Somatosensory alterations after single-unit dental implant immediate loading: A 1-year follow-up study.

OBJECTIVE: This cohort study aimed to assess the incidence of somatosensory alterations after implant surgery using standardized quantitative and qualitative sensory testing. METHODS: 33 participants with single-tooth loss, undergoing immediate implant loading were included. Quantitative Sensory Testing (QST) and Qualitative Sensory Testing (QualST) were conducted at eight time points over a year (baseline to 1 year). Two-Way Repeated Measures ANOVA and post hoc Tukey test were used on QST values and Cochran Q test on QualST. RESULTS: The study revealed significant increase in thermal thresholds overtime. At the operated side, overall Cold Pain Threshold (extraoral: p = 0.030; intraoral: p < 0.001), and Cold Detection Threshold (intraoral: p < 0.001) increased overtime. In contralateral region, maxilla Cold Detection Threshold (extraoral: p = 0.024; intraoral: p = 0.031), Warm Detection Threshold (extraoral: p = 0.026; intraoral: p = 0.047) and overall Cold Pain Threshold (extraoral and intraoral: p < 0.001) also increased. QualST showed extraoral pinprick (p = 0.032) and intraoral pinprick (p = 0.000), cold (p = 0.000) and touch (p = 0.002) stimuli abnormalities overtime. CONCLUSIONS: Somatosensory alterations after implant surgery were detected in both quantitative and qualitative sensory assessments, but rapidly decreased during the first follow-ups, and then continuously until 1-year. CLINICAL SIGNIFICANCE: This study provides clinical and controlled evidence on the real effect of the somatosensory alterations overtime, leading to a better understanding of neurosensory behaviour after single-tooth dental implant rehabilitation.

Adding mechanobiological cell features to finite element analysis of an immediately loaded dental implant.

Finite element analysis (FEA) has been used to analyze the behavior of dental materials, mainly in implantology. However, FEA is a mechanical analysis and few studies have tried to simulate the biological characteristics of the healing process of loaded implants. This study used the rule of mixtures to simulate the biological healing process of immediate implants in an alveolus socket and bone-implant junction interface through FEA. Three-dimensional geometric models of the structures were obtained, and material properties were derived from the literature. The rule of mixtures was used to simulate the healing periods-immediate and early loading, in which the concentration of each cell type, based on in vivo studies, influenced the final elastic moduli. A 100 N occlusal load was simulated in axial and oblique directions. The models were evaluated for maximum and minimum principal strains, and the bone overload was assessed through Frost's mechanostat. There was a higher strain concentration in the healing regions and cortical bone tissue near the cervical portion. The bone overload was higher in the immediate load condition. The method used in this study may help to simulate the biological healing process and could be useful to relate FEA results to clinical practice.

Influence of abutment angulation on implant failure in immediately placed and restored implants in the esthetic zone: a randomized clinical trial

Background: Tooth extraction socket in the aesthetic area is a major indication for immediate implant placement greatly improving patient satisfaction and preserving the alveolar ridge. However, the effect of non-axial force on the peri-implant bone with subsequent early implant failure remains unclear. Objective:Evaluate the prognosis of tilted implants immediately placed and restored with angled abutments in comparison to straight implants restored with straight abutments in the esthetic area (anterior or premolars) using computer-aided surgical guides. Material and methods: Badly decayed non-restorable teeth in the aesthetic zone (anterior or premolars) were extracted atraumatically. Immediately after guided implant insertion, the abutments were adjusted and placed according to the allocation group (0, 15, or 25-degree angle) then a temporary crown was performed out of occlusion in centric and eccentric relation. Early implant failure was assessed at three and six months. Results:There was no statistically significant difference between the two groups (P=0.305). Straight and angled abutment groups showed 6 (14.3%) and 8 (20%) failed cases, respectively. The post-hoc subgroup analysis showed no statistically significant difference between angle 15 and angle 25 degree groups where (P=0.686) or between Anterior and Premolar groups (P=0.853). Conclusion: There was no statistically significant difference in the failure rate when comparing angled to straight immediately placed & restored implants. This applies to both anterior and premolar implants

Nasal Wall Oriented Implants for All-on-4 Fix-Detachable Maxillary Reconstruction / Implantes nasales orientados a la pared para una reconstrucción maxilar desmontable fija All-on-4

Abstract Immediate loading of full-arch prostheses on dental implants in the upper arch is challenging, as the bone is of low quality and obtaining sufficient torque may be difficult. The purpose of this case report is to describe the rehabilitation of a full- arch by means of placement of four internal tapered connection tilted implants and immediate loading. A 65-year-old man sought dental care with a partially edentulous upper arch. The teeth presented mobility and were extracted. In a second step, two conventional-length implants were placed in the anterior region and two tilted and nasal wall-directed extra-long implants in the posterior region. The insertion torques of 60 N.cm allowed the installation of an immediate prosthesis (hybrid). The clinical case report suggests that the placement of tilted and extra-long implants in the paranasal bone and immediate loading may be a viable option for rehabilitation of the edentulous upper arch.

