Influência da extração na instalação imediata e estabilidade primária de implantes osseointegrados para reabilitação total: estudo clínico retrospectivo com 40 pacientes e 162 implantes / The influence of tooth extraction on the immediate implant placement and stability for complete mandibular rehabilitation: a clinical retrospective study with 40 patients and 162 dental implants

Objetivo: verificar a influência das exodontias realizadas no mesmo momento da instalação dos implantes osteointegráveis (IO) na frequência de complicações pós-operatórias e a estabilidade primária desses implantes. Material e métodos: mediante análise dos prontuários dos pacientes tratados na APCD (Bauru-SP), foram selecionados e comparados dois grupos de pacientes que necessitavam de reabilitação oral total de mandíbula. Grupo I: pacientes submetidos à exodontia prévia à instalação de IO (N:13). Grupo II: pacientes submetidos à exodontia e instalação de implantes no mesmo momento (N:27). No grupo I, dos 13 pacientes tratados, 12 (91,67%) foram submetidos à carga imediata (52 implantes). No grupo II, 24 (88,89%) dos 27 pacientes (110 implantes) alcançaram os parâmetros necessários de estabilidade inicial. Resultados: a comparação entre os grupos apontou maior frequência de complicações no grupo II, no qual foram perdidos dois implantes osteointegráveis (1,82%). Conclusão: as extrações realizadas no mesmo momento da instalação dos IO podem contribuir para maior incidência de perda das fixações. Assim, deve-se esclarecer aos pacientes as limitações, vantagens e desvantagens do tratamento com carga imediata.

Objectives: to verify the influence of tooth extraction and immediate implant placement on the frequency of postoperative complications and primary implant stability. Material and methods: upon reviewing of the dental charts of patients treated at APCD (Bauru- SP), two groups were selected based on their need of mandibular implant restorations. Group I: those submitted to tooth extraction and later receiving dental implant placement (N=13); Group II: patients submitted to extraction and implant placement in the same time (N=27). In Group I, 13 patients (91.67%) were submitted to immediate loading (52 implants). In Group II, 24 patients (110 implants, 88,89%) achieved the pre-requisites of initial stability. Results: the frequency of complications was higher in Group II, with two implants lost (1.82%). Conclusion: tooth extraction and dental implant placement in the same day can contribute to more implant failures. Thus, patients need to educated regarding the limitations, advantages, and disadvantages of the immediate loading protocol as a treatment option.

Reconstrução alveolar imediata às exodontias de molares sem uso de barreiras: apresentação de um protocolo / Immediate alveolar reconstruction for molar extraction sites without guided-bone regeneration barrier membranes: a proposed protocol

Este artigo apresenta uma metodologia para tratamento de defeitos alveolares com ausência de uma ou duas paredes ósseas, em regiões de molares, sem o uso de barreiras de Regeneração Óssea Guiada (ROG). A metodologia e seus fundamentos são discutidos e um caso clínico é detalhado para melhor elucidação.

This article presents a special protocol for treatment of alveolar defects in molar regions where one ore two bone walls are absent without using Guided Bone Regeneration (GBR). Its methodological aspects and basic tenets are discussed in addition to a detailed clinica case for better comprehension of this interesting protocol.

Reconstruction of orbital defect with craniomaxillofacial implant / 中华口腔医学杂志

To evaluate the clinical results of reconstruction orbital defect with craniomaxillofacial implant. Three patients with orbital defect were treated with ten implants. The magnetic abutments were attached six months after one stage operation and the prostheses were fabricated. Within 11 to 47 months of follow up, all implants were stable with successful osseointegration. The prosthesis fit the orbital defects well. Reconstruction of orbital defect with craniomaxillofacial implant can be considered as a viable alternative treatment.

Cirurgia oral em paciente com anemia falciforme: o que o cirurgião-dentista precisa saber. Relato de caso / Oral surgery in patient with sickle cell disease: what the dentist need to know. Case report

Anemia falciforme é uma doença hereditária que se caracteriza por um distúrbio sanguíneo que afeta as células vermelhas, resultando, principalmente, em hemoglobinas alteradas. A doença caracteriza-se pela falta de glóbulos vermelhos saudáveis, causando dificuldade em transpor oxigênio para todos os tecidos. As manifestações sistêmicas e na cavidade oral podem ser variadas, sendo importante estar atento aos sinais clínicos e sintomas. Para o tratamento desses pacientes é necessário atenção aos cuidados e riscos a infecções oriundas das técnicas realizadas pelo cirurgião dentista, e, por esta razão, a antibioticoprofilaxia se faz tão necessária juntamente com a relação multidisciplinar. O objetivo deste trabalho foi apresentar um relato de caso de instalação de implante osseointegrado em paciente portadora de anemia falciforme, enfatizando as características da doença e os cuidados que o cirurgião-dentista deve ter no manejo destes pacientes.(AU)

