Evaluation of the occlusal contact area of molar dental implants comparing two different thicknesses (16 µm and 200 µm) of articulating occlusal papers and forces (200 and 250 N): a pivot in vitro study

Introduction: The goal of this pilot study was to evaluate the differences between checking occlusion on implants crowns using 16 or 200 µm thickness of articulating occlusal paper, and to compare the stained occlusal area between the groups after bite forces of 200 and 250 N. Methods: It was included 10 casts of articulated-type IV gypsum, 10 NiCr crowns, articulating occlusal papers (16 µm and 200 µm thick), and a compression test machine. Compressive forces (200 and 250 N.mm) were applied on models, to check the occlusal contact area of fixed and cemented crowns. The contact areas on the crowns were measured through images obtained by the scanning electron microscope. Statistical tests were performed considering the significant level of 5% (p≤0.05). Results: The stains found using 200 µm of articulating paper were higher than those with 16 µm, independent of the force applied. However, the stains obtained in lower teeth with different strengths (200 and 250N) marked with 16 µm articulating paper were not possible to score. The articulating paper variable had significant statistical results (p=0.002), while the variables force (p=0.443) and articulating paper-force interaction (p=0.607) were not significant. The mean area found in staining using the 200 µm and 16 µm papers was, respectively, 8.3380 mm2 and 3.4759 mm2. Conclusion: It was possible to confirm that 200 µm of articulating occlusal paper showed better and significant results to stain the occlusal area, permitting a more accurate adjustment independent of the force applied.

Advances in surface treatment of dental implants: a literature review

Amplamente utilizados para substituir dentes perdidos, os implantes dentários nos últimos anos vêm apresentando tecnologias como superfícies com micro e nanotopografia e ajustes nas composições químicas, dentre outros, para melhorar a osseointegração e reduzir o prazo de tratamento, permitindo, assim, carga funcional imediata ou precoce em pacientes com densidade óssea reduzida. Vários métodos são aplicados com intuito de modificar a superfície do implante, como jateamento com areia, corrosão ácida, oxidação anódica, tratamento com flúor, usinagem, pulverização de plasma de titânio e revestimento de fosfato de cálcio; esses métodos podem aumentar notavelmente a área de superfície quando operada a técnica adequadada de modificação, quer por procedimento de adição ou subtração. Tais modificações promovem superfícies rugosas, as quais aumentam a porcentagem de contato osso-implante (BIC) durante o processo de cicatrização óssea inicial. Os principais benefícios da modificação da superfície são melhorar a molhabilidade (hidrofilicidade), adesão e fixação de células a implantes e proliferação celular. Dentre os tratamentos de superfície de implantes dentários destaca-se o jateamento de areia com granulação grossa e ataque-ácido com HCL/H2SO4 (SLA) em altas temperaturas, o revestimento de superfície do implante com hidroxiapatita, oxidação anódica e o duplo ataque ácido. O objetivo deste trabalho é realizar uma revisão de literatura discutindo a importância e eficácia desses métodos para a osseointegração e, por conseguinte, para a redução do período de tratamento.

Widely used to replace lost teeth, dental implants have been presenting technologies such as surfaces with micro and nano topography and adjustments in chemical compositions, among others, to improve osseointegration and reduce treatment time, thus allowing immediate or early functional load in patients with reduced bone density. Several methods are applied to modify the implant surface, such as sandblasting, acid corrosion, anodic oxidation, fluoride treatment, machining, titanium plasma spraying, and calcium phosphate coating; these methods can notably increase the surface area when the appropriate modification technique is operated, either by the addition or subtraction procedure. Such modifications promote rough surfaces, which increase the percentage of bone-implant contact (BIC) during the initial bone healing process. The main benefits of surface modification are to improve wettability (hydrophilicity), adhesion and attachment of cells to implants, and cell proliferation. Among the surface treatments for dental implants, sandblasting with large grit and acid-etching with HCL/H2SO4 (SLA) stands out at high temperatures. The surface coating of the implant with hydroxyapatite, anodic oxidation, and double acid-etching. This work aims to conduct a literature review discussing the importance and effectiveness of these methods for osseointegration and, therefore, for reducing the treatment period.

Stress distribution in lower second molar mesialization using mini-implants: a pilot study using 3D finite element analysis / Distribuição de tensões na mesialização do segundo molar inferior usando mini-implantes: um estudo piloto usando análise de elementos finitos 3D

Objective: to analyze the stress distribution in a 3D model that simulates second molar mesialization using two different types of mini-implants. Material and Methods: a mandible bone model was obtained by recomposing a computed tomography performed by a software program. The cortical and trabecular bone, a lower second molar, periodontal ligament, orthodontic tube, resin cement and the mini-implants were designed and modeled using the Rhinoceros 4.0 software program. The characteristics of self-drilling orthodontic mini-implants were: one with 7 mm length, 1 mm transmucosal neck section and 1.6 mm diameter and another with 5 mm length and 1.5 mm diameter. A total of 235.161 and 224.505 elements were used for the mesh. These models were inserted into the bone block and then subjected to loads of 200 cN (centinewton). The results were calculated and analyzed by the Ansys 17.0 software program for qualitative verification through displacement and maximum principal stress maps. Results: it was possible to observe that the periodontal ligament presented low displacement and stress values. However, the physiological values presented are among those capable to provide orthodontic movement, with compression and tensile area visualization staggered between 0.1 and -0.1 MPa (megapascal). Conclusion: within the limitations of the study, the mini-implants tested showed similar results where the load on the tooth allowed dental displacement (molar mesialization), with a tendency to rotate it, theoretically allowing the second molar to take the location of the first molar. (AU)