Resumen La carga inmediata de prótesis de arco completo en implantes dentales en el arco superior es un desafío, ya que el hueso es de baja calidad y puede ser difícil obtener un par suficiente. El propósito de este reporte de un caso es describir la rehabilitación de un arco completo mediante la colocación de cuatro implantes inclinados de conexión cónica interna y carga inmediata. Un hombre de 65 años buscó atención dental con un arco superior parcial sin dientes. Los dientes presentaron movilidad y fueron extraídos. En un segundo paso, se colocaron dos implantes de longitud convencional en la región anterior y dos implantes extralargos inclinados y dirigidos a la pared nasal en la región posterior. Los pares de inserción de 60 N.cm permitieron la instalación de una prótesis inmediata (híbrida). El informe del caso clínico sugiere que la colocación de implantes inclinados y extralargos en el hueso paranasal y la carga inmediata pueden ser una opción viable para la rehabilitación del arco superior desdentado.

Rehabilitation of atrophic posterior partial edentulous maxilla with TTPHIL ALL TILT® technique: 3 year follow-up case report / Reabilitação de maxila atrófica posterior parcialmente desdentada com técnica TTPHIL ALL TILT®: relato de caso de acompanhamento de 3 anos

Maxillary sinus pneumatisation pose a grave clinical challenge for implant fixed rehabilitation in posterior maxilla owing to diminished bone volume. This necessitates sinus lift and grafting which increase the duration and cost and possible surgical complications. Pterygoid implant has a greater short term osseointegration and is a proven treatment method for rehabilitation of highly resorbed posterior maxilla. To overcome the limitations of sinus grafting techniques, the current case report describes the use of flapless, tilted and pterygoid implant for restoration of partially edentulous atrophic maxilla eliminating grafting (AU).

A pneumatização do seio maxilar representa um grande desafio clínico para a reabilitação fixa por implante na região posterior da maxila devido ao volume ósseo diminuído. Isso requer elevação do seio e enxerto, fatores que aumentam a duração, o custo e as possíveis complicações cirúrgicas. O implante pterigóide tem uma osseointegração maior em curto prazo e é um método de tratamento comprovado para reabilitação de maxila posterior altamente reabsorvida. Para superar as limitações das técnicas de enxerto de seio, o relato de caso atual descreve o uso de implante sem retalho, inclinado e pterigóide para restauração de maxila atrófica parcialmente edêntula eliminando o enxerto.(AU)

One-year retrospective radiographic assessment of marginal bone loss around basal implants and impact of multiple risk factors using multivariate analysis / Evaluación radiográfica retrospectiva de un año de la pérdida ósea marginal alrededor de los implantes basales y el impacto de múltiples factores de riesgo mediante análisis multivariado

Background: Factors like medical and periodontal conditions, implant location and smoking can affect marginal bone loss (MBL) of basal implants. Objectives: The purpose of this study is to explore the association of MBL with multiple variables including gender, age, smoking status, diabetes, implant placement protocol, location of implant, and type of prosthesis. Material and Methods: A total of 156 single-piece basal implants (Dr. Ihde Dental AG in Gommiswald, Switzerland) were placed in 44 patients. Dental panoramic tomographs were obtained postoperatively and following a one-year of service to determine MBL on mesial and distal sides. The association of MBL with the multiple variables was analysed using the multivariate and the random forest analysis. Results: The mean mesial and distal MBL was 0.64 millimetres. None of the implants presented MBL exceeding 1 millimetre. All implants were retained without complications during the firstyear of service. The MBL was remarkably associated with the smoking status, diabetes, location of implant and implant placement protocol. Diabetes mellitus is the most vital parameter in predicting MBL. Conclusion: The mean MBL of all implants did not exceed the threshold of 1 millimetre during the first year of service. When placing implants in patients who smoke and have diabetes, care should be taken.

