Reabilitação de maxila atrófica com implantes zigomáticos: relato de caso / Rehabilitation of atrophic maxilla with zygomatic implants: case report

Introdução: maxilas severamente atrofiadas representam um desafio às reabilitações implantossuportadas. A reconstrução maxilar com enxertos ósseos para permitir a reabilitação com implantes osseointegrados é um tratamento com boa previsibilidade e alto índice de sucesso. No entanto, a morbidade causada pela necessidade de regiões doadoras e grande quantidade de osso dificulta a aceitação dos pacientes, podendo, inclusive, ser contraindicada dependendo da condição sistêmica. Objetivos: revisar a literatura, discutir as indicações, as complicações, a previsibilidade das reabilitações com implantes zigomáticos, assim como relatar um caso. Relato de caso: os implantes zigomáticos surgiram como uma alternativa para a reabilitação de pacientes maxilectomizados, decorrente da exérese de tumores, perdas ósseas decorrentes de infecções ou traumas, e casos de atrofia óssea severa, como abordado no caso em questão, em que a paciente apresentava edentulismo total em maxila e não gostaria mais de utilizar a prótese convencional, optando pela prótese sobre implante. Considerações finais: a reabilitação com implantes zigomáticos pode apresentar complicações, como o mau posicionamento dos implantes, comprometendo a reabilitação; todavia, apesar das restrições da técnica, a literatura mostra que os implantes zigomáticos, quando bem indicados, representam uma boa alternativa para a reabilitação de maxilas severamente atrofiadas.(AU)

Introduction: severely atrophied jaws pose a challenge to implant-supported rehabilitations. Maxillary reconstruction with bone graft to allow rehabilitation with implants is a treatment with good predictability and high success rate. However, a morbidity is the disease of the donor regions and the greater amount of bone hinders the acceptance of the patients; including, to be contraindicated depending on the systemic condition. Objectives: this article is a review of the literature, such as the indications, complications, predictability of rehabilitations with zygomatic implants, as well as a case report. Case report: the zygomatic implants appeared as an alternative for the rehabilitation of maxilectomized patients, due to the excision of tumors, bone losses due to infections or trauma and cases of severe bone atrophy, as approached in the case in question, in which the patient had total maxillary edentulism and would no longer like to use the conventional prosthesis, opting for the implant prosthesis. Final considerations: rehabilitation with zygomatic implants may present complications, such as poor placement of implants, compromising rehabilitation; however, despite the limitations of the technique, the literature shows that zygomatic implants, when well indicated, represent a good alternative for the rehabilitation of severely atrophied maxilla.(AU)

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Impact of immediately loaded implant-supported maxillary full-arch dental prostheses: a systematic review

Abstract The immediate loading of implant-assisted fixed prostheses in edentulous maxillae may achieve favorable success rates with reduced treatment time. An evidence summary of clinical trials is key to recommend loading protocols in these cases. Objectives To compare immediately loaded, fully implant-supported complete dentures to early and conventional/delayed loading in the edentulous maxillae of adult patients by a systematic review of controlled clinical trials (CCT). Methodology CCTs reports were identified up to January 17, 2019 from Cochrane Oral Health Group's Trial register, Cochrane Central Register of controlled trials (CENTRAL), MEDLINE (Ovid), BIOSIS, EMBASE, CINAHL, Web of Science, and DARE. Two independent reviewers screened titles/abstracts and confirmed inclusion using full texts. Data were extracted and quality assessed (Cochrane Risk of Bias tool) independently and in duplicate. Study heterogeneity prevented pooling by meta-analysis. Results Out of 1,052 candidate studies, four CCTs were included. Two trials had patient satisfaction as an outcome: (1) A randomized trial compared immediately and early loaded fixed dentures and found more satisfaction with the first after 12 months; (2) A non-randomized study found better satisfaction with immediate fixed dentures compared to conventional loading after 3 months (no more at 12 months). Regarding implant success and prosthetic complications, three trials did not report significant differences comparing immediate loading to other protocols. Conclusions This review found weak evidence of differences between immediate load and other loading regimens, regarding patient satisfaction and maintenance events/adversities. The potential of immediate loading for favorable results in edentulous maxillae reinforces the need for well-designed RCTs, for solid clinical guidelines. Registration number CRD42018071316 (PROSPERO database).

