The importance of properly distributing the occlusal load for the correct biomechanics of implant-supported fixed partial dentures: stress analysis in implants, prosthetic components and infrastructures / A importância da distribuição da carga oclusal de forma adequada para a correta biomecânica de prótese parcial fixa implantosuportada: análise das tensões em implantes, componentes protéticos e infraestruturas

ABSTRACT Objective: The present study analyzed the biomechanical behavior of the generated stress on the external surface of the rehabilitation elements (implants, components and infrastructures) according to different occlusion patterns on a fixed partial denture on osseointegrated implants. Method: The experimental groups varied according to the location of the occlusal load applied to the Fixed partial denture, with a total occlusal load of 750N in all groups, opting for greater loads on the occlusal table of the molar in relation to the premolar. This evaluation was performed by the finite element method with simulations by the AnsysWorkbench 16.0 Software program. Results: The results analyzed for implants and their components showed that the more posterior the occlusal loading, the greater the stress developed (group 4), always in the connection area between the prosthetic component and the implant, as this location can induce greater screw loosening. The results analyzed for the infrastructures showed that the most distributed occlusal loading possible (group 1) is the best situation for generating less stress. However, even in group 3 which obtained the highest stresses in the critical area of the prosthetic connection, the zirconia flexural strength values generated were not worrisome. Conclusion: It can be concluded that the occlusal adjustment of Fixed partial dentures are preponderant and decisive factors for correct biomechanics and preservation of the system in the long term in order to avoid possible damage and/or failures, and exert significant and notorious differences in the behavior of all structures studied herein.

RESUMO Objetivo: O presente estudo analisou o comportamento biomecânico do estresse gerado na superfície externa dos elementos reabilitadores (implantes, componentes e infraestruturas) de acordo com diferentes padrões de oclusão em uma prótese parcial fixa sobre implantes osseointegrados. Métodos: Os grupos experimentais variaram de acordo com a localização da carga oclusal aplicada na Prótese Parcial Fixa, com carga oclusal total de 750N em todos os grupos, optando por cargas maiores na mesa oclusal do molar em relação ao pré-molar. Esta avaliação foi realizada pelo método dos elementos finitos com simulações pelo programa AnsysWorkbench 16.0 Software. Resultados: Os resultados analisados para os implantes e seus componentes mostraram que quanto mais posterior a carga oclusal, maior a tensão desenvolvida (grupo 4), sempre na área de conexão entre o componente protético e o implante, pois este local pode induzir maior soltura do parafuso. Os resultados analisados para as infraestruturas mostraram que a carga oclusal mais distribuída possível (grupo 1) é a melhor situação para gerar menos estresse. No entanto, mesmo no grupo 3 que obteve as maiores tensões na área crítica da conexão protética, os valores de resistência à flexão da zircônia gerados não foram preocupantes. Conclusões: Pode-se concluir que o ajuste oclusal das Próteses Parciais Fixas são fatores preponderantes e decisivos para correta biomecânica e preservação do sistema a longo prazo a fim de evitar possíveis danos e/ou falhas, e exercem diferenças significativas e notórias no comportamento de todas as estruturas aqui estudadas.

Management of bruxism associated with temporomandibular disorder: case report / Manejo do Bruxismo associado a Disfunção Temporomandibular: relato de caso

ABSTRACT Studies have found the association between episodes of bruxism and the presence of signs and symptoms of temporomandibular disorder (TMD). The aim of the present study was to report the diagnosis and palliative therapy of bruxism associated with TMD. Patient, 23 years old, male gender, presented at dental clinic, complaining of pain in the temporomandibular joint on the left side and alteration of the form of the anterior teeth. During the anamnesis it was documented that this symptom was recurrent and reported the habit of grinding teeth. The clinical examination observed discrepancy between the centric relation and the maximum habitual intercuspation, unsatisfactory protrusive guide, presence of wear facets, clicking and mandibular deviation during mouth opening. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) questionnaire was applied to diagnose TMD. By means of specific algorithms this disorder was classified as myofascial pain, disc displacement with reduction and osteoarthritis, all affecting the left side. Thus, it was proposed the assembly of the models in semi-adjustable articulator for occlusal mapping and waxing diagnosis, then the occlusal adjustment by selective wear and material addition was executed. After this procedure, the occlusal splint was installed as a palliative therapy for bruxism. This case report suggests that the dental approach by means of occlusal adjustment and occlusal splint, in a patient diagnosed with bruxism and temporomandibular disorder, reduces the signs and symptoms that affect the components of the Stomatognathic System.