Antecedentes: Factores como las condiciones médicas y perio-dontales, la ubicación del implante y el tabaquismo pueden afectar la pérdida marginal de hueso (PMH) de los implantes basales. Objetivo: La finalidad de este estudio es explorar la asociación de PMH con múltiples variables, incluido el sexo, la edad, el tabaquismo, la diabetes, el protocolo de colocación del implante, la ubicación del implante y el tipo de prótesis. Material y Métodos: Se colocaron 156 implantes basales de una sola pieza (Dr.Ihde Dental AG, Gommiswald, Suiza) en 44 pacientes. Se obtuvieron tomografías panorámicas dentales después de la operación y después de un año de servicio para deter-minar la MBL en los lados mesial y distal. La asociación de la PMH con las múltiples variables se analizó mediante el análisis multivariado y de bosque aleatorio. Resultados: La PMH media mesial y distal fue de 0,64 milímetros. Ninguno de los implantes presentó PMH superior a 1 milímetro. Todos los implantes se mantuvieron sin complicaciones durante el primer año de servicio. La PMH se asoció nota-blemente con el tabaquismo, la diabetes, la ubicación del implante y el protocolo de colocación del implante. La diabetes mellitus es el paráme-tro más importante para predecir la MBL. Conclusion: La PMH media de todos los implantes no superó el umbral de 1 milímetro durante el primer año de servicio. Se debe tener especial cuidado al colocar implantes en pacientes que fuman y tienen diabetes.

Clinical efficacy of anodized dental implants for implant-supported prostheses after different loading protocols: A systematic review and meta-analysis.

OBJECTIVES: To summarize the clinical performance of anodized implants connected to different prostheses design after immediate/early (IL) or conventional loading (CL) protocols. MATERIALS AND METHODS: Seven databases were surveyed for randomized (RCTs) and non-randomized controlled clinical trials (CCTs). Studies comparing IL vs. CL protocol of anodized implants supporting single crown, fixed partial denture (FPD), full-arch fixed dental prosthesis (FDP), or overdenture were included. Risk-of-bias was evaluated using Cochrane Collaboration tools. Meta-analyses for different follow-up were analyzed, followed by heterogeneity source assessment and GRADE approach. The outcomes included implant survival rate, marginal bone loss (MBL), implant stability quotient (ISQ), probing depth (PD), plaque index (PI), and peri-implantitis prevalence. RESULTS: From 24 eligible studies, 22 were included for quantitative evaluation. Most RCTs (58%, n = 11) and all the 5 CCTs had high and serious risk-of-bias, respectively. Overall, pooling all prosthesis design, no difference between IL vs. CL protocols was observed for all outcomes (p > .05). However, according to prosthesis type subgroups, CL reduced MBL for full-arch FDP (p < .05). In a point-in-time assessment, with overdenture, although IL presented higher PI (12 months), it showed lower MBL (≥24 months), higher ISQ (3 months), and lower PD (6 and 12 months) (p < .05). Conversely, PD was higher for IL in single crown (3 and 6 months) (p < .05). Regarding MBL, IL demonstrated higher mean difference for full-arch FDP (36 months) and FPD (12 and 36 months) (p < .05). CONCLUSION: Within the limitations of this study, overall, there is no significant difference in the outcomes between IL and CL loading protocols.

Implant and prosthesis survival rates of full-arch immediate prostheses supported by implants with and without bicortical anchorage: Up to 2 years of follow-up retrospective study.

OBJECTIVES: To compare implant and prosthesis survival rates between full-arch immediate prostheses supported by 4 hydrophilic implants with bicortical anchorage and by 5 or 6 hydrophilic implants placed without bicortical anchorage. MATERIAL AND METHODS: The sample was retrospectively selected and comprised completely edentulous patients treated with full-arch immediate prostheses supported by Morse Taper hydrophilic implants. The selected patients were divided into four groups, according to the region of implant placement and type of anchorage. Differences in implant and prosthesis survival rates between groups, as well as the influence of bicortical anchorage on implant primary stability, were verified using Fisher's exact tests (significant at p < .05). RESULTS: The sample comprised 392 implants, 72 were placed in the maxilla with bicortical anchorage, and 85 were placed without. In the mandible, 140 implants were placed with and 95 were placed without bicortical anchorage. The follow-up period was up to 24 months. A 98.8% implant survival rate was observed for the group of implants placed without bicortical anchorage in the maxilla, and of 100% for the other groups. The overall implant survival rate was 99.7% (391 of 392 implants). Prosthesis survival rate was 100% for all groups. No differences were observed between groups with respect to implant and prosthesis survival rates. Significantly higher primary stability was observed for implants placed with bicortical anchorage in both jaws. CONCLUSION: Predictable results and high survival rates were achieved within the period evaluated by the present retrospective study, with immediate full-arch prostheses when only four hydrophilic implants are placed bicortically.

