Fatores biomecânicos relevantes na seleção dos grampos em próteses parciais removíveis com extremo livre: estudo clínico

The free-end removable partial dentures (RPD) shows a complicated and peculiar biomechanical behavior that impose high occlusion forces to the abutment teeth. By this way, the aim of this study was to evaluate the several factors that influence the clasps indication to free-end RPD. It was analysed 84 designed and planned study models of 71 patients, involving 130 clasps near-by a free-end; followed by clinical and radiographical informations. It was observed that bar clasps (“T”, “Tmod”, “i”) were used in 88.46% of abutment teeth. In the others (11.55%), it was used simple, combinated or ring circumferential clasps, and MDL. In abutment teeth with high equator line the “i” clasps were predominant (48.48%). The “Tmod” clasps were predominant in abutment teeth with low equator line (50%) or in middle third (51.35%) and “T” clasps were predominant in inclined equators with mesio-buccal (56.52%) or disto-buccal (66.66%) retention. In the posterior abutment teeth, it was prevalent the distal rest (63.52%) and embracing to the adjacent tooth. Some others factors like long clinical crown (5.38%), wrong position of abutment teeth (4.61%), aesthetics (3.07%), retention in alveolar ridge (2.3%), fragility of abutment teeth (1.53%), short clinical crown (0.76%) and short space to the clasp (0.76%) influenced directly during the clasps selection. Factors like mobility of abutment teeth, height of muscular insertions, depth of buccal fornix and antagonist arch acted like secondary factors. After the informations analysis it may be concluded that the bar clasps with distal rest and embracing to the adjacent tooth were the most indicated to free-end RPD

Análise por computação gráfica das alterações produzidas em próteses totais superiores imersas diretamente em água e pela termociclagem

Objectives: This study aimed to assess dimensional changes in acrylic resin base and artificial teeth position after water storage and thermocycling using computer graphics measurements. Methods: Twenty-four waxed replicas were obtained from a previous upper complete denture. For linear measurements, points in cusps tips of left central incisor and second premolars and molars were marked in one of the prostheses with graphite and transferred to the others using an acrylic resin guide. The prostheses were scanned after waxing, polymerization and treatments and the images were exported to “AutoCad 2002 Today®” software for measurements. Results: There was no statistically significant difference in changes of each segment for each group and between the phases evaluated after polymerization and thermocycling. In groups I and III, the values after polymerization are higher than those after treatment, which suggests shrinkage while the prostheses in group II have expanded. Conclusion: The three groups exhibited artificial teeth movement after tests in comparison to the polymerized prosthesis. The prostheses submitted to water storage in kiln at 36ºC during seven days showed different behavior than the other groups.

Clareamento dentário x autoestima x autoimagem

Dental changes that compromise facial harmony can have serious consequences on the social image of the patient. Depending on the emotional significance for the individual it can change interpersonal relationships, causing profound changes in their patterns of self-acceptance and self-image, with profound effects on their self-esteem of the patient. The search for tooth whitening as cosmetic factor for a harmonic smile grew sharply in the last decade. Although the color of the tooth represents only one aspect in the set of determinants of facial harmony, it is a strong factor because it is quickly perceived. This study aims to report the clinical case of a patient with spots on their upper central incisors. For the patient these spots have compromised her smile, causing harm and discomfort in their everyday social and professional relationships.

