Sobrevivência em fadiga de coroas bioinspiradas bilaminadas: estudo in vitro / Fatigue survival rate of bioinspired bilaminar crowns: in vitro study

O objetivo deste estudo foi avaliar o comportamento biomecânico através da resistência à fadiga e análise por elementos finitos de coroas bioinspiradas bilaminadas com infraestruturas modificadas na superfície vestibular (Estudo A) e utilizando diferentes materiais cerâmicos com módulos elásticos distintos (Estudo B). Para isso, foram confeccionados 90 preparos para coroa total em resina epóxi G10, sobre os quais foram preparadas coroas bioinspiradas de acordo com os seguintes grupos: Estudo A - IC (infraestrutura convencional), IME (infraestrutura modificada estratificada) e IMC (infraestrutura modificada cimentada), todas confeccionadas em dissilicato de lítio (infraestrutura) + porcelana (recobrimento); Estudo B ­ DL+LEU (dissilicato de lítio + leucita), LEU+DL (leucita + dissilicato de lítio), CH+DL (cerâmica híbrida + dissilicato de lítio) e CH+LEU (cerâmica híbrida + leucita). Para o Estudo A, todas as infraestruturas foram usinadas; os recobrimentos dos grupos IC e IME foram confeccionados através da estratificação, e os recobrimentos do grupo IMC foram usinados. Já para o Estudo B, todas as peças foram usinadas, de acordo com o material cerâmico de cada grupo. Em seguida, foi realizada a cimentação adesiva dos recobrimentos sobre as infraestruturas (a depender do grupo) e das coroas sobre os preparos utilizando cimento resinoso fotopolimerizável (Variolink Esthetic LC). Após a cimentação, os espécimes foram submetidos ao teste de fadiga cíclica (10.000 ciclos, 20Hz), e como desfecho foram considerados dois eventos, em que o primeiro foi a ocorrência de trinca e/ou lascamento (evento 1) e o segundo foi a falha catastrófica do conjunto (evento 2). Os valores de carga e número de ciclos para falha em que foram observados os eventos 1 e 2 foram utilizados para realizar a análise de sobrevivência de acordo com Kaplan-Meier e Log-Rank (Mantel-Cox; 95%). As marcas de fratura e o modo de falha das coroas foram avaliados e classificados por estereomicroscópio óptico e microscópio eletrônico de varredura. Por fim, foi realizada análise por elementos finitos (FEA) para ambos os estudos, a fim de avaliar a distribuição de tensões sobre as coroas e interface adesiva. Para o Estudo A, os resultados do teste de fadiga mostraram que, considerando o evento 1 (trinca/lascamento), os grupos IC e IMC apresentaram médias de carga fadiga estatisticamente significantes entre si (733,33 N e 913,33 N, respectivamente), enquanto o grupo IME apresentou média superior (1.020 N). O mesmo foi observado para o número de ciclos em fadiga para todos os grupos. Ao considerar o evento 2 (falha catastrófica), os três grupos apresentaram médias estatisticamente semelhantes entre si (~1.028 N). Os resultados de FEA mostraram que o grupo IC concentrou maior tensão de tração do que os grupos IME e IMC. Para o Estudo B, no teste de fadiga, o grupo DL+LEU apresentou a maior média de resistência à fadiga (evento 1: 913,33 N e evento 2: 1033,33 N), enquanto todas as outras combinações de materiais cerâmicos analisadas foram estatisticamente semelhantes entre si, considerando carga e número de ciclos. Com relação ao FEA, os grupos com cerâmica híbrida (CH+DL e CH+LEU) apresentaram menores picos de concentração de tensão na infraestrutura do que os grupos com cerâmicas vítreas (DL+LEU e LEU+DL), porém, em contrapartida, concentraram maior tensão na interface adesiva. Com isso, conclui-se que a utilização da infraestrutura modificada é uma alternativa viável e promissora para tratamentos reabilitadores, apresentando sobrevivência em fadiga e distribuição de tensões satisfatórias. Além disso, a combinação entre uma infraestrutura de dissilicato de lítio e recobrimento de cerâmica a base de leucita corresponde a melhor abordagem considerando a infraestrutura modificada.(AU)

The objective of this study was to evaluate the biomechanical behavior through fatigue resistance and finite element analysis of bilaminar bioinspired crowns with modified infrastructures on the buccal surface (Study A) and using different ceramic materials with different elastic moduli (Study B). For this, 90 preparations were made for a full crown in G10 epoxy resin, on which bioinspired crowns were prepared according to the following groups: Study A - CI (conventional infrastructure), SMI (stratified modified infrastructure) and CMI (cemented modified infrastructure ), all made of lithium disilicate (infrastructure) + porcelain (veneer); Study B ­ LD+LEU (lithium disilicate + leucite), LEU+LD (leucite + lithium disilicate), HC+LD (hybrid ceramic + lithium disilicate) and HC+LEU (hybrid ceramic + leucite). For Study A, all infrastructures were machined; the coverings of the CI and SMI groups were made through stratification technique, and the veneers of the SMI group were machined. For Study B, all pieces were machined, according to the ceramic material of each group. Then, the veneers were cemented into their infrastructures (depending on the group) and crowns were cemented into preparations using light-cured resin cement (Variolink Esthetic LC). After cementing, the specimens were subjected to the cyclic fatigue test (10,000 cycles, 20Hz), and as an outcome two events were considered: the occurrence of cracking and/or chipping (event 1) and catastrophic failure (event 2). The load (N) and number of cycles to failure in which events 1 and 2 were observed were used to perform the survival analysis according to Kaplan-Meier and Log-Rank (Mantel- Cox; 95%). The fracture marks and failure mode of the crowns were evaluated and classified by optical stereomicroscope and scanning electron microscope. Finally, finite element analysis (FEA) was performed for both studies in order to evaluate the stress distribution over the crowns and adhesive interface. For Study A, the results of the fatigue test showed that, considering event 1 (cracking/chipping), the CI and CMI groups presented average to failure that were statistically significant compared to each other (733.33 N and 913.33 N, respectively), while the SMI group showed higher averages (1,020 N). Same pattern was observed for the number of cycles under fatigue for both groups. When considering event 2 (catastrophic failure), the three groups presented statistically similar means (~1,028 N). The FEA results showed that the CI group concentrated greater tensile stress than the CMI and SMI groups. For Study B, in the fatigue test, the LC+LEU group presented the highest average fatigue resistance (event 1: 913.33 N and event 2: 1033.33 N), while all other combinations of ceramic materials analyzed were statistically similar to each other, considering load and number of cycles. Regarding FEA, the groups with hybrid ceramics (HC+LC and HC+LEU) showed lower stress concentration peaks in the infrastructure than the groups with glass ceramics (LC+LEU and LEU+LC), however, on the other hand, concentrated greater tension at the adhesive interface. With this, it is concluded that the use of modified infrastructure is a viable and promising alternative for oral rehabilitation treatments, presenting satisfactory fatigue survival and adequate stress distribution. Furthermore, the combination of a lithium disilicate infrastructure and a leucite-based ceramic coating corresponds to the best approach considering the modified infrastructure.(AU)

