Noncarious cervical lesions: Response from a 25-year clinical follow-up study.

STATEMENT OF PROBLEM: The etiology and diagnosis of noncarious cervical lesions (NCCLs) remain poorly understood. PURPOSE: The purpose of this clinical study was to examine NCCL progression in an existing group of participants, establish the incidence of new NCCLs in a 25-year follow-up study, and relate them to possible risk factors, including occlusal factors. MATERIAL AND METHODS: Thirty-three participants who had completed a questionnaire about their habits, diet, and personal information were evaluated in this observational retrospective study. Impressions were made, and casts from 3 time periods (Phase I in 1996, Phase II in 1999, and Phase III in 2021) were scanned to obtain digital casts. The casts were then evaluated in a 3-dimensional analysis software program (Geomagic Control; 3D Systems) to establish digital comparisons between NCCLs and occlusal wear. Furthermore, data from an occlusal analysis device (T-Scan; Tekscan) collected in Phase I was used to analyze occlusal interferences relating to the progression of NCCLs. The statistical analysis applied nonparametric tests, followed by the assessment of the association between NCCLs and risk factors, including occlusal wear, through binary logistic regression (α=.05). RESULTS: At the end of Phase III, 7 new individuals with NCCLs were detected compared with Phase II. The median percentage progression of NCCLs per participant was 0.0% in Phase I, 7.1% in Phase II, and 35.7% in Phase III (P<.005). Occlusal wear in Phase I was associated with 5.02 times the occurrence of NCCLs in Phase III; occlusal wear in Phase II was associated with 4.73 times the occurrence of NCCLs in Phase III; and occlusal wear in Phase III was associated with 1.94 times the occurrence of NCCLs in Phase III (P<.001). Occlusal interference in border movements of the mandible was associated with a 3.55 times greater chance of presenting NCCLs in Phase III (P<.001). Additionally, statistically significant risk factors for the presence of NCCLs in Phase III were an acidic diet (P=.043) and alcohol consumption (P=.021). CONCLUSIONS: The 25-year data showed an association between NCCLs and specific risk factors, including occlusal wear and occlusal interferences.

Duration of mastication and oral phase of swallowing in the elderly with different dental conditions: a clinical analysis / Duração da mastigação e da fase oral da deglutição em idosos com diferentes condições dentárias: análise clínica

ABSTRACT Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.

Cerebral Structure and Function in Stroke-free Patients with Atrial Fibrillation.

OBJECTIVES: Atrial fibrillation (AF) is associated with high risk of dementia and brain atrophy in stroke-free patients, but the mechanisms underlying this association remain unclear. We aimed to examine the brain volume and connectivity of paramount cognitive brain networks in stroke-free patients with AF without dementia. MATERIALS AND METHODS: Twenty-six stroke-free patients with AF and 26 age and sex-matched subjects without AF were submitted to a 3-tesla brain structural and functional MRI. An extensive clinical evaluation excluded stroke, dementia, low cardiac output, carotid stenosis and metabolic diseases without optimal therapy. We used CHA2DS2-VASc score to classify the cardiovascular risk factor burden and a broad neuropsychological battery to assess the cognitive performance. Voxel based morphometry analysis of. structural MRI defined whole-brain gray and white matter volumes. Finally, we used eco-plannar MRI images to compare the differences of functional connectivity of 7 large-scale resting-state networks between AF patients and controls. RESULTS: Taking into account the history of hypertension and heart failure, AF was associated to volume decrease of the right basal frontal lobe and right inferior cerebellum. Decreased connectivity of the ventral Default Mode Network (vDMN) was observed in the AF group. No disruption of connectivity was observed in the executive, visuospatial and salience networks. CONCLUSION: Individuals with AF without stroke or dementia have subtle reduction of gray and white matter, restricted to frontal areas and cerebellum. These patients show decreased vDMN connectivity, without other large-scale brain network disruption.

