Concepção morfológica de fórceps, para intervenção no paciente em posição supina e o operador sentado

Ergonomics, the science of working rationalization, seeks the best relationship between man and his working tools. In Dentistry, ergonomics is present as for the professional working correctly seated, in functional comfort, intervening of supine position patient, by means of suitable equipment and instrument. Nowadays, dental equipment is justly rationalized; however, some instruments should take shape, in order to adapt those requirements. The hand tool design should permit a comfortable, non-slip and safe handling. Thus, anatomical details, the correct position of the operator for its use and specific characteristics of application should be taken into account. The instrument under analysis - forceps - was conceived according to these requirements along with a new alveolar tooth extraction technique, based on electromyographic and biomechanical studies. The morphology of the instrument, which makes possible a simple and natural kinetics of the operator, was obtained by changing the paradigm of the conventional cross-action instruments (whose grip is always on the arms of the tool), divesting the handle from the tool arm. This induced on anatomical conceiving of perpendicular handles to the extremity of the tool arm, resulting an efficient and effective instrument, according to indicated on its experimental phase

Spontaneous osteonecrosis of the jaws in the maxilla of mice on antiresorptive treatment: A novel ONJ mouse model

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

Hard and soft tissue changes around implants installed in regular-sized and reduced alveolar bony ridges. An experimental study in dogs

Objective: To study bony and soft tissue changes at implants installed in alveolar bony ridges of different widths.Material and methods: In 6 Labrador dogs, the mandibular premolars and first molars were extracted, and a buccal defect was created in the left side at the third and fourth premolars by removing the buccal bone and the inter-radicular and interdental septa. Three months after tooth extraction, full-thickness mucoperiosteal flaps were elevated, and implants were installed, two at the reduced (test) and two at the regular-sized ridges (control). Narrow or wide abutments were affixed to the implants. After 3 months, biopsies were harvested, and ground sections prepared for histological evaluation.Results: A higher vertical buccal bony crest resorption was found at the test (1.5 +/- 0.7 mm and 1.0 +/- 0.7 mm) compared to the control implants (1.0 +/- 0.5 mm and 0.7 +/- 0.4 mm), for both wide and narrow abutment sites. A higher horizontal alveolar resorption was identified at the control compared to the test implants. The difference was significant for narrow abutment sites. The peri-implant mucosa was more coronally positioned at the narrow abutment, in the test sites, while for the control sites, the mucosal adaptation was more coronal at the wide abutment sites. These differences, however, did not reach statistical significance.Conclusions: Implants installed in regular-sized alveolar ridges had a higher horizontal, but a lower vertical buccal bony crest resorption compared to implants installed in reduced alveolar ridges. Narrow abutments in reduced ridges as well as wide abutments in regular-sized ridges yielded less soft tissue recession compared to their counterparts.

Expressão de genes relacionados à remodelação óssea na fase inicial da reabsorção do rebordo residual em mandíbulas humanas

Pós-graduação em Biopatologia Bucal - ICT

An unusual case of severe primary molar infraocclusion

Dentoalveolar ankylosis is described as the direct union between root cementum/dentin and alveolar bone. Its etiology is unknown, and conflicting opinions have been presented to explain it. Late detection of ankylosed primary teeth may cause serious problems to the occlusion and generally demands a more complex treatment approach. The purpose of this report is to present an unusual case of severe infraocclusion of the primary maxillary right second molar associated with a posterior crossbite in a 6-year-old child. The initial treatment option was tooth extraction, but the tooth resumed eruption spontaneously. After correction of the posterior crossbite and a 1-year follow-up, the tooth remained in occlusion and the permanent successor was developing without problems. From this unusual outcome, it may be concluded that further investigation of this anomaly of eruption is needed. (J Dent Child 2013;80(2):88-91)

Estabilidade oclusal a longo prazo de Classe II, divisão 1, após tratamento com extração de pré-molares

Patients are looking for esthetic and functional changes when seeking orthodontic treatment and expect the remaining of a stable occlusion. Occlusion stability is one of the goals of the orthodontist; however, dental relationships changes in long-term can occur leading to a relapse of the treatment. Teeth and shape of arches tend to return to the original form, been the retention phase important after the appliance removal, even after several years of post-treatment. This article approaches a submission of a clinical case of Class II division 1 treated with extraction of premolars analyzing its long-term stability.

