Cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata / Virtual guided surgery for implantsupported rehabilitation of the edentulous maxilla with immediate loading

Objetivo: Presentar el relato de un caso clínico de cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata. Relato del caso: Paciente, edéntulo total en ambos maxilares, expresó su deseo de cambiar la prótesis total superior removible por una prótesis total fija sobre implantes. Durante la evaluación clínica, se observaron condiciones biológicas favorables al tratamiento como, adecuada faja de tejido queratinizado y leve reabsorción ósea. Como tratamiento se le sugiere al paciente, una planificación inversa, asistida por cirugía virtual guiada, utilizando un prototipo de guía quirúrgica para la colocación de seis implantes dentales en el maxilar y la instalación de una prótesis protocolo de carga inmediata. Conclusiones: Los resultados nos permiten concluir que la cirugía virtual guiada por computadora para rehabilitación protésica implantosoportada de maxilar edéntulo, con carga inmediata, proporciona precisión en los procedimientos quirúrgicos, es fundamental para la confección de prótesis inmediatas, representa una alternativa mínimamente invasiva y el resultado complace a los pacientes.

Objective: present the report of a clinical case of a virtual guided surgery for implant-supported rehabilitation of the edentulous maxilla with immediate loading. Case report: Patient, bi-maxillary edentulous expressed the desire to replace the removable upper total prothesis for a total fixed prothesis on implants. During the clinical evaluation, favorable biological conditions for treatment were observed, such as adequate keratinized tissue band and mild bone resorption. As part of the treatment, the patient was recommended a reverse planning approach, assisted by virtual guided surgery. This involved a prototype surgical guide for the fixation of six dental implants in the maxilla and the installation of an immediate loading protocol prosthesis. Conclusions: The results lead us to conclude that computer-guided virtual surgery for implant-supported prosthetic rehabilitation of the edentulous maxilla with immediate loading, provides a high precision in surgical procedures. It is essential to fabrication of immediate prostheses, represents a minimally invasive alternative, and results in patient satisfaction.

Associated short and regular implants for complete denture retention in an atrophic mandible: clinical follow-up / Implantes corto y regular asociados para retención de prótesis completa en mandíbula atrófica: seguimiento clínico / Implantes curto e regular associados para retenção de prótese total em mandíbula atrófica: acompanhamento clínico

Objective: to present the radiographic clinical follow-up of the prosthetic rehabilitation of a patient with an atrophic mandible, with the installation of short implants associated with an implant of regular length. Method: case report of a completely edentulous patient with an atrophic mandible and a 6-year radiographic clinical follow-up conducted at the dental clinic of the Federal University of Piauí, Teresina, from February 2011 to January 2020. After collecting sociodemographic data, health records, clinical radiographic examinations, and prosthetic surgical planning, four dental implants were installed between the mental foramina. After three months, mini-conical abutments and a fixed prosthesis screwed onto the implants were installed and monitored every six months for a period of six years. Results: the clinical evaluation revealed tissue stability without significant peri-implant changes after the follow-up period. Radiographically, bone resorption was not observed around the implant. Stability of the prosthesis and absence of prosthetic complications were observed during the follow-up period. Conclusion: short implants associated with regular-length implants can be placed in the anterior region of an atrophic mandible for rehabilitation with fixed complete dentures.

Objetivo: apresentar o acompanhamento clínico radiográfico da reabilitação protética de um paciente com mandíbula atrófica com a instalação de implantes curtos associados a um implante de comprimento regular. Método: relato de caso de uma paciente desdentada total com mandíbula atrófica, e acompanhamento clínico radiográfico de seis anos, realizado na clínica odontológica da Universidade Federal de Piauí, Teresina, no período de fevereiro de 2011 a janeiro de 2020. Após coleta de dados sociodemográficos e registro de saúde, exames clínicos radiográficos e planejamento cirúrgico protético, foram instalados quatro implantes dentários entre os forames mentonianos. Após o período de três meses foram instalados mini pilares cônicos e uma prótese fixa aparafusada sobre os implantes que foi acompanhada a cada seis meses por um período de seis anos. Resultados: as avaliações clínicas mostraram estabilidade tecidual sem alterações peri-implantares significativas após o período de acompanhamento. Radiograficamente foi observada a manutenção sem reabsorção óssea ao redor dos implantes. A estabilidade da prótese e a ausência de complicações protéticas foram observadas clinicamente durante o período de acompanhamento. Conclusão: os implantes curtos associados a implante de comprimento regular podem ser colocados na região anterior da mandíbula atrófica para reabilitação com prótese total fixa.