Sickle cell disease is a hereditary disease characterized by a disorder that affects the blood red cells resulting mainly in altered hemoglobin. The disease results in lack of enough healthy red blood cells causing difficulty in transposing oxygen to all tissues. Systemic and bucal manifestations can be varied and it is very important to be aware of the clinical signs and symptoms. In the treatment of these patients it is necessary to pay attention for the risks of arising infections from the techniques performed by dentists and that´s why antibiotic prophylaxis is done as needed along with the multidisciplinary relationship. The objective of this study was a report of case of osseointegrated implant installation in a female patient with sickle cell anemia, emphasizing the characteristics of the disease and the care that the dentist must have in the management of these patients.(AU)

Reconstrução imediata de fenestração peri-implantar por meio de enxerto autógeno em bloco obtido do ramo mandibular / Immediate reconstruction of peri-implant fenestration with autogenous block grafts harvested from mandibular ramus

As fenestrações das paredes alveolares são relativamente comuns durante o procedimento cirúrgico para instalação de implantes. O objetivo do presente trabalho foi relatar um caso clínico de reconstrução de fenestração peri-implantar imediatamente após a instalação de implante osseointegrável, através de enxerto ósseo autógeno em bloco obtido do ramo mandibular. Paciente do sexo masculino procurou o Departamento de Cirurgia e Clínica Integrada para trocar sua prótese parcial removível classe IV de Kennedy por prótese parcial fixa implantossuportada. Foram instalados dois implantes nos espaços protéticos correspondente aos dentes 12 e 21. Houve uma fenestração peri-implantar da parede vestibular durante a instalação do implante correspondente ao dente 12, que foi reconstruídapor meio de enxerto autógeno em bloco obtido do ramo mandibular e fixado por meio de parafuso bicortical. Após seis meses de concomitante período de incorporação do enxerto ósseo autógeno e osseointegração, iniciou-se o processamento para confecção da prótese parcial fixa implantossuportada. Diante da reabilitação protética alcançada, concluiu-se que o enxerto ósseo autógeno obtido da área doadora ramo mandibular constitui uma alternativa segura e eficaz para reconstrução de defeitos peri-implantares em forma de fenestração óssea...

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types...

Clinical Study on Implant Survival and Graft Resorption Rate After Maxillary Sinus Bone Grafting

Clinical study on survival rate of osseointegrated implants

The retrospective study of the prognosis of implants in chronic periodontitis patients / 대한치주과학회지

The successful use of osseointegrated implants to replace missing teeth has been demonstrated for both the completely and the partially edentulous patients. Many studies have confirmed an excellent long- term prognosis. The successful outcome of any implant procedure is surely dependent on the interrelationship of the various components that includes the following: biocompatibility of the implant material, macroscopic and microscopic nature of the implant surface, the status of the implant bed in both a health(noninfected) and a morphologic(bone quality) context, the surgical technique, the undisturbed healing phase, the subsequent prosthetic design, and long-term loading phase. Periodontally compromised patients have poor status of the implant bed and periodontal pathogen. No longitudinal data are available whether these factors affect the prognosis of implants. In this study, 102 machined Branemark implants are inserted to analyze the success rate of 1-4 years and marginal bone loss in 49 chronic periodontitis patients. The following conclusions could be drawn from this study. 1. The cumulative success rate of implants at the 4-year of loading was 95.10%. 2. 5 failed implants have been removed. One implant have been removed due to infection, two implants were removed due to failure of osseointegration. and other two implants were removed due to mechanical failure caused by over-loading. 3. Mean marginal bone loss from the time of loading was 0.94mm at first year, 1.12mm at second year, 1.25mm at third year. These results suggest that implant therapy is good treatment modality in chronic periodontitis patients, and periodontal treatment including oral hygiene program is completed prior to insertion of implants.