X-linked hypohidrotic ectodermal dysplasia management with removable prosthesis in a pediatric patient: case report / Manejo de displasia ectodérmica hipohidrótica ligada al cromosoma X con prótesis removible en un paciente pediátrico: reporte de caso

Introduction: Ectodermal dysplasia is a rare genetic disorder that affects structures derived from ectoderm such as teeth, hair, nails, and sweat glands. Oligodontia is a common finding that affects the chewing, smiling and self- esteem of these pediatric patients. Case Report: We present a case report of a 7-years-old pediatric patient who consulted with his mother, showing the same condition. The intervention consisted of a removable prosthesis with satisfactory results. Conclusion: The X-linked hypohidrotic ectodermal dysplasia represents a challenge for a pediatric dentist who offers rehabilitation to the patient according to craniofacial development, age, socioeconomic status, and the number of missing teeth.

Introducción: La oligodoncia es un hallazgo común que afecta la masticación, la sonrisa y la autoestima de estos pacientes pediátricos. Case Report: Presentamos un reporte de caso de un paciente pediátrico de 7 años que consultó con su madre presentando la misma condición. La intervención consistió en una prótesis de remoción con resultados satisfactorios. Conclusión: La displasia ectodérmica hipohidrótica ligada al cromosoma X representa un desafío para un odontopediatra que ofrece rehabilitación al paciente de acuerdo con el desarrollo craneofacial, la edad, el nivel socioeconómico y el número de dientes faltantes.

Reabilitação oral utilizando prótese parcial removível associada a implantes osseointegrados: relato de caso / Oral rehabilitation using removable partial prosthesis associated with osseointegrated implants: case report

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)

Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)

Restabelecimento da Dimensão Vertical de Oclusão com JIG estético modificado e Prótese Parcial Removível Overlay: relato de caso / Reestablishment of occlusal vertical dimension with a modified aesthetic JIG and an overlay removable partial denture: a case report

A reabilitação de pacientes parcialmente edêntulos com desgaste dentário severo e dimensão vertical de oclusão reduzida é desafiadora e complexa. Objetivo: Descrever o restabelecimento da dimensão vertical de oclusão e parâmetros estéticos com uma prótese parcial removível do tipo overlay (PPRO) com auxílio de um JIG estético modificado. Relato de caso: Paciente do sexo masculino, 58 anos de idade, procurou serviço odontológico queixando-se de insatisfação com a estética do sorriso e perda dos dentes posteriores. Ao exame clínico, foram observados desgaste dentário excessivo e edentulismo parcial nas arcadas superior e inferior. Então, foi proposto tratamento em 2 etapas (provisória e definitiva) com PPRO em maxila. O JIG estético foi usado como guia de referência para incrementos em resina composta fotopolimerizável e o restabelecimento da dimensão vertical de oclusão foi determinado a partir de métodos métrico, fonético e estético. Os dentes desgastados foram aumentados e os dentes ausentes substituídos por dentes artificiais a partir de uma PPRO provisória. Após 2 meses de adaptação, a reabilitação final com PPRO definitiva foi conduzida baseando-se na reabilitação com a PPRO provisória. Conclusão: O paciente relatou satisfação com a estética e desempenho funcional com o tratamento. Portanto, o JIG estético beneficia o planejamento e o tratamento para restabelecer a dimensão vertical de oclusão. Além disso, a PPRO é uma alternativa reversível, de baixo custo, para reabilitar a estética e a função de pacientes com desgaste severo e perda parcial dos dentes.

The rehabilitation of partially edentulous patients with severe tooth wear and reduced occlusal vertical dimension is challenging and complex. Objective: To describe the reestablishment of occlusal vertical dimension and aesthetic parameters with an overlay re-movable partial denture (ORPD) with the aid of a modified aesthetic JIG. Case report: A 58-year-old man sought dental service complaining of dissatisfaction with the aesthetics of his smile and a loss of posterior teeth. At clinical examination, excessive tooth wear and partially edentulism in the lower and upper arches were observed. A two-step treatment (interim and definitive) with an ORPD in the upper arch was proposed. The aesthetic JIG was used as a reference guide for the increments in light-curing resin composite, and the reestablishmentthe occlusal vertical dimension was determined using aesthetic, phonetic, and metric methods. The worn teeth were increased, and the missing natural teeth were replaced by artificial teeth using a temporary ORPD. After two months of adaptation, de-finitive rehabilitation with a definitive ORPD was performed based on the interim ORPD. Conclusion: The patient reported satisfaction with the esthetic and functional performance of this treatment. Therefore, the aesthetic JIG benefits the planning and treatment of reduced vertical dimension. Moreover, the ORPD is a reversible and lower-cost alternative to rehabilitate the aesthetics and function of patients with severe teeth wear and partial teeth loss.