The bruxism paradigm in the absence of teeth: observational cross-sectional study in full denture users / O paradigma do bruxismo na ausência de dentes: estudo observacional de corte transversal em usuários de próteses totais

ABSTRACT BACKGROUND AND OBJECTIVES: Bruxism is defined as an activity of the masticatory muscles, which is independent of the teeth presence, so it can occur in total edentulous patients and users of dental prostheses. In this sense, It is therefore necessary to know the clinical manifestations of bruxism in this population. The objective of this study was to evaluate the clinical manifestation and the presence of probable sleep and awake bruxism in a sample of users of full dentures treated at a teaching dental clinic in the city of Ribeirão Preto/SP. METHODS: The adopted sample consisted of 30 patients (mean age 72 years, 18 women/12 men). The following questionnaires were used to assess probable bruxism: Oral Behavior Checklist (OBC), Questionnaire of the American Academy of Orofacial Pain (AADO) and the Depression Anxiety and Stress Scale (DASS-21). The clinical assessment included the identification of wear on the prostheses, tongue indentations, bitten cheek and sensitivity in the masticatory muscles and temporomandibular joints. The data was analyzed using descriptive statistics. RESULTS: The average of use of the dentures were nine years. Six patients (20%) reported self-perceived sleep bruxism, and 11 (36%) reported self-perceived awake bruxism. OBC showed an average total score of 9.8 ± 6.2, with "teeth clenching" being the most described symptom. DASS-21 presented an average of 16.5, and stress, anxiety and depression were within normal limits. The most commonly reported symptoms in the AADO were headache, neck pain, pain and/or difficulty during jaw function and recent trauma to the head, neck or jaws. In the clinical evaluation, 15 (50%) patients had wear on prosthesis, only 2 (6%) had bitten cheek, none had tongue indentations, 4 (13%) had pain during palpation. CONCLUSION: Despite the limitations of the study (cross-sectional, small sample and absence of instrumental evaluation of bruxism), it is possible to conclude that a significant portion of users of total dentures presented probable bruxism, with tooth clenching being the main report and wear on the prosthesis the main clinical manifestation.

RESUMO JUSTIFICATIVA E OBJETIVOS: O bruxismo é definido como uma atividade da musculatura mastigatória, que independe da presença de dentes, portanto pode ocorrer em pacientes desdentados totais e usuários de próteses dentárias. Assim, é preciso conhecer como o bruxismo se manifesta clinicamente nessa população. O objetivo deste estudo foi investigar a presença do provável bruxismo de sono e de vigília em usuários de prótese total atendidos em uma clínica odontológica de ensino em Ribeirão Preto/SP. MÉTODOS: Uma amostra de conveniência foi composta por 30 pacientes (média de 72 anos, 18 mulheres e 12 homens). Os seguintes questionários foram utilizados para avaliar o provável bruxismo: Oral Behavior Checklist (OBC), Questionário da Academia Americana de Dor Orofacial (AADO) e o Depression Anxiety and Stress Scale (DASS-21). A avaliação clínica incluiu a identificação de desgastes nas próteses, língua dentada, bochecha mordiscada e sensibilidade nos músculos mastigatórios e nas articulações temporomandibulares. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: A média de uso das próteses foi de nove anos. Seis indivíduos (20%) relataram bruxismo do sono e 11 (36%) relataram bruxismo de vigília. O OBC apresentou média de escore total de 9,8 ± 6,2, sendo "apertar de dentes" o sintoma mais descrito. O DASS-21 apresentou média total de 16,5, com valores de estresse, ansiedade e depressão dentro da normalidade. Os sintomas mais relatados no AADO foram cefaleia, dores no pescoço, dor e/ou dificuldade durante a função mandibular e trauma recente na cabeça, pescoço ou maxilares. Na avaliação clínica, 15 (50%) dos pacientes apresentaram desgastes na prótese, 4 (13%) dor por palpação, 2 (6%) bochecha mordiscada e nenhum (0%) língua dentada. CONCLUSÃO: Apesar das limitações deste estudo (corte transversal, amostra reduzida e ausência de avaliação instrumental do bruxismo) foi possível concluir que uma parcela significativa de usuários de próteses totais apresentou provável bruxismo, sendo o apertamento dentário o principal relato e desgastes na prótese a principal manifestação clínica.

