Oral Rehabil Research Articles

Withdrawal: Early loading of two implants supporting mandibular overdentures in geriatric edentulous patients: a 12-year follow-up study.

Withdrawal: Early loading of two implants supporting mandibular overdentures in geriatric edentulous patients: a 12-year follow-up study, by Eugenio Velasco-Ortega, Nuno Matos-Garrido, Alvaro Jiménez-Guerra, Ivan Ortiz-Garcia, Jesús Moreno-Muñoz, Enrique Núñez-Márquez, José Luis Rondón-Romero, Raul Ayuso-Montero, José López-López, Loreto Monsalve-Guil, J Oral Rehabil 2023, 10.1111/joor.13552. The above article, published online on 1 July 2023 in Wiley Online Library https://onlinelibrary.wiley.com/doi/10.1111/joor.13552, has been withdrawn by agreement between the journal's Editor in Chief, Peter Svensson, and John Wiley & Sons Ltd. The withdrawal has been agreed as the article has been under simultaneous consideration in multiple journals, leading to its publication elsewhere.

What is bruxism?

What is bruxism?

Late mandibular fracture after attempted third molar surgery: case report

Removal of lower third molar corresponds to one of the most common procedures in oral surgery. The extraction can result in several intraoperative or postoperative complications, especially when fully impacted molars are involved. This case report describes a mandibular angle fracture following removal of a fully impacted lower third molar of a 41 years old male patient. The fracture occurred 3 days after the attempt to extract the tooth 38 by a dentist surgeon. Several factors influencing the possibility of fracture including gender, age, dental position, and angulation were reviewed and associated with the injury. A fracture line in the angular region of the jaw was observed in radiological and tomographic analysis, both essential to perform the diagnosis. Open reduction internal fixation treatment approach was realized to ensure the best patient’s recovery. We conclude that the difficult to maintain a soft diet and the complete dentition factor could have been determinant to cause the fracture.Descriptors: Mandibular Fractures; Fracture Fixation; Molar, Third.ReferencesAl-Belasy FA, Tozoglu S, Ertas U. Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology. J Oral Maxillofac Surg. 2009; 67(4):856-61.daBodner L, Brennan PA, McLeod NM. Characteristics of iatrogenic mandibular fractures associated with tooth removal: review and analysis of 189 cases. Br J Oral Maxillofac Surg. 2011;49(7):567-72.Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007; 19(1):117-28.Joshi A, Goel M, Thorat A. Identifying the risk factors causing iatrogenic mandibular fractures associated with exodontia: a systemic meta-analysis of 200 cases from 1953 to 2015. Oral Maxillofac Surg. 2016;20(4):391-96.Libersa P, Roze D, Cachart T, Libersa JC. Immediate and late mandibular fractures after third molar removal. J Oral Maxillofac Surg. 2002;60(2):163-66.Perry PA, Goldberg MH. Late mandibular fracture after third molar surgery: a survey of Connecticut oral and maxillofacial surgeons. J Oral Maxillofac Surg. 2000;58(8):858-61.Pires WR, Bonardi JP, Faverani LP, Momesso GAC, Muñoz XMJP, Silva AFM et al. Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases. Int J Oral Maxillofac Surg. 2017;46(1):46-53.Krimmel M, Reinert S. Mandibular fracture after third molar removal. J Oral Maxillofac Surg. 2000;58(10):1110-12.Wagner KW, Otten JE, Schoen R, Schmelzeisen R. Pathological mandibular fractures following third molar removal. Int J Oral Maxillofac Surg. 2005;34(7):722-26.Ethunandan M, Shanahan D, Patel M. Iatrogenic mandibular fractures following removal of impacted third molars: an analysis of 130 cases. Br Dent J. 2012;212(4):179-84.Ellis E 3rd. Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am. 2009;21(2):163-74.Pell GJ, Gregory GT. Report on a ten year study of a tooth division technique for removal of impacted teeth. Am J Orthodont Surg. 1942; 28:660-71.Antoun JS, Lee KH. Sports-related maxillofacial fractures over an 11-year period. J Oral Maxillofac Surg. 2008;66(3):504-8.Chrcanovic BR, Custódio AL. Considerations of mandibular angle fractures during and after surgery for removal of third molars: a review of the literature. Oral Maxillofac Surg. 2010; 14(2):71-80. Iizuka T, Tanner S, Berthold H. Mandibular fractures following third molar extraction. A retrospective clinical and radiological study. Int J Oral Maxillofac Surg. 1997;26(5):338-43.Woldenberg Y, Gatot I, Bodner L. Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?. Med Oral Patol Oral Cir Bucal. 2007;12(1):E70-2.Miyaura K, Matsuka Y, Morita M, Yamashita A, Watanabe T. Comparison of biting forces in different age and sex groups: a study of biting efficiency with mobile and non-mobile teeth. J Oral Rehabil. 1999;26(3):223-27.Bezerra TP, Studart-Soares EC, Pita-Neto IC, Costa FW, Batista SH. Do third molars weaken the mandibular angle?. Med Oral Patol Oral Cir Bucal. 2011;16(5):e657-63.Grau-Manclús V, Gargallo-Albiol J, Almendros-Marqués N, Gay-Escoda C. Mandibular fractures related to the surgical extraction of impacted lower third molars: a report of 11 cases. J Oral Maxillofac Surg. 2011;69(5):1286-90.