Caso Clínico: Reabilitação Cerâmica Anterior com Sistema CAD/CAM / Anterior Rehabilitation with CAD/CAM System: Case Report

Devido a constante busca por um sorriso harmônico, o nível de exigência e a expectativa dos pacientes tornam-se elevados, propiciando o desenvolvimento de novos materiais e técnicas odontológicas que visam procedimentos mais conservadores e resultados cada vez mais previsíveis esteticamente. As técnicas com Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) têm ocupado lugar de destaque na Odontologia. Isso se deve ao fato de que o projeto auxiliado por computador ou fabricação assistida por computador oferece um método de restauração que diminui o risco de erro humano e fornece resultados altamente estéticos em um tempo clínico reduzido, embora com custos relativamente altos. O objetivo do presente estudo é apresentar, através de um relato de caso clínico, uma reabilitação estética por meio da aplicação prática do sistema CAD / CAM. Com a finalização do caso foi possível observar melhora estética através da confecção das coroas cerâmicas anteriores e melhora da condição oclusal com a confecção de prótese removível superior, a qual viabiliza uma maior durabilidade das coroas cerâmicas, pois distribui melhor as cargas oclusais entre os elementos, evitando cargas excessivas no local das novas restaurações indiretas. Este relato de caso foi realizado em duas sessões odontológicas alcançando satisfação estética da paciente. Possui um acompanhamento de curto prazo, portanto, são necessários casos com acompanhamento a longo prazo para comprovar o sucesso dessa técnica. Pode-se considerar uma limitação o elevado custo tecnológico, porém é notório avanço na odontologia para melhorar a qualidade no tratamento em períodos extremamente curtos.

Due to the constant search for a harmonic smile, the level of demand and the expectations of patients become high, enabling the development of new materials and dental techniques that aim at more conservative procedures and more and more predictable results aesthetically. Techniques with Computer Aided Design and Computer Aided Manufacturing (CAD / CAM) have occupied a prominent place in Dentistry. This is due to the fact that computer aided design or computer aided manufacturing offers a restoration method that lowers the risk of human error and provides highly aesthetic results in a reduced clinical time, albeit at relatively high costs. The objective of the present study is to present, through a clinical case report, an aesthetic rehabilitation through the practical application of the CAD / CAM system. With the completion of the case, it was possible to observe aesthetic improvement through the preparation of the anterior ceramic crowns and improvement of the occlusal condition with the manufacture of a removable upper prosthesis, which enables greater durability of the ceramic crowns, as it better distributes the occlusal loads among the elements, avoiding excessive loads at the site of new indirect restorations. This case report was carried out in two dental sessions, achieving patient aesthetic satisfaction. It has a short-term follow-up, therefore, cases with long-term follow- up are necessary to prove the success of this technique. The high technological cost can be considered a limitation, but there is a notable advance in Dentistry to improve the quality of treatment in extremely short periods.

Ángulos de convergencia en preparaciones dentarias realizadas en tipodontos por estudiantes de Odontología, Unach / Convergence angles in dental preparations performed on typodont by students of dentistry, UNACH

El objetivo de esta investigación fue analizar los ángulos de convergencia en preparaciones dentarias para coronas realizadas en tipodontos, por estudiantes de décimo semestre de Odontología Unach. Las preparaciones dentales para coronas poseen características de retención y resistencia, principios fundamentales que ofrecen éxito y longevidad de la corona definitiva. Varios investigadores a nivel mundial han desarrollado diversos métodos para evaluar los ángulos de convergencia de las preparaciones extracoronarias; sin embargo, en nuestro medio, no existen estudios acerca de la medición de estos ángulos. Esta investigación fue de carácter experimental, transversal y observacional, se obtuvieron 32 preparaciones dentarias para coronas de recubrimiento completo, cada estudiante tuvo 60 minutos para tallar dos preparaciones dentarias en simuladores clínicos. Los tipodontos fueron escaneados y digitalizados mediante el escáner CAD-CAM Ceramill Database versión 1.0 año 2010 del Laboratorio "BrothersDent" para producir imágenes tridimensionales. El software iTero midió los ángulos vestíbulo-lingual (VL) y mesio-distal (MD) de cada preparación. Los ángulos más pequeño y más grande observados fueron 3.1° y 102.5° para molares mandibulares. El promedio del ángulo VL para dientes anteriores fue 40,38 ±4,38° en varones y 36,97 ±3,95° en mujeres y el promedio del ángulo MD fue 44,68 ±5,51° en varones y 40,08 ±3,99° en mujeres. Para dientes posteriores el promedio VL fue 27,46 ±7,82° en varones y 40,98 ±4,63° en mujeres; y el promedio del ángulo MD fue 40,73 ±5,95° en varones y 50,62 ±7,00° en mujeres. En conclusión, los ángulos de convergencia logrados por estudiantes fueron mayores que los ideales recomendados según Shillingburg.

This research aimed to analyze the angles of convergence in dental preparations for crowns performed on typodont, by 10th semester students of school of dentistry, UNACH. Dental preparations for crowns have retention and resistance characteristics, fundamental principles that offer success and longevity of the final crown. Various researchers worldwide have developed various methods to evaluate the convergence angles of extra coronary preparations; however, in our context, there are no studies on the measurement of these angles. This research was experimental, cross-sectional and observational, 32 dental preparations were obtained for fully covered crowns, each student had 60 minutes to carve two dental preparations in clinical simulators. The typodonts were scanned and digitized using the scanner CAD-CAM Ceramill Database version 1.0 - 2010 of "BrothersDent" Laboratory in order to produce three-dimensional images. The iTero software measured the vestibule-lingual (VL) and mesio-distal (MD) angles of each preparation. The smallest and largest angles observed were 3.1 ° and 102.5 ° for mandibular molars. The mean VL angle for anterior teeth was 40.38 ± 4.38 ° in males and 36.97 ± 3.95 ° in females, and the mean MD angle was 44.68 ± 5.51 ° in males and 40, 08 ± 3.99 ° in women. For posterior teeth the average VL was 27.46 ± 7.82 ° in men and 40.98 ± 4.63 ° in women; and the mean MD angle was 40.73 ± 5.95 ° in men and 50.62 ± 7.00 ° in women. In conclusion, the convergence angles achieved by students were greater than the recommended ideals according to Shillingburg.

