Socket regeneration after immediate loading implants with tissue and bone graft: 1-year clinical follow-up

Evaluation of ridge alteration after 1 year follow up after immediate loading implant placement. Methods: Ten patients were included in the study, in whom the ridge volume, height, and thickness were evaluated from region of interest (ROI) of tomographic images of the operated areas (test group) and compared to the opposite tooth (control group). Results: After one year, there was no implant loss and all patients were satisfied with the treatment. In the test group there was a statistically significant increase in ridge height (2.89±1.05 mm) when compared to the control group. No significant difference in relation to ridge volume and thickness was observed. In the intragroup evaluation, a significant gain in ridge height (2.65±3.08 mm) was observed when compared to baseline. Conclusion: The placement of an immediate implant, temporary crown, and tissue regeneration in sockets with buccal defects promotes the regeneration of the buccal wall while preventing the reduction of bone volume and thickness

Impact of dental cone-beam computed tomography on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning / Impacto de la tomografía computarizada de haz cónico en el diagnóstico y plan detratamiento preimplantologico de senos maxilares

Objective: To determine the impact of CBCT on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning. Material and Methods: Diagnostic evaluation and treatment plan for the maxillary sinus were evaluated by eight specialists experienced in dental implant placement. Eight panoramic radiographs (PAN) and CBCT examinations were obtained from five adult patients with a specific clinical need for dental implants. Evaluation was performed first on PAN then, at least 2 weeks later, on CBCT. Residual alveolar ridge height, mucosal thickening, radiographic findings and treatment plan were recorded. The confidence level was evaluated for both diagnostic evaluation and treatment plan. The kappa statistic for intra-observer reproducibility and McNemar test were performed. Results: In the diagnostic evaluation, CBCT showed significant impact on the diagnosis of radiographic findings. Availability of CBCT significantly changed the treatment plan, for less invasive treatment, or no treatment need. Observers had significantly greater confidence when using CBCT than PAN, when indicating presence of mucosal thickening and radiographic findings in the maxillary sinus. In addition, CBCT increased confidence in the treatment plan. Conclusion: The present study suggests that CBCT has an impact on the diagnostic evaluation of radiographic findings in the maxillary sinus and on the decision to place implants, owing to misdiagnosis of pathology and planning of more invasive treatments when using PAN. Availability of CBCT also improves clinician confidence. Further studies at higher levels of diagnostic efficacy should be performed, to justify the use of CBCT, by evaluating the actual treatment performed and its outcome.

Objetivo: Determinar el impacto de la tomografía computarizada de haz cónico (CBCT) en la evaluación diagnóstica y el plan de tratamiento del seno maxilar en la planificación de implantes dentales. Material y Métodos: La evaluación diagnóstica y el plan de tratamiento del seno maxilar fueron evaluados por ocho especialistas con experiencia en la colocación de implantes dentales. Se obtuvieron ocho radiografías panorámicas (PAN) y exámenes CBCT de cinco pacientes adultos con una necesidad clínica específica de implantes dentales. La evaluación se realizó primero en PAN y luego, al menos dos semanas después, en CBCT. Se registraron la altura del reborde alveolar residual, el engrosamiento de la mucosa, los hallazgos radiográficos y el plan de tratamiento. Se evaluó el nivel de confianza tanto para la evaluación diagnóstica como para el plan de tratamiento. Se realizó el estadístico kappa para la reproducibilidad intraobservador y la prueba de McNemar. Resultados: En la evaluación diagnóstica, CBCT mostró un impacto significativo en el diagnóstico de los hallazgos radiográficos. La disponibilidad de CBCT cambió significativamente el plan de tratamiento, para un tratamiento menos invasivo o sin necesidad de tratamiento. Los observadores tuvieron una confianza significativamente mayor al usar CBCT que PAN, al indicar la presencia de engrosamiento de la mucosa y hallazgos radiográficos en el seno maxilar. Además, CBCT aumentó la confianza en el plan de tratamiento. Conclusión: El presente estudio sugiere que la CBCT tiene un impacto en la evaluación diagnóstica de los hallazgos radiográficos en el seno maxilar y en la decisión de colocar implantes, debido al diagnóstico erróneo de la patología y la planificación de tratamientos más invasivos al usar PAN. La disponibilidad de CBCT también mejora la confianza del clínico. Se deben realizar más estudios a niveles más altos de eficacia diagnóstica para justificar el uso de CBCT, evaluando el tratamiento real realizado y su resultado.

Vertical bone augmentation with guided bone regeneration: a scoping review / Aumento óseo vertical con regeneración ósea guiada: scoping review

Introduction: There are multiple techniques for vertical bone augmentation. Guided bone regeneration is one of them; however, the literature is diverse and includes different study designs, which makes it difficult to synthesize results. Objective: To analyze the general technical characteristics, clinical results, and complications of vertical bone augmentation performed with guided bone regeneration in humans. Material and Methods: This scoping review was based on the PRISMA-ScR guidelines. A search was performed in the Pubmed, Scielo, and Worldcat databases. Papers published from 1990 to April 2020 were included in the study. Research articles not conducted in humans or published in languages other than English and Spanish were excluded. Title and abstract were screened by two reviewers, then full studies were extracted, and data tabulated. Results: 89 studies were included. The highest percentage reported having obtained a vertical bone increase of less than 5 mm and having used non-resorbable membranes. The most frequent type of graft is autogenous and combinations of grafts, the most common being autogenous with xenograft. All studies that reported bone stability of implants in regenerated bone were favorable, as was implant survival, reporting values between 83.8% and 100%. Membrane exposure is the most frequently reported complication, followed by infection or abscesses, and tissue dehiscence. Conclusion: Vertical bone regeneration is a reliable technique, with high predictability and low incidence of complications compared to other vertical bone augmentation techniques.

