The importance of the lifelike esthetic appearance of all-ceramic restorations on anterior teeth

The success of rehabilitation will not depend on just clinical procedures. A proper dental technique (ceramist) is required as well as the respect for some biomimetic principles to obtain the desired final result. This study has the purpose of describing a prosthetic rehabilitation with laminate veneers and all-ceramic crowns of a patient unsatisfied with a previous esthetic treatment because of the negligence of some biomimetic principles. A 45-year-old female patient was admitted to the dental clinic complaining about the lifelike appearance of her all-ceramic restorations. Before the fabrication of new restorations, a mock-up was conducted to verify the patient's satisfaction. A ceramist conducted all the fabrication process so that surface characterizations could be visually verified and the lifelike appearance of natural tooth could be reproduced. After the cementation procedure, the patient reported being satisfied with the lifelike appearance of the new restorations. Based on the clinical findings of the present case report, it can be concluded that the reproduction of the lifelike esthetic appearance of natural teeth and the visualization of the final results before definitive procedures are essential to obtain the clinical success.

Three-dimensional finite element analysis of anterior single implant-supported prostheses with different bone anchorages

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

Neuromuscular efficiency of the vastus lateralis and biceps femoris muscles in individuals with anterior cruciate ligament injuries

To analyze strength and integrated electromyography (IEMG) data in order to determine the neuromuscular efficiency (NME) of the vastus lateralis (VL) and biceps femoris (BF) muscles in patients with anterior cruciate ligament (ACL) injuries, during the preoperative and postoperative periods; and to compare the injured limb at these two times, using the non-operated limb as a control. EMG data and BF and VL strength data were collected during three maximum isometric contractions in knee flexion and extension movements. The assessment protocol was applied before the operation and two months after the operation, and the NME of the BF and VL muscles was obtained. There was no difference in the NME of the VL muscle from before to after the operation. On the other hand, the NME of the BF in the non-operated limb was found to have increased, two months after the surgery. The NME provides a good estimate of muscle function because it is directly related to muscle strength and capacity for activation. However, the results indicated that two months after the ACL reconstruction procedure, at the time when loading in the open kinetic chain within rehabilitation protocols is usually started, the neuromuscular efficiency of the VL and BF had still not been reestablished.

Aplicação da análise de jarabak, no estudo da relação entre a altura total facial anterior e posterior, em pacientes portadores de má-oclusão de classe I e classe II divisão 1 de angle, por meio de radiografias cefalométricas

ln order to predict the facial growth using Jarahak's analysis, cephalometric radiographies of 120 subjects during the mixed dentition and between 6 and 10 years of age were studied. From the total, 60 subjects (30 males and 30 females) were classified as Angle's Class I and 60 subjects (30 males and 30 females) were classified as Angle's Class II, Division 1. AIl subjects did not receive any orthodontic treatment. The proportion between anterior and posterior facial heigth (SGo-NMe) was studied, which is determined by the formula PFH x 100/ AFH = %, neither being straight (> 62% < 65), clockwise ( > 58% < 62%) and anti-clockwise ( > 65% - 80%). Mean average, standard deviation and facial height proportion (SGo - NMe) were determined for males and females according to Angle's classification of malocc!usion. Sexual dimorphism was examined with regard to different types of Angle's malocclusion and the direction of the facial growth, and the correlation of four cephalometrics measurements were analvsed

Reconstruction of the anterior wall of the frontal sinus using bovine bone matrix: histological study with monkeys

The purpose of this study was to evaluate the repair process in the reconstruction of the anterior wall of the frontal sinus of monkeys with bovine bone matrix. Four adult Cebus apella monkeys underwent an ostectomy of the anterior wall of the frontal sinus. The frontal sinus mucosa and the nasofrontal duct were not manipulated. Reconstruction occurred with implants of bovine bone matrix laminae measuring 2.0 x 2.5 cm and 0.4 mm thick, stabilized under pressure in the lateral wall of the frontal sinus. The monkeys were sacrificed over a period of 150 days and routine laboratory procedures were followed for hematoxylin-eosin staining and histologic evaluation of the specimens. Neoformed bone tissue was observed in contact with the frontal sinus mucosa and the bovine bone matrix. The frontal sinus mucosa remained whole without fibrous tissue or cystic formations. There was no occurrence of cellularization as well as revascularization of the bovine bone matrix, though it has permitted bone conduction on this surface. It was possible to conclude that the demineralized bovine bone matrix was biotolerable, being incorporated into the bone without the presence of inflammatory cells with characteristics of inertness and antigenicity and behaved as an osteoconductive material.