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis / Custo-efetividade da prótese implanto-suportada comparada à prótese total convencional

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

RESUMO OBJETIVO Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$ 464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.

Técnica de Alemán y Pico para la profundización del surco vestibular inferior / Alemán and Pico technique for deepening the inferior vestibular edge

A pesar de los avances en la tecnología para preservar la dentición, aún se requiere la rehabilitación del sistema masticatorio en pacientes desdentados parcial o totalmente, lo que resulta difícil y frustrante -- tanto para los afectados como para los protesistas -- si existe atrofia grave del hueso alveolar. Este problema se puede solucionar mediante una intervención quirúrgica denominada profundización del vestíbulo, dirigida a lograr el aumento de la cresta alveolar y, con ello, el soporte de las prótesis dentales. A tal efecto, en el presente trabajo se propone y describe una nueva opción terapéutica: la técnica de Alemán y Pico, para la profundización del surco vestibular inferior, la cual no es tan invasiva y resulta factible cuando no se cuenta con las condiciones necesarias para colocar implantes, ya sea por escasez de recursos materiales o por situaciones propias del paciente

In spite of the advances in technology to preserve the eruption of teeth, the rehabilitation of the masticatory system is still required in partial or totally toothless patients, what is difficult and frustrating -- either for those affected patients or for the prosthesists -- if serious atrophy of the alveolar bone exists. This problem can be solved by means of a surgical procedure denominated deepening of the vestibule directed to achieve the increase of the alveolar crest and, with it, the support of the dental prosthesis. To such an effect, this work intends and describes a new therapeutic option: the Alemán and Pico technique, for deepening of the inferior vestibular edge, which is not so invasive and it is feasible when the necessary conditions to place an implant are not available, either due to shortage of material resources or due to situations of the patients themselves

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants

Abstract There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. Objective: To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. Material and Methods: Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). Results: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). Conclusion: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant.

Implantología digital con guías quirúrgicas 3D / Digital implantology with 3D surgical guides

Se utilizaron métodos digitales de fabricación para guías quirúrgicas de restricción absoluta, para la colocación asistida de implantes dentales que facilitaron la predicción y planificación de la rehabilitación protética virtual a través de protocolos de CAD-CAM con impresoras 3D de escritorio, aditivas, de bajo costo-eficiencia, obteniendo exactitud controlada y alta precisión, lo que permitió reproducibilidad y predecibilidad implantológica. Con el fin de universalizar, promover y difundir el uso de la tecnología 3D como herramienta facilitadora que la práctica dental actual requiere, se investigó la desviación entre la posición planeada y la final encontrada de los implantes colocados bajo asistencia guiada, dando como resultado una discrepancia clínicamente insignificante que sugiere que la guía quirúrgica en impresoras 3D puede ser utilizada como herramienta clínica para posicionar adecuadamente los implantes dentales.

Análisis tridimensional de la deformación ósea cortical en prótesis parcial fija implantosoportada con voladizo distal sobre implantes cortos en maxilar / Three-dimensional analyisis of cortical bone deformation in implant-supported fixed partial prosthesis with distal cantilever, on short maxillary implants

