Use of 4 Immediately Loaded Zygomatic Fixtures for Retreatment of Atrophic Edentulous Maxilla After Complications of Maxillary Reconstruction

This article reports the 20-month clinical outcome of the use of 4 zygomatic implants with immediate occlusal loading and reverse planning for the retreatment of atrophic edentulous maxilla after failed rehabilitation with autogenous bone graft reconstruction and maxillary implants. The intraoral clinical examination revealed mispositioned and loosened implants underneath a maxillary complete denture. The panoramic radiograph showed 6 maxillary implants. One implant was displaced into the right maxillary sinus, and the implant anchored in the region of tooth 21 was fractured. The other implants presented peri-implant bone loss. The implants anchored in the regions of teeth 21 to 23 and 11 to 13 were first removed. After 2 months, the reverse planning started with placement of 4 zygomatic fixtures, removal of the implants migrated into the sinus cavity and anchored in the region of tooth 17, and installation of a fixed denture. After 20 months of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. The outcomes of this case confirm that the zygoma can offer a predictable anchorage and support function for a fixed denture in severely resorbed maxillae.

Radiographic assessment of photodynamic therapy as an adjunctive treatment on induced periodontitis in immunosuppressed rats

Objective: The aim of this study was to assess radiographically the effect of photodynamic therapy (PDT) as an adjunctive treatment to scaling and root planing (SRP) on induced periodontitis in dexamethasone-induced immunosuppressed rats. Material and Methods: The animals were divided into 2 groups: ND group (n=60): saline treatment; D group (n=60): dexamethasone treatment. In both ND and D groups, periodontal disease was induced by the placement of a ligature in the left first mandibular molar. After 7 days, ligature was removed and all animals received SRP, being divided according to the following treatments: SRP: saline and PDT: phenothiazinium dye (TBO) plus laser irradiation. Ten animals per treatment were killed at 7, 15 and 30 days. The distance between the cementoenamel junction and the height of the alveolar bone crest in the mesial surface of the mandibular left first molars was determined in millimeters in each radiograph. The radiographic values were analyzed statistically by ANOVA and Tukey's test at a p value <0.05. Results: Intragroup radiographic assessment (ND and D groups) showed that there was statistically significant less bone loss in the animals treated with PDT in all experimental periods compared to those submitted to SRP. Intergroup radiographic analysis (ND and D groups) demonstrated that there was greater bone loss in the ND group treated with SRP compared to the D group treated with PDT at 7 and 30 days. Conclusion: PDT was an effective adjunctive treatment to SRP on induced periodontitis in dexamethasone-induced immunosuppressed rats.

Flabby Ridge Correction Using an Auxiliary Technique With Connective Tissue Graft

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Histometric analysis of ligature-induced periodontitis in rats: a comparison of histological section planes

The purpose of this study was to analyze the histometry of ligature-induced periodontitis in rats at different histological section depths. Sixteen male adult Wistar rats were randomly assigned to two groups: ligature and control. In the ligature group, rats received a sterile 4/0 silk ligature around the maxillary right 2nd molar. Thirty serial sections containing the 1st and 2nd molars, in which the coronal and root pulp, cementoenamel junction (CEJ) in the mesial side of the 2nd molar, interproximal alveolar bone and connective fiber attachment were clearly visible, were selected for histometric analysis. The histological sections were clustered in groups of 10 sections corresponding the buccal (B), central (C) and lingual (L) regions of the of periodontal tissue samples. The distance between the CEJ in the mesial side of the 2nd molar and the attached periodontal ligament fibers (CEJ-PL) as well as the distance between the CEJ and the alveolar bone crest (CEJ-BC) were determined. From CEJ-PL and CEJ-BC distances measured for each specimen, the measurements obtained in the B, L and C regions were recorded individually and together. Data were submitted to statistical analysis. Significant differences (p<0.001) were observed between the control and ligature groups regarding CEJ-PL (0.05 mm and 0.26 mm, respectively) and CEJ-BC (0.47 mm and 0.77 mm, respectively) measurements. Regarding the depth of the buccal, central and lingual planes, the means of CEJ-PL and CEJ-BC of both groups showed no statistically significant differences (p>0.05). In conclusion, the selection of 10 serial sections of the central region of periodontal tissue samples at any depth can be considered as representative for the evaluation of periodontal ligament fiber attachment and bone loss in ligature-induced periodontitis in rats.