Objetivo: analisar a distribuição de tensões em um modelo 3D que simula a mesialização do segundo molar usando dois tipos diferentes de mini-implantes. Material e Métodos: um modelo de osso mandibular foi obtido por recomposição de uma tomografia computadorizada realizada por um software. O osso cortical e trabecular, um segundo molar inferior, ligamento periodontal, tubo ortodôntico, cimento resinoso e os mini-implantes foram projetados e modelados no software Rhinoceros 4.0. As características dos mini-implantes ortodônticos auto perfurantes foram: um com 7 mm de comprimento, 1 mm de secção transmucosa e 1,6 mm de diâmetro e outro com 5 mm de comprimento e 1,5 mm de diâmetro. Para a malha, foram utilizados 235.161 e 224.505 elementos. Esses modelos foram inseridos no bloco ósseo e então submetidos a cargas de 200 cN (centinewton). Os resultados foram calculados e analisados pelo software Ansys 17.0 para verificação qualitativa por meio de mapas de deslocamento e tensões máximas principais. Resultados: foi possível observar que o ligamento periodontal apresentou baixos valores de deslocamento e tensões. Porém, os valores fisiológicos apresentados são capazes de proporcionar movimentação ortodôntica, com visualização da área de compressão e tração escalonada entre 0,1 e -0,1 MPa (megapascal). Conclusão: dentro das limitações do estudo, os mini-implantes testados apresentaram resultados semelhantes onde a carga sobre o dente permitiu o deslocamento dentário (mesialização do molar), com tendência a girá-lo, permitindo teoricamente que o segundo molar ocupe do lugar do primeiro molar (AU)

Biomechanics of implant-supported restorations / Biomecânica das restaurações implantossuportadas

The rehabilitation of patients with dental implant-supported restorations is an ideal treatment option in contemporary dentistry. The aim of this review was to compile and to demonstrate the mechanical response during loading condition, on the stress distributions of implant-supported prostheses. The findings show that the majority of stresses were concentrated in the cervical region of the implant/abutment interface and that they can be affected by several clinical parameters and loading conditions. Finally, the final prosthetic design should combine superior mechanical response, long-term survival rate and allow patient satisfaction. (AU)

A reabilitação de pacientes com restaurações implanto-suportadas é uma opção de tratamento ideal na odontologia contemporânea. O objetivo desta revisão foi compilar e demonstrar a resposta mecânica durante a aplicação de carga, na distribuição de tensão de próteses implanto-suportadas. Os achados mostram que a maioria das tensões se concentram na região cervical da interface implante/pilar e pode ser afetada por diversos parâmetros clínicos e condições de carregamento. Por fim, o desenho protético final deve combinar uma melhor resposta mecânica, taxa de sobrevida a longo prazo e permitir a satisfação do paciente. (AU)

Use of scanning electron microscope to evaluate the marginal fit of protocol bars obtained through benchtop or intraoral digital scanners

Aim: To evaluate the marginal fit of protocol bars milled from digital models obtained by conventional molding followed by bench scanning or digital molding with an intraoral scanner. Methods: Four morse-cone implants and the mini-pillars were installed in a 3D printed mandible model (master model). Digital models of the master model were obtained by (n=10): (Group A - Conventional) conventional (analog) molding of the master model followed by bench scanning or (Group B - Digital) molding of the master model with an intraoral scanner. All-on-four protocol bars were designed and milled from the digital models for both groups and screwed into the master model. Scanning electron microscopy (SEM) images from the distal, central, and mesial regions of each implant were obtained and the implant-protocol bar marginal fit was measured in an image software (Image J). The mean misfit of each region was analyzed by two-factor ANOVA, Tukey test, and Student's t-test (0,05 = 0.05). Results: The digital approach (B) showed higher misadaptation than the conventional approach (A, p < 0.05), regardless of the region evaluated. In group A, the central region showed higher maladjustment than the mesial region (p<0.05), however, there were no differences among regions of group B (p>0.05). Conclusion: The conventional method of acquiring digital models using the bench scanner produced bars for the All-On-Four protocol with better marginal fit than the digital models obtained with an intraoral scanner

Effect of radiotherapy on the differentiation and osteogenic activity of mesenchymal stem cells on dental implants / Efeito da radioterapia na diferenciação e atividade osteogênica de células-tronco mesenquimais em implantes dentários

Objective: to evaluate the differentiation and gene expression of transcripts related to osteogenesis in a primary culture of Mesenchymal Stem Cells (MSCs) derived from rat femurs submitted to radiotherapy and the installation of pure titanium implants. Material and Methods: fifty-four rats received titanium implants in both femurs and were divided into three groups: Control: implant surgery (C); Implant + immediate irradiation (IrI), and Implant + late irradiation (IrL). Euthanasia occurred 3, 14, and 49 days after surgery. The bone marrow MSCs from the femurs were isolated and cultivated. The cell viability, total protein content, alkaline phosphatase (ALP) activity, and the formation of mineralization nodules and cellular genotoxicity were analyzed. The gene expression of Alkaline Phosphatase (phoA), Collagen 1 (COL1), Runt-related transcription factor 2 (RUNX2), Osterix (OSX), Osteopontin (OPN), Integrin ß1(ITGB1), Bone Sialoprotein (BSP), Osteonectin (SPARC), Osteocalcin (Bglap), Transforming Growth Factor ß-type (TGF-ß), Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-6 (IL-6), Apolipoprotein E (APOE) and Prostaglandin E2 synthase (PGE2) were evaluated by qRT- PCR. Results: ionizing radiation suppresses the gene expression of essential transcripts for bone regeneration, as well as cellular viability, as observed in the IrI and IrL groups. Conclusion: although this can lead to the loss of osseointegration and failure of the implant, the MSCs showed more activity at 49 days than at 3 and 14 days. (AU)

