Rehabilitation of the Maxillary Arch After Bone Graft Using Immediate Loading With Implant-Supported Fixed Restoration

Moderate and controlled loading environments support or enhance osteogenesis, and, consequently, a high degree of bone-to-implant contact can be acquired. This is because when osteoprogenitor cells are exposed to limited physical deformation, their differentiation into osteoblasts is enhanced. Then, some range of microstrain is considered advantageous for bone ingrowth and osseointegration. The primary stability has been considered one of the main clinical means of controlling micromotion between the implant and the forming interfacial tissue, which helps to establish the proper mechanical environment for osteogenesis. Based on the biological aspects of immediate loading (IL), the objective of this study is to present a clinical case of maxillary arch rehabilitation using immediate loading with implant-supported fixed restoration after bone graft. Ten dental implants were placed in the maxilla 6 months after the autogenous bone graft, removed from the mandible (bilateral oblique line and chin), followed by the installation of an immediate-load fixed cross-arch implant-supported restoration because primary stability was reached for 8 implants. In addition, instructions about masticatory function and how it is related to interfacial micromotion were addressed and emphasized to the patient. The reasons for the IL were further avoidance of an interim healing phase, a potential reduction in the number of clinical interventions for the patient, and aesthetic reasons. After monitoring the rehabilitation for 8 years, the authors can conclude that maxillary IL can be performed followed by a well-established treatment planning based on computed tomography, providing immediate esthetics and function to the patient even when autogenous bone graft was previously performed in the maxilla.

Implants in the zygomatic bone for maxillary prosthetic rehabilitation: a systematic review

The purpose of this systematic review was to evaluate clinical studies on the follow-up survival of implants inserted in the zygomatic bone for maxillary rehabilitation. A comprehensive search of studies published from 2000 to July 2012 and listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in accordance with the PRISMA statement. Relevant studies were selected according to predetermined inclusion and exclusion criteria. The initial database search yielded 751 titles. After filtering, 313 abstracts were selected, culminating in 42 full text articles. Application of eligibility criteria led to the elimination of 17 articles. Hence 25 full-text articles were considered clinically relevant and were included. Calculations of the interval survival rates and cumulative survival rates of implants could be carried out on the data extracted from the final list of included studies for the different time intervals. These studies reported the insertion of a total of 1541 zygomatic implants and 33 implant failures. Failure generally occurred during the first year interval and was related to clinical complications, such as recurrent acute and chronic sinusitis. After a 36-month follow-up, the survival rate was 97.86%. Additional studies with longer follow-up periods, including the number of zygomatic implants inserted and details of the variations in the surgical techniques used and the impact of the maxillary morphology are still required.

Use of Stress Analysis Methods to Evaluate the Biomechanics of Oral Rehabilitation With Implants

Because the biomechanical behavior of dental implants is different from that of natural tooth, clinical problems may occur. The mechanism of stress distribution and load transfer to the implant/bone interface is a critical issue affecting the success rate of implants. Therefore, the aim of this study was to conduct a brief literature review of the available stress analysis methods to study implant-supported prosthesis loading and to discuss their contributions in the biomechanical evaluation of oral rehabilitation with implants. Several studies have used experimental, analytical, and computational models by means of finite element models (FEM), photoelasticity, strain gauges and associations of these methods to evaluate the biomechanical behavior of dental implants. The FEM has been used to evaluate new components, configurations, materials, and shapes of implants. The greatest advantage of the photoelastic method is the ability to visualize the stresses in complex structures, such as oral structures, and to observe the stress patterns in the whole model, allowing the researcher to localize and quantify the stress magnitude. Strain gauges can be used to assess in vivo and in vitro stress in prostheses, implants, and teeth. Some authors use the strain gauge technique with photoelasticity or FEM techniques. These methodologies can be widely applied in dentistry, mainly in the research field. Therefore, they can guide further research and clinical studies by predicting some disadvantages and streamlining clinical time.

