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.

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.

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.

Impact of different scan strategies and implant angulation on impression accuracy of full arch multiple implant: an in vitro study / Impacto de diferentes estratégias de escaneamento e angulação dos implantes na acurácia da moldagem de implantes múltiplos em arco completo: um estudo in vitro

Objective: to evaluate the impact of three different scan strategies and implant angulation on impression accuracy of an intraoral scanner for full-arch multiple implant scan. Material and Method: A maxillary edentulous model with six implant analogs served as a reference model. The four anterior analogs were positioned parallel to each other, the distal right and the distal left was placed with an angulation of 15o and 20o, respectively. Thirty impression were performed using an intraoral scanner (CEREC Primescan). The master cast was digitalized with an industrial reference scanner (ATOS Core 80). All scans were converted to standard tessellation language (STL), superimposed on the reference scan with a 3d inspection software (GOM Inspect Professional 2019) and then analyzed. Results: All linear distances presented equivalence [p<0.01] to those found on the reference scan for all scan strategies. All scan strategies presented a tendency of negative means for linear distances except for d4 in strategy C. All angular distances did not present equivalence [p=0.05] to those found on the reference scan. Significant 3D deviations [p<0.05] were found between strategy B (0.02 ± 0.01) and C (0.05 ± 0.04) for d1. In all others linear and angular distances no statistically significant difference was found between strategies A, B and C. Conclusions: There was no statistically significant difference between strategies A, B and C except for d1 in strategy B and C; Implant angulation did not affect the accuracy of the CEREC Primescan IOS (AU)

Objetivo: avaliar o impacto de três diferentes estratégias de escaneamento e angulação do implante na acurácia da moldagem de um scanner intraoral na moldagem de múltiplos implantes em arco completo. Material e Métodos: Um modelo edêntulo de maxila contendo seis análogos de implante serviu como modelo de referência. Os quatro análogos anteriores foram posicionados paralelos entre si, o distal direito e o distal esquerdo foram posicionados com angulação de 15o e 20o, respectivamente. Trinta moldagens foram realizadas usando um scanner intraoral (CEREC Primescan). O modelo mestre foi digitalizado com um scanner de referência industrial (ATOS Core 80). Todas as escaneamentos foram convertidas para a linguagem de mosaico padrão (STL), sobrepostas ao escaneamento de referência com um software de inspeção 3D (GOM Inspect Professional 2019) e, em seguida, analisadas. Resultados: Todas as distâncias lineares apresentaram equivalência [p <0,01] àquelas encontradas na escaneamento de referência para todas as estratégias. Todas as estratégias de escaneamento apresentaram tendência de médias negativas para distâncias lineares, exceto para d4 na estratégia C. Todas as distâncias angulares não apresentaram equivalência [p = 0,05] às encontradas no escaneamento de referência. Desvios 3D significativos [p <0,05] foram encontrados entre a estratégia B (0,02 ± 0,01) e C (0,05 ± 0,04) para d1. Em todas as outras distâncias lineares e angulares, nenhuma diferença estatisticamente significativa foi encontrada entre as estratégias A, B e C. Conclusões: Não houve diferença estatisticamente significante entre as estratégias A, B e C, exceto para d1 na estratégia B e C; A angulação do implante não afetou a precisão do CEREC Primescan. (AU)

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.

Interarch distance is a target restorative space value: clinical decisionmaking of implant restoration guided by measured value / 华西口腔医学杂志

When design an implant restoration for edentulous patients, many doctors ignore the sufficiency of the interarch distance (vertical distance) or horizontal distance of the patient to accommodate the superstructure and restoration before designing the implant plan. However, the connotation of measuring the interarch distance or horizontal distance has not been clarified in clinical practice. It is often based on visual estimation after operation, and the decision-making path of implant restoration is inverted, resulting in many mistakes regarding the restoration after implantation. The main reason is the lack of standardized paths and practical methods to use before surgery. This article recommended initially establishing a maxillo-mandibular relationship based on natural teeth, old dentures, or new ones and then using the height and horizontal distance or angle of the target restorative space, which was easier to grasp as the measured index. The minimum vertical distance (including the height of the gingival surface and the bone surface) and the horizontal distance (or the angle from the bone or gingival surface to the proposed occlusal plane) should be measured before operation. A decision tree of edentulous jaw restoration guided by the values of the repair space was established based on the measured values. This article clarified the measuring points and planes and thus provided a quantitative relationship basis for the design of implant restoration.