Oral health conditions of institutionalized older adults and associated factors / Condições de saúde bucal de idosos institucionalizados e seus fatores associados

INTRODUCTION: The growth of the Brazilian older adult population has influenced the increased demand for institutionalization for this public, which usually has poor oral health conditions such as edentulism. OBJECTIVE: To characterize the oral health conditions and verify the variables related to the edentulism of institutionalized older adults and verify the relation of the time of institutionalization with oral health. METHODS: It was a cross-sectional study conducted with 512 institutionalized older adults in which the sociodemographic profile, general health conditions, and oral health care and conditions were evaluated by clinical exams, consultations of medical records, and structured questionnaires. The data were analyzed in the Statistical Package for Social Sciences using the Pearson Chi-square and Fisher's Exact tests and a logistic regression model using a 95% confidence level. RESULTS: A high DMFT (29.4), high prevalence of complete edentulism (61.3%), high need for maxillary (73.6%), and mandibular oral rehabilitation (56.8%) were observed. Edentulism was associated with older age (p<0.001), lower schooling (p<0.001) and non-retirement (p=0.031). It was found that longer institutionalization time remained associated with edentulism even when adjusted by sociodemographic and general health variables (p=0.013). It was also associated with the absence of brushing (p=0.024) and a lower frequency of tooth, gum, and prosthesis brushing (p<0.001). CONCLUSION: It is suggested to establish oral health care routines within long-term institutions for the effective maintenance of oral health throughout the institutionalization time.

INTRODUÇÃO: O crescimento da população idosa brasileira tem influenciado no aumento da procura por institucionalização para esse público, que costuma apresentar precárias condições de saúde bucal como o edentulismo. OBJETIVO: Caracterizar as condições de saúde bucal e verificar as variáveis relacionadas ao edentulismo de idosos institucionalizados, além verificar a relação do tempo de institucionalização com a saúde bucal. MÉTODOS: Trata-se de um estudo transversal realizado com 512 idosos institucionalizados em que o perfil sociodemográfico, as condições gerais de saúde e os cuidados e condições de saúde bucal foram avaliados por meio de exames clínicos, consultas a prontuários e questionários estruturados. Os dados foram analisados no Statistical Package for the Social Sciences por meio dos testes Qui-quadrado de Pearson e Exato de Fisher e um modelo de regressão logística com nível de confiança de 95%. RESULTADOS: Observou-se alto CPOD (29,4), alta prevalência de edentulismo total (61,3%), alta necessidade de reabilitação oral maxilar (73,6%) e mandibular (56,8%). O edentulismo esteve associado a maior idade (p<0,001), menor escolaridade (p<0,001) e ausência de aposentadoria (p=0,031). Verificou-se que o maior tempo de institucionalização permaneceu associado ao edentulismo mesmo quando ajustado por variáveis sociodemográficas e de saúde geral (p=0,013). Além disso, também esteve associado à ausência de escovação (p=0,024) e menor frequência de escovação de dentes, gengivas e próteses (p<0,001). CONCLUSÃO: Sugere-se estabelecer rotinas de atenção à saúde bucal nas instituições de longa permanência para a manutenção efetiva da saúde bucal ao longo do tempo de institucionalização.

Edentulismo, necessidade de prótese e autopercepção de saúde bucal entre idosos institucionalizados / Edentulism, need for dentures, and self-perception of oral health among institutionalized older people

RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.

ABSTRACT The aim was to describe the oral health status of institutionalized older people, focusing on edentulism, need for dentures, and Self-Perception of Oral Health (SPOH), and to explore the association with individual factors. A cross-sectional study was carried out in Ponta Grossa, in the South of Brazil, with a convenience sample of older people living in three Long Stay Institutions for the Elderly. Using a structured questionnaire, data on demographic, general, and oral health characteristics and access to health services were collected. In the oral examination, the Index of Decayed, Missing and Filled permanent Teeth (DMFT), number of teeth present, use and need for dental prosthesis, and presence of oral lesions were evaluated. 130 older people were evaluated, most of them over 80 years old (62.20%). The mean DMFT was 30.62 (± 2.85), 62.31% of attendees were edentulous, 41.54% used, and 79.23% needed dental prosthesis. Oral lesions were identified in 35.42% of those evaluated and 64.86% of the participants classified their SPOH as good. It is concluded that the oral health of the participants was considered poor, from a clinical point of view, taking into account the high prevalence of edentulism and the need to use dental prosthesis.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey

Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Halitosis and Pain Threshold of Peri-Implant Tissues: An Observational Cohort Study

Abstract In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey's test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.

