Prótese implant��vel de condu����o ��ssea (BAHA): relato de caso

INTRODU����O: A Prótese Implant��vel de Condu����o ��ssea (BAHA) consiste em uma excelente op����o na reabilita����o auditiva de pacientes com perda auditiva condutiva e mista uni ou bilateral, e sensorioneural unilateral. Tem sido uma alternativa vantajosa sobre os aparelhos de condu����o ��ssea convencionais e os aparelhos de amplifica����o sonora individuais (AASI) quando o uso dos mesmos fica impossibilitado pela presen��a de otite externa cr��nica de dif��cil controle cl��nico. OBJETIVO: Apresentar o primeiro caso de BAHA realizado no Brasil, ap��s a autoriza����o da ANVISA, para a reabilita����o da perda auditiva mista com epis��dios de otite externa cr��nica. M��TODO: Paciente do sexo feminino, 50 anos, com perda auditiva de grau moderado �� direita e severo �� esquerda, zumbido bilateral, decorrente de otosclerose, submetida a quatro cirurgias de estapedotomia e com impossibilidade de uso de AASI devido a otorreia e otalgia bilateral. A avalia����o m��dica e audiol��gica indicaram o benef��cio do BAHA. Realizada a cirurgia e implanta����o do sistema BAHA, a paciente apresentou melhora significativa nos limiares audiom��tricos, na percep����o e discrimina����o da fala, al��m de relatar extrema satisfa����o relacionada ao fator est��tico. COMENT��RIOS FINAIS: O processo cir��rgico do BAHA �� seguro, simples e r��pido, proporcionando excelentes resultados audiol��gicos e alto grau de satisfa����o por parte dos pacientes.

Prótese total articulada de joelho utilizada no tratamento de osteossarcoma apendicular em c��o

O objetivo do trabalho foi reportar o planejamento cir��rgico, a t��cnica operat��ria, a instrumenta����o e os resultados da substitui����o completa do ter��o m��dio distal do f��mur, do plat�� tibial e da articula����o do joelho por prótese em um c��o acometido por osteossarcoma no f��mur esquerdo. A prótese foi confeccionada em a��o, apresentando tr��s componentes articulados, mantendo o movimento semelhante �� articula����o do joelho. As por����es femorais e tibiais da prótese foram cimentadas aos respectivos ossos, ap��s ostectomia do f��mur e do plat�� tibial. O animal foi submetido a seis sess��es de quimioterapia, com doxorrubicina e carboplatina, intercaladas mensalmente, objetivando inibir o crescimento de poss��veis met��stases pulmonares. Durante os seis primeiros dias, o animal apresentou neuropraxia e impot��ncia funcional do membro. Aos 10 dias, o c��o iniciou leve apoio e aos 30 dias j�� utilizava o membro p��lvico de forma mais efetiva, por��m, o ��ngulo de extens��o da articula����o foi reduzido de 150° a 100° devido �� contratura muscular e �� fibrose na regi��o da fossa popl��tea. Ap��s um ano de observa����o, n��o houve melhora do ��ngulo de extens��o do joelho, por��m, o animal fazia uso do membro com claudica����o. Aos 425 dias de p��s-operat��rio, o animal veio a ��bito por insufici��ncia renal. Nesse tempo n��o ocorreram met��stases pulmonares ou locais vis��veis radiograficamente, mas o propriet��rio n��o permitiu a realiza����o da necropsia do paciente, sendo imposs��vel confirmar outros dados que pudessem esclarecer melhor a causa morte. Conclui-se que a substitui����o total do joelho de c��o �� uma cirurgia fact��vel, que permite a preserva����o e a utiliza����o do membro ap��s ressec����o da neoplasia, embora outras pesquisas devam ser conduzidas para obten����o de melhores resultados p��s-cir��rgicos.

A fala nas diferentes modalidades de reabilita����o oral prot��tica em idosos

TEMA: a produ����o da fala nas modalidades de reabilita����o oral prot��tica. OBJETIVO: verificar se o tipo de reabilita����o oral interfere na produ����o da fala. M��TODO: 36 idosos (m��dia = 68 anos), divididos em 3 grupos, foram avaliados: 13 com dentes naturais (A), 13 com prótese total mucosossuportada superior e inferior (B) e 10 com prótese total mucosossuportada superior e implantossuportada inferior (C). A estabilidade das próteses foi avaliada por um dentista e amostras de fala foram analisadas por 5 fonoaudi��logos. Para determinar a freq����ncia de altera����o dos sons da fala utilizou-se o c��lculo da Porcentagem de Consoantes Corretas (PCC). RESULTADOS: observou-se poucos casos com altera����o de fala, com maior freq����ncia no grupo C (23,08%), sendo a articula����o travada presente em todos os grupos, a redu����o dos movimentos labiais em dois grupos (A e B) e a articula����o exagerada e a falta de controle salivar em um dos grupos (C e B). Quanto �� PCC, menor valor foi observado para os fones linguodentais nos grupos B e C (maior ocorr��ncia de altera����o), seguido dos fones alveolares, predominando casos sem altera����o no grupo A, contrariamente aos demais grupos, sendo a proje����o lingual e o ceceio as altera����es mais encontradas. N��o houve diferen��a entre os grupos e a maioria do grupo B estava com a prótese inferior insatisfat��ria, n��o havendo associa����o entre altera����o de fala e prótese insatisfat��ria. CONCLUS��O: apesar da amostra pequena, indiv��duos reabilitados com prótese total apresentam altera����o nos fones linguodentais e alveolares e o tipo de prótese, bem como a estabilidade desta parece n��o interferir na produ����o da fala.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Br��nemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