Objetivo: avaliar a diferenciação e expressão gênica de transcritos relacionados à osteogênese em cultura primária de MSCs derivadas de fêmures de ratos submetidos à radioterapia e instalação de implantes de titânio puro. Material e Métodos: cinquenta e quatro ratos receberam implantes de titânio em ambos os fêmures e foram divididos em três grupos: Controle: cirurgia de implante (C); Implante + irradiação imediata (IrI) e Implante + irradiação tardia (IrL). A eutanásia ocorreu 3, 14 e 49 dias após a cirurgia. As MSCs de medula óssea dos fêmures foram isoladas e cultivadas. Foram analisadas a viabilidade celular, teor de proteína total, atividade da fosfatase alcalina (ALP), formação de nódulos de mineralização e genotoxicidade celular. A expressão gênica de Fosfatase Alcalina (phoA), Colágeno 1 (COL1), fator de transcrição relacionado a Runt 2 (RUNX2), Osterix (OSX), Osteopontina (OPN), Integrina ß1 (ITGB1), Sialoproteína Óssea (BSP), Osteonectina (SPARC), Osteocalcina (Bglap), Fator de Crescimento Transformador tipo ß (TGF-ß), Fator Estimulante de Colônia de Granulócitos-Macrófagos (GM-CSF), Interleucina-6 (IL-6), Apolipoproteína E (APOE) e Prostaglandina E2 sintase (PGE2) foram avaliados por qRT-PCR. Resultados: a radiação ionizante suprime a expressão gênica de transcritos essenciais para a regeneração óssea, bem como a viabilidade celular, como observado nos grupos IrI e IrL. Conclusão:embora isso possa levar à perda da osseointegração e falha do implante, as MSCs apresentaram maior atividade aos 49 dias do que aos 3 e 14 dias (AU)

Tratamento cirúrgico da osteomielite dos maxilares: relato de caso / Surgical treatment of osteomyelitis of the jaws: Case report / Tratamento quirúrgico de la osteomielitis de los maxilares: reporte de um caso

A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)

Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)

La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)

Facial pain due to contact between dental implant with the Canalis Sinuosus / Dor facial devido ao contato entre o implante dentário com o Canalis Sinuosus

The Canalis Sinuosus is a structure of the maxilla that allows the passage of the anterosuperior alveolar nerve and has a neurovascular activity. To visualize this structure, Conical Beam Computed Tomography (CBCT) is best recommended. This article aimed to report a case of facial pain after the insertion of a dental implant due to compression of the Canalis Sinuosus. Thus, the implant was removed, followed by the insertion of a bone graft. After that, the facial pain stopped. In conclusion, the identification of anatomical structures in preoperative examinations is essential in surgical dental procedures.

O Canalis Sinuosus é uma estrutura da maxila, que permite a passagem do nervo alveolar anterosuperior e tem uma atividade neurovascular. Para visualizar essa estrutura, a Tomografia Computadorizada de Feixe Cônico (TCFC) é melhor recomendada. Este artigo teve como objetivo relatar um caso de dor facial após a inserção de um implante dentário, devido à compressão do Canalis Sinuosus. Assim, o implante foi removido, seguido pela inserção de um enxerto ósseo. Depois disso, a dor facial foi interrompida. Em conclusão, a identificação de estruturas anatômicas em exames pré-operatórios é essencial em procedimentos odontológicos cirúrgicos.

Assessment of quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis

Aim: Tooth loss is very prevalent in Brazil, reflecting high demand for dental services, especially those related to oral rehabilitation. This study aimed to assess the quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis. Methods: Thirty-two patients were evaluated before and after rehabilitation with dental implants and fixed prosthesis using the OHIP-14 questionnaire and the Visual Analogue Scale (VAS) after 6 months follow-up. Results:OHIP-14 revealed a significant improvement after treatment in all seven parameters and in the global score (P < 0.001). VAS presented positive results related to patient satisfaction regarding oral rehabilitation, except for the hygiene of the fixed dentures. Conclusion: At the end of this study, OHIP-14 scores decreased by 50% in most of the questions raised, and VAS presented positive results, except for hygiene of the fixed dentures, presenting an improvement in the quality of life of total edentulous patients after rehabilitation with implants and fixed prosthesis

Microbial evaluation of implant surface - a clinical study comparing submerged, non-submerged and immediately loaded implants

Aim: The aim of the present study was to evaluate the microbial contamination in internal and external walls of cone morse implant walls. Methods: Eleven patients with edentulous mandibular posterior area were selected to received dental implants, divided into groups: submerged (S), non-submerged (NS), and immediately loaded (IL). Microbiological evaluations (microorganisms' number, aerobic and anaerobic colony forming units (CFU) number and microorganisms' qualification) were divided into internal and external collection of the implant walls, at different stages: T0 (surgical procedure), T2 (suture removal), T4 (reopening S group), T6 (suture removal S group), and T8 (abutment placement in S and NS). All data were submitted to statistical analyses, with confidence level of 0.05. Results: There was difference in number of microorganisms observed over time within the same group (p < 0.05). A difference was observed in CFU when evaluated within the same group over time (p < 0.05), except for the IL group. In internal collection, a predominance of non-formation of microorganisms was observed at T0 in all groups, while formation of Gram-positive Diplococci and Gram-positive Bacilli was observed at T8 (p>0.05). In external collection, an increase in number of microorganisms was observed at T0. Conclusion: There was no difference in microbial contamination among the evaluated groups. The microorganism's colonization changed over time