Resumo Este estudo teve como objetivo avaliar a halitose e o limiar de dor dos tecidos moles peri-implantares em indivíduos reabilitados com próteses implantossuportadas. Um total de 48 indivíduos foram divididos em quatro grupos (n=12), de acordo com as reabilitações: prótese fixa unitária, prótese fixa multidentária, sobredentadura e protocolo de Brånemark. A halitose foi medida com um halímetro, enquanto o limiar de dor foi medido com monofilamentos de von Frey. As medições foram feitas antes (t0) e 30 dias após (t1) a colocação das tampas de cicatrização e no momento (t2) e 30 dias após (t3) a colocação da prótese. Os dados de halitose foram analisados por meio do teste qui-quadrado e correção de Bonferroni (p < 0,05). ANOVA de duas vias e o teste de Tukey (p < 0,05) foram usados para analisar os dados do limiar de dor. Observou-se associação entre halitose e tempo para o protocolo de Brånemark [X2(6) = 18,471; p = 0,005] e grupos overdenture [X2(6) = 17,732; p = 0,007], e entre halitose e tipo de prótese apenas em t0 [X2(6) = 12,894; p = 0,045]. A interação entre o tempo e o tipo de prótese interferiu significativamente nos valores médios do limiar de dor (p = 0,001). Na maioria dos pontos de tempos, a maioria dos participantes de cada grupo apresentava halitose clinicamente inaceitável. Após 30 dias de uso das próteses, o grupo overdenture apresentou menor limiar de dor em comparação ao grupo do protocolo de Brånemark.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly: a cross-sectional study

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly

Influence of diameter in the stress distribution of extra-short dental implants under axial and oblique load: a finite element analysis

Aim: This study evaluated the influence of a wide diameter on extra-short dental implant stress distribution as a retainer for single implant-supported crowns in the atrophic mandible posterior region under axial and oblique load. Methods: Four 3D digital casts of an atrophic mandible, with a single implant-retained crown with a 3:1 crown-to-implant ratio, were created for finite element analysis. The implant diameter used was either 4 mm (regular) or 6 mm (wide), both with 5 mm length. A 200 N axial or 30º oblique load was applied to the mandibular right first molar occlusal surface. The equivalent von Mises stress was recorded for the abutment and implant, minimum principal stress, and maximum shear stress for cortical and cancellous bone. Results: Oblique load increased the stress in all components when compared to axial load. Wide diameter implants showed a decrease of von Mises stress around 40% in both load directions at the implant, and an increase of at least 3.6% at the abutment. Wide diameter implants exhibited better results for cancellous bone in both angulations. However, in the cortical bone, the minimum principal stress was at least 66% greater for wide than regular diameter implants, and the maximum shear stress was more than 100% greater. Conclusion: Extra-short dental implants with wide diameter result in better biomechanical behavior for the implant, but the implications of a potential risk of overloading the cortical bone and bone loss over time, mainly under oblique load, should be investigated

Transición de prótesis removible a rehabilitación fija de arco completo sobre implantes: Impacto en el perfil facial. Reporte de caso

El perfil facial de un paciente con prótesis total removible podría no ser óptimo cuando el paciente tiene rebordes óseos conservados tridimensionalmente, planteando la necesidad de una prótesis dentaria y no dentogingival. El objetivo de este reporte es describir la transición y tratamiento de una paciente desdentada maxilar, usuaria de prótesis removible con excesivo soporte labial y disponibilidad ósea favorable. En la planificación se prueban parámetros estéticos mediante una ordenación dentaria sin flanco y en base a esta se planifica una "Cirugía de Implantes Protésicamente Guiada" para rehabilitación fija de arco completo sobre implantes en posiciones 1.6, 1.3, 1.1, 2.1, 2.3 y 2.6. Se concluye que con la técnica descrita se puede realizar una evaluación clínica veraz de la propuesta protésica, lo que se traspasa a la guía radiográfica y quirúrgica. Lo anterior permite consistencia entre planificación, cirugía, provisonalización y prótesis definitiva.

The facial profile of a patient with a complete removable denture may not be optimal when the patient has a three-dimensionally preserved bone ridge, raising the need for a dental rather than dentogingival prosthesis. The objective of this report is to describe the transition and treatment of a maxillary edentulous patient, user of a removable prosthesis with excessive lip support and favorable bone availability. In the planning phase, aesthetic parameters are tested using a dental set-up without flank. Based on this, a "Prosthetically Driven Implant Surgery" is planned for a fixed full-arch implant-supported prosthesis with implants located in 1.6, 1.3, 1.1, 2.1, 2.3 and 2.6. It is concluded that, with the described technique, a truthful clinical evaluation of the prosthetic proposal can be performed, and then transferred to the radiographic and surgical guide. This allows consistency between planning, surgery, provisionalization and final prosthesis.

The challenges of reconstruction and rehabilitation of atrophic jaw with an autogenous graft from skull cap ­ a case report / Os desafios da reconstrução e reabilitação de mandíbula atrófica com enxerto autógeno de calota craniana ­ relato de caso

Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.

Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.

