Comprehensive prosthodontic treatment of an elderly patient with compromised ridges: a clinical case report / Tratamiento prostodóntico integral de un paciente anciano con proceso alveolar comprometido: informe de un caso clínico

Introduction: The objective of a complete denture prosthesis is restoring aesthetics, comfort, and function by the replacement of missing dental and alveolar structures employing a stable prosthesis. Case Report: Many conditions can complicate the treatment plan and fabrication of a complete denture prosthesis. Complete denture fabrication in clinically compromised conditions is a challenging task for the dentist. In this clinical report, we present comprehensive management of a patient with denture-induced hyperplasia, flabby ridge, and severely resorbed edentulous ridge. The three part strategy for management of the above-mentioned challenges can provide high-quality complete dentures, based on recognized prosthodontic principles. This first part will discuss the management of denture induced hyperplasia by elimination of the inflammation and excision of the lesion. Part two will cover management of the flabby ridge using a modified window technique for the impression of maxillary flabby tissues for an improved and controlled application of the impression material that is usually obtainable in dental practice. Part three highlights the rehabilitation procedure of the resorbed mandibular ridge using a functional impression technique with minimum soft tissue displacement and neutral zone arrangement of teeth to improve stability of the denture. Conclusion: rehabilitation of a patient with denture induced hyperplasia, flabby ridge, and severely resorbed edentulous ridges was successful.

Introducción: El objetivo de una prótesis completa es restaurar la estética, la comodidad y la función mediante el reemplazo de las estructuras dentales y alveolares faltantes empleando una prótesis estable. Case Report: Muchas condiciones pueden complicar el plan de tratamiento y la fabricación de una prótesis completa. La fabricación completa de la dentadura en con-diciones comprometidas clínicamente es una tarea desafiante para el dentista. En este reporte de un caso clínico, presentamos el ma-nejo integral de un paciente con hiperplasia inducida por dentadura postiza, cresta flácida y cresta edéntula severamente reabsorbida. La estrategia de tres partes para el manejo de los desafíos mencionados anteriormente puede proporcionar prótesis completas de alta calidad, basadas en reconocidos principios protésicos. La primera parte discutirá el manejo de la hiperplasia inducida por dentadura postiza mediante la eliminación de la infla-mación y la extirpación de la lesión. La segunda parte cubrirá el manejo de la cresta alveolar flácida utilizando una técnica de ventana modificada para la impresión de tejidos flácidos maxilares para una aplicación mejorada y controlada del material de impresión que generalmente se obtiene en la práctica dental. La tercera parte destaca el procedimiento de rehabilitación del reborde mandibular reabsorbido utilizando una técnica de impresión funcional con un desplazamiento mínimo de los tejidos blandos y una disposición de la zona neutra de los dientes para mejorar la estabilidad de la dentadura. Conclusion: La rehabilitación de un paciente con hiperplasia inducida por dentaduras postizas, cresta flácida y reabsorbida fue exitosa.

Manejo interdisciplinario para una óptima rehabilitación oral / Interdisciplinary management for optimal oral rehabilitation

Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)

The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)

ADEQUAÇÃO DO MEIO BUCAL E REALIZAÇÃO DE TRATAMENTOS PRÉ-PROTÉTICOS PARA REINTEGRAR O PACIENTE ODONTOLÓGICO NA SEQUÊNCIA DE REABILITAÇÃO ORAL / Preprosthetic Treatments Enabling Oral Rehabilitation in the Public Service

Objetivos: Este artigo objetiva relatar a experiência do projeto de extensão realizado na Faculdade de Odontologia de Pernambuco com os alunos da graduação do Curso de Odontologia, com a finalidade a adequação do meio bucal e realização de tratamentos pré-protéticos para reintegrar o paciente odontológico na sequência de Reabilitação Oral, Visando o atendimento da demanda reprimida de pacientes da população local de Camaragibe e Região, que não conseguem ser incluídos nos serviços de próteses dentárias. Materiais e Métodos: Nestes pacientes foram realizados tratamentos incluindo cirurgias de gengivectomias, frenectomias e aumentos de Coroa Clínica e confecção de coroas dentárias provisórias com a supervisão dos professores de áreas distintas, além da orientação de saúde bucal. Resultados: A meta proposta pelo projeto foi atingida, pois foi viabilizado e oportunizado aos pacientes tratados o ingresso em serviços especializados para confecção de próteses dentárias definitivas. Conclusões: O projeto facilitou a inclusão dos pacientes nas clínicas de prótese dentária da Faculdade de Odontologia de Pernambuco, dando continuidade aos seus tratamentos de forma mais ágil. Além de proporcionar aos estudantes vinculados um enriquecimento profissional, atuando de forma interdisciplinar com aquisição de novos conhecimentos técnicos e científicos, e pessoal, ao viabilizar o exercício, de forma gratificante, com ações de favorecimento à sociedade respondendo às necessidades da população.