RESUMO Estudos tem encontrado a associação entre os episódios de bruxismo e a presença dos sinais e sintomas de disfunção temporomandibular (DTM). O objetivo do presente trabalho foi relatar o diagnóstico e terapia paliativa do bruxismo associado à DTM. Paciente, 23 anos, gênero masculino, apresentou-se à clínica odontológica, queixando-se de dor na articulação temporomandibular do lado esquerdo e alteração da forma dos dentes anteriores. Durante a anamnese foi documentado que esse sintoma era recorrente e relatado o hábito de ranger os elementos dentais. No exame clínico observou-se discrepância entre relação cêntrica e máxima intercuspidação habitual, guia protrusiva insatisfatória, presença de facetas de desgaste, estalido e desvio mandibular durante o movimento de abertura bucal. O questionário Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) foi aplicado para diagnosticar a DTM. Por meio de algoritmos específicos essa desordem foi classificada como dor miofascial, deslocamento de disco com redução e osteoartrite, todos acometendo o lado esquerdo. Desta forma, foi proposto a montagem dos modelos em articulador semi-ajustável para mapeamento oclusal e enceramento diagnóstico. Em seguida o ajuste oclusal por desgaste seletivo e acréscimo de material foi executado. Finalizado esse procedimento, a placa estabilizadora da oclusão foi instalada como terapia paliativa para o bruxismo. Esse relato de caso sugere que a abordagem odontológica por meio do ajuste oclusal e placa oclusal, em paciente diagnosticado com bruxismo e disfunção temporomandibular, reduz os sinais e sintomas que afetam os componentes do Aparelho Estomatognático.

Intervención temprana de la mordida cruzada por la pista directa de Planas: relato de siete años de seguimiento / Early Intervention of Crossbite by Planas Direct Tracks: Follow up Report After Seven Years / Intervenção precoce da mordida cruzada pela Pistas Diretas de Planas: relato de sete anos de seguimento

Resumen Introducción: entre las maloclusiones, la mordida cruzada es la de mayor prevalencia entre los niños en edad preescolar y se considera la principal depreciadora del sistema estomatognático, con un alto riesgo de desarrollar secuelas musculoesqueléticas irreparables en la edad adulta. Por lo tanto, es fundamental elegir un tratamiento eficaz que no requiera la cooperación directa del paciente y que utilice técnicas simples de ortodoncia. El objetivo de este artículo es informar la eficacia del tratamiento de rehabilitación neuroclusal (RNO) con la técnica de las pistas directas de Planas en la corrección temprana de la mordida cruzada posterior y el seguimiento de su estabilidad oclusal durante siete años. Presentación del caso: niña de 4 años de edad, que usó biberón, diagnosticada con mordida cruzada posterior funcional unilateral izquierda y desviación de la línea media. Para el tratamiento de la RNO, se realizaron los ajustes oclusales en los dientes 63, 64 y 65, y después de la desprogramación neuromuscular, se confeccionaron las pistas directas de Planas en los dientes cruzados. Después de 29 días, se corrigió la mordida y se hicieron ajustes oclusales para proporcionar una mayor armonía oclusal. Hubo monitoreamiento cada seis meses durante siete años para verificar el equilibrio y la estabilidad del tratamiento. Conclusiones: la RNO con el uso de pista directa de Planas fue eficaz para corregir la mordida cruzada posterior con una técnica simple y de bajo costo que puede ejecutar el clínico general.

Abstract Introduction: Among malocclusions, that of cross-bite is the most prevalent among preschool children and is considered to be the main depreciator of the stomatognathic system and is further linked to a high risk of developing irreversible musculoskeletal sequelae in adulthood. Thus, it is important to choose an effective treatment early on that does not require the direct cooperation of the patient and that utilizes simple orthodontic techniques in its execution. The objective of this study was to report the efficacy of the Neuroclusal Rehabilitation (RNO) treatment, with the Planas Direct Tracks technique in a case of early treatment of posterior crossbite, and the follow up of its occlusal stability for seven years. Case presentation: a 4-year-old female patient, who was bottle-fed, was diagnosed with a left unilateral functional posterior crossbite and midline deviation. For treatment of RNO, occlusal adjustments were made on the teeth 63, 64 and 65 and after neuromuscular deprogramming, the Direct Planks were made in the crossed teeth. After 29 days, the bite was corrected, and occlusal adjustments were made in order to provide greater occlusal harmony. Monitoring and evaluation took place every six months for seven years in order to verify the balance and stability of the treatment. Conclusion: the RNO treatment with the use of Planas Direct Tracks is an effective solution for the correction of posterior crossbite using a simple, low-cost technique that can be performed by general practitioners.

Resumo Introdução: entre as más oclusões, a mordida cruzada é a de maior prevalência entre as crianças em idade pré-escolar, e se considera a principal depreciadora do sistema estomatognático, com um alto risco de desenvolver sequelas musculoesqueléticas irreparáveis na idade adulta. Portanto, é fundamental escolher um tratamento eficaz que não requeira a cooperação direta do paciente e que utilize técnicas simples de ortodontia em sua execução. O objetivo deste estudo foi informar a eficácia do tratamento de Reabilitação Neuroclusal (RNO), com a técnica das Pistas Diretas de Planas na correto precoce da mordida cruzada posterior e o seguimento de sua estabilidade oclusal durante 7 anos. Apresentação do caso: paciente de sexo feminino de 4 anos de idade, que usou mamadeira, diagnosticada com mordida cruzada posterior funcional unilateral esquerda e desvio da linha média. Para o tratamento da RNO, se realizaram os ajustes oclusais nos dentes 63, 64 e 65, depois da desprogramação neuromuscular, se confeccionaram as Pistas Diretas de Planas nos dentes cruzados. Depois de 29 dias, se corrigiu a mordida e se fizeram ajustes oclusais para proporcionar uma maior harmonia oclusal. O monitoramento se realizou cada seis meses por 7 anos para verificar o equilíbrio e a estabilidade do tratamento. Conclusões: a RNO com o uso de Pista Direta Planas foi eficaz para a correção da mordida cruzada posterior com uma técnica simples, de baixo custo que pode ser realizada pelo clínico geral.

