Rehabilitation of a patient diagnosed with Ectodermal Dysplasia presenting hypodontia: a case report

Purpose: The study showed a patient with Ectodermal Dysplasia (ED) who was treated with implants and fixed dental prosthesis by a multidisciplinary team. Case Report: Acrylic resin dental prostheses were designed as long-term provisionals, which allowed modifications when required. After imaging and treatment planning, four implants were placed in the inter-foramenal area of the mandible and 2 years later the definitive prosthesis was fitted. In a second phase, the patient received a combination of autogenous and allogeneic bone grafts in the maxilla. The autogenous graft was removed from the retro-molar region in the mandible. He also received a fixed dental prosthesis supported by 4 implants on the position of the upper canines and second pre-molars. Conclusion: Patient reports successful outcomes and despite the long treatment, patient states is confident with his appearance and speaking improvement. Follow-up was done every six months, for 10 years, and showed encouraging post-treatment outcomes.

Computer guided surgery in the maxillary esthetic zone / Cirurgia guiada por computador em área estética da maxila

ABSTRACT This clinical report describes the implant rehabilitation for the treatment of pathological roots resorption due to inadequate orthodontic movement in prosthetic space reduced by means of load and immediate implants, computer-guided surgery and use of the own tooth crown in a 21-year-old-patient. The atraumatic exodontics of the right and left upper lateral incisors was performed, and then immediate placement of osseointegrated implants using the computer guided surgery technique. The crown teeth itself was used in the immediate aesthetic and functional rehabilitation. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 27 months follow-up presented uneventful. The procedures included in this complex rehabilitation treatment in the esthetic zone were appropriate and essential for the maintenance of the soft and hard tissues contour and thickness ensuring the excellence in rehabilitation.

RESUMO Este relato de caso clínico descreve a reabilitação com implantes para o tratamento da reabsorção radicular patológica devido à movimentação ortodôntica inadequada em espaço protético reduzido, por meio implante imediato e carga imediata, pela técnica da cirurgia guiada por computador e uso da própria coroa dentária, em paciente de 21 anos. A exodontia atraumática dos incisivos laterais superiores direito e esquerdo foi realizada, em seguida realizou-se a instalação imediata dos implantes osseointegráveis, utilizando a técnica de cirurgia guiada por computador. Os próprios dentes da coroa foram usados na reabilitação estética e funcional imediata. A conclusão do tratamento resultou em sucesso funcional e estético com acompanhamento de 27 meses sem intercorrências. Os procedimentos incluídos neste complexo tratamento de reabilitação na zona estética foram adequados e essenciais para a manutenção do contorno e espessura dos tecidos moles e duros garantindo a excelência na reabilitação.

Incidence of surgical and prosthetic complications in total edentulous patients rehabilitated by the All-on-Four® technique: a retrospective study

ABSTRACT: Objective: To analyze the level of survival and the main complications presented by total edentulous patients after the All-on-Four® treatment, through a retrospective analysis. Methods: The medical records of 32 rehabilitated patients, between 2010 to 2018 were selected, presenting a total of 128 implants with subsequent fixed prostheses. The following variables were analyzed: gender, age, patient's systemic condition, time of implant installation, number of implants, and surgical and prosthetic complications. Results: The procedures were performed over on average 5.9 years ago and were more prevalent in female patients(59.6%). Out of the 32 patients selected 75% presented some systemic alteration, with hypertension being the most frequent disease. Regarding the implant placement, the rehabilitation in the mandible was more prevalent(62.5%), while in the maxilla(31.2%), and in the bimaxillary region(6.25%). As for the complications, out of 128 implants installed, 13 presented loss of osseointegration, leading to a survival rate of 90.44% (94.3% mandible and 83.3% maxilla). Furthermore, 15 surgical and 20 prosthetic complications were diagnosed. Among the surgical complications, the most frequent were loss(5-33%) and bone fracture(3-20%), while the most frequent prosthetic complications included loosening and/or or fracture of the prosthetic component and prosthetic fracture (6-30%). Conclusion: All-on-Four® is a procedure that has a high survival rate.