Vivências maternas e autismo: os primeiros indicadores de TEA e a relação mãe e filho / Vivencias maternas y autismo: los primeros indicadores de TEA y la relación madre y niño / Maternity experiences and autism: the firsts signs of ASD and the mother and child relationship / Expériences maternelles et autisme: les premiers indicateurs duTSA et de la relation mère-enfant

Mães de filhos com Transtorno do Espectro Autista (TEA) tendem a vivenciar diversos desafios na maternidade. Este estudo qualitativo tem como objetivo compreender as vivências maternas e as experiências com os primeiros indicadores de TEA. Seis mães com filhos diagnosticados com TEA responderam um questionário sociodemográfico e uma entrevista semiestruturada. Notou-se que mesmo antes do diagnóstico as mães percebiam que algo não ia bem com o bebê, havendo sobrecarga materna com os inúmeros cuidados que os filhos necessitam e que a rede de apoio é de extrema importância. Contudo, a intervenção precoce é relevante e pode contribuir de forma positiva com a relação mãe e bebê e sua subjetividade antes de um diagnóstico e o TEA implica em cuidados não somente com a criança, mas também ao seu cuidador principal

Las madres de niños con trastorno del espectro autista (TEA) tienden a experimentar varios desafíos en la maternidad. Este estudio cualitativo tiene como objetivo comprender las experiencias y vivencias maternas con los primeros indicadores de TEA. Seis madres con hijos diagnosticados de TEA respondieron un cuestionario sociodemográfico y una entrevista semiestructurada. Se notó que incluso antes del diagnóstico, las madres se dieron cuenta de que algo no iba bien con el bebé, con la sobrecarga materna, con los innumerables cuidados que los niños necesitan y que la red de apoyo es sumamente importante. Sin embargo, la intervención temprana es relevante y puede contribuir positivamente a la relación entre la madre y el bebé y su subjetividad antes de un diagnóstico y el TEA implica un cuidado no solo para el niño, sino también para su cuidador principal

Mothers whose children are in the Autism Spectrum Disorder (ASD) usually go through a variety of challenges in maternity. This qualitative research aims to comprehend the maternity experiences with the first signs of ASD. Six mothers which had their children diagnosed with ASD answered a sociodemographic questionnaire and a semi structured interview. It was eminent that even before the diagnosis the mothers could perceive that there was something different with their babies, how the need for the extra care that their babies demand is overwhelming and how important it is for them to have support. However, the early intervention is relevant and can contribute positively in the relationship between mother and child and in the mother ́s subjectivity before a diagnosis is given and ASD imply in taking care not only of the child but also of their main keeper

Les mères d'enfants atteints d'un Trouble du Spectre Autistique (TSA) ont tendance à éprouver plusieurs types de difficultés pendant la maternité. Cette étude qualitative vise à comprendre les expériences maternelles et les expériences avec les premiers indicateurs de TSA. Six mères d'enfants atteints de TSA ont répondu à un questionnaire sociodémographique et à un entretien semi-structuré. Il a été noté qu'avant même le diagnostic, les mères se rendaient compte que quelque chose n'allait pas bien avec le bébé. Elles font face à une surcharge maternelle avec d'innombrables soins à porter aux enfants. L'étude montre que le réseau de soutien est extrêmement important. Cependant, une intervention précoce est pertinente et peut contribuer positivement à la relation entre la mère et le bébé et leur subjectivité avant que le diagnostic soit réalisé. Le TSA implique une prise en charge non seulement de l'enfant, mais aussi de son principal soignant

Influence of Abutment Fabrication Method on 3D Fit at the Implant-Abutment Connection.

PURPOSE: To three-dimensionally evaluate the internal fit at the implant-abutment interface of abutments fabricated with different workflows using a combination of the silicone replica technique and microcomputed tomography (µCT). MATERIALS AND METHODS: Thirty abutments were fabricated to restore internal-connection implants and were divided into three groups according to fabrication method: (1) full digital (abutment machined using CAD/CAM system); (2) Ti-Base (prefabricated standard Ti-Base abutments); and (3) UCLA (UCLA-type abutments) (n = 10/group). Linear and volume measurements were performed to assess the internal misfit using a silicone replica of the implant-abutment interface misfit area, which was three-dimensionally reconstructed after µCT. The internal discrepancies in three different regions of interest (Gapsuperior, Gapmarginal, and Gapcenter) were assessed. Data were statistically evaluated using ANOVA and Tukey test (P < .05). RESULTS: Ti-Base and UCLA abutments presented significantly lower misfit volume (0.49 mm3, 95% CI: ± 0.045 mm3 and 0.48 mm3, 95% CI: ± 0.045 mm3, respectively) and mean internal gap (25.20 µm, 95% CI: ± 3.14 µm and 27.97 µm, 95% CI: ± 3.14 µm, respectively) than the full digital group (0.70 mm3, 95% CI: ± 0.045 mm3; 34.90 µm, 95% CI: ± 3.14 µm) (P < .001), but did not differ from each other (P = .825). While Gapcenter was significantly higher in the full digital group (P < .001), Gapsuperior and Gapmarginal did not demonstrate significant differences among groups. All regions were statistically similar within groups, except for Gapcenter in the full digital group, which exhibited higher mean values compared to the other regions (P = .000). The 3D measurements for quantification of internal discrepancy were strongly associated with the 2D measurements. CONCLUSION: Ti-Base and UCLA abutments exhibited better internal fit at the implant-abutment interfaces compared to a fully digitalized workflow (CAD/CAM custom abutments).