Relationship between periodontitis and rheumatoid arthritis and the effect of non-surgical periodontal treatment

This study analyzed the association of periodontal disease (PD) and rheumatoid arthritis (RA). Seventy-five 35-60-year-old patients were assigned to 5 groups according to the presence (+) or not (-) of PD and RA and the treatment received (TR+) or not (TR-) for PD. Group 3 uses total prosthesis (TP). Clinical and laboratory evaluations were performed at baseline, 3 and 6 months of follow-up by probing pocket depth, bleeding on probing and plaque index for PD, HAQ, DAS28, SF-36 and laboratory: AAG, ESR, CRP for RA. Statistically significant differences for PD after 3 (p=0.0055) and after 6 months (p=0.0066) were obtained in Group 1 (RA+PD+TR+) and 2(RA+PD+TR-); significant reduction in the % of BOP after 6 months (p=0.0128) and significant reduction in the % of Pl after 3 (p=0.0128) and 6 months (p=0.0002) in Group 1. Statistically significant differences between Groups 1 and 3 (RA+TP) for DAS28 at baseline and after 3 months were observed, but not after 6 months. No other parameters for RA were significantly affected. The relationship between RA and PD disease activities is not clear, but the importance of periodontal treatment in the control of inflammation to avoid tooth extraction is evident.

Masticatory afficiency in denture wearers with bilateral balanced occlusion and canine guidance

The maintenance of masticatory function is especially important for patients wearing complete dentures due to their limitations. Thus, the bilateral balanced occlusal concept is used to achieve greater masticatory efficiency. However, a critical review of the literature reveals that there is not sufficient scientific evidence to support bilateral balanced occlusion as the most appropriate occlusal concept in complete dentures. Therefore, the aim of this study was to evaluate the masticatory efficiency in complete dentures wearers with bilateral balanced occlusion and canine guidance. A double-blinded controlled crossover clinical trial was conducted. The sample was composed by 24 edentulous patients who wore sets of complete dentures with both occlusal concepts during equal periods of 3 months. Objective data were collected through the masticatory efficiency test performed by the colorimetric method with the beads, in which capsules of a synthetic material enclosing fuchsine-containing granules were used. Subjective data were recorded by patient's ratings of their chewing function. No significant statistical difference was found for masticatory efficiency (p=0.095) between the two occlusal concepts studied. The results suggest that bilateral balanced occlusion does not improve the masticatory efficiency in complete denture wearers.

Vertical alveolar crest bone maintenance around implants in two-stage surgery: an in situ study in dogs

The aim of this study was to evaluate in situ changes in the alveolar crest bone height around immediate implant-supported crowns in comparison to tooth-supported crowns (control) with the cervical margins located at the bone crest level, without occlusal load. In Group I, after extraction of 12 mandibular premolars from 4 adult dogs, implants from Branemark System (MK III TiU RP 4.0 x 11.5 mm) were placed to retain complete acrylic crowns. In Group II, premolars were prepared to receive complete metal crowns. Sixteen weeks after placement of the crowns (38 weeks after tooth extraction), the height of the alveolar bone crest was measured with a digital caliper. Data were analyzed statistically by the Mann-Whitney test at 5% significance level. The in situ analysis showed no statistically significant difference (p=0.880) between the implant-supported and the tooth-supported groups (1.528 + 0.459 mm and 1.570 + 0.263 mm, respectively). Based on the findings of the present study, it may be concluded that initial peri-implant bone loss may result from the remodeling process necessary to establish the biological space, similar to which occurs with tooth-supported crowns.