Prevalencia del Síndrome de Combinación y sus factores asociados en la Clínica de la Facultad de Odontología de la Universidad de Cuenca, periodo 2015-2016 / Prevalence of Combination Syndrome and associated factors at Clínica de la Facultad de Odontología, Universidad de Cuenca, 2015-2016

INTRODUCCIÓN: Un conjunto de cambios patológicos en el sistema estomatognático frente a la pre-sencia de una prótesis total maxilar y una prótesis parcial removible mandibular han sido descritos como el Síndrome de Combinación. El objetivo de este estudio fue determinar la prevalencia del sín-drome y si factores como la edad, el sexo o el tipo de edentulismo mandibular están asociados al mis-mo en los pacientes de la Clínica de la Facultad de Odontología de la Universidad de Cuenca período 2015-2016. MÉTODOS: Estudio observacional,transversal, descriptivo y de correlación. La muestra estuvo cons-tituida por 312 pacientes edéntulos. Se estableció la presencia del síndrome de combinación cuando un paciente presentaba un mínimo de tres signos asociados. Se determinó la prevalencia del síndro-me de combinación en la muestra y la asociación entre las variables sexo, edad, tipo de edentulismo con la presencia de síndrome de combinación. RESULTADOS: La prevalencia del SC resultó en un 21.8%. Padecer de edentulismo parcial clase I de Kennedy (3.6 veces mayor probabilidad que los otros tipos de edentulismo) y ser adulto mayor de 60 años (1.8 veces mayor probabilidad), tuvieron asociación con el desarrollo del síndrome de Combinación. CONCLUSIÓN: La prevalencia de SC es del 21.8%, la progresión de la edad y el edentulismo parcial clase I de Kennedy conducen a una mayor probabilidad para desarrollar el síndrome de combinación y deben evaluarse como factores de riesgo.(au)

BACKGROUND: The set of pathological changes in the stomatognathic system in the presence of a total maxillary prosthesis and a removable partial mandibular prosthesis has been described as the Combi-nation Syndrome. The main purpose of this study was to determine its prevalence and if features such as age, sex or type of mandibular edentulism are associated with the syndrome in the patients of the Odontologic Clinic of the of Faculty of Dentistry, Universidad de Cuenca during the academic period 2015-2016. METHODS: Cuantitative, cross sectional descriptive and correlational study. The sample consisted of 312 edentulous patients. The diagnosis of the syndrome in this study was determined by the presence of a minimum of three associated signs. We determine the prevalence of combiantion syndrome and the as-sociation between sex, age and edentulism type and combination syndrome. RESUlTS: The prevalence of combination syndrome is 21.8%. Adults 60 years or older (1.8 times higher probability) and patients who suffer from Kennedy class I partial edentulism (3.6 times higher probability than other types of edentulism), have a higher probability for developing the syndrome. CONClUSION: The prevalence of CS was 21.8%, age and suffering from Kennedy class I partial edentulism should be considered as risk factors for developing the syndrome.(au)

Atrophic jaw fracture and predictability in oral rehabilitation: case report / Fratura de mandíbula atrófica e previsibilidade na reabilitação oral: relato de caso

Introduction: The treatment of atrophic jaw fractures requires extensive knowledge by the maxillofacial surgeon. The correct diagnosis and planning optimize the possibility of oral rehabilitation towards many possible alternatives. The difficulty in repairing these fractures makes the treatment complex, in which normally invasive techniques are used. However; which give us satisfactory and predictable aesthetic-functional results. Objective: The objective of this work is to report an atrophic jaw fracture and posterior dental implants re-habilitation. Case report: A 53 years old female patient, victim of in face aggression referred to the emergency care. At the clinical examination, the patient had laceration in the upper lip region and the left side of the mandibular area, with bilateral mobility and paresis. In the oral examination, total lower and partial upper edentulism. After tomographic evaluation, a bilateral fracture of the mandibular body was confirmed, with significant bone fragments uneven. Surgery was performed with total transcervical access and use of reconstruction plate. After 90 days of follow-up, the oral rehabilitation with osseointegrated implants was performed. Conclusion: Complex atrophic mandible fractures in total edentulous patients can be treated with open reduction and stable fixation, allowing a faster return to normal function, improve of quality of life and assists in increasing safety for implant installation (AU)

