ABSTRACT
As cerâmicas de zircônia apresentam ótimas propriedades como biocompatibilidade, resistência flexural e dureza, tornando-se uma possível alternativa para substituição das restaurações metalocerâmicas. Entretanto, a zircônia sofre degradação superficial quando exposta ao calor e à umidade, e a utilização de estabilizadores e o domínio do processamento são relatados para melhorar a sua resistência. O uso da zircônia na Odontologia é uma realidade, mas pesquisas ainda são necessárias para avaliar seu desempenho a longo prazo na cavidade oral. Dessa forma, o objetivo deste estudo foi, através de uma revisão bibliográfica, avaliar o desempenho da zircônia como um biomaterial de uso odontológico...
Zirconia ceramics have excellent properties, such as biocompatibility, flexural strength and, hardness, and therefore are viable alternatives to metal-ceramic restorations. However, zirconia suffers superficial degradation when exposed to heat and humidity, thus the use of stabilizers and proper process of the area are important in order to improve its resistance. The use of zirconia in Dentistry is a reality, but studies are needed to assess its performance in long periods in the oral cavity. Thus, the objective of this study was to evaluate the performance of zirconia as a biomaterial for dental use through a literature review...
Subject(s)
Biocompatible Materials , Computer-Aided Design , Tensile Strength , ZirconiumABSTRACT
Abordar os principais aspectos relacionados à reabilitação oral ao relatar um caso clínico utilizando prótese parcial removível (PPR) com attachment ball. Discussão: As próteses implanto-suportadas são consideradas um tratamento efetivo para a reabilitação de muitos pacientes desdentados parciais. No en¬tanto, limitações ósseas e/ou sistêmicas e o custo elevado dos implantes podem contraindicar essa modalidade terapêutica. Assim, a reabilitação oral com PPR torna-se uma ótima opção de tratamento. É conhecido que as PPRs a grampo não apresentam boa estética em muitas situações clínicas; porém, PPRs associadas a attachments permitem diversas possibilidades de soluções clínicas quando um diagnóstico e plano de tratamento mais elaborado podem ser executados. Conclusão: A PPR retida por attachment propicia resultado estético superior, transmissão adequada da carga mastigatória aos dentes suportes e excelente retenção...
To discuss the main aspects related to oral rehabilitation through the report of a clinical case using removable dental prosthesis (RDP) with ball attachment. Discussion: The implant-supported fixed restorations are considered an effective treatment for the rehabilitation of many partially edentulous patients. However, bone and/or systemic limitations and the high cost of implants may contraindicate this therapeutic modality. Thus, the oral rehabilitation using RDP becomes a great treatment option. It is known that RDP retained to a clip do not present a good esthetic in several clinical conditions; however, the RDP with attachments allows several possibilities for clinical solutions when a diagnosis and a more elaborated treatment plan can be performed. Conclusion: The RDP with attachment provides better aesthetical result, adequate transmission of masticatory load to support teeth and an excellent retention...
Subject(s)
Humans , Female , Denture, Partial, Removable , Mouth Rehabilitation/methods , Dental Clasps , Models, Dental , Dental Prosthesis Design , Treatment OutcomeABSTRACT
Grandes avanços na história da Implantodontia vêm sendo documentados, porém, existem ainda algumas limitações no tratamento reabilitador com implantes dentários, o que desafia os profissionais a buscarem novas opções de tratamento. Pacientes que apresentam atrofia maxilar necessitam de procedimentos mais complexos, como enxertos ósseos extensos. Uma proposta de tratamento mais simplificada, com menor morbidade e menor tempo de tratamento, foi desenvolvida (Sistema all-on-four). Essa proposta de tratamento se baseia na redução do número de implantes compensada por um maior espaçamento entre eles, além da utilização dos implantes distais inclinados unidos por uma estrutura rígida que favorece a biomecânica e diminui a extensão do cantiléver.
Important progresses in the history of implants have been documented, but there are still some limitations in treatment rehabilitation with dental implants, challenging professionals to search for new treatment alternatives. Patients, with maxillary atrophy demand more complex procedures such as extensive bone grafts. A basic proposal for a treatment with lower morbidity and short-term duration has been developed (The All-on-Four Concept). This is based on reducing the number of implants compensated by an enlarged space between them, besides the use of tilted distal implants connected through a rigid structure that favors biomechanics and reduces cantilever extension.
Subject(s)
Biomechanical Phenomena , Dental ImplantsABSTRACT
BACKGROUND: Depressive symptoms and chronic disease have adverse effects on patients' health-related quality of life (H-RQOL). However, little is known about this effect on H-RQOL when only the two core depressive symptoms - loss of interest and depressed mood - are considered. The objective of this study is to investigate H-RQOL in the presence of loss of interest and depressed mood at a general medical outpatient unit. METHODS: We evaluated 553 patients at their first attendance at a general medical outpatient unit of a teaching hospital. H-RQOL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Depressed mood and loss of interest were assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD)-Patient Questionnaire. A physician performed the diagnosis of chronic diseases by clinical judgment and classified them in 13 possible pre-defined categories. We used multiple linear regression to investigate associations between each domain of H-RQOL and our two core depression symptoms. The presence of chronic diseases and demographic variables were included in the models as covariates. RESULTS: Among the 553 patients, 70.5% were women with a mean age of 41.0 years (range 18-85, SD ± 15.4). Loss of interest was reported by 54.6%, and depressed mood by 59.7% of the patients. At least one chronic disease was diagnosed in 59.5% of patients; cardiovascular disease was the most prevalent, affecting 20.6% of our patients. Loss of interest and depressed mood was significantly associated with decreased scores in all domains of H-RQOL after adjustment for possible confounders. The presence of any chronic disease was associated with a decrease in the domain of vitality. The analysis of each individual chronic disease category revealed that no category was associated with a decrease in more than one domain of H-RQOL. CONCLUSION: Loss of interest and depressed mood were associated with significant decreases in H-RQOL. We recommend these simple tests for screening in general practice.