Study on functional occlusal morphology by using three-dimensional printed diagnostic crown and functional generated path technology / 中华口腔医学杂志

Objective@#To establish the functional occlusal morphology of fixed prostheses by using functional generated path (FGP) technology on a three-dimensional-printed diagnostic crown in order to decrease the chance of occlusal adjustment during try-in procedure of the complete crown, and to avoid the risk of occlusal interference after cementation of prosthesis.@*Methods@#A double-blind clinical trial was performed. Ten subjects (4 males, 6 females) who needed a first molar complete crown restoration were enrolled in Department of Prosthodontics, Peking University School and Hospital of Stomatology from July 2018 to December 2018. The working models with the abutment teeth of the ten participants were scanned to obtain the digital models, then the occlusal surfaces of crown were formed by either FGP technology on a three-dimensional (3D) printed diagnostic crown and then were scanned directly for computer aided design and computer aided manufacture (CAD/CAM) crown fabrication as experiment group, or conventional technology based on database as control group. Then zirconia crowns were fabricated for two groups. During crown try-in of the two groups, preferred crowns of subjects were recorded, the occlusal contact criteria including the occlusal contact area (mm2), the heights of occlusal high spot (mm) before and after the adjustment of crowns were digitally analyzed, and the amount of adjustment (mm and mm3) were calculated on digital models by using a reverse engineering software (Giomagic Sudio & Quality). Differences of values were compared statistically with paired t-test (α=0.05).@*Results@#The amount for occlusal adjustment for crowns in the experiment group [(7.320±4.238) mm3] was statistically less than that in the control group [(20.178±9.650) mm3] (P<0.05), the occlusal contact area of experiment group [(11.430±4.102) mm2] was statistically bigger than that of the control group [(4.808±3.223) mm2] (P<0.05), the heights of occlusal high spots for crowns in the experiment group was (0.043±0.019) mm while it was (0.594±0.201) mm in the control group with statistically significant differences (P<0.05).@*Conclusions@#This method could lead to a crown with less adjustment of occlusion, less occlusal high spot and less risk of occlusal interferences.

Reabilitação neuroclusal em paciente odontopediátrico com mordida cruzada posterior unilateral: relato de caso clínico / Neuro-occlusal rehabilitation in pediatric dental patient with unilateral posterior crossbite: clinical case report

Objetivo: relatar a sequência clínica de tratamento para descruzar uma mordida cruzada posterior unilateral na dentição decídua por meio da reabilitação neuroclusal. Relato de caso: o caso clínico foi realizado em um paciente do sexo masculino, com 5 anos de idade, diagnosticado com mordida cruzada posterior unilateral funcional do lado direito. Após a verificação de interferências dentais nos caninos e molares em oclusão cêntrica, realizaram-se os ajustes oclusais. Seguiu-se então o protocolo para confecção de pistas diretas de Planas, utilizando resina composta em planos inclinados na metade vestibular da face oclusal dos dentes 84 e 85 e na face vestibular dos dentes 53, 54 e 55. Logo após a confecção das pistas, observou-se a correção da mordida cruzada e a estabilidade na mudança postural da mandíbula. Considerações finais: a reabilitação neuroclusal por meio de pistas diretas de Planas apresenta grande eficácia na correção da mordida cruzada posterior, proporcionando estabilidade mandibular e estímulo para o crescimento e desenvolvimento crânio-maxilo-facial. (AU)

Objective: To report the clinical treatment sequence to uncross a unilateral posterior crossbite in deciduous dentition using neuro-occlusal rehabilitation. Case report: The clinical case was performed in a 5-year-old male patient diagnosed with a functional unilateral posterior crossbite on the right side. After verifying dental interferences with canines and molars in centric occlusion, the occlusal adjustments were performed. The protocol for producing Planas direct tracks was followed using composite resin in inclined planes in the buccal half of the occlusal surface of teeth 84 and 85 and in the buccal surface of teeth 53, 54, and 55. After the preparation of tracks, the crossbite correction and the stability in postural mandibular change were observed. Final considerations: Neuro-occlusal rehabilitation using Planas direct tracks is highly effective in correcting posterior crossbite, providing mandibular stability and stimulus for the growth and development of the maxillofacial skull. (AU)

Eficácia de dois sistemas de polimento na devolução da lisura superficial de restaurações cerâmicas vítreas em dentes posteriores: estudo clínico, randomizado, prospectivo e cego / Efficacy of two polishing systems on the return of surface smoothness of glass-ceramic restorations in posterior teeth: clinical, randomized, prospective and blinded study

