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.

Estudio histológico del processo de reparación alveolar después de la aplicación tópica de la solucioón anestésica prilocaína 3 % con felipressina o,o3 ui/ml

The aim of this study was to evaluate the local anesthetic solution, composed by Prilocaine 3% and felipressin 0,03 UI/ml, influence on the alveolar repair process in rats after dental extraction. This research was previously approved by the Ethic Committee in Research of the Masters Degree Program in Oral and Maxillofacial Surgery of the Marília University (UNIMAR), Marília, São Paulo, Brazil. It was an experimental, randomly controlled study, with bifactorial analysis (group control versus experimental group, in function of the postoperative times (2 X 4)). For the accomplishment of this study 32 rats were used (Rattus norvegicus, albinus, Wistar), males, adults, weighing between 280 and 320 grams. The animals were selected and divided into Group I (control) and Group II (Citocain 3%® - Prilocaine 3% with felipressin 0,03UI/ml) with 16 rats each; being four animals of the Group I and four of the Group II, destined to the euthanasia in the postoperative periods of 3rd, 7th, 15th and 24th days. The histological analysis with base in the developed methodology, allowed us to conclude that the anesthetic solution of Citocain 3%® applied with gauze compress on the surgical dental wound, produced tissue events that committed the basic biological principles, that are responsible for the regeneration of the gingival epithelium and the alveolar process repair in rats. The Group I presented better results in the alveolar repair when compared to the Group II.

Reabilitação total da maxila com enxerto intraoral: relato de caso

The early tooth loss and periodontal disease often leave inadequate bone volume for installation of osseointegrated implants. The autogenous bone graft is considered the gold standard for reconstruction of residual bone defects. Some surgical techniques can be performed, including extra or intraoral donor sites depending on the degree of bone loss, depending on surgical-prosthetic planning and general condition of the patient. The intraoral bone grafts offer a safe option to rebuilt bone volume in smaller rehabilitations, with low morbidity and minimal postoperative discomfort. Among the possible donor sites, the mandibular ramus and body, which offer predominantly cortical bone, and the chin area, which offers corticomedullary bone tissue, can be harvested. The graft will be suitable both in quantity and quality, preserving the capacity of osteogenesis, osteoinduction and osteoconduction, which differentiate autogenous grafts from other biomaterials. The aim of this study was to report a clinical case in which the mandibular ramus graft was used for total reconstruction of an edentulous maxilla, showing that even large areas can be reconstructed with grafts from intraoral origin. All the steps that allowed the complete reconstruction of the maxilla done by an intraoral donor area are listed in the text, culminating in an extremely satisfactory clinical result.

Protese total fixa em função imediata confeccionada em resina composta indireta

Immediate functioning of osseointegrated implants has been widely employed in edentulous patients due to its safety and high predictability. However, viability and success of immediate-loaded implants is defined by factors such as number of implants, distribution and splinting, as well as reduction of oblique loads and excessive occlusal contacts. The indirect composite resin-modified glass enable building of a highly aesthetic prosthesis, combining satisfactory resistance and better force dissipation on occlusal loading. This article describes a resin composite, mandibular fixed prosthesis on osseointegrated implants in immediate function.

A utilização do enxerto ósseo autógeno para tratamento de lesão de furca grau II

Destruction of bone and periodontal ligament as a result of periodontal disease can lead to anatomical defects in the furcation area. Treatment of these lesions is a major challenge to the clinician. Periodontal instruments have limited access to this area and plaque and calculus removal from root surfaces are extremely difficult. For proper treatment planning a number of factors must be taken into consideration to achieve immediate and long term success. Surgical therapy associated with bone grafts may be a viable option in the treatment of class II furcation defects, aiming to restore lost tissues. The aim of this paper is to report a clinical case where a simplified surgical approach with the use of autogenous graft was used to treat a class II furcation defect Twelve months after the surgery, an increase in clinical attachment level and pocket depth reduction resulted in a complete closure of the furcation lesion.