Objetivo: Analizar la distribución de tensiones que provoca una fuerza axial en el modelo tridimensional, con elmétodo de elementos finitos, en la prótesis parcial fija implantosoportada con voladizo distal (PPFIVD) sobre implantes dentales cortos en el sector posterior del maxilar parcialmente desdentado. Materiales y métodos: Se crearon modelos geométricos del maxilar. Se diseñaron dos grupos y cuatro subgrupos. En zona premolar, se ubicaron implantes cortos StandardPlus SLA® (Straumann) de diferentes longitudes. Grupo A: PPFIVD con dos implantes, GA1 de 8 mm y GA2 de 4 mm. Grupo B: PPFIVD con un implante, GB1 de 8 mm y GB2 de 4 mm. Se aplicó una fuerza axial de 100 N a 30°.Resultados: La distribución de las tensiones en los implantes fue menor en GA1 que en GA2, y en GB1 que enGB2. A nivel óseo, la distribución de las tensiones fue mayor en GA1 que en GA2, y en GB2 que en GB1. Se observaron microdeformaciones óseas periimplante y, posteriormente, desplazamiento del conjunto prótesis/implante. Conclusiones: La PPFIVD sobre dos implantes de 8 y4 mm ferulizados podría ser una alternativa viable al levantamiento del piso de seno maxilar. La PPFIVD sobre un implante de 4 mm no sería recomendable. Las tensiones elevadas provocaron menor rendimiento en geometría oseoimplantaria, evidenciando microdeformaciones en el tejido óseo tridimensional y desplazamientos de la PPFIVD.

Misfit and fracture load of implant-supported monolithic crowns in zirconia-reinforced lithium silicate

Abstract Zirconia-reinforced lithium silicate (ZLS) is a ceramic that promises to have better mechanical properties than other materials with the same indications as well as improved adaptation and fracture strength. Objective In this study, marginal and internal misfit and fracture load with and without thermal-mechanical aging (TMA) of monolithic ZLS and lithium disilicate (LDS) crowns were evaluated. Material and methods Crowns were milled using a computer-aided design/computer-aided manufacturing system. Marginal gaps (MGs), absolute marginal discrepancy (AMD), axial gaps, and occlusal gaps were measured by X-ray microtomography (n=8). For fracture load testing, crowns were cemented in a universal abutment, and divided into four groups: ZLS without TMA, ZLS with TMA, LDS without TMA, and LDS with TMA (n=10). TMA groups were subjected to 10,000 thermal cycles (5-55°C) and 1,000,000 mechanical cycles (200 N, 3.8 Hz). All groups were subjected to compressive strength testing in a universal testing machine at a crosshead speed of 1 mm/min until failure. Student's t-test was used to examine misfit, two-way analysis of variance was used to analyze fracture load, and Pearson's correlation coefficients for misfit and fracture load were calculated (α=0.05). The materials were analyzed according to Weibull distribution, with 95% confidence intervals. Results Average MG (p<0.001) and AMD (p=0.003) values were greater in ZLS than in LDS crowns. TMA did not affect the fracture load of either material. However, fracture loads of ZLS crowns were lower than those of LDS crowns (p<0.001). Fracture load was moderately correlated with MG (r=-0.553) and AMD (r=-0.497). ZLS with TMA was least reliable, according to Weibull probability. Conclusion Within the limitations of this study, ZLS crowns had lower fracture load values and greater marginal misfit than did LDS crowns, although these values were within acceptable limits.

Prótesis completa implantoasistida del maxilar inferior / Implant-supported complete denture of the lower jaw

En este artículo espero poder hacer llegar al lector a la comprensión de la evolución protética implanto asistida, desde el mejoramiento de la retención otorgada a la prótesis completa inferior (PCI) con solo 2 implantes hasta la rehabilitación totalmente implanto asistida en paciente edéntulos. Para lograr este objetivo tan ambicioso tendremos que valernos de varios artículos en diferentes números de revista del AAO. En este capítulo veremos alternativas protéticas ideales en la retención de una completa inferior, dificultades con las que nos podemos encontrar, soluciones a la dificultad en la posición tridimensional del implante y biomecánica de la PCI que nos orienta en la elección del elemento de retención más adecuado para nuestro caso.