Semidirect vital tooth onlay restoration: a case report

In the loss of much of the coronary structure, either through caries or a fracture, it is indicated to perform restorative laboratory techniques in order to re-establish the patient's health, function and aesthetics, through conservative and minimally invasive techniques. The aim of this manuscript is to report on a clinical case of a posterior restoration using a semidirect composite resin onlay restoration. Initially, a direct morphological reconstruction of bulk-fill resin was performed, followed by cavity preparation with diamond tips. Alginate melding and a model of elastomer-based material were performed. The professional made the onlay piece in micro-hybrid composite resin in the model incrementally. Cementation was performed with dual resin cement following manufacturer's recommendations. Finally, the occlusal adjustment was performed in the maximum habitual intercuspal position and during eccentric mandible movements. We conclude that the semidirect restorative technique in composite resin is as effective as direct and indirect restorations; however, the correct indication of these restorative procedures will define the clinical prognosis.Descriptors: Dental Restoration; Permanent; Molar. Rehabilitation.ReferencesAngeletaki F, Gkogkos A, Papazoglou E, Kloukos D. Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent. 2016;53:12-21.Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Özcan M. Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis. J Dent Res. 2016;95:985-94.Spreafico RC, Krejci I, Dietschi D. Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo. J Dent. 2005;33:499-507.Lins R, Vinagre A, Alberto N, Domingues MF, Messias A, Martins LR, Nogueira R, Ramos JC. Polymerization Shrinkage Evaluation of Restorative Resin-Based Composites Using Fiber Bragg Grating Sensors. Polymers (Basel). 2019a;11;E859.Lins RBE, Aristilde S, Osório JH, Cordeiro CMB, Yanikian CRF, Bicalho AA, Stape THS, Soares CJ, Martins LRM. Biomechanical behaviour of bulk-fill resin composites in class II restorations. J Mech Behav Biomed Mater. 2019b;2:255-261.Opdam NJM, Roeters FJM, Feilzer AJ, Verdonschot EH. Marginal integrity and postoperative sensitivity in Class 2 resin composite restorations in vivo. J. Dent. 1998;26: 555-62.Bicalho AA, Valdívia AD, Barreto BC, Tantbirojn D, Versluis A, Soares CJ. Incremental filling technique and composite material–part II: shrinkage and shrinkage stresses. Operat. Dent. 2014;39:E83–E92.Soares CJ, Faria-E-Silva AL, Rodrigues MP, Vilela ABF, Pfeifer CS, Tantbirojn D, Versluis A. Polymerization shrinkage stress of composite resins and resin cements - What do we need to know? Braz Oral Res. 2017;28:e62.van Dijken JW. A 6-year evaluation of a direct composite resin inlay/onlay system and glass ionomer cement-composite resin sandwich restorations. Acta Odontol Scand. 1994;52:368-76.Ferracane JL, Stansbury JW, Burke FJ. Self-adhesive resin cements - chemistry, properties and clinical considerations. J Oral Rehabil. 2011;38:295-314.Bacelar-Sá R, Sauro S, Abuna G, Vitti R, Nikaido T, Tagami J, Ambrosano GMB, Giannini M. Adhesion Evaluation of Dentin Sealing, Micropermeability, and Bond Strength of Current HEMA-free Adhesives to Dentin. J Adhes Dent. 2017;19:357-364.Alharbi A, Rocca GT, Dietschi D, Krejci I. Semidirect composite onlay with cavity sealing: a review of clinical procedures. J Esthet Restor Dent. 2014;26:97-106.Hirata R, Kabbach W, de Andrade OS, Bonfante EA, Giannini M, Coelho PG. Bulk Fill Composites: An Anatomic Sculpting Technique. J Esthet Restor Dent. 2015;27:335-43.Fron Chabouis H, Prot C, Fonteneau C, Nasr K, Chabreron O, Cazier S, Moussally C, Gaucher A, Khabthani Ben Jaballah I, Boyer R, Leforestier JF, Caumont-Prim A, Chemla F, Maman L, Nabet C, Attal JP. Efficacy of composite versus ceramic inlays and onlays: study protocol for the CECOIA randomized controlled trial. Trials. 2013;3:278.Torres CRG, Zanatta RF, Huhtala MFRL, Borges AB. Semidirect posterior composite restorations with a flexible die technique: A case series. J Am Dent Assoc. 2017;148:671-676.Marcondes M, Souza N, Manfroi FB, Burnett LH Jr, Spohr AM. Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements. J Adhes Dent. 2016;18:59-67.Liu X, Fok A, Li H. Influence of restorative material and proximal cavity design on the fracture resistance of MOD inlay restoration. Dent Mater. 2014;30:327-33.Fruits TJ, Knapp JA, Khajotia SS. Microleakage in the proximal walls of direct and indirect posterior resin slot restorations. Oper Dent. 2006;31:719-27.