The assessment of periimplant soft tissue condition with morse taper abutment connection: a rapid review

Aim: This study aims to evaluate the clinical assessment results of periimplant soft tissue with morse taper (internal abutment connection). Methods: The study was conducted using a rapid review by searching the articles from PubMed NCBI and Cochrane by using keywords. All articles were selected by the year, duplication, title, abstract, full-text, and finally, all selected articles were processed for final review. Following clinical parameters were included; Periimplant Probing Pocket Depth (PPD), Plaque Score (PS), modified Plaque Index (mPI), Mucosal Thickness (MTh), Gingival Height (GH), periimplant mucosal zenith, Pink Esthetic Score (PES), Bleeding On Probing (BOP), Sulcus Bleeding Index (SBI), and modified Gingival Index (mGI). Results: 9 selected articles were obtained from the initial literature searching count of 70 articles. The overall samples included 326 morse taper implants. Based on the evaluation, 3 out of 4 articles reported pocket depth < 4 mm, no bleeding was reported in 2 out of 4 articles. 4 out of 4 articles reported low plaque accumulation, low soft tissue recession was reported in 3 out of 3 articles, and 4 out of 4 articles reported acceptable PES values. Conclusion: The evaluations indicate that the morse taper (internal abutment connection) has favorable assessment results based on various clinical parameters

Fibrina rica en plaquetas aplicada en conjunto con biomodificación alveolar en la regeneración ósea guiada. Reporte de caso / Platelet rich fibrin applied in conjunction with alveolar biomodification in guided bone regeneration. Case report

Resumen Debido a los diferentes problemas existentes a la hora de realizar procedimientos implantológicos por la calidad del remanente óseo y el estado de los tejidos periodontales en la zona a rehabilitar, existen opciones de regeneración ósea inducida que muestran tasas de éxito considerablemente favorables al ser empleadas en casos donde es necesario una regeneración ósea extensa capaz de soportar un implante dental. El objetivo del presente estudio es describir el éxito en la regeneración ósea por medio de alternativas combinadas de fibrina rica en plaquetas y modificación biológica con tetraciclina. Reporte del caso clínico: paciente femenina de 67 años que consulta por inflamación, supuración y dolor en la zona antero-superior. Es diagnosticada como absceso periapical crónico, se hace cirugía de extracción de órganos dentales, posterior a eso se hace descontaminación y adaptación de los alveolos con tetraciclina para realizar la regeneración ósea guiada con fibrina rica en plaquetas, hueso tipo Lumina Bone Porous y Lumina Coat, luego se espera el proceso de evolución para colocación de implantes dentales. El éxito obtenido con el uso de fibrina rica en plaquetas y la biomodificacion ósea como coadyuvante en la desinfección de la zona a tratar, logró mostrar resultados altamente favorables en el proceso de regeneración ósea guiada.

Abstract As the different problems that exist when carrying out implant procedures due to the quality of the bone remnant and the state of the existing periodontal tissues in the area to be rehabilitated, there are induced bone regeneration options that show considerably favorable success rates as they are used in cases where extensive bone regeneration is necessary to support a dental implant. The objective of the present study is to describe the success in bone regeneration using combined alternatives of platelet-rich fibrin and biological modification with tetracycline. Report of the clinical case: 67-year-old female patient consulted for inflammation and suppuration and pain in the upper antero-superior area, she was diagnosed as chronic periapical abscess, dental organ extraction surgery was performed, after that decontamination and adaptation of the alveoli was performed with tetracycline to perform guided bone regeneration with platelet-rich fibrin, Coat membrane and Lumina bone criteria, then wait for the evolution process to place dental implants. The success obtained with the use of FRP and bone biomodification as an adjuvant in the disinfection of the area to be treated achieved to show highly favorable results in the guided bone regeneration process.

Fratura de implante dentário: relato de caso / Dental implant fracture: case report / Fractura de implante dental: informe de un caso

Com o aumento da população brasileira e consequentemente o número de edêntulos realizando tratamentos reabilitadores com implantes dentários, se tornou frequente aparições de complicações como, por exemplo, sua fratura. O presente trabalho tem por objetivo apresentar as causas prováveis relacionadas a fratura de implante dentário, através de um relato de caso clínico onde pode-se avaliar a condição da fratura apresentada e como foi solucionada. Após a analise do caso clínico, foi constatado que o principal fator que levou a sua fratura foram as sobrecargas oclusais associadas ao mal posicionamento e a qualidade do implante antigo. A partir disso, conclui-se que é de extrema importância o cirurgião dentista estar ciente de todas as possíveis complicações acerca do implante dentário, afim de realizar um bom planejamento cirúrgico diminuindo a taxa de insucesso levando a um bom prognóstico.

With the increase of the Brazilian population and, consequently, the number of edentulous individuals undergoing rehabilitation treatmentes with dental implants, the appearance of complications such as, for example, their fracture has become frequent. The present work aims to presente the probable causes related to dental implant fracture, trough a clinical case report where the condition of the fracture presented and how it was resolved can be evaluated. After analyzing the clinical case, it was found that de main factor that led to its fracture were the occlusal overloads associated with poor positioning and the quality of the old implant. From this , it is concluded that it is extremely important for the dental surgeon to be aware of all possible complications regarding the dental implant, in order to carry out a good surgical planning, reducing the failure rate, leading to a good prognosis.

