One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations.

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

In vitro evaluation of the influence of bone cortical thickness on the primary stability of conventional- and short-sized implants.

BACKGROUND: The aim of this in vitro study was to evaluate the influence of the cortical thickness on the primary stability of short and conventional-sized implants with two types of prosthetic connection. MATERIAL AND METHODS: Seventy-two implants were used. These implants were placed in polyurethane blocks that simulated low-density bone tissue (type IV bone), with two bone cortical heights (type I bone): 1mm and 3mm. The implants were divided into 6 groups with 12 implants each according to the type of prosthetic connections (external-hexagon -EH and morse taper- MT) and implant sizes (conventional- 4x10mm and short 5x5mm; 5.5x5mm; 5x6mm; 5.5x6mm). Insertion torque (IT) and resonance frequency analyzes (RFA) were performed to evaluate the primary stability of the implants. RESULTS: All implants installed in blocks with 3mm of cortical thickness showed greater IT than those installed in 1mm. The short-sized MT implants had a higher IT than conventional implants of the same connection. Short-sized EH implants showed less IT than short-sized MT implants in blocks with 3mm of cortical. In blocks with 1mm of cortical, conventional EH implants had a higher IT compared to short-sized EH implants. The conventional sized implants presented higher RFA values despite the thickness of the cortical in the blocks. CONCLUSIONS: The greater bone cortical thickness and implants size provides greater primary stability of the implants regardless the prosthetic connection. Key words:Implants connection, implants macrostructure, primary stability.

In Vitro Evaluation of the Primary Stability of Short and Conventional Implants.

The objective of this study was to evaluate the primary stability of short and conventional dental implants with different platform types at different site densities in vitro. One hundred twenty implants were placed in polyurethane blocks that simulate different bone densities (bone types I and IV). The implants were divided into 10 groups, with 12 implants each according to the type of prosthetic connections (external hexagon, EH; morse taper, MT) and size of the implants (conventional: 4 × 10 mm; short: 5 × 5, 5.5 × 5, 5 × 6, and 5.5 × 6 mm). Insertion torque and resonance frequency analyses were performed to evaluate the primary stability. The Kruskal-Wallis test complemented by Dunn's test and the Mann-Whitney test were used for statistical analysis. These tests were applied at the confidence level of 95% (P < .05). The implants installed in blocks with density type IV exhibited reduced insertion torque compared with implants placed in blocks with density type I. Short implants with EH exhibited increased insertion torque compared with short implants with MT in blocks with bone density type I. In general, implants installed in blocks with density type I exhibited greater primary stability. The short implants with EH with a 5.5-mm diameter and the short implants with MT with a 5-mm diameter exhibited reduced primary stability. No differences between short and conventional implants were noted. Short implants have primary stability and insertion torque at least equivalent to conventional implants irrespective of the platform type and density of the site.

Aesthetic Implant Rehabilitation in Periodontally Compromised Patients: A Surgical and Prosthetic Rationale.

Two cases of aesthetic implant abutment rehabilitation in the maxillary anterior area in periodontally compromised patients following conventional periodontal therapy and tooth extractions are presented. For the two cases of anterior tooth loss due to advanced periodontal disease progression, atraumatic flapless extractions were performed followed by the placement of immediate implants and provisional restorations. For the first case, lithium disilicate cemented over the abutment was used to achieve excellent aesthetic results. In the second case, custom zirconia abutments were used as prosthetic components. The results at the 3-year follow-up showed absence of inflammation and/or infection on the peri-implantar tissue with satisfactory aesthetic and excellent biological and clinical results achieved with reduced treatment time and morbidity for both patients. Total absence of infection and frequent plaque control after implant placement are mandatory before selection of the abutment material. The planning of the final treatment as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed in relation to the literature.

Correction of Malpositioned Implants through Periodontal Surgery and Prosthetic Rehabilitation Using Angled Abutment.