Mechanical behavior of dental implants in different positions in the rehabilitation of the anterior maxilla

Statement of problem. In dental rehabilitations that involve implants, the number of implants is sometimes smaller than the number of lost teeth. This fact can affect the biomechanical behavior and success of the implants.Purpose. The purpose of this study was to investigate the mechanical behavior of different implant positions in the rehabilitation of the anterior maxilla.Material and methods. Three-dimensional models of the maxilla were created based on computed tomography images for 3 different anterior prosthetic rehabilitations. In group IL, the implants were placed in the lateral incisor positions with pontics in the central incisor positions; in group IC, the implants were in the central incisor positions with cantilevers in the lateral incisor positions; and, in group ILIC, one implant was in a lateral incisor position and one was in a central incisor position, with a pontic and a cantilever in the remaining positions. A 150 N load was distributed and applied at the center of the palatal surface of each tooth at a 45-degree angle to the long axis of the tooth. The resulting stress-strain distribution was analyzed for each group.Results. The lowest displacement of the prosthetic structure was observed in group IC, although the same group exhibited the largest displacement of the bone tissue. In the bone tissue, the von Mises stress was mainly observed in the cortical bone in all groups. The maximum value of the von Mises stress shown in the cortical tissue was 35 MPa in the implant that neighbors the cantilever in group ILIC. The maximum von Mises stress in the trabecular bone was 3.5 MPa.Conclusion. The prosthetic configuration of group IC limited the displacement of the prosthetic structure but led to greater displacement of the bone structure. The use of a cantilever increased the stress concentration in the implant and in the bone structure adjacent to the cantilever under the conditions studied here.

Failures in the rehabilitation treatment with removable partial dentures

Background. Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients. Methods and results. For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs. Conclusions. This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.

A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations

Objective: The aim of this study was to evaluate the 2-year clinical performance of class II restorations made with a composite resin with two different viscosities.Methods: 47 patients received two class II restorations (n = 94), one made with GrandioSO (conventional viscosity CV), and the other with GrandioSO Heavy Flow (flowable viscosity FV), subjecting both materials to the same clinical conditions. The self-etching adhesive Futurabond M was used for all restorations. The composites were inserted using the incremental technique. The restorations were evaluated using the modified USPHS criteria according to the periods: baseline, 6 months, 1 year and 2 years after restorative procedures.Results: After 24 months, 40 patients attended the recall and 78 restorations were evaluated. In all periods, no secondary caries was observed. After 6 months, there were slightly overall changes of scores for most parameters. After 24 months, the higher number of changes from score Alfa to Bravo was observed for marginal discolouration (32.5% CV and 39.5% FV) and colour match (15% CV and 31.6% FV), followed by proximal contact (25% CV and 23.7% FV) and marginal adaptation (20% CV and 21.1% FV). For wear, surface texture and postoperative sensitivity the changes were very small. Just two restorations were lost during the 24-month follow up. Less than 5% of all restorations showed postoperative sensitivity. Chi-square test showed no significant differences between the two materials for all parameters analysed.Conclusion: After 2 years of clinical service, no significant differences were observed between GrandioSO conventional and GrandioSO Heavy Flow for the parameters analysed. Both materials provided acceptable clinical behaviour in class II restorations. Clinical Significance: This study presents the possibility of using a flowable composite with high filler content, for performing class II restorations. (C) 2014 Elsevier Ltd. All rights reserved.

Neuromuscular electrical stimulation for stroke rehabilitation: Is spinal plasticity a possible mechanism associated with diminished spasticity?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols

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

Risco de desordens músculo-esqueléticas nos membros superiores de graduandos de Odontologia

Este estudo teve por objetivo avaliar o risco de desenvolvimento de desordens músculo-esqueléticas nos membros superiores de graduandos de Odontologia considerando as variáveis sexo, tipo de procedimento clínico executado, região da boca tratada e prática do trabalho a quatro mãos. Foram avaliados alunos, de ambos os sexos, matriculados no oitavo semestre do curso de graduação da Faculdade de Odontologia de Araraquara - UNESP. Foram efetuadas tomadas fotográficas durante a realização de 283 procedimentos clínicos, utilizando-se máquina fotogrática digital. Para análise das fotografias, utilizou-se o programa Image Tool. As posturas de trabalho adotadas por cada estudante na sua atuação como “operador” foram observadas pelo método RULA (Rapid Upper Limb Assessment), o qual inclui o uso de um diagrama de análise de postura do indivíduo e três tabelas de escores que permitem a avaliação da exposição aos fatores de risco para o desenvolvimento de desordens músculo-esqueléticas. As fotografias foram analisadas por um professor da área de ergonomia calibrado (_=0,91). Para cada procedimento foi atribuído um escore de risco final. Os procedimentos executados foram classificados em duas grandes categorias: procedimentos preparatórios e procedimentos restauradores/reabilitadores. Os dados de risco de desordens músculoesqueléticas nos membros superiores foram apurados, e sua prevalência foi estimada por ponto e por intervalo de confiança de 95%. O estudo da associação do risco de desordens músculo-esqueléticas às variáveis de interesse foi realizado por meio do Teste de Qui-quadrado (_ 2). O nível de significância adotado foi de 5%. Observou-se que na maioria dos procedimentos executados o risco de desordens músculo-esqueléticas segundo a classificação... (Resumo completo, clicar acesso eletrônico abaixo)