Manejo odontológico integral de una paciente con disostosis cleidocraneal. Reporte caso / Integral dental management of a patient with cleidocraneal dysplasia. Case report

Introducción: la disostosis cleidocraneal (CCD) es una enfermedad genética rara que compromete el desarrollo óseo normal, causada por la alteración en el gen RUNX2 del cromosoma 6p (brazo corto). Sus consecuencias incluyen alteraciones óseas por anomalías en la osificación intramembranosa que, a su vez, conllevan a modificaciones en el desarrollo de huesos craneales, claviculares, a múltiples efectos sobre el número, erupción y recambio dental, y a dificultades funcionales, además de cambios en la conducta psicosocial por el deterioro en la calidad de vida. Objetivo: describir el manejo integral de una paciente con disostosis cleidocraneal, a través de la revisión de caso clínico y el reporte de hallazgos en su mejoramiento, como consecuencia de tratamientos quirúrgicos, rehabilitación y el apoyo interdisciplinario, aspecto de gran importancia para este tipo de pacientes. Caso clínico: paciente femenina de 31 años con diagnóstico de CCD que asistió a la Unidad Estomatológica de la Universidad de Cartagena ­ Colombia, y fue remitida desde Genética por presentar inconformidad funcional y dolor leve durante la masticación de los alimentos por movilidad dental severa en dientes antero-inferiores; además, manifestó permanencia de órganos dentarios deciduos, la cual fue tratada en fases. Al tratamiento se le dio un enfoque multidisciplinar, lo que mejoró, de forma sustancial, la autopercepción e interrelación de la paciente en la sociedad.

Background: Cleidocranial dysostosis (CCD) is a rare genetic disease that compromises normal bone development, caused by the alteration in the RUNX2 gene of chromosome 6p (short arm), which causes bone alterations due to abnormalities in intramembranous ossification that leads to alterations in the development of cranial and clavicular bones and multiple efects on the number, eruption and dental turnover, which leads to functional difculties, in addition to behavior and alterations in psychosocial behavior and the deterioration of their quality of life, Objective: To describe the comprehensive management of a patient with cranial Cleido dysostosis, through a clinical case review, reporting among the fndings the improvement of the patient through surgical treatments, rehabilitation and interdisciplinary support, of great importance for this type of patient. Clinical case: A 31-year-old female patient with a diagnosis of CCD, who attended the Stomatology Unit of the University of Cartagena - Colombia, referred by the treating geneticist, due to functional discomfort and mild pain during chewing food due to severe dental mobility. in anterior-inferior teeth, also showing permanence of deciduous dental organs, which was treated in phases in which a multidisciplinary approach was given to its management, which substantially improved its self-perception and its interrelation in society.

Zygomatic implants in intra-sinus versus extra-maxillary approaches for prosthetic rehabilitation in severely atrophic maxillae: finite element analysis / Implantes cigomáticos en abordajes intra sinusal versus extra maxilar para rehabilitación protésica en maxilares severamente atróficos: análisis de elementos finitos

Objetive: To compare the stresses and deformations generated on the surrounding bone of the zygomatic implants when using an intra sinusal and extra-maxillary approach, through the finite element method. Material and Methods: Computer aided designs (CADs) were constructed using SolidWorks Software of a skull with bone resorption to be rehabilitated through a fixed hybrid prosthesis using two zygomatic and two conventional straight implants. For the boundary conditions (load conditions), symmetry in the sagittal plane was assumed and that all the materials were isotropic, homogeneous and linearly elastic. Two zygomatic implantation techniques were simulated: intra sinusal (Is) and extra maxillary (Em). Vertical and lateral loads of 150 N and 50 N were applied to the finite element models to obtain Von Mises equivalent stress and strain (displacement). Results: The average measurement of the Von Mises stress (MPa) recorded were as follows: Approach of the implant body (Is: 0.24- Em: 0.28,) effort of implant body with vertical load: Is: 0.69 - Em: 0.96; effort of peri-implant surface under horizontal load: Is: 2.11 - Em: 0.94. Average displacement under vertical load of peri-implant surface Is: 0.35 - Em: 0.40, and of implant body Is: 1.34 - Em: 2.04. Average total deformation in approach Is: 2.23 mm - Em: 0.80mm, and average total deformation in the implant body under horizontal load was Is: 0.14 - Em: 0.21. Conclusion: The results of this study indicate that despite the differences that occurred in both stress and strain (displacement) between the intra-sinus and extra-maxillary approaches, the static strength of the bone, which is approximately 150 MPa in tension and 250 MPa in compression was not exceeded. Considering the limitations of finite element analysis, there seems to be no biomechanical reason to choose one approach over the other.

