Céramiques dentaires en prothèse dentaire: développment historique

La céramique est utilisée depuis longtemps en dentisterie. Elle est considérée comme le matériau le plus esthétique. Les céramiques sont devenues de plus en plus populaires comme matériaux de restauration en raison de leurs esthétique, leurs inertie et leurs biocompatibilité. De nombreux différents types de systèmes céramiques ont été introduits ces dernières années qui pourraient être utilisés pour des restaurations indirectes. Ils peuvent être déroutants pour le clinicien de les connaître et de faire le choix par la suite. Il est important de les comprendre de façon simple. Leur compréhension pourrait être facile en se basant sur le développement historique, la structure chimique et leurs applications. Cependant, les problèmes majeurs de la céramique sont leur fragilité et leur susceptibilité aux fractures [Lawn etal. 2001]1, [Griggs., 2007]2. Les couts financiers pour le développement d'une céramique résistante aux fractures et esthétique sont élevés : la couronne européenne et le marché FDP avaient approché 2 milliards de dollars en 2007 [Millennium ResearchGroup ; 2007]3 ;la couronne mondiale et le marchéFDP était estimé à 25 milliards de dollars en 2010 et à plus de 30 milliards de dollars en 2015 [Palmer., 2010]4. Cet article fournit un aperçu de la céramique dentaire qui est présenté d'une manière simplificatrice permettant une compréhension de leur développement

Prothèse composite stabilisée sur implants: à propos d'un cas clinique

Ce cas clinique décrit la prise en charge d'un édentement maxillaire unilatéral de grande étendue par une prothèse composite stabilisée sur implants. Dans cette situation clinique défavorable et lorsque la solution par prothèse fixée sur implants ne peut être retenue pour des raisons locales ou générales, la prothèse amovible partielle métallique (PAPM) reste l'alternative de choix. Elle peut être stabilisée efficacement par des implants. En effet, l'utilisation de ces derniers comme support de moyens de rétention complémentaires est d'un apport considérable. Ainsi, la PAPM stabilisée sur implants permet de modifier l'architecture de l'édentement, d'optimiser l'équilibre prothétique, de rallier exigences esthétiques et fonctionnelles assurant alors une meilleure intégration prothétique

Immediate Postextraction Screw-Retained Partial and Full-Arch Rehabilitation: A 3-Year Follow-up Retrospective Clinical Study.

The aim of this study was to document the performance of a novel technique (OnlyOne), involving immediate restoration of postextraction implants supporting a partial or full-arch restoration. A retrospective analysis of patients with at least 3 years of follow-up was performed. Implants were tilted mesiodistally and vestibulopalatally according to the available bone. Prosthetically guided definitive abutments were connected at surgery and never disconnected. Anorganic bovine bone grafting was done to preserve the buccal bone and the ridge contour. Patients received a screw-retained provisional prosthesis within 24 hours of surgery and a final screw-retained prosthesis within 1 year. Prostheses emerged from natural soft tissue. Clinical and radiographic evaluation was routinely performed. A total of 70 patients received 153 implants in fresh extraction sockets. The mean follow-up was 38.0 ± 3.0 months (range 36 to 51 months). One implant failed at the 3-year follow-up. Implant survival was 99.3%. Marginal bone level change averaged -0.68 ± 1.2 mm at the last radiographic control. Immediate placement and restoration of implants designed for high primary stability with a definitive abutment placed at surgery and final screw-retained prosthesis with no artificial gingiva is a viable procedure with excellent medium-term outcomes.

Importancia estética de la prótesis inmediata / Cosmetic importance of the immediate prosthesis

Se presentan los casos clínicos de 3 adultos con dientes extraídos, atendidos en la consulta de prótesis dental del Policlínico Docente 30 de Noviembre de Santiago de Cuba, a quienes se les colocó prótesis inmediata como única solución ante el deterioro bucal que presentaban. Con el proceder realizado se logró la recuperación estética de los pacientes, así como la reinserción en las actividades sociales y laborales, evitando así las afectaciones psíquicas que suelen aparecer(AU)

The case reports of 3 adults with extracted teeth are presented. They were assisted in the dental prosthesis service of 30 de Noviembre Teaching Polyclinic in Santiago de Cuba to whom immediate prothesis were placed as the only solution due to the oral deterioration that presented. With this procedure the cosmetics of the patients was recovered and their reintegration to the social and labor activities was achieved, with which the psychic disorders that usually appear were avoided(AU)

Importancia estética de la prótesis inmediata / Cosmetic importance of the immediate prosthesis

