Estudo do nível de conhecimento e interesse do cirurgião dentista no diagnóstico e tratamento da síndrome da apnéia/hipopnéia obstrutiva do sono (SAHOS) / Study of the level of knowledge and interest of the dental surgeon in the diagnosis and treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS)

Atualmente, o tratamento do ronco primário e da Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS)1 através de aparelhos intra-orais (AIO) tem recebido a atenção dos pesquisadores pela comprovada eficácia destes dispositivos. Os aparelhos mais indicados são os reposicionadores de mandíbula que promovem um avanço mandibular, afastando os tecidos da orofaringe superior, o que evita a obstrução parcial ou total da área. Sua indicação é para casos de ronco primário e apnéias leves e moderadas2, no entanto é necessário que os candidatos apresentem número de dentes suficientes com saúde periodontal para a ancoragem do aparelho. Por ser uma doença de consequências sistêmicas graves, o tratamento da SAHOS é em sua essência de responsabilidade do médico especialista na área, porém o cirurgião dentista deve ter conhecimento para diagnosticar e tratar, quando o AIO for a opção terapêutica. A interpretação da polissonografia, exame que diagnostica e conduz para a escolha correta do tratamento, e dos dados cefalométricos são os principais quesitos ao Cirurgião Dentista que se propõe a tratar portadores da SAHOS. Nesse trabalho foi elaborado um questionário e aplicado aos cirurgiões dentistas de três diferentes cidades do Estado de São Paulo para que fosse possível avaliar o conhecimento desses profissionais a respeito do diagnóstico e tratamento da SAHOS. 70 Cirurgiões Dentistas foram entrevistados e os resultados mostraram que 70% destes têm interesse em trabalhar com os AIOs. Esse grupo se relacionou estatisticamente significante com aqueles que afirmaram já terem sido alguma vez questionado por algum paciente a respeito desse tratamento. Quanto à criação de uma especialidade para essa área, os profissionais da área de prótese e implante se mostraram mais interessados. E, do número total de entrevistados, apenas 25% já tiveram contato com esse tipo de aparelho, mas não conhece o protocolo de atendimento para o tratamento desses pacientes(AU)

Currently, the treatment of primary snoring and Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)1 through intraoral appliances (OA) has received the attention of researchers due to the proven effectiveness of these devices. The most suitable devices are jaw repositioning devices that promote mandibular advancement, moving the tissues away from the upper oropharynx, which prevents partial or total obstruction of the area. Its indication is for cases of primary snoring and mild to moderate apnea2, however it is necessary that candidates have a sufficient number of teeth with periodontal health to anchor the appliance. As it is a disease with serious systemic consequences, the treatment of OSAHS is, in essence, the responsibility of the specialist in the area, but the dental surgeon must have the knowledge to diagnose and treat, when OA is the therapeutic option. The interpretation of polysomnography, na exam that diagnoses and leads to the correct choice of treatment, and cephalometric data are the main requirements for the Dental Surgeon who proposes to treat patients with OSAHS. In this work, a questionnaire was developed and applied to dentalsurgeons from three different cities in the State of São Paulo so that it was possible to assess the knowledge of these professionals regarding the diagnosis and treatment of OSAHS. 70 Dental Surgeons were interviewed and the results showed that 70% of them are interested in working with AIOs. This group had a statistically significant relationshipwith those who stated that they had already been asked by a patient about this treatment. Regarding the creation of a specialty for this area, professional in the area of ??prosthesis and implant were more interested. And, of the total number of respondents, only 25% have already had contact with this type of device, but do not know the care protocol for the treatment of these patients(AU)

Aparelhos de registro tipo "George Gauge" para posição mandibular terapêutica em aparelhos intra-orais para ronco primeiro e síndrome obstrutiva da apneia e hiponeia / Obstrutiva do sono (SHAOS) type recording devices "George Gauge" recording devices for therapeutic mandibular position in intraoralappliances for snoring first and obstructive sleepapnea hyponea syndrome (SHAOS)