Survival of short dental implants in atrophied jaw: a systematic review

AIM: Short implants are manufactured for use in atrophic regions of the jaw. Therefore, the current does not sufficiently reveal a direct correlation between the impact of implant length on implant survival. The purpose of this systematic review was to compile the evidence of short implant survival in atrophied jaws. METHODS: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to September 2015 using the following terms in some combinations: "short implant", "mandible/atrophied jaws", and "implant survival/ survival rate/ survival analysis". RESULTS: The 19 included studies present in average 5.5 years (range 1.0-20.0 years) follow-up and 96.1% (range 73.4-100.0 percent) survival rate of the short implants in atrophied mandibular. CONCLUSIONS: This systematic review found evidences regarding to safety of short implant placement in atrophied jaws although stronger evidence is essential to confirm this finding.

Gingival Melanin Depigmentation With Diode Laser - Case Report / Despigmentación Melánica Gingival con Láser de Diodo - Relato de Caso

ABSTRACT: The pigmented lesions of the oral cavity may be endogenous or exogenous. Endogenous lesions are benign and usually caused by melanin, and they are called gingival melanin pigmentations. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary and mandibular portions. After local anesthesia, we started depigmentation with high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory postoperative results.

RESUMEN: Las lesiones pigmentadas de la cavidad oral pueden ser endógenas o exógenas. Las endógenas son benignas y generalmente causadas por la melanina, denominándose pigmentaciones melánicas gingivales. Entre las opciones para la despigmentación de estas regiones, se destaca la laserterapia, por ser un procedimiento poco invasivo. Este trabajo tuvo como objetivo relatar un caso clínico de la técnica de despigmentación gingival utilizando láser de diodo de alta intensidad en la región anterior de los maxilares para ablación del tejido pigmentado con la finalidad de mejorar la estética gingival. El paciente presentaba como queja estética el aspecto oscurecido de la encía en la región anterior de la maxila y de la mandíbula. Tras aplicar anestesia local, se inició la despigmentación con láser de diodo de alta intensidad, siendo que la ablación se realizó a partir de la encía insertada hacia la encía marginal libre. El paciente regresó tras 30 y 180 días, presentando encía saludable y con ausencia de repigmentación melánica. Así fue posible concluir que el láser de diodo mostró ser una buena alternativa para la despigmentación melánica, ya que se presentó como un procedimiento con menor morbidad y buen resultado postoperatorio.

Hyaluronic acid for repairing interdental papilla in esthetic area: case report

ABSTRACT: Background: Hyaluronic acid is a treatment option for this deficiency gingival papilla, since it aims to increase tissue volume in the region of loss of interdental papilla, minimally invasive. Aim this study was to describe the application of Hyaluronic acid in a deficient gingival papilla. Case report: Patient presented absence of interdental papilla in the maxillary arch around upper anterior teeth. A comprehensive exam was performed, plus 2D photographs taken with a professional camera coupled to a device for image standardization, and an intraoral scanning with the OMNICAM scanner. Three applications of Hyaluronic acid were performed to fill the black spaces, at an interval of four weeks. The patient was followed-up for three months, and the recovery of papilla was observed. Conclusion: The Hyaluronic acid as gingival filling material can be considered as a treatment option for augmenting interdental papilla in aesthetic area.

Morse taper performance: A finite element analysis study

OBJECTIVES: To evaluate and compare the magnitude and distribution of stresses generated on implants, abutments and first molar metal-ceramic crowns using finite element analysis. METHODS: Preliminary three-dimensional models were created using the computer-aided design software SolidWorks. Stress and strain values were observed for two distinct virtual models: model 1 - Morse taper and solid abutment; model 2 - Morse taper and abutment with screw. A load (250 N) was applied to a single point of the occlusal surface at 15° to the implant long axis. Von Mises stresses were recorded for both groups at four main points: 1) abutment-retaining screws; 2) abutment neck; 3) cervical bone area; 4) implant neck. RESULTS AND CONCLUSION: Model 1 showed a higher stress value (1477.5 MPa) at the abutment-retaining screw area than the stresses found in model 2 (1091.1 MPa for the same area). The cervical bone strain values did not exceed 105 µm for either model.