The goal of this article is to show the evolution of implant retained prosthesis driven by enhancements on retention of complete lower jaw prosthesis in edentulous patients. This can be reached by a different array of options, ranging from a simple one such as two implants retaining the lower jaw complete prosthesis, to a complex one completely supported and retained by implants prosthesis. Therefore, to reach such an ambitious goal, it will be necessary to devote several AAO series of journal´s articles to describe all these possibilities. In this very first article of the series, we will explore ideal prosthetic choices to get retention in a lower jaw complete prosthesis. We´ll see the solutions of the challenges we can face, for instance how to overcome difficulties related to the implant location (from a 3D perspective), and also how to leverage the biomechanics of the lower jaw complete prosthesis to select an appropriate retaining system.

Short implants to support mandibular complete dentures - photoelastic analysis

Abstract This study evaluated the stress behavior around short implants in edentulous atrophic mandibles. Six groups included implants with two diameters regular and wide (4 and 5 mm) and three lengths (5, 7 and 9 mm) as follows: Ci9 (9 x 4 mm), Ci7 (7 x 4 mm), Ci5 (5 x 4 mm), Wi9 (9 x 5 mm), Wi7 (7 x 5 mm) and Wi5 (5 x 5 mm). These groups were compared to the control group CG (11 x 4 mm). The analysis was performed with the photoelastic method (n = 6). Each model comprised 4 implants with the same length and diameter connected by a chromium-cobalt bar that simulates a fixed denture. A 0.15 kg force was applied at the end of the cantilever (15 mm), and the maximum shear stress was recorded around the distal and subsequent implants. The stress values were determined, and the quantitative data (Fringes®) were submitted to statistical analysis with one-way ANOVA and the Dunnett test (p < 0.05). It was observed that the reduction in implant length increased stress values with a significant difference (p < 0.05) between CG Ci7 and Ci5, while the increase in implant diameter reduced the stress values without any differences found between short and long implants. Implants with 5 and 7 mm with regular diameter increased stress levels while short implants with larger diameters experienced similar stress to that of longer implants.

Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth

OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

Implantes y ortodoncia: ¿qué hago primero? / Implants and orthodontics: what should I do first?

A veces, los ortodoncistas desconocen los principios básicos de la implantología y los implantólogos no suelen dimensionar los beneficios de la ortodoncia en la resolución de tratamientos no convencionales.

Effect of cantilever length and alloy framework on the stress distribution in peri-implant area of cantilevered implant-supported fixed partial dentures

ABSTRACT Because many mechanical variables are present in the oral cavity, the proper load transfer between the prosthesis and the bone is important for treatment planning and for the longevity of the implant-supported fixed partial denture. Objectives To verify the stress generated on the peri-implant area of cantilevered implant-supported fixed partial dentures and the potential effects of such variable. Material and Methods A U-shaped polyurethane model simulating the mandibular bone containing two implants (Ø 3.75 mm) was used. Six groups were formed according to the alloy’s framework (CoCr or PdAg) and the point of load application (5 mm, 10 mm and 15 mm of cantilever arm). A 300 N load was applied in pre-determined reference points. The tension generated on the mesial, lingual, distal and buccal sides of the peri-implant regions was assessed using strain gauges. Results Two-way ANOVA and Tukey statistical tests were applied showing significant differences (p<0.05) between the groups. Pearson correlation test (p<0.05) was applied showing positive correlations between the increase of the cantilever arm and the deformation of the peri-implant area. Conclusions This report demonstrated the CoCr alloy shows larger compression values compared to the PdAg alloy for the same distances of cantilever. The point of load application influences the deformation on the peri-implant area, increasing in accordance with the increase of the lever arm.

