Frequência de ressonância e sondagem peri-implantar em implantes curtos sob carga imediata com prótese total fixa em cantiléver na arcada mandibular: acompanhamento de um ano

This paper presents a case report with the use of short dental implants and immediate prosthesis placement. After 13 months of follow-up, peri-implant probing values are near 1.87 mm and ISQ values around 78.56.

Implantes curtos em região posterior da mandíbula

The rehabilitation of edentulous areas with osseointegrated dental implants is a well-documented, predictable procedure in the literature, with high success rates. However, the lack of bone at the recipient bed or proximity to anatomic structures limits the rehabilitation procedure especially at the posterior mandible. Thus, short implants are an alternative treatment for such cases of severe bone resorption. The purpose of this study was to review the success rate of short implants, especially those based in the posterior mandible and to show a clinical case. A literature review was made on electronic databases PubMed and Bireme with articles published between the years 2005 to 2012, using the keywords "short dental implants". It was concluded that the success rates of short implants are similar to those presented by conventional implants but still related to their geometry and surface treatment. Also, short implants can be considered as a viable alternative for the rehabilitation of severely resorbed jaws. However, many authors consider that more research is necessary when a short implant is compared to a long dental implant.

Implantes dentais em pacientes com diabetes mellitus

Dental implants represent a great improvement in Dentistry in respect to rehabilitation of edentulous ridges due to the functional and aesthetic reestablishment with long-term predictability and success. However, the effectiveness of this treatment relies on successful osseointegration during the healing period. In this way, the applicability of dental implants in patients with diabetes mellitus (DM) remains controversial, by the fact that the hyperglycemic status presents a negative effect on the osseointegration. It is not clear yet if the therapy with dental implants is an absolute contraindication to these patients. For this reason, the aim of the present study is to review the literature about the treatment with dental implants in patients with diabetes and to propose a protocol to perform dental implants in patients with diabetes. Diabetes has been considered a relative contraindication to dental implants, as the patients with adequate metabolic control can be treated with this kind of therapy, because inadequate metabolic control can lead to the failure of the treatment. Besides, there are risk factors for the diabetic implant patient that may decrease the success rates of dental implants therapy. In this way, the dentist should understand all the relevant implications before considering the indication of dental implants to patients with diabetes. It is important to have more controlled studies to evaluate the effects of diabetes on the implant-tissue interface and further investigations are necessary in order to elucidate the role of insulin and molecular mechanisms that might interfere on the osseointegration in patients with diabetes.

Incorporação de enxertos ósseos autógenos e homógenos em humanos: abordagem tomográfica

The objective of this study was to evaluate the remodeling of autologous and homologous bone grafts in humans, using tomographic images. For this, CT images from 10 patients (5 treated with autologous bone grafts and 5 treated with homologous bone grafts), made previously to the grafting procedures, and 14 and 180 days post operatory were evaluated regarding to bone height, width, and density, in a total of 19 bone blocks, 10 homologous and 9 autologous. Results showed similarities between the two tested materials regarding bone width and density. It can be concluded that the homologous bone presented, in a tomographic approach, after 180 days of follow-up, characteristics which can corroborate its use as a bone graft material, providing and sustaining a good bone volume for oral rehabilitation with dental implants.

The influence of different implant surfaces on osseointegration in diabetes: a systematic review of the literature

AIM: The aim of this study was to evaluate, through a systematic review of the literature, the effects of different implant surface modifications on osseointegration in diabetic subjects. METHODS: A search was performed of the PubMed database, using a combination of the following keywords: “Implant surface” OR “Dental implants” AND “Diabetes” OR “Hyperglycemia”. Papers published in English between January 1960 and November 2013 were selected. All experimental models were considered in this search, but case reports and in vitro studies were excluded from this review. RESULTS: The initial search identified 182 articles. After reading the titles and abstracts, 39 articles were selected for full reading. Finally, 4 papers were selected after evaluation of all the papers, and these papers are discussed in this review. Due to the methodological heterogeneity of the selected studies, it was not possible to perform a meta-analysis of the data. CONCLUSION: It can be concluded that although the benefits of surface modifications present in individuals with diabetes have biological plausibility, there is little evidence of the benefits of these modifications.