Complicações Associadas aos Enxertos Ósseos Aposicionais com Osso Autógeno

Introdution: Tooth extraction results in alveolar ridge resorption due to the progressive reabsorption, which frequently is a limitating factor of dental implants treatment, in function of the insufficient bone height for execution, could be indicated the use of grafts for increase of the alveolar edge. However, the success of the bone graft requests the meticulous attendance of the clinical stages. Proposition: The objective of this research was to evaluate the postoperative complications associated to the autogenous bone grafts. Materials and Methods: Through a random retrospective analysis, 90 file records of patients submitted to the surgical procedure of autogenous bone graft in the period of January from 2000 to the March of 2008. A clinical record was elaborated with base in the necessary data for this evaluation. Results: About the file data analysis, 59 female with average of 49,42 years and 31 male with average of 47,90 years. The previous diseases most related were arterial hypertension, stomachache and diabetis. The smokers was noticed in 13,3% of patients. The donor site most used was a mandibular ramus. The postoperative complications in receiving area represented 17,8% of file datas analysed and in the donor site only one patient showed parestesis. Conclusion: Among the total analyzed files it was observed that the postoperative complications associated with the autogenous bone grafts represented 18,9% of the patients submitted to the procedure, more frequently affecting the receiving area, obtaining partial exposure of the bone graft and absence of inserted gingiva on vestibular cortical bone.

Tratamento multidisciplinar: relato de casos clínicos

Introduction: Adult patients are more prone to periodontal disease mainly caused by poor plaque control. In these patients, orthodontic movement is not contraindicated, but it is necessary to evaluate their periodontal status so that we can establish the appropriate treatment plan. Objective: The objective of this article is to describe and discuss the clinical cases of severely periodontally compromised individuals in need of oral rehabilitation. Methods: The study consisted of orthodontic treatment of two cases with periodontal involvement. After clinical and radiographic examinations, the cases were analyzed by a multidisciplinary team of Orthodontics, Periodontics and Prosthodontics, in order to provide the patient with the best possible esthetic, functional and stability outcomes. Periodontal treatment consisted of supra and subgingival scaling prior to orthodontic treatment, and regular maintenance performed on a quarterly basis throughout orthodontic movement. Activation was carried out every 45 to 50 days, with light forces. Retention remains to the present day, even after completion of the rehabilitation. Conclusion: Multidisciplinary oral rehabilitation treatment yields satisfactory results. The interaction between Orthodontics and Periodontics reveals that patients with reduced, but healthy periodontium, can receive orthodontic treatment as long as the forces applied do not exceed patient's biological limits.

Effect of platelet-rich plasma on healing of class III furcation defects treated with autogenous bone grafting and guided tissue regeneration: a histomorphometric study in dogs

The purpose of this study was to evaluate the effects of the platelet-rich plasma (PRP) when used in combination with autogenous bone graft and bioabsorbable membrane (Resolut® ) in the treatment of Class  III furcation defects in dogs. Material and method: Class III furcation defects (5 mm in height and in depth) were surgically created in the mandibular third premolars of five mongrel dogs. After nine weeks, the lesions were treated with scaling and root planning and each defect received one of the following treatments: autogenous bone graft + membrane (group C) or PRP + autogenous bone graft + membrane (group T). After a healing period of 90 days, the animals were sacrificed. Routine histological processing and staining with hematoxilyn and eosin and Masson trichrome were performed and a histomorphometric analysis determined the effect of the treatments on periodontal tissue regereneration. Data were analyzed by Hotelling’s T-squared (p < 0.05). Result: No statistically significant difference between C and T groups was observed by the histomorphometric analysis of the furcation area. Both treatment groups demonstrated similar regenerative results with the furcation defects partially filled and periodontal regeneration limited to the experimental notches of the lesions. (p > 0.05). Conclusion: According to the present results, PRP does not enhance the periodontal regeneration in class III furcation defects treated with autogenous bone graft and bioabsorbable membrane.