O objetivo do estudo foi verificar o repolimento do dissilicato de lítio em boca variando o uso de dois sistemas de polimento em restaurações posteriores. Adicionalmente, o comportamento das restaurações cerâmicas foi avaliado longitudinalmente segundo os critérios USPHS modificados. Participaram do estudo 12 pacientes que necessitavam de pelo menos 2 dentes posteriores bilaterais a serem restaurados com cerâmica em dissilicato de lítio monolítica, totalizando 62 restaurações analisadas. As restaurações foram alocadas em dois grupos, sendo: G1 - 31 restaurações cerâmicas utilizando o sistema de polimento Exa-Cerapol, feltro e pasta diamantada, e G2: idêntico ao G1, utilizando o sistema de polimento Shofu, feltro e pasta diamantada. A escolha das restaurações em cada grupo foi randomizada, segundo o conceito split-mouth design. O atendimento foi realizado por profissionais graduados, calibrados na técnica, porém não cientes das razões do estudo. As restaurações foram replicadas com resina epóxi em 3 momentos: após a cimentação (T0); após o ajuste oclusal (T1); e após o polimento (T2), para análise quantitativa em rugosímetro. Amostras representativas de cada grupo nos mesmos tempos foram levadas para análise em microscópio confocal a laser (LSCM). O comportamento das restaurações cerâmicas foi avaliado longitudinalmente nos tempos (T): T0 ­ após a realização do polimento, T1 -30 dias após, T2 -180 dias após. Não houve diferença estatisticamente significante entre os grupos para os tempos testados (p>0,05). Diferenças estatisticamente significantes foram observadas intra grupos, entre os tempos T0 e T1 e entre T1 e T2 (p<0,05), tanto em G1 quanto em G2. A taxa de sobrevida das restaurações sem fraturas foi de 100%; a sobrevida por ocorrência de complicações biológicas com troca de restaurações (n=1) foi de 98,4%; índice de solturas sem substituição de restauração (n=6) foi de 96,9%. Conclui-se que os dois sistemas foram eficazes no repolimento intrabucal das restaurações em dissilicato de lítio monolítico. O protocolo clínico realizado pelos profissionais graduados se mostrou eficaz com ausência de trincas/fraturas no período de 6 meses de acompanhamento(AU)

The aim of the study was to verify the lithium disilicate repolishing in the mouth by varying the use of two polishing systems in posterior restorations. Additionally, the behavior of ceramic restorations was longitudinally evaluated according to the modified USPHS criteria. The study included 12 patients who needed at least 2 bilateral posterior teeth to be restored with ceramic in monolithic lithium disilicate, totaling 62 restorations analyzed. The restorations were allocated into two groups: G1 - 31 ceramic restorations using the Exa-Cerapol polishing system, felt and diamond paste, and G2: identical to G1 using the Shofu polishing system, felt and diamond paste. The choice of restorations in each group was randomized according to the split-mouth design concept. The service was performed by graduated professionals, calibrated in the technique, but not aware of the reasons for the study. The restorations were replicated with epoxy resin in 3 moments: after cementation (T0); after occlusal adjustment (T1); and after polishing (T2), for quantitative roughness analysis. Representative samples from each group at the same times were taken for analysis by confocal laser microscope (LSCM). The behavior of ceramic restorations was evaluated longitudinally at the times (T): T0 - after polishing, T1 -30 days after, T2 -180 days after. There was no statistically significant difference between the groups for the tested times (p> 0.05). Statistically significant differences were observed between groups T0 and T1 and between T1 and T2 (p <0.05) in both G1 and G2. The survival rate of restorations without fractures was 100%; survival due to the occurrence of biological complications with restoration replacement (n = 1) was 98.4%; Release rate without restoration replacement (n = 6) was 96.9%. It was concluded that both systems were effective in intraabucal repolishing of monolithic lithium disilicate restorations. The clinical protocol performed by the graduated professionals proved to be effective with no cracks / fractures within 6 months of follow-up(AU)

Etiology and clinical technology of the food impaction with tight proximal contacts / 中华口腔医学杂志

Food impaction with tight proximal contacts, also known as kinetic food impaction and food impaction without anatomical structure destruction, is mainly caused by a transient separation in contacts area during mastication. It′s an intractable food impaction with high morbidity and low cure rate. There are two kinds of pathogenesis accepted: the shifting of anterior teeth incongruous with adjacent teeth or lack of anterior shifting; lack of food escape grooves. The preferred treatment is occlusal adjustment, but it′s difficult to determine the area and extent of selective grinding, to quantify the occlusal adjustment, or to predict the prognosis. This review summarized the pathogenesis and treatment modality for kinetic food impaction in order to provide evidence for future researches and clinical application.

Simulated occlusal adjustments and their effects on zirconia and antagonist artificial enamel

PURPOSE: The aim of this study was to evaluate the effect of occlusal adjustments on the surface roughness of yttria-tetragonal zirconia polycrystal (Y-TZP) and wear of opposing artificial enamel.

