Prótese parcial removível retida por implantes: relato de caso

A ausência de dentes posteriores inferiores representa dificuldades no planejamento e controle de próteses parciais removíveis, pois o suporte é proporcionado por dentes e mucosa, que apresentam características anatômicas diferentes. O planejamento de próteses parciais removíveis apoiadas sobre implantes na região distal torna a prótese dento-implanto-suportada e não dento-muco-suportada sendo, uma opção aos casos de extremidade livre. Por meio deste relato de caso, um paciente portador de arco classe II de Kennedy foi reabilitado com prótese parcial removível apoiada sobre implante na região distal. A colocação do implante resultou em uma oclusão mais estável, o que melhorou a funcionalidade da prótese e proporcionou maior conforto ao paciente. Observou-se que esta resolução pode ser uma alternativa viável de tratamento, pois apresenta custo reduzido em relação à prótese fixa sobre implantes, entretanto, requer um acompanhamento em longo prazo com uma série de casos para tornar-se um método rotineiro de tratamento.

Prótese parcial removível retida por implantes: relato de caso

A ausência de dentes posteriores inferiores representa dificuldades no planejamento e controle de próteses parciais removíveis, pois o suporte é proporcionado por dentes e mucosa, que apresentam características anatômicas diferentes. O planejamento de próteses parciais removíveis apoiadas sobre implantes na região distal torna a prótese dento-implanto-suportada e não dento-muco-suportada sendo, uma opção aos casos de extremidade livre. Por meio deste relato de caso, um paciente portador de arco classe II de Kennedy foi reabilitado com prótese parcial removível apoiada sobre implante na região distal. A colocação do implante resultou em uma oclusão mais estável, o que melhorou a funcionalidade da prótese e proporcionou maior conforto ao paciente. Observou-se que esta resolução pode ser uma alternativa viável de tratamento, pois apresenta custo reduzido em relação à prótese fixa sobre implantes, entretanto, requer um acompanhamento em longo prazo com uma série de casos para tornar-se um método rotineiro de tratamento.

Qualidade de vida, eficiência mastigatória e presença de disfunção temporomandibular em usuários de prótese parcial removível com arco dental curto inferior

Even nowadays there is in Brasil a large number of edentulous and a precarious financial condition of most of the population. In addition, World Health Organization aims for oral health, which consists on the maintenance of a natural dentition, functional and aesthetic composed of at least 20 teeth, without need of prosthetic intervention throughout life. From this and considering the lack of researches about the permanence of edentulous spaces in the oral cavity, and also avoiding overtreatment, this research has been proposed. Thus, the aim was to evaluate the effect of different lengths of the shortened lower dental arch in the presence or absence of a removable partial denture (RPD) on masticatory function, quality of life and occurrence of temporomandibular dysfunction. To achieve this goal, we compared the masticatory efficiency (colorimetric test), the oral comfort through the analysis of the impact of oral health in quality of life (OHIP-14), the presence of temporomandibular dysfunction (RDC/TMD) and the general quality of life (WHOQOL) of patients with shortened dental arches (SDA) (n=60), which is an arch with a reduction of teeth starting posteriorly, and patients with complete dental arch (Complete DA) (n = 34). The group of patients whit SDA was divided among PPR wears (PPD + SDA) (n = 17) and non-wears (n = 43). The population of this study consisted on patients who received or looked for treatment at the clinics of the Department of Dentistry of UFRN, from clinical analysis and records. The sample was chosen by convenience. For statistical analysis, it was a database in SPSS 17.0, followed by descriptive analysis with frequencies, absolute values, tests of central tendency and variability. The statistical tests used were chi-squared and analysis of variance as well as Tukey s post test, when applicable, all with a 95% confidence level. The results shown a prevalence of TMD of 47,1% among patients using PRP and 69,8% among those who didn t, but this result wasn t statistically significant. The mean of the results of masticatory efficiency, WHOQOL and OHIP didn t show association to the presence or absence of PPR and to the lower number of occlusal units of the patients (0, 1, 2 or more occlusal). The association only occurred among the different groups of SDA and the patients with complete dental arch. Taking into account the results, it could be observed that studied patients with low posterior support using lower PRP didn t have better masticatory efficiency, general quality of life, less impacts of their oral conditions in quality of life or not even less temporomandibular dysfunction or better masticatory efficiency when compared to those who didn t use the prosthesis