Registro do perfil de emergência para mimetização dos dentes naturais na região estética

Introdução: o tratamento com implantes dentários para a reposição de dentes na região estética exige a utilização de materiais e técnicas que permitam o máximo de naturalidade entre a restauração, os dentes vizinhos e o tecido gengival. Dessa forma, torna-se necessário criar o correto perfil de emergência para o dente, assim como a utilização de materiais com alto potencial estético. Objetivo: o objetivo do presente trabalho foi ilustrar, através de um caso clínico, a utilização de uma técnica de moldagem para a correta cópia do perfil de emergência do dente e sua transferência para o modelo de trabalho, tornando possível a confecção de uma restauração totalmente cerâmica, perfeitamente integrada ao tecido gengival. Caso clínico: paciente de 30 anos, procurou o clínica de prótese dentária com desejo de melhorar a estética dos dentes. Após diagnóstico e planejamento, foram confeccionadas 2 coroas totalmente cerâmicas sobre os dentes 12 e 21, e confecção de 1 coroa cerâmica sobre um pilar de zircônia após o estabelecimento e registro do perfil de emergência do dente 11. Conclusão: após a conclusão do tratamento, observou-se naturalidade, estética e perfeita integração entre as restaurações, os dentes remanescentes e o tecido gengival.

Laminados cerâmicos em dentes tratados endodonticamente: considerações restauradoras e endodônticas com finalidade protética

A harmonia e beleza de um sorriso podem ser comprometidos pela presença de apenas um dente da região anterior que se apresente escurecido, mesmo que os demais elementos estejam alinhados e com forma adequada. A alteração de coloração, mesmo que mínima, sendo na região frontal é capaz de gerar um ponto de tensão e de desequilíbrio no sorriso, concentrando o olhar do observador no local1,2,3. Logo, a demanda dos pacientes por um sorriso estético, belo e harmonioso aumenta o desafio do profissional que visa integrar as características ópticas de um dente anterior despolpado e escurecido com os demais dentes polpados e sem manchamentos significativos. O clareamento é a alternativa mais conservadora para resolver o escurecimento em dentes despolpados. Apesar de resultados satisfatórios, alguns clínicos e autores relutam em assumir, como rotina, os procedimentos de clareamento para dentes despolpados, pelo alto índice de recidiva de escurecimento4,5. Mas, é importante lembrar que as recidivas descritas, normalmente, não contemplam um retorno aos valores inicias de manchamento. Deve ser feito um bom planejamento, levando em considerações fatores como a idade do paciente, o grau de escurecimento, o tempo em que o dente se encontra escurecido e a dificuldade em se alcançar o clareamento do dente, que são determinantes para o sucesso do tratamento clareador e para estabelecer a longevidade do clareamento obtido. Por isso, não são todos os dentes despolpados que apresentam alteração de cor que podem ser clareados, devendo ser avaliados com precisão os critérios estabelecidos3. Os dentes tratados endodonticamente e escurecidos, muitas vezes, necessitam da reintegração estética, associando as técnicas de clareamento com procedimentos restauradores ou, dependendo da condição do dente, a escolha imediata por procedimentos restauradores diretos ou indiretos.

Considerações relevantes na seleção de dentes artificiais

Nowadays the search for aesthetic in removable dentures is considered a success clinical factor. Besides, both the selection of artificial denture teeth and the characterization of dentures have been based on the facial harmony and cultural factors. But these factors change over time. Therefore, the present study aimed to discuss the selection of artificial denture teeth in relation to patient’s variables such as face shape, skin color, hair color, eye color, age and gender. Moreover, artificial denture teeth’ color, shape and size were presented.

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.

The influence of the alveolar ridge shape on the stress distribution in a free-end saddle removable partial denture supported by implant

The alveolar ridge shape plays an important role in predicting the demand on the support tooth and alveolar bone in the removable partial denture (RPD) treatment. However, these data are unclear when the RPD is associated with implants. This study evaluated the influence of the alveolar ridge shape on the stress distribution of a free-end saddle RPD partially supported by implant using 2-dimensioanl finite element analysis (FEA). Four mathematical models (M) of a mandibular hemiarch simulating various alveolar ridge shapes (1-distal desceding, 2- concave, 3-horizontal and 4-distal ascending) were built. Tooth 33 was placed as the abutment. Two RPDs, one supported by tooth and fibromucosa (MB) and other one supported by tooth and implant (MC) were simulated. MA was the control (no RPD). The load (50N) were applied simultaneously on each cusp. Appropriate boundary conditions were assigned on the border of alveolar bone. Ansys 10.0 software was used to calculate the stress fields and the von Mises equivalent stress criteria (σvM) was applied to analyze the results. The distal ascending shape showed the highest σvM for cortical and medullar bone. The alveolar ridge shape had little effect on changing the σvM based on the same prosthesis, mainly around the abutment tooth.