When dental implants are malpositioned in relation to the adjacent teeth and alveolar bone or in an excessive buccal or lingual position, the final prosthesis rehabilitation impairs the peri-implant health of the gingival tissues and the aesthetics of the patient. Thus, the purpose of this case was to report and discuss a multidisciplinary protocol for the treatment of a compromised maxillary tooth in a patient with an abscess in his right central incisor due to an excessive buccal implant position. The patient presented with an implant-supported provisional restoration on his right maxillary central incisor and a traumatic injury in his left central incisor. The treatment protocol consisted in (i) abutment substitution to compensate the incorrect angulation of the implant, (ii) clinical crown lengthening, (iii) atraumatic extraction of the left central incisor, and (iv) immediate implant placement. Finally, (v) a custom abutment was fabricated to obtain a harmonious gingival contour around the prosthetic crown. In conclusion, when implants are incorrectly positioned in relation to the adjacent teeth, associated with soft-tissue defects, the challenge to create a harmonious mucogingival contours may be achieved with an interdisciplinary approach and with the placement of an appropriate custom abutment.

Eight-year follow-up of a fixed-detachable maxillary prosthesis utilizing an attachment system: clinical protocol for individuals with skeletal class III malocclusions.

The aim of this article is to describe a successful clinical protocol for prosthodontic rehabilitation of a patient with a skeletal Class III malocclusion using a fixed-detachable maxillary prosthesis supported by 6 implants and the MK1 attachment system. The patient was followed up for 8 years. A 46-year-old edentulous woman with a skeletal Class III malocclusion expressed dissatisfaction with her old existing maxillary denture from an esthetic point of view and frustration regarding its function. A fixed-detachable maxillary prosthesis using the MK1 attachment system was made. The patient was followed up clinically and radiographically for 8 years. No bone loss, fracture of prosthetic components, or fracture of the prosthesis was detected in that period. A fixed detachable maxillary prosthesis using the MK1 attachment system is a treatment option for patients with Class III malocclusions who opt not to undergo orthognathic surgery.

Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach.

Orthodontic extrusion with multidisciplinary treatment can provide predictable outcomes in selected situations, reducing the costs and the adaptation times of gingival tissues after implant integration. Forced orthodontic extrusion is strongly related to interactions of teeth with their supportive periodontal tissues. This article reports a case of orthodontic extrusion of the maxillary incisors for later implant rehabilitation in a patient with periodontal disease. Slow forces were applied for 14 months. After this time, the teeth were extracted, and the implants were placed on the same day. Also in the same session, the provisional crown was fabricated for restoration of the anterior maxillary interdental papillae loss and for gingival contouring. Clinical and radiographic examinations at the 6-year follow-up showed successful tooth replacement and an improved esthetic appearance achieved by this multidisciplinary treatment. The decision to perform orthodontic extrusion for implant placement in adult patients should be multidisciplinary.

Comparison of the accuracy for three dental impression techniques and index: an in vitro study.

OBJECTIVES: This in vitro study compared the dimensional accuracy of stone index (I) and three impression techniques: tapered impression copings (T), squared impression copings (S) and modified squared impression copings (MS) for implant-supported prostheses. METHODS: A master cast, with four parallel implant abutment analogs and a passive framework, were fabricated. Vinyl polysiloxane impression material was used for all impressions with two metal stock trays (open and closed tray). Four groups (I, T, S and MS) were tested (n=5). A metallic framework was seated on each of the casts, one abutment screw was tightened, and the gap between the analog of implant and the framework was measured with a stereomicroscope. The groups' measurements (80 gap values) were analyzed using software (LeicaQWin - Leica Imaging Systems Ltd.) that received the images of a video camera coupled to a Leica stereomicroscope at 100× magnification. The results were statistically analyzed with Kruskal-Wallis One Way ANOVA on Ranks test followed by Dunn's Method, 0.05. RESULTS: The mean values of abutment/framework interface gaps were: Master Cast=32 µm (SD 2); Group I=45 µm (SD 3); Group T=78 µm (SD 25); Group S=134 µm (SD 30); Group MS=143 µm (SD 27). No significant difference was detected among Index and Master Cast (P=.05). CONCLUSION: Under the limitations of this study, it could be suggested that a more accurate working cast is possible using tapered impression copings techniques and stone index.