Evidence of Validity of the Autism Mental Status Examination (AMSE) in a Brazilian Sample.

This study investigated the psychometric properties of the Autism Mental Status Examination (AMSE) in a Brazilian sample of children and adolescents with autism spectrum disorder (ASD). A sample of 260 children and adolescents, comprising 56 (21.5%) females and 204 (78.5%) males, was assessed. The participants were submitted to both the childhood autism rating scale (CARS-BR) and the AMSE. The CARS-BR was used to estimate ASD severity and the cutoff point on the AMSE. Spearman's correlation test was employed to determine the correlation between the AMSE and CARS-BR scales. The cutoff values were calculated using the ROC (receiver operating characteristic) curve, identifying the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The homogeneity of the items of the AMSE was determined using Cronbach´s alpha. The AMSE exhibited good internal consistency (0.74), sensitivity (0.91) and specificity (0.98); and high correlation with the CARS-BR (ρ = 0.91, p < 0.01). Preliminary results showed that the AMSE is a tool with good psychometric properties for ASD screening.

Influence of the composition and shades of ceramics on light transmission and degree of conversion of dual-cured resin cements.

OBJECTIVE: Since the transmittance of ceramics can influence the degree of conversion (DC) of resin cements, ceramics composition and shade should be considered in the selection of resin cement. This in vitro study aimed to evaluate the effect of the transmittance of different composition, opacities and shades of ceramics on the degree of conversion of two dual-cured resin cements. METHODOLOGY: Sixty discs were prepared from low translucency (LT) and medium opacity (MO) lithium disilicate ceramic, and zirconia ceramic (Z). Each group was subdivided into 5 subgroups (n=4) in shades A2, A3.5, B2, C2 and D3. The transmittance measurement was performed in a spectrophotometer. The Variolink II and Rely X U200 resin cements were photoactivated by LED (1400 mW/cm2) for 40 s through the ceramic discs and without the discs (control group). The DC was measured with infrared FTIR spectroscopy, immediately after light activation. Data were analyzed with Kruskall-Wallis and one-way ANOVA, following post-hoc comparisons by Tukey test and Pearson's correlation test (P<0.05). RESULTS: LT ceramic exhibited higher transmittance values compared to MO and Z ceramics. LTA2 and LTB2 showed statistically higher transmittance values compared to MOA2, MOA3.5 and ZA3.5. For Variolink II, the ceramic interposition did not influence the DC, since there were no statistical differences between groups with ceramic interposition and the control group. For Rely X U200 cement, the interposition of some ceramics types/shades (LTA3.5, MOA2, MOA3.5 and ZA3.5) significantly decreased the DC values compared to control group. A positive correlation was found between the ceramic transmittance and DC values of both tested cements. Conclusions. The transmittance and DC values of the cements were influenced by composition and shades of the ceramics. The higher the transmittance of ceramics, the higher the DC values for both cements.