Rehabilitation with implants simultaneously to mandible fracture treatment. Follow up of 18 months

ABSTRACT: Objective: This study was reduction of a bilateral mandibular fracture through the installation of dental implants with immediate loading, re-establishing the stomatognathic function of the patient. Case Report: A 58-year-old male patient seek the emergency room from hospital after suffering a motorcycle accident. After physical and imaging examinations was diagnosed with bilateral mandibular fracture. The treatment of choice, once the patient was edentulous, was the reduction and stabilization of the fracture with the installation of 5 dental implants with immediate loading. After 1 year of postoperative follow-up, the facial contour along with the occlusion were reestablished. Radiographically, it was found the proper placement of plates and screws with correct baseline realignment and maintenance of implant-supported prosthesis. Conclusion: In this case report with follow-up of 18 months, the functional prosthetic rehabilitation and immediate aesthetic with immediate loading system, after reduction and fixation of mandibular fractures proved to be a good treatment option.

Some aspects of bone remodeling around dental implants

ABSTRACT: Considering that success of dental implants is not only related to osseointegration, but also with their survival rates, the aim of this study was to perform a literature review about bone remodeling around osseointegrated implants. A detailed search strategy was used for this, and articles published between the years 1930 and 2012 were selected. The rare data found in the literature demonstrated that implants are osseointegrated 30 days after their placement. However, active bone remodeling with osteoclasts and osteoblasts working in synchrony continues to occur. Therefore, after osseointegration, the initially formed bone, which presents characteristics of spongy bone, is gradually resorbed and replaced by compact bone after 90 days. Furthermore, other portions of bone tissue a little more distant from the interface, which establish direct contact with the implant, are also damaged during the drilling process, and therefore, they also need to be remodeled. Among the rare studies found in the literature about bone remodeling after osseointegration, there were no verified studies on the possible influence of implant surface treatments on bone remodeling that occurs after osseointegration. Only studies involving implants with machined surfaces have been conducted up to now.

Cirugía de elevación del seno asociada con pseudoquiste antral y mucocele / Sinus lifting surgery associated with antral pseudocyst and mucocele

Introducción: pseudoquistes y quistes verdaderos de los maxilares son contraindicaciones para cirugías de aumento de volumen óseo en la región posterior de la maxila. Objetivo: describir dos casos de pacientes con transtornos en los senos maxilares (pseudoquiste y quiste verdadero del maxilar) en senos maxilares neumatizados que necesitaban reconstrucción ósea, para posterior rehabilitacion con implantes oseointegrados. Presentación de casos: se presentan dos casos clínicos en que la planificación quirúrgica consistió en la remoción de la lesión y simultánea elevación del suelo del seno maxilar. En el primer caso, pseudoquiste antral, se procedió a la aspiración del contenido quístico previamente a la elevación de la membrana de Schneider. En el segundo caso, quiste verdadero del seno maxilar, se realizó la remoción completa de la lesión quística. En ambos casos no hubo perforación de la membrana, y el hueso bovino inorgánico fue utilizado como material de relleno. La instalación de los implantes fueron después de 7 meses de la cirugía de elevación de seno. Los controles clínicos y tomográficos mostraron adecuada oseointegración de los implantes y ausencia de recidiva y/o restos de la lesión. Conclusiones: el quiste verdadero del seno maxilar causa la destrucción de las paredes óseas y debe ser removido previamente a las cirugías de elevación sinusal. Ningún tratamiento es indicado para el pseudoquiste antral, teniendo claro que la lesión no representa necesariamente una contraindicación para la elevación de la membrana sinusal y colocación de injerto óseo para implantes. Mientras tanto, la aspiración previa de contenido líquido del pseudoquiste evita posibles complicaciones infecciosas posoperatorias(AU)

