Prótese total fixa na maxila: soluções protéticas

The modalities of treatment with prostheses over implants for total edentulous patients can be divided in fixed and removable prostheses (overdentures). The fixed prostheses modality has proven to offer better results as to the functional aspects and, results in higher longevity. Overdentures are considered as a modality of rehabilitation utilized to compensate the need for better retention, aside from augmenting chewing efficiency. Its use is justified by its facilitated hygiene, reduced surgical and prosthetic costs, reestablishment of labial support and elimination of the possibility of air escape. However, this option presents psychosocial downside, since the fact that it is considered a removable rehabilitation modality does not please the majority of patients. Although many patients prefer a fixed implant-supported prosthesis to a removable overdenture, frequently it is necessary to utilize an implant retained overdenture as an alternative to the treatment, due to anatomical, physiological, aesthetic, hygienic, and financial limitations regarding the patient. The objective of this study was to discuss a clinical case of a partially edentulous patient treated in the Implantodontic Surgery Post-Graduation Course from the Kenedy Dentistry Institute Mozarteum/Famosp Unit – Goiânia-Brazil), and submitted to osseointegrated implants surgical fixation techniques. A modality of differential diagnosis was established after osseointegration period, it aimed at facilitating the choice of a rehabilitation model that could favor the patient’s and professional`s expectations. Therefore the appreciated aspects were function, comfort, aesthetics, and especially the patient satisfaction.

Reabilitação estética por meio de prótese ocular a base de PMMA: relato de caso

Eye loss results on facial asymmetry compromising its aesthetics. Ocular prostheses are important to re-establish aesthetics; protect the anophthalmic cavity; recover function such as the redirection of lachrymatory liquid; and reintegrate the patient to society. The aim of this study was to describe a case report, demonstrating clinical and laboratorial procedures for confection of ocular prostheses and highlighting their advantages. A female patient was afflicted by toxoplasmosis, which led to the loss of her eye. An eye visceration was performed. The patient reported no previous use of ocular prosthesis. A PMMA ocular prosthesis was manufactured restoring patient’s aesthetic and facial contour. The patient was satisfied with the treatment. Therefore the present study has shown that PMMA ocular prosthesis is able to restore facial aesthetics and can be a safe and satisfactory alternative for patients that have lost their eyes due to toxoplasmosis.

O impacto das próteses implantosuportadas na harmonia facial

Many patients seeking dental care wish to improve facial and smile aesthetics to be accepted in modern day society. In denture wearers, the physiological resorption causes atrophy mainly in the maxilla, being necessary to carry out reconstruction techniques and sometimes orthognathic surgery to improve occlusal stability and facial harmony. The aim of this study is to discuss the features related to the rehabilitation of edentulous patients with indication for reconstruction of the maxilla using bone grafts and orthognathic surgery by means of a clinical case. In the present case, after the prosthetic rehabilitation, the patient was full satisfied with obtained results and dismissed the initially proposed surgical protocol. Therefore, professionals should provide therapeutic options but the patient’s opinion should prevail provided its clinical feasibility.

Parafunção severa: reabilitação oral com prótese total mandibular x overlay maxilar: relato de caso

In many oral rehabilitation professionals seeking venture renew people smile. However, these procedures have functional implications and aesthetic criteria which must be satisfied so that the final result is predictable. The restoration of relations intermaxillary, phonetics, masticatory function, esthetics and patient comfort are the goals to be achieved. An effective way to achieve these goals when immediate reconstruction with permanent dentures is not possible, make use of a type of partial denture called overlay. Bruxism is a manifestation of biopsychological imbalance that affects the stomatognathic system, characterized by clenching and / or attrition of teeth together so centric or eccentric, can be manifestation of nocturnal or diurnal. Its effects can manifest themselves in different parts of the stomatognathic system, varying the severity of the damage as the resistance of the structures affected, the time of existence, its regularity and the general state of the wearer. The description of the steps followed in solving this case, in which the patient edentulous mandibular arch while the maxillary arch showed absence of teeth 16 and 26 and, except for the teeth 17 and 27, all other teeth showed wear very sharp in the sense denoting incisal cervical, severe impairment of the vertical dimension, the quality of masticatory function and a marked impairment phonetic, this case report aims to guide the beginning of a rehabilitation, as well as the transitional phase of treatment for recovery of functional and aesthetic relationships intermaxillary .