Lesão cervical não cariosa e hipersensibilidade dentinária: relato de caso clínico / Non-carious cervical lesions and dental hypersensitivity: a clinical case reportq

As lesões cervicais não cariosas (LCNC) caracterizam-se pela perda irreversível e gradual de tecido mineralizado junto da junção amelo-cementária, sem qualquer envolvimento bacteriano e é um dos fatores relacionados à hipersensibilidade dentinária (HD), caracterizado por uma dor aguda, provocada e de curta duração. Paciente L.C.M, sexo feminino, 38 anos de idade, compareceu à Clínica Odontológica da Faculdade Patos de Minas (FPM), relatando sensibilidade nos dentes 44 e 45. Após assinado o Termo de consentimento livre e esclarecido (TCLE), a paciente realizou tomadas radiográficas e foi submetida a anamnese e exame clínico, no qual, foi observada a presença de LCNC e diagnosticada como multifatorial. O ajuste oclusal foi realizado com pontas diamantadas e borrachas abrasivas removendo contatos prematuros. A restauração direta em resina composta foi indicada para a obliteração mecânica/física dos túbulos dentinários, como opção de tratamento. Foi realizado condicionamento ácido do esmalte, por 30seg e da dentina por 15seg, com ácido fosfórico 37% (Condac, FGM), lavado com água pelo mesmo tempo, seguido de controle de umidade e duas camadas de adesivo convencional (Ambar, FGM), fotoativando apenas a segunda camada por 20seg com LED (Kavo 1100 mW/cm²). A LCNC foi restaurada com resina composta convencional (A3E, Llis, FGM), com dois incrementos de aproximadamente 2mm cada, seguidas de acabamento e polimento. A hipersensibilidade foi cessada imediatamente logo após o ajuste oclusal e tratamento restaurador, ressaltando a importância do diagnóstico e do exame clínico. A remoção dos contatos prematuros e a restauração com resina composta foram essenciais para o sucesso deste tratamento, visto que a origem da perda mineral foi cessada concomitante com o alívio da dor.

The non-carious cervical lesions (NCCI) are characterized by the irreversible and gradual loss of mineralized tissue combined to the amelo-cementary junction, without any bacteria participation and is one of the factors related to dentin hypersensitivity (HD), classified by an acute pain, incited and in short term. Patient L.C.M, woman, 38 years old, attended to the Dental Clinic of Faculty Patos de Minas (FPM), reporting sensitivity on teeth 44 and 45. After signed the agreement form, the patient was submitted to an anamnesis, clinical exam and x-ray, in which, it was detected the presence of NCCL, diagnosed by multifactorial. Occlusal adjustment was performed with diamond and rubber tips removing the early contact area. The resin-composite restoration was recommended as a treatment option to physic and mechanically obliterate the dentin tubules. Enamel was etched for 30 sec and dentin for 15 sec with 37% phosphoric acid (Condac, FGM) and washed with water for 30 sec. Two layers of a dentin adhesive (Ambar, FGM) was applied and light cured for 20 sec with a LED light curing unit (Kavo 1100 mW / cm²). The NCCL was restored with a resin-composite (A3E, Llis, FGM), with two increments of approximately 2mm each, followed by a finishing and polishing protocol. The hypersensitivity was interrupted immediately after occlusal adjustment and restorative treatment, emphasizing the importance of diagnosis and clinical exam. Removal of premature contacts and restoration with composite resin were essential for the success of this treatment, since the origin of the mineral loss was controlled concomitantly with pain relief.

Preliminary study on the clinical application of temporary treatment denture in difficult edentulous cases before complete denture restoration / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To explore the clinical effects of treatment denture on difficult edentulous cases before complete denture restoration.</p><p><b>METHODS</b>Thirty-six patients who experienced unsuccessful restoration of conventional complete dentures were included in this study. Treatment dentures were fabricated to solve issues such as abnormal occlusion, tissue surface problems, and neuromuscular dysfunction of the stomatognathic system caused by systemic diseases. The final complete dentures were fabricated by duplicating the treatment dentures. Jaw relation index, stability, and retention were evaluated at different stages. Oral health-related quality of life was measured using the Chinese version of Oral Health Impact Profile for edentulous subjects (OHIP-EDENT).</p><p><b>RESULTS</b>Among the 36 patients, 33 successfully completed the final restoration with positive effects.</p><p><b>CONCLUSIONS</b>Treatment denture is an effective pre-restorative option that can be used to correct abnormal occlusion, improve tissue surface problems, and aid in neuromuscular rehabilitation training. Treatment dentures contribute to the successful restoration of the final complete dentures and is worthy of clinical applications.</p>

Stability of periodontally compromised teeth after splint and non-surgical therapy: two cases followed-up for 1 to 3 years

This article describes cases of applying non-surgical treatment including scaling and root planing, occlusal adjustment and tooth splinting of periodontally compromised lower anterior incisors Clinical and radiographic evaluations were performed over a 1–3-year period. All clinical parameters and radiographic bone levels improved in both cases. Dramatic regeneration of alveolar bone and lamina dura were observed on radiographic images, and no specific complications occurred during the follow-up period. Within the limitations of this study, these cases demonstrated the possibility of tooth rescue through non-surgical treatment and splinting of periodontally compromised teeth typically considered for extraction.