Introduction: maxillary pseudocysts and true cysts are contraindications for bone volume augmentation surgery in the posterior maxillary region. Objective: describe two cases of patients with maxillary sinus disorders (pseudocyst and true cyst) in pneumatized maxillary sinuses requiring bone reconstruction with a view to eventual rehabilitation with osseointegrated implants. Case presentation: two clinical cases are presented in which surgical planning consisted in lesion removal and simultaneous maxillary sinus floor elevation. In the first case, antral pseudocyst, aspiration was performed of the cystic content before elevation of the Schneiderian membrane. In the second case, true cyst of the maxillary sinus, total removal of the cystic lesion was performed. Membrane perforation did not occur in either case. Inorganic bovine bone was used as filler in both. Implantation was performed 7 months after sinus lifting surgery. Clinical and tomographic examination showed adequate implant osseointegration and absence of recurrence and/or lesion remnants. Conclusions: true maxillary sinus cysts cause bone wall destruction, and should be removed before performing sinus lifting surgery. No treatment is indicated for antral pseudocyst, for the lesion does not necessarily constitute a contraindication for sinus membrane lifting and bone graft placement for implantation. On the other hand, previous aspiration of the liquid content of the pseudocyst prevents possible postoperative infectious complications(AU)

The effects of subcutaneous injection of nicotine on osseointegration of machined and anodized implants in rabbits

Abstract Purpose: To evaluate the influence of subcutaneous injection nicotine in osseointegration process on different implant surfaces. Methods: Twenty-two male rabbits were distributed into two groups according to the subcutaneous injections: (1) nicotine 3 mg/day/kg and (2) 0.9 % NaCI 3 mL/day/kg, three times a day; subgroups were then designated-machined and anodized implants were placed in the right and left tibia bones, respectively. The animals were submitted euthanasia after periods of eight weeks to determine nicotine and cotinine levels, alkaline phosphatase and biomechanical analysis. Results: The plasmatic levels of nicotine and cotinine were 0.5 ± 0.28 ng/mL and 9.5 ± 6.51 ng/mL, respectively. The alkaline phosphatase analyses in blood levels in control group were observed 40.8 ± 11.88 UI/L and 40.75 ± 12.46 UI/L, for the surfaces machined and anodized, respectively. In the test group was observed levels 37.9 ± 4.84 UI/L, for both implant surfaces. No significant differences were observed between control and test groups and between the implant surfaces regarding alkaline phosphatase blood levels. For biomechanics, no significant differences were observed in control group between the machined (25±8.46 Ncm) or anodized (31.2 ± 6.76 Ncm) implants. However, the treatment with nicotine induced higher torque than control in both machined (38.3 ± 13.52 Ncm) and anodized (35.5 ± 14.17 Ncm) implants, with p = 0.0024 and p = 0.0121, respectively. Conclusion: Subcutaneous injection of nicotine following implant insertion didn't have effect on osseointegration, independently from the implant surface.

Rehabilitation using immediate loading in patients with partial resection of the jaw

ABSTRACT: Ameloblastoma is a rare tumor that affects the maxillomandibular region. Surgical resection is often indicated, and oral rehabilitation becomes a challenge. This study aims to report on the mandibular rehabilitation with implant supported prosthesis using immediate loading with subsequent resection. A patient with a confirmed diagnosis of multicystic ameloblastoma in the left jaw underwent a partial resection of the mandible and a reconstruction with a titanium plate. After 2 years of follow-up with clinical examinations and imaging testing and with no signs of recurrence, the patient underwent the technique of immediate load implants, rehabilitating the mandible with an implant supported fixed prosthesis and the maxilla with a conventional complete denture. During the seven years of follow-up with the patient, there was no sign of recurrence of ameloblastoma. The rehabilitation with oral implants under immediate loading demonstrated to be successful, and the cemented cylinder technique used in this study coupled with passivity showed a favorable prognosis for the longevity of implants.

Correlação dos níveis socioeconômicos e de educação dos pais com o índice CEO-D na primeira infância / Correlation of the socioeconomic and parents' education levels with the CEO-D index in early childhood