Surgical and nonsurgical treatment of papillary hyperplasia: A case report / Tratamiento quirúrgico y no quirúrgico de la hiperplasia papilar inflamatoria: Reporte de Caso

Dentures with dental plaque predispose recurrent hyperplasia on the palatal mucosa. Surgical procedures for the treatment of inflammatory papillary hyperplasia involve postsurgical discomfort and morbidity. This repot describes clinical and histologic aspects of a patient with severe akantolitic inflammatory papillary hyperplasia. The palatal mucosa was treated with a surgical bur with a low-speed handpiece. A new removable denture was performed and adapted. A follow-up of 4 years showed staility of health at palatal mucosa. Patient referred low discomfort and morbidity when using bur technique. Control of removable denture was critical for long-term healing and soft tissue stability.

Las prótesis dentales con placa bacteriana predisponen a la hiperplasia recurrente en la mucosa palatina. Los procedimientos quirúrgicos para el tratamiento de la hiperplasia papilar inflamatoria implican molestias y morbilidad posquirúrgicas. Este reporte describe los aspectos clínicos e histológicos de un paciente con hiperplasia papilar inflamatoria acantolítica severa. La mucosa palatina fue tratada con una fresa quirúrgica con una pieza de mano de baja velocidad. Se realizó y adaptó una nueva prótesis parcial removible. Después de un seguimiento de 4 años, se encontró estabilidad de la salud de la mucosa palatina. El paciente se refirió a la baja incomodidad y morbilidad al usar la técnica de la fresa. El control de la prótesis parcial removible fue crítico para la cicatrización a largo plazo y la estabilidad de los tejidos blandos, evitando la recidiva de la hiperplasia papilar inflamatoria.

Considerações sobre os tipos de próteses parciais removíveis e seu impacto na qualidade de vida / Considerations on types of removable partial dentures and their impact on oral health

O objetivo deste estudo foi discutir, por meio de uma revisão de literatura, as indicações, contraindicações, vantagens, desvantagens das alternativas reabilitadoras mais comuns utilizando PPRs e o impacto desses tratamentos na qualidade de vida relacionada à saúde bucal dos pacientes. Foi realizada uma pesquisa ampla na literatura, com a utilização dos termos "Prótese Parcial Removível", "Qualidade de Vida", "Saúde bucal"; "Satisfação do Paciente", no período entre 1990 e 2018, no Medline, Google Scholar, internet e livros didáticos. Foi demonstrado que a reabilitação com PPRs associadas a implantes resultou em melhor qualidade de vida associada à saúde bucal dos usuários, seguida por PPRs retidas por encaixe e PPRs convencionais. Entretanto, o profissional deve considerar as condições sistêmicas, bucais e econômicas de cada paciente, tendo o conhecimento biomecânico bem como a ciência dos benefícios e das desvantagens de cada tipo de tratamento para estabelecer um correto diagnóstico do caso e, assim, indicar o melhor tipo de PPR. Dessa forma, é possível oferecer o melhor tratamento para cada paciente parcialmente edêntulo, devolvendo estética e função de maneira satisfatória de modo a resultar em maior nível de satisfação e qualidade de vida(AU)

The purpose of this study was to discuss, through a review of the literature, indications, contraindications, advantages, disadvantages of the most common rehabilitation alternatives using RPDs and the impact of these treatments on patients' oral health quality of life. A broad research was conducted in the literature, using the terms "Partial Removable Prosthesis", "Quality of Life", "Oral Health"; "Patient Satisfaction" in the period between 1990 and 2018, in Medline, Google Scholar, internet and textbooks. It was demonstrated that rehabilitation with RPDs associated with implants resulted in a better oral health quality of life of users, followed by RPDs with attachments and conventional RPDs. However, the professional should consider the systemic, oral and economic conditions of each patient, based on the biomechanical knowledge, as well as the science of the benefits and disadvantages of each type of treatment to establish a correct diagnosis of the case, and thus, indicate the best type of RPD. In this way, it is possible to offer the best treatment for each partially edentulous patient, returning aesthetics and function in a satisfactory manner in order to result in a higher level of satisfaction and quality of life(AU)

Comparison of flow conditions of adhesives and retention force of restorations among four cement-retained methods of implant-supported fixed prostheses / 中华口腔医学杂志

Objective@#To compare the effect on the flow conditions of adhesives and the retention force of restorations among different cement-retained methods of implant-supported fixed prostheses.@*Methods@#Four common cement-retained methods were selected, including the occlusal hole for screw access (OH), the lingual hole for adhesives overflow (LH), the resin replica for titanium abutment (RR), and the traditional cement-retained method (the control group). The adhesive used in this study was resin-modified glass ionomer cement. The two-dimensional analysis models of computational fluid dynamics (CFD) were established. The flow conditions of adhesives in the adhesion process was analyzed by the CFD analysis. The internal filling ratio and the amount of neck overflow of adhesives below the edge of the prosthesis were calculated. Ten zirconia prostheses in each group were processed and cemented. The retention force was examined by mechanical tensile experiments in vitro.@*Results@#The CFD analysis showed the internal filling ratio of adhesives from high to low was the LH group, the OH group, the RR group and the control group. The amount of neck overflow of adhesives below the edge of the prosthesis from less to more was the RR group, the OH group, the LH group and the control group. The retention force was (240.7±33.9) N in the control group, (278.2±59.1) N in the OH group, (292.9±47.9) N in the LH group, and (262.8±59.4) N in the RR group. There was a statistically significant difference in the retention force between the LH group and the control group (P=0.029). There was no significant difference among the other groups (P>0.05).@*Conclusions@#The modified cement-retained methods can effectively reduce the amount of neck overflow of adhesives, and improve the filling condition of adhesive in the adhesive clearance to ensure the retention force of the prostheses. Clinically, the appropriate modified cement-retained method should be selected according to the three-dimensional position of the implant and the position of prosthetic margin.