CIE L*a*b*: comparison of digital images obtained photographically by manual and automatic modes

The aim of this study was to analyze the color alterations performed by the CIE L*a*b* system in the digital imaging of shade guide tabs, which were obtained photographically according to the automatic and manual modes. This study also sought to examine the observers' agreement in quantifying the coordinates. Four Vita Lumin Vaccum shade guide tabs were used: A3.5, B1, B3 and C4. An EOS Canon digital camera was used to record the digital images of the shade tabs, and the images were processed using Adobe Photoshop software. A total of 80 observations (five replicates of each shade according to two observers in two modes, specifically, automatic and manual) were obtained, leading to color values of L*, a* and b*. The color difference (ΔE) between the modes was calculated and classified as either clinically acceptable or unacceptable. The results indicated that there was agreement between the two observers in obtaining the L*, a* and b* values related to all guides. However, the B1, B3, and C4 shade tabs had ΔE values classified as clinically acceptable (ΔE = 0.44, ΔE = 2.04 and ΔE = 2.69, respectively). The A3.5 shade tab had a ΔE value classified as clinically unacceptable (ΔE = 4.17), as it presented higher values for luminosity in the automatic mode (L* = 54.0) than in the manual mode (L* = 50.6). It was concluded that the B1, B3 and C4 shade tabs can be used at any of the modes in digital camera (manual or automatic), which was a different finding from that observed for the A3.5 shade tab.

Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants?

Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, an interdisciplinary approach should be observed during the diagnosis, prognosis, and treatment plan to provide a result with good predictability and meet the esthetic and functional expectations of the patient. The present study describes a case of a young patient with tooth agenesis of maxillary lateral incisors, which was conducted with an integrated planning. After 5-year follow-up of 2 fixed implant-supported prostheses, clinical and radiographic examination showed the treatment to be successful.

CIE L*a*b*: comparison of digital images obtained photographically by manual and automatic modes.

The aim of this study was to analyze the color alterations performed by the CIE L*a*b* system in the digital imaging of shade guide tabs, which were obtained photographically according to the automatic and manual modes. This study also sought to examine the observers' agreement in quantifying the coordinates. Four Vita Lumin Vaccum shade guide tabs were used: A3.5, B1, B3 and C4. An EOS Canon digital camera was used to record the digital images of the shade tabs, and the images were processed using Adobe Photoshop software. A total of 80 observations (five replicates of each shade according to two observers in two modes, specifically, automatic and manual) were obtained, leading to color values of L*, a* and b*. The color difference (ΔE) between the modes was calculated and classified as either clinically acceptable or unacceptable. The results indicated that there was agreement between the two observers in obtaining the L*, a* and b* values related to all guides. However, the B1, B3, and C4 shade tabs had ΔE values classified as clinically acceptable (ΔE = 0.44, ΔE = 2.04 and ΔE = 2.69, respectively). The A3.5 shade tab had a ΔE value classified as clinically unacceptable (ΔE = 4.17), as it presented higher values for luminosity in the automatic mode (L* = 54.0) than in the manual mode (L* = 50.6). It was concluded that the B1, B3 and C4 shade tabs can be used at any of the modes in digital camera (manual or automatic), which was a different finding from that observed for the A3.5 shade tab.

Protocolo cirúrgico para reabilitação de dentes com fratura radicular visando a excelência estética / Achieving esthetic results through a surgical protocol for the rehabilitation of teeth with root fracture

A extração dentária resulta em alterações acentuadas no volume dos tecidos ósseos e gengivas. A reabsorção do osso alveolar inviabiliza a colocação tridimensional ideal do implante. Mesmo quando um implante é colocado imediatamente após a extração dentária, a tábua óssea vestibular pode ser reabsorvida, comprometendo a estética do tratamento reabilitador. Se essa reabsorção pudesse ser evitada ou minimizada após a extração do dente, resultados mais previsíveis poderiam ser alcançados. Para isso, o enxerto de osso autógeno, associado ou não a biomateriais, em alvéolos pós-extração, é procedimento amplamente discutido pela literatura científica, e mostra resultados seguros em relação à regeneração óssea. Este estudo demostra um protocolo cirúrgico que resultou em ótimo resultado estético