Introducción: Existen múltiples técnicas para el aumento óseo vertical siendo una opción la regeneración ósea guiada, sin embargo, la literatura es diversa y con distintos diseños que dificultan la síntesis de resultados. Objetivo: Analizar las características generales técnicas, resultados clínicos y complicaciones del aumento óseo vertical realizado con regeneración ósea guiada en humanos. Material y Métodos: Esta revisión de alcance se basó en la guía PRISMA-ScR. Se realizó una búsqueda en las bases de datos Pubmed, Scielo y Worldcat. Fueron incluidos aquellos publicados desde el año 1990 hasta abril de 2020. Se excluyeron los estudios no realizados en humanos o publicados en idiomas distintos al inglés y español. Dos revisores examinaron título y resumen, luego los estudios completos se extrajeron y se ordenaron los datos en tablas. Resultados: 89 estudios fueron incluidos. El mayor porcentaje reportó haber obtenido un aumento óseo vertical menor a 5 mm y haber utilizado membranas no reabsorbibles. El tipo de injerto que más frecuente es el autógeno y las combinaciones de injertos, siendo el más común autógeno con xenoinjerto. Todos los estudios que reportaron estabilidad ósea de implantes en hueso regenerado fueron favorables, al igual que la supervivencia de implantes, reportando valores entre 83,8% y 100%. La exposición de membrana es la complicación que más se repite en los estudios, seguido por infección o abscesos y dehiscencia de tejidos. Conclusión: La regeneración ósea vertical es una técnica confiable, con alta predictibilidad y baja incidencia de complicaciones en comparación a otras técnicas de aumento óseo vertical.

Anastomosis between the posterior superior alveolar artery and the infra-orbital artery: a review of current terminology / Anastomosis entre la arteria alveolar superior posterior y la arteria infra-orbital: una revisión de la terminología actual

SUMMARY: The posterior superior alveolar artery (PSAA) and the infra-orbital artery (IOA) present intraosseous and extraosseous rami which form an anastomosis in the lateral wall of the maxillary sinus. This anastomosis is always present, however it has not yet been included in anatomical terminology (AT), and different terms are used in scientific communication to refer to it. The aim of this study was to carry out a review of the different terms used to name this vascular structure. A literature review was carried out on the terms used to name the anastomosis between the PSAA and IOA in imaging studies and human cadavers that assessed the presence/frequency of this anatomical structure. The search was carried out in the Medline, EMBASE and LILACS databases, in Portuguese, Spanish and English, with no date restrictions. Qualitative analysis was applied to the studies selected, analysing the terminology used to refer to the anastomosis between the PSAA and IOA. Of the 2108 original articles found, 60 were selected as potentially relevant and 54 studies were finally included for qualitative analysis. Sixteen terms were found to refer to the anastomosis between the PSAA and IOA, the most frequent being Posterior Superior Alveolar Artery (PSAA), followed by Alveolar Antral Artery (AAA). Many terms are used in the medical literature to designate the anastomosis between the PSAA and IOA, the most frequent being PSAA and AAA. There is a need to unify the terms used to designate this vascular structure, and to incorporate the selected term into anatomical terminology, in order to avoid confusion in scientific communication.

RESUMEN: La arteria alveolar superior posterior (AASP) y la arteria infra-orbital (AIO) tienen ramas intra y extra óseas que forman una anastomosis en la pared lateral del seno maxilar. Esta anastomosis está siempre presente, sin embargo, aún no ha sido incluida en la terminología anatómica (TA), por lo que en la comunicación científica se utilizan diferentes términos para referirse a ella. El objetivo de este estudio fue realizar una revisión sobre los diferentes términos utilizados para nombrar esta estructura vascular. Se realizó una revisión de la literatura sobre los términos utilizados para nombrar la anastomosis entre AASP y AIO en estudios imagenológicos y en cadáveres humanos que evaluaron la presencia/frecuencia de esta estructura anatómica. La búsqueda fue realizada en las bases de datosMedline, EMBASE y LILACS, en los idiomas portugués, español e inglés, sin restricción de fecha. Los estudios seleccionados fueron evaluados de forma cualitativa, analizando la terminología empleada para referirse a la anastomosis entre AASP y AIO. Fueron encontrados 2108 artículos originales, siendo seleccionados 60 artículos potencialmente relevantes y finalmente fueron incluidos 54 estudios para análisis cualitativo. Fueron encontrados 16 términos para referirse a la anastomosis entre AASP y AIO, siendo AASP el más frecuente seguido de arteria alveolo-antral (AAA). Son muchos los términos utilizados en la literatura médica para designar la anastomosis entre AASP y AIO, siendo AASP y AAA los más usados. La unificación de los términos utilizados para designar esta estructura vascular y su incorporación en la Terminología Anatómica contribuiría a evitar equívocos en la comunicación científica.