Tratamiento con dispositivos orales para síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) / Treatment with oral devices for obstructive sleep apnea-hypopnea syndrome (OSAHS)

Resumen El objetivo de este artículo es mejorar la práctica con dispositivos orales (DO) por parte del odontólogo tratante, al alcanzar una adecuada selección del DO y brindar seguridad y efectividad al paciente. Con el uso de estos, se intenta disminuir la frecuencia o duración de los eventos respiratorios. Los DO están indicados en pacientes con ronquido primario, síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) leve-moderado y SAHOS severo que no quieran o no toleren tratamiento con presión positiva. Además, se clasifican en aparatos de retención de lengua, aparatos no ajustables y ajustables, siendo estos últimos los más recomendados por ser dispositivos de avance mandibular (DAM), pues son hechos a la medida, ajustables y de arco dual. Su mecanismo de acción consiste en protruisión del maxilar inferior, adelantamiento del hueso hioides y apertura mandibular. Los DAM son más eficaces en pacientes jóvenes, con menor índice de masa corporal (IMC), circunferencia de cuello reducida, SAHOS posicional y mandíbula retrognática. Se pueden presentar efectos adversos como salivación excesiva, cambios oclusales y trastornos temporomandibulares. Se ha demostrado que los DAM tienen un impacto en la disminución del índice de apnea-hipopnea (IAH) y somnolencia diurna, mejoría en la oxigenación nocturna, función cardiovascular, calidad de vida y comportamiento neurocognitivo. Asimismo, los DAM son superiores al tratamiento con presión positiva de vía aérea (PAP) en adherencia. Se sugiere que la terapia combinada de DAM con PAP y otros tratamientos es promisoria para aquellos pacientes que responden de manera insuficiente a la monoterapia.

Abstract The objective of this article is to improve the management of oral devices (OD) by treating dentists, by achieving an adequate selection of OD, and providing safety and effectiveness to the patient. The use of this type of devices attempt to decrease the frequency or duration of respiratory events. ODS are indicated in patients with primary snoring, mild-to-moderate obstructive sleep apnea-hypopnea syndrome (OSAHS), and severe OSAHS who do not want or cannot tolerate positive airway pressure therapy. ODS are classified into tongue retaining devices, and non-adjustable and adjustable devices -the latter being the most recommended due to its characterization as a mandibular advanced device (MAD) since they are tailor-made, adjustable and have a dual arc. Their action mechanism consists of protrusion of the lower jaw, hyoid bone advancement and mandibular opening. MAD are more effective in young patients with lower body mass index (BMI), reduced neck circumference, positional OSAHS and retrognathic jaw. Adverse effects such as excessive salivation, occlusal changes and temporomandibular disorders may occur. MAD have proven to have an impact on decreased apnea-hypopnea index (AHI) and daytime sleepiness; they also improve nocturnal oxygenation, cardiovascular function, quality of life and neurocognitive behavior. In addition, adherence to treatment with MAD is greater than to positive airway pressure (PAP) treatment. A therapy combining MAD with PAP and other treatments is promising for those patients who respond insufficiently to monotherapy.

Neuroclusal rehabilitation and planas direct tracks in the posterior crossbite treatment / Reabilitação neuroclusal e pistas diretas de planas na correção da mordida cruzada posterior

ABSTRACT Objective: To evaluate the effectiveness of neuroclusal rehabilitation treatment using Planas Direct for posterior crossbite correction. Methods: This is a clinical study in which 43 children were selected, of both sexes, between 3 and 6 years old, diagnosed with posterior crossbite and midline deviation. Interviews were conducted with the parents in order to ascertain the practice of harmful habits. The treatment was based on neuroclusal rehabilitation in order to investigate and eliminate the occlusal obstacles which depreciate the stomatognathic system. The aim of the study was also to reprogram the affected neuromuscular activity. Planas direct were performed on crossed teeth in order to restructure the neuroclusal area and the stomatognathic system, as well. Epi Info software, 3.5.4 for Windows, through the distribution of frequencies and the Pearson chi-square test were used for statistical analysis. Results: Occlusal restoration in 79% of children was performed however 21% abandoned treatment. The crossbite and midline correction period ranged from from 14° to the 91° treatment. Significant associations of the variables were observed as follows: deleterious habits (p = 0.0001) and midline deviation (p = 0.0001) at the beginning or end of treatment. Conclusion: It was concluded that the neuroclusal rehabilitation and Direct Slopes Planas were effective in correcting the posterior crossbite.