Se presentan los casos clínicos de 3 adultos con dientes extraídos, atendidos en la consulta de prótesis dental del Policlínico Docente 30 de Noviembre" de Santiago de Cuba, a quienes se les colocó prótesis inmediata como única solución ante el deterioro bucal que presentaban. Con el proceder realizado se logró la recuperación estética de los pacientes, así como la reinserción en las actividades sociales y laborales, evitando así las afectaciones psíquicas que suelen aparecer

The case reports of 3 adults with extracted teeth are presented. They were assisted in the dental prosthesis service of 30 de Noviembre Teaching Polyclinic in Santiago de Cuba to whom immediate prothesis were placed as the only solution due to the oral deterioration that presented. With this procedure the cosmetics of the patients was recovered and their reintegration to the social and labor activities was achieved, with which the psychic disorders that usually appear were avoided

Prótesis inmediata con analgesia acupuntural en una adulta mayor / Immediate prosthesis with acupunctural analgesia in an elderly

Se describe el caso clínico de una paciente de 62 años de edad, quien temía a los anestésicos dentales convencionales, pero tenía gran preocupación por rehabilitar su estética con prótesis inmediata. Se decidió aplicar anestesia acupuntural y realizar las extracciones dentales para que recibiera el tratamiento deseado. No se manifestaron reacciones adversas y la paciente quedó satisfecha por los resultados obtenidos, así como por las ventajas que ofrece esta terapia natura(AU)

The case report of a 62 years patient is described who was afraid of the conventional dental anesthetics, but she had great concern to rehabilitate her aesthetics with immediate prosthesis. It was decided to apply acupunctural anesthetic and to carry out the dental extractions so that she received the desired treatment. There were not adverse effects and the patient was satisfied with the results obtained, as well as with the advantages of this natural therapy(AU)

Immediate occluding definitive partial fixed prosthesis versus non-occluding provisional restorations - 4-month post-loading results from a pragmatic multicenter randomised controlled trial.

PURPOSE: To compare the clinical outcome of dental implants restored with definitive occluding partial fixed prostheses within 1 week, after implant placement with immediate non-occluding provisional restorations, which were to be replaced by definitive prostheses after 4 months. MATERIALS AND METHODS: Fifty partially edentulous patients treated with one to three dental implants, at least 8.5 mm long and 4.0 mm wide inserted with a torque of at least 35 Ncm, were randomised in two groups of 25 patients each, to be immediately loaded with partial fixed prostheses. Patients of one group received one definitive screw-retained metal-ceramic prosthesis in occlusion within 1 week after placement. Patients of the other group received one non-occluding provisional acrylic reinforced prosthesis within 24 h after implant placement. Provisional prostheses were replaced after 4 months by definitive ones. The follow-up for all patients was 4-months post-loading. Outcome measures were prosthesis and implant failures, any complications, peri-implant marginal bone level changes, aesthetic evaluation by a clinician, patient satisfaction, chair time and number of visits at the dental office from implant placement to delivery of definitive restorations. RESULTS: No patient dropped out. Two immediately occlusally loaded implants with their related definitive prostheses (8%) failed early (difference in proportions = 0.08; 95% CI: -0.03 to 0.19; P = 0.490). Four complications occurred in the occlusal group versus one in the non-occlusal group; (difference in proportions = 0.12; 95% CI: -0.04 to 0.28; P = 0.349). Four months after loading, patients subjected to non-occlusal loading lost an average of 0.72 mm of peri-implant bone versus 0.99 mm of patients restored with occluding definitive partial fixed prostheses. There were no statistically significant differences for marginal bone level changes between the two groups (mean difference = -0.27 mm; 95% CI: -0.84 to 0.30; P = 0.349). The differences for aesthetic scores showed no statistical significance (8.26 versus 7.58; P = 0.445); the same was seen for aesthetics evaluated by patients (Mann-Whitney U test: P = 0.618). Patients in the non-occlusal group were significantly more satisfied with the function of their implant-supported prostheses (Mann-Whitney U test: P = 0.039). Significantly less chair time (mean difference = -28.4 min; 95% CI: -48.82 to -7.99; P = 0.007) and the number of visits (mean difference = -1.88; 95% CI: -2.43 to -1.33; P < 0.001) were required for the immediate definitive prosthesis group. CONCLUSION: This study did not provide a conclusive answer but may suggest that provisional prostheses non-occlusally immediately loaded may increase patient functional satisfaction, chair time and the number of visits, with respect to definitive prostheses immediately loaded in functional occlusion.

Fabrication of a Denture without Try-In Clinical Trouble Shooting.

