Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / Outcome of maxillary overdentures according to the number of dental implants in full edentulous patients

RESUMEN Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

ABSTRACT Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

Férulas de Gunning. Una alternativa de tratamiento que sigue presente. Reporte de 02 casos / Gunning's splints. An alternative treatment that is still present. A report of 02 cases

Las fracturas condilares continúan siendo un desafío para los cirujanos maxilofaciales, debido a los múltiples tipos de fracturas que pueden ocurrir y los tratamientos disponibles. El tratamiento de este tipo de fractura podría dificultarse si el paciente presenta edentulismo. Así, entre las opciones de tratamiento, el uso de una férula o la prótesis dental preexistente como medio de fijación se muestra como una opción viable. Se presentan 02 casos clínicos de pacientes masculinos de 36 y 83 años de edad que presentan un maxilar edéntulo y fracturande cóndilo mandibular de lado derecho; para su tratamiento se utilizó una férula de Gunning superior con fijación intermaxilar mediante el uso de tornillos de fijación intermaxilar y elásticos intermaxilares durante 4 semanas. Después de 3 meses de evolución, ambos pacientes presentaron una adecuada apertura bucal, sin desviaciones o limitación a la apertura bucal. Las férulas de Gunning, a pesar que actualmente son poco usadas, continúan siendo una opción apropiada para los casos de fractura del cóndilo mandibular en pacientes edéntulos.

Condylar fractures continue to be a challenge for maxillofacial surgeons, due to the multiple types of fractures that can occur and the treatments available. Treatment of this type of fracture could be difficult if the patient has edentulism. Thus, among the treatment options, the use of a splint or the pre-existing dental prosthesis as a means of fixation appears to be a viable option. Two clinical cases are presented of male patients aged 36 and 83 years who present an edentulous maxilla and fracture of the mandibular condyle on the right side; For treatment, an upper Gunning splint with intermaxillary fixation was used through the use of intermaxillary fixation screws and intermaxillary elastics for 4 weeks. After 3 months of evolution, both patients presented adequate mouth opening, without deviations or limitations to mouth opening. Gunning splints, although they are currently rarely used, continue to be an appropriate option for cases of fracture of the mandibular condyle in edentulous patients.

Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / dental implants

Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

Finite element analysis of the influence of scaffold materials on the fixed restoration of edentulous maxillary implants under two designs / 中国组织工程研究

BACKGROUND:In the treatment of edentulous maxillary implants supported fixed repair,the selection of upper scaffold structure materials and the design of different distal implant implantation methods have a close influence on the long-term stability of the whole mouth implant repair. OBJECTIVE:To comprehensively explore the influence of three different materials of upper scaffold and two implant fixation designs on the biomechanics of the fixed maxillary implant repair based on the three-dimensional finite element method. METHODS:Based on the conical beam CT data of a healthy adult with normal jaws,the Mimics software was used to separate the maxillary and maxillary dentin three-dimensional solid models,and the Geomagic Studio software was used to construct the three-dimensional finite element model of denture with denture implant and fixed maxillary arch combined with specific model parameters.According to the different designs of distal implants in the maxillary posterior region,two scheme models were established.Scheme 1(Design 1)was designed in accordance with the"All-on-4"design used in clinical practice.Two implants were vertically implanted in the bilateral incisor region of the maxilla,and the other two implants were implanted in the bilateral second premolar region at a 30° angle.In scheme 2(Design 2),two implants were vertically implanted in the lateral incisor region of the maxilla,and two short implants were vertically implanted in the posterior region of the maxilla in the bilateral second premolar region.Three materials(titanium,zirconia and polyether ether ketone)were used to assign values to the upper scaffold structure in the two designs,and six different models were obtained.The biomechanical effects of the implant,surrounding bone tissue and the upper scaffold structure were compared and analyzed in the oblique loading direction. RESULTS AND CONCLUSION:(1)The maximum stress peaks of all models were distributed in the neck region around the posterior implant and the cortical bone under the two edentulous implant fixed restoration schemes,regardless of the material of the upper scaffold.(2)Compared with the alternative design of Design 2,which adopted vertical implantation of short implants,Design 1 showed a more ideal stress distribution on the maxilla.(3)The scaffold model constructed by polyether ether ketone material transferred higher stress to the implant and surrounding bone tissue close to the loading zone of the upper jaw bone,followed by titanium and zirconia.As for the support itself,the peak stress of the upper scaffold of polyether ether ketone was significantly lower than that of the zirconia and titanium scaffolds.Zirconia scaffolds were used among the three upper scaffolds to disperse the stress distribution of implant and bone tissue.(4)The results suggest that both designs can be applied to clinical practice.However,from the perspective of biomechanics,the stress distribution of the implant,surrounding bone tissue and upper scaffold in Design 1 is more rational,which is more conducive to the long-term prognosis of fixed implant repair in patients with edentulous jaws.The upper scaffold material has a certain influence on the stress distribution of the implant-bone interface.

