Enxerto de tecido conjuntivo para correção da margem peri-implantar

Soft tissue recessions frequently cause esthetic disharmony and dissatisfaction. The results of coverage in peri-implant sites, in comparison with soft tissue coverage around a tooth, is less predictable. This clinical report describes the correction of an esthetic problem with a single-tooth implant-supported using a subepithelial connective tissue graft (SCTG) combined with the re-establishment of a new limit of gingival margin, and emergence crown profile. After anamnese and clinical exam it was observed an implant in the region of tooth 22 in vestibular position to alveolar ridge with a recession of 5 mm in its vestibular face. In the first cirurgical procedure the crown and the abutment were removed and a SCTG associated with a coronally positioned flap was performed in order to re-establish the limit of gingival margin. After 90 days, it was observed that the tissue in the implant site showed no adequate volume or thickness. Because of that, another SCTG was performed. The reopening procedure to install the healing cap was performed after 4 weeks. Then the prosthesis was installed. At 180 and 360 days postoperative, the implant adjacent tissue presented regular contour, color compatible with health and absence of bleeding. The patient was satisfied with the esthetic result. According to the clinical results and favorable esthetics it was possible to conclude that the use of ETC to correct an esthetic deficiency may be a feasible approach to establish new and stable peri-implant soft tissue contours.

Impacto do uso de fita adesiva na qualidade de vida de pacientes institucionalizados e usuários de próteses totais convencionais

Objective: Evaluate the impact of the use of strip adhesive over the quality of life of institutionalized patients and wearers of complete dentures. Material and method: Twenty-nine institutionalized patients wearers of complete denture were selected to this study and after a clinical exam, a questionnaire (adjusted and based upon the index of Oral Health Impact Profile and Oral Health-Related Quality of Life, OHIP and OHQOL) was applied to evaluate issues related to epidemiological conditions (gender and age), quality of life (pain, discomfort, functional limitations, phonetic, social, psychological and esthetic), taste and notion of implant treatment. Following this part, the patients received instruction to use the strips adhesives (Corega Fita Adesiva, Glaxo-Smith-Kline, Rio de Janeiro, Brazil), considering three in maxillary prosthesis and two in the lower prosthesis during a period of 30 days. After this period, all the patients were recall and the questionnaire was reapplied; add some adhesive performance questions, to compare the results before and after the adhesive use in terms of percentage. Result: After the adhesive strips use there were improvement of the functional, social and physcological limitation aspects, but without percentual increasement of phonetic and esthetics aspects. The results showed 65.5% of the answers stating adhesive maintenance between 6-12 hours, easy removal (68.9%), and without change the taste (89.6%). The notion for implant treatment was decreased changing from 75.8 to 37.9% after the adhesive use. Conclusion: The results enhanced a positive impact over quality of life of the respondents after the strip adhesive use, showing decrease of pain and discomfort, mainly of inferior dental prosthesis.

Análise das proporções faciais e sua relação com o formato dentário e com a dimensão vertical de repouso e de oclusão entre discentes institucionalizados

Considering the importance of the esthetic and the adequate register of vertical dimension (VD) to the oral rehabilitation, this study had as aims the analysis and comparison of two methods to get VD (Pleasure and Willis), functional space (FE), acquisition and correlation of facial and dental measurements. To do this, rest (RVD) and occlusal vertical dimension (OVD) and FE were achieved from the 30 students of the Federal University of Goias College of Dentistry. Following that, dental measurements of height and of the superior central incisors (SCI) and canine distance were registered. A facial analysis was performed to get the intercomissura, interalar, interpupilar, intercantal distance, besides register parameters as coincidence of dental and facial line, type of smile, face and SCI forms, and mastication type. The collected data were tabulated, compared by medias and standard deviations, and submitted to non-parametrical statistical analysis of Kruskal-Wallis and .Mann-Whitney with 5% of probability. The results doesn’t indicated statistical significant difference between FE of the two techniques. The measures of facial analysis are comparable with literature published data’s, but can’t be used as a parameter to the selection of intercanine distance. In 56.7% of the cases, there were coincidences of face and SCI forms, which could be a viable parameter in the selection of acrylic resin artificial tooth.

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.

