Sandra Lúcia Dantas Moraes

Purpose: This overview of systematic reviews aimed to compare continuous positive airway pressure and mandibular advancement devices for the treatment of obstructive sleep apnea by distinguishing objective physiological outcomes from patient-centered outcomes and critically appraising the methodological quality of the available evidence. Methods: Following PRISMA guidelines and PROSPERO registration (CRD42021268587), we systematically searched five databases to identify systematic reviews comparing continuous positive airway pressure and mandibular advancement devices in obstructive sleep apnea based on a PICO framework. The outcomes of interest included the Apnea–Hypopnea Index, oxygen desaturation index, treatment adherence, and quality of life. Methodological quality was assessed using AMSTAR-2, and overlap among reviews was evaluated using a citation matrix and the corrected covered area. Results: Fourteen systematic reviews were included. CPAP demonstrated greater efficacy than mandibular advancement devices in improving objective physiological outcomes, particularly the apnea–hypopnea index and oxygen desaturation indices. Both therapies showed comparable effects on daytime sleepiness, while some reviews reported better treatment adherence and more favorable patient-centered outcomes with MADs. Methodological quality was limited: no review was classified as high quality, and most were assessed as low or critically low quality. Analysis of the corrected coverage area indicated a high overlap between the primary studies included in the different reviews. Conclusion: Continuous positive airway pressure is more effective than mandibular advancement devices in improving the apnea–hypopnea index and oxygen desaturation index. However, mandibular advancement devices were associated with positive effects on quality of life and sleep, though certainty regarding the sustainability of these outcomes and their long-term efficacy remains limited in the current literature. Treatment choice should be individualized, and evidence should be interpreted with caution due to methodological limitations and the high overlap between the included systematic reviews. PROSPERO registration number: CRD2021268587.

Objectives: To map and characterize the therapeutic strategies described in the literature for the management of microstomia in patients with systemic sclerosis. Methods: This scoping review was conducted in accordance with the PRISMA‐ScR guidelines. Searches were performed in Medline/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and gray literature searches. Studies involving adults with systemic sclerosis of any subtype who received local or systemic interventions aimed at improving microstomia and reported at least one mouth opening–related outcome were eligible. Results: Forty‐five studies were included. Non‐surgical interventions predominated, including physiotherapy, injectables, and oral medications, whereas surgical treatments were less frequently reported and mainly involved autologous fat grafting. Randomized controlled trials primarily evaluated conservative interventions, while surgical approaches were mostly investigated in quasi‐experimental studies. Heterogeneity was observed across study designs, outcome measures, follow‐up durations, and assessment instruments. Objective measures of mouth opening, especially interincisal distance, were the most reported outcomes. Conclusions: The available evidence on microstomia management in systemic sclerosis is predominantly based on non‐surgical interventions and is marked by substantial methodological heterogeneity. Future research should prioritize standardized outcome measures, longer follow‐up periods, and well‐designed multicenter studies to better define the role of conservative and surgical treatments in this clinical setting.

Objective: To synthesize barriers associated with delays in the diagnosis and initiation of treatment of oral cancer across high‐income countries (HICs) and low‐ and middle‐income countries (LMICs) contexts, aligned with the Aarhus diagnostic–therapeutic intervals. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and ProQuest. Observational, qualitative, and mixed‐methods studies reporting patient‐reported perceptions or system‐level barriers affecting the diagnostic‐therapeutic pathway and associated with diagnostic or treatment delays in adult oral cancer were included. Data were narratively synthesized, and identified barriers were semantically standardized and mapped to the Aarhus intervals. Results: Sixteen studies were included. Barriers were categorized into psychosocial, symptom appraisal, health literacy, structural, professional‐related, and organizational domains. Studies focusing on the patient interval most frequently reported psychosocial and appraisal‐related barriers. Studies examining diagnostic, composite, or total intervals more commonly identified professional‐related and organizational barriers. Studies from LMICs more frequently addressed extended segments of the care pathway and reported nonbiomedical management strategies, health literacy–related barriers, and professional or structural barriers beyond the patient interval. Conclusion: Delays in oral cancer care reflect an interconnected, trajectory‐based process shaped by interacting individual, professional, and system‐level factors, supporting the need for integrated interventions across the care continuum.