Influência do formato do rebordo alveolar sagital em reabilitações com associação de prótese parcial removível de extremidade livre e implante ósseo integrado

The association of mandibular distal extension removable partial dentures with an osteointegrated implant is a treatment option at hasn't been fully explored by modern rehabilitation dentistry yet. The objective of this study is to evaluate, by means of the bidimensional method of finite elements, the distribution of tension on the structures supporting the distal extension removable partial denture (DERPD), associated to a 10.0 x 3.75 mm osteointegrated implant with an ERA retention system, in alveolar ridges of different shapes. Eight models were created, representing, from a sagittal perspective: Model A (MA) – a half arch with a horizontal ridge without posterior support, with the presence of the lower left canine, and a conventional DERPD, with metallic support in the incisal aspect of this canine, as replacement for the first and second pre-molars and the first and second molars of the lower left half arch; Model B (MB) – similar to MA, but different because of the presence of a 3.75 x 10.00 mm implant with an associated ERA retention system in the posterior region of the DERPD base; Model C (MC) - similar to MA, however with a distally ascending ridge format; Model D (MD) – similar to MC, but different because there is an implant associated to a retention system; Model E (ME) - similar to MA, however with a distally descending ridge format; Model F (MF) – similar to ME, but ditfferent in the sense that there is an implant with an associated ERA retention system; Model G (MG) – similar to MA, however with a distally descending-ascending ridge format; Model H (MH) – similar to MG, but different in the sense that there is an implant with an associated ERA retention system. The finite element program ANSYS 9.0 was used to load the models with vertical forces of 50 N, on each cuspid tip. The format of distal descending edge (ME and MF) was that presented worse results, so in the models with conventional RPD as in the models with RPD associated to the implant and ERA system of retention, for the structures gingival mucosa and tooth support. 1) the distally descending ridge presented the most significant stress in the model with the conventional RPD (ME) or with a prosthesis associated to an implant (MF) and 2) the horizontal ridge (MB) provided more relief to the support structures, such as the tooth and the spongy bone, when there was an implant associated to an ERA retention system. The incorporation of the implants with the ERA system retention, in the posterior area of the toothless edge, it promotes larger stability and retention to PPREL, improving the patient's masticatory acting and, consequently, its comfort and function.

A inter-relação entre as infecções pulpares e a diabetes

Diabetes is a metabolic disease that affects the dental pulp due to some local changes. Before this information, a research through literature was made with the purpose to study the interrelation between pulp infections and diabetes. We analyzed several articles that described researches involving animals and they showed that there is a relation between diabetes and size, progression and severity of the periradicular lesions. There is evidence that diabetes is an important factor over the oral tissue, causing alterations in the inflammatory mediators and changing the structure of the pulp. Although many studies prove that there is an interrelation between diabetes and pulp infections, there are still some gaps in the current literature that need to be filled.

Detecção de microrganismos de infecções bucais: perspectivas e cuidados a serem seguidos

The diagnosis of head and neck infections constitutes relevant step in their treatment. However, in spite of the fact that most of diseases in head and neck region are infectious in nature, several reasons collaborated for dentists do not ask laboratory tests in order to help clinical diagnosis. By mean of this review literature, based on research articles about the newest and most reliable methods of diagnosis for clinical laboratories, the authors discuss the advantages and disadvantages of each selected method and the relevant aspects in transportation of the specimens to the laboratory. Saliva, biofilm, pus, and blood are the most frequent specimens for microbial diagnosis, being that the most used methods are culture and those based on detection of deoxyribonucleic acid by polymerase chain reaction method. Whereas, the culture depends on cellular viability, and has reduced sensitivity, as well as needs favorable conditions in the sample collection and transportation, PCR shows high sensitivity and specificity, but it does not allow the determination of antibiogram, what reduces its usefulness. In addition, few laboratories possess conditions to perform cultivation of obligate anaerobes or have experience in the molecular detection of these microorganisms.