An immediate denture is a prosthesis which is fabricated without a denture try-in procedure in the patient's mouth and inserted at the same visit immediately after extraction of the teeth. This article presents an atypical case where the immediate interim denture had to be fabricated while the patient waited in the chair.

Utilização dos dentes naturais para reabilitação provisória após exodontia por comprometimento periodontal / Use of natural teeth for provisional rehabilitation after extraction caused by periodontal commitment

OBJETIVO: o objetivo deste trabalho foi relatar um caso clínico de periodontite crônica localizada, no qual foi indicada exodontia dos elementos comprometidas e os mesmos foram aproveitados para confecção de uma prótese provisória imediata. DESCRIÇÃO DO CASO: Paciente E.A.S.N, gênero masculino, atendido na clínica da FacDelta - UNIME Salvador, foi diagnóstico com periodontite crônica severa localizada e planejado exodontia das unidades comprometidas e reabilitação com prótese provisória imediata, utilizando os próprios dentes recém-extraídos. Após secção na altura do terço médio da raiz e remoção da polpa, os elementos foram selados com resina composta fotopolimerizada, seguindo o protocolo de restauração adesiva. Posteriormente, um fragmento de foi ortodôntico pré-curvado foi fixado nos dentes pilares assim como os dentes extraídos foram fixados ao foi utilizando resina composta. Oclusão foi ajustada para não haver contatos cêntricos e excêntricos, realizado acabamento e polimento e instrução de higiene oral e sobre a cuidados com a mastigação na região. CONCLUSÃO: Prótese provisória imediata utilizando os próprios dentes do paciente recém-extraídos configurou uma opção reabilitadora viável para este caso devido às restrições de tempo e financeira do paciente, por ser uma técnica conservadora e na obtenção da sua satisfação

OBJECTIVE: The objective of this study was to report a case of localized chronic periodontitis, and the extraction of committed elements was indicated and they were utilized in the immediate provisional prosthesis. CASE DESCRIPTION: Patient E.A.S.N, male, attended in the FacDelta - UNIME Salvador clinic, he was diagnosed with located severe chronic periodontitis and planned extraction of the affected units and rehabilitation with immediate provisional prosthesis using their own extracted teeth. After had been sectioned in the middle third of the height of the root and removed the pulp, the elements were sealed with light-cured composite resin, following the adhesive restoration protocol. Subsequently, a fragment of pre-curved orthodontic wire was fixed in abutment teeth and extracted teeth were fxed to wire using composite resin. Occlusion was adjusted in order to avoid contacts, it was done the fnishing and polishing and the patient was instructed about oral hygiene and the avoidance with chewing in the region. CONCLUSION: immediate provisional prosthesis using their own extracted patient's teeth was a viable rehabilitative option for this case due to patient's time and fnancial constraints; it was a conservative technique and got his satisfaction

Consideraciones sobre el perfil de emergencia en implantes dentales: parte 2 / Considerations on implant emergence profile: part 2

Existe poca información objetiva acerca del perfil de emergencia en implantes dentales que aborde el tema de manera global e integral. Sin embargo, varios aspectos que involucran el perfil de emergencia de una restauración han sido ampliamente estudiados y documentados en forma separada. Habiéndose analizado en la primera parte de este artículo la relación entre los aspectos biológicos, quirúrgicos y los diferentes tipos de implantes disponibles, en esta segunda parte se amplía la revisión sobre el manejo quirúrgico y clínico, con el fin de lograr un enfoque objetivo para la comprensión del perfil de emergencia en restauraciones sobre implantes dentales.

Fabricating an immediate denture for a medically compromised elderly patient.

Fabricating an immediate denture (ID) in the conventional manner may be complicated and difficult. An alternative technique is described for the fabrication of an ID that eliminates the need for an interim prosthesis and reduces treatment time.

[Transient removable dentures]. / Les prothèses amovibles transitoires.

Removable dentures are always transient current. The epidemiology and causes of tooth gaps demonstrate the need to master the different prosthetic treatment. This made whether to propose treatment plans that take into account psychological, physiological and technical support for this patient. Different situations may arise. A gradual transition may be considered or immediate passage to the total edentulous according to general criteria, local and desiderata of patients. After tooth extraction, the transitional prosthesis can control bone lysis thereby it is part of a complete treatment before prosthesis. It also facilitates a good psychological and physiological integration before the prosthesis use.

Immediate rehabilitation of the posterior maxilla with extensive sinus pneumatization with one axial and one trans-sinus tilted implant: a 3-year clinical report and a classification.