Influence of Ridge Inclination and Implant Localization on the Association of Mandibular Kennedy Class I Removable Partial Denture

The aim of this study was to evaluate the tendency of displacement of the supporting structures of the distal extension removable partial denture (DERPD) associated to the implant with different inclinations of alveolar ridge and implant localizations through a two-dimensional finite-element method. Sixteen mandibular models were fabricated, presenting horizontal, distally descending, distally ascending, or descending-ascending ridges. All models presented the left canine and were rehabilitated with conventional DERPD or implant-retained prosthesis with the ERA system. The models were obtained by the AutoCAD software and transferred to the finite-element software ANSYS 9.0 for analysis. A force of 50 N was applied on the cusp tips of the teeth, with 5 points of loading of 10 N. The results were visualized by displacement maps. For all ridge inclinations, the assembly of the DERPD with distal plate retained by an anterior implant exhibited the lowest requisition of the supporting structures. The highest tendency of displacement occurred in the model with distally ascending ridge with incisal rest. It was concluded that the association of the implant decreased the displacement of the DERPD, and the anterior positioning of the implant associated to the DERPD with the distal plate preserved the supporting structures for all ridges.

Analysis of Masticatory Cycle Efficiency in Complete Denture Wearers

Purpose: This study assessed masticatory efficiency and duration of the masticatory cycle in 14 asymptomatic patients with severe bone resorption. All patients had worn complete dentures for over 10 years. Recall visits were scheduled at 5 months and 1 year after receiving new dentures.Materials and Methods: Fourteen patients were evaluated in this study. The Research Diagnostic Criteria questionnaire and tests of the efficiency and duration of the masticatory cycle were performed with artificial food before, 5 months after, and 1 year after new dentures were delivered. Masticatory efficiency was assessed using a sieve system; artificial food was ground for 35 masticatory cycles and monitored by the operator.Results: Masticatory efficiency at 5 months was significantly improved for the 0.42-mm mesh. An improvement in masticatory efficiency and a reduction in mastication time were observed with the new dentures after 1 year.Conclusion: The results of this study indicated that 5 months did not allow enough time to demonstrate improved muscular capacity and ability after receiving new dentures. After 1 year, the duration of the masticatory cycle was reduced, and masticatory efficiency was significantly improved.

Care Required When Using Bisphosphonates in Dental Surgical Practice

Bisphosphonates are pharmacologic compounds characterized by high tropism to bone tissue. They affect bone metabolism by inhibition of osteoclast recruitment, proliferation, differentiation, and function. Because they can reduce bone resorption, bisphosphonates are used mainly for the treatment of osteometabolic conditions. However, the use of bisphosphonates has been associated with the onset of osteonecrosis of the jaws and indication of dental implants. As a result of this, the aim of this study was to present the risks and the care that health professionals should take in cases of surgical procedures such as placement of dental implants in patients who make use of bisphosphonates.

Implant Platform Switching: Biomechanical Approach Using Two-Dimensional Finite Element Analysis

In implant therapy, a peri-implant bone resorption has been noticed mainly in the first year after prosthesis insertion. This bone remodeling can sometimes jeopardize the outcome of the treatment, especially in areas in which short implants are used and also in aesthetic cases. To avoid this occurrence, the use of platform switching (PS) has been used. This study aimed to evaluate the biomechanical concept of PS with relation to stress distribution using two-dimensional finite element analysis. A regular matching diameter connection of abutment-implant (regular platform group [RPG]) and a PS connection (PS group [PSG]) were simulated by 2 two-dimensional finite element models that reproduced a 2-piece implant system with peri-implant bone tissue. A regular implant (prosthetic platform of 4.1 mm) and a wide implant (prosthetic platform of 5.0 mm) were used to represent the RPG and PSG, respectively, in which a regular prosthetic component of 4.1 mm was connected to represent the crown. A load of 100 N was applied on the models using ANSYS software. The RPG spreads the stress over a wider area in the peri-implant bone tissue (159 MPa) and the implant (1610 MPa), whereas the PSG seems to diminish the stress distribution on bone tissue (34 MPa) and implant (649 MPa). Within the limitation of the study, the PS presented better biomechanical behavior in relation to stress distribution on the implant but especially in the bone tissue (80% less). However, in the crown and retention screw, an increase in stress concentration was observed.