Introdução: estudos mostram que condições socioeconômicas podem interferir no nível de conhecimento dos pais sobre higiene bucal dos filhos, influenciando diretamente no índice de cárie. Objetivo: Avaliar o nível sócioeconômico e o conhecimento de uma amostra de 127 pais/responsáveis e correlacioná-lo com o índice de cárie diagnosticado em seus filhos com idades variando entre 3 e 5 anos. Método: foi aplicado um questionário composto por questões fechadas, abordando condições socioeconômicas e conhecimento dos pais/responsáveis sobre saúde e higienização bucal na primeira infância. Um único examinador calibrado realizou o levantamento epidemiológico nos filhos dos pais participantes. Os dados foram analisados por estatística descritiva e pelo teste de correlação linear de Pearson a um nível de significância de 5%. Resultados e Discussão: 60% dos pais possuíam renda de 3 a 5 salários mínimos, 70% com ensino médio completo e 73% das crianças com ceo-d=0. Ao avaliar a correlação entre o conhecimento dos pais/responsáveis e demais variáveis, observou-se diferença estatisticamente significante com o nível econômico/renda (p=0,006) e também com o grau de escolaridade dos pais (p=0,001). Houve diferença estatisticamente significante entre a correlação de índice de ceo-d e o conhecimento sobre saúde bucal (p=0,02). Não foi constatada correlação estatisticamente significante entre o índice ceo-d e a renda familiar (p=0,95), nem com o grau de escolaridade dos pais (p=0,06). Conclusão: concluiu-se que houve correlação negativa entre o índice de ceo-d das crianças e o conhecimento dos pais/responsáveis sobre saúde bucal, e correlação positiva entre o conhecimento dos pais/responsáveis e o nível sócioeconômico.(AU)

Introduction: studies show that socioeconomic conditions may interfere with parents' knowledge about oral hygiene of children, and then influencing caries index. Objective: to evaluate the socioeconomic level and knowledge of a sample of 127 parents/guardians and correlate it with caries index diagnosed in their children, ranging 3 to 5 years. Method: a questionnaire composed of closed questions was applied, addressing socioeconomic conditions and knowledge of parents/guardians about health and oral hygiene in early childhood. A single calibrated examiner performed the epidemiological survey on children of the participating parents. Data were analyzed by descriptive statistics and Pearson's linear correlation test at a significance level of 5%. Results and Discussion: 60% of the parents had income of 3 to 5 minimum wages, 70% with complete secondary education and 73% of the children with ceo-d = 0. When assessing the correlation between parents/guardians' knowledge and other variables, a statistically significant difference was observed with economic/income level (p = 0.006) and also with the parents' educational level (p = 0.001). There was a statistically significant difference between the correlation of ceo-d index and knowledge about oral health (p = 0.02). No statistically significant correlation was found between the ceo-d index and the family income (p = 0.95), nor with the parents' educational level (p = 0.06).Conclusion: it was concluded that there was a negative correlation between the children's ceo-d index and the knowledge of the parents/guardians about oral health, and a positive correlation between the knowledge of the parents/guardians and the socio-economic level.(AU)

The influence of primary occlusal trauma on the development of gingival recession / La influencia del trauma oclusal primario en el desarrollo de la recesión gingival

This study aimed to histometrically evaluate the presence of gingival recession in the mesial surface of the teeth of rats experimentally subjected to primary occlusal trauma. This evaluation verified the distance from the cement-enamel junction (CEJ) to the free marginal gingiva (FMG) and to the height of the alveolar bone crest (CEJ-crest bone distance). There were 10 animals, randomly divided into 2 groups: occlusal trauma (OT) (n = 5) - creation of an occlusal interference by fixing an orthodontic wire segment on the mandibular first molar occlusal face, which was randomly chosen, and a Control Group (CG) (n = 5) - five animals with no exposure to the OT variable were euthanised after 14 days to obtain the initial parameters. The inter-group evaluation showed there was no significant difference between OT × CG when the CEJ-FGM distance (P = 0.192) was evaluated after 14 days, but there was a significant difference between the two groups as regards the CEJ-alveolar crest bone distance (P = 0.0142). Thus, it can be concluded that the OT induction model, after 14 days of experiment, promoted bone resorption. This was observed by the increase in the CEJ-alveolar crest bone distance. It also did not promote gingival recession, which was evaluated by the CEJ-FGM distance.

