Oclusión basada en evidencia: rompiendo paradigmas / Occlusion based on evidence: breaking paradigms

La odontología basada en evidencias es una metodología que busca que las decisiones clínicas diarias que toman los profesionales en estomatología se encuentren fundamentadas en la evidencia científica, en ella se integran las experiencias clínicas, las necesidades, las preferencias del paciente y la evidencia clínicamente relevante más actual analizada por pares. Estos pilares son parte del proceso en la toma de decisiones para la atención al paciente. La odontología basada en evidencias surge de las exitosas experiencias obtenidas con el desarrollo e implementación de la medicina fundamentada en pruebas, al aplicar el método científico en la evaluación, planificación y toma de decisiones de las prestaciones sanitarias, sobre todo a través de los estudios controlados. En general, toda la práctica odontológica ha tenido grandes avances basados en evidencias, con hechos verídicos comprobados, pero los conceptos fundamentales de oclusión no han tenido una mejora cimentada en el conocimiento científico, prueba de ello es que se siguen ocupando teorías y conceptos de las filosofías de oclusión en la rehabilitación de muchos pacientes, seguimos creyendo en mitos y sofismas que no han podido ser demostrados. En esta revisión, demostramos los grandes avances en los conceptos de oclusión e invitamos a todos los odontólogos a romper los paradigmas de la oclusión antigua sin evidencias científicas y a utilizar las herramientas del método científico en la práctica clínica odontológica (AU)

Evidence-based dentistry is a strategy that seeks to ensure that the daily clinical decisions made by the dental professional are based on scientific evidence. It integrates the clinical experience of the dentist, the needs and preferences of the patient, and the most current relevant clinical evidence. All three are part of the decision-making process for patient care. Evidence-based dentistry arises from the successful experiences obtained with the development and implementation of evidence-based medicine, applying the scientific method in the evaluation, planning and decision-making of health benefits, especially through controlled studies. In general, all dental practice has had great advances based on evidence, with proven true facts, but the fundamental concepts of occlusion have not had an improvement based on scientific knowledge, proof of this is that theories and concepts continue to be used. of the philosophies of occlusion in patient rehabilitation, we follow myths and sophisms that have not been demonstrated, in this review, we demonstrate the great advances in the concepts of occlusion and we know all dentists to break the paradigms of the old occlusion without scientific evidence (AU)

Agenesis of maxillary lateral incisors: diagnosis and treatment options

ABSTRACT Introduction: There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases. Objectives: To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.

RESUMO Introdução: Existem diferentes possibilidades de planejamento ortodôntico para os casos que apresentam ausência congênita de incisivos laterais superiores. Esse é um assunto que divide a opinião de ortodontistas e reabilitadores orais, devido às vantagens e desvantagens de cada uma das opções de tratamento, as quais podem envolver a abertura de espaços para futuros implantes e/ou restaurações protéticas ou o fechamento dos espaços, com posicionamento dos caninos superiores no lugar dos incisivos laterais. O correto diagnóstico e uma criteriosa avaliação de cada paciente permitem determinar a melhor abordagem terapêutica. Nesse artigo, serão discutidos os principais tópicos a serem considerados no planejamento desses casos. Objetivos: Avaliar os principais aspectos relacionados ao planejamento do tratamento ortodôntico nos casos de ausência congênita de incisivos laterais superiores, de maneira a auxiliar nas tomadas de decisão, com embasamento clínico e científico.

Conceitos importantes sobre o dente canino / Important aspects of canine tooth

A Odontologia Restauradora é fundamentada numa tríade: função, biologia e estética. Muitas vezes, durante o planejamento estético, nos preocupamos com a forma, harmonia, coesão facial, cor e posição principalmente dos dentes Incisivos centrais e laterais. O canino é um dente muito importante também para todos esses efeitos e responsável pela curvatura do sorriso, dando o início do efeito paralaxe do corredor bucal. O mau posicionamento desse dente no arco pode comprometer a estética e função, afetando principalmente a guia canina. É importante lembrar que esse dente protege mutualmente o arco dentário anterior e posterior e alguns conceitos são importantes para estabelecer sua forma correta e sua posição ideal na arcada.

Restorative dentistry is based on the triad: function, aesthetics, and biology. During treatment planning, we often care about shape, facial harmony, color and position, especially when it comes to central and lateral incisors. however the canine teeth is also very important since impact all these factors. In addition canine teeth are also responsible for the curvature of the smile, initiating the buccal corridor. Poor positioning of the canines may compromise both aesthetic and function, with great impact over canine guidance. It is important to notice that this tooth protects the maxillary and mandibular arches, and some aspects must be observed in order to achieve its proper shape and position.