Biomechanical characteristics of "All-on-4" concept analyzed by three-dimensional finite element method / 中国组织工程研究

BACKGROUND:With the increasing demand for edentulous jaw restoration,"All-on-4"concept is widely used.The load transfer mode of implant is different from that of natural tooth.The three-dimensional finite element analysis can study the stress distribution of implants and surrounding bone tissues under functional loading.On this basis,it provides research methods for finding suitable implant materials,optimizing implant geometry,and designing clinical surgical protocols. OBJECTIVE:To review researches related to three-dimensional finite element analysis in"All-on-4"concept. METHODS:Relevant literature published from 2003 to 2023 was searched in CNKI and PubMed databases with the search terms of"finite element method;All-on-4;edentulous;biomechanics"in Chinese and English.Finally,65 articles were included for review. RESULTS AND CONCLUSION:(1)In the case of insufficient horizontal bone mass,we can choose to apply narrow diameter implants,but we need to pay attention to the effect of the presence of the cantilever on the stress distribution and reduce the risk of failure.(2)The"All-on-4"concept reduces the stress distribution of bone by tilting the distal middle implant,but the ideal angle of the distal implant tilt in different jaw types requires further study.(3)The presence of cantilevers increases the risk of implant failure,and keeping the cantilever length/AP distance ratio at 0.9 helps to minimize mechanical complications.(4)When a framework is made of a material with a lower elastic modulus,the stress on the framework itself will be smaller,but it will increase the stress on the implant,prosthetic screw,abutment and peri-implant bone.On the contrary,when a material with a higher elastic modulus is used,it can reduce the stress on the prosthetic components,implants and peri-implant bone in the restoration,but the stress on the framework itself is higher.(5)The"All-on-4"concept allows for a better mechanistic balance,but requires the development of a long-term,effective treatment program that is tailored to the patient's specific situation.(6)Proper occlusal scheme is the key to the success of implant treatment,and there is no difference between canine-guide occlusion and group function occlusion in terms of the longevity of the restoration.However,there are many factors that influence occlusal design,and further in vitro experiments as well as a number of clinical studies are needed to explore the ideal occlusal design of the"All-on-4".

Digital repair for a patient with limited mouth opening: a case report and literature review / 口腔疾病防治

Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.

Oral rehabilitation with removable partial denture in a patient undergoing partial maxillectomy: a case report / Reabilitação oral com prótese parcial removível em paciente submetido a maxilectomia parcial: relato de caso

ABSTRACT The Removable Partial Denture stands as an effective rehabilitation choice for patients who have undergone partial maxillectomy surgery due to maxillary tumors, involving the partial surgical removal of the maxillary bone. Removable partial denture are meticulously designed to restore masticatory, phonetic, and aesthetic functions, thereby contributing significantly to enhancing self-esteem and aiding patients in resuming social activities. During the patient's history-taking phase, it is of paramount importance to assess the patient's overall health, psychological state, expectations, and limitations. Ensuring regular follow-ups is imperative to prevent complications and to guarantee the durability of the prosthesis. Prosthetic planning constitutes a critical phase and can pose challenges, especially in achieving proper retention, stability, and suitable supports. Factors such as the defect size, the number of remaining teeth, and the amount of remaining bone structures can influence the treatment prognosis. It is crucial to emphasize that lack of adequate planning can lead to rehabilitation failures, resulting in discomfort, compromised functionality, and even potential harm to the patient's health. In this context, this study aims to present a successful clinical case of a patient who underwent partial maxillectomy and was rehabilitated through a Removable Partial Denture fixed with clasps on the entire left upper hemi-arch. This case vividly illustrates the importance of a personalized approach to prosthetic rehabilitation in patients with partial maxillectomy, taking into account the specificities of each case and highlighting the necessity of interdisciplinary collaboration to achieve satisfactory outcomes.