Resolução de alteração estéticaem dente anterior com projeção cervical de esmalte

Enamel projection is often localized in furcation area between the roots of molars and is considered as predisposing factor for localized periodontal disease. When localized in anterior teeth, may determine anti-aesthetic condition as gingival recession. In this case, an enamel projection in tooth 23 produce an anti-aesthetic condition with was treated by mucogingival surgery.

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.

Resolução estética associando prótese sobre implante e prótese convencional na região anterior

The combination of several methods for solving aesthetics in a clinical case can be a complicating factor. The diagnosis and planning of the event held in conjunction with the dental technician expand the possibilities of success. The present case illustrates the aesthetic resolution through the association of implant- and tooth-supported prostheses using metal free ceramic systems. A 38-year old male patient presented with a complex smile. After diagnosis and treatment planning, two ceramic crowns were made, one on tooth 11 and one on the implant region 21, along with a laminated porcelain veneer on the region of 12. Aesthetic needs of the patient are predictable only with a sound diagnosis.

Variação da temperatura superficial dos músculos masseter e temporal anterior durante o apertamento dental voluntário com placas interoclusais maxilares de duas diferentes espessuras

Muscle activity has been studied indirectly through analyses of temperature variation in skin surface temperature on the masticatory muscles. These procedure may be an important tool for clinical evaluation and assessment of the evolution of temporomandibular disorders, as well as monitoring the adopted protocol. Thus, its utilization for identified pathological alterations on blood circulation and/or on metabolic activity in subcutaneous tissues, such as the masticatory muscles, is justified. The aim of this study was to investigate the effect of occlusal splints’ thickness on the variation of surface temperature of the anterior temporal and masseter muscles during rest and clenching. It were analyzed 20 symptomatic subjects (10 males and 10 females) selected through the Research Diagnostic Criteria (RDC) questionnaire. Temperature expressed in degrees Celsius (ºC) was measured on the surface of both muscles measured with the aid of a digital thermometer with an infrared radiation reading system. The surface temperature of the anterior temporal and masseter muscles presented significant reduction during teeth clenching in relation to the mandibular rest position. However, there were no significant differences between conditions with and without occlusal splint or between the different thicknesses of splints analyzed. Masticatory muscles showed a considerable similar behavior for both sides, and no significant distinctions were observed between male and female patients.

Distal extension removable partial denture with resilient attachment connect to an anterior fixed implant-supported prosthesis: a clinical report

Background: Considering the limited qualitative and quantitative bone in the posterior arch, this modality of prosthetic treatment could provide a positive emotional factor reestablished by immovability of the anterior fixed implant-supported segment. Objective: This clinical report demonstrates the possibility of achieving positive results with a removable partial denture connected to an implant-supported fixed prosthesis associated to an extra resilient attachment. Clinical significance: In cases of posterior mandibular and maxilla atrophy added to the patients desire against the bone graft, this kind of prosthetic treatment has an important place as an alternative.

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.

Diagnostic accuracy of the EMG parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome

Objective To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Design Sensitivity and specificity analysis. Setting Physical rehabilitation center and laboratory of biomechanics and motor control. Participants Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Interventions Not applicable. Main Outcome Measure The diagnostic accuracy was calculated for sEMG parameters’ reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. Results The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80–.90), precise (SEM=2.71–3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). Conclusions The results provide evidence to support the use of EMG signals (B2 – frequency band of 45–96Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.