Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

Prevalence of troublesome symptoms related to temporomandibular disorders and awareness of bruxism in 65- and 75-year-old subjects

doi: 10.1111/j.1741‐2358.2011.00558.x Prevalence of troublesome symptoms related to temporomandibular disorders and awareness of bruxism in 65‐ and 75‐year‐old subjects Objective: To assess the prevalence of three troublesome temporomandibular disorder (TMD) symptoms and awareness of bruxism in two cohorts of subjects aged 65 and 75 years. Background: Epidemiological studies have demonstrated varying prevalence of TMD symptoms. The results concerning elderly people are inconclusive. Material and methods: In 2007 identical questionnaires were sent to all subjects born in 1942 and 1932 living in two Swedish counties. The response rate was 73.1% for the 65‐ and 71.9% for the 75‐year‐old subjects, totally 9093 subjects. Results: The great majority reported no or only a few TMD problems. Less than 4% considered their TMD symptoms to be rather great or severe. The mean prevalence of TMD‐related symptoms and bruxism was greater in women than in men in both age groups. The 75‐year‐old women reported a marked lower prevalence of TMD symptoms and bruxism than the 65‐year‐old women, whereas the age differences were small among the men. Self‐reported bruxism was associated with a higher prevalence of TMD symptoms. Conclusions: The great majority of the subjects did not report any troublesome TMD related symptoms. However, 5.4% of the 65‐year‐old women and 3.8% of the 75‐year‐old women considered their symptoms severe or rather severe.     

Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.     

Relationship between symptoms of temporomandibular disorders and dental status, general health and psychosomatic factors in two cohorts of 70-year-old subjects

Objective: To study the prevalence of symptoms of temporomandibular disorders (TMD) in two cohorts of 70‐year‐old subjects examined 8 years apart and analyse the relationship between such symptoms and dental status, general health and various background factors. Materials and methods: Two cohorts of 70‐year‐old subjects, born in 1922 (n = 422) and 1930 (n = 491) respectively, were examined with an interval of 8 years. A TMD symptom index (0–5) was established on answers to five questions related to TMD symptoms. Results: There were no statistically significant differences between the two cohorts for prevalence of TMD symptoms and TMD index, neither for headache, neck ache, bruxism and chewing ability. TMJ sounds was the most prevalent symptom, 14%, whereas other TMD symptoms had low prevalence. The distribution of the TMD symptom index showed that 81% reported no symptoms, 15% one symptom, 3% two symptoms and 1% three to five symptoms. Single TMD symptoms and the TMD index exhibited significant associations (p < 0.001) with bruxism, headache, neck pain and several general health and psychosomatic factors, but with dental status only in women. Logistic regression showed that bruxism, neck pain, mouth dryness and a number of psychosomatic factors were associated with the TMD index. Conclusions: Besides TMJ sounds (14%), other TMD symptoms were rarely reported by the 70‐year‐old subjects. The TMD index was significantly associated with bruxism and several general health and psychosomatic complaints but with dental status only in women.     

Symptoms of craniomandibular disorders in elderly Brazilian wearers of complete dentures

Objective: Investigate the incidence of symptoms of craniomandibular disorder in elderly Brazilian wearers of full dentures. Design: In this cross‐sectional study, a questionnaire based on Helkimo's anamnestic index was applied to a group of 65‐year‐olds or older individuals who wear a set of full dentures. Setting: Interviews were carried out at the dental clinics of the University of Taubaté and the University of Vale do Paraíba, Brazil. Subjects: From a total of 384 patients, 84 elderly wearers of full dentures were interviewed. Main outcome measures: The questionnaire identified the most commonly related symptoms of craniomandibular disorders. Results: The patient's average age was 73.5 years (ranging from 65 to 89 years), 81% of them females. Only 5% reported pain when opening their mouths, and the same percentage complained of temporomandibular joint luxation and a sensation of tired muscles during mastication. Similar rates were found for pain in the temporomandibular joint area (6%), pain in the temporal muscle area (7%), difficulty to move the mandible in the morning (4%) and pain during excursive (protrusive and lateral) movements (8%). The highest rates were found for pain in the masseter muscle area (39%) and articular noises (24%). Conclusion: The incidence of craniomandibular disorder symptoms was low in this group of elderly wearers of full dentures, except for pain in the masseter (39%) and articular noises (24%).     