Implant rehabilitation of the posterior maxilla can entail difficulties due to reduced bone quantity and poor bone quality, especially after long-term edentulism. In some patients, multiple surgeries are necessary, which may lead to higher patient morbidity and longer treatment times before a prosthetic rehabilitation can be achieved. This article presents an immediate fixed prosthesis in a posterior atrophic maxilla supported by 1 anterior axial implant and 1 posterior tilted fixture placed with an intrasinus insertion. Additionally, a classification scheme for immediate treatment for the posterior maxilla based on the available residual bone is provided.

Sobredentadura metálica en paciente bruxópata / Metallic overdenture in patient with bruxism habit

Se presenta el caso de un paciente masculino de 49 años de edad que acudió a la consulta de prótesis, el mismo había recibido tratamiento de estomatología general integral, donde se le sugirió la exodoncia de los dientes anteroinferiores, por la pérdida de la mitad de sus coronas anatómicas. Se le realizaron exámenes radiográficos y test de vitalidad, comprobando la vitalidad de los dientes; se le diagnosticó una disfunción masticatoria producto del hábito del bruxismo y se procedió a realizar una prótesis parcial removible metálica inferior (sobredentadura), la cual permitió controlar el hábito parafuncional y lograr la rehabilitación en un mismo tratamiento. Además, se logró devolver la funcionabilidad y la integridad de los dientes remanentes (sin necesidad de realizar tratamientos pulporradiculares), restaurando la dimensión vertical oclusiva y el contorno facial. Se propuso este tratamiento combinado, como alternativa eficaz en el manejo del bruxismo en pacientes parcialmente desdentados (AU)

A case of a 49 year-old male patient who went to the prosthesis consultation is presented; he had received stomatology general integral treatment and had been suggested to out the anteroinferior teeth because of the loss of half of his anatomic crowns. Radiographic examinations and vitality tests were carried out, checking the vitality of the teeth. He was diagnosed a masticatory dysfunction as a result of the habit of bruxism, proceeding to make an inferior metallic removable partial denture (overdenture), which allowed to control the unconscious habit and to achieve the rehabilitation in the same treatment. Besides, it permitted to bring back the functionality and integrity to the remains of the teeth (without necessity of performing endodontic treatments), also restoring the occlusive vertical dimension and the facial contour. This combined treatment is put forward as an effective alternative for the management of bruxism in partially edentulous patients (AU)

Rehabilitación protésica inmediata por fracaso de un reimplante dentario: presentación de un caso / Immediate prosthetic rehabilitation because of failure of a dental reimplantation: a case presentation

Fundamento: la avulsión dentaria es la salida completa del diente de su alveolo, el mejor tratamiento para un niño es la reimplantación de su propio diente, pero la terapéutica ofrece grandes retos al profesional que dependen de múltiples factores.Objetivo: demostrar que la rehabilitación por prótesis inmediata, es una alternativa ante el fracaso de un reimplante dentario.Caso Clínico: paciente masculino, de doce años de edad, que acudió con su padre a la consulta de prótesis estomatológica del Policlínico de atención a combatientes de los servicios médicos del MININT de Camagüey, porque hace dos años y medio le fue reimplantado el diente antero superior derecho al recibir un golpe en la cabeza que le provocó la salida del mismo de su alveolo y entonces presentó signos y síntomas característicos de una evolución desfavorable.Conclusión: se comprobó la existencia de una reabsorción radicular inflamatoria avanzada, asociada a otros factores como: prolongado tiempo extraoral del diente reimplantado, deficiente medio de conservación, inadecuado tipo y tiempo de ferulización y el tórpido manejo endodóntico. La rehabilitación protésica inmediata fue el tratamiento adecuado para restablecer los parámetros psíquicos, estéticos y funcionales demandados por el paciente(AU)

Background: dental avulsion is the complete loss of a tooth from its alveolus; the best treatment for a child is the reimplantation of the own tooth but the therapeutics presents great challenges for the professionals that depend on many factors.Objective: to demonstrate that the rehabilitation by means of immediate prosthesis is an alternative to the failure of a dental reimplantation.Clinical case: a twelve-year-old male patient that came with his father to the stomatological consultation of prosthesis of the policlinic for veterans of the medical service of the Ministry of Internal Affairs of Camagüey. Two and a half years ago, the patient underwent the reimplantation of the right anterosuperior tooth after receiving a blow to the head that caused the loss from the alveolus; then, the patient presented signs and symptoms characteristic of an unfavourable progress.Conclusions: the existence of an advanced inflammatory radicular reabsorption was confirmed, associated to other factors like: a prolonged extraoral time of the reimplanted tooth, a deficient conservation medium, inadequate type and time of splinting and the torpid endodontic handling. The immediate prosthetic rehabilitation was the suitable treatment to re-establish the psychic, aesthetic, and functional parameters required by the patient(AU)