Introdução: O tratamento de fraturas em mandíbula atrófica requer amplo conhecimento por parte da cirurgião bucomaxilofacial. O correto diagnóstico e planejamento otimizam a possibilidade de reabilitação, diante das muitas alternativas possíveis. A dificuldade em reparar essas fraturas torna o tratamento complexo, no qual normalmente técnicas invasivas são usadas. Entretanto, é possível alcançar resultados funcionais e estéticos satisfatórios e previsíveis. Objetivo: O objetivo de este trabalho é relatar uma fratura em mandíbula atrófica seguida de reabilitação com implantes dentários em região posterior. Relato de caso: Paciente do sexo feminino, 53 anos, vítima de agressão em face buscou o serviço de emergência. No exame clínico, observou-se laceração na região do lábio superior esquerdo com mobilidade bilateral e paralisia em região mandibular. No exame intra-oral, edentulismo total inferior e parcial superior. Após avaliação tomográfica, a fratura bilateral do corpo mandibular foi confirmada, com presença de significativos fragmentos ósseos. A cirurgia foi realizada com acesso transcervical total e uso de placa de reconstrução. Após 90 dias de acompanhamento foi iniciada a etapa de reabilitação oral com implantes osseointegrados. Conclusão: Fraturas atróficas complexas da mandíbula em pacientes desdentados totais podem ser tratados com redução e fixação estável, permitindo um rápido retorno da função, melhora da qualidade de vida, além de auxiliar no aumento da segurança no momento da instalação dos implantes (AU)

Digital workflow of immediate implant-supported restoration for atrophic edentulous patients / 口腔疾病防治

@#Rehabilitation and reconstruction of atrophic edentulous predicament represents significant challenges for implant dentists due to the anatomical conditions of the edentulous jaw. Implant-supported fixed complete dental prostheses represent a scientifically and clinically validated treatment for recovering patients, masticatory function and esthetic effect. However, the highly demanding implant surgical techniques and complex rehabilitation procedures for immediate functional reconstruction make it difficult to achieve the desired treatment outcomes. The application of digital and CAD/CAM technology in various stages of the treatment process is logical for patients and dentists. This article summarizes the workflow of digital-assisted implantation with immediate functional reconstruction of atrophic edentulous combined with a clinical case. Digital-assisted diagnosis, design, implantation, immediate reconstruction and final rehabilitation can optimize the implant surgery and immediate rehabilitation workflow, improve the accuracy of implant-supported immediate functional reconstruction, reduce the demand for a large amount of bone graft, and achieve higher patient satisfaction. The “prosthetic-oriented, begin with the end in mind” concept of edentulous jaw implant prosthetics can accurately and efficiently restore the patient,s beauty and chewing function in a minimally invasive manner, and is worthy of clinical promotion.

Radiomorphometric analysis of edentulous posterior mandibular ridges in the first molar region: a cone-beam computed tomography study

PURPOSE: The aim of our study was to determine the prevalence and degree of lingual concavities in the first molar region of the mandible to reduce the risk of perforating the lingual cortical bone during dental implant insertion.METHODS: A total of 163 suitable cross-sectional cone-beam computed tomography images of edentulous mandibular first molar regions were evaluated. The mandibular morphology was classified as a U-configuration (undercut), a P-configuration (parallel), or a C-configuration (convex), depending on the shape of the alveolar ridge. The characteristics of lingual concavities, including their depth, angle, vertical location, and additional parameters, were measured.RESULTS: Lingual undercuts had a prevalence of 32.5% in the first molar region. The mean concavity angle was 63.34°±8.26°, and the mean linear concavity depth (LCD) was 3.03±0.99 mm. The mean vertical distances of point P from the alveolar crest (Vc) and from the inferior mandibular border were 9.39±3.39 and 16.25±2.44, respectively. Men displayed a larger vertical height from the alveolar crest to 2 mm coronal to the inferior alveolar nerve (Vcb) and a wider LCD than women (P<0.05). Negative correlations were found between age and buccolingual width at 2 mm apical to the alveolar crest, between age and Vcb, between age and Vc, and between age and LCD (P<0.05).CONCLUSION: The prevalence of lingual concavities was 32.5% in this study. Age and gender had statistically significant effects on the lingual morphology. The risk of lingual perforation was higher in young men than in the other groups analyzed.

