Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Contribuição ao estudo das relações dos conectores maiores de próteses parciais removíveis com tecidos gengivais

The effect in the gingival tissue of four distinctive types of relationships between the major conector and the gingival margin was investigated in eight subjects in association with the experimental gingivitis model. The subjects wore appliances constructed in acrylic resin (retained by means of embrasure hooks) throughout the day an night, except during meals. After the appliances had been placed, the subjects were abstained from any oral hygiene for twenty-one days. Records of the Plaque Index, Gingival Index and probing deplh were taken at baseline and at each week. Data showed that there was a small increase in the Plaque Index and Gingival Index for the four areas and that the degree of inflammation of the covered areas was higher in the area without relief

Presença de candida e de anticorpos anti-candida na cavidade bucal de pacientes com periodontite crônica do adulto

The presence of Candida and the production of histolytic enzyms by the isolated samples were observed in the saliva and gingival fluid in adult chronic periodontitis patients and health ones. It was also verified the quantity of antibodies against Candida (IgG, IgA, IgM and IgE) in the saliva and sera of the same patients through ELISA technique. Yeasts of the genus Candida mainly C. albicans were isolated from saliva in higher number from adult chronic periodontitis patients in relation to the controle with statistically significant difference. The meon of the quantity of isolated Candida (UFC/ml) were higher for periodontítis patients, although this difference was not statistically significative. Samples of Candida isolated from both groups produced hystolytic enzymes (hyaluronidase, condroitin sulfatase, proteinase, phospholipase) that are considered patogenicity factors in periodontol diseases. Only one sample of each group (C albicans) didn't produce the four analysed enzymes. The antibodies levels against Candida (IgG, IgM and IgA in saliva, IgG and IgA in sera and IgG and IgM in gingival Fluid), were statistically higher in adult chronic periodontitis patients in relation to periodontically health individuals, suggesting humoral immune response by periodontitis patients to the yeasts of the genus Candida

Aumento de gengiva queratinizada em mucosa peri-implantar

Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation.

Abordagens periodontais na promoção da harmonia do sorriso

Several therapeutic approaches have been proposed in order to achieve an esthetically pleasing and harmony smile. The present study reports a case in which gingivectomy was performed in the region of the upper anterior teeth combined with osteotomy in the region of the upper posterior teeth and removal of the superior labial frenum to promote harmony smile by decreasing the gummy smile and adequacy of buccal corridor. Osteoplasty gingivoplasty, and frenectomy procedures were planned and performed in a single session. The extraction of the maxillary third molars was also performed in order to avoid postoperative complications. Follow-up visits were performed at 7, 15, 30 and 180 days postoperatively. At 7 days, the gingival tissue was in the initial process of healing, demonstrating inflammation still in evidence. At 15 days, the gingival tissue was found in the final healing process, showing characteristics of normal health gum. At 30 days, there was complete healing of gingival tissues without clinical exposure of the root surfaces. After 180 days, tissues remained in healthy, demonstrating the success of the treatment. Patient showed complete satisfaction with the results. It can be concluded that, when properly indicated, the combination of gingivectomy, osteotomy and frenectomy procedures are promising therapeutic approaches for promoting harmony smile.

Recobrimento de múltiplas recessões com enxerto subepitelial: tratamento de descontaminação da superfície radicular com laser de Erbium YAG

Multiple gingival recessions may cause mainly dentinary sensibility and aesthetic alterations. The subepithelial graft is a mucogingival technique which can be used to treat multiple gingival recessions. In this case report the Erbium YAG laser was applied to promote radicular surface decontamination, an important step to reach reinsertion of the gingival tissues on exposed radicular surface.

A utilização de abutment de zircônia na reabilitação oral: aspectos protéticos e periodontais

Zirconia abutments are used to obtain satisfactory aesthetic results in implant fixed anterior prostheses when metal abutments promote a grayish mucosal discoloration of the peri-implant soft tissues. However, there is a lack of studies to confirm the clinical performance of the peri-implant soft tissues surrouding zirconia abutments. This study described a case report of a patient treated with implant fixed all-ceramic crown made out on zirconia abutment after 3 years of followup. A 47-year-old female patient was admitted to the dental clinic (Aracatuba Dental School) complaining about the fracture of her implant fixed single crown in the region of the left lateral incisor. The patient chose the replacement of the fractured prosthesis for an allceramic crown. After 3 years of follow-up it was observed that maintenance of the aesthetic results and the peri-implant soft tissue without any inflammation or gingival recessions. Within the limitations of a case report, it can be conclude that zirconia abutments is a effective rehabilitation treatment because it preserves the aesthetics and function through the maintenance of peri-implant tissues.

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.

A importância da mucosa queratinizada na implantodontia

The purpose of current implantology is to ensure that implants maintain its state of full health, proper function and aesthetics. The aim of this paper is to discuss, through a literature review, the importance of keratinized mucosa in relation to cleaning, gingival maintenance, aesthetics involving dentistry implant and evaluating some options to provide a keratinized mucosa when it is insufficient. For the studies identification, it is included or considered in this review, Pubmed database with the following keywords: implant and mouth mucosa and, according to the criteria for inclusion and exclusion, 27 articles were selected. According to the reviewed articles, it was found that the keratinized tissue does not influence the survival of the implant, but it facilitates the cleaning, decreases the irritation of the peri-implant tissues and promotes aesthetics in anterior regions.

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.