Prevalence of peri-implant disease on platform switching implants: a cross-sectional pilot study

The objective of this study was to assess the prevalence of mucositis and peri-implantitis associated with the use of two types of implants—conventional versus platform switching after one year of loading. A longitudinal study of 64 implants in 25 patients was performed. Clinical variables, such as clinical pocket depth and bleeding upon probing, plaque, mobility, gingival recession, clinical attachment loss, and radiographic bone loss, were analyzed. The case definition for peri-implantitis was established as pockets of ≥ 5 mm with bleeding and bone loss ≥ 2 mm. One year after implant loading, the prevalence of mucositis and peri-implantitis with conventional implants (CIs) was 81.2% and 15.6%, respectively. For platform switching implants (PSIs) the prevalence was 90% and 6.6%, respectively. These differences were not statistically significant (p = 0.5375). However, there was a trend towards a lower prevalence of peri-implantitis with platform switching Implants.

Implantes retrosinusales como alternativa al levantamiento del piso del seno maxilar / Angled retrosinusal implants as an alternative to maxillary sinus floor lifting

En maxilares superiores edéntulos con senos neumatizados, que presenten tejido óseo retro sinusal aceptable, es posible la colocación de implantesen posición angulada con la técnica mínimamente invasiva (flapless) como alternativa al levantamiento del piso del seno maxilar. En los casos de patologías sinusales que desaconsejanla invasión de los mismos para la colocación de implantes, esta alternativa sería la más indicadapara solucionar el problema protético del pilar distal. Si bien se requiere experiencia y habilidad en la técnica,no cabe duda de los beneficios en costos y en postoperatorios para el paciente.

A possible choice for implant rehabilitationin the toothless maxila with neumatized sinus,is to use the pre and retro sinusal zones,whenever the bone volume allows doingso in order to avoid the sinus bottom liftingtechnique, which, even though it has goodpredictability and success, it is a much moretraumatic and expensive surgical procedurethan the mere placing of angled retrosinusalimplants that, with the help of ComputerizedAxial Tomography, could be installed witha minimumly invasive technique (flapless).

Estudio clínico e histológico de aloinjerto de hueso liofilizado en alvéolos pos extracción: presentación de caso clínico / Clinical and histological study of bone freeze drying allograft in postextraction sockets: report of a clinical case

Objetivos: evaluar las respuestas clínicas e histológicas y determinar la calidad del hueso obtenido por medio del aloinjerto utilizado en un alvéolo posextracción en el que se realizó una técnica de preservación del volumen alveolar, a fin de colocar implantes. Caso clínico: una paciente de 47 años recibió un tratamiento de preservación del volumen alveolar posextracción mediante aloinjerto de hueso liofilizado (matriz ósea UNC en polvo) contenido por una lámina ósea cortical (matriz ósea UNC en membrana). A los 120 días, se tomó biopsia y se colocaron implantes. La muestra se observó con microscopía óptica. Conclusión: histológicamente, se identificaron restos de partículas y de lámina ósea, e intensos fenómenos de angiogénesis y neoformación ósea. La observación clínica permitió visualizar los márgenes nítidos del reborde y verificar la conservación del volumen ósea en el lugar en el que se realizó la fijación primaria de los implantes. La técnica de preservación con los biomateriales citados permite la colocación del implante en una posición adecuada, con resultados funcionales y estéticos.

Planejamento: a chave para a obtenção de resultados estéticos e funcionais em restaurações implantossuportadas / Planning: The key to obtaining aesthetic and functional results in implant-supported restorations

Diversos fatores determinam o sucesso na obtenção dos objetivos funcionais e estéticos com restaurações implantossuportadas. O trabalho em equipe é essencial desde o momento do diagnóstico, bem como o compromisso de todos os membros envolvidos com a resolução das diversas situações que surgem diariamente na prática odontológica. Um planejamento abrangente mostra-se a chave para alcançar os resultados propostos, respeitando uma prática interdisciplinar e utilizando protocolos aceitos clinicamente e cientificamente, baseados em evidências científicas. Assim, o presente artigo apresentará a integração paciente-dentista-TPD, na busca por resultados sustentáveis em longo prazo...