Computer-Guided Surgery in Implantology: Review of Basic Concepts

The aim of the present study was to conduct a critical literature review about the technique of computer-guided surgery in implantology to highlight the indications, purposes, immediate loading of implants and complications, protocol of fabrication, and functioning of virtual planning software. This literature review was based on OLDMEDLINE and MEDLINE databases from 2002 to 2010 using the key words "computer-guided surgery" and "implant-supported prosthesis." Thirty-four studies regarding this topic were found. According to the literature review, it was concluded that the computer-assisted surgery is an excellent treatment alternative for patients with appropriate bone quantity for implant insertion in complete and partially edentulous arches. The Procera Nobel Guide software (Nobel Biocare) was the most common software used by the authors. In addition, the flapless surgery is advantageous for positioning of implants but with accurate indication. Although the computer-guided surgery may be helpful for virtual planning of cases with severe bone resorption, the conventional surgical technique is more appropriate. The surgical guide is important for insertion of the implants regardless of the surgical technique, and the success of immediate loading after computer-guided surgery depends on the accuracy of clinical and/or laboratorial steps.

Electromyographic activity of the mandible muscles at the beginning and end of masticatory cycles in patients with complete dentures

The aim of this study was to assess the electrical activity of the masseter and anterior temporal muscles in subjects with severe bone resorption at two different times: ( a) the initial period, with the complete dentures they had worn for over 10 years, and (b) the final period, 5 months after having new dentures put into place. Twelve asymptomatic subjects were asked to respond to the questionnaire, according to the research diagnostic criteria for temporomandibular disorders, before denture rehabilitation and 5 months after the new dentures were put in place. The electrical activity of the muscles was recorded during mastication in the initial and final period, using artificial food (Optocal). The operator monitored the 35 chewing cycles that were repeated to grind the artificial food. After wearing the new dentures for 5 months, the right anterior temporal muscle showed a statistical difference before and after denture rehabilitation at the beginning and end of mastication. Muscular capacity and ability reduced the electrical activity in the masseter muscles after rehabilitation. Copyright (c) 2008 S. Karger AG, Basel.

TMJ Vibrations in Asymptomatic Patients Using Old and New Complete Dentures

Purpose: The aim of this study was to assess the presence of temporomandibular joint (TMJ) noises in subjects with severe bone resorption, who have worn the same complete dentures for over 10 years, and 5 months after treatment with increments of acrylic resin on the occlusal surface after having new dentures in place.Methods: After applying the research diagnostic criteria (RDC)/temporomandibular disorder (TMD) questionnaire, 20 asymptomatic subjects were assessed before and 5 months after the new dentures were put in place. Joint vibrations were assessed by the Sono Pak program by selecting the vibrations that occurred during the opening and closing cycle.Results: The means of the results revealed a nonnormal distribution and were submitted to Kruskal-Wallis statistical analysis (p < 0.05). The vibration means were of low intensity (<= 9.96 Hz). After rehabilitation, there was a reduction in the vibrations (<= 5.2 Hz) statistically significant only at the end of mouth opening with the old dentures when compared with the other cycles.Conclusion: The intensity and number of occurrences of joint vibrations were reduced after 5 months of wearing new dentures.

Surgical and Prosthetic Rehabilitation of Patients With Hemimandibular Defect

Purpose: This work intended to investigate, by means of a literature revision, the techniques and materials used for the rehabilitation of hemimandibular defect patients, prosthetic and occlusal aspects of these patients, and chewing and swallowing.Materials and Methods: For the confection of this revision, we consulted the database indexers Google Scholar, PubMed, and SciELO and found studies published between the periods 1972 and 2008. The terms used for the search had been "to hemimandibular defects," "to temporomandibular joint protheses," and "vascularized cap grafts," which had been searched separately and combined.Conclusions: Diverse techniques and materials used for the reconstruction of hemimandibular defects exist; however, great bone resorption is still observed, which will compromise the prosthetic rehabilitation of these patients. More prospective works and stories of clinical cases duly registered will be able to elucidate in a clearer form the anatomic and functional devolutions of the verbal socket of hemimandibular defect patients.

Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth

Objective. The aim of this study was to evaluate the influence of apical foramen widening on the healing of chronic periapical lesions in dogs' teeth after root canal filling with Sealer 26 or Endomethasone.Study design. Forty root canals of dogs' teeth were used. After pulp extirpation, the canals were exposed to the oral cavity for 180 days for induction of periapical lesions, and then instrumented up to a size 55 K-file at the apical cemental barrier. In 20 roots, the cemental canal was penetrated and widened up to a size 25 K-file; in the other 20 roots, the cemental canal was preserved (no apical foramen widening). All canals received a calcium hydroxide intracanal dressing for 21 days and were filled with gutta-percha and 1 of the 2 sealers: group 1: Sealer 26/apical foramen widening; group 2: Sealer 26/no apical foramen widening; group 3: Endomethasone/apical foramen widening; group 4: Endomethasone/no apical foramen widening. The animals were killed after 180 days, and serial histologic sections from the roots were prepared for histomorphologic analysis. Scores were assigned according to preestablished histomorphologic parameters and analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests.Results. Regarding new cementum formation, repair of cementum and bone resorption areas, presence of microorganisms, inflammatory cell infiltrate and periodontal ligament conditions, significantly better periapical healing was obtained when foramen widening was done and Sealer 26 was used.Conclusion. Apical foramen widening and calcium hydroxide-containing sealer were more favorable to the healing of chronic periapical lesions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-940)

A importância da interação entre odontopediatrias e pediatrias no manejo de dentes natais e neonatais

OBJETIVO: Apresentar revisão de literatura sobre dentes natais e neonatais, abordando características clínicas, fatores etiológicos, medidas terapêuticas e a importância do conhecimento desta anomalia, por odontopediatras e pediatras. FONTES DE DADOS: Foram selecionados os artigos mais relevantes sobre o tema, desde 1950 até 2006, pesquisados no Medline e na Bibliografia Brasileira em Odontologia (BBO), além de livros de pertinentes. SÍNTESE DOS DADOS: Os dentes natais e neonatais consistem em uma anomalia de erupção, sendo caracterizados por seu irrompimento na cavidade oral durante o período intra-uterino ou no primeiro mês de vida respectivamente, podendo fazer parte da dentição decídua normal ou supranumerária. Esses dentes, em geral, apresentam bordos cortantes e podem estar relacionados ao aparecimento de ulcerações na base da língua do bebê e/ou no seio materno, comprometendo a amamentação. A fraca implantação óssea desses dentes favorece sua grande mobilidade, tornando-se, assim, um fator de risco à sua aspiração ou deglutição pela criança. A abordagem terapêutica depende da dentição à qual pertence o dente e dos possíveis problemas que este pode causar à saúde da criança ou da mãe. CONCLUSÕES: O conhecimento sobre as características clínicas e os possíveis distúrbios aos quais os dentes natais e neonatais estão relacionados por odontopediatras e pediatras possibilita a interação necessária para o diagnóstico precoce e a abordagem integral da criança.

Protective effects of Tacrolimus, a calcineurin inhibitor, in experimental periodontitis in rats

Objective: Periodontitis is a well-appreciated example of leukocyte-mediated bone loss and inflammation with pathogenic features similar to those observed in other inflammatory diseases, such as arthritis. Since Tacrolimus, is an immunomodulatory drug used for the treatment of some cases of arthritis, we hypothesized that it may modulate periodontal disease.Design: Using a murine model of ligature-induced periodontal disease, we assessed the effects of daily administrations of Tacrolimus (1 mg/kg body weight) on bone loss, enzymatic (myeloperoxidase) analysis, differential white blood cells counts, airpouch exudate and cytokine expression for 5-30 days.Results: Radiographic, enzymatic (myeloperoxidase) and histological analysis revealed that Tacrolimus reduced the severity of periodontitis. More specifically, Tacrolimus suppressed the expression of serum interleukin (IL-1 beta), tumour necrosis factor (TNF-alpha), IL-6, airpouch exudate PGE(2) and leukocytosis usually observed after the induction of periodontitis. Tacrolimus treatment in periodontitis-induced rats conferred protection against the inflammation-induced tissue and bone loss associated with periodontitis, through a mechanism involving IL-1 beta, TNF-alpha and IL-6.Conclusions: the effects of Tacrolimus on periodontal disease pathogenesis may provide clues to a novel approach to host modulation therapy in destructive periodontal disease. (C) 2007 Elsevier Ltd. All rights reserved.