Objetivo: Comparar por el método de elementos finitos los esfuerzos y deformaciones generados sobre el hueso circundante de implantes cigomáticos tratados con un abordaje intra sinusal y extra maxilar. Material y Métodos: Se construyeron los diseños asistidos por computadora (CAD) utilizando el Software SolidWorks de un cráneo con una reabsorción ósea para ser rehabilitado, a través de una prótesis híbrida fija, mediante dos implantes cigomáticos y dos rectos convencionales. Para las condiciones de frontera (condiciones de carga) se asumió simetría en el plano sagital y que todos los materiales eran isotrópicos, homogéneos y linealmente elásticos. Se simularon dos técnicas de implantación cigomática: una intra sinusal (Is) y otra extra maxilar (Em). Se aplicaron cargas verticales y laterales de 150 N y 50 N a los modelos de elementos finitos para obtener el esfuerzo equivalente de Von mises y la deformación (desplazamiento). Resultados: La medición promedio del esfuerzo de Von Mises (MPa) registró: abordaje del cuerpo de implante (Is: 0.24-Em: 0.28) esfuerzo del cuerpo de implante con carga vertical: (Is:0.69 ­ Em: 0.96); esfuerzo de la superficie peri implantar ante carga horizontal (lateral):( Is:2.11 ­ Em:0.94). Desplazamiento promedio ante carga vertical de la superficie peri implantar (Is:0.35 ­ Em:0.40) y del cuerpo del implante (Is:1.34 ­ Em:2.04). Deformación total promedio en mm en abordaje (Is: 2.23 ­ Em:0.80) y deformación total promedio en el cuerpo del implante ante carga horizontal (Is:0.14 ­ Em:0.21). Conclusión: Los resultados de este estudio indican que a pesar de las diferencias que se presentaron tanto en el esfuerzo como en la deformación (desplazamiento) entre los abordajes intra sinusal y extra maxilar, la resistencia estática del hueso, que es de aproximadamente 150 MPa en tensión y 250 MPa en compresión no se superó. Considerando las limitaciones de los AEF, parece no haber razones biomecánicas para elegir uno u otro enfoque.

Concept of functional dentition and impact on the quality of life of partially edentulous patients / Concepto dentición funcional e impacto en la calidad de vida de los pacientes desdentados parciales

Main Objective: To compare, through the OHIP-7Sp, the impact on the quality of life of partially edentulous patients, according to WHO criteria "with functional dentition", 21 or more teeth and "without functional dentition", less than 21 teeth. Material and Methods: 97 partially edentulous patients were selected between 35 and 75 years old, ASA I or II with ≤ 28 teeth remaining. Were divided in two groups, non-functional dentition (NFD) n=47 and functional dentition (FD) n=50. OHIP-7Sp survey was applied to each patient to measure the impact on quality of life in the seven dimensions considered in this survey. The scale of measurement ranges from 0 to 4, in which 0 is "never" and 4 "always", with a maximum value of 28, considering the instrument in its entirety. Highest score indicates a greater impact on quality of life. For comparison of both groups, the non-parametric Mann-Whitney test was used with a level of 95% significance. Results: Concerning all patients evaluated through the OHIP-7Sp, the mean age was 53 years. There were significant differences in the total OHIP-7Sp score, with a mean and median for the NFD group of 9.53 and 9 and for the FD group 5.02 and 5, respectively. Disaggregating the analysis, significant differences emerged in dimensions 2, 3, 4, 5, and 6 (p<0.05). Conclusion: There was a significantly greater impact on the quality of life, measured with the OHIP-7Sp, in the NFD group compared to the FD group.

Objetivo Principal: Comparar mediante el OHIP-7Sp, el impacto en la calidad de vida de pacientes desdentados parciales, según criterio OMS "con dentición funcional", 21 o más dientes y "sin dentición funcional", menos de 21 dientes. 0 Material y Métodos: Fueron seleccionados 97 pacientes desdentados parciales entre 35 y 75 años, ASA I o II con remanencia de ≤ 28 dientes. Fueron divididos en 2 grupos, dentición no funcional (DNF) n=47 y dentición funcional (DF) n=50. Se aplicó encuesta OHIP-7Sp a cada paciente para medir el impacto en la calidad de vida en las 7 dimensiones que contempla esta encuesta. La escala de medición, abarca de 0 a 4, en la cual 0 es "nunca" y 4 "siempre", con un valor máximo de 28, considerado el instrumento en su totalidad. El puntaje más alto indica un mayor impacto en la calidad de vida. Para la comparación de ambos grupos se utilizó el test no paramétrico de Mann-Whitney con un nivel de significancia del 95%. Resultados: Del total de pacientes evaluados mediante el OHIP-7Sp, el promedio de edad fue de 53 años. Hubo diferencias significativas en el puntaje del OHIP-7Sp total, con una media y mediana para el grupo DNF de 9,53 y 9 y para el grupo DF de 5,02 y 5, respectivamente. Desagregando el análisis, emergieron diferencias significativas en las dimensiones 2, 3, 4, 5, y 6 (p<0,05). Conclusión: Hubo significativamente mayor impacto en la calidad de vida, medido con el OHIP-7Sp, en el grupo DNF comparado con el grupo DF.