Several factors determine the success of functional and esthetic outcomes with implant-supported prosthetic replacement. Team work is essential as from the time of diagnosis, along with commitment of all members involved in solving different situations daily arising in dental practice. Meticulous planning is the key to achieve the desired result, respecting an interdisciplinary practice and using clinically scientifically acceptable evidence-based protocols. Thus, this article presents a case of patient-dentist-dental hygiene technician integration in the quest for sustainable results in the long run...

Análise da deformação gerada nos intermediários e na região óssea peri-implantar sob diferentes condições de carga em prótese parcial fixa parafusada / Strain analysis of abutment and bone tissue around dental implants under different loading conditions on screw-retained fixed partial prostheses

O sucesso a longo prazo dos implantes tem como fatores críticos a incidência e a transferência de estresses mecânicos sobre a prótese, intermediários, implantes e destes para o tecido ósseo adjacente, devendo cada parte deste sistema ser submetido somente a forças às quais estão aptos a receber. A proposta deste trabalho foi avaliar a deformação gerada nos intermediários e na região óssea peri-implantar diante da aplicação de cargas funcionais e parafuncionais em prótese parcial fixa de três elementos parafusadas sobre dois implantes. Para este trabalho, foi utilizado um modelo experimental homogêneo à base de poliuretano, simulando o tecido ósseo, com dois implantes do tipo hexágono externo paralelos que receberam intermediários do tipo multi-unit. Na superfície de cada intermediário foram instalados três sensores (strain gauges), capazes de medir a microdeformação dispostos de maneira eqüidistante entre si. Na região óssea simulada, foram instalados quatro sensores para cada implante, posicionados nas faces mesial, distal, vestibular e lingual. A aplicação da carga estática de 300N foi realizada em uma máquina de ensaios universais. As leituras foram realizadas em quatorze momentos para todos os corpos de prova, variando o direcionamento da carga (axial e inclinada à 30 graus) e simulando ainda sete diferentes pontos de aplicação de carga (1- pilar mesial, 2 - pôntico, 3- pilar distal, 4- simultaneamente no pilar mesial, pontico e pilar distal, 5- no pilar mesial e distal, sem contato no pôntico, 6- no pilar mesial e no pôntico, 7- no pilar distal e no pôntico). Os resultados mostraram que a direção da carga interferiu na magnitude e distribuição da microdeformação, de forma que, no osso simulado, os valores encontrados na carga axial se encontraram dentro da tolerância fisiológica independente do local de aplicação de carga. Observou-se uma distribuição mais uniforme quando a carga foi aplicada simultaneamente nos pilres mesial...

Long-term success with implants has some critical factors such as incidence and transmission of mechanical stress to the prosthesis, abutments, and implants to the adjacent bone tissue. Each part of the system should be subjected to loads under its strength limit. The purpose of the present study was to evaluate abutment and peri-implant bone tissue strains during functional and parafunctional loads application in a three-unit screw-retained fixed prosthesis supported by two implants. In order to simulate the bone tissue, an experimental model made of homogeneous polyurethane was used wherein two external hexagon implants were placed parallel to each other, provided with multi-unit abutments. On the surface of each abutment three sensors (strain gauges) were positioned equidistant to each other to measure microstrains. The simulated bone around each implant received four strain gauges, positioned on the mesial, distal, buccal and lingual aspects. The tests were performed applying a 300N static load on a universal testing machine. The readings were made at fourteen moments for each specimen, changing load direction (axial and 30 degrees oblique) and also simulating seven different points of load application (1- mesial abutment, 2- pontic, 3- distal abutment, 4- simultaneously on the mesial abutment, pontic and distal abutment, 5- mesial and distal abutment (no pontic contact), 6- mesial abumtent and pontic, 7- distal abutment and pontic. The results showed that the load direction significantly influenced the magnitude and distribution of microstrains, so that for the simulated bone, the values found during axial load were within the physiological threshold independent of the point of load application; however, a more uniform distribution was observed when force was applied simultaneously on the mesial abutment, pontic and distal abutment. Furthermore, microstrain values above the tolerance limits were observed during oblique load, and for this...