Restoration method of original occlusal vertical distance in edentulous jaw / 口腔疾病防治

@#The loss of jaw position relationship will seriously affect the face and masticatory function of patients, and accurate restoration of vertical dimension of occlusion (OVD) is the key to occlusal reconstruction in edentulous patients. There are many methods to measure OVD in edentulous patients. In this paper, the working principle, scope of application, advantages and disadvantages, measurement methods and operation points of OVD recording method are reviewed in order to provide some reference for clinical treatment. The results show that the pre- extraction recording method is more objective and accurate, but the diagnosis model before extraction is required to accurately reflect the patients′ original OVD; the rest and stop jaw reference method is easily affected by subjective factors, and the edentulous patients with unstable jaw relationship are forbidden; the swallowing method is more subjective, especially suitable for patients with emotional tension and poor coordination; The facial landmark measurement method is more objective, but it is also affected by some subjective measurement factors. The patients with maxillofacial malformation are forbidden; the subjectivity of speech method is strong, and the accuracy of measurement results is closely related to the clinical experience of doctors, and the patients with aphasia and deafness are forbidden. X-ray cephalometric method and finger measurement method have strong objectivity. They are new measurement methods in recent years and have a bright future. Among them, finger measurement method is especially suitable for patients with maxillofacial deformity or postoperative deformity of tumor.

Prevalence of partial edentulism according to Kennedy and Applegate in patients treated at a university dental clinic in Lambayeque-Peru / Prevalencia de edentulismo parcial según Kennedy y Applegate en pacientes de la clínica odontológica de una universidad de Lambayeque-Perú

Introduction: Edentulism is an irreversible chronic condition that seriously affects the stomatognathic system. Consequently, determining its prevalence may contribute to prioritize preventive and rehabilitative oral health interventions. Objective: To determine the prevalence of partial edentulism according to the Kennedy and Applegate classification in patients attending the Dental Clinic at Universidad San Martín de Porres - Lambayeque Campus, Peru, in the years 2016 and 2017. Materials and methods: A descriptive, retrospective and cross-sectional study was designed. The study comprised 321 clinical records that previously underwent a quality control stage, which included a calibration process (k=0.86). The criteria and rules proposed by Kennedy and Applegate were applied to estimate the prevalence of edentulism in each jaw according to sex; tables of frequency distribution containing percentage results were used. Results: The highest prevalence of partial edentulism in the upper jaw corresponded to Class III (42.4%), followed by Class I (34.6%), and Class II (16.5%). In the lower jaw, the most prevalent were Class I (42.4%), Class III (36.4%), and Class II (15.6%). According to sex, Class III and Class I were the most prevalent in both females and males. Conclusion: Class III and I were the most prevalent in the upper jaw in both females and males; while in the lower jaw, Classes I and III were the most prevalent for both sexes.