Rehabilitación protésica inmediata por fracaso de un reimplante dentario: presentación de un caso / Immediate prosthetic rehabilitation because of failure of a dental reimplantation: a case presentation

FUNDAMENTO: la avulsión dentaria es la salida completa del diente de su alveolo, el mejor tratamiento para un niño es la reimplantación de su propio diente, pero la terapéutica ofrece grandes retos al profesional que dependen de múltiples factores. OBJETIVO: demostrar que la rehabilitación por prótesis inmediata, es una alternativa ante el fracaso de un reimplante dentario. CASO CLÍNICO: paciente masculino, de doce años de edad, que acudió con su padre a la consulta de prótesis estomatológica del Policlínico de atención a combatientes de los servicios médicos del MININT de Camagüey, porque hace dos años y medio le fue reimplantado el diente antero superior derecho al recibir un golpe en la cabeza que le provocó la salida del mismo de su alveolo y entonces presentó signos y síntomas característicos de una evolución desfavorable. CONCLUSIÓN: se comprobó la existencia de una reabsorción radicular inflamatoria avanzada, asociada a otros factores como: prolongado tiempo extraoral del diente reimplantado, deficiente medio de conservación, inadecuado tipo y tiempo de ferulización y el tórpido manejo endodóntico. La rehabilitación protésica inmediata fue el tratamiento adecuado para restablecer los parámetros psíquicos, estéticos y funcionales demandados por el paciente.

BACKGROUND: dental avulsion is the complete loss of a tooth from its alveolus; the best treatment for a child is the reimplantation of the own tooth but the therapeutics presents great challenges for the professionals that depend on many factors. OBJECTIVE: to demonstrate that the rehabilitation by means of immediate prosthesis is an alternative to the failure of a dental reimplantation. CLINICAL CASE: a twelve-year-old male patient that came with his father to the stomatological consultation of prosthesis of the policlinic for veterans of the medical service of the Ministry of Internal Affairs of Camagüey. Two and a half years ago, the patient underwent the reimplantation of the right anterosuperior tooth after receiving a blow to the head that caused the loss from the alveolus; then, the patient presented signs and symptoms characteristic of an unfavourable progress. CONCLUSIONS: the existence of an advanced inflammatory radicular reabsorption was confirmed, associated to other factors like: a prolonged extraoral time of the reimplanted tooth, a deficient conservation medium, inadequate type and time of splinting and the torpid endodontic handling. The immediate prosthetic rehabilitation was the suitable treatment to re-establish the psychic, aesthetic, and functional parameters required by the patient.

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 1 / Diagnosis and management of fractured teeth associated with parafunction: part 1

Objetivo: presentar el caso de un paciente con fractura dentaria de etiología parafuncional y su resolución implantoprotética. Caso clínico: una paciente de 65 años de edad, con fractura verticalc ompleta en la pieza dentaria 2.4, consultó por dolor al masticar. Se realizó la exodoncia atraumática del diente y se colocó un implante con corona provisoria, de forma inmediata. Finalmente, se colocaron un emergente y una corona libres de metal y se instaló una placa de protección neuromiorrelajante. Conclusión: la prevención y el diagnóstico tempranos de las fracturas dentarias atribuidas a parafunción, permiten la realización de tratamientos menos invasivos que conservan las piezas dentarias naturales del paciente

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 1 / Diagnosis and management of fractured teeth associated with parafunction: part 1

Objetivo: presentar el caso de un paciente con fractura dentaria de etiología parafuncional y su resolución implantoprotética. Caso clínico: una paciente de 65 años de edad, con fractura verticalc ompleta en la pieza dentaria 2.4, consultó por dolor al masticar. Se realizó la exodoncia atraumática del diente y se colocó un implante con corona provisoria, de forma inmediata. Finalmente, se colocaron un emergente y una corona libres de metal y se instaló una placa de protección neuromiorrelajante. Conclusión: la prevención y el diagnóstico tempranos de las fracturas dentarias atribuidas a parafunción, permiten la realización de tratamientos menos invasivos que conservan las piezas dentarias naturales del paciente (AU)

Transition from failing dentition to full-arch fixed implant-supported prosthesis with a staged approach using removable partial dentures: a case series.

The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full-arch fixed implant-supported prosthesis may be inserted. Eight patients, who had undergone maxillary full-arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow-up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.