Mudou o quê?!: fatos e relatos do crescimento econômico brasileiro no século XXI

The objective of this research is a production of a reporting-book broaching different aspects of the brazilian economic growing, more specifically on the last ten years. These visages surround topics so much discussed by the brazilian and international media. As these medias searched answers for the success of the Brazil's Economy in the 21st century, specially with the good results of the GDP in 2010, the reporting-book also was produced in order to explain better the brazilian scene on the crest of the greatest economic crisis of recent years which has led developed countries to its political and economic degradation

Tratamento do sorriso gengival: como estabelecer proporção e harmonia

The etiology of gingival smile is multifactorial and the correct diagnosis eill determine a successful treatment planning. Altered passive eruption occurs during the final stages of tooth eruption, when apical migration of the periodontal tissues does not occur, resulting in a distance > 2mm between the alveolar crest and the cement-enamel juncrion. This change leads to the shortening of the clinical crown and even further may lead to excessive gingival exposure. For treatment, there is a necessity for the combined removal of gingiva and bone tissue. This article discusses the literature on the issue and reports a case where periodontal plastic surgery was performed for the correcrion of a gingival smile.

Periodontal disease-associated compensatory expression of osteoprotegerin is lost in type 1 diabetes mellitus and correlates with alveolar bone destruction by regulating osteoclastogenesis

Alveolar bone resorption results from the inflammatory response to periodontal pathogens. Systemic diseases that affect the host response, such as type 1 diabetes mellitus (DM1), can potentiate the severity of periodontal disease (PD) and accelerate bone resorption. However, the biological mechanisms by which DM1 modulates PD are not fully understood. The aim of this study was to determine the influence of DM1 on alveolar bone resorption and to evaluate the role of receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) in osteoclastogenesis in rats. PD was induced by means of ligature in nondiabetic and in streptozotocyn-induced DM1 rats. Morphological and morphometric analyses, stereology and osteoclast counting were performed. RANKL and OPG mRNA levels, protein content, and location were determined. PD caused alveolar bone resorption, increased the number of osteoclasts in the alveolar bone crest and also promoted changes in RANKL/OPG mRNA expression. DM1 alone showed alveolar bone destruction and an increased number of osteoclasts at the periapical and furcal regions. DM1 exacerbated these characteristics, with a greater impact on bone structure, resulting in a low OPG content and a higher RANKL/OPG ratio, which correlated with prominent osteoclastogenesis. This work demonstrates that the effects of PD and DM1 enhance bone destruction, confirms the importance of the RANKL signaling pathway in bone destruction in DM1 in animal models and suggests the existence of alternative mechanisms potentiating bone degradation in PD.

Radical management of solid ameloblastoma of the mandible: report of a case with 5-year follow-up

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. This pathology can be classified into 4 groups: unicystic, solid or multicystic, peripheral, and malignant. Solid ameloblastomas of the mandible are the most common of them, and represent a challenging group of tumours to treat; in addition the follicular histopathological subtype has a high likelihood of recurrence. Thus, the challenges in the management of this tumour are to provide complete excision in addition to reconstruct the bony defect, in order to provide the patient with reasonable cosmetic and functional outcome. With this in mind, this paper aimed to describe the management of a solid multilocular ameloblastoma of follicular subtype in a 39-year-old female. Case report The authors report a case of a solid multilocular ameloblastoma of follicular subtype in a 39-year-old female who was successfully treated by partial resection of the mandible with immediate reconstruction using an iliac crest, as a donor site. After 15 months, the patient was rehabilitated using titanium implant dentistry, and has been followed up for 5 years without signs or symptoms of recurrence. Conclusion Correct surgical planning is the key for successful management of solid ameloblastoma with multilocular features, which is best treated using radical resection with immediate reconstruction, which ensures complete tumour excision, prevents recurrence, and enables fast and safe dental rehabilitation. Biomedical prototypes should be used since they provide acceptable precision and are useful for surgical planning.

Osteotomia sagital da crista alveolar para instalação de implantes Bicon

This case report presents details of a new surgical technique for mandibular ridge sagittal osteotomy and expansion associated to immediate dental implants in atrophic ridges. The bone atrophies represents a challenge for the surgeons that intends to modify this situation. In the past, the only viable option was the onlay bone graft. However, the bone graft requests a second surgical site that certainly increases the postoperative morbidity, without mentioning the longer treatment time required. The sagittal osteotomy of the alveolar crest represents a faster option, because it eliminates the time requested for bone graft integration, providing rehabilitation of edentulous areas with thin alveolar crests that otherwise would need additi onal surgical procedures for a satisfactory result. The authors report a clinical case in which this technique was used with the installation of a Bicon dental implant in the same surgical time, showing all the steps for this single-tooth rehabilitation.