As multifatoriedades do aumento da SHAOS têm diversas causas, desdês de obesidades até sedendarismo de grande proporção. No entanto a ciência tem feito grandes esforços para isso se altere. Mesmo assim muito tem que se pesquisar para um tratamento efetivo que seja capaz de ajudar o paciente a ter um sono reparador e uma qualidade de vida mais satisfatória. A sofisticação dos CPAP, melhores alternativas para o tratamento se sofisticaram de tal em volume, barulho e tamanho que estão aumentanto em muito sua utilização. Os mini-cpaps são uma prova disso. No entanto ainda nos confrontamos com a baixa adesão do tratamento frente ao desconforto causado. Ao aparelhos intra-orais são uma alternativa viáveis para os casos de IAH (índice de apneia e hipopneia) leve, moderada e ronco primário. Importante frisar que sem um exame de polissografia e teleradiografias laterais o Cirurgião Dentista não pode fazer nada(AU)

The multifactorial causes of the increase in SHAOS have several causes, from obesity to a large sedentary lifestyle. However science has made great efforts to change this. Even so, much remains to be researched for an effective treatment that is capable of helping the patient to have a restful sleep and a more satisfactory quality of life. The sophistication of CPAP, the best alternatives for treatment, has become so sophisticated in volume, noise and size that its use is greatly increasing. The mini-cpaps are proof of that. However, we are still faced with the low adherence to the treatment due to the discomfort caused. Intraoral appliances are a viable alternative for cases of mild, moderate AHI (apnea and hypopnea index) and primary snoring. It is important to emphasize that without a polysomnography exam and lateral teleradiographies, the Dental Surgeon cannot do anything(AU)

A higiene do sono como início do tratamento do ronco primário e síndrome da apneia e hipopneia do sono / Sleep hygiene as a starting point for the treatment of primary snoring and sleep apnea and hypopnea syndrome

O valor inestimável ao sono, devido a estudos que comprovaram sua importância à saúde e à qualidade de vida. Tais conhecimentos levaram a identificação de doenças específicas, dentre elas a Síndrome de Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS). Esta doença incide na obstrução das vias aéreas superiores durante o sono, acarretando paradas na respiração e consequências sistêmicas. Estudos atuais e características que interferem na qualidade de vida dos sujeitos, tal como produtividade. O objetivo deste trabalho é o profissional saber que com atitudes cotidianas podemos anemizar o quadro necessitando dessa forma de um tratamento mais brando e de melhor acesso a todos(AU)

The priceless value of sleep, due to studies that have proven its importance to health and quality of life. Such knowledge led to the identification of specific diseases, among them the Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS). This disease focuses on obstruction of the upper airways during sleep, causing breathing stops and systemic consequences. Current studies and characteristics that inter the quality of life of subjects, such as productivity. The objective of this work is for the professional to know that with everyday attitudes we can anemize the condition, thus needing a milder treatment and better access to all(AU)

Os sinais e sintomas que o cirurgião dentista deve conhecer para ajudar na identificação de um paciente que precisa de tratamento de Síndrome da Apneia e Hipopneia do Sono / The signs and symptoms that the dentist should know to help in identifying a patient who needs treatment for Sleep Apnea and Hypopnea Syndrome

Ter um sono de qualidade é imprescindível para a saúde. Cada pessoa sabe a quantidade que a repara melhor. Dessa forma, sono em fora de hora de sesta pode ser problemas em potencial. Um paciente que adormeci em um tratamento dentário pode estar com um déficit de sono que o adormecer durante um tratamento dentário é uma situação inusitada que, pode ser um paciente que precisa de uma a polissonografia e um possível tratamento para o possível presente ronco primário e Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SHAOS). O Cirurgião Dentista deve conhecer os sinais e sintomas mais comuns dos pacientes com problemas de sono para poder indicá-los corretamente a um médico especialista em sono. Dessa forma já se tem como certo que esse é um problema médico, no entanto o Cirurgião Dentista é um profissional importante nas modalidades de tratamento que temos para a síndrome. O simples ato da indicação e acompanhamento do tratamento faz o Cirurgião Dentista, importante nessa cadeia de tratamento(AU)

