória pela aplicação de questionário específico baseado em uma escala visual analógica (EVA de 100,0 mm), a satisfação foi avaliada por meio de um questionário. A ingestão de nutrientes foi avaliada por meio de diário alimentar de três dias, e posteriormente foi traduzido em valores nutricionais por meio da utilização da Tabela Brasileira de Composição de Alimentos. Essas avaliações foram conduzidas em momentos distintos: 24 horas, 30 dias, três meses e seis meses após a instalação das próteses totais convencionais. A análise dos dados foi realizada por meio de ANOVA para dois fatores ou Equações de Estimação Generalizadas (EEG), com nível de significância de 5%. Os resultados mostraram que houve maior amplitude de abertura e fechamento no período de 30 dias (µ=29,270±1,516 mm) em comparação ao período de seis meses (µ=25,784±1,068 mm) após a instalação das próteses totais, no plano anteroposterior. Ainda, o grupo RR apresentou uma maior amplitude de movimentos mandibulares durante a mastigação (µ=6,854±0,364 mm) em comparação à RN (µ=5,347±0,364 mm). Para o eixo vertical, houve uma menor amplitude de movimentos mandibulares durante a mastigação no período de 24 horas (µ=12,698±0,425 mm) em comparação ao período de seis meses (µ=14,415±0,536 mm) após a instalação das próteses. O período de avaliação foi significante para a máxima força oclusal (ANOVA, p=0,000), sendo observada maior força no período de três meses (µ=78,50±6,49 N) em comparação aos períodos de 24 horas (µ=57,34±5,55 N) e 30 dias (µ=62,72±5,97 N). O tipo de rebordo foi significante para o desempenho mastigatório (ANOVA, p=0,000, RN 30,25±9,93%, RR 12,41±7,17%). Ainda, o período de avaliação também foi significante (ANOVA, p=0,000), o desempenho mastigatório foi maior para o período de seis meses (µ=24,25±12,26 %) em comparação ao período de 24 horas (µ=18,09±10,89 %) após a instalação das próteses. A análise dos escores obtidos na EVA demonstrou efeito significante do rebordo na mastigação de cenoura crua, resultando em maior facilidade (EEG, p= 0,019) desse alimento para RN. Observou-se um efeito significante do período de 30 dias na facilidade em mastigar bife (EEG, p= 0,001), na qualidade em mastigar queijo (EEG, p= 0,000), cenoura crua (EEG, p= 0,001), bife (EEG, p= 0,000) e alface (EEG, p= 0,022). Ainda o período de 3 meses foi significante para a facilidade em mastigar pão fresco (EEG, p= 0,045), cenoura crua (EEG, p= 0,000) e habilidade em mastigar pão fresco (EEG, p= 0,026), maçã crua (EEG, p= 0,003), além da qualidade geral (EEG, p= 0,001). A análise dos escores obtidos no questionário de satisfação com as próteses totais demonstrou efeito significante da altura do rebordo mandibular para a qualidade geral (EEG, p= 0,047), retenção da prótese total inferior (EEG, p= 0,001), capacidade de mastigar (EEG, p= 0,037), conforto da prótese total inferior (EEG, p= 0,000) e somatória (EEG, p= 0,001), sendo melhor no grupo RN.. O período de avaliação foi significante para o conforto com a prótese total inferior (p=0,002), demonstrando que no período de 3 meses (µ=1,61±0,079) houve um maior conforto em relação aos períodos de 24 horas (µ=1,29±0,10) e 30 dias (µ=1,36±10). Ainda, no período de 30 dias, o grupo RN obteve melhor satisfação (µ=2,00±0,00) com a retenção da prótese total superior em comparação à RR (µ=1,64±0,16). Os resultados mostraram que a ingestão de proteínas foi maior no período de três meses (µ= 25,01±0,7 %) em comparação ao período de 24 horas (µ= 20,41±1,7 %) após a instalação das próteses. Este estudo concluiu que, após a instalação de novas próteses totais convencionais, alterações significantes no padrão de movimentos mandibulares ocorrem nos períodos iniciais (24 horas e 30 dias), um período de 3 meses foi necessário para um melhor desempenho mastigatório e da máxima força de mordida oclusal, maior ingestão de proteínas e melhor autopercepção da mastigação e do conforto com a prótese total inferior. Ainda, durante todo o período de avaliação do estudo, concluiu-se que indivíduos com rebordo mandibular normal apresentam maior desempenho mastigatório e satisfação com suas próteses totais convencionais novas.