Type II diabetes mellitus,congestive heart failure,and zinc metabolism

Zinc status was assessed in patients with type II diabetes mellitus and congestive heart failure (CHF). Three groups of patients were enrolled into the study: Group 1: 15 patients with type II diabetes mellitus and CHF; Group 2: 20 patients with isolated type II diabetes mellitus; and Group 3: nine patients with isolated CHF. Twenty-four-hour urine was measured for creatinine, protein, and zinc, and blood was drawn for creatinine, proteins, liver enzymes, hemoglobin A₁c, and zinc. Insulin treatment and hemoglobin A₁c were comparable in the diabetic patients of groups 1 and 2, but group 1 was also treated with captopril and diuretics like the CHF patients of group 3. Plasma zinc levels were statistically similar in all three groups, but urinary zinc excretion (μmol/24 h) and urinary zinc: creatinine (μmol/mmol) ratio were significantly higher in the type II diabetics and CHF group (27.2±1.5; 1.69±0.6, respectively) compared to the diabetic patients alone (19.4±0.76; 0.97±0.3, respectively) and the CHF patients (9.7±0.3; 0.62±0.3, respectively). Patients with type II diabetes mellitus and CHF were treated with higher doses of captopril than the CHF patients (56.25±24 mg vs 18.8±11 mgP<0.05). Thus, patients with type II diabetes mellitus and CHF excrete larger amounts of zinc, which may eventually lead to zinc deficiency.     

The oral health‐related quality of life in edentulous patients treated with Conventional complete dentures

Objective: To compare the oral health‐related quality of life (OHRQoL) between patients with both maxillary and mandibular complete denture and those with either the maxillary or the mandibular complete denture. Background: Satisfaction of denture wearers can be estimated using the OHRQoL questionnaires like the OHIP‐EDENT and the Geriatric Oral Health Assessment Index (GOHAI). Methods: Two questionnaires were used to compare the OHRQoL between edentulous patients who had conventional removable complete denture on both jaws and those who had on either one of the jaws. Result: The age of the participants ranged from 42 to 75 years, with the mean age of 58 ± 8.12 years. The mean OHIP‐EDENT scores were significantly high among those who wore conventional dentures in both jaws (54.12 ± 5.21), compared with the participants who only had denture either on upper or lower jaw (46.52 ± 7.35). It was noticed that the mean GOHAI score was significantly lower (p < 0.05) among participants who had conventional denture on both upper and lower jaw (28.25 ± 3.67), as compared to those who had conventional denture only on one arch (35.12 ± 2.11). Conclusion: Patients with complete dentures in both jaw (Group I) were less satisfied than patients with single complete denture (Group II). The result obtained in this study shows dissatisfaction with conventional dentures among edentulous patients.     

Maximum bite force after the replacement of complete dentures

Objective: The aim of the present study was to investigate whether the maximum bite force ( MBF ) can be improved by the replacement of complete dentures for elderly people. Design: Nine edentulous volunteers, mean age 74.2 (± 5.5) years and average denture experience 19.4 ± 19.5 years (1 to 50 years) had replacement dentures made. After a rehearsal session, MBF was recorded with the old dentures, and with the new dentures immediately at insertion, at 3, 8 days, 2–3 weeks, 1, 2, 3 and 6–10 months post insertion ( p‐i. ). MBF was recorded with the central bearing point method using a full‐bridge strain gauge load cell. Data were analysed off‐line using the mean of two peak readings per patient per session. Results: The results indicate that MBF tended to be impaired when replacement dentures were first fitted (n.s.). However, this trend reversed during the first month p‐i. for patients with a “moderate” lower ridge resorption of Atwood grade 3 or 4 (n = 5). Patients with more severe lower ridge resorption Atwood grade 5 or 6 (n = 4) showed a significantly lower MBF over the entire observation period (p0.05) and took longer to regain bite strength. Only patients with moderate bone resorption exceeded their pre‐insertion level of MBF within the observation period of 6–10 months p‐i. Conclusion: The present pilot study suggests that, at least for elderly patients with severe bone resorption, delayed improvement of MBF should be expected with replacement complete dentures.     