Implantes imediatos, e seus defeitos peri-implantares (GAP) preenchidos com o uso de biomateriais sintéticos / Implants, and their peri-implant defects (GAP) filled with the use of synthetic biomaterials

A colocação de implantes osseointegráveis requer volume ósseo adequado, porém, a extração de dentes leva a diferentes padrões de remodelaç ão e reabsorção óssea. A reabsorção do rebordo alveolar tem sido considerada uma consequência inevitável da extração dentária e pode ser um problema significativo em Implantodontia. Após a extração dentária, mesmo com a instalação de implantes imediatos, o sítio desdentado do processo alveolar sofre substancial modelagem óssea, com a diminuiç ão das dimensões da crista alveolar. Após a inserção de um implante em um local de extração fresco, um defeito marginal (GAP) ocorre, frequentemente, entre o rebordo e a superfície do implante, A fim de superar esse problema e para facilitar a formaç ão de osso no defeito marginal, vários processos de enxerto têm sido utilizados, associados ou não ao uso de membranas de barreira, bem como diversos tipos de substitutos ósseos que podem ser utilizados para tal procedimento. Esse trabalho tem por objetivo revisar e discutir a literatura relacionada ao uso de biomateriais sintéticos para preenchimento desses defeitos que se formam ao redor de implantes instalados em alvéolos frescos. No entanto, ainda não existe um biomaterial ideal que possua todas as pro- priedades desejáveis. Além disso, o volume de osso residual deve ser avaliado antes da extração de dentes, de modo que os cirurgiões possam utilizar técnicas diferentes para preservar o osso alveolar.

Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Reference standard thickness for bone plates of upper teeth: an ultra-high-resolution study using tomographic mapping / Padrão de referência de espessura para cristas ósseas de dentes superiores: um estudo de ultra-alta resolução usando mapeamento tomográfico

Objective: it is important to know the thicknesses of the alveolar bone plates (ABPs) based on the current literature for the planning and success of orthodontic treatment. However, studies have scientific limitations regarding ABPs as the image resolution is not adequate and is restricted to a few teeth or buccal face only. This study was aimed at reporting a reference standard for bone plates of upper teeth, in which 15 patients (mean age of 21.79 years) with balanced occlusion and a harmonious facial profile were evaluated using cone-beam computed tomography at a voxel size of 0.1 mm. Material and Methods: bone tissues of the cervical, middle, and apical thirds of the root (buccal and palatal), the distance between cement-enamel junction (CEJ) and alveolar bone crest (ABC), and inclination of the teeth to the palatal plane were evaluated. Paired t-test, Spearman's correlation tests, and linear regression tests were used (P < 0.05). Results: the buccal distance between the CEJ and ABC was greater than the palatal one in all pairs of teeth. Most of the bone tissues had a thickness ≤ 1 mm in the buccal face, whereas in the cervical-apical direction, the thickness was ≥ 2 mm. There is no equivalence between genders in the sample. Conclusion: the reduced buccal bone architecture around the first premolars was indicative of local gingival recessions, and the lack of gender uniformity was suggestive of individual evaluation. References of normal bone tissue determining the orthodontic limits were provided to assist in the treatment planning. (AU)

Objetivo: é importante conhecer as espessuras das cristas ósseas alveolares (COAs) com base na literatura atual para o planejamento e sucesso do tratamento ortodôntico. No entanto, os estudos apresentam limitações científicas em relação às COAs, pois a resolução da imagem não é adequada e está restrita apenas a alguns dentes ou face vestibular. Este estudo teve como objetivo descrever um padrão de referência para corticais ósseas de dentes superiores, no qual 15 pacientes (idade média de 21,79 anos) com oclusão equilibrada e perfil facial harmonioso foram avaliados por meio de tomografia computadorizada de feixe cônico no tamanho de voxel de 0,1 mm. Material e Métodos: os tecidos ósseos dos terços cervical, médio e apical da raiz (vestibular e palatina), a distância entre a junção cemento-esmalte (JCE) e a crista óssea alveolar (COA) e a inclinação dos dentes ao plano palatino foram avaliados. Foram utilizados o teste t pareado, os testes de correlação de Spearman e os testes de regressão linear (P < 0,05). Resultados: a distância vestibular entre a JEC e a COA foi maior que a palatina em todos os pares de dentes. A maioria dos tecidos ósseos apresentou espessura ≤ 1 mm na face vestibular, enquanto no sentido cérvico-apical a espessura foi ≥ 2 mm. Não há equivalência entre os gêneros na amostra. Conclusão: a arquitetura óssea vestibular reduzida ao redor dos primeiros pré-molares foi indicativa de recessões gengivais locais, e a falta de uniformidade de gênero foi sugestiva de avaliação individual. Referências de tecido ósseo normal determinando os limites ortodônticos foram fornecidas para auxiliar no planejamento do tratamento. (AU)

Comprehensive prosthodontic treatment of an elderly patient with compromised ridges: a clinical case report / Tratamiento prostodóntico integral de un paciente anciano con proceso alveolar comprometido: informe de un caso clínico