Behaviors and hygiene habits of complete denture wearers

In this study, a questionnaire was applied to patients from Ribeir��o Preto Dental School, University of S��o Paulo, Brazil, to evaluate the hygiene methods and habits concerning the use of complete dentures, the age of dentures, and whether patients have been instructed on how to clean their dentures. The mean age of patients was 63.35 years, and most of them were females (82.08%). The results showed that 62.26% of the respondents had been using the same maxillary complete denture for more than 5 years, and 49.06% used the same mandible complete denture for more than 5 years. Of the patients interviewed, 58.49% slept with the dentures. Mechanical brushing was the most used cleaning method by the patients (100%), using water, dentifrice and toothbrush (84.91%). Most patients (51.89%) reported never having been instructed by their dentists as to how to clean their dentures. Based on the limitations of this study, it was concluded that the patients interviewed had limited knowledge about prosthetic hygiene and oral care. The method more used by patients was the mechanical method of brushing, most patients used the same complete dentures for more than 5 years and slept with the dentures.

T-Bar clasp-retained removable partial denture as an alternative to implant-based prosthetic treatment

This article reports the case of a 55-year-old female patient who presented with unsatisfactory temporary crowns in the right mandibular premolars and molars, and a premolar-to-molar fixed partial denture in the left side. The clinical and radiographic examinations revealed a fracture of the left first premolar that was a retainer of the fixed partial denture and required extraction. Initially, the acrylic resin crowns were replaced by new ones, and a provisional RPD was made using acrylic resin and orthodontic wire clasps to resolve the problem arising from the loss of the fixed partial denture. Considering the patient's high esthetic demands, the treatment options for the definitive prosthetic treatment were discussed with her and rehabilitation with implant-supported dentures was proposed because the clinical conditions of the residual alveolar ridge were suitable for implant installation, and the patient's general health was excellent. However, the patient did not agree because she knew of a failed case of implant-retained denture in a diabetic individual and was concerned. The patient was fully informed that implant installation was the best indication for her case, but the arguments were not sufficient to change her decision. The treatment possibilities were presented and the patient opted for a clasp-retained removable partial denture (RPD) associated with the placement of crowns in the pillar teeth. The temporary RPD was replaced by the definitive RPD constructed subsequently. Although RPD was not the first choice, satisfactory esthetic and functional outcomes were achieved, overcaming the patient's expectations. This case report illustrates that the dentist must be prepared to deal with situations where, for reasons that cannot be managed, the patient does not accept the treatment considered as the most indicated for his/her case. Alternatives must be proposed and the functional and esthetic requirements must be fulfilled in the best possible manner.

Immediate implants placed into infected sockets: a case report with 3-year follow-up

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

Bite force in temporomandibular dysfunction (TMD) and healthy complete denture wearers

The signs and symptoms of temporomandibular dysfunction (TMD) may contribute to reduce bite force and muscular activity. The aims of this study were to compare bite force in complete denture wearers with TMD (TMD group) and without TMD (healthy group).The TMD group consisted of 9 individuals, who had worn a maxillary and a mandibular complete removable denture for more than 10 years. The healthy group consisted of 9 participants who wore dentures and had satisfactory interocclusal and maxillomandibular relationship. Helkimo Index was used to analyze the dysfunction level. Maximum bite force was measured using a digital dynamometer with capacity of 100 kgf and adapted to oral conditions.The TMD group presented smaller mean bite force values than the healthy group, though without statistical significance (p>0.05). This outcome suggests that the TMD signs and symptoms and the structural conditions of the dentures did not affect the maximal bite force of complete denture wearers.

Candida albicans in patients with oronasal communication and obturator prostheses

Patients using obturator prostheses often present denture-induced stomatitis. In order to detect the presence of oral Candida albicans in patients with oronasal communications and to evaluate the effectiveness of a topical antifungal treatment, cytological smears obtained from the buccal and palatal mucosa of 10 adult patients, and from the nasal acrylic surface of their obturator prostheses were examined. A therapeutic protocol comprising the use of oral nystatin (Mycostatin��) and prosthesis disinfection with sodium hypochlorite was prescribed for all patients. Seven patients were positive for C. albicans in the mucosa, with 1 negative result for the prosthetic surface in this group of patients. Post-treatment evaluation revealed the absence of C. albicans on prosthesis surface and on the oral mucosa of all patients. The severity of the candidal infection was significantly higher in the palatal mucosa than in the buccal mucosa, but similar in the palatal mucosa and prosthesis surface, indicating that the mucosa underlying the prosthesis is more susceptible to infection. The therapeutic protocol was effective in all cases, which emphasizes the need for denture disinfection in order to avoid reinfection of the mucosa.