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.

Aplicação do laser Er,Cr:YSGG em periodontia e implantodontia: revisão de literatura

Lasers are widely used tools in many therapeutic modalities in medical lasers and can be divided into low and high intensity. For the treatment of periodontal disease, lowintensity lasers are related to reduce the number of bacteria and to induce inflammatory and analgesic properties. The high intensity lasers can be used in surgical procedures, improving hemostasis, promoting more accurate cuts, removal of dental calculus as well as thermomechanical and photochemical interactions with tissue. The high-intensity laser Erbium impregnated with chromium: YSGG laser has shown satisfactory results when applied in endodontic, restorative denstistry, surgical procedures and non-surgical periodontal treatment. The purpose of this review is to evaluate the studies that investigated the effects of Er, Cr: YSGG laser on the morphology and biocompatibility of titanium and root surfaces irradiated with these lasers, even beyond the effect on the treatment of periodontitis and periimplantitis.

Próteses parciais removíveis associadas a encaixes: implicações clínicas e laboratoriais

Nowadays, the fixed partial dentures and/or dental implants is the most requested treatmentby the majority of partially edentulous patients. However, depending on the periodontal condition of the remaining teeth, as well as the bone condition of the prosthetic space, the oral rehabilitation with these treatments may be limited or even contraindicated. In such cases, the use of removable partial dentures associated to attachments becomes an important alternative for aesthetic and functional rehabilitation. Attachments are mechanical devices consisted of two parts (patrix-matrix), one placed inside another, which act as direct retainer, providing retention, support and stability to the dentures. These devices can be classified as intra or extracoronal attachments, considering their position in relation to the abutment tooth. However, regardless the type of attachment, the association between fixed and removable partial dentures should be performed respecting the biomechanical principles of both. Therefore, the purpose of this study was to review and discuss the literature about the clinical and laboratory implications of the association between fixed and removable partial dentures by means of attachments.

Influência do desenho do implante na micromovimentação de implantes imediatos com carga imediata: análise multivariada em elementos finitos

The purpose of this paper was to evaluate the influence of different implant designs on the micromovements of immediately placed implants. CT-based finite element models comprising an upper central incisor socket and four commercially available internal connection implant designs (SIN SW®, 3i Certain®, Nobel ReplaceTM, and RN synOcta® ITI Standard) of comparable diameter and length were constructed. 50, 100 and 200N magnitude loads were applied over the implant. ANOVA at 95% level of significance was used to evaluate bone to implant relative displacement (micromovements). The implant design (68,80%) greatly influences the micromovement of immediately placed implants. However, the loading magnitude (68,80%) is the most important factor regarding the implant stability in this protocol.

A survey of the management of patients with temporomandibular disorders by general dental practitioners in southern Brazil

Purpose: Temporomandibular disorders (TMD) are recognized as one of the mostcontroversial topics in dentistry, despite the fact that both basic science and clinicalresearchers have currently reached some degree of consensus. This study aimed toconduct a questionnaire-based survey about the management of TMD patients bygeneral dental practitioners (GDPs).Materials and Methods: One hundred fifty-one GDPs with a private practice in a cityof southern Brazil were included, independent of school of origin, gender, graduationyear, and curriculum content. All participants were administered a questionnaire aboutthe management of patients with TMD, and the responses were analyzed by binomialand chi-square tests (α = 0.05).Results: Of the GDPs, 88.7% received TMD patients, who were primarily diagnosedon the basis of medical history (36.6%) or physical examination (30.4%). Of these,65.4% referred the patients elsewhere, primarily to specialists in occlusion (36.1%) ororthodontics (29.7%). Occlusal splinting was the most commonly used managementmodality (20.8%), followed by occlusal adjustment (18.1%) and pharmacotherapy(16.6%). Splints were fabricated in maximum habitual intercuspation or centric re-lation depending on individual patient (54.8%). The hard stabilization form was themost common type of appliance used (35.0%). Moreover, 73.8% of the GDPs didnot employ semi-adjustable articulators, and 69.5% adjusted the appliances at thetime of fixing. The duration of splint use and the frequency of follow-up were con-sidered patient dependent by 62.1% and 72.8%, respectively. GDPs considered thetwo major TMD etiologic categories as multifactorial (20.8%) and occlusion (19.9%).Multidisciplinary medical and dental treatment was considered necessary by 97.9%.Conclusions: The evaluated general dental practitioners manage TMD patients ac-cording to international guidelines.