El edentulismo se presenta como una alteración irreversible y crónica, que genera consecuencias en el sistema estomatognático, por lo cual es necesario conocer su prevalencia para priorizar intervenciones de salud bucal preventivas y de rehabilitación. Objetivo: Determinar la prevalencia de edentulismo parcial según la clasificación de Kennedy y Applegate en pacientes atendidos en la Clínica Odontológica de la Universidad San Martín de Porres - Filial Lambayeque, en los años 2016 y 2017. Material y Método: Se diseñó un estudio descriptivo, retrospectivo y transversal, con 321 historias clínicas que pasaron previamente por un control de calidad que incluyó un proceso de calibración (k=0.86). Para estimar la prevalencia de edentulismo en cada maxilar y de acuerdo al género, fueron aplicados los criterios y reglas de kennedy y Applegate, utilizando tablas de distribución de frecuencias con resultados porcentuales. Resultados: La mayor prevalencia de edentulismo parcial para maxilar superior corresponde a la Clase III con 42,4%, siguiendo en orden descendente la Clase I con 34.6% y la Clase II con 16.5%. En el maxilar inferior, la más prevalente fue la Clase I con 42,4%, continuando la Clase III con 36.4% y la Clase II con 15.6%. De acuerdo a género, resultaron más prevalentes la Clase III y la Clase I tanto para mujeres como para hombres. Conclusiones: Las clases III y I fueron las más prevalentes en el maxilar superior, tanto para género masculino como femenino; mientras que en el maxilar inferior, fueron las clases I y III las más prevalentes también para ambos géneros.

Computed tomographic analysis of maxillary sinus anatomy relevant to sinus lift procedures in edentulous ridges in Taiwanese patients

PURPOSE: To analyze the maxillary sinus anatomy over edentulous ridges in the bilateral posterior maxillary area in Taiwanese patients using cone-beam computed tomography (CBCT). METHODS: In total, 101 anatomical sites from 61 patients, including 32 premolar and 69 molar regions, were analyzed using CBCT. Measurements were made of the width and height of edentulous ridges, the thickness of the lateral wall of the maxillary sinus, and the presence of a sinus septum and the posterior superior alveolar artery (PSAA). A statistical analysis of the measurements was performed, and correlations among the measurements were assessed. RESULTS: The average ridge width was 10.26±3.16 mm, with a significantly greater ridge width in the second molar region than in the premolar region. The mean residual ridge height was 8.55±4.09 mm, and ridge height showed an opposite trend from ridge width for the premolar and molar regions. A sinus septum was present at 5.9% of the sites, and the PSAA was observed in 24.5%. The average thickness of the lateral wall of the maxillary sinus was 2.08±0.94 mm, with no significant difference between the tooth position and lateral wall thickness. CONCLUSIONS: This study presents the anatomical features of the maxillary sinus, which should be considered in sinus lift procedures for implant placement, in the Taiwanese population. The use of CBCT is recommended to avoid intraoperative complications.

Evaluation of the clinical efficacy of implant-supported overdenture with edentulous mandible in elderly patients / 华西口腔医学杂志

The aging society of the global population has led to an increase in the number of patients with edentulous jaw, a common multiple disease. Given the developments in implant techniques, the method of implant denture has received a positive and good response in terms of the quality of life and psychological well-being of patients. Implant-supported overdenture in mandible has two main advantages. 1) It has better retention and chewing efficiency than those of mandibular conventional denture. The required implant site of implant-supported overdenture is less than that of fixed implant-supported denture and can repair more defect tissues to help restore beauty and pronunciation. The price of the former is more acceptable than that of the latter. Therefore, this article aimed to systemically analyze and further discuss the clinical effect of implant-supported overdenture in elderly patients; combine existing related studies on the selection of number, site, and upper restoration of implants; and illustrate the advantages of removable implant-supported protheses in the repair of toothless mandible.

Prosthetic rehabilitation of soft palate resection edentulous patient with maxillary obturator / 대한치과보철학회지

This report is a case of 76-year old male patient who had difficulty in swallowing, pronunciation and suffered regurgitation of food. The patient lacks uvula and both tonsils, had short palatoglossal arch and soft palate, as well as defective left palatopharyngeal arch. The height and width of the soft palate defect were measured by reconstructing the Computed Tomography (CT) image in three dimensions. Phonation and soft palate obstructing ability were examined by nasometry and nasal endoscopy. Evaluations on phonetics and swallowing were done and improvements were shown. The patient was satisfied with the results of treatment.