Falhas e complicações com o uso de prótese parcial removível inferior de extremidade livre bilateral

Aim: To determine the frequency and type of complications related to removable partial denture (RPD) less, Kennedy Class I, over time . Materials and Methods: This observational study consisted of a sample of 65 users PPR lower arches in Kennedy Class I and dentures, rehabilitated in the Department of Dentistry, Federal University of Rio Grande do Norte (UFRN). Patients were followed through periodic controls during periods of 60 days, 6 months and 1 year from installation. After the first year of control had other returns annually. The occurrence of complications or prosthetic failure was observed and recorded in a specific clinical record over 39 months. The patterns of failures observed were classified in the following situations: occurrence of traumatic ulcers after 2 months of installation, lack of retention, fracture or caries in the rest, fracture or dislocation of the artificial teeth, the larger connector fracture, fracture clip fracture support, poor support (need to reline the denture) and prosthesis fracture. Results: The incidence of complications was low frequency, being higher in the second year of use of the prosthesis. Among the complications that occurred more is the loss of retention (31.57%). Failures more severe and difficult to solve as the fracture elements of the metal structure of the PPR had low occurrence and were represented by only one case of the larger connector (5.3%) fractures. Conclusion: Removable partial dentures mandibular free end opposing of the conventional dentures have a low complication rate after 39 months of use when subjected to periodic controls

Avaliação do planejamento de prótese parcial removível em modelos recebidos por laboratórios de João Pessoa-PB

Objective: To evaluate the planning and quality of plaster models for fabricati on of removable parti al dentures received from three commercial prosthodonti c laboratories located in the city of João Pessoa, PB, Brazil, which perform the casting procedures in their facilities. Methods: Forty 40 plaster models were photographed per laboratory, totalizing 120 models. The evaluation was performed using two questi onnaires, one designed for the dental prosthesis technicians, and another applied by the investigator for the visual evaluati on of the models. Data were analyzed using the SPSS soft ware version 13.0. Results: Ninety-two (76.7%) models did not present planning. In addition, no model presented references of insertion plane or guide pins. Calculati on of the mouth preparati on index (MPI) to evaluate the distribution of the oclusal and cingulum abutments or rests showed that 86 (71.7%) models were classifi ed as poor, 23 (19.2%) models as good and only 11 (9,.2%) models as acceptable. Defects were found in 102 (85%) models. Conclusion: The prosthodontists are not preparing the mouth of their pati ents, neglecti ng the planning of removable partial dentures, and passing this responsibility to the dental prosthesis technicians. In addition, the quality of the models sent to the laboratories was unsatisfactory.

Avaliação do planejamento de prótese parcial removível em modelos recebidos por laboratórios de João Pessoa-PB

Objective: To evaluate the planning and quality of plaster models for fabricati on of removable parti al dentures received from three commercial prosthodonti c laboratories located in the city of João Pessoa, PB, Brazil, which perform the casting procedures in their facilities. Methods: Forty 40 plaster models were photographed per laboratory, totalizing 120 models. The evaluation was performed using two questi onnaires, one designed for the dental prosthesis technicians, and another applied by the investigator for the visual evaluati on of the models. Data were analyzed using the SPSS soft ware version 13.0. Results: Ninety-two (76.7%) models did not present planning. In addition, no model presented references of insertion plane or guide pins. Calculati on of the mouth preparati on index (MPI) to evaluate the distribution of the oclusal and cingulum abutments or rests showed that 86 (71.7%) models were classifi ed as poor, 23 (19.2%) models as good and only 11 (9,.2%) models as acceptable. Defects were found in 102 (85%) models. Conclusion: The prosthodontists are not preparing the mouth of their pati ents, neglecti ng the planning of removable partial dentures, and passing this responsibility to the dental prosthesis technicians. In addition, the quality of the models sent to the laboratories was unsatisfactory.