Objectives: This paper aims to report the experience of an extension project conducted at the College of Dentistry of Pernambuco with graduate students from the College of Dentistry, in order to adapt oral cavity and achievement of pre-prosthetic treatments to reinstate dental patient following Oral Rehabilitation, order the attendance of patients suppressed the local population and Camaragibe region, which can not be included in the denture services. Materiais and Methods: treatments were conducted in these patients including gingivectomy, frenulectomy, lengthening of clinical crowns and making provisional dental crowns under the supervision of teachers and guidance on oral health. Results: The proposed project goal was reached, and it was possible to the patients admission to specialized services for dental prosthesis. Conclusions: The project facilitated the inclusion of patients in dental clinics of the College, thus continuing their treatment more quickly, and provide enrichment to students participating in vocational training, working in an interdisciplinary manner and preparing them to respond to the needs of the population.

Differential expression of immunologic proteins in gingiva after socket preservation in mini pigs

During healing following tooth extraction, inflammation and the immune response within the extraction socket are related to bone resorption. Objective : We sought to identify how the alloplastic material used for socket preservation affects the immune responses and osteoclastic activity within extraction sockets. Material and Methods : Using a porcine model, we extracted teeth and grafted biphasic calcium phosphate into the extraction sockets. We then performed a peptide analysis with samples of gingival tissue from adjacent to the sockets and compared the extraction only (EO) and extraction with socket preservation (SP) groups. We also used real-time polymerase chain reaction (PCR) to evaluate the expression level of immunoglobulins, chemokines and other factors related to osteoclastogenesis. Differences between the groups were analyzed for statistical significance using paired t tests. Results : Levels of IgM, IgG and IGL expression were higher in the EO group than in the SP group 1 week post-extraction, as were the levels of CCL3, CCL5, CXCL2, IFN-γ and TNF-α expression (p<0.05). In addition, receptor activator of nuclear factor kappa-B ligand (RANKL) was also significantly upregulated in the EO group (p<0.05), as were IL-1β, IL-6 and IL-8 (p<0.05). Conclusions : These results suggest that the beneficial effect of socket preservation can be explained by suppression of immune responses and inflammation. .

Bicuspidised Molar as a Potential Prosthetic Abutment- A Case Report

Conservative management of periodontally compromised teeth with advanced furcation defects has proved to be challenging to the periodontists since ages. With the evolution of implant-based oral rehabilitation of edentulism, the ideology of preservation of the natural dentition is slowly fading. This case report aims at highlighting the conservative management of a grade III furcation-involved molar by bicuspidisation procedure and use of the treated tooth as an abutment for fixed prosthesis. Bicuspidisation is a surgical procedure performed on the mandibular molars for the separation of the mesial and distal roots with their respective crown portions; this separation eliminates the existence of a furcation and facilitates effective oral hygiene practice. The use of bicuspidisation still remains to be one of the most viable traditional options for the management of a Glickman's classification grade III furcation defect in the mandibular molar teeth to facilitate reduction in periodontal infection, oral hygiene maintenance, preservation of natural tooth structure and having the potential to serve as abutments for a fixed partial denture. A bicuspidised multirooted tooth can successfully serve as a potential abutment.

Distracción osteogénica alveolar como método de aumento del reborde alveolar / Alveolar osteogenic distraction as method to increase the alveolar ridge

La distracción osteogénica alveolar, como proceso biológico de neoformación de hueso alveolar, nos motivó a la realización de la presente revisión bibliográfica, con el objetivo enfatizar en el análisis de las variables: antecedentes históricos en Cuba, clasificación de los distractores, fases de la distracción (latencia, distracción y consolidación), indicaciones, contraindicaciones, ventajas, desventajas y complicaciones. Se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos, como MEDLINE y PubMed con la utilización de descriptores alveolar distraction y osteogenic distraction. Se consultaron las fuentes bibliográficas publicadas fundamentalmente en los últimos 5 años, lo que reveló que esta técnica es una excelente alternativa para la formación de huesos y tejidos blandos en zonas de atrofia alveolar, que consta de tres etapas: latencia, distracción y consolidación; un método previsible y con bajas tasas de reabsorción ósea en comparación con otras técnicas de aumento del reborde alveolar. Tiene su principal indicación en la terapia de implantes al proveer volumen óseo. Debemos individualizar cada caso y usar el método más adecuado según las características clínicas y personales del paciente. Una adecuada selección de los casos y una mejor comprensión de la técnica son los puntales para lograr exitosos resultados mediante la distracción osteogénica alveolar. En Cuba se ha aplicado poco la distracción alveolar, por lo que ha sido necesario ampliar los estudios sobre esta temática(AU)