Diretrizes para o tratamento e acompanhamento periodontal durante o tratamento ortodôntico

The aim of this paper was to search though a revision of the literature the cares before, during and after the orthodontic treatment in patients with a periodontal disease. The literature shows that the orthodontical treatment in healthy patients brings no risk to the periodontium, although the presence of an active periodontal disease counter indicates the dental movement. Thus, it is extremely important to execute a correct diagnosis of any periodontal alteration and treat them before the beginning of the orthodontical treatment. Besides, during the whole orthodontical treatment is also important to have a periodontal control with periodic reevaluations and at the end of the orthodontical treatment, a new oral hygiene orientation may be needed to finally establish the follow-up of the patient according to the risk of periodontal disease.

Resistência à flexão em porcelana feldspática: efeito da ciclagem mecânica e limite de fadiga pelo método escada

This study evaluated the fatigue limit (FL) by the staircase method and the effect of mechanical cycling on the flexural strength (FS) of Duceragold feldspathic porcelain. Specimens (25 x 5 x 2 mm) were made according to manufacturer’s directions and submitted to three-point flexural strength test (n = 10). To determine FL (n = 30; 10,000 cycles; 2 Hz), an initial loading of 60% of the FS and an incremental loading (step) of 3% of the FS were used. Data were analyzed by Anova and Tukey´s test (p < 0.05). Although the proposed cycles have not reduced FS significantly, fractography analysis showed striation, characteristic signs of mechanical fatigue.

Considerações gerais sobre prótese fixa adesiva

The success rate of resin-bonded fixed partial dentures is directly related to the adhesive system and the tooth preparation design for good retention. These resin-bonded bridges represent a prosthodontic alternative, based on their costeffectiveness, conservative techniques, and ease of laboratory manufacturing. Through a thorough review of the literature, this study aimed to report on cavity designs, types of materials used, and the advantages and disadvantages of the resin-bonded fixed partial denture. One of significant advantages of the resin-bonded fixed partial dentures is the conservation of the tooth structure, whereas its main disadvantage includes aesthetic limitations, given that the alloy may in fact be visible. Preparation design, cement type, and casting alloy type, as well as surface treatment, are among the factors that influence the longevity of resin-bonded fixed partial dentures. Treatments with resin-bonded fixed partial dentures present a bright outlook regarding the conservation of tooth structures, as well as a high level of success.

Reabilitação oral de paciente com síndrome da combinação: relato de caso

The Combination Syndrome represents an important pathologic condition of the masticatory system that requires a complex rehabilitation treatment. The presence of flaccid mucosa is one of the most common features due to bone resorption of the pre-maxilla caused by anterior hyperfunction of the mandibular teeth on the maxillary complete denture, where the impact of oclusal loading in this region results in movement of the maxillary prosthesis into the ridge, resulting in increased resorption of the residual ridge, internal misfit and loss of the retention of the maxillary complete denture. The presence of flaccid mucosa, in such cases, leads to problems of support and stability of the maxillary complete denture, which can be treated by surgical reduction of the thickness of the tissue or using specific techniques of fabrication of prostheses. This article describes the oral rehabilitation of a patient with the Combination Syndrome where the surgical reduction of flaccid mucosa was not performed, using a modified technique of functional impression in two steps, with the objective of generating forces and less distortion in flaccid mucosa during functional impression.

Microstructural, physical, and fluid dynamic assessment of spinel-based and phosphate-bonded investments for dental applications

This work reports the experimental evaluation of physical and gas permeation parameters of four spinel-based investments developed with or without inclusion of sacrificial fillers. Data were compared with those of three commercial formulations. Airflow tests were conducted from 27 to 546°C, and permeability coefficients were fitted from Forchheimer's equation. Skeletal densities found for spinel- (ρs = 3635 ± 165 kg/m3) and phosphate-bonded (ρs = 2686 ± 11 kg/m3) samples were in agreement with the literature. The developed investments were more porous and less permeable than commercial brands, and the differences were ascribed to the different pore morphologies and hydraulic pore sizes of ceramic matrices. The inclusion of both fibers and microbeads resulted in increases of total porosity (42.6–56.6%) and of Darcian permeability coefficient k1 (0.76 × 10−14–7.03 × 10−14 m2). Air permeation was hindered by increasing flow temperatures, and the effect was related to the influence of gas viscosity on ΔP, in accordance with Darcy's law. Casting quality with molten titanium (CP Ti) was directly proportional to the permeability level of the spinel-based investments. However, the high reactivity of the silica-based investment RP and the formation of α-case during casting hindered the benefits of the highest permeability level of this commercial brand.