Inflammatory fibrous hyperplasia in pediatric dentistry due to deleterious habit: case report

This paper reports the clinical case of a pediatric dentistry patient, presenting a correlation between non-nutritive suction and inflammatory fibrous hyperplasia. A 10-year-old female patient attended the Pediatric Dentistry Clinic of the Araçatuba Dental School-Brazil (FOA/UNESP) with her mother, who reported a "little ball under the upper lip" of the daughter, observed three months before, with gradual increase. The clinical examination revealed poor positioning of tooth 21 and a fibrous hyperplasia at 2 cm from the upper region of the respective tooth. A presumptive diagnosis of inflammatory fibrous hyperplasia was established. The proposed treatment was lesion excision, fabrication of a Hawley appliance for repositioning of tooth 21 and counseling on the need to cease the deleterious digital sucking habit. We conclude that elimination of the traumatic agent is fundamental for therapeutic success, in addition to surgical removal.Descriptors: Hyperplasia; Fingersucking; Habits.ReferencesEspinoza-Zapata M, Loza-Hernández G, Mondragón-Ballesteros R. Prevalence of buccal mucosa lesions in pediatric patients. Preliminary report. Cir Cir. 2006; 74(3):153-57.Cawson R, Eveson J. Oral pathology and diagnosis: Color atlas with integrated text. Phipadelphia, USA: Saunders, 1995;1-128.Rodriguez AF, Sacsaquispe SJ. Hyperplasia Fibrosa Inflamatória y posibles factores asociados em adultos mayores. Rev Estomatol Heridiana.2005;15(2):139-44.American Academy of Pediatric Dentistry. Management considerations for pediatric oral surgery and oral pathology. Pediatr Dent 2018;40(6):373-82.Neville B, Damm DD, Allen C, Chi A. Oral and Maxillofacial Pathology, 4th ed. Elsevier; 2016.Góis EG, Ribeiro HC, Vale MP, Paiva SM, Serra-Negra JMC, Ramos-Jorge ML et al. Influence of nonnutritive sucking habits, breathing pattern and adenoid size on the development of malocclusion. Angle Orthod. 2008;78(4):647-54.Scarpelli BB, Berger SB, Punhagui MF, Oliveira CAZ, Ferelle A, Oltramari-Navarro PVP. Evaluation of a preventive educational program for malocclusions: 7-year study. Braz oral res. 2016;30(1):e119.Cavalvanti AL, Bezerra PKM, Moura C, Bezerra PM, Granville-Gracia AF. Relationship between malocclusion and deleterious oral habits in preschool children in Campina Grande, PB, Brazil. Stom Glass S. 2008;55:154-62.Montaldo L, Montaldo P, Cuccaro P, Caramico N, Minervini G. Effects of feeding on non-nutritive sucking habits and implications on occlusion in mixed dentition. Int J Paediatr Dent. 2011;21(1):68-73.Vasconcelos FMN, Massoni ACLT, Heimer MV, Ferreira AMB, Katz CRT, Rosenblatt A. Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-45.Suhani RD, Suhani MF, Muntean A, Mesaros M, Badea ME. Deleterious oral habits in children with hearing impairment. Clujul Med. 2015;88(3):403-7.Bueno SB, Bittar TO, Vazquez FL, Meneghim MC, Pereira AC. Association of breastfeeding, pacifier use, breathing pattern and malocclusions in preschoolers. Dental Press J Orthod.2013;18(1):30e1-6.Gheno JN, Martins MAT, Munerato MC, Hugo FN, Sant'ana Filho M, Weissheimer C et al. Oral mucosal lesions and their association with sociodemographic, behavioral, and health status factors. Braz oral res. 2015;29(1):00289.Warren JJ, Bishara SE, Steinbock KL, Yonezu T, Nowak AJ. Effects of oral habit´s duration on dental characteristics in the primary dentition. J Am Dent Assoc. 2001;132(12):1685-93.Barros RMG, Campos KSM, Cabral LM. Relato de caso clínico de hiperplasia fibrosa inflamatória. Rev Odontol Araçatuba. 2014;35(2):15-18.Dutra KL, Longo L, Grando LJ, Riveiro ERC. Incidence of reactive hyperplastic lesions in the oral cavity: a 10 years’ retrospective study in Santa Catarina, Brazil. Braz J Otorhinolaryngol 2019; Braz j otorhinolaryngol. 2019;85(4):399-407.Palacios-Sánchez B, Cerero-Lapiedra R, Campo-Trapero J, Esparza-Gómez GC. Alteraciones gingivales no relacionadas con placa. RCOE. 2006;11(1):43-55.Coelho CM, Sousa YT, Daré AM. Denture-related oral mucosal lesions in a Brazilian school of dentistry. J Oral Rehabil. 2004;31(2):135-39.