Getting quality sleep is essential for health. Each person knows the amount that repairs them best. So sleep outside of nap time can be potential problems. A patient who fell asleep in a dental treatment may have a sleep deficit that falling asleep during a dental treatment is an unusual situation that, may be a patient who needs a polysomnography and a possible treatment for the possible present primary snoring and syndrome. Obstructive Sleep Apnea and Hypopnea (SHAOS). The Dental Surgeon must know the most common signs and symptoms of patients with sleep problems in order to correctly refer them to a sleep specialist. Thus, it is already taken for granted that this is a medical problem, however the Dental Surgeon is an important professional in the treatment modalities we have for the syndrome. The simple act of indicating and monitoring the treatment makes the Dental Surgeon important in this treatment chain(AU)

Índices utilizados para diagnóstico e plano de tratamento do ronco primário e da síndrome da apnéia obstrutiva do sono (SAOS) / Assessment of the knowledge of dentists in the face of care for severe cardiac patients in primary care

Os distúrbios do sono vem sendo cada dia mais estudados e evidenciados perante a medicina, sendo que muitos destes estão atrelados a fatores etiológicos ligados a diversas doenças sistêmicas, tais como, hipertensão arterial, problemas cardíacos e fator de risco para diabetes. Sendo assim, a utilização de Índices como o de Epworth, Berlim e Pittsburgh como auxiliadores anamnésicos, é de grande valia para um correto diagnóstico. Por meio deste, pudemos concluir que tais índices são de extrema importância por serem referências iniciais para a solicitação de exames mais complexos e de alto custo. Portanto, este trabalho tem por objetivo fazer uma revisão da literatura sobre a essência científica de tais índices, analisando a eficácia dos mesmos(AU)

Sleep wake disorders see being increasingly studied day and evidenced before the medicine, and many of these disorders are linked to etiological factors related to various systemic diseases such as, hypertension, heart disease and a risk factor for diabetes. Thus, the use of indices such as the Epworth, Berlin and Pittsburgh as amnesic helpers, is of great value to a correct diagnosis. Through this we can conclude that such indices are extremely important because they are initial references to the request for more complex tests and costly. Therefore, this study aims to review the literature on the scientific essence of such indices, analyzing effectiveness(AU)

Reabilitação estética e funcional em paciente com desgaste dental acentuado: relato de caso clínico / Esthetic and functional rehabilitation in a patient with excessive dental wear: a case report

O uso de facetas cerâmicas de dissilicato de lítio é uma excelente opção para a correção estética e funcional de dentes com alteração de formato, como o causado por desgaste dental acentuado, pois esse material apresenta características mecânicas e ópticas adequadas. Assim, o objetivo deste estudo foi descrever os procedimentos de reabilitação com facetas cerâmicas de um paciente jovem com desgaste dental acentuado. Paciente do gênero masculino, 26 anos, buscou atendimento devido à cor insatisfatória dos seus dentes. Durante a anamnese, paciente relatou não ranger ou apertar os dentes, contudo afirmou elevado consumo de alimentos ácidos e uso de força excessiva durante a escovação dental. Durante o exame clínico, foi observado desgaste dental acentuado na face vestibular dos dentes maxilares e leve na superfície oclusal dos dentes posteriores. Foi proposta a instalação de facetas cerâmicas de dissilicato de lítio dos elementos 15 ao 25 e de placa interceptora. O resultado da reabilitação foi satisfatório para o paciente devido ao reestabelecimento da estética, função e auto-estima(AU)

The use of ceramic facets of lithium disilicate is an excellent option for the aesthetic and functional correction of teeth with alteration of shape, such as that caused by accentuated dental wear, since this material presents adequate mechanical and optical characteristics. Thus, the objective of this study was to describe the rehabilitation procedures with ceramic facets of a young patient with marked dental wear. A male patient, 26 years old, sought care due to the unsatisfactory color of his teeth. During the anamnesis, patient reported no grinding or grinding of teeth, however, he stated high consumption of acidic foods and excessive force during dental brushing. During the clinical examination, sharp dental wear was observed on the buccal face of the maxillary teeth and light on the occlusal surface of the posterior teeth. It was proposed the installation of ceramic facets of lithium disilicate of elements 15 to 25 and of interceptor plate. The result of the rehabilitation was satisfactory for the patient due to the reestablishment of aesthetics, function and self-esteem(AU)