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Rationale and objectives: Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self‐perception of oral health among institutionalised and community‐dwelling elderly in São José dos Campos, Brazil. Methods: Two hundred and fifteen community‐dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI). Results: The major prevalence of TMD symptoms was for the Ai0 (symptom‐free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (χ² test, p = 0.049). Community‐dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One‐way anova = 0.005) self‐perception of oral health (33.45) than did the community‐dwelling group (32.66). There were only weak Pearson’s correlations among the anamnestic (?33.0%) or clinical (?14.7%) findings by the TMD and GOHAI indices. Symptom‐free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups. Conclusions: The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self‐perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self‐perception of oral health measured by the GOHAI index.     

Anatomical changes in the structure of the temporomandibular joint caused by complete edentulousness

doi: 10.1111/j.1741‐2358.2011.00498.x
Anatomical changes in the structure of the temporomandibular joint caused by complete edentulousness Background: The posterior slope of the articular eminence of completely edentulous patients compared to patients with maintained occlusion shows significant flattening. Objective: The aim of this present study was to reveal a possible correlation between edentulousness and the flattening of the eminence and to find out whether this deformation is connected to age. Material and methods: Thirty patients were examined in three groups, each consisting of 10 persons (group I: 18‐ to 25‐year‐old patients with maintained occlusion, group II: patients over 60 with maintained occlusion, group III: edentulous patients over 60). The three groups were compared according to dental status, age, sex and side. Measurements were carried out on orthopantomographic images taken with Kodak 8000 Digital Panoramic System. The angle of the posterior slope of the articular eminence relative to the Frankfort plane was measured on both sides. Data were analysed statistically with the one‐way anova test (α = 0.05). Results: The highest values were measured in group I (right side: 39.8 ± 5.4°, left side: 43.0 ± 5.9°), values were somewhat lower in group II (right side: 38.9 ± 4.7°, left side: 39.5 ± 7.4°) and were the lowest in group III, which was significantly lower on both sides than the results of group I and group II (right side: 29.8 ± 6.0°, left side: 31.9 ± 5.2°, p < 0.01). The correlation coefficient between age and the flattening of the eminence in group I, II and III was 0.23, 0.35 and 0.92, respectively. Conclusion: The flattening of the articular eminence could be correlated with age; however, the rate of deformation is significantly higher in completely edentulous patients than in patients with maintained occlusion.     

A 3-year longitudinal study of quality-of-life outcomes of elderly patients with implant- and tooth-supported fixed partial dentures in posterior dental regions

