Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: A randomized controlled clinical trial with a minimum follow-up of 7 years.

STATEMENT OF PROBLEM: Long-term clinical studies are lacking on the influence of the type of abutment, titanium or zirconia, on peri-implant tissues. PURPOSE: The purpose of this randomized clinical trial was to evaluate peri-implant tissues with titanium or zirconia abutments. MATERIAL AND METHODS: A total of 26 single-tooth implant-supported prostheses in 14 participants were analyzed. They received either a titanium abutment with a metal-ceramic crown (TAG) or a zirconia abutment with a ceramic crown (ZAG). Data were collected immediately, at 5 months, and at a minimum of 7 years after crown delivery. The success rate, plaque and bleeding indexes, bleeding on probing, white and pink esthetic scores, and the relationships of the gingival phenotype with the pink esthetic score were analyzed. Statistical analyses were conducted with the t test for paired and independent data (α=.05). RESULTS: The mean follow-up time was 95.2 ±2.6 months, showing an implant success rate of 96.7%. No statistically significant differences were found between TAG and ZAG among the time intervals evaluated for plaque or bleeding indexes (P>.05). A statistically significant difference was found for peri-implant probing depths in the mid-buccal sites between the groups at all the time intervals evaluated (TAG, P=.008; ZAG, P=.021): TAG showed an increase between 5 months (3.65 ±0.93 mm) and over 7 years (4.47 ±1.32 mm); and ZAG showed a reduction (5 months=5.22 ±1.71 mm; over 7 years=4.25 ±1.28 mm) in values. For the pink (PES) and white esthetic score (WES), ZAG (PES: immediately=6.33 ±1.41; 5 months=7.44 ±1.81; over 7 years=8.25 ±1.03; WES: immediately=7.67 ±1.50; over 7 years=8.38 ±0.74) showed higher mean values than TAG (PES: immediately=5.94 ±2.35; 5 months=6.53 ±2.15; over 7 years=7.44 ±1.81; WES: immediately=7.00 ±1.17; over 7 years=8.35 ±1.27) (P<.05). Statistically significant differences were found for gingival phenotype and for PES in TAG (P=.031), and the participants with thick phenotype showed higher PES in the 3 time intervals studied. CONCLUSIONS: Zirconia abutments exhibited better results than titanium abutments in terms of the peri-implant tissues. Moreover, in those with a thin phenotype, zirconia provided improved gingival esthetics.

Diagnóstico e tratamento restaurador com resina composta e matriz oclusal em molar com lesão de cárie oculta / Diagnosis and restorative treatment with composite resin and occlusal matrix on molar with occult caries lesion

Atualmente, o diagnóstico de cárie tem sido mais difícil em razão do aparecimento de pacientes com cáries ocultas nos dentes posteriores, sendo necessários métodos auxiliares capazes de proporcionar ao dentista segurança quanto à intervenção restauradora. Este trabalho teve como objetivo demonstrar, com um relato de caso clínico, a utilização do aparelho DIAGNOdent® (Kavo) como método auxiliar no diagnóstico de cárie oculta num primeiro molar inferior e a técnica restauradora direta com resina composta com auxílio de uma matriz oclusal em acrílico autopolimerizável (AU).

Currently the diagnosis of caries has been more difficult due to the presence of patients with occult caries in the posterior teeth, so ancillary methods are necessary to provide the dentist safety regarding restorative intervention. The objective of this study was to demonstrate through a clinical report, the use of the DIAGNOdent® (Kavo) device as an aid in the diagnosis of occult caries in a lower first molar and the direct restorative technique with a composite resin using an Acrylic self-curing occlusal matrix (AU).

Dream Recall Frequencies and Dream Content in Wilson's Disease with and without REM Sleep Behaviour Disorder: A Neurooneirologic Study.

Objective. Violent dream content and its acting out during rapid eye movement sleep are considered distinctive for rapid eye movement sleep behaviour disorder (RBD). This study reports first quantitative data on dreaming in a cohort of patients with treated Wilson's disease (WD) and in patients with WD with RBD. Methods. Retrospective questionnaires on different dimensions of dreaming and a prospective two-week home dream diary with self-rating of emotions and blinded, categorical rating of content by an external judge. Results. WD patients showed a significantly lower dream word count and very few other differences in dream characteristics compared to age- and sex-matched healthy controls. Compared to WD patients without RBD, patients with WD and RBD reported significantly higher nightmare frequencies and more dreams with violent or aggressive content retrospectively; their prospectively collected dream reports contained significantly more negative emotions and aggression. Conclusions. The reduction in dream length might reflect specific cognitive deficits in WD. The lack of differences regarding dream content might be explained by the established successful WD treatment. RBD in WD had a strong impact on dreaming. In accordance with the current definition of RBD, violent, aggressive dream content seems to be a characteristic of RBD also in WD.

Zirconia Abutment Supporting All Ceramic Crowns in the Esthetic Zone: Interim Results of a Prospective Study.

AIM: This prospective study evaluated peri-implant tissues around all-ceramic crowns fabricated using CAD/CAM technology. MATERIAL AND METHODS: Twenty-five patients received pre-fabricated zirconia implant abutments with CAD/CAM zirconia copings in the esthetic zone. Implants were evaluated at baseline, and at 3 and 6 months in function. RESULTS: Radiographic analyzes showed stable bone crest around the implants. Esthetics were more favorable as time lapsed (p > 0.05). Bleeding Index was constant in all time intervals. Plaque index reduced from 3 to 6 months. CONCLUSION: The all-ceramic CAD/CAM crowns were clinically, radiographically and esthetically stable during the study period.