Reabilitação Oclusal com Prótese Parcial Removível Provisória Tipo “Overlay” – Relato de Caso

An appropriate design of a prosthetic rehabilitation should not impute the restoration of occlusal vertical dimension (OVD) to new prostheses, at the risk of the patient does not adapt to a new condition, since a certain amount of time is often necessary for adaptation to a new OVD. This article performed prosthetic rehabilitation with an overlay provisional removable partial denture prior to definitive treatment because the patient showed a considerable decrease in the OVD. Three techniques for OVD determination were used. It is possible to conclude that the use of interim removable partial dentures is of great importance at the beginning of the rehabilitation treatment in order to adapt the patient to a new occlusal condition.

Reabilitação Oclusal com Prótese Parcial Removível Provisória Tipo “Overlay” – Relato de Caso

An appropriate design of a prosthetic rehabilitation should not impute the restoration of occlusal vertical dimension (OVD) to new prostheses, at the risk of the patient does not adapt to a new condition, since a certain amount of time is often necessary for adaptation to a new OVD. This article performed prosthetic rehabilitation with an overlay provisional removable partial denture prior to definitive treatment because the patient showed a considerable decrease in the OVD. Three techniques for OVD determination were used. It is possible to conclude that the use of interim removable partial dentures is of great importance at the beginning of the rehabilitation treatment in order to adapt the patient to a new occlusal condition.

Utilização do titâneo na confecção de estruturas metálicas em prótese parcial removível

Due to properties such as excellent biocompatibility, high resistance to corrosion and low specific weight, titanium has been considered a material of great interest for Dentistry. It has been widely used in implants and orthognathic surgeries. Recently, titanium has been seen as a feasible alternative for the fabrication of removable partial denture frameworks, either in pure titanium (99.75%) or in titanium alloy forms (Ti-6Al-4V; Ti-6A1-7Nb). Based on a review of the literature, this work studied the use of titanium for the fabrication of removable partial denture frameworks, focusing on its advantages and disadvantages as well as its characteristics. It was concluded that the use of titanium is a convenient option for partially edentulous arches rehabilitation with quite satisfactory and promising clinical results. However, the need for highly-equipped laboratories increases the cost, preventing its large scale use.

Utilização do titâneo na confecção de estruturas metálicas em prótese parcial removível

Due to properties such as excellent biocompatibility, high resistance to corrosion and low specific weight, titanium has been considered a material of great interest for Dentistry. It has been widely used in implants and orthognathic surgeries. Recently, titanium has been seen as a feasible alternative for the fabrication of removable partial denture frameworks, either in pure titanium (99.75%) or in titanium alloy forms (Ti-6Al-4V; Ti-6A1-7Nb). Based on a review of the literature, this work studied the use of titanium for the fabrication of removable partial denture frameworks, focusing on its advantages and disadvantages as well as its characteristics. It was concluded that the use of titanium is a convenient option for partially edentulous arches rehabilitation with quite satisfactory and promising clinical results. However, the need for highly-equipped laboratories increases the cost, preventing its large scale use.

Caracterização Microestrutural e Tribocorrosiva de Sistemas Metalocerâmicos Odontológicos do Tipo Ni-Cr/Porcelana E Ni-Cr/Ti/Porcelana