doi: 10.1111/j.1741‐2358.2011.00592.x
A 3‐year longitudinal study of quality‐of‐life outcomes of elderly patients with implant‐ and tooth‐supported fixed partial dentures in posterior dental regions Background: Clinical studies have mainly been focused on oral health‐related quality‐of‐life (OHRQoL) outcomes of removable dentures. Objective: To evaluate therapy of elderly patients with implant‐supported fixed partial dentures (IFPD) and tooth‐supported fixed partial dentures (FPD) in the posterior dental regions. Patients and methods: The OHIP49 was used to measure OHRQoL in 64 patients with IFPD and 38 patients with FPD, before, 3 weeks and 3 years after rehabilitation. A control group (CG) consisted of 62 individuals. Results: The Oral Health Impact Profile questionnaire (OHIP) follow‐up scores of the patients with FPD and the patients with IFPD were significantly smaller in comparison with the baseline scores (p < 0.01). The OHIP scores were further reduced at the 3‐year follow‐up. The patients with IFPD had significantly higher scores than the patients with FPD and the CG at the baseline and at the follow‐ups. In the patients with FPD, both age groups (≤60 and >60) showed equal improvement of the OHRQoL. In the IFPD group, patients older than 60 years showed better improvement (p < 0.05). There were no significant differences dependent on gender and antagonistic teeth (p > 0.05). Conclusion: The FPD and the IFPD treatment showed significant improvement of OHRQoL. The FPD treatment improved OHRQoL equally in both age groups, while the IFPD treatment improved OHRQoL better in older patients.     

Changes in EMG activity during clenching in chronic pain patients with unilateral temporomandibular disorders

The study assessed the differences in electromyographic (EMG) activity recorded during clenching in women with chronic unilateral temporomandibular disorders (TMDs) as compared to control subjects. Seventy-five full dentate, normo-occlusion, right-handed, similarly aged female subjects were recruited. Twenty five subjects presented with right side TMD, 25 presented with left side TMD and 25 pain-free control subjects participated. Using integrated surface EMG over a 1 s contraction, the anterior temporalis and masseter muscles were evaluated bilaterally while subjects performed maximum voluntary clenching. Lower EMG activation was observed in patients with TMD as compared to control subjects (temporalis: 195.74 ± 18.57 vs. 275.74 ± 22.11, P = 0.011; masseters: 151.09 ± 17.37 vs. 283.29 ± 31.87, P < 0.001). An asymmetry index (SAI) was calculated to determine ratios of right to left sided activation. Patients with right-sided TMD demonstrated preferential use of their left-sided muscles (SAI ?5.35 ± 4.02) whereas patients with left-sided TMD demonstrated preferential use of their right-sided muscles (SAI 6.95 ± 2.82), (P = 0.016). This unilateral reduction in temporalis and masseter activity could be considered as a specific protective functional adaptation of the neuromuscular system due to nociceptive input. The asymmetry index (SAI) may be a useful measure in discriminating patients with right vs. left-sided TMD.     

Clinical studies on the appearance of natural anterior teeth in young and old adults

Objectives: To evaluate the typical appearance of natural anterior teeth in young and elderly people and to develop guidelines for the natural appearance of dentures. Design: Clinical examination and photography. Inclusion criteria were a dental state with natural anterior teeth and no more than two crowns. Subjects: A study group (SG) consisting of 64 patients ranging in age from 60 to 86 years (67.3 ± 5.8) and a control group (CG) composed of 64 dental students aged 21–33 years (25.8 ± 2.4). Setting: Dental schools of the Johannes‐Gutenberg‐University Mainz and the University of Leipzig. Results: Most participants were content with the appearance of their own natural teeth. With relaxed lips a mean of 1.5 (±0.19) mm of upper incisors and 1.6 (±0.19) mm of lower incisors were visible in the SG compared with 2.5 (±0.16) and 0.4 (±0.07) mm in the CG, respectively. The subjects in the SG showed a greater diversity in position of teeth in the anterior arch and this was more often with incisors than with canines. Features such as stains, cracks and defects were much more noticeable in the SG. An inter‐dental ‘black triangle’ seemed to be a typical feature of an aged dental appearance. Conclusion: The majority of people older than 60 years who still have their own natural anterior teeth would not wish for a change in appearance if they needed a prosthodontic reconstruction. Thus techniques for customisation should be promoted to obtain a natural appearance in dentures.     