Introduction: The objective of a complete denture prosthesis is restoring aesthetics, comfort, and function by the replacement of missing dental and alveolar structures employing a stable prosthesis. Case Report: Many conditions can complicate the treatment plan and fabrication of a complete denture prosthesis. Complete denture fabrication in clinically compromised conditions is a challenging task for the dentist. In this clinical report, we present comprehensive management of a patient with denture-induced hyperplasia, flabby ridge, and severely resorbed edentulous ridge. The three part strategy for management of the above-mentioned challenges can provide high-quality complete dentures, based on recognized prosthodontic principles. This first part will discuss the management of denture induced hyperplasia by elimination of the inflammation and excision of the lesion. Part two will cover management of the flabby ridge using a modified window technique for the impression of maxillary flabby tissues for an improved and controlled application of the impression material that is usually obtainable in dental practice. Part three highlights the rehabilitation procedure of the resorbed mandibular ridge using a functional impression technique with minimum soft tissue displacement and neutral zone arrangement of teeth to improve stability of the denture. Conclusion: rehabilitation of a patient with denture induced hyperplasia, flabby ridge, and severely resorbed edentulous ridges was successful.

Introducción: El objetivo de una prótesis completa es restaurar la estética, la comodidad y la función mediante el reemplazo de las estructuras dentales y alveolares faltantes empleando una prótesis estable. Case Report: Muchas condiciones pueden complicar el plan de tratamiento y la fabricación de una prótesis completa. La fabricación completa de la dentadura en con-diciones comprometidas clínicamente es una tarea desafiante para el dentista. En este reporte de un caso clínico, presentamos el ma-nejo integral de un paciente con hiperplasia inducida por dentadura postiza, cresta flácida y cresta edéntula severamente reabsorbida. La estrategia de tres partes para el manejo de los desafíos mencionados anteriormente puede proporcionar prótesis completas de alta calidad, basadas en reconocidos principios protésicos. La primera parte discutirá el manejo de la hiperplasia inducida por dentadura postiza mediante la eliminación de la infla-mación y la extirpación de la lesión. La segunda parte cubrirá el manejo de la cresta alveolar flácida utilizando una técnica de ventana modificada para la impresión de tejidos flácidos maxilares para una aplicación mejorada y controlada del material de impresión que generalmente se obtiene en la práctica dental. La tercera parte destaca el procedimiento de rehabilitación del reborde mandibular reabsorbido utilizando una técnica de impresión funcional con un desplazamiento mínimo de los tejidos blandos y una disposición de la zona neutra de los dientes para mejorar la estabilidad de la dentadura. Conclusion: La rehabilitación de un paciente con hiperplasia inducida por dentaduras postizas, cresta flácida y reabsorbida fue exitosa.

Índice de sucesso de exodontias realizadas com extrator minimamente traumático / Exodonticssuccess index performed with a minimally traumatic extractor / Índice de éxito de exodonciarealizado com unextractor traumático mínimo

Introdução:Técnicas para extração dentária vêm sendo aperfeiçoadas objetivando um procedimento que diminua o esforço profissional, o tempo cirúrgicoeamenize as dores e os processos inflamatórios. Neste sentido os extratores minimamente traumáticos,com a exodontia vertical, propõem-se a preservar o osso alveolar e proporcionar uma recuperação mais rápida e confortável para o paciente. Objetivo:Avaliar a efetividade do kit para extração minimamente traumática da Maximus® (Contagem, Minas Gerais, Brasil) na exodontia de raízes residuais de incisivos, caninos e pré-molares unirradiculares. Metodologia:Trata-se de um ensaio clínico, prospectivo e analítico. Os pacientes foram operados utilizando o dispositivo, sendo avaliados os dados demográficos, tempo cirúrgico, dor e conforto após a cirurgia, bem como o grau de satisfação profissional com o uso do dispositivo. Para verificar diferenças significativas foi utilizado o teste de Mann-Whitney e a busca de associações foi realizada com o Exato de Fisher. Para todos os testes foi estabelecida uma significância com p<0,05.Resultados:Quarenta elementos foram removidos, o tempo cirúrgico foi em média 16,28 minutos, níveis de dor e conforto imediatamente após a cirurgia se mantiveram baixos (p<0,0001), e o grau de satisfação profissional se manteve alto (p<0,0001). A taxa de sucesso do dispositivo foi de 93,3% para os elementosincisivos e 20% para os elementos caninos e pré-molares (p<0,0001).Conclusões:A eficácia do extrator é determinada pelo tamanho da superfície radicular cobertas com fibras periodontais e a localização do dente. No entanto pode ser bem indicada no planejamento de reabilitações implantosuportadas em região anterior de maxila e mandíbula (AU).

Introduction:Techniques for tooth extraction have been improvedaiming at a procedure that reduces professional effort, surgical time, pain and inflammatory processes. In this sense, minimally traumatic extractors with vertical extraction, propose to preserve the alveolar bone and provide a faster and more comfortablerecovery for the patient. Objective:To evaluate the effectiveness of the Maximus® Minimally Traumatic Extraction Kit (Contagem, Minas Gerais, Brasil) in the extraction of uniradicular residual roots from incisors, canines and premolars.Methodology:Thisis a clinical, prospective and analytical trial. Patients were operated on using the device, and demographic data, surgical time, pain and comfort after surgery were evaluated, as well as the degree of professional satisfaction with the use of the device.To verify significant differences, the Mann-Whitney test was used and the search for associations was performed with Fisher's exact test. For all tests, significance was set at p<0.05.Results:Forty elements were removed, surgical time averaged 16.28 minutes, levels of pain and comfort immediately after surgery remained low (p<0.0001), and the degree of job satisfaction remained high (p<0.0001). The success rate of the device was 93.3% for the incisor elements and 20% for the canine and premolar elements (p<0.0001).Conclusions:The effectiveness of the extractor is determined by the size of the root surface covered with periodontal fibers and the location of the tooth. However, can be well indicated in planning implanted rehabilitation in the anterior region of the maxilla and mandible (AU).