Con el aumento de la población brasileña y, en consecuencia, del número de personas edéntulas que se someten a tratamientos de rehabilitación con implantes dentales, las complicaciones, como las fracturas, se han vuelto comunes. El presente trabajo tiene como objetivo presentar las probables causas relacionadas con la fractura de implantes dentales, a través del reporte de un caso clínico, donde se puede evaluar la condición de la fractura presentada y la forma en que fue resuelta. Tras analizar el caso clínico, se comprobó que el principal factor que condujo a la fractura fue la sobrecarga oclusal asociada a una mala colocación y a la calidad del implante antiguo. Esto lleva a la conclusión de que es muy importante que el cirujano dental conozca todas las posibles complicaciones de los implantes dentales, para realizar una buena planificación quirúrgica, reduciendo así la tasa de fracasos y consiguiendo un buen pronóstico.

Preservação alveolar e instalação tardia de implante dentário: relato de caso / Alveolar preservation and late dental implant installation: case report / Preservación alveolar e instalación tardía de implante dental: reporte de caso

Introdução. Decorrente do trauma local, durante a exodontia, ou pela falta de estímulos mastigatórios, a ausência dentária promove respostas biológicas que desencadeiam um processo de reabsorção óssea. A preservação óssea alveolar propõe minimizar a reabsorção óssea alveolar, promovendo maior biodisponibilidade óssea para a reabilitação por implantes dentários. Os implantes dentários são uma modalidade terapêutica eficaz para a reabilitação de ausências dentárias. Objetivo. relatar um caso de reabilitação por implante em alvéolo cicatrizado, após preservação alveolar. Relato de caso. Paciente A.L.L., sexo masculino, 23 anos, compareceu à clínica odontológica da UNIBRA. Ao exame físico observou-se ampla destruição coronária do elemento 25 e, ao exame radiográfico notou-se tratamento endodôntico. O tratamento proposto foi a exodontia minimamente traumática, preservação alveolar com matriz de colágeno e instalação de implante dentário em alvéolo cicatrizado. Discussão. Em desdentados, a falta de estímulos mastigatórios, promove um desequilíbrio no turnover ósseo, desencadeando um processo de reabsorção. A preservação alveolar por matriz de colágeno visa minimizar a reabsorção e fornecer maior biodisponibilidade óssea para a reabilitação por implantes. Conclusão. A preservação alveolar com a matriz de colágeno cumpriu com seu objetivo e, a reabilitação por implante dentário em alvéolo cicatrizado é uma modalidade eficaz na reabilitação de pacientes desdentados... (AU)

Introduction. Due to local trauma, during tooth extraction, or the lack of masticatory stimuli, the absence of teeth promotes biological responses that trigger a process of bone resorption. Alveolar bone promotion minimizes alveolar bone resorption, promoting high bone bioavailability for rehabilitation with dental implants. Dental implants are a treatment modality to edentulous. Objective. Report a case of implant rehabilitation in a healed socket after alveolar preservation. Case report. Patient A.L.L., male, 23 years old, attended the UNIBRA dental clinic. On physical examination, a wide coronary destruction of element 25 was observed and, on radiographic examination, endodontic treatment was noted. The proposed treatment was a minimally traumatic tooth extraction, alveolar preservation with collagen matrix and implant placement in healed sockets. Discussion. In edentulous patients, the lack of masticatory stimuli promotes an imbalance in bone turnover, triggering a resorption process. Alveolar preservation by collagen matrix aims to minimize resorption and provide greater bone bioavailability for implant rehabilitation. Conclusion. Alveolar preservation with collagen matrix fulfilled its objective, and rehabilitation by dental implant in a healed socket is an effective modality in the rehabilitation of edentulous patients... (AU)

Introducción. Por traumatismo local, durante la extracción dentaria, o por falta de estímulos masticatorios, la ausencia de dientes promueve respuestas biológicas que desencadenan un proceso de reabsorción ósea. La preservación ósea alveolar propone minimizar la reabsorción ósea alveolar, promoviendo una mayor biodisponibilidad ósea para la rehabilitación mediante implantes dentales. Los implantes dentales son una modalidad terapéutica eficaz para la rehabilitación de dientes perdidos. Objetivo. reportar un caso de rehabilitación con implantes en un alvéolo cicatrizado después de preservación alveolar. Reporte de un caso. Paciente A.L.L., masculino, 23 años, acudió a la clínica odontológica de la UNIBRA. El examen físico reveló destrucción coronaria extensa del elemento 25 y el examen radiográfico reveló tratamiento endodóntico. El tratamiento propuesto fue extracción dental mínimamente traumática, preservación alveolar con matriz de colágeno y colocación de implante dental en alvéolo cicatrizado. Discusión. En pacientes edéntulos, la falta de estímulos masticatorios promueve un desequilibrio en el recambio óseo, desencadenando un proceso de reabsorción. La preservación alveolar mediante matriz de colágeno tiene como objetivo minimizar la reabsorción y proporcionar una mayor biodisponibilidad ósea para la rehabilitación con implantes. Conclusión. La preservación alveolar con matriz de colágeno cumplió su objetivo, y la rehabilitación mediante implante dental en un alvéolo cicatrizado es una modalidad eficaz en la rehabilitación de pacientes edéntulos... (AU)

Norma técnica de salud para el uso del odontograma: NTS N° 188-MINSA/DGIESP-2022 / Technical health norm for the use of the odontogram: NTS N° 188-MINSA/DGIESP-2022