Extração de incisivo inferior: uma alternativa no tratamento da classe III

The correction of a Class III malocclusion in adult patients is one of the major challenges in orthodontics due to facial deformities occurring during the unfavorable growth of this kind of pattern, as well as the treatment options capable of producing facial changes aesthetically acceptable and adequate for today's beauty standards. One acceptable alternative treatment is the removal of a lower incisor. For a Class III correction through a lower incisor extraction a thorough analysis and planning must be carried out by taking into consideration the amount of overjet and overbite, periodontal condition of the teeth and the possibility of obtaining a good dental occlusion with acceptable facial aesthetics. Will be presented two case reports of patients presenting an anteroinferior crowding, Class III malocclusion condition. The treatment through a lower incisor extraction and the reasons why this treatment was adopted will be discussed.

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histological validation

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Complicações Associadas aos Enxertos Ósseos Aposicionais com Osso Autógeno

Introdution: Tooth extraction results in alveolar ridge resorption due to the progressive reabsorption, which frequently is a limitating factor of dental implants treatment, in function of the insufficient bone height for execution, could be indicated the use of grafts for increase of the alveolar edge. However, the success of the bone graft requests the meticulous attendance of the clinical stages. Proposition: The objective of this research was to evaluate the postoperative complications associated to the autogenous bone grafts. Materials and Methods: Through a random retrospective analysis, 90 file records of patients submitted to the surgical procedure of autogenous bone graft in the period of January from 2000 to the March of 2008. A clinical record was elaborated with base in the necessary data for this evaluation. Results: About the file data analysis, 59 female with average of 49,42 years and 31 male with average of 47,90 years. The previous diseases most related were arterial hypertension, stomachache and diabetis. The smokers was noticed in 13,3% of patients. The donor site most used was a mandibular ramus. The postoperative complications in receiving area represented 17,8% of file datas analysed and in the donor site only one patient showed parestesis. Conclusion: Among the total analyzed files it was observed that the postoperative complications associated with the autogenous bone grafts represented 18,9% of the patients submitted to the procedure, more frequently affecting the receiving area, obtaining partial exposure of the bone graft and absence of inserted gingiva on vestibular cortical bone.

Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement

Forced orthodontic eruption (FOE) is a non-surgical treatment option that allows modifying the osseous and gingival topography. The aim of this article is to present a clinical case of a FOE, which resulted in an improvement of the amount of available bone and soft-tissues for implant site development. Patient was referred for treatment of mobility and unesthetic appearance of their maxillary incisors. Clinical and radiographic examination revealed inflamed gingival tissue, horizontal and vertical tooth mobility and interproximal angular bone defects. It was chosen a multidisciplinary treatment approach using FOE, tooth extraction, and immediate implant placement to achieve better esthetic results. The use of FOE, in periodontally compromised teeth, promoted the formation of a new bone and soft-tissue in a coronal direction, without additional surgical procedures, enabling an esthetic, and functional implant-supported restoration.

A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration: a 2-year follow-up

Introduction: The demand for optimal esthetics has increased with the advance of the implant dentistry and with the desire for easier, safer and faster technique allowing predictable outcomes. Thus, the aim of this case report was to describe a combined approach for the treatment of a periodontally compromised tooth by means of atraumatic tooth extraction, immediate flapless implant placement, autogenous block and particulate bone graft followed by connective tissue graft and immediate provisionalization of the crown in the same operatory time. Case Report: A 27-year-old woman underwent the proposed surgical procedures for the treatment of her compromised maxillary right first premolar. The tooth was removed atraumatically with a periotome without incision. A dental implant was inserted 3 mm apical to the cement-enamel junction of the adjacent teeth enabling the ideal tridimensional implant position. An osteotomy was performed in the maxillary tuber for block bone graft harvesting that allowed the reconstruction of the alveolar buccal plate. Thereafter, an autogenous connective tissue graft was placed to increase both the horizontal and vertical dimensions of the alveolar socket reaching the patient functional and esthetic expectations. Conclusion: This treatment protocol was efficient to create a harmonious gingival architecture with sufficient width and thickness, maintaining the stability of the alveolar bone crest yielding excellent aesthetic results after 2-years of follow-up. We suggest that this approach can be considered a viable alternative for the treatment of periodontally compromised tooth in the maxillary esthetic area enhancing patient comfort and satisfaction.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Behaviour of the buccal crestal bone levels after immediate placement of implants subjected to immediate loading