Introducción: Se han mejorado las técnicas de extracciónde dientescon el objetivo de un procedimiento que reduzca el esfuerzo profesional, el tiempo quirúrgico, el dolor y los procesos inflamatorios. En este sentido, los extractores mínimamente traumáticos con extracción vertical tienen como objetivo preservar el hueso alveolar y proporcionar una recuperación más rápida y cómoda para el paciente. Objetivo: Evaluar la efectividad del Kit de Extracción Mínimamente Traumática Maximus® (Contagem, Minas Gerais, Brasil) en la extracción de raíces residuales de incisivos, caninos y premolares uniradiculares. Metodología: Es un ensayo clínico, prospectivo y analítico. Los pacientes fueron intervenidos con el dispositivo y se evaluaron datos demográficos, tiempo quirúrgico, dolor y comodidad después de la cirugía, así como el grado de satisfacción laboral con el uso del dispositivo. Para verificar diferencias significativas se utilizó la prueba de Mann-Whitney y la búsqueda de asociaciones se realizó mediante la prueba exacta de Fisher. Para todas las pruebas, la significancia se estableció en p <0,05. Resultados:Se retiraron cuarenta ítems, el tiempo quirúrgico promedió 16,28 minutos, los niveles de dolor y comodidad inmediatamente después de la cirugía permanecieron bajos (p<0,0001) y el grado de satisfacción laboral se mantuvo alto (p<0,0001). La tasa de éxito del dispositivo fue del 93,3% para los elementos incisivos y del 20% para los elementos caninos y premolares (p<0,0001).Conclusiones: La efectividad del extractor está determinada por el tamaño de la superficie radicular cubierta por fibras periodontales y la ubicación del diente. Sin embargo, puede resultar muy adecuado para planificar la rehabilitación con implantes en la región anterior del maxilar y la mandíbula (AU).

Analysis of the presence, location and morphometry of the «alveolar antral artery¼ by cone-beam computed tomography in Chilean adults / Análisis de la presencia, ubicación y morfometría de la arteria alvéolo-antral por tomografía computarizada de haz cónico en adultos chilenos

SUMMARY: The posterior superior alveolar artery is responsible for the vascularisation of the mucous which covers the posterior wall of the maxillary sinus, pulp and the periodontal tissues of upper molars. The collateral rami of the infraorbital artery irrigate the mucous of the anterior and lateral walls of the maxillary sinus, as well as the pulp and periodontal tissue of the upper anterior teeth and upper premolars. Both these arteries present intraosseous and extraosseous rami which form an anastomosis in the anterior and lateral walls of the maxillary sinus, called the alveolar antral artery (AAA). The aim of this study was to analyse the presence, location and morphometry of the AAA in a Chilean population, considering sex, side and age, using Cone-Beam computed tomography (CBCT). Forty-two CBCT examinations of Chilean adults were evaluated to analyse the presence, location (extraosseous, intraosseous or subperiosteal) and diameter (<1mm, 1-2 mm, 2-3 mm, >3 mm) of the AAA and the distance from the AAA to the amelocemental limit of the upper second premolar (2PM), permanent upper first molar (1M) and permanent upper second molar (2M) by sex and age range. Pearson's chi-squared test, Student's t-test, ANOVA and Pearson's correlation coefficient were applied, using a significance threshold of 5 %. AAA was found in 75 sides (89.3 %), 38 on the right side (90.5 %) and 37 on the left (88.09 %); extraosseous location was most common. More than 80 % of the arteries presented a diameter between 1 and 2 mm, with no important differences between sexes or age ranges. In younger individuals, the artery was located closer to the vestibular amelocemental limit than in older individuals. Carrying out a proper treatment plan which includes imagenological analysis before surgical procedures is essential to avoid possible haemorrhagic events in the region.

RESUMEN: Arteria alveolar superior posterior es responsable de la vascularización de la mucosa que recubre la pared posterior del seno maxilar, la pulpa y el tejido peridontal en el que se insertan los molares superiores. Las ramas colaterales de la arteria infraorbitaria irrigan la mucosa de las paredes anterior y lateral del seno maxilar, así como la pulpa y el periodonto de los dientes anteriores superiores y los premolares superiores. Ambas arterias presentan ramas intraóseas y extraóseas que forman una anastomosis en las paredes anterior y lateral del seno maxilar, denominada arteria alvéolo antral (AAA). El objetivo de este estudio fue analizar la presencia, localización y morfometría del AAA en una población chilena, considerando sexo, lado y edad, mediante tomografía computarizada Cone-Beam (CBCT). Se evaluaron 42 exámenes CBCT de adultos chilenos para analizar la presencia, ubicación (extraósea, intraósea o subperióstica) y diámetro (<1 mm, 1-2 mm, 2-3 mm,> 3 mm) del AAA. y la distancia del AAA al límite amelocemental del segundo premolar superior (2PM), primer molar superior permanente (1M) y segundo molar superior permanente (2M) por sexo y rango de edad. Se aplicaron la prueba de chi-cuadrado de Pearson, la prueba t de Student, ANOVA y el coeficiente de correlación de Pearson, utilizando un umbral de significancia del 5 %. Se encontró AAA en 75 lados (89,3 %), 38 del lado derecho (90,5 %) y 37 del lado izquierdo (88,09 %); la localización extraósea fue la más común. Más del 80 % de las arterias presentaban un diámetro entre 1 y 2 mm, sin diferencias importantes entre sexos ni rangos de edad. En individuos más jóvenes, la arteria se ubicó más cerca del límite amelocemental vestibular que en individuos mayores. La realización de un adecuado plan de tratamiento que incluya análisis imagenológico antes de los procedimientos quirúrgicos es fundamental para evitar posibles eventos hemorrágicos en la región.

Alveólise decorrente de traumatismo dentário: relato de caso / Alveolysis due to dental trauma: case report

The alveolysis is a pathological condition classified as partial or total dehiscence (the root exposure is partial or total and involves the marginal bone) and apical fenestration (the root exposure doesn't involve the marginal bone). Usually occurs by vestibular and in the anterior region of the maxilla. It's commonly associated with chronic infections provoked by dental caries and dental trauma. This study aims to report a clinical alveolysis case in a previous traumatized deciduous tooth of a 4 years old child. Clinical examination noticed aveolysis apical fenestration type associated to partial dehiscence (tooth 51) and presence of mobility. In the radiographic examination it was found thickening of the pericementary space and external root resorption. The indicated treatment was extraction of the affected tooth and the use of maintainer of space. Based on the reported case, it is concluded that early care and the control of traumatized and decayed teeth are essential for the prevention of alveolysis.

A alveólise é uma condição patológica classificada em deiscência parcial ou total (a exposição radicular é parcial ou total, e envolvendo o osso marginal) e fenestração apical (a exposição radicular não envolve o osso marginal). Geralmente ocorre por vestibular e na região anterior da maxila. Está comumente associada a infecções crônicas decorrentes de cárie e traumatismo dentário. O objetivo deste estudo foi relatar um caso clínico de alveólise em dente decíduo anterior traumatizado de uma criança de 4 anos de idade. Ao exame clínico constatou-se alveólise do tipo fenestração apical associada à deiscência parcial (dente 51) e presença de mobilidade. Ao exame radiográfico foi observado espessamento do espaço pericementário e reabsorção radicular externa. O tratamento indicado foi a exodontia do dente afetado e o uso de mantenedor de espaço. Com base no caso relatado, conclui-se que a atenção precoce e o controle de dentes traumatizados e cariados são essenciais para a prevenção da alveólise.

Cirugía ósea resectiva / Resective osseous surgery

Una de las causas de la evolución de la periodontitis es la formación de defectos óseos y pérdida de inserción clínica. Una manera de eliminar el defecto intraóseo y su bolsa periodontal es eliminar las paredes de hueso que componen el defecto para colocar el complejo dentogingival en una posición más apical. La cirugía ósea es un procedimiento periodontal resectivo que involucra la modificación del tejido óseo del soporte dental, la cual es una modalidad del tratamiento periodontal quirúrgico que puede utilizarse para eliminar eficazmente los defectos óseos periodontales para estabilizar la inserción periodontal. El objetivo del presente estudio es realizar una revisión de la literatura sobre las consideraciones actuales, técnicas y principios de la cirugía ósea resectiva en el paciente periodontalmente comprometido (AU)

One of the causes of the evolution of periodontitis is the formation of bone defects and loss of clinical attachment, where one way to eliminate the intraosseous defect and its periodontal pocket is to eliminate the bone walls that make up the defect to place the dentogingival complex in a more apical position. Bone surgery is periodontal surgery that involves the modification of the supporting bone tissue of the teeth, which is a modality of surgical treatment that can be used to effectively eliminate periodontal defects and stabilize the periodontal insertion. The aim of the present study is to conduct a literature review about the considerations, techniques and principles of resective bone surgery in the periodontally compromised patient (AU)

Horizontal ridge augmentation of a single atrophic site in the anterior maxilla using hydroxyapatite and rhBMP-2 / Augmento óseo horizontal de reborde alveolar en sitio atrófico único en maxila anterior usando hidroxiapatita y rhBMP-2