RESUMO Objetivo: Avaliar a eficácia do tratamento da reabilitação neuroclusal com as Pistas Diretas Planas na correção das mordidas cruzadas posteriores. Métodos: Trata-se de um estudo clínico no qual foram selecionadas 43 crianças, de ambos os sexos, entre 3 e 6 anos de idade, diagnosticadas com mordida cruzada posterior funcional e desvio de linha média. Foram realizadas entrevistas com os responsáveis dos participantes, para averiguar a prática de hábitos deletérios. O tratamento baseou-se na reabilitação neuroclusal, no intuito de investigar e eliminar os empecilhos oclusais que depreciam o sistema estomatognático, e assim, reprogramar a atividade neuromuscular afetada. Foram confeccionadas as Pistas Diretas de Planas nos dentes cruzados, a fim de reestrutura os estímulos neuroclusais e o sistema estomatognático. Na análise estatística, utilizou-se o software Epi Info software, versão 3.5.4 for Windows, por meio da distribuição das frequências e o Teste do Qui-quadrado de Pearson. Resultados: Houve o restabelecimento oclusal em 79% das crianças, visto que 21% abandonaram o tratamento. O período de correção da mordida cruzada e linha média compreenderam-se ao 14° ao 91° de tratamento. Foram observadas associações significativas das variáveis: hábitos deletérios (p=0.0001) e desvio de linha média (p=0.0001) no início e final do tratamento. Conclusão: Conclui-se que a reabilitação neuroclusal e as Pistas Direta de Planas foram eficazes na correção das mordidas cruzadas posteriores.

Rescue of a periodontally compromised tooth by non-surgical treatment: a case report

PURPOSE: This article describes a case of the successful non-surgical management of a periodontally compromised maxillary premolar. METHODS: A combination therapy, including root planing, occlusal adjustment, and tooth splinting, was applied. Clinical and radiographic examinations were performed during the 16-month follow-up period. RESULTS: All periodontal parameters were improved. There were dramatic decreases (3–6 mm) in the probing pocket depth, tooth mobility, and marginal bone loss. Interestingly, gradual resolution of the periapical radiolucency and alveolar bone regeneration were observed in the radiographs, and the periodontal condition was maintained during the follow-up period. CONCLUSIONS: Within the limits of this study, these results demonstrate the importance of natural tooth preservation through proper periodontal treatment and occlusal adjustment of the periodontally compromised tooth, which is typically targeted for tooth extraction and dental implantation.

The clinical diagnosis and treatment of 78 cracked teeth with pulpitis / 重庆医学

Objective To analysis the causes and characteristic of cracked teeth with pulpitis and explore clinical diagnosis and treatment methods.Methods A total of 78 tooth that was identified as a cracked tooth with pulpitis was recorded and analyzed in terms of the age,the position in the mouth,and the location of crack-line.After reducing the cusp height,root canal therapy and crown restoration,the patients were followed up for one year and the treatment effectiveness was reviewed.Results The most prevalent age was 39-49 years.The most of cracked teeth were found in the maxillary molars.There were 65 cases (83.33%)that were treated successfully,the function of 1 1 cases (14.10%)were improved,and the rate of failure were 2.56% (2 cases).Conclu-sion Reasonable clinical diagnosis and treatment can contribute to the retention of the cracked teeth.Coronal restoration after root canal therapy might be a very effective way to treat cracked teeth with pulpitis.

The occlusal changes after initial periodontal therapy in patients with chronic periodontitis analysed by T-scan Ш occlusal analysis system / 实用口腔医学杂志

Objective:To observe the occlusal changes of patients with chronic periodontitis(CP)after initial periodontal therapy an-alysed by T-scan Ш occlusal analysis system.Methods:26 patients with CP were included.The patients were treated by initial perio-dontal therapy,including scaling,subgingival curettage,root planning and oral hygiene instruction.The occlusion time(OT),disoclu-sion time(DT),center of force trajectory(COFT),the percentage of bite force for maximum movie force at maximum area frame (MABF /MMF)and the bite force distribution balance between the left and right sides (BFDB)were measured by T-scan III occlusal analysis system before and six weeks after the treatment.All the data were statistically analyzed.Results:After initial periodontal treatment,the OT and DT extended for (0.20 ±0.14)s and (0.11 ±0.08)s respectively(P <0.05),the COFT increased by (0.81 ±1.19)mm(P <0.05).Moreover,the MABF /MMF and BFDB decreased by(7.20 ±4.41)% and (8.90 ±7.71)% respectively (P <0.05).Conclusion:Initial periodontal treatment may improve the occlusion of patients with chronic periodontitis.