Effects of Photodynamic Therapy with Blue Light and Curcumin as Mouth Rinse for Oral Disinfection: A Randomized Controlled Trial

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Calvarial Autogenous Bone Graft for Maxillary Ridge and Sinus Reconstruction for Rehabilitation With Dental Implants

Autogenous bone grafting is the gold-standard technique for bone augmentation procedures prior to implant placement. If the amount of available intraoral donor bone is insufficient, it is necessary to harvest bone graft from extraoral sites, such as calvaria. Although this technique is well established, only a few case reports show the histological analysis of the grafted bone at the moment of implant placement. This article reports the case of a 48-year-old female patient with a critical atrophic maxillary ridge reconstructed using autogenous calvarial bone graft prior to implant placement, with clinical and histological evaluation. Bone was collected under general anesthesia from the parietal bone. The outer cortical originated the bone blocks, and the medullar bone layer between was collected to be used in the sinus augmentation procedure, together with 5 of the bone blocks triturated. Six months after bone augmentation, 8 implants were placed in the grafted area and 2 biopsies were retrieved (anterior and the posterior regions), allowing the visualization of the bone-remodeling process in the grafted areas. The patient had a stable recovery. Our results showed that although necrotic bone could still be seen in the outer layer of the grafted area, the interface between this necrotic bone and the already remodeled bone was consistent with biocompatibility. Two-year radiographic evaluation showed success of the grafts and the implants in supporting an esthetic and functionally stable prosthesis. Summarizing, calvarial bone grafts are a viable alternative for the attainment of adequate bone volume prior to implant placement.

Canine retraction and anchorage loss Self-ligating versus conventional brackets in a randomized split-mouth study

Objective: To evaluate the velocity of canine retraction, anchorage loss and changes on canine and first molar inclinations using self-ligating and conventional brackets.Materials and Methods: Twenty-five adults with Class I malocclusion and a treatment plan involving extractions of four first premolars were selected for this randomized split-mouth control trial. Patients had either conventional or self-ligating brackets bonded to maxillary canines randomly. Retraction was accomplished using 100-g nickel-titanium closed coil springs, which were reactivated every 4 weeks. Oblique radiographs were taken before and after canine retraction was completed, and the cephalograms were superimposed on stable structures of the maxilla. Cephalometric points were digitized twice by a blinded operator for error control, and the following landmarks were collected: canine cusp and apex horizontal changes, molar cusp and apex horizontal changes, and angulation changes in canines and molars. The blinded data, which were normally distributed, were analyzed through paired t-tests for group differences.Results: No differences were found between the two groups for all variables tested.Conclusions: Both brackets showed the same velocity of canine retraction and loss of anteroposterior anchorage of the molars. No changes were found between brackets regarding the inclination of canines and first molars.

Benefits of kinesiotherapy and aquatic rehabilitation on sickle cell anemia. A case report

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da prevalência das doenças peri-implantares e do sucesso e sobrevivência de implantes osseointegrados com 8 a 10 anos de função

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aesthetic rehabilitation of oligodontia in primary dentition with adhesive partial denture

The primary teeth are essential for bone development and establishment of the arches on occlusion. Thus, the congenitally absence of teeth may trigger a shift in the balance of the occlusion, promoting disharmony in the structures of the maxilla-mandibular system. However, some interventions are possible to be performed in these cases even in pediatric patients, to redirect growth, preventing growth deviations and reestablishing the aesthetic. The aim of this paper is to report the treatment of a 4-year-old child presenting congenitally absence of mandibular central and lateral incisors and maxilla lateral incisors, which consequently compromises aesthetics, occlusal function, and the development and the functional growth of the bones. The oral rehabilitation was performed with an adhesive partial denture, which was able to restore the aesthetic and the occlusal function, therefore being a viable alternative in the treatment of this patient of little age.