Complex rehabilitation of atrophic mandible with implant-supported prosthesis

ABSTRACT: In this study, we report the case of a patient presenting a severe atrophic mandible that was treated with short implants and stable internal fixation, without using bone grafts or biomaterials. The patient had a long history of failure of several previous consecutive treatments. Cone-bean tomography revealed a small amount of mandibular bone, suggesting a high risk of fracture of the mandible during drilling and installation of osseointegrated implants. We opted to place 5 implants (4.0 × 7.0 mm) between the mental foramens. Since the mandible presented a high risk of fracture, we inserted a titanium plate (2.3 mm) as bone reinforcement along the entire length of the mandible, including the bilateral mandibular angles. A Branemark type prosthesis was installed 5 days after the procedure. After 24 months, the patient continues to be satisfied and presents good masticatory functions without any complications.

Comportamento dos tecidos peri-implantares quando utilizada carga imediata em implantes unitários na região anterior de maxila: uma revisão sistemática / Peri-implantation tissue behavior when used immediate loading in unit implants in the previous region of maxila: a systematic review

Objetivo: Avaliar o comportamento dos tecidos peri-implantares (moles e duros) após a carga imediata de implantes unitários em áreas estéticas de maxila. Material e Métodos: Uma busca eletrônica foi realizada nas bases de dados BVS e PubMed por dois avaliadores independentes. Quando não houve consenso entre os avaliadores, depois de ler o artigo completo, um terceiro revisor foi incluído. Foram acrescidos textos completos de ensaios clínicos dos últimos 15 anos que avaliaram os seguintes parâmetros: altura da crista óssea, altura da papila interdental e recessão gengival vestibular. Resultados: Um total de nove artigos foi selecionado. Os dados mostraram que o comportamento dos tecidos peri-implantares em implantes com carga imediata foi muito semelhante aos observados em implantes com carga tardia. Além disso, em maiores períodos de acompanhamento, foi verificado que as papilas podem migrar coronalmente ao longo do tempo e que os tecidos duros apresentaram perda óssea média a 1,0 mm, independentemente da utilização ou não de carga imediata. No que diz respeito à estética, em geral, os pacientes ficaram satisfeitos e as perdas notadas ao longo do tempo parecem não interferir da satisfação estética do paciente. Conclusões: A perda de papilas, recessão gengival vestibular e perda óssea podem ocorrer silenciosamente, sendo o tempo mais importante para sua ocorrência que a utilização de carga imediata ou não, o que torna a carga imediata uma alternativa viável e promissora em regiões estéticas sem comprometer o comportamento dos tecidos peri-implantares. (AU)

Objective: Evaluate the behavior of peri-implant tissues (soft and hard) after loading. Low implants in aesthetic maxilla units. Material and methods: Therefore an electronic search was performed in the VHL and PubMed databases by two independent evaluators. When there was no consensus among the reviewers, after reading the full article, a third reviewer was included. We included complete texts of clinical trials of the last 15 years, which ancestors the respective parameters: height of the bone crest, height of the interdental papilla and gingival vestibular recession. Results: A total of nine articles were selected. The data showed that the behavior of the peri-implant tissues in loaded implants. There were very important observations in late load implants. In addition, at longer follow-up periods, it was verified that as papillae may migrate coronally over time and with hard tissues they presented mean bone loss of 1.0 mm, regardless of whether or not the load was used. With regard to aesthetics, patients were generally satisfied and perceived losses over time without interference from the aesthetic satisfaction of the patient. Conclusions: Thus, a loss of papillae, vestibular gingival recession and bone loss can occur silently, being the most important time for its occurrence that the use of load, there is not, which makes a load of a viable and promising alternative in aesthetic regions without Compromise the behavior of peri-implant tissues. (AU)

Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study.

INTRODUCTION: Oral anticoagulants are widely prescribed drugs. Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy. The purpose of this study was to evaluate the incidence of bleeding complications after dental extractions in patients on anticoagulant therapy (warfarin) in whom different local hemostatic methods were used. MATERIAL AND METHODS: Patients using warfarin and requiring extractions of at least two teeth were screened to participate in this prospective, randomized study. Extraction sites were considered as sampling units (statistically representative sample size) and were allocated to one of the three study groups (G1-4.8% tranexamic acid; G2-fibrin sponge; and G3-no local hemostatic agents). RESULTS: Eighty-four extraction sites were obtained from patients with mitral valve prolapse (47.4%), prosthetic cardiac valve (23.7%), venous thromboembolism (21.1%), and pulmonary embolism (5.2%). International normalized ratio (INR) values ranged between 2.1 and 3.1 (mean 2.51 ± 0.1). Postoperative bleeding was observed in four surgical sites (p < 0.001) and was mainly in older patients (p = 0.005). DISCUSSION: The three local hemostatic protocols were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin. The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy.