Immunocontraception and increased longevity in equids

Intensive population management by means of fertility control has been shown to change the age profile of a wild horse herd. The primary change has been an increase in the number and percent of older animals, as expected, but also the appearance of new and older age classes. An examination of direct effects of fertility control on two groups of treated animals shows a significant increase in longevity over non‐treated animals that is associated with contraceptive treatment. The mean age at death (MAD) was calculated for 128 wild horses for which precise birth and death dates were known, including 56 stallions, 42 untreated mares, 11 mares treated with a porcine zona pellucida contraceptive vaccine for 1–2 years, and 19 mares treated with the same vaccine for ≥3 years. The MAD for stallions (10.3±0.84 [SEM] years), and mares treated for 1–2 years (10.2±0.56), was significantly greater (P<0.05) than for untreated mares (6.4±0.85), and significantly <19.9±1.66 for mares treated ≥3 years (19.9±1.66). Zoo Biol 26:237–244, 2007. © 2006 Wiley‐Liss, Inc.     

心源性睡眠呼吸异常：心衰患者睡眠期间陈-施呼吸 机制探讨的初步报告*

目的: 探讨心衰患者陈施呼吸的发生率及发生机制。方法: 连续入选2015年3月~2015年5月于阜外医院行睡眠呼吸监测的患者56例,分为心衰组和非心衰组。结果: 两组睡眠呼吸暂停的发生率均较高,心衰组11例患者中呼吸暂停低通气指数（AHI）>5的有10例,平均AHI指数23.93±14.63;非心衰组45例患者中AHI>5的有33例,平均AHI指数16.20±18.76;心衰组中枢性睡眠呼吸暂停（CSA）次数占睡眠呼吸暂停总数的比例明显大于非心衰组病人,分别为80.21%±30.55%和27.16%±35.71%,P<0.01。结论: 心脏的循环功能和肺脏的呼吸功能是联合一体化,相互联系、互为因果而又互相影响。慢性心力衰竭的循环障碍促成了潮式呼吸的发生,所以称之为心源性呼吸睡眠异常。     

Characteristics of EMG frequency bands in temporomandibullar disorders patients

The aim of the present study was to determine whether any specific frequency bands of surface electromyographic (sEMG) signals are more susceptible to alterations in patients with temporomandibular disorders (TMD), when compared with healthy subjects. Twenty-seven healthy adults (19 women and eight men; mean age: 23 ± 6.68 years) and 27 TMD patients (20 women and seven men; mean age: 24 ± 5.89 years) voluntarily participated in the experiment. sEMG data were recorded from the right and left masseter muscles (RM and LM) and the right and left anterior temporalis muscles (RT and LT) as the participants performed tests of chewing (CHW) and maximal clenching effort (MCE). Frequency domain analysis of the sEMG signal was used to analyze differences between TMD patients and healthy subjects in relation to the Power Spectral Density Function (PSDF). The analysis focused on the median frequency (MDF) of the sEMG signal and PSDF frequency bands after the EMG spectrum was divided into twenty-five frequency band of 20 Hz each. The Mann-Whitney test was used to compare MDF between TMD patients and healthy subjects and the frequency bands were analyzed using three-way ANOVA with three factors: frequency band, muscle and group. The results of the analysis confirmed that the median frequency values in TMD patients were significantly higher (p < 0.05) than those recorded for healthy subjects in the two experimental conditions (MCE and CHW), for all of the muscles assessed (RM, LM, RT and LT). In addition, frequency content between 20 and 100 Hz of the normalized PSDF range was significantly lower (p < 0.05) in TMD patients than in healthy. This study contributes to quantitatively identify TMD dysfunctions, by non-invasive sEMGs; this assessment is clinically important and still lacking nowadays.     