RESUMO A prótese parcial removível é uma opção eficaz de reabilitação para pacientes que passaram por cirurgia de maxilectomia parcial em decorrência de tumores maxilares, ou seja, remoção cirúrgica parcial do osso maxilar. A prótese parcial removível deve ser projetada para recuperar as funções mastigatória, fonética e estética, contribuindo assim na melhoria da autoestima e ajudando o paciente a retornar às atividades sociais. Durante a anamnese, é de grande importância verificar o estado geral e psicológico do paciente, suas expectativas e limitações, garantir o acompanhamento frequente para evitar complicações e garantir a durabilidade da prótese. O planejamento protético é uma etapa crítica e pode apresentar desafios, especialmente na obtenção de retenção, estabilidade e suportes adequados. Fatores como o tamanho do defeito, o número de dentes remanescentes e a quantidade de estruturas ósseas remanescentes podem interferir no prognóstico do tratamento. É importante ressaltar que a falta de planejamento pode levar a falhas na reabilitação, resultando em desconforto, má funcionalidade e até mesmo danos à saúde do paciente. Nesse contexto, o presente trabalho tem como objetivo apresentar um caso clínico de sucesso de uma paciente que foi submetida a uma maxilectomia parcial e reabilitada por meio de uma prótese parcial removível fixada por grampos em todo o hemiarco superior esquerdo. Este caso ilustra a importância de uma abordagem personalizada para a reabilitação protética em pacientes com maxilectomia parcial, considerando as particularidades de cada caso e a colaboração interdisciplinar para a obtenção de resultados satisfatórios.

Cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata / Virtual guided surgery for implantsupported rehabilitation of the edentulous maxilla with immediate loading

Objetivo: Presentar el relato de un caso clínico de cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata. Relato del caso: Paciente, edéntulo total en ambos maxilares, expresó su deseo de cambiar la prótesis total superior removible por una prótesis total fija sobre implantes. Durante la evaluación clínica, se observaron condiciones biológicas favorables al tratamiento como, adecuada faja de tejido queratinizado y leve reabsorción ósea. Como tratamiento se le sugiere al paciente, una planificación inversa, asistida por cirugía virtual guiada, utilizando un prototipo de guía quirúrgica para la colocación de seis implantes dentales en el maxilar y la instalación de una prótesis protocolo de carga inmediata. Conclusiones: Los resultados nos permiten concluir que la cirugía virtual guiada por computadora para rehabilitación protésica implantosoportada de maxilar edéntulo, con carga inmediata, proporciona precisión en los procedimientos quirúrgicos, es fundamental para la confección de prótesis inmediatas, representa una alternativa mínimamente invasiva y el resultado complace a los pacientes.

Objective: present the report of a clinical case of a virtual guided surgery for implant-supported rehabilitation of the edentulous maxilla with immediate loading. Case report: Patient, bi-maxillary edentulous expressed the desire to replace the removable upper total prothesis for a total fixed prothesis on implants. During the clinical evaluation, favorable biological conditions for treatment were observed, such as adequate keratinized tissue band and mild bone resorption. As part of the treatment, the patient was recommended a reverse planning approach, assisted by virtual guided surgery. This involved a prototype surgical guide for the fixation of six dental implants in the maxilla and the installation of an immediate loading protocol prosthesis. Conclusions: The results lead us to conclude that computer-guided virtual surgery for implant-supported prosthetic rehabilitation of the edentulous maxilla with immediate loading, provides a high precision in surgical procedures. It is essential to fabrication of immediate prostheses, represents a minimally invasive alternative, and results in patient satisfaction.

The bruxism paradigm in the absence of teeth: observational cross-sectional study in full denture users / O paradigma do bruxismo na ausência de dentes: estudo observacional de corte transversal em usuários de próteses totais

ABSTRACT BACKGROUND AND OBJECTIVES: Bruxism is defined as an activity of the masticatory muscles, which is independent of the teeth presence, so it can occur in total edentulous patients and users of dental prostheses. In this sense, It is therefore necessary to know the clinical manifestations of bruxism in this population. The objective of this study was to evaluate the clinical manifestation and the presence of probable sleep and awake bruxism in a sample of users of full dentures treated at a teaching dental clinic in the city of Ribeirão Preto/SP. METHODS: The adopted sample consisted of 30 patients (mean age 72 years, 18 women/12 men). The following questionnaires were used to assess probable bruxism: Oral Behavior Checklist (OBC), Questionnaire of the American Academy of Orofacial Pain (AADO) and the Depression Anxiety and Stress Scale (DASS-21). The clinical assessment included the identification of wear on the prostheses, tongue indentations, bitten cheek and sensitivity in the masticatory muscles and temporomandibular joints. The data was analyzed using descriptive statistics. RESULTS: The average of use of the dentures were nine years. Six patients (20%) reported self-perceived sleep bruxism, and 11 (36%) reported self-perceived awake bruxism. OBC showed an average total score of 9.8 ± 6.2, with "teeth clenching" being the most described symptom. DASS-21 presented an average of 16.5, and stress, anxiety and depression were within normal limits. The most commonly reported symptoms in the AADO were headache, neck pain, pain and/or difficulty during jaw function and recent trauma to the head, neck or jaws. In the clinical evaluation, 15 (50%) patients had wear on prosthesis, only 2 (6%) had bitten cheek, none had tongue indentations, 4 (13%) had pain during palpation. CONCLUSION: Despite the limitations of the study (cross-sectional, small sample and absence of instrumental evaluation of bruxism), it is possible to conclude that a significant portion of users of total dentures presented probable bruxism, with tooth clenching being the main report and wear on the prosthesis the main clinical manifestation.