Three-dimensional finite element analysis of cantilever fixed bridge supported by implants with mandibular central incisor / 中华口腔医学杂志

Objective@#To investigate effect of the contact surface between the bridge and the adjacent teeth on the stress distribution of the implant and bone tissue and the displacement of the prosthesis in the cantilever fixed implant bridge restoring missing mandibular central incisors.@*Methods@#Two-dimensional images of the mandible and dentition in healthy adults were obtained using CT data. A three-dimensional finite element model of cantilever fixed bridge supported by implants with mandibular central incisor was established by computer reconstruction technique.The contact surface between the bridge and the adjacent natural tooth was designed as "oval" and "trapezoid". The "trapezoid" has a slightly smaller median diameter on the labial side and a slightly larger medial diameter on the lingual side. Loading of 120 N was applied on the tangential margin of the middle line of the long axis of the bridge 41. The direction was set at 0°, which was parallel to the long axis of the tooth and downward. The buccal to lingual and downward angles were 30°, 45° and 60°, respectively, perpendicular to the long axis of the tooth and 90° to the lingual side.The stress distribution of the implant and surrounding bone tissue and the displacement of the prosthesis were compared between the two models.@*Results@#Under axial and buccolingual loading, the maximum equivalent stress peak in the implant and surrounding bone tissue in the cantilever with trapezoidal contact surface design and the maximum displacement of the prosthesis were lower. Moreover, the distribution of stress was more balanced and the concentration range of stress was smaller. With the loading angle increasing, this trend was more obvious. When loading angle increased to 90°, the maximum equivalent stress and the maximum displacement of the elliptic contact surface model implant and surrounding bone tissue were 196 and 101 MPa and 0.196 mm, respectively, while the trapezoidal contact surface model were 157 and 72 MPa and 0.164 mm, respectively.@*Conclusions@#The trapezoidal contact surface of the bridge and the adjacent teeth in the cantilever fixed bridge supported by implants with mandibular central incisor is beneficial to reduce the impact of the leverage on the implant and surrounding bone tissue.

Application of polyetheretherketone and its composite as frameworks in fixed dental prostheses / 中华口腔医学杂志

Characterized by eminent mechanical properties, chemical stability and biosafety, polyetheretherketone (PEEK), as a brand-new type of biomedical material, has been applied in the field of stomatology. This review elaborates on basic behaviors and fabrication methods of PEEK and its composite, and their application in fixed dental prostheses (FDP) as frameworks as well as their adhesive properties. Meanwhile, this review also looks into the prospect of the integration of additive manufacturing in fabricating frameworks of PEEK and its composite in FDP.

Rehabilitación estética y funcional con una prótesis parcial fija en la dentición primaria: reporte de caso / Aesthetic and functional rehabilitation with a fixed prosthetic denture in the primary dentition: A case report / Aesthetic and functional rehabilitation with a fixed prosthetic denture in the primary dentition: A case report

La caries de infancia temprana (CIT) es una enfermedad de etiología multifactorial que afecta al ser humano en fase prees-colar, en un nivel más agresivo se presenta como caries severa en la infancia (CSI) y tiene inicio en los incisivos primarios superiores. Paciente, 4 años de edad de sexo femenino, al examen clínico presenta múltiples lesiones de caries, con diag-nóstico de necrosis pulpar y fístulas en los incisivos centrales superiores primarios que fueron extraídos, lesiones de caries en los incisivos laterales superiores sin compromiso pulpar que fueron utilizados como pilares para la prótesis, el tratamien-to indicado fue la construcción y cementación de una prótesis fija de sistema tubo-barra, llamada prótesis Denari, creada por el Dr. Walter Denari (UNISANTA- Brasil), la cual presenta como características principales: permite el crecimiento transversal del maxilar superior, es fijo con el objetivo de evitar pérdidas por parte del niño, recupera la función y la sonrisa perdida. Se realiza un desgaste mínimo de los pilares dentales y es una alternativa de tratamiento que evita alteraciones en el habla, degluciones atípicas y restablece la armonía de la sonrisa de forma simple y eficiente en el paciente.

Early Childhood Caries (ECC) is a disease of multifactorial etiology that affects the human being in the preschool stage, in a more aggressive level presents as severe caries in childhood (S-ECC) and has onset in the upper primary incisors. Patient, 4 years old female, on clinical examination presented multiple caries lesions, with diagnosis of pulp necrosis and fistulas in the primary upper incisors that were extracted, caries lesions on the upper lateral incisors without pulp involvement that were used as the pillars for the prosthesis, the treatment indicated was the construction and cementation of a fixed prosthe-sis of a tube-bar system, called Denari prosthesis, created by Dr. Walter Denari (UNISANTA- Brasil), which presents as main characteristics: Transversal growth of the upper jaw, it is fixed with the aim of avoiding losses on the part of the child, regain function and smile lost. It's a minimal wear of dental pillars and is an alternative treatment that avoids alterations in speech, atypical swallows and restores the harmony of simple and efficient smile way in the patient.

Cárie precoce na infância (CPI) é uma doença de etiologia multifatorial que afeta os seres humanos em fase pré-escolar, um nível mais agressivo é apresentado como Cárie Severa na infância (CSI) e tem início nos incisivos primários superiores. Paciente, do sexo feminino de 4 anos de idade, ao exame clínico apresenta múltiplas lesões de cárie, com diagnóstico de ne-crose pulpar e fístulas nos incisivos centrais superiores primários que foram extraídos, lesões de cárie nos incisivos laterais superiores sem envolvimento pulpar que foram utilizados como pilares protéticos, o tratamento indicado foi a construção e cimentação de uma prótese fixa de sistema tubo-barra, chamada próteses Denari, criado pelo Dr. Walter Denari (UNISAN-TA- Brasil), o qual apresenta as seguintes características principais: permite crescimento transversal da maxila, é fixo com o objetivo de evitar perdas pela criança, recupera a função e o sorriso perdido. Realiza-se um desgaste mínimo dos pilares dentários e é um tratamento alternativo que evita alterações na fala, deglutição atípica e restabelece a harmonia do sorriso de forma simples e eficiente no paciente.