Influence of the composition and shades of ceramics on light transmission and degree of conversion of dual-cured resin cements

Abstract Objective Since the transmittance of ceramics can influence the degree of conversion (DC) of resin cements, ceramics composition and shade should be considered in the selection of resin cement. This in vitro study aimed to evaluate the effect of the transmittance of different composition, opacities and shades of ceramics on the degree of conversion of two dual-cured resin cements. Methodology Sixty discs were prepared from low translucency (LT) and medium opacity (MO) lithium disilicate ceramic, and zirconia ceramic (Z). Each group was subdivided into 5 subgroups (n=4) in shades A2, A3.5, B2, C2 and D3. The transmittance measurement was performed in a spectrophotometer. The Variolink II and Rely X U200 resin cements were photoactivated by LED (1400 mW/cm2) for 40 s through the ceramic discs and without the discs (control group). The DC was measured with infrared FTIR spectroscopy, immediately after light activation. Data were analyzed with Kruskall-Wallis and one-way ANOVA, following post-hoc comparisons by Tukey test and Pearson's correlation test (P<0.05). Results LT ceramic exhibited higher transmittance values compared to MO and Z ceramics. LTA2 and LTB2 showed statistically higher transmittance values compared to MOA2, MOA3.5 and ZA3.5. For Variolink II, the ceramic interposition did not influence the DC, since there were no statistical differences between groups with ceramic interposition and the control group. For Rely X U200 cement, the interposition of some ceramics types/shades (LTA3.5, MOA2, MOA3.5 and ZA3.5) significantly decreased the DC values compared to control group. A positive correlation was found between the ceramic transmittance and DC values of both tested cements. Conclusions. The transmittance and DC values of the cements were influenced by composition and shades of the ceramics. The higher the transmittance of ceramics, the higher the DC values for both cements.

Esthetic rehabilitation with zirconia on tooth and morse taper implant: case report / Reabilitação estética em zircônia sobre dente e implante cone morse: caso clínico

Among the ceramic materials used in dentistry, Zirconia presents the ideal opacity for cases where the clinical challenge is to neutralize the difference in the colors of the substrates. The "ceramic steel", so called by some authors, guarantees to Zirconia resistance and hardness similar to a metal, but with aesthetic advantages superior to the metal-ceramic restorations, which can exhibit exposure of the metal band over time. This article describes a complex rehabilitation treatment involving dental elements with different substrates: 11 - vital tooth with large crown damage; 21 ­ endodontically treated tooth and cast metal core; 22 - Morse taper implant. The selection of a completely zirconia-based ceramic system allowed masking the different conditions of substrates, so achieving the esthetic expectations. Moreover, considering the patient's high smile line, excellent gingival esthetics was obtained with an internal connection Morse taper implant associated with an individualized anatomic abutment.

Dentre os materiais cerâmicos utilizados na Odontologia, a Zircônia apresenta a opacidade ideal para os casos em que o desafio clinico é neutralizar a diferença nas cores dos substratos. O "aço cerâmico", assim chamado por alguns autores, garante à Zircônia resistência e dureza semelhantes a um metal, mas com vantagens estéticas superiores às restaurações metalocerâmicas, as quais podem apresentar exposição da cinta metálica ao longo do tempo. Este artigo descreve um tratamento reabilitador complexo, envolvendo elementos dentários com diferentes substratos: 11 - dente vital com ampla destruição coronária; 21 - dente com tratamento endodôntico e núcleo metálico fundido; 22 ­ ausente, reabilitado com implante do tipo cone morse. A seleção do sistema totalmente cerâmico à base de zircônia, permitiu mascarar as diferentes condições dos substratos atingindo as expectativas estéticas. Além disso, diante do sorriso alto gengivoso presente neste caso, a excelência na estética gengival foi obtida utilizando implante com conexão interna do tipo cone morse associado a um pilar anatômico individualizado.

Influence of curing protocol and ceramic composition on the degree of conversion of resin cement.

OBJECTIVE: Due to increasing of aesthetic demand, ceramic crowns are widely used in different situations. However, to obtain long-term prognosis of restorations, a good conversion of resin cement is necessary. To evaluate the degree of conversion (DC) of one light-cure and two dual-cure resin cements under a simulated clinical cementation of ceramic crowns. MATERIAL AND METHODS: Prepared teeth were randomly split according to the ceramic's material, resin cement and curing protocol. The crowns were cemented as per manufacturer's directions and photoactivated either from occlusal suface only for 60 s; or from the buccal, occlusal and lingual surfaces, with an exposure time of 20 s on each aspect. After cementation, the specimens were stored in deionized water at 37°C for 7 days. Specimens were transversally sectioned from occlusal to cervical surfaces and the DC was determined along the cement line with three measurements taken and averaged from the buccal, lingual and approximal aspects using micro-Raman spectroscopy (Alpha 300R/WITec®). Data were analyzed by 3-way ANOVA and Tukey test at =5%. RESULTS: Statistical analysis showed significant differences among cements, curing protocols and ceramic type (p<0.001). The curing protocol 3x20 resulted in higher DC for all tested conditions; lower DC was observed for Zr ceramic crowns; Duolink resin cement culminated in higher DC regardless ceramic composition and curing protocol. CONCLUSION: The DC of resin cement layers was dependent on the curing protocol and type of ceramic.

