Próteses totais mucossuportadas ofertadas na Atenção Primária à Saúde em Belo Horizonte, MG: avaliação após 5 anos de uso

Abstract

The total prosthesis (TP) is the most used rehabilitating treatment in edentulous patients and it may rescue the aesthetics, the masticatory function and the phonation. The survey of the oral health conditions of the Brazilian population (2011) revealed that 69% of the adult population and almost 99% of the elderly used or needed some sort of dental prosthesis. The inclusion of the prosthetic rehabilitation in the scope of Basic Assistance in Health is one of the guidelines of the National Policy in Oral Health (2004). This service was started in Belo Horizonte in July 2010 with the offer of total prosthesis (TPs) and partial removable prosthesis (PRP) of acrylic. The aim of this study was to evaluate the association between the uses of the total prosthesis mucus-supported offered in the Primary Care in Health after one and five years of the insertion with the technical quality of these prostheses and the satisfaction of the users towards them. A follow-up study was carried out with a sample of 233 users at random, selected within a universe of 572 users who had received the pair of full prosthesis in 2011. The use of the total prosthesis both inferior and superior was evaluated, which resulted in the dichotomous dependent variable: no use; use of the pair or of one of the prosthesis. The technical quality was evaluated with regards to the arrangement of the anterior teeth, free functional space, stability, retention and extension of the mandibular prosthesis, static and dynamic occlusion. The integrity of the prosthesis considered the presence of fracture of the basis and irregular edges. The evaluation of the satisfaction concerning the pain, retention, stability, comfort, mastication, speech and appearance resulted in a score ranging from 0 to 100, which was categorized adopting the cut-off point of 70 to dissatisfied or very satisfied/satisfied. The following co-variables were assessed: age, gender, marital status, years of schooling and family income, previous use of total prosthesis, time for upper teeth loss and frequency of visits to the dental surgeon after the placement of the prosthesis. The associations were tested through a logical regression analysis; the effect of the variables in the use of total prosthesis along the proposed periods was estimated via logistic regression models with random effects in the intercept. The data collection through interviews and examination of the oral cavity and the prosthesis was carried out between November 2012 to January 2013 and from July to October 2016. The examiners were previously calibrated and the agreement intra and inter-examiners was calculated using pondered Kappa and the coefficients were superior to 0,81. The participation rate was 97,8% (228) in one year and 50% (114) in five years after the placement of the prosthesis. There was no statistically significant difference between the responsive and the non-responsive concerning gender, age, schooling, frequency of visits to the dental surgeon and satisfaction towards the prosthesis. However, the technical quality of the prosthesis within the criteria of stability, static and dynamic occlusions was lower among the non-responsive. After one year, 64,9% used the pair of prosthesis, 14% used one of the prosthesis and 21,1% did not use any. In five years, 64,1% used the pair of prosthesis, 14,9% used at least one of the prosthesis and 21,0% did not use any. It was observed that among the subjects who used the pair of prosthesis in five years, 86,3% already used the pair in one year and among those who did not use them 37,5% abandoned their use after the first year. After five years, regarding the technical quality of the prosthesis, around 70% were considered adequate for the arrangement of the anterior teeth, free functional space, and mandibular prosthesis stability, static and dynamic occlusion. More than 80% of the mandibular prosthesis presented retention problems and ridge extension. The almost full totality of the prosthesis did not present integrity problems. Concerning the satisfaction towards the prosthesis, 57,02% of the users were very satisfied/satisfied. The satisfaction factors better evaluated were aesthetics, speech and comfort. The inferior full prosthesis retention resulted in the higher level of dissatisfaction. Associations between the uses of full prosthesis were found after one year of placement in subjects whose prosthesis presented stability, free functional space ranging between 1 and 4 mm and were satisfied/very satisfied. After five years of placement, the use of full prosthesis was associated to the stability of the mandibular prosthesis and satisfaction. The offered prosthesis satisfies the assisted population and the majority presents technical quality and integrity. A greater use after five years of placement was observed among the satisfied users and those who had stable mandibular prosthesis; this use was higher among the subjects who already used that one year after the placement, indicating a greater rate of abandonment in the first year. Follow-up protocols of the patients after the placement of the full prosthesis must be implemented in the scope of public health services to favor the adhesion and success of the rehabilitating treatment.