Effect of different lateral occlusion schemes on peri-implant strain: A laboratory study

PURPOSE: This study aims to investigate the effects of four different lateral occlusion schemes and different excursions on peri-implant strains of a maxillary canine implant. MATERIALS AND METHODS: Four metal crowns with different occlusion schemes were attached to an implant in the maxillary canine region of a resin model. The included schemes were canine-guided (CG) occlusion, group function (GF) occlusion, long centric (LC) occlusion, and implant-protected (IP) occlusion. Each crown was loaded in three sites that correspond to maximal intercuspation (MI), 1 mm excursion, and 2 mm excursion. A load of 140 N was applied on each site and was repeated 10 times. The peri-implant strain was recorded by a rosette strain gauge that was attached on the resin model buccal to the implant. For each loading condition, the maximum shear strain value was calculated. RESULTS: The different schemes and excursive positions had impact on the peri-implant strains. At MI and 1 mm positions, the GF had the least strains, followed by IP, CG, and LC. At 2 mm, the least strains were associated with GF, followed by CG, LC, and IP. However, regardless of the occlusion scheme, as the excursion increases, a linear increase of peri-implant strains was detected. CONCLUSION: The peri-implant strain is susceptible to occlusal factors. The eccentric location appears to be more influential on peri-implant strains than the occlusion scheme. Therefore, adopting an occlusion scheme that can reduce the occurrence of occlusal contacts laterally may be beneficial in reducing peri-implant strains.

Immediate placement and functional loading of implants on canine with fixed partial denture for a patient having canine protected occlusion: a case report

Conventional implant protocols required a load-free healing period of three to six months between placement and functional loading of the implants. Many efforts have been made to minimize the duration of treatment time. Several literatures have documented immediate function with provisional or definitive prosthesis within a week of the placement in response to these demands. In addition, immediate implant placement has advantages such as shortened treatment time and preservation of soft tissue architectures. This article presents immediate implant placement into fresh extraction sockets followed by functional immediate loading with provisional prosthesis on canine and premolars for a patient having canine protected occlusion.

Immediate placement and functional loading of implants on canine with fixed partial denture for a patient having canine protected occlusion: a case report

Conventional implant protocols required a load-free healing period of three to six months between placement and functional loading of the implants. Many efforts have been made to minimize the duration of treatment time. Several literatures have documented immediate function with provisional or definitive prosthesis within a week of the placement in response to these demands. In addition, immediate implant placement has advantages such as shortened treatment time and preservation of soft tissue architectures. This article presents immediate implant placement into fresh extraction sockets followed by functional immediate loading with provisional prosthesis on canine and premolars for a patient having canine protected occlusion.

Masticatory afficiency in denture wearers with bilateral balanced occlusion and canine guidance

The maintenance of masticatory function is especially important for patients wearing complete dentures due to their limitations. Thus, the bilateral balanced occlusal concept is used to achieve greater masticatory efficiency. However, a critical review of the literature reveals that there is not sufficient scientific evidence to support bilateral balanced occlusion as the most appropriate occlusal concept in complete dentures. Therefore, the aim of this study was to evaluate the masticatory efficiency in complete dentures wearers with bilateral balanced occlusion and canine guidance. A double-blinded controlled crossover clinical trial was conducted. The sample was composed by 24 edentulous patients who wore sets of complete dentures with both occlusal concepts during equal periods of 3 months. Objective data were collected through the masticatory efficiency test performed by the colorimetric method with the beads, in which capsules of a synthetic material enclosing fuchsine-containing granules were used. Subjective data were recorded by patient's ratings of their chewing function. No significant statistical difference was found for masticatory efficiency (p=0.095) between the two occlusal concepts studied. The results suggest that bilateral balanced occlusion does not improve the masticatory efficiency in complete denture wearers.

A manutenção da função mastigatória tem importância especial em pacientes portadores de prótese total devido às limitações inerentes a esse tipo de prótese. Nesse contexto, a oclusão balanceada bilateral (OBB) é empregada com o intuito de obter-se uma maior eficiência mastigatória. Entretanto, analisando-se a literatura criticamente, observa-se que não existem evidências científicas suficientes que suportem a aplicação da OBB como conceito oclusal ideal em prótese total (PT). Assim, o presente trabalho teve o objetivo de verificar se pacientes portadores de PT dupla com OBB apresentam maior eficiência e capacidade mastigatória que aqueles com desoclusão com guia canino (DGC). Com esse intuito, realizou-se um ensaio clínico controlado duplo-cego do tipo crossover. A amostra foi composta de 24 pacientes portadores de prótese total dupla, onde todos fizeram uso de ambos os conceitos oclusais por períodos iguais de 3 meses. A avaliação da eficiência mastigatória foi realizada através do método colorimétrico com o uso de cápsulas mastigatórias. Não se encontrou diferença estatística significativa para a eficiência (p=0,0952) entre os dois conceitos oclusais estudados. Dessa forma, pode-se concluir que usuários de PT dupla com OBB não apresentam maior eficiência mastigatória que aqueles com DGC.