A importância da geometria dos implantes para o planejamento em reabilitação oral: revisão de literatura

The design of implant structure is still a questioning to the professionals, while their variations can to influence of stress distribution favorably to bone. Therefore, the aim of study was to review addressing the topic of osseointegrated implants design establishing answers for the patient oral rehabilitation, according variations existing on the market. It was conducted a detailed search strategy by the PubMed/ Medline and Bireme, it was used as descriptors: “dental implants cylinder”; “dental implants thread”; “dental implants geometry”, until May 2014. From 798 articles, after review were selected 18 articles and 1 specific area book. The results were divided to compare design of implant and threads for further discussion and conclusions. Thus, conclude that the threads implants are best used because of its advantages with respect to the stress distribution and stability primary. The variations of the differents types of threads, have influence for stress distribution.

Reabilitação protética implantossuportada em região anterior maxilar com utilização de gengiva artificial cerâmica: relato de caso

The osseointegrated implants created a progress in oral rehabilitation. But this rehabilitation may be complicated by anatomical conditions, mainly in maxillary anterior region, where a higher aesthetic is required. The aim of study was to report one case which the use of angled abutments were necessary to allow the correct positioning of the prosthesis and also the prosthetic reconstruction with gingival-colored ceramic to provide best aesthetic result for patient. The aesthetic and functional results provided greater patient satisfaction with her smile. The correct planning is essential to provide to patient the best aesthetic and functional results, being necessary the use of abutments and gingival-colored ceramic to reach better results. Uniterms: dental implantacion, esthetics, mouth rehabilitation.

Aspectos clínicos influentes no planejamento das próteses sobre implantes tipo overdenture e protocolo

The aim of his study was to review the current scientific literature in order to discuss the surgical, prosthetics and psychological/psychosocial aspects during the treatment planning of edentulous patients, when a total fixed prosthesis or overdenture is indicated. To identify studies to take part in this review, a search was conducted for the following databases: PubMed, Dentistry and Oral Sciences Source, Journals@Ovid, SpringerLink, Wiley Online Library, Nature (NPG), Oxford Journals. It was used as descriptors: total fixed prostheses and overdentures. Inclusion criteria were: clinical articles, clinical case reports, case series, literature reviews and systematic reviews that addressed the study and comparison of total fixed prostheses and overdentures for a surgical- prosthetic planning. Exclusion criteria were: laboratory and in vitro studies and those whose first language was not English or Portuguese. Of a total of 454 articles, after an analysis according to inclusion and exclusion criteria, 76 articles were selected. During an implantsupported prosthesis rehabilitation with dental in edentulous patients, the use of alternative procedures appear to be effective when compared to more invasive surgical techniques, and thus, the amount of dental implants possible to install associated with prosthetic issues such as lip support, smile line, quantity and quality of mucosa, phonetics, etc., will allow an appropriate treatment planning to each clinical case

Planejamento reverso em implantodontia: relato de caso clínico

The oral rehabilitation has achieved great prominence in the dental implant, especially in the cases of reposition of units dental elements, so it is possible to replace each missing element to implant into your space where the tooth was loss. The reverse planning is fundamental to an appropriate rehabilitation, because promote the elimination of problems that might compromise the aesthetics and function of future dental implants. The objective of this study was to report the treatment plan for a patient in need of oral rehabilitation with implant dental prosthesis, using indications and techniques based on the literature, emphasizing the importance of reverse planning. We conducted an osseointegrated implant surgery using the principles of a connect procedure, thus allowing their successfully installing increasing the predictability of treatment. It is concluded that the success of rehabilitation treatment is directly related to the initial planning, a correct clinical approach and an integrated multidisciplinary team.

O Uso do Arco Facial para o correto posicionamento dos modelos no articulador

It presented the main features so that the wax plan can be conveniently filling the aesthetic and functional requirement of a denture. The steps of face bow mounting and wax plan transfer form the mouth to the articulator, considering the necessary requirement for this purpose are shown. This sequence aims to instruct and warn those who work with dentures about the needs of using face bows for correct reproduction of the models positioning in the articulator

Como realizar o selamento periférico e a moldagem funcional?