Tooth extraction results in marked changes in the volume of bone and gingival tissue. The resorption of alveolar bone prevents ideal three-dimensional implant placement. Even when an implant is placed immediately after tooth extraction, the buccal bone plate can be reabsorbed, resulting in esthetic compromise of the rehabilitation treatment. However, when this resorption can be avoided of minimized after tooth extraction, more predictable results are achieved. For this purpose, autogenous bone grafts, alone or combined with biomaterials used for post-extraction socket is broadly used and reported in the scientific literature since they show reliable results with regard to bone regeneration. The present study demonstrates a surgical protocol that resulted in excellent esthetic results

Procedimentos clínico-laboratoriais em prótese sobre implante utilizando-se o sistema LAVA. Parte 2: confecção do pilar protético e instalação / Clinical and laboratory procedures on implant prosthesis system using LAVA. Part 2: manufacturing and installation of the prosthetic abutment

As cerâmicas odontológicas são conhecidas por sua excelência em reproduzir artificialmente os dentes naturais. Os avanços tecnológicos possibilitaram o desenho e a usinagem desse material em sistema CAD/CAM, o qual se torna uma opção de tratamento que confere boa adaptação da peça à estrutura dentária, e a aplicação da cerâmica de cobertura é realizada pelo ceramista, de modo a conferir boa qualidade estética. A sequência clínica selecionada demostra a substituição de uma prótese sobre implante provisória na região do incisivo lateral superior direito de um paciente jovem do sexo masculino. Durante o exame clínico, constatou-se a necessidade de realizar clareamento dentário previamente ao procedimento reabilitador. A coroa cerâmica foi confeccionada utilizando-se a tecnologia CAD/CAM – sistema LAVA. O objetivo deste artigo, segunda parte de duas etapas, é demonstrar os procedimentos clínico-laboratoriais para a confecção do pilar protético e instalação de uma prótese sobre implante. Utilizando-se o sistema CAD/CAM

Dental ceramics are known by their excellence for artificial reproduction of natural teeth. Technological advances, especially in the field of CAD/CAM systems, made possible to design and mill a number of materials, with good adaptation to the tooth structure, and application of the veneering material by the technician for optimal esthetics. This case report demonstrates the replacement of a provisional implant-supported prosthesis in the region of maxillary right lateral incisor of a young mate individual, using a CAD/CAM all-ceramic material (LAVA, 3M ESPE). During the clinical examination, it was observed the need to perform dental bleaching before the rehabilitation therapy. The aim of the second part of this article is to demonstrate the clinical and laboratorial steps for fabrication of a prosthetic abutment and installation of a CAD/CAM implant-supported restoration

Procedimentos clínico laboratoriais em prótese sobre implante utilizando-se o sistema lava. Parte 1: planejamento e moldagem / Clinical and laboratorial steps in implant supported prosthesis using lava system. Part 1: Planning and impression-taking

A odontologia moderna está cada vez mais direcionada ao uso de sistemas automatizados. O uso desses equipamentos computadorizados permite a confecção de peças protéticas com máxima precisão, com base na tríade desses sistemas (escaneamento, desenho computadorizado e fresagem). Paralelamente aos sistemas automatizados (CAD/CAM), a confecção de próteses sobre implantes fica mais frequente, pela popularização da implantodontia, e elas se tornam essenciais para a reabilitação. Portanto, o entendimento das etapas clínico-laboratoriais faz-se imprescindível para o bom desempenho na confecção e instalação de próteses sobre implantes. O objetivo desse artigo, que é a primeira parte de duas etapas, é demonstrar os procedimentos clínico-laboratoriais, com ênfase no planejamento e na moldagem, para a confecção de uma prótese sobre implante unitária, utilizando-se o sistema lava (Sistema CAD/CAM da 3M ESPE).

