Surgical-orthodontic tractio for impacted maxillary canines: a critical review and suggested protocol

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical-orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages.

Tumor odontogênico queratocístico: revisão de literatura

The odontogenic keratocyst is called keratocyst odontogenic tumor (TOQ), due to its features compatible with neoplasms, such as its high recurrence rate and mechanism of growth. Although its etiology has unknown, the origin seems to be connected with dental lamina remaining. This entity is generally benign, with slow progression, asymptomatic, and among the odontogenic tumors, its prevalence is high. It affects mainly males, with predilection for the posterior mandible, while in most cases associated with an impacted tooth. Radiographically, this lesion is unilocular. Histological features are stratified epithelial basal cells with hyperchromatic paraqueratinizado. Treatment ranges from conservative to radical interventions. As a result of the controversy as TOQ tumor entity, the present work is a literature review of current findings, emphasizing its intrinsic features to contribute to developments in the study of this new entity.

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.

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.

Alteração cromática de resinas compostas laboratoriais submetidas à imersão em diferentes soluções

The pigmentation of indirect composite resins has been one of the most common reasons that lead the restorative treatment to failure. The purpose of this study was to investigate the effect of different solutions on color stability of indirect composite resins. Five brands of indirect composite resins were tested: Adoro, Resilab, Cristobal, Sinfony and Epricord. The samples were immerged in eleven solutions (n=10): common liquid foods (coke soft drink, red wine, coffee and orange juice), mounthrinses (Listerine, Oral-B, Colgate Plax and Periogard) and bleaching agents (carbamide peroxide 16%, 7.5% and hydrogen peroxide 38%) and artificial saliva (control group). The color was measured by a spectrophotometer before and after 7, 14 and 21 days of immersion in common liquid foods, after 12, 24, 36 and 60 hours of immersion in mounthrinses and after 7 and 14 days of immersion in bleaching agents. The Cristobal and Adoro resins showed highest values of ΔE statistically significant compared to the others resin brands. Adoro’s ΔE values changed significantly after the immersion process in red wine and coffee and also between periods measured. The resins Cristobal and Sinfony showed the highest values of ΔE after the immersion process in Listerine with difference statistically significant in comparison to control group. Besides, there was difference statistically significant of the ΔE values  for  Cristobal  after  immersion  in hydrogen peroxide 7,5% in comparison to control group. It can be conclude that all the solutions promoted color change on the indirect composite resins. However, ΔE values  are  whitin  the  values clinically acceptable.

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.

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)