Evaluation of iris color stability in ocular prosthesis

Accurate iris reproduction in the fabrication of ocular prosthesis in order to match the remaining eye is a key factor to mask the loss and achieve an esthetic outcome for anophthalmic patients. This study evaluated the stability of acrylic paints used for replicating iris color in ocular prostheses by the analysis of two factors: the temperature of the acrylic resin polymerization cycle during prosthesis fabrication and the incidence of sun light, which is the main photodegrading agent undermining the longevity of ocular prostheses. An accelerated aging assay was used for both analyses. Specimens simulating the prosthetic iris in the colors blue, yellow, black, brown and green were fabricated, and were submitted to a colorimetric reading before and after undergoing the thermal conditions of acrylic resin polymerization. Next, the specimens were submitted to an artificial accelerated aging assay with ultraviolet radiation A and weekly colorimetric readings during a 3-week period. The color change (??*) values for the four specimens painted with the same color paint were averaged and the resulting values were considered for statistical analysis. Levine's test and Student's t-test were used to analyze the influence of the temperature of the polymerization cycle during prosthesis fabrication on the color stability of each acrylic resin paint. Friedman's test for three dependent samples was used for analysis of color photodegradation as function of time. Significance level was set at 0.05 for all analyses. It was observed that, after the action of the temperature of the polymerization cycle, alteration above clinically acceptable level of ??*> 3.3 was observed only for the yellow color. After the accelerated aging assay, there were statistically significant differences (p<0.05) as a function of time in the green, brown, black and blue colors. Changes were clinically acceptable for the brown and black colors; slightly above the clinically acceptable limit for the green color; and significantly high and impracticable from a clinical standpoint for the blue color. There was no statistically significant differences (p>0.05) for the yellow color, which presented color change only a little above the clinically acceptable limit. In conclusion: 1. Only the yellow color presented alterations above the clinically acceptable levels after the polymerization cycle; 2. After accelerated aging, there was no changes in the yellow color above the clinically acceptable levels; 3. For the green color, degradation was significant and slightly above the clinically acceptable levels; 4. The black, brown and blue colors presented significant alterations as function of time; the alterations of the brown and black colors were within acceptable clinical levels, while the blue color presented a more accentuated degradation over time.

Temperature of denture base resin under different protocols of microwave irradiation

This in vitro study evaluated the temperature of dentures after different microwave irradiation protocols. Two complete dentures (one maxillary and one mandibular denture) were irradiated separately 4 times for each of the following 5 protocols: dentures immersed in water (G1- 6 min, G2- 3 min); dentures kept dry (G3- 6 min); dentures placed in the steam sterilizer (G4- 6 min, G5- 3 min). The final temperature of the dentures was gauged in a thin and in a thick area of each denture with an infrared thermometer. All groups presented an increase in the resin base temperature. The thin areas of the dentures underwent greater heating than the thick areas. There was no significant difference (p&gt;0.05) between the final mean temperatures of dentures immersed in water for 6 (G1) and 3 min (G2). However, the final mean temperatures recorded in G1 and G2 exceeded 71��C and were significantly higher (<0.001) than the final mean temperatures recorded in the other groups. It may be concluded that denture base resins subjected to microwave irradiation immersed in water may be exposed to deleterious temperatures.

Inser����o de graduados em fonoaudiologia de uma universidade p��blica em programas de p��s-gradua����o

OBJETIVO: caracterizar a inser����o de egressos do Curso de Fonoaudiologia da Universidade Estadual Paulista (UNESP) - Mar��lia, em Programas de P��s-Gradua����o (PPG) Stricto Sensu brasileiros. M��TODO: foram utilizadas listas de graduados e Curriculum Vitae do egresso e do orientador. RESULTADOS: dos 537 formados, 16,57% cursaram/estavam cursando PPG e destes, 98,88% em mestrado e 37,08% tamb��m em doutorado. Na grande ��rea de conhecimento, 50% dos egressos de mestrado vincularam-se predominantemente a programas em Ci��ncias da Sa��de, 31,80% em Ci��ncias Humanas e 13,64% em Lingu��stica, Letras e Artes. No doutorado, 33, 33% em Ci��ncias Humanas, 30,30% em Ci��ncias da Sa��de e em Lingu��stica, Letras e Artes. Quanto �� ��rea de conhecimento, predominou a vincula����o, no mestrado, de 30,68% em Fonoaudiologia, 28,41% em Educa����o, 13,64% em Lingu��stica e 9,09% em Medicina I; e, no doutorado, de 33,33% em Educa����o, 30,30% em Lingu��stica e 9,09% em Fonoaudiologia; 55,68% disserta����es e 51,52% teses focalizaram a linguagem. A UNESP predominou com 39,77% no mestrado e 48,48% no doutorado. Predominou a vincula����o a Programas com conceito 4 para 52,27% dos egressos do mestrado e 45,45% do doutorado. Quando constou a informa����o (55,68%), todos receberam fomento. O Teste de Raz��o de Verossimilhan��a n��o indicou diferen��as significativas dos percentuais obtidos entre o mestrado e o doutorado. CONCLUS��O: os resultados superaram os apresentados para o mesmo Estado, mostraram a caracter��stica interdisciplinar da Ci��ncia Fonoaudiol��gica e o predom��nio de tem��tica em linguagem.