La publicación describe los criterios para el registro de datos de las características, anomalías patológicas de las piezas dentarias, así como el registro de procedimientos estomatológicos realizados para el uso y manejo del odontograma en las diferentes UPS, pudiendo ser utilizados en aspectos clínicos, legales, forenses, estadísticos, de investigación o docencia. Asimismo las pautas para estandarizar el gráfico y la nomenclatura básica para el registro de hallazgos clínicos en el odontograma, permitiendo a la comunidad de cirujanos dentistas manejar la misma información

Análise comparativa entre técnicas cirúrgicas de enxertia óssea em reabilitação de maxila atrófica: transplante celular odontológico (TCO) e técnica convencional de enxertia óssea ­ relato de caso clínico / Comparative analysis between surgical techniques of bone grafting in rehabilitation of atrophic maxilla: dental cell transplantation (OCT) and conventional bone grafting technique - a case report

A reabilitação de maxila atrófica se apresenta ainda nos dias de hoje como um desafio anatômico/fisiológico para os profissionais da área odontológica que visam buscar a instalação de implantes para futuras reabilitações protéticas, tendo em vista o grau de dificuldade de reconstituição do rebordo alveolar perdido. Com o intuito de reabilitar essas maxilas frente às adversidades, diferentes técnicas são propostas tais como enxertos ósseos autógenos, homógenos, substitutos ósseos alógenos, xenógenos e aloplásticos e suas respectivas técnicas. O objetivo deste trabalho foi apresentar um relato de caso clínico, no qual duas técnicas de reconstituição de rebordo alveolar de hemi-arco foram realizadas na mesma maxila utilizando biomaterial em bloco, visando comparar os resultados histológicos e clínicos. Após 5 meses da realização da enxertia, foi coletado material dos enxertos alveolares bilateralmente utilizando-se brocas trefinas para estudo histológico. Através da metodologia empregada, pode-se observar maior formação de estrutura óssea no lado em que foi praticada a metodologia transplantes celular odontológico (TCO), que preconiza a associação de sangue medular mandibular ao biomaterial, em relação a técnica contralateral em que utilizou a metodologia convencional, que preconiza a associação ao biomaterial do sangue periférico. Pode-se observar através da metodologia empregada que a utilização de biomateriais potencializados com sangue medular mandibular apresentou maior crescimento de estrutura óssea, incrementando em torno de 35% a mais na neoformação.de osso vital.

The rehabilitation of atrophic maxilla is still presented today as an anatomical/physiological challenge for professionals in the dental field who aim to seek the installation of implants for future prosthetic rehabilitations, in view of the degree of difficulty in reconstituting the lost alveolar ridge. In order to rehabilitate these jaws in the face of adversity, different techniques are proposed such as autogenous, homogenous bone grafts, allogeneic, xenogenous and alloplastic bone substitutes and their respective techniques. The aim of this study was to present a clinical case report, in which two hemi-arch alveolar ridge reconstruction techniques were performed in the same maxilla using biomaterial en bloc, in order to compare the histological and clinical results. After 5 months of grafting, material was collected from the alveolar grafts bilaterally using trephine burs for histological study. Through the used methodology, it was possible to see greater bone formation of structure on the side in which the dental cell transplantation (TCO) methodology was practiced, which advocates the association of mandibular medullary blood to the biomaterial, in relation to the contralateral technique in which the methodology was used conventional method, which advocates the association with peripheral blood biomaterial. It can be observed through the used methodology that the use of biomaterials potentiated with mandibular medullary blood showed greater growth of bone structure, increasing around 35% more in the neoformation of vital bone.

Endoscopic analysis of alterations in sinus floor elevation approaching the summers technique and immediate implant: a clinical trial with 10 years follow-up / Análise endoscópica das alterações na elevação do assoalho do seio maxilar com abordagem da técnica de Summer e implante imediato: um ensaio clínico com 10 anos de acompanhamento

The goal of this study was to evaluate by endoscopy, possible intercurrences during the sinus floor lifting employing the Summers technique, besides verify the implants' survival rate after 10 years. Six patients (12 sinus) were included in this study. The same surgeon performed the procedures, under local anesthesia and venous sedation in the hospital. All participants underwent sinus lift and implant placement in only one procedure, as previously planned, using endoscopic analysis (Stortz®). All cases received bovine bone graft (Bio-Oss®) before the implant placement. After 10 years, the patients were recalled for follow-up. Two intercurrences (16.66%) were detected using the endoscope, one simple rupture, and another perforation with the leaking of the graft within the sinus. Both were reverted and corrected immediately. There was one implant loss (8.33%), therefore this patient did not undergo any intercurrence in transoperative, and the membrane was elevated lesser than 5 mm. The survival rate reached was 91.66%. The osteotome technique constitutes a reliable method with a long-term of 10 years presenting a high implant survival rate, suggesting an elevation up to 5.5 mm in healthy patients. The occurrences in transoperative were only detected by the endoscopic analysis which must be stimulated to guarantee more secure visibility. Otherwise, the association the atraumatic technique and endoscope was tough, increased the costs, limiting the use routinely.