The functional impression technique is one of the most important steps for complete and/or partial edentulism treatment. So, correct analysis and record of supporting structures are essential to determine the denture extension. The functional impression technique has two stages - a customized final impression tray and a border impression - which aims to record the optimal denture supporting area. The aim of this study was to review the literature related to border impression and functional impression techniques, describing the technique and materials, and identifying the procedure’s objectives and function.

Técnicas de obtenção da posição de relação central em pacientes edêntulos

Edentulism causes loss of horizontal intermaxillary relationship, which is defined by the condyle position in the joint cavities, called centric relation. The correct record of centric relation in edentulous pacients has a strong influence on the treatment final result and is considered one of the most difficult clinical steps to achieve success. The aim of this study was to describe the main centric relation recording methods for edentulous patients reported in the literature. The study described physiological methods such as swallowing and pull tongue back, manipulative and graphic methods. It is concluded that the combination of different methods facilitates the correct centric relation record. Dentists must have a good knowledge of those techniques to perform this procedure satisfactorily.

Recuperação da dimensão vertical em pacientes com parafunção severa

The association between emotional stress and intense bruxism has as consequence the Temporomandibular Disorder (TMD), which is an increasingly apparent problem at the dental clinic, requiring judicious means of diagnosis and especially treatment.. Several factors, of equivalent importance, may be related to the DTM, one of them is the loss of vertical dimension of occlusion (VDO), and parafunctional habits and also the loss of stable contacts between the posterior teeth or lack thereof, which generates an increase functional anterior teeth for excessive wear or buccal and consequent.. This paper proposes using a clinical case, to present and discuss the steps for clinical diagnosis, planning and execution of oral rehabilitation with Fixed Partial Denture for restoring vertical dimension of occlusion in a patient with severe parafunction.. Oral rehabilitation of these patients should be carefully planned, respecting the functional and aesthetic aspects.. The parafunction control by monitoring the Temporomandibular Disorder is essential to the longitudinal prediction of rehabilitation performed in these types of rehabilitative treatment.

Halitose na geriatria: diagnóstico, causas e prevalência

Halitosis is the unpleasant odor of exhaust air through the mouth and lungs. There are over 50 causes, and approximately 90% of cases, is of oral origin. May have physiological origin (stress, breath of morning, fasting, and inappropriate diets), local reasons (bad oral hygiene, bacterial plaque retained on the tongue and/or tonsils, lower production of saliva, gum disease) or systemic reasons (diabetes, kidney or liver problems, constipation, etc.). In the Third Age, this problem tends to increase significantly. Thus, the aim of this study was to detect the presence of halitosis in the geriatric group attended in the dental clinic of UNIRP, identifying their incidence and principal causes. The sample consisted of 48 volunteer patients aged 60 years or older and included more than 90% of patients treated in this age group. It was performed a anamnesis and physical examination. The intra-oral halitosis was detected using a breath meter (halimeter). In the group studied, approximately 54.16% had halitosis, 84.61% of these were users of the prosthesis. The tongue coating was present in 80.76% of individuals with halitosis. After brushing the tongue, 88.46% of patients with halitosis have had the initial index oral malodor decreased. Based on the results of this study it was concluded that factors as dental prostheses and tongue coating are critical factors in causing halitosis.

Influence of morphological variables in photoelastic models with implants submitted to axial loading

Purpose: This study used 12 photoelastics models with different height and thickness to evaluate if the axial loading of 100N on implants changes the morphology of the photoelastic reflection. Methods: For the photoelastic analysis, the models were placed in a reflection polariscope for observation of the isochromatic fringes patterns. The formation of these fringes resulted from an axial load of 100N applied to the midpoint of the healing abutment attached to the implant with 10.0mm x 3.75mm (Conexão, Sistemas de Próteses, Brazil). The tension in each photoelastic model was monitored, photographed and observed using the software Phothoshop 7.0. For qualitative analysis, the area under the implant apex was measured including the green band of the second order fringe of each model using the software Image Tool. After comparison of the areas, the performance generated by each specimen was defined regarding the axial loading. Results: There were alterations in area with different height and thickness of the photoelastic models. It was observed that the group III (30mm in height) presented the smallest area. Conclusion: There was variation in the size of the areas analyzed for different height and thickness of the models and the morphology of the replica may directly influence the result in researches with photoelastic models.