Thickness and marking quality of different occlusal contact registration strips

Objectives Evaluate the thickness and the marking quality of different occlusal contact registration strips (OCRS) and a possible correlation between them. Material and Methods The following OCRS were selected: Accufilm II, BK20, BK21, BK22, BK23, BK28, and BK31. The thickness was measured in three points of the OCRS with an electronic measuring device (TESA), and the mean was calculated. To produce the marks on the strips, composite resin specimens were adapted to a universal testing machine (Versat 2000) with 40 kgf load cell at a speed of 1.0 mm/min. The mark images were photographed with a stereoscopic microscope (Stemi SV11) and processed and analyzed by the 550-Leica Qwin® analyzer. Results Values (μm) found in the 1st and 2nd thickness measurements were: Accufilm II - 16.4 and 14.2; BK20 - 10.0 and 8.1; BK21 - 9.5 and 8.0; BK22 - 9.7 and 8.7; BK23 - 9.8 and 7.9; BK28 - 12.8 and 10.0; and BK31 - 8.4 and 8.0, respectively. The mean (mm2) values found in the mark areas were: Accufilm II - 0.078; BK20 - 0.035; BK21 - 0.045; BK22 - 0.012; BK23 - 0.022; BK28 - 0.024; and BK31 - 0.024. The results were submitted to the Kruskal-Wallis (p<0.05) and Pearson’s correlation tests. Conclusions Only in the 2nd measurement, the OCRS thickness observed was similar to the value indicated by the manufacturers; the Accufilm II and the BK28 strips showed the better marks; and no correlation was found between the thickness and the marking area. .

Ajuste oclusal por desgaste seletivo: um novo conceito em terminologia e técnica / Occlusal adjustment for selective grinding: a new concept in terminology and technique

O ajuste oclusal é uma técnica amplamente utilizada para modificar a superfície oclusal a superfície oclusal dos dentes, a fim de restabelecer o equilíbrio oclusal, articular e neuromuscular. Entretanto, sua indicação deve ser específica, considerando-se um procedimento irreversível. Nesse contexto, diversos autores têm abordado a sequência clínica para a realização do ajuste oclusal, embora o uso de diferentes nomenclaturas e técnicas torne-o um procedimento de difícil compreensão aos cirurgiões-dentistas. Assim, o objetivo desse trabalho é discutir os principais aspectos relacionados ao ajuste oclusal em dentes naturais por meio do desgaste seletivo, propondo uma abordagem simplificada da técnica, considerando-se uma avaliação funcional e dinâmica da oclusão

The occlusal adjustment is a technique widely used to modify the occlusal surface occlusal surface of the teeth in order to restore the occlusal, articular and neuromuscular equilibrium. However, its indication should be specific, considering that it is an irreversible procedure. In this context, several authors have addressed the clinical sequence to perform the occlusal adjustment, although the use of different nomenclatures and techniques makes it a difficult understand procedure to dentists. Thus, the aim of this study is to discuss the main aspects related to occlusal adjustment in natural teeth through selective grinding, proposing a simplified approach of the technique, considering a functional and dynamic occlusion assessment

Comparison of occusal aspects in monolithic zirconia crown before and after occlusal adjustment during intraoral try-in: a case report / 대한치과보철학회지

In case of prosthesis fabrication by CAD/CAM, location, area and contour of occlusal contacts can be adjusted so more functional occlusion can be acquired. Also, errors in a manufacturing process is reduced compared to cast metal prostheses and porcelain fused metal prostheses fabricated by conventional methods such as casting and porcelain build up. Therefore, prostheses by CAD/CAM show superior occlusion accuracy. Recently, virtual articulator function has been introduced to CAD/CAM system, which reproduces mandibular movement against maxilla. Thus, it is possible to consider occlusal interference in anterior/lateral movement as well as closing movement. There have been many studies on the marginal and internal fit of prostheses using zirconia but the occlusal fit of zirconia crown fabricated by CAD/CAM has not been researched as much. In this case report, 7 zirconia crowns were designed and fabricated by CAD/CAM for total 5 patients. The models of zirconia crowns before and after occlusal adjustment during intraoral try-in were scanned for occlusal contacts, which were compared to evaluate accuracy of prostheses and understand patterns of occlusal adjustment. Most of the occlusal adjustments were done on functional cusps and slopes of zirconia crown, and the magnitude of occlusal adjustment ranged from 15 microm to 60 microm. In the zirconia crown fabricated with CAD/CAM systems, the occlusal adjustment is a necessary procedure, so additional procedures will be needed for compensating reduced mechanical properties.

Intentional passive eruption combined with scaling and root planing of teeth with moderate chronic periodontitis and traumatic occlusion

PURPOSE: The aim of this clinical trial was to explore the impact of intentional passive eruption (IPE) using occlusal reduction on the periodontal parameters of teeth with moderate chronic periodontitis and traumatic occlusion. METHODS: This study was performed on 40 teeth from 16 subjects. At baseline, 4 weeks after initial periodontal treatment, and 6 months after IPE, clinical and radiographic examinations were performed. The 20 teeth in the test group underwent IPE using occlusal reduction, whereas the 20 control teeth did not undergone occlusal reduction. RESULTS: All the periodontal parameters were improved by the initial periodontal treatment. The teeth in the test group showed a significantly greater decrease in pocket depth, tooth mobility, and marginal bone loss than did the control group (P<0.05), but there were no significant changes in the attachment level. Significantly greater improvements in all the parameters were observed in the test group after 6 months of IPE compared to 4 weeks after the initial periodontal treatment (P<0.05). CONCLUSIONS: Within the limits of this study, performing initial periodontal therapy combined with IPE using occlusal reduction was shown to be very simple and effective. Moreover, IPE would be helpful in improving periodontal parameters.