SUMMARY: Bone morphogenetic protein (rhBMP-2) is a powerful osteo-inductive growth factor widely used in bone reconstruction and both the vehicle used to administer it and the scaffold substrate could determine its success in clinical situations. The aim was to analyse the clinical behaviour of dental implants placed in single alveolar ridges with a horizontal deficiency in the maxillary anterior region that were reconstructed horizontally with rhBMP-2 and porous hydroxyapatite (HA). Inclusion criteria were both males and females, between the ages of 18 and 29 with single tooth loss of one upper incisor. Cone Beam Computed Tomography (CBCT) was used to take measurements prior to bone augmentation and again prior to the implant insertion. Surgery was carried out under local anaesthetic. In the primary procedure, bone substitute was introduced using porous HA and rhBMP-2; after 4 to 5 months, dental implant surgery was carried out and the implant placed; after 3 months of consolidation the provisional prosthesis was placed and then a definitive restoration was placed. Variables were analysed using the t-test with a p-value of < 0.05 in order to assess statistical significance. Thirteen subjects were included (6 females and 7 males). Bone augmentation resulted in a bone gain of 4.15mm (p=0.023), which was shown to be statistically significant. All of the grafts placed were successful and 13 implants were placed, using torques between 30 and 70N, without complications. For the final prostheses, 11 were screw retained and 2 were cemented in place. The horizontal bone augmentation using HA and rhBMP-2 is an efficient technique for single bone defects in the anterior maxillary area; clinical trials on a larger scale are needed to confirm these results.

RESUMEN: La proteína ósea morfogenética (BMP-2) es un potente osteoinductor utilizado ampliamente en técnicas reconstructivas; el vehículo de instalación es determinante en su evolución. El objetivo fue analizar el comportamiento clínico de implantes dentales instalados en rebordes alveolares únicos con deficiencia horizontal del sector anterior reconstruida horizontalmente con BMP-2 e hidroxiapatita (HA) porosa. Fueron incluidos sujetos de ambos sexos de entre 18 y 29 años, con pérdida dentaria unitaria a nivel de incisivos superiores. Se utilizó tomografía computadorizada para realizar mediciones en las etapas previa a la instalación del injerto y previo a la instalación del implante. Las cirugías fueron realizadas bajo anestesia local. En la primera intervención se realizó la instalación del injerto óseo utilizando HA porosa y BMP-2; después de 4 a 5 meses se realizó la instalación del implante dental; 3 meses después se realizó la conexión protésica y rehabilitación final. Las variables fueron estudiadas con la prueba t test considerando el valor de p< 0,05 para considerar significancia estadística. Trece sujetos fueron incluidos (6 mujeres y 7 hombres); con la reconstrucción ósea se obtuvo una ganancia ósea de 4,15mm (p=0.023) que fue estadísticamente significativo. No existió pérdida en ningún injerto realizado; se instalaron 13 implantes con torques entre 30 y 70N sin complicaciones; se realizaron prótesis fijas atornilladas en 11 casos y cementadas en 2 casos. La técnica con HA y BMP- 2 es eficiente para reconstruir defectos horizontales en perdidas unitarias del sector anterior maxilar; ensayos clínicos de mayor escala son necesarios para confirmar estos resultados.

Prosthetically driven alveolar reconstructions: a retrospective study

Abstract This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.

Comparison of the retention of conventional dentures after the use of common adhesive brands on poor denture foundations: an in vitro study / Comparación de la retención de dentaduras convencionales con el uso de marcas comerciales de adhesivos en procesos alveolares deficientes: un estudio in vitro

There is no information about the possible impact in denture retention after the use of common denture adhesives (DAs) when poor denture foundations (PDF) are present. Moreover, there is a lack of information about which current formulation provides greater retention and for how long. Twelve models from edentulous patients with different ridge shape and border height were used and complete dentures were manufactured. Four different formulation brands of DAs were tested after 10 minutes and three, six, nine, and 12 hours of DA application using a universal testing machine. The Fittydent® and Fixodent® adhesives had the highest retention at 12 hours. The PDF group increased on average its retention by 400 %. However, the group presented lower retention compared to the good denture foundation group. In conclusion, DAs significantly increased denture retention. The PDF group were the most benefited with the application of DAs. The Fixodent® paste had the highest retention.

No existe información acerca del posible impacto en la retención de dentaduras después del uso de adhesivos dentales comunes (DAs) cuando existen rebordes alveolares deficientes (PDF). Más aun, existe una falta de información acerca de cuál formula actual provee mayor retención y por cuanto tiempo. Doce modelos de pacientes edentulos con diferentes formas y alturas en sus rebordes alveolares fueron usados, y dentaduras completas les fueron realizadas. Cuatro diferentes fórmulas y marcas de DAs fueron evaluadas después de 10 minutos, tres, seis, nueve y 12 horas de que se aplicó el DA usando una maquina universal de pruebas. Los adhesivos Fittydent® y Fixodent® presentaron la retención más alta a las 12 horas. El grupo con PDF incrementó su retención hasta en un 400 %. Sin embargo, el grupo presentó menor retención cuando se comparó con el grupo que posee adecuados procesos alveolares. Los DAs incrementaron significativamente la retención de las dentaduras. El grupo PDF fue el más beneficiado con la aplicación de DAs. La pasta Fixodent® provee la más alta retención.