How to evaluate adolescents’ dental anxiety? A review of instruments

How to evaluate adolescents’ dental anxiety? A review of instruments

Curcumin probably does not reduce pain importantly after impacted mandibular third-molar surgery compared with mefenamic acid

Maulina T, Diana H, Cahyanto A, Amaliya. The efficacy of curcumin in managing acute inflammation pain on the post-surgical removal of impacted third molars patients: a randomized controlled trial [published online ahead of print June 16, 2018]. J Oral Rehabil. https://doi.org/10.1111/joor.12679.

Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P< 0.0001, ML/Oc P< 0.004, ArGo/GoGn P= 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P< 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.

Uncertainty about whether failure rates are comparable between implant-supported and tooth-supported 3-unit fixed dental prostheses

Pol CWP, Raghoebar GM, Kerdijk W, Boven C, Cune MS, Meijer HJA. A systematic review and meta-analysis of 3-unit fixed dental prostheses: are the results of 2 abutment implants comparable to the results of 2 abutment teeth [published online ahead of print September 23, 2017]? J Oral Rehabil. https://doi.org/10.1111/joor.12575.

Mandibular atrophy may not affect the masticatory performance, swallowing, and oral health–related quality of life of patients receiving 2-implant–supported overdentures

Marcello-Machado RM, Faot F, Schuster AJ, et al. How does mandibular bone atrophy influence the masticatory function, OHRQoL and satisfaction in overdenture wearers? Clinical results until 1 year post-loading [published online ahead of print July 25, 2017]. J Oral Rehabil. https://doi.org/10.1111/joor.12546.

Limitations in systematic review comparing the outcomes of single implant mandibular overdentures with complete conventional dentures render it unuseful in making clinical decisions

Nogueira TE, Dias DR, Leles CR. Mandibular complete denture versus single-implant overdenture: a systematic review of patient-reported outcomes [published online ahead of print August 14, 2017]. J Oral Rehabil. .

Single implant–supported 2-unit cantilever fixed dental prosthesis seem to result in high patient satisfaction and survival up to 3 years

Van Nimwegen WG, Raghoebar GM, Tymstra N, Vissink A, Meijer HJA. How to treat two adjacent missing teeth with dental implants: a systematic review on single implant-supported two-unit cantilever FDP's and results of a 5-year prospective comparative study in the aesthetic zone. J Oral Rehabil. 2017;44(6):461-471. http://dx.doi.org/10.1111/joor.12507.

Resilient liner-retained overdentures seem to have a lower rate of mechanical complications than clip-retained overdentures in patients with 2 implant–supported bar-retained overdentures

Elsyad MA, Shaheen NH, Ashmawy TM. Long-term clinical and prosthetic outcomes of soft liner and clip attachments for bar/implant overdentures: a randomized controlled clinical trial. J Oral Rehabil. 2017;44(6):472-480. http://dx.doi.org/10.1111/joor.12500.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach

Recent studies have suggested that the insertion of dental implants in patients being diagnosed with bruxism negatively affected the implant failure rates. The aim of the present study was to investigate the association between the bruxism and the risk of dental implant failure. This retrospective study is based on 2670 patients who received 10 096 implants at one specialist clinic. Implant- and patient-related data were collected. Descriptive statistics were used to describe the patients and implants. Multilevel mixed effects parametric survival analysis was used to test the association between bruxism and risk of implant failure adjusting for several potential confounders. Criteria from a recent international consensus (Lobbezoo et al., J Oral Rehabil, 40, 2013, 2) and from the International Classification of Sleep Disorders (International classification of sleep disorders, revised: diagnostic and coding manual, American Academy of Sleep Medicine, Chicago, 2014) were used to define and diagnose the condition. The number of implants with information available for all variables totalled 3549, placed in 994 patients, with 179 implants reported as failures. The implant failure rates were 13·0% (24/185) for bruxers and 4·6% (155/3364) for non-bruxers (P < 0·001). The statistical model showed that bruxism was a statistically significantly risk factor to implant failure (HR 3·396; 95% CI 1·314, 8·777; P = 0·012), as well as implant length, implant diameter, implant surface, bone quantity D in relation to quantity A, bone quality 4 in relation to quality 1 (Lekholm and Zarb classification), smoking and the intake of proton pump inhibitors. It is suggested that the bruxism may be associated with an increased risk of dental implant failure.

Preventing chronic pain after acute jaw sprain or strain

Preventing chronic pain after acute jaw sprain or strain

Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism.

Inspired by the international consensus on defining and grading of bruxism (Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ et al. J Oral Rehabil. 2013;40:2), this commentary examines its contribution and underlying assumptions for defining sleep bruxism (SB). The consensus' parsimonious redefinition of bruxism as a behaviour is an advance, but we explore an implied question: might SB be more than behaviour? Behaviours do not inherently require clinical treatment, making the consensus-proposed 'diagnostic grading system' inappropriate. However, diagnostic grading might be useful, if SB were considered a disorder. Therefore, to fully appreciate the contribution of the consensus statement, we first consider standards and evidence for determining whether SB is a disorder characterised by harmful dysfunction or a risk factor increasing probability of a disorder. Second, the strengths and weaknesses of the consensus statement's proposed 'diagnostic grading system' are examined. The strongest evidence-to-date does not support SB as disorder as implied by 'diagnosis'. Behaviour alone is not diagnosed; disorders are. Considered even as a grading system of behaviour, the proposed system is weakened by poor sensitivity of self-report for direct polysomnographic (PSG)-classified SB and poor associations between clinical judgments of SB and portable PSG; reliance on dichotomised reports; and failure to consider SB behaviour on a continuum, measurable and definable through valid behavioural observation. To date, evidence for validity of self-report or clinician report in placing SB behaviour on a continuum is lacking, raising concerns about their potential utility in any bruxism behavioural grading system, and handicapping future study of whether SB may be a useful risk factor for, or itself a disorder requiring treatment.

Chipping – Metallkeramik vs. Vollkeramik

Rinke S, Kramer K, Bürgers R et al. A practice-based clinical evaluation of the survival and success of metal-ceramic and zirconia molar crowns: 5-year results. J Oral Rehabil 2016; 43: 136–144

Management of sleep bruxism in adults: a qualitative systematic literature review.

This paper updates the bruxism management review published by Lobbezoo etal. in 2008 (J Oral Rehabil 2008; 35: 509-23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio-video (AV) recordings, or with any other approach measuring the sleep-time masticatory muscles' activity, viz., PSG without AV recordings or electromyography (EMG) recorded with portable devices. Fourteen (N=14) papers were included in the review, of which 12 were randomised controlled trials (RCTs) and 2 were uncontrolled before-after studies. Structured reading of the included articles showed a high variability of topics, designs and findings. On average, the risk of bias for RCTs was low-to-unclear, whilst the before-after studies had several methodological limitations. The studies' results suggest that (i) almost every type of oral appliance (OA) (seven papers) is somehow effective to reduce SB activity, with a potentially higher decrease for devices providing large extent of mandibular advancement; (ii) all tested pharmacological approaches [i.e. botulinum toxin (two papers), clonazepam (one paper) and clonidine (one paper)] may reduce SB with respect to placebo; (iii) the potential benefit of biofeedback (BF) and cognitive-behavioural (CB) approaches to SB management is not fully supported (two papers); and (iv) the only investigation providing an electrical stimulus to the masseter muscle supports its effectiveness to reduce SB. It can be concluded that there is not enough evidence to define a standard of reference approach for SB treatment, except for the use of OA. Future studies on the indications for SB treatment are recommended.

Frequency of Obstructive Sleep Apnea Syndrome in Dental Patients with Tooth Wear

To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS. Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed. All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients' mean age was 58.5 ± 10.7 years (range: 35-90 years) and the body mass index was 27.9 ± 3.4 kg/m(2). Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 ± 24.9. AHI < 5 was reported in 2 patients, AHI of 5-29 in 17, and AHI ≥ 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004). Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS.