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

Estudo Clínico Longitudinal Comparativo da Condição Periodontal de Pilares Diretos de Próteses Parciais Removíveis Dento- Suportada e Dento-Muco-Suportada

Objective: To perform a long-term clinical evaluation of the periodontium of removable parti al denture (RPD) wearers, comparing the direct pillar teeth of tooth-supported and toothtissue supported RPDs. Method: Fifty patients with mean age of 45 years were enrolled in the study. The individuals were examined by a single examiner at the moment of denture installation and after 3, 6, 9 and 12 months. In each exam, the following parameters were verified: gingival recession (GR), probing depth (PD), plaque index (PI), gingival index (GI) e amount kerati nized mucosa (KM). All patients received oral hygiene instructions and prophylaxis and, when necessary, scaling and root planing. An analysis from the confidence interval was done to evaluate the endpoints regarding the type of denture in the direct pillar group. Results: The tooth-tissue supported dentures showed significantly higher GR, GI and PI values, and significantly lower KM values. Over time, neither of the types of denture presented statistically significant difference from the initial to the final examination for the parameters GR, PD, KM and GI, while the PI was significant only for the tooth-supported dentures. Conclusion: Pillar teeth adjacent to free ends presented a less favorable periodontal conditi on than the pillar teeth adjacent to intercalated spaces. However, the use of RPD did not aggravate the initial condition, after a follow-up period of 12 months. The findings of the study indicate that, within 1 year, there were no significant differences between the direct pillars of the toothsupported and tooth-ti ssue supported dentures, and suggest the need of professional follow up for a longer period.

Estudo Clínico Longitudinal Comparativo da Condição Periodontal de Pilares Diretos de Próteses Parciais Removíveis Dento- Suportada e Dento-Muco-Suportada

Objective: To perform a long-term clinical evaluation of the periodontium of removable parti al denture (RPD) wearers, comparing the direct pillar teeth of tooth-supported and toothtissue supported RPDs. Method: Fifty patients with mean age of 45 years were enrolled in the study. The individuals were examined by a single examiner at the moment of denture installation and after 3, 6, 9 and 12 months. In each exam, the following parameters were verified: gingival recession (GR), probing depth (PD), plaque index (PI), gingival index (GI) e amount kerati nized mucosa (KM). All patients received oral hygiene instructions and prophylaxis and, when necessary, scaling and root planing. An analysis from the confidence interval was done to evaluate the endpoints regarding the type of denture in the direct pillar group. Results: The tooth-tissue supported dentures showed significantly higher GR, GI and PI values, and significantly lower KM values. Over time, neither of the types of denture presented statistically significant difference from the initial to the final examination for the parameters GR, PD, KM and GI, while the PI was significant only for the tooth-supported dentures. Conclusion: Pillar teeth adjacent to free ends presented a less favorable periodontal conditi on than the pillar teeth adjacent to intercalated spaces. However, the use of RPD did not aggravate the initial condition, after a follow-up period of 12 months. The findings of the study indicate that, within 1 year, there were no significant differences between the direct pillars of the toothsupported and tooth-ti ssue supported dentures, and suggest the need of professional follow up for a longer period.

Protocolo clínico para confecção de próteses removíveis

Este protocolo objetiva esclarecer dúvidas existentes a respeito dos passos necessários para a reabilitação com próteses totais e parciais removíveis convencionais. Essas alternativas de tratamento são modalidades terapêuticas consagradas na literatura e podem devolver função mastigatória, estética, fonação e conforto ao paciente quando confeccionadas de maneira satisfatória. Elas representam também uma ótima opção para aqueles pacientes que não podem se submeter ao tratamento com implantes, por apresentarem limitações biológicas ou financeiras. A abordagem do protocolo clínico está dividida em duas partes. A primeira parte ilustra a reabilitação com próteses totais convencionais e a segunda, a reabilitação com próteses parciais removíveis convencionais em arcos inferiores com extremidade livre bilateral. Por meio da demonstração do passo a passo com fotos, dicas clínicas e resumos sistemáticos do conteúdo teórico contido nesse material, o aluno de Odontologia e o cirurgião-dentista poderão conhecer os passos necessários para executar estes tipos de reabilitações, desde o momento clínico de diagnóstico até o de controle e manutenção. Esperamos que essa obra desperte o interesse dos cirurgiões-dentistas por executar esses tipos de próteses e que os ajude a desenvolverem práticas e habilidades que melhorem o desempenho clínico dessas alternativas de tratamento.

Protocolo clínico para confecção de próteses removíveis

Este protocolo objetiva esclarecer dúvidas existentes a respeito dos passos necessários para a reabilitação com próteses totais e parciais removíveis convencionais. Essas alternativas de tratamento são modalidades terapêuticas consagradas na literatura e podem devolver função mastigatória, estética, fonação e conforto ao paciente quando confeccionadas de maneira satisfatória. Elas representam também uma ótima opção para aqueles pacientes que não podem se submeter ao tratamento com implantes, por apresentarem limitações biológicas ou financeiras. A abordagem do protocolo clínico está dividida em duas partes. A primeira parte ilustra a reabilitação com próteses totais convencionais e a segunda, a reabilitação com próteses parciais removíveis convencionais em arcos inferiores com extremidade livre bilateral. Por meio da demonstração do passo a passo com fotos, dicas clínicas e resumos sistemáticos do conteúdo teórico contido nesse material, o aluno de Odontologia e o cirurgião-dentista poderão conhecer os passos necessários para executar estes tipos de reabilitações, desde o momento clínico de diagnóstico até o de controle e manutenção. Esperamos que essa obra desperte o interesse dos cirurgiões-dentistas por executar esses tipos de próteses e que os ajude a desenvolverem práticas e habilidades que melhorem o desempenho clínico dessas alternativas de tratamento.

Eficiência mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com próteses totais removíveis implanto-suportadas

Edentulous patients with complaint about mandibular conventional denture might experience poor masticatory function and negative impact of oral health on quality of life. The aim of this controlled clinical trial was to evaluate the effect of mandibular overdenture on oral health-related quality of life and masticatory efficacy in patients wearing mandibular complete dentures. The edentulous patients (n=16) were rehabilitated with new maxillary and mandibular complete dentures and, after 3 months, mandibular overdentures retained by 2 implants (bar-clip system) were fabricated. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral healthrelated quality of life. Masticatory efficacy was evaluated through a colorimetric method with chewing capsules. The mean OHIP-Edent score was 8.5 with conventional dentures and 2.0 with mandibular overdenture, which means a positive impact of oral health on quality of life with overdentures (p=0.001). The mean absorbance for masticatory efficacy was 0.025 for conventional dentures and 0.073 for overdentures. There was statistically significant difference for masticatory efficacy before and after implants rehabilitation (p=0.003). However, there was no correlation between masticatory efficacy and OHIP (p>0.05). So, mandibular overdenture retained by 2 implants improved the quality of life and masticatory efficacy of edentulous patients with complaint about mandibular conventional complete dentures

Análise mecânica e microestrutural das ligas de cobalto-cromo de uso odontológico após sucessivas refundições

The cobalt-chromium alloy is extensively used in the Odontology for the confection of metallic scaffolding in partial removable denture. During the last few years, it has been reported an increasing number of premature imperfections, with a few months of prosthesis use. The manufacture of these components is made in prosthetic laboratories and normally involves recasting, using parts of casting alloy and parts of virgin alloy. Therefore, the objective of the present study was to analyze the mechanical properties of a commercial cobalt-chromium alloy of odontological use after successive recasting, searching information to guide the dental prosthesis laboratories in the correct manipulation of the cobalt-chromium alloy in the process of casting and the possible limits of recasting in the mechanical properties of this material. Seven sample groups were confectioned, each one containing five test bodies, divided in the following way: G1: casting only with virgin alloy; G2: casting with 50% of the alloy of the G1 + 50% of virgin alloy; G3: casting with 50% of the alloy of the G2 + 50% of virgin alloy; G4: casting with 50% of the alloy of the G3 + 50% of virgin alloy; G5: 50% of alloy of the G4 + 50% of virgin alloy; G6: 50% of alloy of the G5 + 50% of virgin alloy and finally the G7, only with recasting alloy. The modifications in the mechanical behavior of the alloy were evaluated. Moreover, it was carried the micro structural characterization of the material by optic and electronic scanning microscopy, and X ray diffraction.and fluorescence looking into the correlatation of the mechanical alterations with structural modifications of the material caused by successive recasting process. Generally the results showed alterations in the fracture energy of the alloy after successive recasting, resulting mainly of the increasing presence of pores and large voids, characteristic of the casting material. Thus, the interpretation of the results showed that the material did not reveal significant differences with respect to the tensile strength or elastic limit, as a function of successive recasting. The elastic modulus increased from the third recasting cycle on, indicating that the material can be recast only twice. The fracture energy of the material decreased, as the number of recasting cycles increased. With respect to the microhardness, the statistical analyses showedno significant differences. Electronic scanning microscopy revealed the presence of imperfections and defects, resulting of the recasting process. X ray diffraction and fluorescence did not show alterations in the composition of the alloy or the formation of crystalline phases between the analyzed groups. The optical micrographs showed an increasing number of voids and porosity as the material was recast. Therefore, the general conclusion of this study is that the successive recasting of of Co-Cr alloys affects the mechanical properties of the material, consequently leading to the failure of the prosthetic work. Based on the results, the best recommendadition is that the use of the material should be limited to two recasting cycles

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

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.

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.