Air abrasion before and/or after zirconia sintering: surface characterization, flexural strength, and resin cement bond strength

The purpose of this in vitro study was to evaluate the effect of air-abrasion/zirconia sintering order on the yttria partially stabilized tetragonal zirconia polycrystal (Y-TZP) surface characterization (roughness, morphology, and phase transformation), flexural strength (FS), and shear bond strength (SBS) to a resin cement. Y-TZP specimens were air abraded with 50-μm Al2O3 particles after (AS), before (BS), or before and after zirconia sintering (BAS). For roughness (Ra), 30 block specimens (12×12×3.0 mm; n=10) had their surfaces analyzed by a profilometer. Next, on the air-abraded surfaces of these specimens, composite resin discs (n=30) were bonded with RelyX ARC. The bonded specimens were stored for 24 hours in distilled water at 37°C before shear testing. Failure mode was determined with a stereomicroscope (20×). The surface morphology (n=2) was evaluated by SEM (500×). For the four-point flexural strength test (EMIC DL2000), 39 bar-shaped specimens (20×4.0×1.2 mm; n=13) were air abraded according to the three conditions proposed, and an additional group (nonabraded) was evaluated (n=13). The quantitative analysis of phase transformation (n=1) was completed with Rietveld refinement with X-ray diffraction data. Ra (μm) and SBS (MPa) data were analyzed by one-way analysis of variance (ANOVA) and the Tukey test (α=0.05). Pearson correlation analysis was used to determine if there was a correlation between roughness and SBS. For FS (MPa) data, one-way ANOVA and the Dunnett C-test (α=0.05) were used. The air-abrasion/zirconia sintering order influenced significantly (p<0.001) Ra, SBS, and FS. The BS and AS groups presented the highest (1.3 μm) and the lowest (0.7 μm) Ra. The highest SBS (7.0 MPa) was exhibited by the BAS group, followed by the AS group (5.4 MPa) and finally by the BS group (2.6 MPa). All groups presented 100% adhesive failure. A weak correlation (r=−0.45, p<0.05) was found between roughness and SBS. The air-abrasion/zirconia sintering order provided differences in the surface morphology. The nonabraded (926.8 MPa) and BS (816.3 MPa) groups exhibited statistically similar FS values but lower values than the AS (1249.1 MPa) and BAS (1181.4 MPa) groups, with no significant difference between them. The nonabraded, AS, BS, and BAS groups exhibited, respectively, percentages of monoclinic phase of 0.0 wt%, 12.2 wt%, 0.0 wt%, and 8.6 wt%. The rougher surface provided by the air-abrasion before zirconia sintering may have impaired the bonding with the resin cement. The morphological patterns were consistent with the surface roughness. Considering the short-term SBS and FS, the BAS group exhibited the best performance. Air abrasion, regardless of its performance order, provides tetragonal to monoclinic transformation, while sintering tends to zero the monoclinic phase content.

Implantes curtos revisão da literatura

The contemporary implant dentistry is in constant technological development, improving the oral rehabilitation process of partial or totally edentulous patients. On the other hand, anatomical limitations, such as the maxillary sinus and the mandibular canal in the posterior region of the jaws can limit the implant placement. Furthermore, due to the absence of dental elements, alveolar ridge atrophy is frequently observed. This aspect represents a loss either in quantity or quality of the bone tissue available for the dental implant rehabilitation. To make possible the dental implant rehabilitation even in adverse conditions, some solutions have been considered, such as the use of short implants (≤ 10 mm length) and/or small diameter implants (2,8; 3,3 and 3,5 mm width). The aim of this study is to present a literature review considering the use of short implants in oral rehabilitation, presenting the currently view of the matter. Based on the literature review, the use of short implants produced similar clinical success to conventional implants (greater than 10 mm in length). Therefore, its use can be considered a viable alternative, where anatomical limitations are present.