Checagem dos modelos precisos na Implantodontia através do “Index de resina” / Using the “resin Index” to check the accuracy of the plaster model in implantology

A perfeita adaptação passiva das próteses sobre implantes é um fator importante para a obtenção do sucesso na Implantodontia. Para tanto, a eliminação de variáveis que possam afetar o processo de confecção de uma estrutura protética é fundamental, essas vão desde o procedimento de moldagem até a execução da peça protética, sendo que essa fase representa a transição da situação clínica para a fase laboratorial; desta maneira, o modelo de trabalho deve ser o mais preciso possível para evitar qualquer tipo de diferença significativa na adaptação final do trabalho. A confecção, em boca, do “Index de resina” é para auxiliar a conferencia dessa precisão de adaptação no modelo de gesso, eliminando futuros problemas no assentamento das estruturas, na dissipação das cargas mastigatórias e comprometimento da qualidade final do trabalho. Isto se torna imprescindível quando utilizamos a tecnologia CAD/CAM, pois as estruturassão fresadas em monobloco, onde se obtém uma estrutura única em que o assentamento passivo depende diretamente das informações de posicionamento dos análogos, passadas ao software através do modelo de gesso que foi previamente escaneado.

The perfect passive adaptation of the implant prosthesis is an important factor to achievesuccess in implantology. Therefore, the elimination of variables that can affect the process ofprosthetic construction is critical. These variables range from dental impression technique until the final execution of the implant supported prosthesis. The Prosthetic phase is the transition ofthe clinical situation to the laboratory phase; this way, the working model must be as accurateas possible to avoid any significant difference in the final adaptation of the restoration. Theproduction, in mouth, of the “resin Index” is to assist the conference of the precision fit on thestone model, eliminating future problems in the settlement of structures, dissipation of masticatory loads and commitment of the final quality of work. This becomes more imperative whenwe use the CAD / CAM technology, because the structures are milled in a single block where youget a unique structure in which the liability settlement depends directly on the analog position information, passed to the software through the plaster model that was previously scanned.

Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis

OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm²/m, 0.85-0.66 cm²/m², and <0.65 cm²/m², respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41 percent, 42, and 16 percent, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82 percent). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3 percent, 6.1 percent, and 8 percent, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49 percent of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.

Manual instructivo de instalación y control de prótesis totales / Instructive manual of installation and control of total prostheses

Se realizó un estudio de la literatura con el objetivo de describir el paso clínico de instalación y control de prótesis total, durante el período comprendido de enero a mayo del 2005 en la Clínica Estomatológica Provincial Docente de Santiago de Cuba. Se abordaron diversos aspectos, definición de conceptos, así como todo el proceder clínico, instrucciones al paciente y consejo s a los portadores de prótesis. Se enfatizó en el paciente geriátrico, destacándose que precisamente este paso es el indicado para eliminar los defectos evidentes y donde el paciente adquiere el hábito de utilizarlos y el organismo de aceptarlo(AU)

A literature study was conducted aimed at describing the clinical step of installation and control of total prosthesis at the Provincial Teaching Dental Clinic of Santiago de Cuba from January to May, 2005. Diverse aspects were dealt with, as well as the definition of concepts, the whole clinical procedure, instructions to the patients and advises to prosthesis wearers. Emphasis was made on the geriatric patient, and it was stressed that this step is the indicated to eliminate the evident defects, and where the patient acquires the habit to use them and the body to accept them(AU)