El objetivo de este estudio fue evaluar histométricamente en ratas la presencia de recesión gingival en la superficie mesial de los dientes sometidos experimentalmente a trauma oclusal primario a partir de la evaluación de la distancia desde la unión esmalte cemento (CEJ) a la encía marginal libre y la altura de la cresta ósea restante (distancia de la CEJ-cresta ósea) Con este fin, 10 animales fueron divididos al azar en 2 grupos: trauma oclusal (TO) (n = 5) - creación de una interferencia oclusal mediante la fijación de un segmento de alambre de ortodoncia en la superficie oclusal del primer molar elegido al azar; y un grupo control (CO) (n = 5) -5 animales sin la introducción de la variable TO fueron sometidos a eutanasia después de 14 días para obtener los parámetros iniciales. La evaluación intergrupo no mostró diferencias significativas entre los grupos TO × CO al evaluar después de 14 días la distancia de la CEJ-encía marginal libre (p = 0,192) pero mostró una diferencia significativa entre los grupos TO × CO en cuanto a distancia de la CEJ-cresta ósea alveolar (p = 0,0142). Por lo tanto, se concluye que el modelo de inducción del TO después de 14 días del experimento promueve reabsorción ósea siendo observado por el aumento en la distancia de la CEJ-cresta ósea alveolar y no promueve la recesión gingival evaluada a partir de la distancia de la CEJ-encía marginal.

Accuracy of computer-guided surgery / La precisión de la cirugía guiada por ordenador

Dental implant fixation techniques are widely studied in order to reduce surgical morbidity. Computer-guided flapless surgery has been considered an efficient alternative that presents several advantages and some limitations. This technique allows the virtual planning and simulation of the prosthetic-surgical treatment that can help predict the difficulties and limitations in order to reduce possible errors. In addition to the prosthetic predictability, computer-guided surgery enhances accuracy and reduces surgical morbidity. Thus, the aim of this study was to report on a 7-year follow-up of immediately loaded implants inserted into an edentulous maxilla using virtual planning and flapless surgery.

Las técnicas de fijación del implante dental se estudian ampliamente para reducir la morbilidad quirúrgica. La cirugía sin flapless guiada por ordenador ha sido considerada como una alternativa eficiente con varias ventajas y algunas limitaciones. Esta técnica permite la planificación virtual y simulación del tratamiento protésico quirúrgico con la predicción de las dificultades y limitaciones para reducir posibles errores. Además de la previsibilidad de prótesis, la cirugía guiada por ordenador mejora la precisión y reduce la morbilidad quirúrgica. Por lo tanto, el objetivo de este estudio fue reportar a 5 años de seguimiento de los implantes de carga inmediata insertados en un maxilar desdentado utilizando la planificación virtual y la cirugía sin colgajo. El presente caso prospectivo informó el éxito del tratamiento y destacó la importancia de la planificación, lo que justifica el costo de esta tecnología.

Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model

ABSTRACT PURPOSE : To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.

Tratamento alternativo de extensa perfuração da membrana sinusal: 36 meses de acompanhamento clínico / Alternative treatment for large perforation of the maxillary sinus membrane: 36 months of follow-up

Na reabilitação implantossuportada em pacientes com edentulismo maxilar com atrofia óssea, em decorrência da reabsorção e pneumatização do seio maxilar, frequentemente, tem sido utilizada a técnica de elevação do assoalho do seio maxilar, que pode resultar em complicações, incluindo a perfuração da membrana de Schneider. Assim, o objetivo deste estudo foi relatar a técnica alternativa para o tratamento de uma extensa perfuração da membrana sinusal durante uma cirurgia de elevação do assoalho do seio maxilar. Paciente do sexo feminino, com 55 anos de idade. Durante a cirurgia de elevação da membrana sinusal, ocorreu perfuração de aproximadamente 2 cm de extensão. O tratamento proposto foi a técnica alternativa com utilização de membrana de colágeno, para reparar a membrana de Schneider e possibilitar a inserção e manutenção do substituto ósseo. No caso exposto, a membrana de colágeno reabsorvível demonstrou ser um método eficaz para o tratamento de uma extensa perfuração da membrana sinusal.

Generally, the sinus lifting technique has been used for patients with extensive atrophic areas in the maxillary arch due to the pneumatization process, but complications can be found, including the Schneider membrane perforation. Thus, the aim of this article is to present a clinical alternative to treat a large perforation of the sinus membrane during the surgical process. A 55 years-old female patient demonstrated a 2 cm width tearing during the operation. The proposed treatment was the use of a collagen membrane to repair the surgical field and to provide access for the bone substitute. The combined procedure is an efficient method in this kind of maxillary sinus complication.