RESUMO JUSTIFICATIVA E OBJETIVOS: O bruxismo é definido como uma atividade da musculatura mastigatória, que independe da presença de dentes, portanto pode ocorrer em pacientes desdentados totais e usuários de próteses dentárias. Assim, é preciso conhecer como o bruxismo se manifesta clinicamente nessa população. O objetivo deste estudo foi investigar a presença do provável bruxismo de sono e de vigília em usuários de prótese total atendidos em uma clínica odontológica de ensino em Ribeirão Preto/SP. MÉTODOS: Uma amostra de conveniência foi composta por 30 pacientes (média de 72 anos, 18 mulheres e 12 homens). Os seguintes questionários foram utilizados para avaliar o provável bruxismo: Oral Behavior Checklist (OBC), Questionário da Academia Americana de Dor Orofacial (AADO) e o Depression Anxiety and Stress Scale (DASS-21). A avaliação clínica incluiu a identificação de desgastes nas próteses, língua dentada, bochecha mordiscada e sensibilidade nos músculos mastigatórios e nas articulações temporomandibulares. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: A média de uso das próteses foi de nove anos. Seis indivíduos (20%) relataram bruxismo do sono e 11 (36%) relataram bruxismo de vigília. O OBC apresentou média de escore total de 9,8 ± 6,2, sendo "apertar de dentes" o sintoma mais descrito. O DASS-21 apresentou média total de 16,5, com valores de estresse, ansiedade e depressão dentro da normalidade. Os sintomas mais relatados no AADO foram cefaleia, dores no pescoço, dor e/ou dificuldade durante a função mandibular e trauma recente na cabeça, pescoço ou maxilares. Na avaliação clínica, 15 (50%) dos pacientes apresentaram desgastes na prótese, 4 (13%) dor por palpação, 2 (6%) bochecha mordiscada e nenhum (0%) língua dentada. CONCLUSÃO: Apesar das limitações deste estudo (corte transversal, amostra reduzida e ausência de avaliação instrumental do bruxismo) foi possível concluir que uma parcela significativa de usuários de próteses totais apresentou provável bruxismo, sendo o apertamento dentário o principal relato e desgastes na prótese a principal manifestação clínica.

Associated short and regular implants for complete denture retention in an atrophic mandible: clinical follow-up / Implantes corto y regular asociados para retención de prótesis completa en mandíbula atrófica: seguimiento clínico / Implantes curto e regular associados para retenção de prótese total em mandíbula atrófica: acompanhamento clínico

Objective: to present the radiographic clinical follow-up of the prosthetic rehabilitation of a patient with an atrophic mandible, with the installation of short implants associated with an implant of regular length. Method: case report of a completely edentulous patient with an atrophic mandible and a 6-year radiographic clinical follow-up conducted at the dental clinic of the Federal University of Piauí, Teresina, from February 2011 to January 2020. After collecting sociodemographic data, health records, clinical radiographic examinations, and prosthetic surgical planning, four dental implants were installed between the mental foramina. After three months, mini-conical abutments and a fixed prosthesis screwed onto the implants were installed and monitored every six months for a period of six years. Results: the clinical evaluation revealed tissue stability without significant peri-implant changes after the follow-up period. Radiographically, bone resorption was not observed around the implant. Stability of the prosthesis and absence of prosthetic complications were observed during the follow-up period. Conclusion: short implants associated with regular-length implants can be placed in the anterior region of an atrophic mandible for rehabilitation with fixed complete dentures.