Clinical and radiographic evaluation of implant-supported mandibular overdentures subjected to immediate loading: a 36-month follow-up / Evaluación clínica y radiográfica de implantes rehabilitados con sobredentaduras mandibulares y sometidos a carga inmediata: 36 meses de observación

ABSTRACT. Introduction: the aim of this study was to clinically and radiographically evaluate 54 implant-supported mandibular overdentures under the protocol of immediate loading, using a retention system with ball attachments. This evaluation was performed within 36 months of function of the implants. Methods: observational descriptive study in 27 fully edentulous patients who were evaluated in a 36-months follow-up period, after having two internal connection implants placed in the interforaminal area of the lower maxilla. The implants were evaluated in terms of survival rate, amount of peri-implant bone loss, condition of peri-implant tissues, prosthesis behavior, and degree of patient satisfaction. Results: survival rate at 36 months was 98.1% and the average radiographic bone loss was 0.45 mm (SD 0.6); there was a low level of plaque and average probing depth was 1.75 ± 0.75 mm. 57% of prosthesis showed active retention. 43% did not show retention or it was provided by one of its elements. 53.8% of overdentures were stable. A high percentage of patients showed total satisfaction. Conclusion: in a 36-months follow-up, a mandibular overdenture with ball attachments placed on two non-splinted implants immediately loaded is a predictable treatment in patients with fully edentulous lower maxilla, with high implant survival rates, low levels of peri-implant bone loss, and a high degree of patient satisfaction.

RESUMEN Introducción: el objetivo de este estudio consistió en evaluar clínica y radiográficamente, después de 36 meses de función, 54 implantes colocados en el maxilar inferior y rehabilitados con sobredentaduras bajo el protocolo de carga inmediata, utilizando un sistema de retención tipo bola. Métodos: estudio observacional descriptivo que consideró 27 pacientes totalmente desdentados que fueron evaluados en un seguimiento a 36 meses, luego de haber recibido cada uno dos implantes de conexión interna, instalados en la región interforaminal del maxilar inferior. Los implantes fueron evaluados en términos de supervivencia, cantidad de pérdida ósea periimplantar, estado de los tejidos periimplantares, comportamiento de la prótesis y grado de satisfacción de los pacientes. Resultados: la tasa de supervivencia a los 36 meses fue de 98,1%, el promedio de pérdida ósea radiográfica fue de 0,45 mm (DE 0,6); se presentó un nivel de placa bajo y el promedio de profundidad al sondaje fue de 1,75 ± 0,75 mm. El 57% de las prótesis presentaron retención activa. El 43% no presentó retención, o su retención estaba dada por uno solo de sus elementos. El 53,8% de las sobredentaduras se encontraron estables. Un alto porcentaje de los pacientes manifestaron satisfacción total. Conclusión: a 36 meses de observación, una sobredentadura mandibular retenida por pilares en bola colocada sobre dos implantes no ferulizados y cargados inmediatamente es un tratamiento predecible en pacientes con desdentación total inferior, con una alta tasa de supervivencia de los implantes, bajos niveles de pérdida ósea periimplantar y alto grado de satisfacción de los pacientes.

Occlusion design of edentulous implant prosthesis / 华西口腔医学杂志

The occlusion design of dental implants is related to the growing popularity of dental implantology. This paper discusses the occlusion design of the edentulous implant prosthesis and the relationships between stress change and the alveolar bone and between the occlusal design and implantation complications. The horizontal relationship of condyle, the design of the canine-guided occlusion, and the similarities and differences between the dental implant and the natural teeth on biteforce response are mentioned.

Avaliação da satisfação de reabilitações com implantes zigomáticos / Satisfaction of rehabilitation with zygomatic implants

Introdução: A reabilitação oral de pacientes com atrofia óssea maxilar representa um grande desafio por estes pacientes apresentarem comprometimento da qualidade de vida, dificuldades alimentares, complicações nutricionais, dificuldades sociais e emocionais. Propostas de reabilitações de maxilas mutiladas e/ou atróficas com próteses totais fixas implantossuportadas, utilizando implantes zigomáticos, foram relatadas. Objetivo: O objetivo deste estudo foi avaliar o grau de satisfação dos pacientes reabilitados com implantes zigomáticos e convencionais, em função de carga imediata com prótese do tipo protocolo através de um estudo retrospectivo, por meio de questionário respondido pelos pacientes. Material e método: Foram incluídos dezenove pacientes, tratados na clínica do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO) em Curitiba, PR (Brasil), entre dezembro de 2005 e junho de 2010. Os pacientes foram reabilitados com 41 implantes zigomáticos e 73 implantes convencionais, todos do tipo cone Morse. As próteses, tipo híbridas, foram instaladas em carga imediata. Resultado: O índice de satisfação encontrado foi de 100%. Conclusão: Pode-se concluir que esta técnica de reabilitação restabelece fatores primordiais ao ser humano como mastigação, fonética e estética. Os pacientes relataram satisfação com o resultado do tratamento, conseguindo desenvolver atividades sociais dentro da normalidade, elevando sua autoestima.