The partial fixed prosthodontics restoration is used to rehabilitate form and function of partial or total compromised teeth, having to remain permanently joined to remainder tooth. The most useful material on prosthodontics is the feldspar porcelain, commercialized as aluminosilicate powders. Dental porcelains are presented with limited mechanical properties to rehabilitate extensive spaces. The association with Ni-Cr metallic systems (metal-ceramic system) allows that the metallic substructure compensates the fragile porcelain nature, preserving the thermal insulation and aesthetics desirable, as well as reducing the possibility of cracking during matication efforts. Cohesive flaws by low mechanical strength connect the metallic substructure to the oral environment, characterized by a electrolytic solution (saliva), by aggressive temperature, pH cyclic changes and mechanical requests. This process results on ionic liberation that could promote allergic or inflammatory responses, and/or clinical degradation of ceramometal system. The aim of this study was to evaluate the presence of an intermediate titanium layer on the microscopic fracture behavior of porcelains on ceramometal systems. Plasma deposition of titanium films result in regular passivating oxide layers which act as barriers to protect the metallic substrate against the hazardous effects of corrosive saliva. Tribocorrosion tests were performed to simulate the oral environment and mechanical stress, making it possible the early detection of crack formation and growth on metal-ceramic systems, which estimate the adherence between the compounds of this system. Plain samples consisting of dental feldspar porcelain deposited either onto metallic substrates or titanium films were fired and characterized by scanning electron microscopy. The result showed that the titanium film improved the adherence of the system compared to conventional metal-ceramic interfaces, thus holding crack propagation

Caracterização Microestrutural e Tribocorrosiva de Sistemas Metalocerâmicos Odontológicos do Tipo Ni-Cr/Porcelana E Ni-Cr/Ti/Porcelana

The partial fixed prosthodontics restoration is used to rehabilitate form and function of partial or total compromised teeth, having to remain permanently joined to remainder tooth. The most useful material on prosthodontics is the feldspar porcelain, commercialized as aluminosilicate powders. Dental porcelains are presented with limited mechanical properties to rehabilitate extensive spaces. The association with Ni-Cr metallic systems (metal-ceramic system) allows that the metallic substructure compensates the fragile porcelain nature, preserving the thermal insulation and aesthetics desirable, as well as reducing the possibility of cracking during matication efforts. Cohesive flaws by low mechanical strength connect the metallic substructure to the oral environment, characterized by a electrolytic solution (saliva), by aggressive temperature, pH cyclic changes and mechanical requests. This process results on ionic liberation that could promote allergic or inflammatory responses, and/or clinical degradation of ceramometal system. The aim of this study was to evaluate the presence of an intermediate titanium layer on the microscopic fracture behavior of porcelains on ceramometal systems. Plasma deposition of titanium films result in regular passivating oxide layers which act as barriers to protect the metallic substrate against the hazardous effects of corrosive saliva. Tribocorrosion tests were performed to simulate the oral environment and mechanical stress, making it possible the early detection of crack formation and growth on metal-ceramic systems, which estimate the adherence between the compounds of this system. Plain samples consisting of dental feldspar porcelain deposited either onto metallic substrates or titanium films were fired and characterized by scanning electron microscopy. The result showed that the titanium film improved the adherence of the system compared to conventional metal-ceramic interfaces, thus holding crack propagation

Análise comparativa na influência da técnica de moldagem funcional em arcos parcialmente edêntulos sobre os pontos de contato oclusais, a integridade da fibromucosa e a extensão da base da prótese

There is a lack of clinical studies evaluating techniques of functional impression for partially edentulous arches. The aim of this double-blind non-randomized controlled clinical trial was to compare the efficacy of altered cast impression (ACI) and direct functional impression (DFI) techniques. The efficacy was evaluated regarding the number of occlusal units on denture teeth, mucosa integrity at 24-hour follow-up and denture base extension. The sample included 51 patients (female and male) with mean age of 58.96 years treated at Dental Department of UFRN. The patients, exhibiting edentulous maxilla and mandibular Kennedy class I, were divided into two groups (group ACI, n=29; group DFI, n=22). Clinical evaluation was based on the number of occlusal units on natural and/or artificial teeth, mucosa integrity at 24-hour follow-up, and denture base extension. Statistical analysis was conducted using the software SPSS 17.0® (SPSS Inc., Chicago, Illinois). Student T-test was used to reveal association between number of occlusal units and impression technique while chi-square test showed association between mucosa integrity and impression technique. Fischer s exact test was applied for association between denture base extension and impression technique at 95% level of significance. No significant difference was observed between the groups regarding number of occlusal units, mucosa integrity and denture base extension. The altered cast technique did not provide significant improvement in comparison to the direct technique when the number of occlusal units, mucosa integrity and denture base extension

Avaliação da desadaptação das selas de próteses parciais removíveis após 1 a 5 anos de uso