O objetivo deste estudo foi avaliar através de endoscopia as possíveis intercorrências durante levantamento de seio maxilar fechado, além de verificar a taxa de sobrevivência dos implantes após 10 anos. Seis pacientes (12 seios maxilares) foram incluídos neste estudo com idades entre 26 e 74 anos. O mesmo cirurgião realizou os procedimentos, sob anestesia local e sedação venosa em ambiente hospitalar. Todos os participantes foram submetidos à elevação do seio nasal e colocação do implante em apenas um procedimento, conforme planejado anteriormente, por acompanhamento transcirúrgico da endoscopia (Stortz®). Todos os casos receberam enxerto ósseo bovino (Bio-Oss®) antes da colocação do implante. Após 10 anos, os pacientes foram chamados para acompanhamento. Foram detectadas duas intercorrências (16,66%) com o endoscópio, uma ruptura simples e outra perfuração com extravasamento do enxerto para dentro do seio. Ambos foram revertidos e corrigidos imediatamente. Houve perda de um implante (8,33%), portanto esse paciente não apresentou intercorrência no transoperatório e a membrana estava elevada menos de 5 mm. A taxa de sobrevivência alcançada foi de 91,66%. A técnica do osteótomo constitui um método confiável em longo prazo (10 anos) apresentando uma alta taxa de sobrevivência do implante, sugerindo que uma elevação de até 5,5 mm em pacientes saudáveis é possível. Assim, verificou-se que as ocorrências no transoperatório foram detectadas apenas pela análise endoscópica que deve ser estimulada para garantir uma visibilidade mais segura. Por outro lado, a associação da técnica fechada com o endoscópio foi difícil, aumentou os custos, limitando seu uso como rotina

Impact of dental cone-beam computed tomography on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning / Impacto de la tomografía computarizada de haz cónico en el diagnóstico y plan detratamiento preimplantologico de senos maxilares

Objective: To determine the impact of CBCT on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning. Material and Methods: Diagnostic evaluation and treatment plan for the maxillary sinus were evaluated by eight specialists experienced in dental implant placement. Eight panoramic radiographs (PAN) and CBCT examinations were obtained from five adult patients with a specific clinical need for dental implants. Evaluation was performed first on PAN then, at least 2 weeks later, on CBCT. Residual alveolar ridge height, mucosal thickening, radiographic findings and treatment plan were recorded. The confidence level was evaluated for both diagnostic evaluation and treatment plan. The kappa statistic for intra-observer reproducibility and McNemar test were performed. Results: In the diagnostic evaluation, CBCT showed significant impact on the diagnosis of radiographic findings. Availability of CBCT significantly changed the treatment plan, for less invasive treatment, or no treatment need. Observers had significantly greater confidence when using CBCT than PAN, when indicating presence of mucosal thickening and radiographic findings in the maxillary sinus. In addition, CBCT increased confidence in the treatment plan. Conclusion: The present study suggests that CBCT has an impact on the diagnostic evaluation of radiographic findings in the maxillary sinus and on the decision to place implants, owing to misdiagnosis of pathology and planning of more invasive treatments when using PAN. Availability of CBCT also improves clinician confidence. Further studies at higher levels of diagnostic efficacy should be performed, to justify the use of CBCT, by evaluating the actual treatment performed and its outcome.

Objetivo: Determinar el impacto de la tomografía computarizada de haz cónico (CBCT) en la evaluación diagnóstica y el plan de tratamiento del seno maxilar en la planificación de implantes dentales. Material y Métodos: La evaluación diagnóstica y el plan de tratamiento del seno maxilar fueron evaluados por ocho especialistas con experiencia en la colocación de implantes dentales. Se obtuvieron ocho radiografías panorámicas (PAN) y exámenes CBCT de cinco pacientes adultos con una necesidad clínica específica de implantes dentales. La evaluación se realizó primero en PAN y luego, al menos dos semanas después, en CBCT. Se registraron la altura del reborde alveolar residual, el engrosamiento de la mucosa, los hallazgos radiográficos y el plan de tratamiento. Se evaluó el nivel de confianza tanto para la evaluación diagnóstica como para el plan de tratamiento. Se realizó el estadístico kappa para la reproducibilidad intraobservador y la prueba de McNemar. Resultados: En la evaluación diagnóstica, CBCT mostró un impacto significativo en el diagnóstico de los hallazgos radiográficos. La disponibilidad de CBCT cambió significativamente el plan de tratamiento, para un tratamiento menos invasivo o sin necesidad de tratamiento. Los observadores tuvieron una confianza significativamente mayor al usar CBCT que PAN, al indicar la presencia de engrosamiento de la mucosa y hallazgos radiográficos en el seno maxilar. Además, CBCT aumentó la confianza en el plan de tratamiento. Conclusión: El presente estudio sugiere que la CBCT tiene un impacto en la evaluación diagnóstica de los hallazgos radiográficos en el seno maxilar y en la decisión de colocar implantes, debido al diagnóstico erróneo de la patología y la planificación de tratamientos más invasivos al usar PAN. La disponibilidad de CBCT también mejora la confianza del clínico. Se deben realizar más estudios a niveles más altos de eficacia diagnóstica para justificar el uso de CBCT, evaluando el tratamiento real realizado y su resultado.