The alveolar osteogenic distraction, as a biological process of alveolar bone neoformation, motivates us to make the bibliographic review whose objective was to emphasize in analysis the following variables: historical backgrounds in Cuba, distraction classification, distraction phases (latency, distraction and consolidation), indications, contraindications, advantages, disadvantages and complications. A bibliographic review was made by database search of reference systems as MEDLINE and PubliMed using the descriptors alveolar distraction o osteogenic distraction. The published bibliographic sources mainly over 5 years concluding that this technique is an excellent alternative for the bone and soft tissues formation in zones of alveolar atrophy including three stages: latency, distraction and consolidation; being a foreseeable method and with low rates of bone reabsorption compared to other techniques of increase of alveolar ridge. It has its main indication in implant therapy to provide bone volume. We must to individualize each case and to use the more appropriate method according the clinical and personal features of patient. A proper case selection and a better understand of technique are essential to achieve successful results by alveolar osteogenic distraction. In Cuba the alveolar distraction has been not much applied being necessary to expand the studies on this subject matter(AU)

Frenectomy for improvement of a problematic conventional maxillary complete denture in an elderly patient: a case report

Maxillary labial and buccal frena are considered as normal anatomic structures in the oral cavity. However, they may exist intraorally as a thick broad fibrous attachment and/or become located near the crest of the residual ridge, thus interfering with proper denture border extension resulting in inferior denture stability, retention and overall patient satisfaction. This case report highlights the importance of clinical examination and treatment planning which may mandate preprosthetic surgery prior to fabrication of a new conventional complete denture. Adequate patient satisfaction with conventional complete dentures can be significantly increased after frenectomy.

Impactação do segmento posterior da maxila através de osteotomia para reabilitação protética: relato de caso / Segmentary impactation in jawbone posterior through osteotomy for prosthetic rehabilitation

A perda prematura dos dentes naturais provoca importantes alterações, podendo ocasionar desde a migração de dentes até a extrusão do processo alveolar, especialmente em pacientes que não utilizam nenhum tipo de prótese no arco antagonista. Quando ocorre uma extrusão severa do processo alveolar, a extração dos dentes torna-se inevitável. Para solucionar o problema, existe a alternativa de realizar a técnica de impactação da região posterior da maxila por meio de osteotomia, para possibilitar uma futura reabilitação estética e funcional, sem a perda ou desgaste de estruturas rígidas.

The premature loss of the natural teeth makes a important alterations, could cause from the migration of teeth to the extrusion of the alveolar process, especially in patient that they don’t use any prosthesis type. When it happens a severe extrusion of the alveolar process, the extraction of the teeth becomes inevitable. To solve the problem, the alternative exists of accomplishing the technique of impaction the maxillary, through the bilateral segmentary maxillary osteotomy, to turn possible a future aesthetic and functional rehabilitation, without the loss or wear and tear of structures.

Preprosthetic Stage Dental Implant Failure

Since the introduction of the concept of osseointegration, the success rate of dental implant has increased dramatically. So, the uses of dental implant in the treatment of partially or fully edentulous patients have played an important role in dental rehabilitation. Regardless of high success rate of dental implant, some amounts of fixtures cannot help failing. We can classify dental implant failure according to timing, causative factor, etc. This study is focused on dental implant fixture failure, occurring during preprosthetic stage. There are various reasons that cause implant failure on this periods, such as improper patient selection, poor bone quality, and periimplantitis, etc. We investigate the survival rate of 1058 fixtures, which installed in 306 patients in our clinic from January 1997 to December 1999, according to type, sex, location, fixture length and width, using Kaplan-Meier product-limit method and to compare each other with log-rank test. Overall survival rate was 96.80%, and 33 implants failed over the preprosthetic stage. Our survey data identified posterior location of mandible as being associated with implant failure(P<0.05).