Influence of curing protocol and ceramic composition on the degree of conversion of resin cement

Abstract Due to increasing of aesthetic demand, ceramic crowns are widely used in different situations. However, to obtain long-term prognosis of restorations, a good conversion of resin cement is necessary. Objective: To evaluate the degree of conversion (DC) of one light-cure and two dual-cure resin cements under a simulated clinical cementation of ceramic crowns. Material and Methods: Prepared teeth were randomly split according to the ceramic's material, resin cement and curing protocol. The crowns were cemented as per manufacturer's directions and photoactivated either from occlusal suface only for 60 s; or from the buccal, occlusal and lingual surfaces, with an exposure time of 20 s on each aspect. After cementation, the specimens were stored in deionized water at 37°C for 7 days. Specimens were transversally sectioned from occlusal to cervical surfaces and the DC was determined along the cement line with three measurements taken and averaged from the buccal, lingual and approximal aspects using micro-Raman spectroscopy (Alpha 300R/WITec®). Data were analyzed by 3-way ANOVA and Tukey test at =5%. Results: Statistical analysis showed significant differences among cements, curing protocols and ceramic type (p<0.001). The curing protocol 3x20 resulted in higher DC for all tested conditions; lower DC was observed for Zr ceramic crowns; Duolink resin cement culminated in higher DC regardless ceramic composition and curing protocol. Conclusion: The DC of resin cement layers was dependent on the curing protocol and type of ceramic.

Effects of coronal substrates and water storage on the microhardness of a resin cement used for luting ceramic crowns.

UNLABELLED: Composite resin and metallic posts are the materials most employed for reconstruction of teeth presenting partial or total destruction of crowns. Resin-based cements have been widely used for cementation of ceramic crowns. The success of cementation depends on the achievement of adequate cement curing. OBJECTIVES: To evaluate the microhardness of Variolink® II (Ivoclar Vivadent, Schaan, Liechtenstein), used for cementing ceramic crowns onto three different coronal substrate preparations (dentin, metal, and composite resin), after 7 days and 3 months of water storage. The evaluation was performed along the cement line in the cervical, medium and occlusal thirds on the buccal and lingual aspects, and on the occlusal surface. MATERIAL AND METHODS: Thirty molars were distributed in three groups (N=10) according to the type of coronal substrate: Group D- the prepared surfaces were kept in dentin; Groups M (metal) and R (resin)- the crowns were sectioned at the level of the cementoenamel junction and restored with metallic cast posts or resin build-up cores, respectively. The crowns were fabricated in ceramic IPS e.max® Press (Ivoclar Vivadent, Schaan, Liechtenstein) and luted with Variolink II. After 7 days of water storage, 5 specimens of each group were sectioned in buccolingual direction for microhardness measurements. The other specimens (N=5) were kept stored in deionized water at 37ºC for three months, followed by sectioning and microhardness measurements. RESULTS: Data were first analyzed by three-way ANOVA that did not reveal significant differences between thirds and occlusal surface (p=0.231). Two-way ANOVA showed significant effect of substrates (p<0.001) and the Tukey test revealed that microhardness was significantly lower when crowns were cemented on resin cores and tested after 7 days of water storage (p=0.007). CONCLUSION: The type of material employed for coronal reconstruction of preparations for prosthetic purposes may influence the cement properties.