A preliminary study on the forming quality of titanium alloy removable partial denture frameworks fabricated by selective laser melting / 中华口腔医学杂志

Objective@#To evaluate the processing accuracy, internal quality and suitability of the titanium alloy frameworks of removable partial denture (RPD) fabricated by selective laser melting (SLM) technique, and to provide reference for clinical application.@*Methods@#The plaster model of one clinical patient was used as the working model, and was scanned and reconstructed into a digital working model. A RPD framework was designed on it. Then, eight corresponding RPD frameworks were fabricated using SLM technique. Three-dimensional (3D) optical scanner was used to scan and obtain the 3D data of the frameworks and the data was compared with the original computer aided design (CAD) model to evaluate their processing precision. The traditional casting pure titanium frameworks was used as the control group, and the internal quality was analyzed by X-ray examination. Finally, the fitness of the frameworks was examined on the plaster model.@*Results@#The overall average deviation of the titanium alloy RPD framework fabricated by SLM technology was (0.089±0.076) mm, the root mean square error was 0.103 mm. No visible pores, cracks and other internal defects was detected in the frameworks. The framework fits on the plaster model completely, and its tissue surface fitted on the plaster model well. There was no obvious movement.@*Conclusions@#The titanium alloy RPD framework fabricated by SLM technology is of good quality.

A pilot clinical study of immediate provisionalization with a chairside computer aided design and computer aided manufacture monolithic crown for single tooth immediate implant placement / 中华口腔医学杂志

Objective@#To evaluate the primary clinical outcomes of immediate provisionalization with a monolithic crown utilizing a novel chairside computer aided design and computer aided manufacture (CAD/CAM) workflow for single tooth immediate implant placement.@*Methods@#This pilot study was a prospective within-subjects design. Thirteen consecutive patients were included and diagnosed with untreatable single incisor or premolar with fine general and local anatomical conditions. The trial was conducted at Department of Implantology, Peking University School and Hospital of Stomatology, Beijing, between January 2016 and June 2016. The teeth were extracted atraumatically and implants were immediately placed in the fresh sockets. Two screw-retained interim crowns were fabricated for the same site utilizing different workflows, a monolithic lithium disilicate (LS2) crown produced by CEREC (Sirona, Germany) chairside CAD/CAM system (CER group) and a manually fabricated resin crown utilizing conventional workflow (CONV group) respectively. The patients were blinded to the group allocation of the two interim crowns. After the clinical try-in for both crowns in a randomized sequence, the patients' level of satisfaction was assessed with a virtual analogue scale (VAS) questionnaire. The restorations chosen by patients themselves were seated in the implants by one experienced prosthodontist. The accuracy, aesthetic effect and clinical time consumption of both groups were compared. Statistical analyses were performed with the Wilcoxon signed rank test.@*Results@#All patients were treated with atraumatic tooth extraction, immediate implant placement using flapless surgery and immediate provisionalization in a single visit. The interim crowns of both groups could be fitted with or without slight adjustments. For each patient, the interim crown of CER group was chosen to be seated with a relatively higher VAS result. The white esthetic score (WES) results demonstrated no statistically significant difference between CER group (7.5±1.1) and CONV group (7.9±0.9) (P>0.05). The mean total work time was significantly different resulting in (131.9±5.0) min for CER group and (205.2±6.3) min(P<0.05). The major difference lied in the laboratory work time, resulting in (113.5±6.3) min for CER group which was significantly shorter than (185.6±6.6) min for CONV group. As for impression taking time, the CER group (7.5±0.8) min was significantly shorter than CONV group (11.7± 1.1) min (P<0.05). However, analysis for clinical adjustment time showed a significantly longer time for CER group [(11.0±2.1) min vs (8.0±2.8) min, P<0.05]. After 3-6 months of observation, the overall survival rate was 100%. Screw loosening occurred in 4 patients and was tightened again. No other major complication soccurred.@*Conclusions@#The full digital workflow utilizing CEREC chairside CAD/CAM system to fabricate interim crowns after immediate implant placement in one single visit was feasible. It was more time-efficient and could effectively shorten the laboratory work time compared to the conventional workflow. Patients demonstrated high satisfaction and there was no statistical difference in WES results compared to the conventional workflow. Favorable clinical outcomes were gained in this short-term follow-up study.

Evaluation of Marginal and Internal Integrity of Modified Resin-Bonded Fixed Partial Dentures: An In Vitro Study

PURPOSE: The purpose of this study was to evaluate the microleakage of various types of resin-bonded fixed partial dentures (RBFPDs) after artificial aging. MATERIALS AND METHODS: Forty models with missing first molar were fabricated using artificial resin teeth and were divided into four groups: Group A, conventional RBFPDs design; Group B, modified RBFPDs design; Group C, assembled 3-piece RBFPDs design; and Group D, assembled 3-piece RBFPDs with different occlusal rest positions. Half of the specimens underwent chewing simulation process (240,000 cycles, 50 N load, 1.7 Hz) and thermocycling (temperatures 5℃~55℃, dwelling time 30 seconds) and the remaining 20 specimens didn't receive any treatment. All the specimens were immersed in 2% methylene blue solution for 24 hours to evaluate microleakage, and were sectioned at the middle part of abutment teeth. To evaluate the microleaskage, a dye penetration was calculated. RESULT: With artificial aging, cyclic loading and thermocycling, a 3-piece RBPFD and a 2-piece RBPFD using original tooth undercuts have significantly lower microleakge (P<0.05) compared to the conventional design of RBPFD and modified RBPFD. CONCLUSION: Within the limit of this experiment, the assembled RBFPDs exhibited a smaller microleakage than the conventional RBFPDs, implying that the assembled RBFPDs can be more effective for reducing the dislodgement of the RBFPDs.

Removable Partial Denture Using Anterior Implant-Supported Fixed Prostheses for Edentulous Patients: A Case Report

This case study was to report the possible increase in the denture retention and psychological relief using the implant-supported fixed prostheses in a completely edentulous patient. The implants were placed in the anterior portion of the mandible in a patient who had completely edentulous state following the extraction of residual abutment teeth, and consequently a distal extension removable partial denture was fabricated. The patient's adaptation and satisfaction to the new prosthesis was monitored and confirmed in terms of masticatory function and esthetics, by restoring the oral condition similar to initial status before the residual teeth extraction. After 6 months, radiographic examination confirmed that both the abutment teeth and the implants were stable and well maintained. Considering the relatively short clinical follow-up period, however, continuous long-term monitoring was required.