The period of functional adaptation to the new conventional complete dentures comprises many transitory problems, and this period is directly related to the success of the rehabilitation. The aim of this study was to evaluate the influence of the height of the mandibular ridge on the mandibular movements, maximum occlusal force, masticatory function (performance and ability), nutrient intake and on the satisfaction of patients at different stages after the insertion of new conventional complete dentures. Twenty-eight completely edentulous individuals (NR, n=14, normal mandibular ridges; RR, n=14, resorbed mandibular ridges) received a new set of complete dentures. A kinesiographic device was used to evaluate the amplitude of the mandibular movements during opening and chewing of a test food (bread). The maximum occlusal force was evaluated by means of a gnatodynamometer, the masticatory performance was evaluated by the sieves method, the masticatory ability by the application of a specific questionnaire based on a visual analog scale (VAS) of 100 mm and the satisfaction was evaluated by the application of a questionnaire. Nutrient intake was assessed by three-day food diary and further compared to the Brazilian Food Composition Table. These evaluations were performed in different moments: 24 hours, 30 days, three months and six months after the insertion of the complete dentures. Data were analyzed by 2-way ANOVA or Generalized Estimating Equation (GEE), at 5% of level of significance. The results showed that, in the anteroposterior axis, vertical opening was significantly higher at 30 days (µ = 29.270 ± 1.516 mm) compared to 6 months after the insertion of the complete dentures (µ = 25.784 ± 1.068 mm). The amplitude of mandibular movement during chewing was significantly higher for RR (µ = 6.854 ± 0.364 mm) in comparison to NR (µ = 5.347 ± 0.364 mm). For the vertical axis, significant differences on the amplitude of mandibular movement during chewing were observed between 24 hours (µ=12,698±0,425 mm) compared to 6 months (µ=14,415±0,536 mm). A significant effect of the period was observed for maximum occlusal force (ANOVA, p=.000), which was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N). The degree of mandibular ridge resorption was significant for the masticatory performance (ANOVA, p=.000, NR 30.25±9.93%, RR 12.41±7.17%). A significant effect of the period was observed (ANOVA, p=.000), the masticatory performance was higher at six months (24.25±12.26 %) in comparison to 24 hours after the insertion of the complete dentures (18.09±10.89 %). The analysis of the VAS scores showed a significant effect of the ridge on chewing raw carrot, resulting in greater ease (GEE, p = 0.019) of this food for participants for NR. It was observed a significant effect of the 30-day on the greater ease of chewing beef (EEG, p = 0.001), quality of chewing cheese (EEG, p = 0.000), raw carrot (EEG, p = 0.001), beef (EEG, p = 0.000) and lettuce (EEG, p = 0.022). The period of three months was significant for the greater ease of chewing fresh bread (EEG, p = 0.045), raw carrot (EEG, p = 0.000) and ability to chewing fresh bread (EEG, p = 0.026), raw apple (EEG , p = 0.003), in addition to the general quality (EEG, p = 0.001). The analysis of the scores of the satisfaction questionnaire with the new conventional complete dentures showed significant effect of the ridge for the general satisfaction (EEG, p = 0.047), retention of the mandibular denture (EEG, p = 0.001), chewing (EEG, p = 0.037), comfort of wearing mandibular denture (EEG, p = 0.000) and sum (EEG, p = 0.001), being better in participants with NR. The evaluation period was significant for the comfort of wearing mandibular denture (p = 0.002), showing that in the three months (1.61 ± 0.07) there was greater comfort compared to the 24 hours (1.29 ± 0.10) and 30 days after the insertion of the complete dentures (1.36 ± 10). Also, within 30 days, participants with NR had better satisfaction with retention of the maxillary denture (2.00 ± 0.00) compared to participants with RR (1.64 ± 0.16). The protein intake was higher at three months (25.01 ± 0.7%) compared to the 24 hours after the insertion of the complete dentures (20.41 ± 1.7%). The present study concluded that, after the insertion of the new complete dentures, changes in the mandibular movements occur in the initial periods (24 hours and 30 days), a period of 3 months was necessary for better masticatory performance and improvement of maximum occlusal bite force, increased protein intake and self-perceived of chewing and comfort with the mandibular denture. In addition, irrespective of the follow-up period, it can be concluded that participants with normal mandibular ridges have higher masticatory performance and satisfaction with their new conventional complete dentures.