Effects of coronal substrates and water storage on the microhardness of a resin cement used for luting ceramic crowns

Composite resin and metallic posts are the materials most employed for reconstruction of teeth presenting partial or total destruction of crowns. Resin-based cements have been widely used for cementation of ceramic crowns. The success of cementation depends on the achievement of adequate cement curing. Objectives: To evaluate the microhardness of Variolink® II (Ivoclar Vivadent, Schaan, Liechtenstein), used for cementing ceramic crowns onto three different coronal substrate preparations (dentin, metal, and composite resin), after 7 days and 3 months of water storage. The evaluation was performed along the cement line in the cervical, medium and occlusal thirds on the buccal and lingual aspects, and on the occlusal surface. Material and Methods: Thirty molars were distributed in three groups (N=10) according to the type of coronal substrate: Group D- the prepared surfaces were kept in dentin; Groups M (metal) and R (resin)- the crowns were sectioned at the level of the cementoenamel junction and restored with metallic cast posts or resin build-up cores, respectively. The crowns were fabricated in ceramic IPS e.max® Press (Ivoclar Vivadent, Schaan, Liechtenstein) and luted with Variolink II. After 7 days of water storage, 5 specimens of each group were sectioned in buccolingual direction for microhardness measurements. The other specimens (N=5) were kept stored in deionized water at 37ºC for three months, followed by sectioning and microhardness measurements. Results: Data were first analyzed by three-way ANOVA that did not reveal significant differences between thirds and occlusal surface (p=0.231). Two-way ANOVA showed significant effect of substrates (p<0.001) and the Tukey test revealed that microhardness was significantly lower when crowns were cemented on resin cores and tested after 7 days of water storage (p=0.007). Conclusion: The type of material employed for coronal reconstruction of preparations ...

Protocolo de Brãnemark com carga imediata: relato de caso / Immediate loading of Brãnemark protocol: case report

O tratamento de edentulismo total por meio do protocolo de Branemark propicia ótima resolutividade e alto grau de satisfação ao paciente. A técnica original foi baseada no tratamento de mandíbulas totalmente edêntulas com a utilização de uma prótese fixa parafusada sobre implantes osseointegrados para reabilitar todo o arco inferior e consistia em dois estágios cirúrgicos. Entretanto, reabilitar pacientes com esse protocolo necessitava usar próteses totais removíveis durante vários meses ​para permitir que o processo de cicatrização ocorresse livre de estresse oclusal nos implantes. Visando encurtar o tempo de tratamento foi desenvolvida a técnica com carga imediata, que permite a diminuição do tempo de instalação da prótese definitiva, possibilitando a colocação dos implantes sob função em até 48h após a cirurgia. O objetivo deste trabalho é apresentar a sequência clínica da confecção de um protocolo de Brãnemark com carga imediata dos implantes

Brãnemark protocol is a fixed prosthetic resolution for total edentulous with a high degree of satisfaction and resolution. The initial application was based on the treatment of totally edentulous mandible using a fixed prosthesis over dental implants to rehabilitate the mandibular arch. The treatment steps of original Brãnemark protocol original sequence for treatment of totally edentulous patient consisted of two surgical stages. Although, rehabilitate patients with the protocol established by Brãnemark required a period of several months and the patient had to use removable dentures to allow implants to heal free from occlusal stress. Aiming at reducing treatment duration, the immediate loading protocol arises as a new approach that shortens timing for placing occlusal loading implants, for up to 48h after surgery. The objective of this paper is to present the steps of Brãnemark protocol with immediate loading of the implants

Effects of curing protocol and storage time on the micro-hardness of resin cements used to lute fiber-reinforced resin posts.

OBJECTIVES: To determine the micro-hardness profile of two dual cure resin cements (RelyX-U100, 3M-eSPe and Panavia F 2.0, Kuraray) used for cementing fiberre inforced resin posts (Fibrekor-Jeneric Pentron) under three different curing protocols and two water storage times. MATERIAL AND METHODS: Sixty 16 mm long bovine incisor roots were endodontically treated and prepared for cementation of the Fibrekor posts. The cements were mixed as instructed, dispensed in the canal, the posts were seated and the curing performed as follows: (a) no light activation; (b) light-activation immediately after seating the post, and; (c) light-activation delayed 5 minutes after seating the post. The teeth were stored in water and retrieved for analysis after 7 days and 3 months. The roots were longitudinally sectioned and the microhardness was determined at the cervical, middle and apical regions along the cement line. The data was analyzed by the three-way ANOVA test (curing mode, storage time and thirds) for each cement. The Tukey test was used for the post-hoc analysis. RESULTS: Light-activation resulted in a significant increase in the microhardness. This was more evident for the cervical region and for the Panavia cement. Storage in water for 3 months caused a reduction of the micro-hardness for both cements. The U100 cement showed less variation in the micro-hardness regardless of the curing protocol and storage time. CONCLUSIONS: The micro-hardness of the cements was affected by the curing and storage variables and were material-dependent.