Modern dentistry is increasingly directed to the use of automated systems. The use of computerized equipment enables manufacturing of prosthetic pieces with maximum accuracy based on a three-step concept (scanning, computer design and miling). Parallel to the automated (CAD/CAM) systems, implant-supported prosthesis are becoming more common due to the popularity of dental implants, making the knowledge of the laboratorial steps essential for successful rehabilitations. The aim of this article, the first of two-part study, is to present the clinical-laboratorial procedures with emphasis on the planning and impression-taking for fabrication of an implant-supported prosthesis using the LAVA system (CAD/CAM System from 3M ESPE).

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos / Association of fixed partial prosthesis, dental implants, and periodontal aesthetic procedures for rehabilitation of partially edentulous patients

A doença periodontal é uma doença inflamatória crônica que resulta na destruição dos tecidos de suporte com consequente perda dental. A substituição dos dentes perdidos por restaurações implantossuportadas tem demonstrado ser um método de tratamento altamente previsível com bom prognóstico em longo prazo. Contudo, algumas sequelas da perda dentária inviabilizam a instalação de implantes osseointegrados em posição ideal, sendo, neste caso, necessários procedimentos regenerativos para tornar possível este tipo de reabilitação. Procedimentos menos invasivos, como próteses convencionais, surgem como uma opção terapêutica para reabilitação de casos em que não há estrutura óssea suficiente para implantes e não há aceitação de procedimentos invasivos por parte dos pacientes. Sendo assim, este trabalho teve como objetivo apresentar a resolução de uma reabilitação por meio de tratamento não invasivo e multidisciplinar. A paciente, gênero feminino, compareceu a clínica da faculdade apresentando próteses fixas mandibulares mal adaptadas bilateralmente, lesões endodônticas, recessão gengival nos dentes pilares e sensibilidade dentinária. Para a adequada resolução deste caso foi proposto à associação de implantes osseointegrados, prótese parcial fixa, exodontia e procedimentos periodontais estéticos, com a utilização de enxerto de tecido conjuntivo subepitelial. Após dois anos de pós-operatório, a paciente mostrou satisfação estética e mastigatória. Com base no caso apresentado, este trabalho discutiu os diversos fatores que podem afetar a escolha de uma determinada modalidade de tratamento, para a reabilitação de espaços edêntulos unitários.

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Importância do tratamento estético periodontal na reabilitação protética / Importance of aesthetic periodontal treatment on prosthetic rehabilitation: a case report

A recessão gengival é uma deformidade comum que afeta um grande número de indivíduos e está frequentemente associada com comprometimento estético e com hipersensibilidade dentinária. Várias técnicas cirúrgicas têm sido propostas ao longo dos anos para lidar com este problema. Desde 1950, enxertos livres e enxertos gengivais pediculados têm sido bastante utilizados para o tratamento de recessão gengival. Contudo, com a classificação de Miller, proposta em 1985 e com o surgimento de outras técnicas utilizando enxerto de tecido conjuntivo subepitelial para recobrimento de raiz, os resultados se tornaram mais previsíveis, especialmente no que diz respeito a recessões Classe I e II, ou seja, na ausência de perda óssea interproximal. Este artigo relata a importância do tratamento estético periodontal na reabilitação protética de um paciente portador de recessão gengival Classe I de Miller com 3 mm de extensão vertical no canino superior direito. O plano de tratamento consistiu em recobrimento radicular utilizando enxerto de tecido conjuntivo subepitelial (SCTG) associado com deslocamento coronário do retalho e confecção de novas próteses.

Otimização da estética na região anterior da maxila com utilização de implantes osseointegrados / Optimizing esthetics in anterior maxilla using osseointegrated implants

Resultados estéticos de excelência na região anterior da maxila, utilizando-se implantes osseointegrados, são dependentes da execução de um planejamento correto das muitas fases da reabilitação, tais como: preparo pré-cirúrgico, fase cirúrgica e protética e acompanhamento a longo prazo. A substituição de um único dente anterior é um desafio para os cirurgiões, devido às demandas estéticas dos pacientes e à dificuldade da anatomia preexistente da região. O objetivo deste trabalho é discutir alguns aspectos que influenciam o resultado estético final da reabilitação, com ênfase nos procedimentos regenerativos e posicionamento ideal do implante, por meio da apresentação de um relato de caso. Com o protocolo apresentado, ótimo resultado estético foi alcançado, juntamente com a satisfação imediata do paciente...