Alcance da odontologia digital na implantodontia / Scope of digital dentistry in implanthodontics

O objetivo do presente estudo é realizar uma revisão narrativa da literatura sobre a aplicação de sistemas Computer Aided Design (CAD) e Computer Aided Manufacturing (CAM) na implantodontia. Para isso, foram consultados estudos publicados entre os anos de 2009 e 2019. Assim, de forma mais detalhada, o estudo buscou apresentar aspectos históricos e definições, discutir etapas da produção, bem como tipos de materiais utilizados, e apontar benefícios e limitações em relação às técnicas adotadas tradicionalmente. Observou-se que o CAD/CAM vem dando suporte e inovação a reabilitação oral de pessoas edêntulas possibilitando procedimentos menos invasivos, mais precisos, com tempo reduzido de tratamento e com mais segurança para o paciente.

The aim of this study was to conduct a narrative review of the literature on the application of Computer Aided Design (CAD) and Computer Aided Manufacturing (CAM) systems in implantology. For this, studies published from 2009 to 2019 were consulted. Thus, in more detail, the study sought to present historical aspects and definitions, discuss stages of production, as well as types of material used and point out benefits and limitations, in relation to tooth technique usualy adopted . This technology has been supporting and innovating in the oral restorationofedentulouspeople.CAD / CAM enables less invasive, more accurate,safer procedures for the patient.

Effect of different implant placement depths on crestal bone levels and soft tissue behavior: A 5-year randomized clinical trial.

OBJECTIVES: This randomized clinical trial analyzed the long-term (5-year) crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the anterior mandibular region at different depths (equi- and subcrestal). MATERIALS AND METHODS: Eleven edentulous patients were randomly divided in a split-mouth design: 28 equicrestal implants (G1) and 27 subcrestal (1-3 mm) implants (G2). Five implants were placed per patient. All implants were immediately loaded. Standardized intraoral radiographs were used to evaluate crestal bone (CB) changes. Patients were assessed immediately, 4, 8, and 60 months after implant placement. The correlation between vertical mucosal thickness (VMT) and soft tissue recession was analyzed. Sub-group analysis was also performed to evaluate the correlation between VMT and CB loss. Rank-based ANOVA was used for comparison between groups (α = .05). RESULTS: Fifty-five implants (G1 = 28 and G2 = 27) were assessed. Implant and prosthetic survival rate were 100%. Subcrestal positioning resulted in less CB loss (-0.80 mm) when compared to equicrestal position (-0.99 mm), although the difference was not statistically significant (p > .05). Significant CB loss was found within the G1 and G2 groups at two different measurement times (T4 and T60) (p < .05). Implant placement depths and VMT had no effect on soft tissue recession (p > .05). CONCLUSIONS: There was no statistically significant difference in CB changes between subcrestal and equicrestal implant positioning; however, subcrestal position resulted in higher bone levels. Neither mucosal recession nor vertical mucosa thickness was influenced by different implant placement depths.

Effect of Different Immediate Implant Loading Protocols on Peri-implant Soft Tissue Health / Efeito de diferentes protocolos de implante com carga imediata no tecido mole peri-implantar

Objectives: This clinical study was conducted to evaluate the effect of immediate loading on peri-implant soft tissue health using three protocols: I) Immediate functional loading using polymer infiltrated ceramic (PIC) material (IFLV). II) Immediate functional loading using polymethyl methacrylate (PMMA) followed by delayed functional loading using PIC material (IFLP). III) Immediate non-functional loading using PMMA followed by delayed functional loading using PIC material (INFLP). Material & Methods: 30 Implants were placed in the upper premolar area and divided randomly according to the immediate loading protocol. In the control group (INFLP), CAD/CAM PMMA crowns were placed out of occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns in functional occlusion. For (IFLV) group, CAD/CAM VITA ENAMIC crowns were immediately loaded in functional occlusion; while in (IFLP) group, CAD/CAM PMMA crowns were placed in functional occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns. Modified pink esthetic score (MPES) and probing depth were used for evaluation of peri-implant soft tissue at base line and follow up periods. Results: INFLP showed higher MPES results compared to IFLV and IFLP. Moreover, the INFLP probing depth at 3 months showed higher results compared to the other groups. Conclusions: Immediate non-functional loading showed the best outcomes. However, peri-implant soft tissue health of the immediate functional loading using the PIC crown material was clinically acceptable (AU)