Effects of curing protocol and storage time on the micro-hardness of resin cements used to lute fiber-reinforced resin posts

OBJECTIVES: To determine the micro-hardness profile of two dual cure resin cements (RelyX - U100®, 3M-eSPe and Panavia F 2.0®, Kuraray) used for cementing fiberreinforced resin posts (Fibrekor® - Jeneric Pentron) under three different curing protocols and two water storage times. MATERIAL AND METHODS: Sixty 16mm long bovine incisor roots were endodontically treated and prepared for cementation of the Fibrekor posts. The cements were mixed as instructed, dispensed in the canal, the posts were seated and the curing performed as follows: a) no light activation; b) light-activation immediately after seating the post, and; c) light-activation delayed 5 minutes after seating the post. The teeth were stored in water and retrieved for analysis after 7 days and 3 months. The roots were longitudinally sectioned and the microhardness was determined at the cervical, middle and apical regions along the cement line. The data was analyzed by the three-way ANOVA test (curing mode, storage time and thirds) for each cement. The Tukey test was used for the post-hoc analysis. RESULTS: Light-activation resulted in a significant increase in the microhardness. This was more evident for the cervical region and for the Panavia cement. Storage in water for 3 months caused a reduction of the micro-hardness for both cements. The U100 cement showed less variation in the micro-hardness regardless of the curing protocol and storage time. CONCLUSIONS: The micro-hardness of the cements was affected by the curing and storage variables and were material-dependent.

Utilização de implante estreito de TiZr em região de alta incidência de carga: relato de caso / The use of TiZr narrow implant in high impact load region: case report

Implantes estreitos de titânio surgiram na Implantodontia com a indicação clássica de serem utilizados para substituição de incisivos laterais superiores, incisivos inferiores, espaços edêntulos pequenos e com baixa incidência de carga mastigatória. Porém, na literatura encontra-se relatos de falhas mecânicas e biológica desses implantes, quando utilizados em situações de maior incidência de carga mastigatória, como em caninos e molares. Para permitir uma ampliação das indicações dos implantes de diâmetro reduzido, uma nova liga foi desenvolvida com objetivo de compensar as deficiências relatada. Os novos implantes estreitos são confeccionados a partir de uma liga de titânio e zircônia (TiZr), com 13-17% de zircônia em sua composição e possuem 3,3 mm de diâmetro. A nova liga apresenta maior resistência do que os implantes de titânio grau IV e melhor biocompatibilidade que as ligas de Ti-6Al-4V. Assim, vem sendo uma alternativa viável para ampliar as indicações clássicas dos implantes estreitos convencionais. No caso apresentado, o implante estreito de TiZr foi utilizado em região de segundo molar inferior como pilar de uma prótese fixa de 4 elementos, a fim de permitir a reabilitação de uma paciente que possuía perda óssea vertical severa, necessitando o implante tangenciar do nervo alveolar inferior. O controle foi feito durante 15 meses sem apresentar qualquer complicação, sendo assim, concluiu-se que os implantes estreitos de TiZr podem ser utilizados em espaços edêntulos reduzidos e táboa óssea fina, independente do dente a ser substituído

Narrow titanium implants came with the classic indication for use for replacement of maxillary lateral incisors, lower incisors and small edentulous spaces with low incidence of masticatory load. However, the literature reports biological and mechanical failures of these implants when used in situations of higher incidence of masticatory load, such as canines and molars. To amplify the indication of small diameter implants, a new alloy was developed in order to compensate for the deficiencies reported. The new narrow implants are made from an alloy of titanium and zirconium (TiZr) with 13-17% of zirconia in their composition and have 3.3 mm diameter. The new alloy has higher resistance than the titanium implants grade IV and better biocompatibility than the alloy Ti-V-6Al4, therefore it has being a viable alternative to broaden the classical indications of narrow conventional implants. In the case reported, the Strait of TiZr implant was used in the region of the second molar as an abutment for a fixed prosthesis in the four elements in order to allow the rehabilitation of a patient with severe vertical bone loss requiring that the implant was tangent to lower alveolar nerve. The control was carried out for 15 months without any complications, and therefore, it was concluded that the narrow TiZr implants can be used in reduced edentulous spaces and thin bone, independent of the tooth to be replaced