Peri-implantite: tratamentos e manutenção peri-implantar ­ parte 2* / Peri-implantitis: treatments and maintenance ­ part II

Objetivo: orientar os profissionais a diagnosticar as doenças peri-implantares, conhecer suas características, avaliar os fatores de risco e escolher tratamentos adequados para cada situação. Material e métodos: a busca foi realizada nos bancos de dados Medline e EBSCO, entre 1992 e 2013, limitada aos artigos completos publicados em língua inglesa. Todos os níveis de evidência foram incluídos (relato de caso, experimentos em animais, revisões bibliográficas e estudos estatísticos com humanos). Resultados: o principal agente etiológico das doenças peri-implantares ainda é a placa bacteriana. No entanto, fatores de risco sistêmicos e locais influenciam no seu desenvolvimento. Os principais microrganismos presentes nas infecções peri-implantares são os mesmos encontrados na periodontite: bactérias gram e anaeróbicas. O tratamento não cirúrgico sozinho não apresentou resultados satisfatórios, contudo, quando associado com antisséptico bucal ou antibiótico, reduz a infecção. O tratamento cirúrgico permite o debridamento acurado da região peri-implantar, a descontaminação da superfície do implante e resulta em ganho de inserção clínica e reconstrução óssea. Conclusão: até o presente momento, nenhum protocolo padrão de tratamento da peri-implantite foi estabelecido. A prevenção e a manutenção do controle de placa através da higienização são eficazes em manter a baixa incidência das doenças peri-implantares.

Objective: to guide professionals on the diagnosis, identification, risk factor evaluation, and adequate treatment selection for peri-implant diseases. Material and methods: a literature search was made on the Medline and EBSCO electronic databanks within 1992 and 2013, limited to articles published in the English language. All evidence levels were included (case reports, animal experiments, reviews, and statistical studies in humans). Results: the main etiological agent is still bacterial plaque. However, local and systemic risk factors influence the development of peri-implantitis. The main microorganisms in peri-implant diseases are the same found for periodontitis: gram bacteria and anaerobes. The surgical treatment performed as a single measure did not present satisfactory results; nevertheless, when associated to antibiotics or oral anti-septic products, the infection levels were reduced. The surgical treatment allows for accurate debridement of the peri-implant site and implant surface decontamination, with clinical gains on attachment and bone reconstruction. Conclusion: until the present moment, there is no standard protocol for peri-implant treatment. Prevention of plaque build-up and maintenance through hygiene measures are efficient to reduce the incidence of peri-implant diseases.

Reabilitação imediata em área estética em alvéolo com grande comprometimento ósseo / Immediate rehabilitation of the aesthetic region with alveolar bone loss

As reabilitações em áreas estéticas com defeitos ósseos alveolares são desafios na utilização de implantes dentários. Dessa forma, o objetivo do estudo foi relatar um caso clínico da reabilitação implanto-suportada em alvéolos frescos com parede óssea comprometida, devido à pequena área de ancoragem para a inserção de implantes. No presente caso, o paciente apresentou-se com fratura do elemento dentário 24 associada à perda óssea extensa na face vestibular e reduzida altura óssea para ancoragem superior devido à proximidade com o soalho do seio maxilar, necessitando de reabilitação com implantes osseointegrados, com profissionalização imediata e regeneração óssea guiada (ROG), acompanhado de associação de substituto ósseo e membranas autólogas de fibrina. Após o período de osseointegração, foram realizados procedimentos de moldagem personalizada para a reabilitação final com prótese metalocerâmica. Baseada na metodologia descrita nesse relato de caso é possível notar, após o período de 18 meses de acompanhamento clínico e radiográfico/tomográfico, que não houve sintomatologia dolorosa, infecção, mobilidade do implante e perda óssea peri-implantar acentuada. O paciente apresentou-se satisfeito com relação à estética e função protética.