Vestibular Alveolar bone height measurement: Accuracy and Correlation between direct and indirect techniques / Medición de la altura del hueso alveolar vestibular: precisión y correlación entre técnicas directa e indirecta

ABSTRACT Cone Beam Computed Tomography (CBCT) has modified the perspective of dentistry images, providing manipulable threedimensional images with a 1:1 patient:image ratio. Treatments and diagnosis are modified or corroborated by CBCT; however, its accuracy in thin structures such as cortical bone has been subjected to critical review. The aim of this study is to correlate the measurement of vestibular alveolar bone height using direct measurements and measurements performed with conebeam tomographic images with standard (SD) voxel resolution. Thirty incisor and premolar teeth of patients undergoing open curettage were measured with a highprecision caliper and with Cone Beam Computed Tomography (CBCT) at an SD resolution of 0.16 mm voxels in a 3D Orthophos XG Sirona scanner. Intraobserver evaluation was performed using the intraclass correlation coefficient (ICC). Direct measurements and CBCT measurements were correlated using Pearson correlation (PCC). The mean difference between indirect and direct measurements was 3.15 mm. Paired t test and Pearson Correlation coefficient determined that all measurements differed statistically from each other with p<0.05. With the CT scanner and protocol used in this study, CBCT images do not enable accurate evaluation of vestibular alveolar bone height.

RESUMEN La tomografía de haz cónico (CBCT) ha modificado la perspectiva de la imagenología en odontología que brinda una imagen tridimensional manipulable con una relación 1:1, paciente: imagen. Los tratamientos y diagnósticos se ven modificados o corroborados por el CBCT; sin embargo, la exactitud que presenta en estructuras delgadas como las corticales óseas ha sido sometida a críticas. El objetivo fue correlacionar la medición de la altura del hueso alveolar vestibular mediante mediciones directas y las realizadas con imágenes tomográficas de haz cónico con resolución de vóxel estándar (SD). Treinta dientes incisivos y premolares de pacientes sometidos a un curetaje abierto se midieron con un calibrador de alta precisión y una tomografía computarizada de haz cónico (CBCT) a una resolución SD de 0,16 mm de vóxeles en un escáner 3D Orthophos XG Sirona. La evaluación intraobservador se realizó utilizando el coeficiente de correlación intraclase (ICC), y las mediciones directas y las mediciones CBCT se correlacionaron utilizando la correlación de Pearson (PCC). La diferencia media entre las mediciones indirectas y directas fue de 3,15 mm. La prueba t pareada y el Coeficiente de Correlación de Pearson determinaron que todas las mediciones fueron estadísticamente diferentes entre sí con una p <0.05. Con el escáner de TC y el protocolo utilizado en este estudio, las imágenes CBCT no permiten una evaluación precisa de la altura del hueso alveolar vestibular.

Preservación alveolar post extracción en zona estética: decisiones clinicas predecibles en sitio severamente afectado / Alveolar ridge preservation in the esthesic zone: predictable decisions in a severly affected site

INTRODUCCIÓN: La valoración particular de sitios severamente comprometidos, involucra considerar los tiempos necesarios de cicatrización, así como evidencia actual en términos de biomateriales y técnicas quirúrgicas con el fin de lograr un tratamiento exitoso. MATERIAL Y MÉTODO: Paciente sexo femenino, 28 años, asiste por dolor e infección en diente 2.1 al Postítulo de Periodoncia UDD. Se observa defecto extenso y lesión que compromete tanto las tablas óseas vestibular como palatina. El tratamiento consistió en: exodoncia y regeneración ósea, instalación del implante 6 meses después de la exodoncia y cirugía de conexión 7 meses después más injerto de tejidos blandos. RESULTADOS: El tratamiento de defectos combinados (tejidos duros y blandos), asociados a procesos infecciosos de larga data, mediante rehabilitación implanto soportada puede ser muy predecible y exitoso en la medida que se respeten los tiempos de regeneración de diferentes estructuras.

INTRODUCTION: The specific assessment of a severely compromised sites involves: the consideration of healing time according to the different kinds of tissues involved and the knowledge of the evidence available concerning biomaterials and surgical techniques. MATERIAL AND METHODS: Female patient attends the postgraduate school of periodontics, UDD University in Santiago de Chile, because of pain and chronic infection compromising tooth 2.1. At clinical evaluation, the site has an extensive defect, with active fistula that compromises the buccal and palatal bone plates. The treatment consisted of exodontia and guided bone regeneration, implantation six months after initial exodontia and abutment connection surgery seven months after implant insertion. RESULTS: the treatment of combined defects associated with a long-standing infectious process can be very predictable and successful, only if the measures of time and tissue handling are considered and applied.

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Prevalence of horizontal alveolar changes in edentulous patients: a retrospective tomographic study

Abstract Horizontal bone loss after tooth extraction is a common finding that demands bone reconstruction in various cases. The aim of this study was to assess the horizontal alveolar status in partially and completely edentulous patients using cone-beam computed tomography (CBCT). In total, 1516 CBCT scans of 1404 adult patients were analyzed. Assessment of the images was performed in accordance with the previously published horizontal alveolar change (HAC) classification, which categorizes horizontal bone defects into four classes: HAC 1, HAC 2, HAC 3 and HAC 4 (from the least severe to the most severe condition). Analysis of 1048 scans from partially edentulous patients presented a distribution of 63.55%, 22.14%, 13.36% and 0.95% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Analysis of 468 scans from completely edentulous patient images presented a distribution of 19.87%, 28.63%, 41.67% and 9.83% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Based on these results, as in HAC 4, no cancellous bone was found between the cortical buccal and lingual/palatal bone plates, it seems reasonable to state that the absence of cancellous bone is higher in completely edentulous patients than in partially edentulous patients. Therefore, the absence of cancellous bone seems to be higher in completely edentulous than in partially edentulous patients.