Sobrevida, éxito, y efecto en la calidad de vida del tratamiento con sobredentadura mandibular en el Servicio de Especialidades Dentales, Hospital Clínico San Borja Arriarán, Chile: estudio clínico prospectivo de 11 casos. Parte I

RESUMEN: En los hospitales públicos chilenos, los pacientes desdentados mandibulares pueden ser tratados con una Sobredentadura-Mucosoportada, Implanto-Retenida (SMIR). Para tal fin, se adaptaron los lineamientos del plan piloto "Programa de Prestaciones Valoradas. Odontología 2012 Ministerio de Salud", en ausencia de una Guía Ministerial. El objetivo de esta serie de casos fue evaluar si la implementación y adaptación del plan piloto del tratamiento con SMIR mejoró la calidad de vida de los pacientes. Se evaluaron sobrevida, éxito implantario, e impacto en la calidad de vida. Los resultados indican una sobrevida y éxito implantario del 100% y una mejora de la calidad de vida. Conclusión: el tratamiento con SMIR mejora la calidad de vida de los pacientes, en el servicio público.

ABSTRACT: In Chilean public hospitals, patients with Complete Edentulous Mandible are treated with Implant-Retained and Mucosa-supported Overdenture (IRMO). For this purpose, the guidelines of the pilot plan "Valued Benefits Program in Dentistry 2012, Ministry of Health" have been adapted. The aim of this study was to evaluate whether these adapted protocols have been successful. We measured implant survival and success, and impact on quality of life with OHIP-14 criteria. Results indicate 100% implant survival and success and improved quality of life. Conclusion: IRMO improves patients' quality of life in public services.

The association between sleep disturbances and tooth loss among post-stroke patients / Prevalência de edentulismo e distúrbios de sono após acidente vascular cerebral

ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

RESUMO Antecedentes: A perda de dentes tem sido associada a distúrbios neurológicos e do sono. É considerada um preditor de acidente vascular cerebral (AVC), com modificações na permeabilidade das vias aéreas e predisposição à apneia obstrutiva do sono. Objetivo: Investigar a qualidade do sono, o risco de apneia obstrutiva do sono e a sonolência excessiva em pacientes pós-AVC com perda dentária, atendidos na Clínica Neurovascular da Universidade Federal de São Paulo. Métodos: O estudo avaliou a prevalência de diferentes tipos de AVC em 130 pacientes com diferentes graus de perda dentária e a presença de distúrbios do sono, risco de apneia obstrutiva do sono e sonolência excessiva. Resultados: A prevalência de AVC isquêmico foi de 94,6%, sem deficiência significativa ou deficiência leve. Nossa amostra tinha má qualidade de sono e alto risco de apneia obstrutiva do sono, sem sonolência diurna excessiva. Metade de nossa amostra perdeu entre nove e 31 dentes, e mais de 25% tiveram edentulismo. A maioria usava próteses dentárias totalmente removíveis e, desses pacientes, mais da metade dormia com elas. Conclusões: Encontramos alta prevalência de má qualidade do sono e alto risco de apneia obstrutiva do sono em pacientes pós-AVC com perda dentária. Isso indica a necessidade de mais estudos sobre o tratamento e a prevenção de distúrbios do sono em pacientes com AVC e perda dentária.

Effect of treatment dentures on denture space in edentulous patients and its clinical evaluation / 口腔疾病防治

Objective@#To investigate the effect of treatment dentures on changes in denture space in edentulous patients and to evaluate its clinical effect.@* Methods@#Twenty patients with treatment dentures were investigated with a questionnaire and Oral Health Impact Profile (OHIP-14) before and after treatment. The denture space, denture tissue surface, occlusal points, Gothic arch images, mucosal condition, lateral occlusal condition, bite force, retention and stability, patient mastication ability, denture satisfaction, and OHIP-14 score were collected for statistical analysis.@*Results @# After wearing treatment dentures, the denture space significantly improved, the tissue conditioners on the treatment denture gradually began to be distributed, and the occlusal points gradually became symmetrical. The gothic arch images showed that the joints, nerves, and muscles gradually stabilized. The mucosal condition changed to a healthy state. The lateral occlusal conditions were improved. There were also significant differences in the bite force, retention and stability, subjective and objective chewing ability, satisfaction with the denture and OHIP-14 score before and after treatment (P < 0.05). The objective chewing ability was positively correlated with the retention stability of the denture, the subjective chewing ability and the satisfaction of the denture, and it was negatively correlated with OHIP-14.@* Conclusion@#Treatment dentures could help to restore denture space to an ideal condition and improve the oral health of patients. This treatment could also improve the retention and stability of the denture and the chewing ability to improve patient satisfaction. This treatment has clinical application value and promotion potential.