The period of functional adaptation to the new conventional complete dentures comprises many transitory problems, and this period is directly related to the success of the rehabilitation. The aim of this study was to evaluate the influence of the height of the mandibular ridge on the mandibular movements, maximum occlusal force, masticatory function (performance and ability), nutrient intake and on the satisfaction of patients at different stages after the insertion of new conventional complete dentures. Twenty-eight completely edentulous individuals (NR, n=14, normal mandibular ridges; RR, n=14, resorbed mandibular ridges) received a new set of complete dentures. A kinesiographic device was used to evaluate the amplitude of the mandibular movements during opening and chewing of a test food (bread). The maximum occlusal force was evaluated by means of a gnatodynamometer, the masticatory performance was evaluated by the sieves method, the masticatory ability by the application of a specific questionnaire based on a visual analog scale (VAS) of 100 mm and the satisfaction was evaluated by the application of a questionnaire. Nutrient intake was assessed by three-day food diary and further compared to the Brazilian Food Composition Table. These evaluations were performed in different moments: 24 hours, 30 days, three months and six months after the insertion of the complete dentures. Data were analyzed by 2-way ANOVA or Generalized Estimating Equation (GEE), at 5% of level of significance. The results showed that, in the anteroposterior axis, vertical opening was significantly higher at 30 days (µ = 29.270 ± 1.516 mm) compared to 6 months after the insertion of the complete dentures (µ = 25.784 ± 1.068 mm). The amplitude of mandibular movement during chewing was significantly higher for RR (µ = 6.854 ± 0.364 mm) in comparison to NR (µ = 5.347 ± 0.364 mm). For the vertical axis, significant differences on the amplitude of mandibular movement during chewing were observed between 24 hours (µ=12,698±0,425 mm) compared to 6 months (µ=14,415±0,536 mm). A significant effect of the period was observed for maximum occlusal force (ANOVA, p=.000), which was higher at three months (78.50±6.49 N) compared to 24 hours (57.34±5.55 N) and 30 days (62.72±5.97 N). The degree of mandibular ridge resorption was significant for the masticatory performance (ANOVA, p=.000, NR 30.25±9.93%, RR 12.41±7.17%). A significant effect of the period was observed (ANOVA, p=.000), the masticatory performance was higher at six months (24.25±12.26 %) in comparison to 24 hours after the insertion of the complete dentures (18.09±10.89 %). The analysis of the VAS scores showed a significant effect of the ridge on chewing raw carrot, resulting in greater ease (GEE, p = 0.019) of this food for participants for NR. It was observed a significant effect of the 30-day on the greater ease of chewing beef (EEG, p = 0.001), quality of chewing cheese (EEG, p = 0.000), raw carrot (EEG, p = 0.001), beef (EEG, p = 0.000) and lettuce (EEG, p = 0.022). The period of three months was significant for the greater ease of chewing fresh bread (EEG, p = 0.045), raw carrot (EEG, p = 0.000) and ability to chewing fresh bread (EEG, p = 0.026), raw apple (EEG , p = 0.003), in addition to the general quality (EEG, p = 0.001). The analysis of the scores of the satisfaction questionnaire with the new conventional complete dentures showed significant effect of the ridge for the general satisfaction (EEG, p = 0.047), retention of the mandibular denture (EEG, p = 0.001), chewing (EEG, p = 0.037), comfort of wearing mandibular denture (EEG, p = 0.000) and sum (EEG, p = 0.001), being better in participants with NR. The evaluation period was significant for the comfort of wearing mandibular denture (p = 0.002), showing that in the three months (1.61 ± 0.07) there was greater comfort compared to the 24 hours (1.29 ± 0.10) and 30 days after the insertion of the complete dentures (1.36 ± 10). Also, within 30 days, participants with NR had better satisfaction with retention of the maxillary denture (2.00 ± 0.00) compared to participants with RR (1.64 ± 0.16). The protein intake was higher at three months (25.01 ± 0.7%) compared to the 24 hours after the insertion of the complete dentures (20.41 ± 1.7%). The present study concluded that, after the insertion of the new complete dentures, changes in the mandibular movements occur in the initial periods (24 hours and 30 days), a period of 3 months was necessary for better masticatory performance and improvement of maximum occlusal bite force, increased protein intake and self-perceived of chewing and comfort with the mandibular denture. In addition, irrespective of the follow-up period, it can be concluded that participants with normal mandibular ridges have higher masticatory performance and satisfaction with their new conventional complete dentures.
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Palavras-chave
Prótese Total, Adaptação Fisiológica, Mastigação, Força de Mordida, Satisfação do Paciente, Estado Nutricional, Complete denture, Physiological Adaptation, Mastication, Bite Force, Patient Satisfaction, Nutritional Status