Subject(s)
Depression/psychology , Quality of Life/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/psychology , Chronic Disease/psychology , Cross-Sectional Studies , Depression/physiopathology , Female , Health Surveys , Humans , Linear Models , Male , Middle Aged , Surveys and Questionnaires , Young AdultABSTRACT
Os implantes osseointegráveis representam grande avanço no tratamento odontológico, proporcionando significativa melhora no restabelecimento da saúde bucal, da função e da estética. Com seu advento, novos conceitos foram incrementados às técnicas de reabilitação oral. Ao revisar esses conceitos, o presente trabalho busca avaliar as vantagens, desvantagens, indicações e contraindicações de cada modalidade de retenção sobreimplantes. A pesquisa da literatura pertinente ao tema avaliou estudos clínicos, experimentais, revisões da literatura e livros entre os anos de 1981 a 2010. Muitas vezes, a escolha do tipo de retenção baseia-se somente na preferência do profissional, porém, a seleção do sistema de retenção deve ter uma indicação precisa para cada caso. Para tanto, o protesista deve ter conhecimento sobre os princípios fundamentais de passividade e adaptação da restauração protética, estética, espaço interoclusal, saúde dos tecidos moles peri-implantares, necessidade de manutenção, reversibilidade da restauração e aspectos oclusais de cada uma das opções protéticas para adequada execução dos casos clínicos. Conclui-se que a escolha do sistema de retenção não deve ser feita de forma genérica e sim ser individualizada dentro da particularidade de cada caso. Não devemos pensar que uma retenção seja melhor ou pior quando comparamos próteses retidas por cimento versus parafuso, o que deve ser levado em consideração são vantagens, desvantagens, indicações e contraindicações de cada caso em particular.
The osseointegrated implants represent a major advance in dental treatment, providing a significant improvement in the restoration of oral health, function, and aesthetics. Since its advent, new concepts evolved in techniques for oral rehabilitation. When reviewing these concepts, this study sought to determine the advantages, disadvantages, indications, and contraindications for each type of retention. The literature research evaluated clinical studies, research, literature reviews, and books between the years of 1981 to 2010. Oftentimes, the choice of retention is based solely on the preference of professional, but selection of the system should have an indication for each case. Thus, dental clinicians must know the fundamental principles of passivity and fit of prosthetic restorations; interocclusal space; aesthetic; peri-implant soft tissue health; need for maintenance; retrievability, and occlusal aspects of each prosthetic option for proper implementation in clinical cases. We conclude that the choice of retention system should never be made by chance, but individualized within the particularity of each case. Screwed- are not superior to cement-retained prostheses and vice-versa; thus one must take into account the advantages, disadvantages, indications, and contraindications of each particular case.
Subject(s)
Dental Implants , Dental Prosthesis, Implant-SupportedABSTRACT
OBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%). DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.
Subject(s)
Depression/diagnosis , Depressive Disorder, Major/diagnosis , Family Practice , Primary Health Care/standards , Adolescent , Adult , Ambulatory Care/standards , Ambulatory Care/statistics & numerical data , Cross-Sectional Studies , Depression/psychology , Depressive Disorder, Major/psychology , Diagnostic and Statistical Manual of Mental Disorders , False Negative Reactions , False Positive Reactions , Female , Humans , Male , Primary Health Care/statistics & numerical data , Psychiatry , Sensitivity and Specificity , Severity of Illness Index , Socioeconomic Factors , Young AdultABSTRACT
OBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4-76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2-99.4%). DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Depression/diagnosis , Depressive Disorder, Major/diagnosis , Family Practice , Primary Health Care/standards , Ambulatory Care/standards , Ambulatory Care/statistics & numerical data , Cross-Sectional Studies , Diagnostic and Statistical Manual of Mental Disorders , Depression/psychology , Depressive Disorder, Major/psychology , False Negative Reactions , False Positive Reactions , Psychiatry , Primary Health Care/statistics & numerical data , Sensitivity and Specificity , Severity of Illness Index , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Studies investigating the performance of instruments to detect major depressive disorder (MDD) have reported inconsistent results. Subsyndromal depression (SD) has also been associated to increased morbidity, and little is known about its detection in primary care setting. This study aimed to investigate the performance of the Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect MDD and any depression (threshold at SD) in an outpatient unit of a teaching general hospital. METHODS: Nineteen primary care physicians using the PRIME-MD evaluated 577 patients, 240 of them (75% female; mean age, 40.0 +/- 14.4), including all with MDD and a randomly subset of those without MDD, were evaluated by 11 psychiatrists using the Structured Clinical Interview Axis I Disorders, Patient Version (SCIDI/P) for DSM-IV as the standard instrument. RESULTS: The kappa between the PRIME-MD and the SCID was 0.42 for the diagnosis of any depression and 0.32 for MDD. The distribution of the number of depressive symptoms per patient suggested the existence of a continuum between SD and MDD, and a high frequency of subjects with 4-6 symptoms (close to the cutoff for the diagnosis of MDD). LIMITATIONS: The sample has a modest size and is a subset of an original one. CONCLUSION: A continuum between SD and MDD may in part explain the relatively low agreement for the diagnosis of MDD in our sample and possibly in other studies. Studies investigating the performance of screening instruments to detect MDD, should consider the relevance of identifying SD, and the influence of the distribution of the number of depressive symptoms in their results.