The aim of this study was to measure changes in buccal alveolar crestal bone levels after immediate placement and loading of dental implants with Morse taper prosthetic abutments after tooth extraction. This study followed the STROBE guidelines regarding prospective cohort studies. The sample comprised 12 patients with a mean age of 45 years, in whom a central or upper lateral incisor was indicated for extraction. Prior to extraction, computed tomography (CT) analysis was carried out to assess the presence of the buccal bone crest. CT scans were performed at 24 h and at 6 months after immediate implant placement and immediate loading. The distance from the most apical point of the implant platform to the buccal bone crest was assessed at the two time points. The buccal bone crest height was evaluated at three points in the mesio-distal direction: (1) the centre point of the alveolus, (2) 1 mm mesial to the centre point, and (3) 1 mm distal to the centre point. The values obtained were subjected to statistical analysis, comparing the distances from the bone crest to the implant platform for the two time points. After 6 months there was a statistically significant, non-uniform reduction in height at the level of the crest of the buccal bone in the cervical direction. It is concluded that the buccal bone crest of the immediate implants that replaced the maxillary incisors underwent apical resorption when subjected to immediate loading.

Dynamic UCLA for single tilted implant in an aesthetic region

The aim of this paper was to present a rehabilitation of a patient with a dynamic universal castable long abutment (UCLA) for a single tilted implant in the anterior maxillary area. A 57-year-old male patient attended the dentistry college clinic complaining of a vertical fracture of a residual root of the dental element 22. The tooth extraction was indicated for the implant installation. Due to the socket buccal wall thickness, the implant was installed with an inclination to the palate. It was done in a two-stage surgical protocol, and an external hexagon implant (3.75×11.5mm) was placed. After a six-month healing period to correct the implant position, a dynamic UCLA was set in place, rectifying the implant emergence profile at 20°. The ceramic structure fitting was performed and, after the patient's consent, the prosthesis was finalized and installed. After a follow-up period of twenty months, no complications were observed. The installation of tilted implants with a dynamic UCLA may be a viable option, faster and less invasive than bone grafts.

Sub-crestal positioning of implants results in higher bony crest resorption: an experimental study in dogs

To compare peri-implant soft- and hard-tissue integration at implants installed juxta- or sub-crestally. Furthermore, differences in the hard and soft peri-implant tissue dimensions at sites prepared with drills or sonic instruments were to be evaluated. Three months after tooth extraction in six dogs, recipient sites were prepared in both sides of the mandible using conventional drills or a sonic device (Sonosurgery(®) ). Two implants with a 1.7-mm high-polished neck were installed, one with the rough/smooth surface interface placed at the level of the buccal bony crest (control) and the second placed 1.3 mm deeper (test). After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. The buccal distances between the abutment/fixture junction (AF) and the most coronal level of osseointegration (B) were 1.6 ± 0.6 and 2.4 ± 0.4 mm; between AF and the top of the bony crest (C), they were 1.4 ± 0.4 and 2.2 ± 0.2 mm at the test and control sites, respectively. The top of the peri-implant mucosa (PM) was located more coronally at the test (1.2 ± 0.6 mm) compared to the control sites (0.6 ± 0.5 mm). However, when the original position of the bony crest was taken into account, a higher bone loss and a more apical position of the peri-implant mucosa resulted at the test sites. The placement of implants into a sub-crestal location resulted in a higher vertical buccal bone resorption and a more apical position of the peri-implant mucosa in relation to the level of the bony crest at implant installation. Moreover, peri-implant hard-tissue dimensions were similar at sites prepared with either drills or Sonosurgery(®) .