The non-adaptation of the removable partial prosthesis (RPP) base to fibromucosal tissue is caused by resorption of residual ridges (RRR). The onset of bone resorption, which occurs after tooth extraction and continues throughout life, is accelerated by local or systemic factors. Aim: Assess the degree of non-adaptation of removable partial prosthesis saddles and the factors that influence it. Methodology: A sectional study was conducted with 81 patients using RPP who had their prostheses installed between 2003 and 2007 (1 to 5 years of use) at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Norte (UFRN). After anamnese and clinical examination, a cast was made with polyether-based material, using the base of the prosthesis to make the impression. The base of the saddle was loaded with the casting material and positioned in the mouth, applying pressure on the supports. After polymerization, the material was removed from the saddle and measurements were taken at 3 different points using a pachymeter. Results: The non-adaptation of the saddle increased significantly with years of use (p = 0.005). The tooth-tissue supported prostheses obtained higher mean non-adaptation values than those of tooth supported prostheses (p < 0.001). Flaccid mucosa showed the worst non-adaptation results, which were statistically different from resilient mucosa (p < 0.001). The greater the extension of the saddle, the greater the non-adaptation (p < 0.001). The natural tooth antagonistic arch yielded better results than did RPP and total prosthesis (p < 0.001). Saddle non-adaptation at the free end was less near the pillar tooth and greater in the more posterior region (p < 0.001). When adaptation of the supports to the niches was poor, greater saddle non-adaptation occurred than when it was good or fair (p < 0.001). Saddles located in the posterior region of the arch had greater non-adaptation than those in the anterior region (p = 0.023). Conclusion: The mean non-adaptation of the saddle to the residual ridges was 0.27 mm. It can be concluded that, even with the use of RPP, bone height reduction was slight within the 1-5-year period of use. The following are factors that influence adaptation of the RPP saddle base: years of use, age, force transmission path to the alveolar bone, location of the toothless area, antagonistic arch, type of mucosa, adaptation of supports to the niche and extension of the saddle

Avaliação clínica longitudinal do periodonto de dentes pilares e não pilares de próteses parciais removíveis

The literature has shown a relation between periodontics and the removable partial denture (RPD), with progressive destruction observed in the support structures. The aim of this study was to clinically assess periodontal condition in users of removal partial denture (RPD), and compare right abutments teeth, indirect abutments and controls before installation and after 1 year, in addition to comparing tooth-supported and tooth mucosa-supported abutments. A total of 50 patients, 32 women and 18 men, mean age of 45 years, took part in the study. The patients were examined by a single examiner at prosthesis installation and after 3, 6, 9 and 12 months. The following were verified at each examination: Probe Depth (PD), Plaque Index (PI), Gingival Index (GI), the amount of Keratinized Mucosa (KM), Gingival Recession (GR) and Dental Mobility (DM); in addition patients received oral hygiene orientation, accompanied by prophylaxis, periodontal scaling and root planing (PSRP), when necessary. Analysis of Variance (ANOVA) with Tukey-Kramer post test was used to assess the dependent variables (PD, PI, KM, GR) of the three groups over time while Friedman s test was used for GI. To assess the outcomes of prosthesis type in the right abutment group, a confidence interval-based analysis was performed. The results showed that the control group was the least compromised in all the variables studied. With respect to development of the groups over time, it was verified that the measures for GR, PD, GI and KM increased from initial examination to 1 year of use in all the groups, but only PI showed a significant increase. There was a non-discriminatory low prevalence of dental mobility. The tooth mucosa-supported prosthesis had significantly higher values for GR, GI and PI and significantly lower ones for KM when compared to tooth-supported. Over time, both types of prostheses showed no significant differences from initial to final examination for the variables GR, PD, KM and GI, with PI significant only for tooth-supported. The results showed that the teeth most involved in RPD design had greater potential of periodontal damage, probably because of greater dental biofilm accumulation. Abutments elements adjacent to the free extremities had less favorable periodontal condition than those adjacent to interpolated spaces, but the use of RPD did not worsen the initial condition