Purpose: The purpose of this systematic review was to compare the clinical outcomes and patient‐reported outcome measures (PROMs) of digitally and conventionally fabricated removable partial denture (RPD) frameworks. Methods: This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses. An electronic search was performed in PubMed/MEDLINE, Scopus, Embase, and Web of Science. Clinical studies comparing clinical outcomes and/or PROMs of digitally and conventionally fabricated RPD frameworks, with no restrictions on publication year or language, were included. Studies involving other types of oral rehabilitation or those without full‐text availability were excluded. Results: From 863 studies identified, 14 were included in this review. Clinical outcomes assessed included adaptation, periodontal health, masticatory efficiency, denture stomatitis, weight, success, and placement rates, adjustment time, stability, number of framework remakes, and components requiring adjustment. PROMs included patient satisfaction, oral health‐related quality of life (OHRQoL), and patient preference. No significant difference in rest adaptation was observed between conventional and digital workflows ( p  = 0.070). Some studies suggested that digitally fabricated RPD frameworks may be associated with reduced bone loss, improved masticatory efficiency, and fewer incidences of denture stomatitis. Regarding PROMs, the digital workflow resulted in higher patient satisfaction, whereas OHRQoL and patient preference were similar between techniques. Conclusions: Digitally fabricated RPD frameworks showed satisfactory clinical outcomes and PROMs and may represent a viable alternative to conventional methods.

Objective: To investigate the relationship between the use of maxillary and mandibular complete dentures, head posture, and postural stability in edentulous older adults. Background: Tooth loss can negatively impact both head posture and postural stability, increasing the risk of falls. Complete dentures (CD) may restore balance by improving occlusion and supporting head and neck alignment, but their full impact on balance is still unclear. Materials and Methods: An electronic search was performed in PubMed/MEDLINE, Cochrane Library, Scopus, and Embase up to June 2024. A search strategy was developed based on the Population, Intervention, Comparison, Outcome framework. The quality of the included studies was assessed using the Cochrane Risk of Bias tool, and the certainty of the evidence was evaluated with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: Eight clinical trials were included, involving 167 participants aged 40 to 82 years. Most studies reported improvements in head posture and postural stability immediately after rehabilitation with complete dentures, with trends showing increased cranio‐vertical angles, improved dynamic stability, faster walking speed, and reduced center of gravity sway, some of which persisted for up to 30 days. The certainty of evidence was moderate for body balance and very low for head posture. Conclusions: Oral rehabilitation with CD appears to provide immediate improvements in head posture and body balance in edentulous individuals, potentially enhancing safety and reducing the risk of falls. However, further studies are needed to evaluate long‐term effects and standardise methodologies.

Objective: This study aims to map the existing literature on natural products used as disinfection substances for conventional polymethyl methacrylate (PMMA) and computer‐aided design and manufacturing (CAD‐CAM) dentures. Background: Denture wearers are at high risk for denture stomatitis. Natural products have attracted the interest of the scientific community as an alternative to synthetic ones. Materials and methods: The guiding question “Which natural products have been applied to disinfect complete dentures in conventional PMMA or CAD‐CAM PMMA resin?” Searches were conducted in the PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases, and manual searches were performed in reference journals in the area with studies published until December 2023, without language or date restrictions. Results: A total of 4272 articles were identified, and 46 studies were included after applying the eligibility criteria. Thirty‐nine natural products were evaluated. Of the included studies, 43 presented positive findings and three obtained negative findings on the effectiveness of natural products in inhibiting or killing Candida albicans . Conclusion: Natural products, predominantly sourced from the Plantae kingdom, have demonstrated efficacy in reducing Candida albicans on the surface of conventional PMMA. However, the evidence primarily stems from in vitro studies, underscoring the necessity for additional clinical research to validate their applicability under real microbiological conditions in prosthesis users.

Purpose: To investigate the effects of different surface treatments and thermal cycling on the shear bond strength between 3D‐printed teeth and denture bases.Material and Methods: For the shear bond strength (SBS) test, the specimens were the maxillary central incisors (11 × 9 × 7 mm) bonded on a cylindrical base (20 × 25 mm). The control group was heat‐cured polymethylmethacrylate (PMMA) (N = 20). The printed group was divided into five subgroups (N = 20): no treatment, sandblasting with aluminum oxide (Al₂O₃), methyl methacrylate monomer, acetone, and adhesive with urethane dimethacrylate. Half of the samples were subjected to 2000 thermal cycling cycles, and all samples were subjected to the SBS test. The failure mode was established as adhesive, cohesive, or mixed through stereomicroscopic analysis. The surface roughness test (Sa) was performed using optical profilometry, and the rectangular specimens (14 × 14 × 2.5 mm) were divided into four groups according to the surface treatments (N = 7 per group). Paired T and Wilcoxon tests were conducted to perform comparisons within the same group. The Kruskal–Wallis and Dwass‐Steel‐Critchlow‐Fligner post‐hoc tests were conducted to compare the groups.Results: Al₂O₃ sandblasting in the 3D‐printed groups achieved high SBS values comparable to those of the control group in the thermal cycled (p = 0.962) and non‐thermal cycled samples (p = 0.319). It was the only treatment capable of modifying the surface of the 3D‐printed resin, thereby increasing the roughness (p = 0.016).Conclusions: Sandblasting is recommended to increase the bond strength between the tooth and denture bases.