A clinical report of an oral lichen planus associated to epidermoid carcinoma in contact with metallic restorations

The aim of this study was to relate the clinical case of a patient with oral lichen planus (OLP) and a history of epidermoid carcinoma associated with metallic restorations. The etiology of OLP is a mucocutaneous disease, which is poorly understood. Studies point to the potential of malignant transformation of OLP and its association with metallic restorations. The metallic restorations were replaced by crowns with a ceramic covering associated and osseointegrated implants in the edentulous areas. About 1 year later, it was observed a bilateral regression of the tongue lesions. The replacement of metallic restorations can contribute to improvement of OLP.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Reabilitação estético-funcional sobre implantes agulhados e endósseos

This report shows the resolution of a case study whose aim was promote the aesthetic and functional rehabilitation of upper left hemi-arch over endosseous and needle implant prostheses. To improve the position of the needle implants, we performed the bucco-palatal bending of needles splinting them with composite resin; we removed the screwed implant prosthesis in the regions of the premolars (24 and 25) and molar (26). The mini-abutments of the last two implants were replaced, and in the first premolar and canine, we used cemented abutments due to implant angulation having planned soldering because of implant size and contact with one needle implant that could interfere with intimate contact bone/implant damaging biomechanics. Pick-up impressions were performed with an open tray, using a retractor cord in the needle implants and respective transfer copings. Therefore, models were related on semi-adjustable articulator after a face-bow recording and interocclusal indexes. After working cast fabrication and try-in of infra-structures, these were adjusted and related into the articulator again. Then, after ceramic build-up, adjustments, finishing, and torque, chemically-activated resin cement was applied on units 21 to 24. At the end of the case, we concluded that a good aesthetic and functional rehabilitation depends on thorough knowledge of techniques for each clinical situation.

Aspectos biológico-celulares da osseointegração baseados nas superfícies de implantes

Osseointegration involves a cascade of biological events, which can be accelerated by modifying the micro and/or nanometric topography of dental implant surfaces. Considering that different treatment types modify the titanium surface giving it a more pronounced rough topography, and physicochemical changes that appear to positively influence the osseointegration process, a literature review was made on the main types of surface treatments and their influence on the biological and cellular aspects of osseointegration, with publications dating from 1969 until the present moment. Although the precise role of the implant surface on the osseointegration of dental implants is not completely clear, the specific effects of implant surface on bone regeneration, initial kinetics, and evolution of mechanical properties have shown to be quite promising. Thus, based on dental implant surface modifications, osseointegration can be defined as a process by which rigid asymptomatic fixation of an alloplastic material can be achieved and kept in close contact with bone tissue, being resistant to early and late functional loads. This process can be modulated by an appropriate treatment of the alloplastic material surface.

Diagnóstico e planejamento em cirurgia parendodôntica: utilização da tomografia cone beam

The ability to tridimensionally evaluate pathological and anatomical areas, in apical surgery planning, presents a number of advantages. Cone beam computed tomography (CBCT) was developed for dental applications. This paper aims to present a literature review on CBCT, highlighting its advantages over both conventional computed tomography (CT) and radiography. Moreover, its clinical applications in apical surgery are discussed. LITERATURE REVIEW AND CONCLUSION: Unlikely CT, CBCT captures a volume of data in a single 360º rotation, providing benefits such as higher accuracy, better resolution, reduced scanning time and reduced radiation dose. In the maxillofacial region, CBCT has been mainly used in the assessment of dento-alveolar pathology and oral traumatology. CBCT provides a better diagnosis and quantitative information on periodontal bone levels than conventional radiography. It has also been used for patients requiring surgical facial reconstruction, orthognathic surgery, dental implants, and more complex tooth extractions. Besides that, it seems to be a significant tool in modern endodontic practice, presenting useful applications in apical surgery.