A cone-beam computed tomography study to assess anterior loop and other anatomic variations in mental foramen area in an iranian population / Un estudio de tomografía computarizada de haz cónico para evaluar el asa anterior y otras variaciones anatómicas en el área del foramen mentoniano en una población iraní

Purpose: This study aimed to determine the prevalence and length of the anterior loop (AL) of the inferior alveolar nerve, and evaluate the emergence direction of the mental nerve and the location of mental foramen in a group of Iranian patients. Material and Methods: This study was carried out on CBCT scans of 150 patients (57 males and 93 females; mean age 40.8 ±14.33 years). The presence and extent of the AL was determined in reconstructed images. The emergence path of the mental nerve was classified into three groups: anteriorly directed emergence, right-angled pattern of emergence, and posteriorly directed emergence. The location of mental foramen relative to adjacent premolars was determined. Results: AL was identified in 14.7% of the cases with a mean length of 1.39± 0.91 mm (range 0.25 to 3.50 mm). No significant differences were observed in the prevalence and extent of the AL between genders (p>0.05). The right-angled pattern of emergence was more dominant (43.7%). The most prevalent location of mental foramen was between the first and second premolars (68.3%). There was no significant association between the presence of AL with the path of emergence of the mental nerve (p=0.627) or the location of the mental foramen (p= 0.10 0). Conclusion: The prevalence of anterior loop was relatively low in the present sample (14.7%) with a length range of 0.25 to 3.5 mm. Due to the importance of this anatomic variation in implant surgery, it is suggested to carefully assess CBCT images before the surgical procedure to avoid neurosensory complications.

Propósito: Este estudio tuvo como objetivo determinar la prevalencia y la longitud del loop anterior (LA) del nervio alveolar inferior, y evaluar la dirección de emergencia del nervio mentoniano y la ubicación del foramen mentoniano en un grupo de pacientes iraníes. Material y Métodos: Este estudio se llevó a cabo en exploraciones de tomografía computarizada de haz cónico de 150 pacientes (57 hombres y 93 mujeres; edad media 40,8 ± 14,33 años). La presencia y extensión de la LA se determinó en imágenes reconstruidas. La vía de emergencia del nervio mentoniano se clasificó en tres grupos: emergencia dirigida anteriormente, patrón de emergencia en ángulo recto y emergencia dirigida posteriormente. Se determinó la ubicación del foramen mentoniano en relación con los premolares adyacentes. Resultados: Se identificó LA en el 14,7% de los casos con una longitud media de 1,39± 0,91 mm (rango 0,25 mm a 3,50 mm). No se observaron diferencias significativas en la prevalencia y extensión de la AL entre sexos (p>0,05). El patrón de emergencia en ángulo recto fue más dominante (43,7%). La localización más prevalente del foramen men-toniano fue entre el primer y segundo premolar (68,3%). No hubo asociación significativa entre la presencia de AL con la vía de emergencia del nervio mentoniano (p=0,627) o la ubicación del foramen mentoniano p=0,100).Conclusión: La prevalencia de asa anterior fue rela-tivamente baja en la presente muestra (14,7%) con un rango de longitud de 0,25 mm a 3,5 mm. Debido a la importancia de esta variación anatómica en la cirugía de implantes, se sugiere evaluar cuidadosamente las imágenes de tomografía computarizada de haz cónico antes del procedimiento quirúrgico para evitar complicaciones neurosensoriales.

Vertical bone augmentation with guided bone regeneration: a scoping review / Aumento óseo vertical con regeneración ósea guiada: scoping review

Introduction: There are multiple techniques for vertical bone augmentation. Guided bone regeneration is one of them; however, the literature is diverse and includes different study designs, which makes it difficult to synthesize results. Objective: To analyze the general technical characteristics, clinical results, and complications of vertical bone augmentation performed with guided bone regeneration in humans. Material and Methods: This scoping review was based on the PRISMA-ScR guidelines. A search was performed in the Pubmed, Scielo, and Worldcat databases. Papers published from 1990 to April 2020 were included in the study. Research articles not conducted in humans or published in languages other than English and Spanish were excluded. Title and abstract were screened by two reviewers, then full studies were extracted, and data tabulated. Results: 89 studies were included. The highest percentage reported having obtained a vertical bone increase of less than 5 mm and having used non-resorbable membranes. The most frequent type of graft is autogenous and combinations of grafts, the most common being autogenous with xenograft. All studies that reported bone stability of implants in regenerated bone were favorable, as was implant survival, reporting values between 83.8% and 100%. Membrane exposure is the most frequently reported complication, followed by infection or abscesses, and tissue dehiscence. Conclusion: Vertical bone regeneration is a reliable technique, with high predictability and low incidence of complications compared to other vertical bone augmentation techniques.

Introducción: Existen múltiples técnicas para el aumento óseo vertical siendo una opción la regeneración ósea guiada, sin embargo, la literatura es diversa y con distintos diseños que dificultan la síntesis de resultados. Objetivo: Analizar las características generales técnicas, resultados clínicos y complicaciones del aumento óseo vertical realizado con regeneración ósea guiada en humanos. Material y Métodos: Esta revisión de alcance se basó en la guía PRISMA-ScR. Se realizó una búsqueda en las bases de datos Pubmed, Scielo y Worldcat. Fueron incluidos aquellos publicados desde el año 1990 hasta abril de 2020. Se excluyeron los estudios no realizados en humanos o publicados en idiomas distintos al inglés y español. Dos revisores examinaron título y resumen, luego los estudios completos se extrajeron y se ordenaron los datos en tablas. Resultados: 89 estudios fueron incluidos. El mayor porcentaje reportó haber obtenido un aumento óseo vertical menor a 5 mm y haber utilizado membranas no reabsorbibles. El tipo de injerto que más frecuente es el autógeno y las combinaciones de injertos, siendo el más común autógeno con xenoinjerto. Todos los estudios que reportaron estabilidad ósea de implantes en hueso regenerado fueron favorables, al igual que la supervivencia de implantes, reportando valores entre 83,8% y 100%. La exposición de membrana es la complicación que más se repite en los estudios, seguido por infección o abscesos y dehiscencia de tejidos. Conclusión: La regeneración ósea vertical es una técnica confiable, con alta predictibilidad y baja incidencia de complicaciones en comparación a otras técnicas de aumento óseo vertical.