Histórico de traumatismo dentoalveolar e movimentação ortodôntica: uma relação perigosa?

O traumatismo dentoalveolar é uma ocorrência cada vez mais comum na população em geral e está relacionado, na maioria das vezes à violência no trânsito, violência urbana e à prática esportiva. Esse aspecto, por conseguinte, tem aumentado sobremaneira o número de pacientes que procuram o tratamento ortodôntico e que relatam ter passado por algum episódio de trauma em seus dentes. Dentro desse contexto, muitas questões surgem com relação ao manejo de dentes com histórico de traumatismo dentoalveolar. Do ponto de vista histológico, quais as diferenças em movimentar-se um dente com histórico de trauma? O fato de um dente ter sido traumatizado pode influenciar no planejamento e no tratamento ortodôntico? E o protocolo das ativações do aparelho deveria ser alterado? O objetivo desse trabalho é apresentar uma breve revisão de literatura, bem como dois casos clínicos de pacientes que sofreram trauma dentário prévio à movimentação ortodôntica, no sentido de gerar subsídios técnicos e científicos para o especialista em Ortodontia, de modo que busque conhecer as implicações e limitações em movimentar dentes traumatizados.

Granuloma periférico de células gigantes: relato de caso

The peripheral giant cell granuloma (GPCG) is defined as a benign disorder of uncertain etiopathogenesis and proliferative reaction of the fibrous connective tissue or periosteum, which is characterized histologically by the presence of multinucleated giant cells. The purpose of this study is to report a case of GPCG in a 56-year-old white woman presenting a bleeding nodule on palpation, a red color with small whitish ulcerated areas, defined limits, resilient consistency, a pedicled base 2.0 cm in diameter, asymptomatic, involving the permanent lower left third molar, which presented mobility. Radiographically there was significant bone loss in this tooth region, whose initial diagnosis was pyogenic granuloma. The definitive diagnosis was obtained after excisional biopsy the microscopic examination of which identified the presence of multinucleated giant cells. The clinical postoperative follow-up revealed a favorable cicatricial repair of the operated area with no recurrence after 9 months of monitoring.

Auditoria em Saúde: justificativas de glosas no setor odontológico

Objective – To collecting data about the main explanations for glosses and demonstrating the percentage of production loss in the odontologic procedures. Methods – It is about an epidemiological study of historical series, retrospective and quantitative, based on the data collection of DATASUS information system and reports realized by the city of Aquidauana/MS audit system from 2001 to 2010. Results – The results show that in this period, 921.300 odontologic procedures were presented as production; being 223.226 (24,2%) individual procedures and 698.074 (75,8%) collective. There were 23.881 (2,6%) glosses, being 10.158 (42,5%) in the collective procedures and 13.723 (57,5%) in the individual ones. The main cause for glosses related to individual procedures was the repetition of procedures for the same patient and the same tooth (42,4%). In the collective activities, it was the non-accomplishment of the oral health collective program (68,9%). There was an increase of loss in the individual procedures going from less than 5% in the period of 2001 to 2007; to 5,8 % in 2008; 8,9% in 2009 and 14,1 % in 2010 and in the collective procedures the loss reached 4% in 2010. Conclusion – It was concluded that the most frequent cause of glosses explanation was the repetition of procedures for the same patient and the same tooth in the individual cases and the non-accomplishment of the oral health collective program in the collective activities. The importance of the audit system as a trust-worthy instrument for the managers in the planning and evaluation of health actions with the intention of guarantee the solution of the serv-ices provided.