Wilson's disease with and without rapid eye movement sleep behavior disorder compared to healthy matched controls.

OBJECTIVE: Quantitative data are reported on rapid eye movement (REM) sleep behavior disorder (RBD) in a cohort of predominantly neurological Wilson's disease (WD). METHODS: A total of 41 patients with WD and 41 healthy, age- and gender-matched controls were studied by conducting face-to-face interviews, neurological and clinical examinations, laboratory tests, and WD- and RBD-specific scales. Video-polysomnography and quantification of REM sleep without atonia (RWA) were conducted in 35 patients and 41 controls. RESULTS: Patients with WD showed significantly worse sleep quality, less sleep efficiency, increased wakefulness after sleep onset, and more arousals compared to healthy controls. Five patients with WD (four women) fulfilled the diagnostic criteria for RBD with significantly higher values in RWA, RBD Questionnaire-Hong Kong, and RBD Screening Questionnaire compared to patients with WD without RBD. In three patients with WD, RBD had manifested before any other symptom that could be attributed to WD. Percentage of RWA was significantly lower in WD without RBD than in WD with RBD, but still significantly increased compared to controls. CONCLUSIONS: RBD can be comorbid with WD. RWA is commonly present in WD, both in the presence or absence of clinical RBD. A causal connection is possible, though retrospective determination of RBD onset and the low number of patients do not allow a definitive conclusion at this point. However, screening for WD in idiopathic RBD is available at low cost and is recommended. Early-stage copper chelation therapy provides a highly effective treatment to prevent further WD manifestations and might also control the comorbid RBD.

Associação terapêutica de dexametasona e meloxicam no controle inflamatório, após cirurgias de terceiros molares / Combination therapeutic dexamethasone and meloxicam in inflammatory controlafter third molars surgery

Os corticosteroides (CS) e anti-inflamatórios não esteroides (AINES) têm sido usados na busca do controle de processos inflamatórios em pacientes submetidos a cirurgias. O objetivo deste estudo foi avaliar o efeito entre o uso exclusivo de dexametasona e a associação desta e meloxicam no controle de edema, trismo e dor após selecionaram se cirurgias de terceiros molares inclusos. 15 pacientes com terceiros molares mandibulares inclusos (3MI) em posições simétricas, divididos por sorteio em grupos terapêuticos (GT). No grupo 1(GT1), receberam dose única via oral de 12 mg de dexametasona uma hora antes do procedimento cirúrgico; grupo 2 (GT2), 12 mg de dexametasona uma hora antes do procedimento cirúrgico e 15 mg de meloxicam no pós-operatório imediato por via oral, mantido a cada 24 horas, durante 3 dias. O edema e trismo foram avaliados, respectivamente, através de mensurações lineares da face e da distância interincisal pré e pós-operatória (24, 48 e 72h). A intensidade de dor foi avaliada através da escala visual analógica (EVA). Os dados foram submetidos ao teste t-student e teste Levene (p<0,05). As medidas de edema e trismo não apresentaram diferenças estatisticamente significativas. A associação resultou em menor intensidade de dor com diferença estatisticamente significativa. Concluiu-se que as duas terapias foram válidas no controle do edema e trismo, sendo a terapia combinada de dexametasona e meloxicam mais eficiente no controle da dor... (AU)

This Corticosteroids and anti-inflammatory non-steroidal drugs have been used in the search control inflammation of patients submitted to dental surgery. The goalwastoevaluate the effect of exclusive use of dexamethasoneandcombinationofdexamethasoneandmeloxicam in control of edema, trismus and pain following the extraction of impacted third molars (3MI). Fifteen healthy patients with indication for removal third molars in symmetricalpositionswereselected, dividedbydrawlot in therapeuticgroups (GT). In group1 (GT1), received a single oral dose of dexamethasone 12 mg one hour before the surgical procedure; in group 2 (GT2), oral dose of dexamethasone 12 mg one hour beforesurgery, and oral dose of 15 mg of meloxicamimmediatelypostoperative oral, at 24, 48 e 72h following surgery. At 24, 48 and 72 h following surgery, swelling was determine dusing linear measurement son the face andtrismus, by maximal mouth opening. Postoperative pain was self-recorded by patientsusing a visual analoguescale (VAS). Data analysisinvolved t-studentte stand Levenetest (p <0.05). Edema measures and trismus showed no statistically significant differences. The combination the rapeuticresulted in less pain with statistically significant difference. In conclusion, both the rapieswerevalids in controlling edema andtrismus, and combination the rapeutic more effective in pain control... (AU)

An alternative approach for augmenting the anterior maxilla using autogenous free gingival bone graft for implant retained prosthesis.

Numerous factors may keep surgeons from placing implants in the anterior maxilla in order to avoid suboptimal restorative outcomes. This paper describes a technique of an autogenous-free gingival-bone block graft, which allows bone and gingival augmentation and a primary seal to be achieved simultaneously. Additionally, it describes a technique for achieving primary soft tissue closure of maxillary extraction sockets using a rotated pedicle palatal connective tissue flap.