Objetivo: Este estudo clínico foi realizado para avaliar o efeito da carga imediata na saúde do tecido mole peri-implantar usando três protocolos: I) Carga imediata funcional usando material de cerâmica infiltrada com polímero (PIC) (IFLV). II) Carga imediata funcional usando polimetilmetacrilato(PMMA) seguida por carga funcional retardada usando material PIC (IFLP). III) Carga imediata não funcional usando PMMA seguida por carga funcional retardada usando material PIC (INFLP). Material e Métodos: 30 implantes foram colocados na área dos pré-molares superiores e divididos aleatoriamente de acordo com o protocolo de carga imediata. No grupo controle (INFLP), as coroas CAD / CAM PMMA foram colocadas sem oclusão por 3 meses, e então substituídas pelas coroas CAD / CAM VITA ENAMIC na oclusão funcional. Para o grupo (IFLV), as coroas CAD / CAM VITA ENAMIC foram carregadas imediatamente em oclusão funcional; enquanto no grupo (IFLP), as coroas CAD / CAM PMMA foram colocadas em oclusão funcional por 3 meses, e então substituídas por coroas CAD / CAM VITA ENAMIC. O escore da estética rosa modificado (PESM) e a profundidade de sondagem foram realizados para avaliação do tecido mole peri-implantar no início e nos períodos de acompanhamento. Resultados: INFLP apresentou resultados de PESM superiores em comparação com IFLV e IFLP. Além disso, a profundidade de sondagem INFLP em 3 meses apresentou resultados superiores em comparação com os outros grupos. Conclusões: A carga imediata não funcional apresentou os melhores resultados. No entanto, a integridade do tecido mole peri-implantar da carga imediata funcional usando o material da coroa PIC foi clinicamente aceitável. (AU)

Calidad de vida en el adulto mayor con prótesis dental implanto retenida de carga inmediata / Quality of life in the elderly with immediate-retained implanted dental prosthesis

RESUMEN Fundamento: los pacientes adultos mayores desdentados totales con grandes atrofias óseas, tienen afectada la masticación, fonación, deglución, la psiquis y por tanto su calidad de vida. Para ellos existe una alternativa de tratamiento, la implantología bucal. Objetivo: describir los resultados del tratamiento de prótesis total implantosoportada con carga inmediata en la calidad de vida de pacientes adultos mayores. Métodos: investigación descriptiva de corte transversal realizada en la consulta de implantología de la Facultad de Estomatología de La Habana, sobre 41 pacientes a los que, después de dos meses de rehabilitados con prótesis total implantosoportada con carga inmediata, se le aplicó el cuestionario de calidad de vida relacionado con salud bucal (OHIP-14). Se consideró como no impacto o impacto negativo cuando no hubo mejoría e impacto o impacto positivo cuando hubo mejoría de la calidad de vida. Resultados: las dimensiones con mayor impacto negativo fueron: dolor físico (48,8 %), incapacidad física (51,2 %), malestar psicológico (73,2 %) y las de impacto positivo fueron: limitación funcional, incapacidad social, psicológica y la minusvalía, con 95,1 %; 92,7 % y 100 % respectivamente. Conclusiones: el tratamiento mediante prótesis dental total implantosoportada mejora la calidad de vida de pacientes adultos mayores.

ABSTRACT Foundation: Total older toothless adult patients with large bone atrophies; have affected chewing, phonation, swallowing, psyche and therefore their quality of life. For them there is an alternative treatment, oral implantology. Objective: to describe the results on the quality of life of elderly patients of the total implant-supported prosthesis treatment with immediate load. Methods: descriptive cross-sectional research conducted in the implantology office of the Havana Faculty of Dentistry, on 41 patients who, after two months of rehabilitation with implant-supported total prosthesis with immediate loading, the quality of life questionnaire was applied related to oral health (OHIP-14). It was considered as no impact or negative impact when there was no improvement and positive impact or impact when there was improvement of the quality of life. Results: the dimensions with the greatest negative impact were: physical pain (48.8%), physical disability (51.2%), psychological distress (73.2%) and positive impact were: functional limitation, social, psychological disability and the disability, with 95.1%; 92.7% and 100% respectively. Conclusions: the implant-supported total dental prosthesis treatment improves the quality of life of elderly patients.

Implantes zigomáticos de carga imediata: relato de caso / Immediate load zygomatic implants: case report

Introdução: atualmente, o relevante desafio enfrentado pela odontologia se constitui na redução do tempo de tratamento e na restrição dos procedimentos cirúrgicos, na perspectiva de se assegurar o máximo conforto às pessoas que buscam a reabilitação oral. Em se tratando de pacientes edêntulos totais, os eventos que devem ser desenvolvidos demandam de um planejamento correto tendo em consideração o tempo de execução. Face a esses pressupostos, a reabilitação oral busca reconstituir a mastigação, a estética, o suporte labial e a fonética. Objetivo: o caso clínico ora descrito visa demonstrar a instalação de 4 implantes zigomáticos seguindo-se da colocação da prótese definitiva em sistema de carga imediata. Metodologia: com base na literatura científica e tendo em vista a limitação das condições anatômicas e clínicas apresentadas pela paciente do sexo feminino, com 68 anos de idade e boa saúde, fez-se a opção pela instalação de 4 implantes zigomáticos associada à técnica de carga imediata. Resultado e conclusão: em compatibilidade com os dados da literatura, o êxito cirúrgico e a reabilitação oral alcançados, associados à satisfação manifestada pela paciente, são indicadores de elevada previsibilidade quanto à longevidade da sobrevida dos implantes zigomáticos instalados.