A relevância do periodontista na prevenção da doença periodontal em pacientes ortodônticos: relato de caso clínico

The increase of the retentive areas of bacterial plaque can be observed in patients who use dental braces in the mouth. The difficulty of making hygienic is one of the problems that this particular group of patients faces day by day, and consequently, the establishment of gingival inflammation becomes more frequent. The objective of this case report is to show the importance of the periodontist in preventing and promoting health to the users of dental braces, aimed at education and motivation as one of the priorities of this treatment. The ESA patient, 29 years old, male, attended the dental office of a periodontist, sent by the orthodontist, due to the extensive area of gingival hyperplasia and gingivitis, in both arches. The possibility of taking out the dental braces was considered by the orthodontist, but after the periodontist evaluation, this step was procrastinated. Thus, the periodontist started the adequacy of the oral environment together with the work of education and promotion of health, which lasted until the complete recovery of the healthy gingival condition of the patient. In this way, it is possible to observe the relevance of the work of the periodontist in the application of preventive methods in oral health for orthodontic patients. The motivation of these patients in relation to the orientations of buccal hygienic, maintenance of oral health and diet should not be considered as secondary and should be prioritized, because only in this way it would be possible to reach a good occlusion, without esthetic and functional prejudice.

Recuperação da harmonia dos dentes anteriores por meio de implantes e restaurações cerâmicas

Introdução: a ausência ou alterações da estrutura dentária, principalmente em áreas estéticas, compromete a aparência, as relações sociais, a autoestima e, consequentemente, a qualidade de vida do indivíduo. Atualmente, avanços tecnológicos e científicos na Odontologia têm possibilitado várias opções de tratamentos reabilitadores e restauradores que oferecem resultados cada vez mais seguros e confiáveis. Objetivo: relatar, por meio de um caso clínico, a recuperação da harmonia dos dentes anteriores com a utilização de laminados de cerâmica e prótese sobre implante associada a recursos para recuperar a estética gengival. Conclusão: o planejamento adequado, associado aos conhecimentos de uma Odontologia integrada, possibilita resultados extremamente satisfatórios, resgatando a função e a estética, tanto dentária quanto gengival, proporcionando um sorriso harmonioso e o bem-estar social do paciente.

Anaeróbios do complexo vermelho de Socransky e infecções bucais em pacientes com imunocomprometimento: características clínicas e prognóstico do tratamento

Os anaeróbios obrigatórios que compõem o complexo vermelho de Socransky são reconhecidos pelo seu envolvimento nas doenças periodontais humanas, mas em pacientes imunocomprometidos os mesmos parecem estar associados a quadros sépticos mais graves e de tratamento mais complexo. Esse estudo objetivou avaliar a ocorrência de Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf) e Treponema denticola (Td) no biofilme, mucosas e saliva de 160 pacientes HIV+, 5 pacientes leucêmicos, 50 pacientes submetidos à radioterapia para tratamento de câncer de cabeça e pescoço e sua correlação com sintomatologia clínica. Amostras de biofilme sub e supragengival, saliva e mucosas foram coletadas após a realização do exame clínico intrabucal. Após a extração do DNA, a detecção desses microrganismos era realizada por PCR. Esses patógenos foram detectados de todos os espécimes clínicos de pacientes com necrose de tecidos moles bucais. Nos pacientes HIV+, a frequência de detecção de Pg e Tf entre pacientes com periodontite foi 2,8 e 2,1 vezes mais elevada do que a observada nos indivíduos periodontalmente saudáveis. T. denticola foi detectado apenas nos sítios com necrose, supuração e perda óssea pronunciada. Pg e Tf se mostraram associados com perda óssea e sangramento gengival. A presença desses microrganismos esteve associada a odor fétido e dor, o que pode auxiliar o clínico na escolha de antimicrobianos como auxiliares do tratamento, devendo-se evitar o emprego de β-lactâmicos, podendo-se associar essas drogas ao metronidazol.

Classe mollicutes na boca de pacientes com dependência química

Drug addiction is one of the biggest public health problems worldwide, not only by the dimensions of the problem, but also by the severity of the damage, creating favorable conditions for opportunistic microorganisms such as class Mollicutes. This study aims to evaluate the presence of the main species and genera of this group in the subgingival biofilm of drug addiction patients, comparing them with non-dependent subjects. For this purpose, data on systemic health conditions, socioeconomic characteristics, drug addiction from 72 patients with drug addiction kept in rehab clinics and 100 non-dependent patients who formed the control group were obtained. Intra and extraoral clinical examinations were performed and samples of subgingival plaque were collected through sterile absorbent paper cones. The presence of different genera and species of the class Mollicutes was evaluated by PCR using the specific primers and conditions for each microorganism. The statistical analysis was performed using the Chi-square test for comparisons of three or more variables and the Mann-Whitney test, with significance level of 5%. Out of species and genera evaluated, Mycoplasma salivarium showed correlation with gingival inflammation in both patient groups and was more frequently detected among drug addiction patients

Ocorrência de microrganismos periodontopatogênicos em pacientes com dependência química

Drug addiction won dramatic aspects in terms of its dimensions and the effects that it imposes. These chemical agents are able to reduce the immune reactivity and tissue repair, and enhance microbial aggression, aggravating the destruction of the periodontium and other side effects. This study aimed to evaluate the presence of key periodontal pathogens in the mouth of drug addiction patients, comparing it with individuals who do not exhibit this dependence, as well as assess the influence of oral conditions on the occurrence of such microorganisms. For this purpose, data on systemic health conditions, socioeconomic, patterns of licit or illicit drug consumption of 100 patients with chemical dependency kept in rehabilitation clinics and an equal number of non-dependent patients, who formed the control group were obtained. Intra and extraoral clinical examinations were performed and samples of supragingival and subgingival biofilm, saliva and mucous membranes were collected. The presence of the targeted microorganism was assessed by polymerase chain reaction (PCR). It was found that Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola showed close correlation with bone loss and gingival bleeding in drug addiction dependents and control group, but the oral mucous membranes and saliva of addicts showed higher occurrence of these pathogens.