Objetivo: apresentar o acompanhamento clínico radiográfico da reabilitação protética de um paciente com mandíbula atrófica com a instalação de implantes curtos associados a um implante de comprimento regular. Método: relato de caso de uma paciente desdentada total com mandíbula atrófica, e acompanhamento clínico radiográfico de seis anos, realizado na clínica odontológica da Universidade Federal de Piauí, Teresina, no período de fevereiro de 2011 a janeiro de 2020. Após coleta de dados sociodemográficos e registro de saúde, exames clínicos radiográficos e planejamento cirúrgico protético, foram instalados quatro implantes dentários entre os forames mentonianos. Após o período de três meses foram instalados mini pilares cônicos e uma prótese fixa aparafusada sobre os implantes que foi acompanhada a cada seis meses por um período de seis anos. Resultados: as avaliações clínicas mostraram estabilidade tecidual sem alterações peri-implantares significativas após o período de acompanhamento. Radiograficamente foi observada a manutenção sem reabsorção óssea ao redor dos implantes. A estabilidade da prótese e a ausência de complicações protéticas foram observadas clinicamente durante o período de acompanhamento. Conclusão: os implantes curtos associados a implante de comprimento regular podem ser colocados na região anterior da mandíbula atrófica para reabilitação com prótese total fixa.

Fratura idiopática de mandíbula atrófica / Idiopathic fracture of atrophic jaw / Fractura idiopática de mandíbula atrófica

Objetivo: Discorrer sobre o tratamento cirúrgico de uma fratura idiopática de mandíbula atrófica. Relato de caso: Idosa compareceu à emergência de um hospital referência em traumas na Paraíba relatando dificuldade ao se alimentar, impossibilidade de uso da prótese dentaria, sintomatologia dolorosa em região mandibular direita com processo infeccioso ativo, sem histórico de trauma direto em face. Ao exame tomográfico constatou-se fratura em mandíbula atrófica com presença de dente incluso na região. Diante do quadro, optou-se por iniciar antibioticoterapia empírica e planejou-se tratamento cirúrgico de reconstrução mandibular com sistema load-sharing, tendo auxílio de biomodelo para conformação prévia da placa. Conclusão: O correto planejamento e escolha do sistema de fixação são fundamentais para o sucesso do tratamento. O uso de biomodelo com pré modelagem de placa mostrou-se positivo por otimizar o tempo cirúrgico, reduzindo os riscos inerentes ao procedimento nesta faixa etária e a utilização de sistema capaz de suportar a carga sofrida na estrutura óssea comprometida nestes casos é mandatório... (AU)

Objective: to discuss the surgical treatment of an idiopathic fracture of the atrophic mandible. Case report: elderly woman attended the emergency department of the Emergency and Trauma Hospital Dom Luiz Gonzaga Fernandes, in Campina Grande, Brazil. The patient reported pain on eating and inability to use her denture as painful symptoms in the right mandibular region with active fistula, without any records of facial trauma. Tomographic examination revealed an atrophic mandibular fracture with an impacted tooth in the region. The following procedures were performed: antibiotic therapy, surgical fixation using a 2.4mm pre-molded plate, shaped using a biomodel, and fistulectomy. Conclusion: Thus, to plan accordingly aiming to minimize the surgical time and its associate damage and the use of appropriate fixation systems capable of supporting the load on the compromised bone are essential to a successful treatment, specially with elderly patients due their general health condition and preexistent comorbities... (AU)

Objetivo: Discutir sobre el tratamiento quirúrgico de una fractura idiopática de la mandíbula atrófica. Caso clínico: Anciana compareció al servicio de urgencias del Hospital de Emergencia y Trauma de Campina Grande Dom Luiz Gonzaga Fernandes, PB, relatando dificultad para alimentarse, imposibilidad de uso de prótesis dental, sintomatología dolorosa en la región mandibular derecha con fístula activa, sin antecedentes de traumatismo directo en la cara. El examen tomográfico presentó una fractura mandibular atrófica con presencia de un diente incluido en la región. Como resultado se realizó antibioticoterapia, procedimiento de fijación quirúrgica con una placa de 2,4 mm premoldeada en biomodelo y fistulectomía. Conclusión: De esta forma, el correcto planeamiento para minimizar el tiempo quirúrgico y los daños asociados, principalmente en los ancianos por su estado general de salud y comorbilidades preexistentes, la utilización de sistemas de fijación adecuados capaces de soportar la carga sufrida en los huesos comprometidos, es fundamental para el éxito del tratamiento... (AU)

Oral health conditions of institutionalized older adults and associated factors / Condições de saúde bucal de idosos institucionalizados e seus fatores associados