Seleção do sistema cerâmico na reabilitação estética anterior: relato de caso / Selection of the ceramic system in esthetic rehabilitation: case report

Problemas estéticos relacionados ao sistema metalocerâmico têm impulsionado o desenvolvimento dos sistemas conhecidos como totalmente cerâmicos e que atualmente podem ser considerados a primeira alternativa no tratamento restaurador para próteses unitárias e fixas. O desafio está em conhecer as propriedades de cada um desses sistemas, uma vez que não há, até o momento, um único sistema cerâmico que possa ser empregado em qualquer situação clínica. Este artigo descreve as razões que guiaram a seleção da cerâmica IPS e.max Press à base de dissilicato de lítio, assim como os principais procedimentos clínicos empregados para a reabilitação estética

Esthetic concerns related to porcelain-fused-to-metal restorations driven the development of ceramic systems. Currently, these all-ceramic systems can be regard as the first alternative in the restorative treatment, including unitary and multiple prostheses. Understanding the mechanical and esthetic properties of each material is challenging, since no system can be used for all clinical conditions up to date. This article describes the principles that guide selection of a lithium dissilicate ceramics (IPS e.max Press) as well as the main clinical steps, involved in the rehabilitation of a patient esthetic compromised in the anterior teeth

Fatores de risco biomecânicos em próteses implantossuportadas: revisão de literatura / Biomechanical risk factors for implant-supported prostheses: literature review

Os esforços mastigatórios aplicados sobre as próteses implantossuportadas podem comprometer a eficiência do tratamento. Os implantes osseointegrados estão suscetíveis a diversos fatores de risco, dentre eles os de ordem biomecânica, envolvendo a compreensão das cargas ou sobrecargas oclusais aplicadas sobre todos os componentes do sistema biológico (suporte ósseo-periodontal) e mecânico (componentes prótese-implante). O objetivo dessa revisão de literatura foi discorrer sobre os fatores de risco de ordem biomecânica e sua influência no sucesso das próteses sobre implante. Os autores concluíram que o controle das cargas biomecânicas recebidas pelas próteses implantossuportadas são fatores fundamentais para a longevidade do tratamento, por atuarem diretamente sobre a prótese, parafusos, intermediário, implante e suporte ósseo.

The masticatory efforts applied over the prosthesis implant-supported may compromise the success of treatment. Implants are susceptible to various risk factors, including the biomechanics of order, involving the understanding of applied occlusal loads or overloads on all components of the biological system (bone and periodontal support) and mechanical (prosthesis-implant components). The purpose of this review is to discuss the risk factors of order biomechanics and its influence on the success of implant prostheses. The authors concluded that the control of biomechanical loads received by the implant-prosthesis are criticaI to the longevity of the treatment, because they act directly on the prosthesis, screws, intermediate, implant and bone support.

Autismo e epilepsia: modelos e mecanismos / Autism and epilepsy: models and mechanisms

O autismo está associado a epilepsia em aproximadamente 30% dos casos com evidências sugerindo a mesma neurofisiopatologia. O mecanismo comum em ambas doenças ainda não está bem definido e a heterogeneidade dos sintomas clínicos nas crianças com transtorno do espectro autista e epilepsia reforça a importância de uma abordagem que inclui a investigação de etiologias biológicas através de estudos de neuroimagem, dos processos inflamatórios, de genética e neuroquímica. Aqui, iremos revisar os principais aspectos da associação entre autismo e epilepsia.

Autism is associated with epilepsy in early childhood in almost 30% of children with either disorder, with evidence suggesting the same neurophysiopathology. The common mechanism in both diseases is not well defined and the heterogeneity of clinical symptoms in children with autism spectrum disorder (ASD) and epilepsy highlights the importance of a comprehensive assessment that includes investigation of underlying biological etiologies through neuroimaging, inflammatory, genetic and neurochemistry studies. Here, we review the main aspects of this association between autism and epilepsy.