Introduction: currently, the relevant challenge faced by dentistry constitutes in reduce treatment time and restrict surgical procedures, in order to ensure maximum comfort to people seeking oral rehabilitation. In case of total patient treatment, the events to be displayed require correct planning, taking into account the execution time. Do to these assumptions, the oral rehabilitation seeks to reconstitutes chewing, aesthetics, lip and phonetic support. Objective: the clinical case aims to demonstrate the installation of 4 zygomatic implants following the placement of the definitive prosthesis in the immediate loading system. Methodology: based on scientific literature and in view of the limitation of the anatomical and clinical conditions applied by the 68-year-old female patient, she choose to install 4 zygomatic implants used in the immediate loading technique. Result and conclusion: in line with literature data, surgical and oral rehabilitation achieved, associated with patient satisfaction, are indicators of increased predictability regarding the longevity of survival of the zygomatic implants used.

Bioceramic cement in the filling of bone defects in rats

Purpose: To evaluate PBS®MCIMMO cement in the filling of bone defects. Methods: Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. Results: In all comparisons, significance was observed for group 2 (p = 0.0014–0.0026). Conclusion: The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.(AU)

Una Nueva Alternativa para la Creación de Papilas en Implantes de Carga inmediata: Reporte de Caso / A New Alternative for the Creation of Papillae in Immediate Loading Implants: Case Report

RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.

ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.

Performance mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com prótese fixa implantossuportada com carga imediata / Masticatory performance and impact of oral health on quality of life in patients rehabilitated with implant-supported fixed prosthesis with immediate loading

O impacto da saúde oral na qualidade de vida (OHRQoL) dos pacientes através da substituição de próteses totais convencionais (PTC) por próteses fixas implantossuportadas (PFIS) ainda não está totalmente claro, devido à grande heterogeneidade metodológica. O objetivo desse ensaio clínico controlado não randomizado foi comparar a OHRQoL e a performance mastigatória (PM) em pacientes reabilitados com PTC e com PFIS com carga imediata na mandíbula. A amostra foi composta por 40 indivíduos com idade média de 59,08 anos (± 7,04), predominantemente do sexo feminino (n=36), distribuídos em dois grupos: PTC e PFIS. Todos os pacientes foram reabilitados com PTC inicialmente, 23 permaneceram com suas PTC, e o restante (17 pacientes), após 3 meses de uso das PTC tiveram suas próteses convertidas em PFIS com barra distal com carga imediata, sendo 7 suportadas por 3 implantes e 10 suportada por 4 implantes. O OHRQoL foi mensurado através do questionário OHIP-Edent (versão brasileira) e a PM, através do método das tamises com o X50 calculado. Dados foram coletados antes (T0), e após 3 meses da instalação das PTC e da PFIS (T1). Para a análise dos dados, Teste t de Student para amostras pareadas foi aplicado para avaliar o mesmo grupo antes e após a intervenção clínica, sendo na comparação entre os grupos aplicado o Teste t para grupos independentes e o "d" de Cohen calculado para ambas comparações. Teste de correlação de Spearman foi empregado para avaliar a correlação entre as variáveis. Os resultados mostraram que ao comparar o grupo PTC em T0 e T1, não houve melhora na OHRQoL e nem redução do X50, indicando que a PM não melhorou. Já no grupo PFIS, houve melhora significativa na OHRQoL (p < 0,001) com tamanho do efeito "muito grande" (Cohen'd = 2,49) e melhora significativa na PM com tamanho do efeito "muito grande" (Cohen' d = 2,47). Considerando a comparação no tempo T1 de ambos os grupos, o grupo PFIS apresentou menor valor de OHRQoL e menor valor de X50, indicando maior impacto positivo na qualidade de vida e melhor PM, quando comparado ao grupo PTC (p < 0,001). Constatou-se correlação entre a PM e o OHIP-Edent de forma positiva apenas para o grupo PTC, no tempo T0, no domínio "desconforto psicológico", indicando que a medida que a PM piorava, o desconforto psicológico aumentava. Concluiu-se que a conversão da prótese total convencional em prótese fixa implantossuportada impacta positivamente na qualidade de vida e na performance mastigatória dos usuários com um tamanho de efeito "muito grande" (AU).