Residual stress within the porcelain veneer of 3-unit zirconia fixed dental prostheses with different framework designs measured by nanoindentation / Estresse residual na porcelana de revestimento de próteses parciais fixas de 3 elementos com diferentes desenhos de infraestrutura mensurado por nanoendentação

The present study aimed to identify different concentrations of residual stress of surfaces of porcelain veneer (PV) fused to zirconia 3-unit fixed dental prostheses (FDPs) with even thickness and modified (lingual collar connected to proximal struts presenting 12 mm2 connector area) framework designs by nanoindentation method. Twenty-three FDPs replacing second premolar (PM) were fabricated and the cyclic loading was applied on twenty FDPs. Fractured, suspended and non-fatigued FDPs were selected and divided (n=3/each) into: 1) Fractured even thickness (ZrEvenF); 2) Suspended even thickness (ZrEvenS); 3) Fractured with modified framework (ZrModF); 4) Suspended with modified framework (ZrModS); 5) Non-fatigued even thickness (Control). Moreover, the control group surfaces could be divided (n=3/each) into: 6) Mesial PM abutment (MPMa); 7) Distal PM abutment (DPMa); 8) Buccal PM abutment (BPMa); 9) Lingual PM abutment (LPMa); 10) Mesial PM pontic (MPMp); 11) Distal PM pontic (DPMp); 12) Buccal PM pontic (BPMp); 13) Lingual PM pontic (LPMp); 14) Mesial molar abutment (MMa); 15) Distal molar abutment (DMa); 16) Buccal molar abutment (BMa); 17) Lingual molar abutment (LMa). The PV surfaces were nanoindented in regions of interest (ROI) 1, 2 and 3, which were 0.03 mm, 0.35 mm and 1.05 mm from outer PV surface surface towards the PV/framework interface, respectively. Each ROI received 5 nanoindentations with 10 µm of minimum separation loaded to a peak load 4 µN. The Linear Mixed Model test and Least Significant Difference (95%) were used. The statistical analysis among ZrEvenF, ZrEvenS, ZrModF, ZrModS, and Control groups showed differences (p=0.000) except for the comparison between ZrModS and Control group (p=0.371). Also, ROI 1, 2, and 3 were different (p<0.001) with higher residual stresses in outer PV regions relative to those closer to the framework. The comparison among crowns showed that pontic was different from premolar (p=0,001) and molar (p=0,007) abutments, always showing higher residual stress levels. When marginal ridges groups (MPMa, DPMa, MPMp, DPMp, MMa, DMa) were compared, the DMa group was different from DPMp (p=0,004) and MPMa (p=0,00) group, whereas MPMa was different among all groups. The residual stress of porcelain veneer FDPs was different between: fractured and suspended FDPs regardless of the framework design; ROI 1, 2 and 3; and pontic and abutment crowns. Moreover, the proximal areas presented the highest concentration of residual stress. (AU)

O presente estudo teve como objetivo identificar diferentes concentrações de tensão residual de superfícies da cerâmica de revestimento (CR) de próteses parciais fixas de zircônia de 3 elementos (PPFs) com desenho da infraestrutura de espessura mínima e modificada (cinta lingual conectada aos postes proximais com 12 mm2 de área de conector) pelo método de nanoindentação. Vinte e três PPFs repondo segundo premolar (PM) foram confeccionados e o carregamento dinâmico foi aplicado em vinte PPFs. As PPFs fraturadas, suspensas e não fadigadas foram selecionadas e divididas (n=3/cada) nos seguintes grupos: 1) Fraturadas com espessura mínima (ZrEvenF); 2) Suspensas com espessura mínima (ZrEvenS); 3) Fraturadas com infraestrutura modificada (ZrModF); 4) Suspensas com infraestrutura modificada (ZrModS); 5) Não fadigadas com espessura mínima (Controle). Além disso, as superfícies do grupo controle foram divididas (n=3/cada) nos seguintes grupos: 6) Mesial do pilar PM (MPMa); 7) Distal do pilar PM (DPMa); 8) Vestibular do pilar PM (BPMa); 9) Lingual do pilar PM (LPMa); 10) Mesial do pôntico PM (MPMp); 11) Distal do pôntico PM (DPMp); 12) Vestibular do pôntico PM (BPMp); 13) Lingual do pôntico PM (LPMp); 14) Mesial do pilar molar (MMa); 15) Distal do pilar molar (DMa); 16) Vestibular do pilar molar (BMa); 17) Lingual do pilar molar (LMa). As superfícies da CR foram nanoendentadas nas regiões de interesse (ROI) 1, 2 e 3, a qual a distância da superfície externa da CR no sentido da interface CR/infraestrutura era de 0,03 mm, 0,35 mm e 1,05 mm, respectivamente. Cada ROI recebeu 5 nanoendentações com espaço mínimo de 10 µm para carregar até 4 µN. O teste modelo linear misto com diferença estatística mínima (95%) foi executado usando os valores de dureza. A análise estatística entre os grupos ZrEvenF, ZrEvenS, ZrModF, ZrModS, e Control apresentou diferenças (p=0.000) exceto para a comparação entre os grupos ZrModS e Control (p=0.371). Também, ROI 1, 2 e 3 foram diferentes (p<0.001). A comparação entre coroas mostrou que o pôntico foi diferente dos pilares pré-molar (p=0,001) e molar (p=0,007), sempre apresentando os maiores níveis de tensão. Quando os grupos das cristas marginais (MPMa, DPMa, MPMp, DPMp, MMa, DMa) foram comparadas, o grupo DMa foi diferente dos grupos DPMp (p=0,004) and MPMa (p=0,00), enquanto que o grupo MPMa foi diferente de todos os grupos. A tensão residual da cerâmica de revestimento foi diferente entre: PPFs fraturadas e suspensas independente do desenho da infraestrutura; ROI 1, 2 e 3; e pônticos e pilares. Além disso, as áreas proximais apresentaram a maior concentração de tensão residual. (AU)

Avaliação de hábitos de higiene bucal e satisfação em usuários de prótese parcial removível / Assessment of mouth hygiene habits and the satisfaction of removable partial denture