Introduction: Rehabilitation of patients with atrophic maxilla is challenging. Atrophic maxilla patients present compromised quality of life, impaired function, deficient nutrition, social and emotional difficulties. The rehabilitation of atrophic maxilla by zygomatic fixtures has been previously proposed. Objective: This retrospective study evaluated the degree of satisfaction of patients rehabilitated by immediately loaded conventional and zygomatic fixtures supporting full-arch fixed dental prosthesis. A satisfaction questionnaire was used for patient assessment. Material and method: Nineteen patients treated at the Latin American Institute for Dental Research and Education (ILAPEO) between December 2005 and June 2010 were evaluated. Patients were rehabilitated with 41 zygomatic implants and 73 conventional implants under immediate load. Result: All assessed patients were completely satisfied with the provided rehabilitation. Conclusion: It can be concluded that rehabilitation with zygomatic fixtures is capable of restoring function, phonetics, and esthetic for patients with atrophic maxilla. The patients were satisfied with the treatment outcomes and showed increased self-esteem after the rehabilitation.

Abordagem da doença periodontal e do edentulismo em idosos: uma revisão integrativa com foco na atenção primária / Approaching periodontal disease and edentulism in the elderly: a systematic review with a focus on primary health care

A adoção da Estratégia de Saúde da Família (ESF) como modelo de atenção primária à saúde (APS) no Brasil proporcionou mudanças na organização de serviços e nos processos de trabalho dos profissionais da saúde pública, dentro do Sistema Único de Saúde (SUS). No que se refere à saúde bucal, a inserção de equipes odontológicas na ESF, a partir dos anos 2000, também possibilitou, além do aumento do número de cirurgiões-dentistas na APS, alterações no modelo de atenção à saúde bucal. Com o declínio da cárie em populações mais jovens, a doença periodontal e o edentulismo têm assumido papel de destaque como os principais agravos a afetarem a população idosa. Nesse contexto, este trabalho tem por objetivo realizar uma revisão integrativa da literatura sobre o tratamento da doença periodontal e do edentulismo em idosos com foco na APS nas bases de dados do MEDLINE/ PUBMED publicados nos últimos 10 anos. Este trabalho contribui para a qualificação baseada em evidências dos profissionais da odontologia na atenção primária. A pesquisa, ao abordar tratamentos para doença periodontal e edentulismo em idosos, abrange assuntos que serão de grande importância para os serviços, nos próximos anos, considerando-se que o envelhecimento populacional e o acesso dessa população aos serviços se tornará mais frequente e regular com o aumento do número de cirurgiões- dentistas nas Estratégias de Saúde da Família capacitados para orientar suas práticas baseadas em evidências.

Adopting the Family Health Strategy (FHS) as the primary health care (PHC) model in Brazil has brought about changes in the organization of services and in the work processes of public health professionals, within the Unified Health System (UHS). With regard to oral health, the inclusion of dental teams in the FHS, beginning in the 2000s, also made changes in the oral health care model possible, in addition to the increase in the number of dentists in the PHC system. With the decline in tooth decay in younger populations, periodontal disease and edentulism have assumed prominent roles as the main disorders affecting the elderly. In this context, this work aims to carry out an integrative review of the literature on the treatment of periodontal disease and edentulism in the elderly, focusing on PHC in the MEDLINE/PUBMED databases published in the last 10 years. This work contributes to the qualification of evidence-based dentistry professionals in primary health care. In addressing treatments for periodontal disease and edentulism in the elderly, it covers subjects which will be of great importance for the services in the coming years, considering the aging population and that this population's access to services will become more regular and frequent with the increase in the number of dentists in the Family Health Strategies able to guide evidence-based practices.