Oral health impact on the quality of life (OHRQoL) of patients through the replacement of conventional complete dentures (CCD) to implant suported dentures (ISD) is still not completely clear due to the great methodological heterogeneity. The objective of this nonrandomized controlled clinical trial was to compare OHRQoL and masticatory performance (PM) in rehabilitated patients with CCD and ISD under lower immediate loading. The sample consisted of 40 individuals, mean age of 59.08 years (± 7.04), predominantly female (n = 36), were divided into two groups: CCD and ISD. All patients were rehabilitated with CCD initially, 23 remained with their CCD, and 17 patients after 3 months of CCD use had their dentures converted into ISD under immediate loading, supported by 3 or 4 implants. The OHRQoL was measured by OHIPEdent questionnaire (Brazilian version) and the PM, using the sieve method with the calculated X50. Data were collected before (T0), and after 3 months of installation of CCD and ISD (T1). Student's t-test for paired samples was applied to evaluate the same group before and after the clinical intervention, in the comparison between the groups the t test was applied for independent groups and the "d" of Cohen calculated for both groups comparisons. Spearman's correlation test was used to evaluate the correlation between the variables. Comparing the CCD group at T0 and T1, there was no positive impact on the OHRQoL and no significant X50 reduction, which indicates that there was no improvement in the PM. For ISD, there was an improvement in the OHRQoL (p < 0.001) with a large size effect (Cohen'd = 2,49) and a significant improvement in the PM with a large size effect (Cohen'd= 2,47). Comparison in time T1 for both groups, ISD presented lower OHRQoL and lower value of X50, which indicates a higher positive impact on the quality of life and better PM when compared to CCD (p < 0.001). Correlation between PM and OHIP-Edent was found only positively for CCD at time T0, in the "psychological discomfort" domain, indicating that as the PM worsens, the psychological discomfort increases. It is concluded that the conversion of complete dentures into implanted suported denture has a positive impact on the quality of life and on masticatory performance (AU).

Bioceramic cement in the filling of bone defects in rats

Abstract Purpose To evaluate PBS®MCIMMO cement in the filling of bone defects. Methods Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. Results In all comparisons, significance was observed for group 2 (p = 0.0014-0.0026). Conclusion The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.

Provisionalização imediata de implantes em alvéolos íntegros ­ relato de caso / Immediate loading of implants in fresh sockets ­ case report

A instalação de implantes com carga imediata é descrita na literatura como um procedimento com resultados previsíveis. Associado a essa técnica reabilitadora, o uso de implantes compactantes com formato cônico, de 3,5 mm de diâmetro, cria um espaço apropriado entre a tábua óssea vestibular e o implante para o preenchimento com biomaterial, promovendo a manutenção do arco côncavo vestibular, contribuindo para a obtenção e manutenção da estética do caso. O uso de componentes protéticos provisórios possibilita a escolha futura de um abutment definitivo quando a cicatrização dos tecidos adjacentes ao implante estiver concluída. O caso clínico descrito nesse artigo apresenta alta demanda estética. Foram extraídos os dois incisivos centrais superiores da paciente, e no mesmo momento cirúrgico, foram instalados dois implantes nos alvéolos frescos. Esses implantes obtiveram torque acima de 45 Ncm, o que permitiu seu carregamento imediato. Foram utilizados dois pilares provisórios personalizáveis e confeccionadas coroas provisórias através de mockup feito previamente sobre as coroas dos dentes antes das extrações. O gap foi preenchido com grânulos de biomaterial à base de tricálcio fosfato e hidroxiapatita para manutenção da tábua óssea vestibular, material que tem apresentado bons resultados clínicos. A cimentação das coroas provisórias foi então realizada após ajustes de oclusão. Uma semana após, a paciente apresentou os tecidos moles circundantes aos implantes com cicatrização satisfatória e imagens radiográficas com padrão de normalidade. Concluiu-se que a instalação imediata de implantes com provisionalização imediata é uma técnica viável, com bons resultados em casos em que a estética é exigida (AU).

Implant installation with immediate loading is described in the literature as a procedure with predictable results. Associated with this rehabilitation technique, the use of compacting implants with a conical shape, with a diameter of 3.5 mm, creates an appropriate space between the buccal bone board and the implant, to fill with biomaterial that promotes the maintenance of the concave buccal arch, contributing to the aesthetics of the case. The use of provisional prosthetic components allows the future choice of a definitive abutment when the healing of the tissues adjacent to the implant is complete. The clinical case described in this article presents a high aesthetic demand. The two upper central incisors were extracted from the patient, and at the same surgical moment, two implants were installed in the fresh sockets. These implants obtained torque above 45 Ncm, which allowed their immediate loading. Two temporary customizable crowds with temporary abutments were used through mockup previously made on the crowns of the teeth before extractions. The gap was filled with granules of biomaterial based on tricalcium phosphate and hydroxyapatite for maintenance of the buccal bone board, material that has presented good clinical results. The cementation of the provisional crowns was then performed after occlusion adjustments. One week later, the patient presented the soft tissues surrounding the implants with satisfactory healing and radiographic images with normality pattern. It is concluded that the placement of implants with immediate provisional crowds is a viable technique, with good results in cases where esthetics is required (AU).

