Guided implant surgery workflow in edentulous patients: A precise and rapid technique.

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

Spontaneous improvement of gingival recession after correction of tooth positioning.

A 30-year-old woman sought treatment for malpositioned mandibular incisors; the roots were positioned outside the alveolar bone, related to severe localized gingival recession. She had been previously treated orthodontically and subsequently underwent 2 gingival grafts. The new treatment included torquing the roots back within the alveolar bone and referral to a periodontist for a gingival graft. In this clinical report, the possible spontaneous improvement of gingival recession is discussed. A hypothesis described in the literature is called the "creeping attachment" phenomenon. The literature includes conflicting reports about the cause-and-effect relationship between orthodontics and gingival recession. This clinical example reports spontaneous improvement of gingival recession after correction of tooth positioning in the alveolar bone. A gingival graft can be performed after adequate root positioning in the alveolar bone housing, thus increasing the chance of achieving more favorable results.

Diagnóstico das doenças peri-implantares: uma abordagem clínica / Diagnoses of periimplant diseases – A clinical approach

Os parâmetros clínicos e radiográficos estão sendo amplamente utilizados no diagnóstico das doenças peri-implantares. O exame dos tecidos peri-implantares através desses parâmetros permite a detecção de sinais e sintomas da mucosite peri-implantar e da peri-implantite. Além disso, os estudos atuais mostram um aumento na prevalência dessas alterações, o que sugere a necessidade de um diagnóstico precoce. Os parâmetros clínicos que podem ser utilizados neste diagnóstico são os índices de placa, gengival e de sangramento, a profundidade de sondagem, a posição da margem gengival, o nível de inserção clínica, a presença ou ausência de supuração, a quantidade de mucosa queratinizada, o teste de mobilidade e a verificação de perda óssea radiográfica. O objetivo deste estudo foi, através de uma revisão da literatura sobre os parâmetros clínicos e radiográficos, discutir e indicar quais os índices que podem ser utilizados na prática clínica diária a fim de diagnosticar as doenças peri-implantares.

Clinical and radiographic parameters have been widely used on periimplant diseases diagnoses. Peri-implant examination, through these parameters, allows detection of signs and symptoms of Peri-implant Mucositis and Peri-implantitis. Moreover, several studies have shown an increase in the prevalence of those diseases suggesting a necessity for early diagnoses. Peri-implant plaque index, gingival and bleeding index, probing deep, gingival margin position, clinical attachment level, presence or absence of suppuration, keratinized mucosa, mobility test, and radiographic peri-implant bone loss are the most commonly used parameters in peri-implant disease diagnosis. The aim of this literature review is to describe clinical and radiographic parameters, and to discuss and indicate which parameters can be used to diagnose peri-implant diseases.

Tetracycline gel as an adjunct to surgical root debridement.

PURPOSE: To evaluate the influence of tetracycline gel, brushed on tooth surfaces, on periodontal clinical parameters following root debridement. METHODS: 20 subjects diagnosed with chronic periodontitis and presenting a minimum of two proximal sites on anterior teeth (maxillary or mandibular) with probing depth +/- 5 mm, were selected. Following oral hygiene instructions and ultrasonic supragingival instrumentation, subjects were assigned to one of the following groups: RDS--root debridement with Gracey curettes and root brushing with saline solution; and RDT--root debridement with Gracey curettes and root brushing with 40% tetracycline gel. Full-thickness flaps were reflected and instrumentation was performed using a clinical microscope to optimize calculus detection. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) measures were registered at five visits: baseline and days 30, 60, 90 and 120 postoperative. RESULTS: Both approaches were able to markedly reduce the PD values from baseline in all periods (P < 0.0001). No differences were found for RAL values in any of the groups. No differences were found between groups. In conclusion, the application of tetracycline gel does not seem to provide any additional improvement on clinical periodontal parameters after root debridement.

Carcinoma espinocelular em leucoplasia verrucosa proliferativa: relato de caso e revisão da literatura / Squamous cell carcinoma in proliferative verrucous leukoplakia: report of a case and review of the literature

A Leucoplasia Verrucosa Proliferativa (LVP) é uma lesão cancerizável caracterizada por comportamento biológico mais agressivo e maior risco de malignização que as leucoplasias bucais. O diagnóstico da LVP deve ser feito pela combinação de achados clínicos e microscópicos e o acompanhamento dos pacientes deve ser rigoroso envolvendo a remoção de fatores de risco como o tabaco e o álcool e biópsias de controle, que podem ser realizadas quando ocorrerem mudanças nos sinais e sintomas. Este trabalho revisa a literatura sobre LVP e relata um caso de carcinoma espinocelular originado de leucoplasia verrucosa proliferativa, enfatizando os aspectos clínicos e histopatológico bem como a importância do acompanhamento rigoroso do paciente e de exames complementares como o azul de toluidina.

Open flap debridement with or without intentional cementum removal: a 4-month follow-up.

OBJECTIVES: The aim of this study was to investigate the influence of cementum removal on periodontal repair. MATERIAL AND METHODS: Forty subjects with chronic periodontitis and presenting, at least, two proximal sites in anterior teeth (upper or lower) with probing depth > or =5 mm were selected. After oral hygiene instructions and ultrasonic supragingival instrumentation, the subjects were randomly assigned for one of the following groups: CIC, scaled with Gracey curettes; CIUS, scaled with ultrasonic device; CDC, calculus deattachment with Gracey curettes and brushing with saline solution; and CDUS, calculus deattachment with ultrasonic device and brushing with saline solution. Full-thickness flaps were reflected and the instrumentation was performed with a clinical microscope. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) were registered at five experimental periods: baseline and 30, 60, 90 and 120 days postoperative. RESULTS: All the approaches were able to markedly reduce the PD values from the baseline to the other evaluation periods (p<0.0001). The increase in RGML values was statistically significant only for the CDUS group. There were no statistically significant differences between the baseline and postoperative values in all groups for the RAL changes. The changes in RAL were statistically significant only among the groups CDC and CDUS (p<0.0001). CONCLUSION: The conventional scaling and root planing and the calculus deattachment were effective in reducing the probing depth values, regardless of the instrumentation method.