Dental implant rehabilitation in the aesthetic region with alveolar bone deffects is very challenging. The aim of this study was to present a case report of implantsupported prosthesis in fresh socket with bone wall loss due to reduced area to implant insertion.The patient presented with fracture of tooth 24 associated with extensive bone loss on the vestibular face and reduced bone height for upper anchorage due to the proximity to the maxillary sinus, requiring rehabilitation with dental implants with immediate provisionalization and guided bone regeneration (GBR), followed by bone substitute and autologous fibrin membranes. After osteointegration period, customized casting procedures were performed for final rehabilitation with metal-ceramic prosthesis. Based on the described methodology, pain symptomatology, pain, infection, implant mobility, and marked peri-implant bone loss were not observed during 18 months of clinical and radiographic/tomographic follow-up. The patient was satisfied with both aesthetic and function.

Prevalência de lesões bucais em crianças de 6 a 12 anos / Prevalence of oral lesions in children 6 to 12 years

Introdução: na literatura existem poucos levantamentos sobre alterações bucais pediátricas, uma vez que estes apresentam prevalências em faixas etárias mais abrangentes, incluindo jovens ou adultos. Objetivo: apresentar a prevalência das alterações bucais em tecidos moles que mais acometem crianças entre 6 e 12 anos de idade. Método: estudo prospectivo de identificação de lesões bucais da população infantil atendida na Clínica de Odontopediatria, da Faculdade de Odontologia da Universidade do Sagrado Coração, no período de outubro de 2012 a julho de 2013. Neste período, foram atendidas 129 crianças, sendo que 13 (10%) apresentaram alguma manifestação bucal em tecidos envolvendo tecidos moles. Os dados foram registrados por um único examinador em planilha própria, constando identificação do paciente, estado geral, tamanho, aspecto e localização da alteração, sintomas, tempo de instalação, tempo de recuperação, provável diagnóstico e tratamentos odontológicos realizados. Resultados e Discussão: as alterações bucais registradas foram: fístula/abscesso no rebordo alveolar (46,1%); estomatite herpética primária (15,4%); úlcera aftosa (15,4%); herpes simples recorrente (7,7%); língua fissurada (7,7%) e alveólise (7,7%). A localização mais frequente das alterações bucais registradas foi a mucosa alveolar superior (38,5%), seguida da mucosa alveolar inferior (23,1%), lábio superior direito (15,4%), maxila anterior (7,7%), rebordo gengival alveolar superior (7,7%) e dorso da língua (7,7%). A prevalência encontrada neste estudo prospectivo corrobora com outros levantamentos realizados na população infantil. Conclusão: é importante que os profissionais da área da saúde, especialmente o cirurgião-dentista, tenham o conhecimento da prevalência das principais lesões bucais em crianças para que estejam mais preparados para diagnosticá-las e tratá-las.

Introduction: in the literature there are few surveys of pediatric oral lesions, since these have prevalence in wider age groups, including young people or adults. Objective: present the prevalence of oral manifestations in soft tissues that most affect children between 6 and 12 years old. Methods: prospective study of oral lesions identification of children attendances at the Clinic of Pediatric Dentistry, Faculty of Dentistry, University of the Sacred Heart, from October 2012 to July 2013. During this period, 129 children were treated, and 13 (10%) had some oral manifestation in tissues surrounding soft tissues. Data were recorded by a single examiner at a specific note, consisting of patient identification, general condition, size, appearance and location of the oral manifestation, symptoms, installation time, recovery time, possible diagnosis and conducted dental treatments. Results and Discussion: Oral diseases recorded were: fistula/abscess alveolar (46.1%); primary herpetic stomatitis (15.4%), aphthous ulcer (15.4%), recurrent herpes simplex (7.7%), fissured tongue (7.7%) and alveolisys (7.7%). The most frequent location of oral abnormalities recorded was the superior alveolar mucosa (38.5%), followed by the inferior alveolar mucosa (23.1%), right upper lip (15.4%), anterior maxilla (7.7%), gingival superior alveolar (7.7%) and dorsum of the tongue (7.7%). The prevalence found in this prospective study corroborates other surveys in children. Conclusion: It is important that health professionals, especially the dentist, have knowledge of the prevalence of oral lesions in children in order to be better prepared to diagnose and treat them.