Implante imediato em área estética ­ perspectivas atuais e relato de caso / Immediate implant in aesthetic zone ­ current perspectives and case report

Na região anterior da maxila, o resultado estético e sua estabilidade em longo prazo são de suma importância, assim como função e fonética adequadas. Para atingirmos esses objetivos, é necessário o conhecimento sobre a fisiologia óssea, critérios bem definidos sobre quando executar a técnica de implante imediato, assim como conhecimento sobre biomateriais, técnicas de provisionalização e inserção do implante em posicionamento adequado. A colocação imediata do implante é o tratamento de escolha quando os requisitos necessários estão presentes. Para os pacientes, essa abordagem é atraente, pois oferece baixa morbidade, diminuição do tempo de tratamento e a possibilidade de estética imediata com uma prótese provisória instalada no mesmo procedimento. A preservação do contorno e estética pode ser obtida através da utilização de substitutos ósseos, desenho correto da prótese e técnicas de enxerto de tecido mole. A preservação do contorno é realizada com enxerto ósseo autógeno no local, enquanto biomateriais como partículas DBBM são usados para se manter o volume. Também são utilizadas técnicas de enxerto tecidual epitelial tunelizado na face vestibular (AU).

In the anterior region of the maxilla, the aesthetic result and its long-term stability are of paramount importance, as well as adequate function and phonetics. In order to reach these objectives, knowledge about bone physiology, well-defined criteria on when to perform the immediate implant technique, as well as knowledge about biomaterials, implanting techniques and insertion of the implant in proper positioning is necessary. Immediate implant placement is the treatment of choice when necessary requirements are present. For patients, this approach is attractive because it offers low morbidity, shortened treatment time, and the possibility of immediate esthetics with a temporary prosthesis installed in the same procedure. Contour and aesthetic preservation can be achieved through the use of bone substitutes, correct prosthesis design, and soft tissue grafting techniques. Contour preservation is performed with autogenous bone graft at the site, while biomaterials such as DBBM particles are used to maintain volume. Tunnelled epithelial tissue graft techniques on the vestibular face are also used (AU).

"All-on-4": Passo a passo para carga imediata em maxilares atróficos / All-on-4: Step by step for immediate loading in atrophic jaws

A técnica "All-on-4" consiste na instalação de quatro implantes na melhor distribuição anteroposterior possível no rebordo ósseo maxilar remanescente, sendo os dois posteriores inclinados para distal, tangenciando a cortical da extensão anterior do seio maxilar ou do forame mentoniano, e os outros dois implantes instalados na região anterior do maxilar, propiciando condições biomecânicas para suportar uma reabilitação total sobre quatro implantes em carga imediata. Será feita uma revisão de literatura sobre o assunto incluindo os artigos históricos e enfatizando aqueles autores que contribuíram com os conceitos do estado da arte atual, para a elaboração de um passo a passo da técnica. Foi apresentada uma classificação dos maxilares atróficos para a aplicação do "All-on-4", assim como os tipos de acesso, aspectos anatômicos a serem identificados no transoperatório, customização da guia cirúrgica, inclinação dos implantes, critérios para a carga imediata e para a escolha dos componentes inclinados, detalhes das suturas e da rotina pós-operatória. A técnica "All-on-4" simplificou a carga imediata para a grande maioria dos maxilares atróficos desdentados totais, reduzindo o tempo de tratamento, custos, riscos, morbidade e limitando a indicação de enxertos ósseos apenas para os casos de extrema atrofia maxilar (AU).

The "All-on-4" technique is performed with four implants installed in the best possible anteroposterior distribution on the remaining jaw bone, with the two posterior implants angulated to distal, tangential to the cortical of the anterior extension of the maxillary sinus or the mental foramen, and the other two implants installed in the anterior region of the jaw, providing biomechanical conditions to support a total rehabilitation over four implants in immediate loading. A literature review will be performed on the subject including historical articles and emphasizing those authors who contributed with the concepts to the current state of the art, for elaboration of a step by step of All-on-4 technique. Atrophic jaws classification was presented for technique application, as well as the types of access, anatomical aspects to be trans surgically identified, surgical guide customization, implant angulation, criteria for immediate loading and choice of angulated abutments, details of the sutures and postoperative routine. All-on-4 technique simplified immediate loading for the vast majority of total edentulous atrophic jaws, reducing treatment time, costs, risks, morbidity and limiting bone grafts indication only for cases of extremely atrophic jaws (AU).