INTRODUCTION: The growth of the Brazilian older adult population has influenced the increased demand for institutionalization for this public, which usually has poor oral health conditions such as edentulism. OBJECTIVE: To characterize the oral health conditions and verify the variables related to the edentulism of institutionalized older adults and verify the relation of the time of institutionalization with oral health. METHODS: It was a cross-sectional study conducted with 512 institutionalized older adults in which the sociodemographic profile, general health conditions, and oral health care and conditions were evaluated by clinical exams, consultations of medical records, and structured questionnaires. The data were analyzed in the Statistical Package for Social Sciences using the Pearson Chi-square and Fisher's Exact tests and a logistic regression model using a 95% confidence level. RESULTS: A high DMFT (29.4), high prevalence of complete edentulism (61.3%), high need for maxillary (73.6%), and mandibular oral rehabilitation (56.8%) were observed. Edentulism was associated with older age (p<0.001), lower schooling (p<0.001) and non-retirement (p=0.031). It was found that longer institutionalization time remained associated with edentulism even when adjusted by sociodemographic and general health variables (p=0.013). It was also associated with the absence of brushing (p=0.024) and a lower frequency of tooth, gum, and prosthesis brushing (p<0.001). CONCLUSION: It is suggested to establish oral health care routines within long-term institutions for the effective maintenance of oral health throughout the institutionalization time.

INTRODUÇÃO: O crescimento da população idosa brasileira tem influenciado no aumento da procura por institucionalização para esse público, que costuma apresentar precárias condições de saúde bucal como o edentulismo. OBJETIVO: Caracterizar as condições de saúde bucal e verificar as variáveis relacionadas ao edentulismo de idosos institucionalizados, além verificar a relação do tempo de institucionalização com a saúde bucal. MÉTODOS: Trata-se de um estudo transversal realizado com 512 idosos institucionalizados em que o perfil sociodemográfico, as condições gerais de saúde e os cuidados e condições de saúde bucal foram avaliados por meio de exames clínicos, consultas a prontuários e questionários estruturados. Os dados foram analisados no Statistical Package for the Social Sciences por meio dos testes Qui-quadrado de Pearson e Exato de Fisher e um modelo de regressão logística com nível de confiança de 95%. RESULTADOS: Observou-se alto CPOD (29,4), alta prevalência de edentulismo total (61,3%), alta necessidade de reabilitação oral maxilar (73,6%) e mandibular (56,8%). O edentulismo esteve associado a maior idade (p<0,001), menor escolaridade (p<0,001) e ausência de aposentadoria (p=0,031). Verificou-se que o maior tempo de institucionalização permaneceu associado ao edentulismo mesmo quando ajustado por variáveis sociodemográficas e de saúde geral (p=0,013). Além disso, também esteve associado à ausência de escovação (p=0,024) e menor frequência de escovação de dentes, gengivas e próteses (p<0,001). CONCLUSÃO: Sugere-se estabelecer rotinas de atenção à saúde bucal nas instituições de longa permanência para a manutenção efetiva da saúde bucal ao longo do tempo de institucionalização.

Finite element analysis of maxillary edentulous at different implant sites combined with the pterygomaxillary implants / 安徽医科大学学报

Objective @#To explore the effects of different implant sites combined with pterygomaxillary implantation on the biomechanics of implant and bone tissue，and to provide a basis for clinical selection of implant design in accordance with biomechanical principles．@*Methods@#The cone-beam CT scan data of an edentulous maxillary with inadequate posterior bone were selected to complete the establishment of the three-dimensional entity model of the maxilla．The prosthesis and implant-abutment integrated three-dimensional entity models were established using the prosthesis and implant data ，and five groups of three-dimensional finite element models of different implant sites were designed．A unilateral vertical load of 200 N and an oblique load of 100 N were applied to the bilateral posterior dental area，respectively．ANSYS finite element analysis software was used to calculate the stress distribution on the surface of the implant and surrounding bone tissue．SPSS 26. 0 software package was used to statistically analyze the data. @*Results @#① All the five models showed that the maximum stress was concentrated in the neck of the implants and cortical bone. ② The maximum stress value of the implant under oblique loading was greater than that under vertical loading (P＜0. 05) ，but there was no significant difference in the maximum stress value around bone tissue in the 5 groups of models. ③ There was no significant difference in the maximum stress of the implant and bone between the different implant sites combined with pterygomaxillary implants．@*Conclusion @#In the fixed restoration of maxillary edentulous implants，pterygomaxillary implants implanted symmetrically on both sides and changing the position point of the anterior implant do not affected the stress distribution of the whole design．In clinical practice，suitable sites can be selected according to the residual bone mass of patients，and combined with pterygomaxillary implantation for implant design.

Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly: a cross-sectional study

Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly

Influence of diameter in the stress distribution of extra-short dental implants under axial and oblique load: a finite element analysis

Aim: This study evaluated the influence of a wide diameter on extra-short dental implant stress distribution as a retainer for single implant-supported crowns in the atrophic mandible posterior region under axial and oblique load. Methods: Four 3D digital casts of an atrophic mandible, with a single implant-retained crown with a 3:1 crown-to-implant ratio, were created for finite element analysis. The implant diameter used was either 4 mm (regular) or 6 mm (wide), both with 5 mm length. A 200 N axial or 30º oblique load was applied to the mandibular right first molar occlusal surface. The equivalent von Mises stress was recorded for the abutment and implant, minimum principal stress, and maximum shear stress for cortical and cancellous bone. Results: Oblique load increased the stress in all components when compared to axial load. Wide diameter implants showed a decrease of von Mises stress around 40% in both load directions at the implant, and an increase of at least 3.6% at the abutment. Wide diameter implants exhibited better results for cancellous bone in both angulations. However, in the cortical bone, the minimum principal stress was at least 66% greater for wide than regular diameter implants, and the maximum shear stress was more than 100% greater. Conclusion: Extra-short dental implants with wide diameter result in better biomechanical behavior for the implant, but the implications of a potential risk of overloading the cortical bone and bone loss over time, mainly under oblique load, should be investigated

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey

Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Edentulismo, necessidade de prótese e autopercepção de saúde bucal entre idosos institucionalizados / Edentulism, need for dentures, and self-perception of oral health among institutionalized older people

RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.

ABSTRACT The aim was to describe the oral health status of institutionalized older people, focusing on edentulism, need for dentures, and Self-Perception of Oral Health (SPOH), and to explore the association with individual factors. A cross-sectional study was carried out in Ponta Grossa, in the South of Brazil, with a convenience sample of older people living in three Long Stay Institutions for the Elderly. Using a structured questionnaire, data on demographic, general, and oral health characteristics and access to health services were collected. In the oral examination, the Index of Decayed, Missing and Filled permanent Teeth (DMFT), number of teeth present, use and need for dental prosthesis, and presence of oral lesions were evaluated. 130 older people were evaluated, most of them over 80 years old (62.20%). The mean DMFT was 30.62 (± 2.85), 62.31% of attendees were edentulous, 41.54% used, and 79.23% needed dental prosthesis. Oral lesions were identified in 35.42% of those evaluated and 64.86% of the participants classified their SPOH as good. It is concluded that the oral health of the participants was considered poor, from a clinical point of view, taking into account the high prevalence of edentulism and the need to use dental prosthesis.

Discrepancia anteroposterior en registro de relación céntrica con apoyo central intraoral en cubetas rodetes acrílicas (BOPAYACU) e inducción manual en adultos mayores desdentados totales / Anteroposterior discrepancy in centric relation record with intraoral central support in acylic impaction cups (BOPAYACU) and manual induction in edentulous older adults

Objetivo: Comparar la discrepancia anteroposterior medida a nivel de la platina incisiva de 2 métodos de registro intermaxilar en la misma sesión que la im-presión definitiva en adultos mayores desdentados totales. Materiales y métodos. Se incluyeron en el es-tudio 20 pacientes (n=20) con edad promedio de 70 años. En cada uno de ellos se obtuvieron registros intermaxilares con cubetas rodete de acrílico: uno con inducción manual (IM) y otro autoinducido con el sistema de cubeta rodete de acrílico y apoyo central único utilizando una superficie palatina de registro curva (BYC). Los modelos fueron montados en un ar-ticulador Whip Mix modelo 2240 al que se le adicio-nó un dispositivo de papel milimetrado, Orthodent, a nivel de la platina incisiva, para registrar las dife-rencias existentes entre las posiciones obtenidas. El análisis estadístico se llevó a cabo mediante el cálcu-lo de intervalos de confianza (95%) para las diferen-cias medias y prueba de t de student para datos apa-reados (nivel de significancia: α<0,05). Resultados. En el plano mesiodistal a nivel de la platina incisiva se encontró diferencia estadísticamente significativa entre las dos variables de registro (p<0,001). A este nivel el BYC proporcionó registros más retrusivos que IM. Media aritmética (desviaciones estándar) en milímetros: 3,82 (2,1). Conclusión. El sistema de re-gistro con cubetas rodete acrílicas y BYC incorpora-do a las mismas proporciona un registro intermaxi-lar más retrusivo que IM en adultos mayores des-dentados totales cuando se realizan dichos registros en la misma sesión que la impresión definitiva (AU)