A prótese parcial removível a grampo (PPRG) possibilita reabilitar áreas parcialmente edêntulas, restaurando a função mastigatória, estética e fonética. Apesar dos avanços da Odontologia observados nas últimas décadas, estudos indicam que a higiene bucal dos pacientes usuários de PPRG ainda é precária. Desse modo, o objetivo desse estudo foi verificar os hábitos de higienização das próteses e cavidade bucal, bem como o nível de satisfação dos pacientes usuários de PPRG atendidos na Universidade Federal do Ceará (UFC). Trata-se de um estudo descritivo, quantitativo onde foi aplicado um questionário a 31 pacientes usuários de PPRG. Os dados foram analisados através do teste qui-quadrado e expressos na forma de frequência absoluta e percentual considerando uma confiança de 95%. Da amostra, a maioria (77,4%) era do gênero feminino, com idade entre 40 a 60 anos, (64,5%) possuíam ensino médio completo e haviam recebido orientações de higiene após a instalação da prótese (96,8%). O método de higienização mais utilizado foi a escovação mecânica com dentifrício. Quanto à frequência de higienização, 71% responderam realizá-la 3 ou mais vezes ao dia. A cárie foi apontada como o principal fator etiológico das perdas dentárias, apresentando uma diferença significativa em relação ao grau de satisfação dos pacientes com a prótese. Verificou-se que a maior parte dos indivíduos está muito satisfeita com o tratamento, embora ainda apresentem falhas na execução dos métodos de higiene bucal e da prótese.

Removable partial denture with clasps (RPDC) restores partially toothless areas, coupled to the chewing, aesthetic and phonetic functions. In spite of progress in dentistry during the last decades, several studies indicate that mouth hygiene of RPDC patients is rather low. Current analysis verifies the hygiene of dentures and mouth cavity and the satisfaction level of patients with RPDC attended by the dentistry school of the Universidade Federal do Ceará, Brazil. Methods: The descriptive and quantitative study comprised a questionnaire to 31 RPDC users. Data were analyzed by χ2 test and expressed in absolute frequency at 95% confidence level. Most subjects (77.4%) were female, aged between 40 and 60 years (64.5%), with complete college. They had received hygiene directions after the installation of the denture (96.8%). The hygiene method most employed was mechanical brushing with dentifrice, three or more times a day, for 71.0% of the interviewed. Caries was the main etiological factor in teeth loss with a significant difference related to the satisfaction degree of patients with the prosthesis. Most subjects were highly satisfied with the treatment even though there were flaws in the execution of mouth and denture hygiene.

Influence of diameter and intraradicular post in the stress distribution. Finite element analysis / Influência do diâmetro e do retentor intrarradicular na distribuição de tensões. Análise pelo método dos elementos finitos

Introduction: The biomechanical behavior of endodontically treated teeth depending on the selected restorative material and tooth situation to be restored. Objective: To analyze by the two-dimensional finite element method the biomechanical behavior of different diameters in intraradicular posts and teeth with coronal remaining of 2mm. Material and method: Six models were made with three types of posts, as follows: Glass fiber post, carbon fiber post, and cast metal post, both with diameter # 1 (1.1 mm in diameter) and # 2 (1.3 mm of diameter). The modeling was performed using the Rhinoceros 4.0 program. The FEMAP 10.2 and NEiNastran 9.2 programs were used to develop finite element models. The loading used was 100N for axial and oblique forces. The results were visualized using the von Mises stress map. The statistical analysis was made using analysis of variance (ANOVA) and Tukey post-test, with a significance level of 5%. Result: The oblique loading stress values were higher than the axial loading (p< 0.001) for both situations. The glass fiber post showed the lowest concentrations of stress on both loads (p< 0.001). The carbon fiber post presented significant difference compared to the cast metal post, only in the oblique load (p=0.007). The diameter did not increase the stress of the evaluated posts (p=0.302). Conclusion: The fiber posts were more favorable for restoration of endodontically treated teeth; the increase of diameter did not influence the increase of tension; the oblique load was more harmful for both posts and tooth structure.

Introdução: O comportamento biomecânico de dentes tratados endodonticamente é variável conforme o material restaurador selecionado e situação do dente a ser restaurado. Objetivo: Analisar por meio do método dos elementos finitos bidimensional o comportamento biomecânico de diferentes retentores intrarradiculares e diâmetros em dentes com 2mm de remanescente coronário. Material e método: Foram confeccionados seis modelos com três tipo de retentores: pino de fibra de vidro, pino de fibra de carbono e núcleo metálico fundido, ambos com diâmetro #1 (1,1mm de diâmetro) e #2 (1,3mm de diâmetro). A modelagem foi realizada através do programa Rhinoceros 4.0, e em seguida nos programas FEMAP 10.2 e NeiNastran 9.2 para desenvolvimento d os modelos de elementos finitos. Nos carregamentos foram utilizadas forças de 100N axial e oblíquo. Os resultados foram visualizados pelo mapa de tensão von Mises, e pela análise de variância (ANOVA) e pós-teste Tukey, com nível de significância à 5%. Resultado: O carregamento oblíquo apresentou maiores valores de tensões (p< 0,001). O pino de fibra de vidro apresentou menores concentrações de tensões em ambos os carregamentos (p< 0,001). O pino de fibra de carbono apresentou diferença significativa em relação ao núcleo metálico somente no carregamento oblíquo (p=0,007). O diâmetro não influenciou para o aumento de tensões dos retentores avaliados (p=0,302). Conclusão: Os pinos de fibras são mais favoráveis para restaurações de dentes tratados endodonticamente; O aumento do diâmetro não influenciou no aumento de tensões; A carga oblíqua é mais prejudicial à tanto para o retentor quanto para a estrutura dentária.

Immediate fixed partial denture after tooth extraction in patients with systemic diseases: A clinical report

For patients with systemic diseases who face difficulties visiting dental clinics, wearing fixed partial denture in the anterior region on the same day of tooth extraction can reduce the total period of treatment and the number of visits, as well as post-treatment psychological effect on the patient.