Avaliação da satisfação de pacientes submetidos à cirurgia ortognática: análise qualitativa / Evaluation of the satisfaction of patients submitted to orthognathic surgery: qualitative analysis

Os profissionais da odontologia têm se tornado mais consciente da relação dentição com os ossos faciais e seu impacto sobre a aparência facial. Este trabalho tem o propósito de avaliar, de forma qualitativa, o grau de satisfação de pacientes submetidos à cirurgia ortognática. Foram selecionados cinco pacientes submetidos a este tipo de tratamento, os quais foram submetidos a uma entrevista oral, semi-estruturada e gravada. As entrevistas foram transcritas e submetidas à análise de conteúdo. Desta análise resultou um textosíntese, com a categorização dos resultados obtidos. Verificou-se que o principal motivo dos pacientes aderirem à cirurgia foi a estética da face, sendo o fator função observado, também, como decisivo ao paciente frente à escolha do tratamento. O tratamento ortodôntico-cirúrgico proporcionou melhoras, tanto de ordem estética, funcional, de elevação da auto-estima, e consequente qualificação positiva no relacionamento interpessoal dos pacientes pesquisados

The dental professionals have become more aware of the relationship with dentition, facial bones and their impact on facial appearance. This work has the purpose of evaluating, in a qualitative way, the degree of patients’ satisfaction submitted to orthognathic surgery. Five patients were selected submitted to this treatment type, which they were submitted to an oral interview, semi-structured and recorded. The interviews were transcribed and submitted to the content analysis. Of this analysis it resulted a text-synthesis, with the categorization of the obtained results. It was verified that the patients’ main reason to adhere to the surgery it was the aesthetics of the face, being the factor function observed, also, as decisive to the patient front to the choice of the treatment. It was verified, likewise, that the orthodontic-surgical treatment provided improvements, so much of order aesthetic, functional, of elevation of the self-esteem, and consequent positive qualification in the researched patients interpersonal relationship

Do third molars weaken the mandibular angle?

Objective: The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molaron the mandibular angle stiffness.Study Design: It was performed a literature search on whole MEDLINE and LILACS data base to find articlesthat match the following inclusion criteria: cohort studies presenting data on patients with mandibular fracturesand third molars; that had a similar angle fracture definition; and that present data available to be cross-classifiedin a statistic analysis.Results: The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan,evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture,comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample wasgrouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was1,94 (95% CI 1,6 – 2,35).Conclusions: The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Evenwith this data, the present study cannot support conditions related to the third molar that may affect this impact.Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure inpopulation groups more predisposed to fracture (AU)

Efeito Antiálgico do Laser AsGaAl na Punção Anestésica / Analgesic Effect of GaAlAs Laser on Anesthetic Action

Objetivo: Este trabalho teve como objetivo avaliar a capacidade do laser de baixa potência em reduzir a sensação dolorosa durante a injeção da substância anestésica. Metodologia: Para isso, foram selecionados sessenta pacientes que iriam receber anestesia na região do palato. Esses pacientes foram divididos em três grupos: o grupo I recebeu irradiação com laser de AsGaAl antes da anestesia; o grupo II recebeu irradiação com a luz do fotopolimerizador antes da anestesia (placebo), e o grupo III não recebeu nenhum tratamento. A sensibilidade foi registrada por meio de uma escala visual numérica (EVN). Resultados: Após a análise dos resultados, pôde-se concluir que o laser de baixa potência de Arseniato de Gálio-Alumínio, segundo protocolo utilizado, promoveu uma redução da dor resultante da aplicação do anestésico na região do palato, quando utilizado previamente ao ato anestésico.

Porpuse: The aim of this study was to evaluate the low level laser capacity in reducing the pain during the anesthetic injection. Metodology: Sixty patient that would receive anesthesia in palate area were selected. Those were divided in three groups: the group I received irradiation with Gallium/Aluminium/Arsenide (GaAlAs) laser before the anesthesia, the group II received irradiation with the light curing unit device before the anesthesia (placebo) and the group III didn't receive treatment. The sensibility was registered through a numeric visual scale (NVS). Results: After the analysis of the results it can be ended that the GaAlAs low level laser, according the parameters used, promoted a pain reduction resulting from the anesthetic application in palate area, when previously used to the anesthetic action.

Criocirurgia no tratamento de lesões benignas dos maxilares: revisão de literatura e análise de 103 casos previamente reportados / Cryosurgery in treatment of benign jaw lesions: literature review and analyze of 103 cases previously reported

Introdução e objetivo: A região maxilofacial pode ser acometida poruma variedade de lesões benignas, mas localmente agressivas e comalto percentual de recorrência. Criocirurgia é um método que utilizabaixas temperaturas capazes de produzir destruição tecidual local. Osobjetivos do presente trabalho são revisar 103 casos de lesões ósseastratadas complementarmente pela criocirurgia e discutir seus principaisaspectos históricos, moleculares e terapêuticos. Revisão de literatura:O uso do nitrogênio líquido em lesões benignas dos maxilares comcomportamento biológico agressivo tem se mostrado uma terapia valiosa que busca manter a função e a estética do paciente e pode serefetiva em muitos casos, diminuindo os índices de recorrência local.Conclusão: A criocirurgia apresenta-se como uma terapêutica relevantepara a abordagem de lesões agressivas dos maxilares. Entretantofaltam subsídios na literatura que indiquem protocolos específicos epadronizados quanto ao número de ciclos de congelamento, à duraçãodas aplicações e ao período de degelo.

Introduction and objective: The maxillofacial region may be affectedby a variety of benign lesions, which are however locally aggressive andwith a high percentage of recurrence. Cryosurgery is a method that useslow temperatures capable of producing local tissue destruction. Theobjective of this study is to review 103 cases of bone lesions treated bycryosurgery and additionally to discuss the main historical, molecularand therapeutic aspects. Literature review: The use of liquid nitrogenin benign jaw lesions with aggressive biological behavior has been shownas a valuable therapy that aims to maintain the patient?s function andaesthetics and that may be effective in many cases by decreasing therates of local recurrence. Conclusion: Cryosurgery shows to be animportant therapeutic approach to aggressive jaw lesions. However,there is a lack of subsidies in the literature to indicate specific andstandardized protocols regarding the number of freezing cycles,duration of the applications and thaw period.