Objective: To compare the anteroposterior discre-pancy measured at the level of the incisal plate of 2 methods of intermaxillary registration in the same session as the definitive impression in fully edentu-lous older adults. Materials and methods. Twenty pa-tients (n=20) with an average age of 70 years were included in the study. On each of them, intermaxillary recordings were obtained with acrylic rims trays: one with manual induction (MI) and the other with a self-induced system and single central support using a curved recording palatal surface (BYC). The models were mounted in a Whip Mix model 2240 articula-tor to which an Orthodent graph paper device was added, at the level of the incisal plate, to record the di-fferences between the positions obtained. Statistical analysis was carried out by calculating confidence intervals (95%) for mean differences and T-student for paired data (significance level: α<0.05). Results. On the mesiodistal plane at the level of the incisal plate, a statistically significant difference was found between the two recording variables (p<0.001). At this level the BYC provided more retrusive recordings than MI. Arithmetic mean (standard deviations) in mi-llimeters: 3.82 (2.1). Conclusions. The registration system with acrylic rim trays and BYC incorporated into them provides a more retrusive intermaxillary registration than MI in fully edentulous older adults when such registrations are made in the same ses-sion as the final impression.(AU)

Halitosis and Pain Threshold of Peri-Implant Tissues: An Observational Cohort Study

Abstract In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey's test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.

Resumo Este estudo teve como objetivo avaliar a halitose e o limiar de dor dos tecidos moles peri-implantares em indivíduos reabilitados com próteses implantossuportadas. Um total de 48 indivíduos foram divididos em quatro grupos (n=12), de acordo com as reabilitações: prótese fixa unitária, prótese fixa multidentária, sobredentadura e protocolo de Brånemark. A halitose foi medida com um halímetro, enquanto o limiar de dor foi medido com monofilamentos de von Frey. As medições foram feitas antes (t0) e 30 dias após (t1) a colocação das tampas de cicatrização e no momento (t2) e 30 dias após (t3) a colocação da prótese. Os dados de halitose foram analisados por meio do teste qui-quadrado e correção de Bonferroni (p < 0,05). ANOVA de duas vias e o teste de Tukey (p < 0,05) foram usados para analisar os dados do limiar de dor. Observou-se associação entre halitose e tempo para o protocolo de Brånemark [X2(6) = 18,471; p = 0,005] e grupos overdenture [X2(6) = 17,732; p = 0,007], e entre halitose e tipo de prótese apenas em t0 [X2(6) = 12,894; p = 0,045]. A interação entre o tempo e o tipo de prótese interferiu significativamente nos valores médios do limiar de dor (p = 0,001). Na maioria dos pontos de tempos, a maioria dos participantes de cada grupo apresentava halitose clinicamente inaceitável. Após 30 dias de uso das próteses, o grupo overdenture apresentou menor limiar de dor em comparação ao grupo do protocolo de Brånemark.

The challenges of reconstruction and rehabilitation of atrophic jaw with an autogenous graft from skull cap ­ a case report / Os desafios da reconstrução e reabilitação de mandíbula atrófica com enxerto autógeno de calota craniana ­ relato de caso

Introduction: One of the challenges of maxillofacial surgery is the rehabilitation of patients with severe bone loss, using implant-supported prostheses. This challenge is based on the small remaining bone structure, and on the need to reconstruct the structure for the rehabilitation with autogenous or exogenous grafts. Case report: We report the case of a patient with severe maxillary atrophy, where a skullcap graft was performed associated with implant placement and prosthetic completion 14 months after the start of treatment. Final considerations: We demonstrate clinical safety for the use of extraoral grafts without complications, representing a good alternative treatment for this group of patients.

Introdução: um dos desafios da cirurgia bucomaxilofacial é a reabilitação de pacientes com perda óssea severa, utilizando próteses implantossuportadas. Este desafio baseia-se na pequena estrutura óssea remanescente e na necessidade de reconstrução da estrutura para a reabilitação com enxertos autógenos ou exógenos. Relato de caso: Relatamos o caso de um paciente com atrofia maxilar grave, onde foi realizado enxerto de calota craniana associado à instalação de implante, com finalização protética 14 meses após o início do tratamento. Consideracoes finais: Demonstramos segurança clínica para o uso de enxertos extrabucais sem complicações, representando uma boa alternativa de tratamento para este grupo de pacientes.