Application evaluation of prefabricated rigid connecting bar in implants immediate impression preparation of edentulous jaw / 北京大学学报(医学版)

OBJECTIVE@#To compare the operation complexity and accuracy of traditional splint impression technique and impression technique with prefabricated rigid connecting bar system for full-arch implants-supported fixed protheses in vitro.@*METHODS@#Standard mandibular edentulous model with six implant analogs was prepared. The implants were placed at the bone level and multiunit abutments screwed into the implants. Two impression techniques were performed: the traditional splint impression technique was used in the control group, and the rigid connecting bar system was used in the test group. In the control group, impression copings were screwed into the multiunit abutments and connected with autopolymerizing acrylic resin. Open tray impression was fabricated with custom tray and polyether. In the test group, cylinders were screwed into the multiunit abutments. Prefabricated rigid bars with suitable length were selected and connected to the cylinders with small amount of autopolymerizing acrylic resin, and open tray impression was obtained. Impression procedures were repeated 6 times in each group. The working time of the two impression methods were recorded and compared. Analogs were screws into the impressions and gypsum casts were poured. The gypsum casts and the standard model were transferred to stereolithography (STL) files with model scanner. Comparative analysis of the STL files of the gypsum casts and the standard model was carried out and the root mean square (RMS) error value of the gypsum casts of the control and test groups compared with the standard model was recorded. The trueness of the two impression techniques was compared.@*RESULTS@#The work time in the test group was significantly lower than that in the control group and the difference was statistically significant [(984.5±63.3) s vs. (1 478.3±156.2) s, P < 0.05]. Compared with the standard model, the RMS error value of the implant abutments in the test group was (16.9±5.5) μm. The RMS value in the control group was (20.2±8.0) μm. The difference between the two groups was not significant (P>0.05).@*CONCLUSION@#The prefabricated rigid connecting bar can save the chair-side work time in implants immediate loading of edentulous jaw and simplify the impression process. The impression accuracy is not significantly different from the traditional impression technology. The impression technique with prefabricated rigid connecting bar system is worthy of clinical application.

Research progress on the effect of implant-supported overdentures on residual ridges / 口腔疾病防治

@#With the growing maturity of implant technology, implant overdenture has gradually become a conventional repair method for edentulous patients to restore beauty and function, which improves the quality of life of edentulous patients. This paper reviews the effects of implant factors, attachment factors, occlusal factors and patients' own factors on residual alveolar ridge. Existing studies suggest that when designing denture, doctors first need to consider the oral mucosa and jaw conditions of patients before operation, and select the appropriate size of implant to ensure that sufficient bone remains around the implant; Secondly, when choosing the type of attachment, the number, location and A-P distance of implants should be fully considered, and the inclination of cusp should be properly reduced to avoid the harm of excessive lateral force to alveolar ridge; Finally, regular reexamination should be carried out after operation to maintain longer service time of denture and more sufficient bone mass of edentulous patients. However, there are many factors affecting jaw absorption. In the future, we should further explore many factors, such as patients' habit and frequency of wearing dentures, oral health and nutritional status, systemic diseases and medication.

Research progress on the design of fixed implant-supported prostheses in edentulous jaws / 口腔疾病防治

@#With the aging of the population and the increase in the number of edentulous patients, implant-supported fixed restorations have become more prevalent in clinical treatment. It is necessary to assess the patient's remaining bone and occlusal situation correctly; the upper jaw usually needs 6 to 8 implants, whereas the lower jaw needs 4 to 6 implants. Patients with severe alveolar bone atrophy can adopt the "all-on-4/6" treatment plan, short implants, and zygomatic and pterygomaxillary implants to avoid complex bone grafting and remain cautious when the surgical procedures require more surgical experience. According to the repair methods, the superstructure can be divided into one-piece repair and segmental repair. One-piece repair has a lower implant number, flexible location, and reasonable stress distribution but a high maintenance cost. Sectional repair easily achieves passive placement, convenient cleaning, and maintenance in the late stages, but implants need quantity and high requirements for alveolar bone. However, the requirements for alveolar bone and implant number are high. Mutually protected occlusion with minimal or no cantilever on provisional prosthesis is recommended.