Treatment of severe facial asymmetry secondary to osteochondroma of the mandibular condyle: case report

Osteochondroma (OC) is the most common benign tumor of long bones. However it is rarely found in the facial skeleton, being the coronoid process and mandibular condyle the most affected sites in this region. It basically consists in bone growth covered by cartilage. The etiology is still controversial: neoplastic, developmental, reparative and traumatic origins have been discussed in literature. The treatments of these lesions include total condylectomy or local resection of the lesion. This paper aims to report a case of a patient with history of trauma and possible fracture of the mandibular condyle in childhood, which in youth developed dentofacial deformity with severe facial asymmetry. The treatment consisted of resection of lesion both with maxillary and mandibular osteotomies associated with graft from the iliac crest bone. Actually, the patient is with a favorable aesthetic, without functional deficit and absence of lesion’s recurrence.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases

Objective The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10 mm) after rigid internal fixation of fractures. Patients and method Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. Results In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. Conclusion With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

Associação da raspagem com antibioticoterapia em um caso de periodontite agressiva generalizada

The treatment of aggressive periodontitis is a challenge to the clinician, therefore the search for effective treatment protocols of this disease is important. The aim of this case report was demonstrate the effectiveness of the combination of systemic antibiotics with non-surgical periodontal therapy in the treatment of generalized aggressive periodontitis. a 27-year-old patient (RCS), smoker for 11 years (10 cigarettes/day on average), with no systemic alteration, attended the periodontal clinic with a complaint abnormal dental position. After the clinical examination, the diagnosis of generalized aggressive periodontitis was defined. The non-surgical periodontal treatment was executed associated with administration of amoxicillin plus metronidazole for ten days. Clinical parameters (Clinical Attachment level, marginal gingival level, periodontal probing depth, bleeding on probing, plaque index and gingival index) and radiographic parameters (distance between the cemento-enamel junction and the bone crest) were evaluated before and after non-surgical periodontal treatment, after antibiotic therapy and three, six and 12 months after the treatment. After one year follow-up, the results showed improvement in clinical and radiographic parameters with stabilized and decreased tooth mobility and absence of tooth loss. It was concluded that the association of non-surgical periodontal therapy with the administration of amoxicillin/metronidazole was effective in the treatment of generalized aggressive periodontitis.

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.

Dynamic functional impression technique fo severely resorbed alveolar ridges

The process of bone resorption can reduce the volume of the alveolar crest, which makes may make difficult impression taking of the alveolar tissue and the subsequent fit of a new denture. This clinical report describes a fast and simple technique for impressions of edentulous ridges to replace complete dentures, using a temporary tissue conditioner material on the denture base. The existing denture must cover the whole supporting area and should be in harmony with the adjacent oral structures. This technique reduces the number of steps involved and minimizes treatment time and expenses.

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.

Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization

ObjectiveThe aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation.Clinical ConsiderationsA 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity.ConclusionThis case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure.Clinical SignificanceIf appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time.

Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs

ObjectiveTo study the buccal dimensional tissue changes at oral implants following free gingival grafting, with or without including the keratin layer, performed at the time of implant installation into alveolar mucosa.Material and methodsThe mandibular premolars and first molars were extracted bilaterally in six Beagle dogs. In the right side of the mandible (Test), flaps were first elevated, and the buccal as well as part of the lingual masticatory mucosa was removed. An incision of the periosteum at the buccal aspect was performed to allow the flap to be coronally repositioned. Primary wound closure was obtained. In the left side, the masticatory (keratinized) mucosa was left in situ, and no sutures were applied (Control). After 3months of healing, absence of keratinized mucosa was confirmed at the test sites. Two recipient sites were prepared at each side of the mandible in the region of the third and fourth premolars. All implants were installed with the shoulder placed flush with the buccal alveolar bony crest, and abutments were connected to allow a non-submerged healing. Two free gingival mucosal grafts were harvested from the buccal region of the maxillary canines. One graft was left intact (gingival mucosal graft), while for the second, the epithelial layer was removed (gingival connective tissue graft). Subsequently, the grafts were fixed around the test implants in position of the third and fourth premolars, respectively. After 3months, the animals were euthanized and ground sections obtained.ResultsSimilar bony crest resorption and coronal extension of osseointegration were found at test and control sites. Moreover, similar dimensions of the peri-implant soft tissues were obtained at test and control sites.ConclusionsThe increase in the alveolar mucosal thickness by means of a gingival graft affected the peri-implant marginal bone resorption and soft tissue recession around implants. This resulted in outcomes that were similar to those at implants surrounded by masticatory mucosa, indicating that gingival grafting in the absence of keratinized mucosa around implants may reduce the resorption of the marginal crest and soft tissue recession.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis

Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days). The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall. Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.

Bone Ceramic® at implants installed immediately into extraction sockets in the molar region: an experimental study in dogs

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