THREE DIMENSIONAL FINITE ELEMENT ANALYSIS ON THE MANDIBULAR CANTILEVERED PROSTHESIS SUPPORTED BY IMPLANTS / 대한치과보철학회지

One of the biggest clinical problems of osseointegrated implant prosthesis is the excessive stress caused by bite forces which are transfered directly into the bone through the osseointegrated implant fixtures. So several biodynamic problems occur when there is an excessive fatigue stress. The factors of stress distribution are the number, kind, position, arrangement of the implants, and the distance between the implants, and the kind, quality of superstructure prosthesis and connection type between the rest implant and the superstructure. Recently, a distal short additional implant, socalled rest implant, is employed to reduced the stresses in conventional cantilevered prostheses. This study was undertaken to analyze the stresses transfered by osseointegrated implant cantilevered prostheses depending upon the number and the position of implants, the presence of rest implant, and the type of their connection. Three dimensional finite element analysis was attempted using ANSIS ver. 5.3 program under IBM INDIGO computer. The results were as follows 1. The rest implant influenced on the pattern of stress distribution on the anterior area of the mandible and the superstructure. 2. In the group employing the rest implants, the fixed type of connection between the rest implant and the superstructure was more stable than the ball attachment type on the stress distribution. 3. In the group employing the ball attachment between the rest implant and the superstructure, the case with 4-implants(on canine, premolar) was little more stable than the case with 6-implants and the case with 4-implants (on incisor, premolar) on the stress distribution. 4. In the cantilevered group, the case with 4-implants(on incisor, premolar) and the case with 6-implants were more stable than the case with 4-implants (on canine, premolar) on the stress distribution. 5. In all of the group, the case with 6-implants and the fixed type of connection was the most stable and the case with 4-implants (on canine, premolar) was the most unstable on the stress distribution.

A STUDY ON THE ELASTIC DEFORMATION AND STRESS DISTRIBUTION OF THE MANDIBLE WITH OSSEOINTEGRATED IMPLANT PROSTHESES USING THREE DIMENSIONAL FINITE ELEMENT ANALYSIS METHOD / 대한치과보철학회지

The human mandible is always under the condition of loading by the various forces exterted by the attached muscles. The loading is an important condition of the stomatognathic system. This condition is composed of the direction and amount of forces of the masticatory muscles, which are controlled by the neuromuscular system, and always influenced by the movement of both opening and closing. Mandible is a strong foundation for the teeth or various prostheses, nevetheless it is a elastic body which accompanies deformation by the external forces on it. The elastic properties of the mandible is influenced by the various procedures such as conventional restorative treatments, osseointegrated implant treatments, reconstructive surgical procedures and so forth. Among the treatments the osseointegrated implant has no periodontal ligaments, which exist around the natural teeth to allow physiologic mobility in the alveolar socket. And so around the osseointegrated implant, there is almost no damping effect during the transmission of occlusal stree and displacements. If the osseointegrated implants are connceted by the superstructure for the stabilization and effective distribution of occlusal stresses, the elastic properties of mandible is restricted accordding to the extent of 'splinting'by the superstructure and implants. To investigate the change of elastic behaviour of the mandible which has osseointegrated impalnt prosthesis of various numbers of implant installment and span of superstructure, a three dimensional finite element model was developed and analyzed with conditions mentioned above. The conclusions are as follows : 1. The displacements are primarily developed at the area of muscle attachment and distributed all around the mandible according to the various properties of bone. 2. The segmentation in the superstructure has few influence on the distribution of stress and displacement. 3. In the load case of ICP, the concetration of tensional stress was observed at the anterior portion of the ramus(9.22E+6Nmm2) and at the lingual portion of the symphysis menti(8.36E+6Nmm2). 4. In the load case of INC, the concentration of tensional stress was observed at the anterior portion of the ramus(9.90E+6Nmm2) and the concentration of tensional stress was observed at the lingual portion of the symphysis menti(2.38E+6Nmm2). 5. In the load case of UTCP, the relatively high concentration of tensional stress(3.66E+7N/mm2) was observed at the internal surface of the condylar neck.

PROSTHETIC REHABILITATION OF THE PARTIALLY EDENTULOUS PATIENT BY USING OSSEOINTEGRATE IMPLANT AFTER REMOVAL OF AMELOBLASTOMA / 대한치과보철학회지

Ameloblastoma is the most agrressive ofht odontogenic tumors and it arises from the dental lamina or the derivatives of lamina. Ameloblastoma is a benign but locally invasive neoplasm consisting of proliferating odontogenic epithelium lying in a fibrous stroma. Usually the ameloblastomas are diagnosed in the forth and fifth decardes. Over 80% of them occur in the mandible, the remainder in the maxilla. The preferred treatment for ameloblastoma is radical excision, conserving(when possible) the inferior border of the mandible. The functional and esthetic rehabilitation of the partially edentulous patient may prevent the remaining structures from supporting conventional prosthetic treatment. Patients with long edentulous spans, malpositioned teeth, residual ridges defects and high muscle attachments may be offered an osseointegrated fixed prosthesis. Osseointegrated dental implants provide a viable alternative of tooth replacement. This is a case report of 16 year old female with ameloblastoma. We treated patient with radical excision, conserving the inferior border of the mandible and allogenous bone graft. The defected residual ridge area was reconstructed implants(Steri-Oss Implant System). the result was satisfactory.