Prevalence of Sleep Apnea and Electrocardiographic Disturbances in Morbidly Obese Patients

Objective: To determine the prevalence of sleep apnea in morbidly obese patients and its relationship with cardiac arrhythmias. Research Methods and Procedures: Fifty‐two consecutive morbidly obese (body mass index ≥ 40 kg/m²) outpatients from the Obesity Clinic of the National Institute of Nutrition Salvador Zubirán underwent two nights of polysomnography with standard laboratory techniques. Electrocardiographic polysomnography signals (Lead II) were evaluated by two experienced cardiologists, and sleep complaints were measured with a standard sleep questionnaire (Sleep Disorders Questionnaire). In order to make comparisons between groups with different severities of sleep‐disordered breathing, we classified the patients in four groups using the apnea‐hypopnea index (AHI): Group 1, AHI 5 < 15 (n = 10); Group 2, AHI 15 < 30 (n = 10); Group 3, AHI 30 < 65 (n = 14); Group 4, AHI ≥ 65 (n = 17). Results: A wide range of sleep‐disordered breathing, ranging from AHI of 2.5 to 128.9 was found. Ninety‐eight percent of the sample (n = 51) had an AHI ≥ 5 (mean = 51 ± 37), and 33% had severe sleep apnea with AHI ≥ 65 with a mean nocturnal desaturation time of <65% over 135 minutes. Electrocardiographic abnormalities were present in 31% of the patients. Cardiac rhythm alterations showed an association with the level of sleep‐disordered breathing and oxygen desaturation. Discussion: We conclude that there is a high prevalence of sleep apnea in morbidly obese patients and that the risk for cardiac arrhythmias increases in this population in the presence of a severe sleep apnea (AHI ≥ 65) with severe oxygen desaturation (Sao ₂ ≤ 65%).     

Safety and efficacy of laparoscopic adjustable gastric banding in the elderly

Objective: Bariatric surgery is not usually recommended in the elderly. The aim of this study is to evaluate the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in older patients registered in the database of the Italian Group for Lap‐Band Gruppo Italiano Lap‐Band (GILB). Methods and Procedures: GILB is a centralized database which collects operative and follow‐up data from 26 Italian surgical centers who utilize the Lap‐Band System as a restrictive procedure. Patients ≥60 years were selected from the database of the GILB and analyzed according to co‐morbidities, conversion, peri‐operative complications, and weight loss. Results: Of 5,290 patients, 216 (4.1%; 184F/32M) were ≥60 years old at surgery (mean age 64.1 ± 4.0 years; range 60–83). Baseline BMI was similar in both sets of patients i.e., ≥60 and <60 years of age (44.2 ± 7.6 kg/m² vs. 44.9 ± 7.4 kg/m²). Patients ≥60 years of age were more frequently affected by co‐morbidities than patients <60 years of age. Two cases of operative mortality were observed in patients <60 years old (0.04%) and one in patients ≥60 years old (0.46%). The proportion of patients requiring revision surgery was comparable as well. Weight loss was significantly lower in elderly patients. Despite their lower weight loss, patients ≥60 years of age experienced a significant improvement of obesity‐related co‐morbidities (they showed improvement 1 year after surgery in 100% of cases of diabetes or sleep apnoea, 67.1% of cases of hypertension, and 34.9% of cases of osteoarthritis). Discussion: LAGB may be performed safely in patients ≥60 years old. Weight loss in older patients seems unsatisfactory if compared to younger subjects. However, the majority of elderly patients show an improvement in obesity‐related co‐morbidities.     

Preliminary simulation model toward the study of the effects caused by different mandibular advancement devices in OSAS treatment

Abstract

The paper aims to evaluate the effects caused by a Mandibular Advancement Device (MAD) for Obstructive Sleep Apnoea Syndrome (OSAS) treatment. This study is based on Finite Element Method (FEM) for evaluating the load distribution on temporomandibular joint, especially on the mandibular condyle and disc, and on periodontal ligaments. The stress values on condyle and periodontal ligaments lead authors to consider MAD a safe procedure even for a long period. The obtained results also show the relationship between MAD material and load distribution at the periodontal ligaments. The paper is a step toward future analyses for studying and comparing the effects of MAD features, such as material, shape and dimensions, in order to allow the clinician prescribing the most fitting device.