Anaeróbios do complexo vermelho de Socransky e infecções bucais em pacientes com imunocomprometimento: características clínicas e prognóstico do tratamento

Os anaeróbios obrigatórios que compõem o complexo vermelho de Socransky são reconhecidos pelo seu envolvimento nas doenças periodontais humanas, mas em pacientes imunocomprometidos os mesmos parecem estar associados a quadros sépticos mais graves e de tratamento mais complexo. Esse estudo objetivou avaliar a ocorrência de Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf) e Treponema denticola (Td) no biofilme, mucosas e saliva de 160 pacientes HIV+, 5 pacientes leucêmicos, 50 pacientes submetidos à radioterapia para tratamento de câncer de cabeça e pescoço e sua correlação com sintomatologia clínica. Amostras de biofilme sub e supragengival, saliva e mucosas foram coletadas após a realização do exame clínico intrabucal. Após a extração do DNA, a detecção desses microrganismos era realizada por PCR. Esses patógenos foram detectados de todos os espécimes clínicos de pacientes com necrose de tecidos moles bucais. Nos pacientes HIV+, a frequência de detecção de Pg e Tf entre pacientes com periodontite foi 2,8 e 2,1 vezes mais elevada do que a observada nos indivíduos periodontalmente saudáveis. T. denticola foi detectado apenas nos sítios com necrose, supuração e perda óssea pronunciada. Pg e Tf se mostraram associados com perda óssea e sangramento gengival. A presença desses microrganismos esteve associada a odor fétido e dor, o que pode auxiliar o clínico na escolha de antimicrobianos como auxiliares do tratamento, devendo-se evitar o emprego de β-lactâmicos, podendo-se associar essas drogas ao metronidazol.

Infecções odontogenicas: relato de caso clínico e implicações terapêuticas

Acute infections maxillo-facial are of great importance, both for its high population, as the risk of complications. The aim of this study was to present a clinical case of extensive odontogenic abscess in a patient of 31 years of age attended the Service of Surgery and Maxillo-Facial, Faculty of Dentistry of Araçatuba - UNESP in Araçatuba, SP. Complications of infections odontogências although infrequent can lead the patient to death.

Infecções parasitárias na gravidez: prevalência e auto medicação com plantas medicinais na região de Araraquara -São Paulo - Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Reabilitação de maxila atrófica com tecido ósseo homógeno e prótese fixa implantossuportada

The techniques of bone reconstruction for atrophic maxillae have been improved in order to promote bone tissue growth in both height and thickness. The grafts performed with use of autogenous bone is considered the gold standard by most researchers, for demonstrating osteogenic capacity and not to promote antigenic response. However, this type of grafting is not possible to get bone tissue in large quantity for extensive renovations. In recent years, alternatives have been researched to overcome the limitations of autogenous bone. Several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts which are obtained from individuals with different genetic load, but from the same species have been extensively used. They can be indicated in cases of arthrosplasty, surgical knee reconstruction, and large bone defects as well as in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. To rehabilitate atrophic maxillae an option that has been performed with high success rate is the reconstruction with bone graft followed by osseointegrated dental implants to rehabilitate the patient aesthetics and functionally. This paper aims to show the feasibility of allogenic bone as material for reconstruction of atrophic maxilla, and subsequent rehabilitation with metal ceramic fixed prosthesis implant and dental restoration with accompanying three years through literature review and clinical case report.

O impacto das próteses implantossuportadas na harmonia facial

Many patients seeking dental care wish to improve facial and smile aesthetics to be accepted in modern day society. In denture wearers, the physiological resorption causes atrophy mainly in the maxilla, being necessary to carry out reconstruction techniques and sometimes orthognathic surgery to improve occlusal stability and facial harmony. The aim of this study is to discuss the features related to the rehabilitation of edentulous patients with indication for reconstruction of the maxilla using bone grafts and orthognathic surgery by means of a clinical case. In the present case, after the prosthetic rehabilitation, the patient was full satisfied with obtained results and dismissed the initially proposed surgical protocol. Therefore, professionals should provide therapeutic options but the patient’s opinion should prevail provided its clinical feasibility.

Oclusão em prótese sobre implante - parte I

Osseointegrated implants have specific nature distinguish them from natural teeth making them more susceptible to the efforts generated by mastication. The absence of periodontal ligament, which absorbs the masticatory forces and allows the movement of the teeth interfere with the reception of occlusal loads and therefore the predictability of implants. In the boneimplant interface did not occur the phenomena of dissipation of impact, even the movement induced. Thus, during planning and installation of implant prosthesis, the type and characteristics of occlusal pattern adopted should be established with criteria to be no grounds for future failures. In this regard we highlight the occlusal overload generated by several reasons like the presence of premature contacts, interference during motion excursive, deleterious habits and inappropriate extensions on cantilevers. Thus, the objective is to provide a review of the literature regarding the importance of occlusion in oral rehabilitation with implants. Factors to be considered in establishing a favorable occlusion, consistent with prostheses on implants will be described