Achieving esthetic excellence in anterior maxilla using dental implants is dependent upon proper planning of every rehabilitation steps. These include the preoperative preparation, the surgical and prosthetic phases, and long-term follow-up. The replacement of a single anterior tooth is a challenge for surgeons due to the esthetic demands of the patients and the difficulty of pre-existing anatomy of the region. The aim of this paper was to present a case report, discussing some aspects that influence the final esthetic result of the rehabilitation, with emphasis on regenerative procedures and optimal placement of the implant. The suggested protocol provided excellent esthetic results, and immediate patient satisfaction...

Reabilitação estético-funcional sobre implantes agulhados e endósseos / Aesthetic Functional Rehabilitation involving needle and endosseous dental implants

Este relato mostra a resolução de um caso clínico cujo objetivo foi promover a substituição de uma reabilitação em hemiarcada superior esquerda em uma paciente que apresentava implantes agulhados e endósseos, ausência estética no sorriso e mau posicionamento tridimensional dos implantes. Para melhorar o posicionamento das agulhas, realizou-se a dobra vestibulopalatina das mesmas, unindo-as com resina composta; removeram-se as próteses parafusadas nos implantes das regiões dos pré-molares (24 e 25) e molar (26), substituiram-se os minipilares nos dois últimos implantes e, no primeiro pré-molar e canino, utilizaram-se os pilares cimentados devido a inclinação dos mesmos, planejando a união com solda pelo pequeno diâmetro dos implantes e o contato de um deles com uma das agulhas, o que poderia interferir na íntima relação osso/implante; futuramente prejudicando a biomecânica. Para realização da moldagem de arrasto com moldeira aberta, utilizou-se fio afastador nos implantes agulhados e transferência dos implantes com os respectivos transferentes. Assim, os modelos foram montados em articulador semiajustável após a tomada de arco facial, registro com silicona e moldagem do antagonista. Realizada a confecção do modelo de trabalho e das infraestruturas, estas foram provadas realizando-se os ajustes necessários seguido da remontagem. As peças então foram submetidas à aplicação de cerâmica, prova, ajustes, acabamento, torque dos componentes e cimentação com cimento resinoso químico dos dentes 21 ao 24. Ao término do caso, pôde-se concluir que boa reabilitação estético-funcional depende de conhecimento profundo das técnicas e dos materiais para as indicações a cada situação clínica.

This report shows the resolution of a case study whose aim was promote the aesthetic and functional rehabilitation of upper left hemi-arch over endosseous and needle implant prostheses. To improve the position of the needle implants, we performed the bucco-palatal bending of needles splinting them with composite resin; we removed the screwed implant prosthesis in the regions of the premolars (24 and 25) and molar (26). The mini-abutments of the last two implants were replaced, and in the first premolar and canine, we used cemented abutments due to implant angulation having planned soldering because of implant size and contact with one needle implant that could interfere with intimate contact bone/implant damaging biomechanics. Pick-up impressions were performed with an open tray, using a retractor cord in the needle implants and respective transfer copings. There fore, models were related on semi-adjustable articulator after a face-bow recording and interocclusal indexes. After working cast fabrication and try-in of infra-structures, these were adjusted and related into the articulator again. Then, after ceramic build-up, adjustments, finishing, and torque, chemically-activated resin cement was applied on units 21 to 24. At the end of the case, we concluded that a good aesthetic and functional rehabilitation depends on thorough knowledge of techniques for each clinical situation

Moldagens unitárias sobreimplantes com hélice de retenção / Unitary implant impression with retention propeller

O objetivo deste artigo foi apresentar uma modificação na técnica para moldagem unitária de implantes, com a criação de uma retenção adicional em forma de hélice, realizada em resina acrílica, sobre o transfer quadrado. A transferência com hélice para implantes ou abutments tem a finalidade de aumentar a retenção no material de moldagem e funcionar como um dispositivo anti-rotacional, preservando a posição original do hexágono durante os atos de moldagem, colocação dos análogos e vazamento do gesso.