Granuloma Periférico de Células Gigantes: Relato de caso com acompanhamento de 2 anos

The peripheral giant cell granuloma (GPCG) is defined as a benign disorder of uncertain etiopathogenesis, and proliferative reaction of the fibrous connective tissue or the periosteum, which is characterized histologically by the presence of multinucleated giant cells. The purpose of this study is report a case of GPCG in a white women, with 56 years old, presenting nodule bleeding to the touch, red and white with small ulcerated areas, defined limits, resilient consistency, pedicled base with 2.0 cm diameter, asymptomatic, involving the permanent lower left third molar, that it was presented with mobility. Radiographically there was significant bone loss in this tooth region, whose initial diagnosis was pyogenic granuloma. The definitive diagnosis was obtained after excisional biopsy in which microscopic examination it was identified e presence of multinucleated giant cells. The clinical postoperative presented favorable cicatricial repairing of the operated area without recurrence after two years of monitoring.

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tratamento tardio de traumatismo dentário anterior pela técnica de apicificação

Introdução: paciente do sexo masculino, 37 anos de idade. Após a anamnese, foi constatado que o dente 11 apresentava abertura coronária e presença de hidróxido de cálcio com histórico de trauma dentário nesse dente. Radiograficamente, o dente 11 apresentava formação radicular incompleta, paredes dentinárias finas e frágeis, com divergência foraminal associada a imagem radiolúcida periapical. Objetivo: relatar um caso clínico de apicificação, realizado com trocas de curativo de hidróxido de cálcio. Métodos: o tratamento de escolha foi a apicificação, a qual teve início na segunda sessão, após 15 dias, por meio de desbridamento químico-mecânico de todo o canal radicular, com limas tipo K e irrigação com uma solução de hipoclorito de sódio a 2,5%. Em seguida, pasta de hidróxido de cálcio (hidróxido de cálcio, iodofórmio e propilenoglicol) foi aplicada e trocada de 15 em 15 dias, durante 4 meses. O exame radiográfico foi novamente realizado e demonstrou o fechamento completo da abertura foraminal e regressão da radiolucência periapical. O canal radicular foi obturado utilizando-se um cone confeccionado a partir da união de três cones #60 e pela técnica de condensação lateral com Sealapex. Resultados: seis meses após a obturação, exames revelaram tecidos periapicais normais e ausência de sintomas. Conclusão: concluiu-se que o tratamento do traumatismo dentário associado à necrose do tecido pulpar e à lesão periapical, com trocas sucessivas de pasta de hidróxido de cálcio, foi adequado para se obter a regressão da lesão periapical, formação de barreira mineralizada e promoção de saúde ao paciente.

Avaliação clínica do clareamento no consultório: técnica de aplicação única do agente clareador

This study aimed to evaluate the clinical effectiveness of two bleaching agents without changing the whitening gel during the clinic session 1X45minutos. 10 patients were selected according to the criteria of inclusion and exclusion and upper arch of the patients were divided into two quadrants (n: 10), G1: gel clareador Clàriant Office (hidrogênio35 Angellus) peroxide% (PH) in superior right side (LD) and the gel WhitenessHp Blue (FGM) PH 35% on the superior left side (LE. 2 clinical sessions were accomplished, 45 minutes each, with an interval of one week between sessions. At first the bleaching treatment patients received prophylaxis, molding to guide measurement of color with condensation silicon and the color evaluation through the apparel spectrophotometer VITA Easyshade (Vita Zhanfabrik, Alemanhã). 14 days after the end of the bleaching treatment was performed the measurement final color of the teeth. The patients reported sensitivity in scale 0-4. The result showed that through T Test comparing quadrants presented no statistical differences (p>0,05) in relation to coloration and dental sensibility. It can be concluded that the materials evaluated are effective for bleaching vital teeth with low tooth sensibility.