Tratamento com aparelho intra-oral da síndrome obstrutiva do sono (SAHOS): relato de caso / Treatment with intra-oral appliance of obstructive sleep apnea syndrome (OSAS): case report

O objetivo deste trabalho foi analisar o tratamento com o uso de aparelhos intra- orais para a síndrome de apneia e hipopnéia obstrutiva do sono e relatar o caso de um paciente portador da síndrome em estágio moderado. O presente caso clínico trata-se de um paciente de 37 anos de idade, portador de síndrome de apneia e hipopneia obstrutiva do sono (SAHOS) moderada, diagnosticada por um exame de polissonografia, que se apresentou com os seguintes sintomas: sonolência e cansaço diurno, possuía apneias durante o sono, além de reportar que sofria de bruxismo e ronco, segundo ele, tudo referido por sua cônjuge. A modalidade de tratamento utilizada foi o aparelho intrabucal, do tipo protrusor mandibular, o qual é um tratamento não invasivo indicado a princípio nos casos de ronco primário e nessa síndrome de grau leve e moderado. O tratamento realizado foi eficaz na melhora da sintomatologia, desobstruindo a passagem de ar nas vias aéreas superiores, permitindo melhor ventilação do paciente e controlando os efeitos colaterais e secundários da síndrome. Os resultados da polissonografia com a utilização do aparelho intra-oral, foi alvo de discussão relatada neste trabalho(AU)

The objective of this study was to analyze the treatment with the use of intra-oral devices for sleep apnea-hypopnea syndrome Obstructive sleep and report the case of a patient with the syndrome in the moderate stage. The present case it is of a white, 37-year-old boy with an apnea-hypopnea syndrome moderate obstructive sleep, who presented with the following symptoms: sleepiness and daytime tiredness, had sleep apneas, and informed us that suffered from bruxism and snoring. The treatment modality used was the intraoral appliance, which is a non-invasive treatment used for this syndrome of mild to moderate. Final Thoughts: The treatment was effective in improving symptoms, clearing the air passage in the upper airway, allowing better ventilation of the patient and controlling side effects and secondary syndrome. However polissonografy results was object of discussion in the paper(AU)

Exames para o diagnóstico da síndrome da apnéia obstrutiva do sono: conhecimentos gerais para o cirurgião dentista que atua na área do sono / Investigations for the diagnosis of the syndrome obstructive sleep apnea: general knowledge for the dentist surgery that works in the sleep area

A Síndrome da Apneia e Hipopnéia Obstrutiva do Sono (SAHOS) foi descrita há quase três décadas na literatura, porém somente há pouco tempo tem conseguido o crescente interesse dos cirurgiões-dentistas; por isso foi feita esta revisão de literatura sobre a inter-relação entre a análise cefalométrica e os pacientes portadores desta patologia. Os estudos revisados mostram que existem diferenças significantes entre uma série de características da via aérea superior e das dimensões esqueléticas entre os pacientes com SAHOS e indivíduos normais. Foi observado que a análise cefalométrica tem sido utilizada como um importante meio auxiliar no diagnóstico e no planejamento do tratamento da Síndrome da Apneia e Hipopnéia Obstrutiva do Sono, associando um grande número de variáveis à prevalência desta síndrome. Esses conhecimentos básicos são de grande importância para o Cirurgião Dentista que atua na área da Odontologia do Sono(AU)

The Syndrome Obstructive Sleep Apnea (OSA) was described almost three decades ago in the literature, but only recently has stimulated a growing interest of dental surgeons; therefore was done this review of literature on the interrelationship between cephalometric analysis and patients with this pathology. The reviewed studies show that there are significant differences between a number of characteristics of the upper airway and skeletal dimensions between OSA patients and people in their normal stages. It was observed that the cephalometric analysis has been used as an important tool in the diagnosis and treatment planning Syndrome Obstructive Sleep Apnea, associating an extensive number of variables to the prevalence of this syndrome. This basic knowledge is of great importance for the Dental Surgeon who works in the area of Odontology Sleep(AU)

Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery.

OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State-Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p =0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation.

Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery

OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State-Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p =0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation.

O tratamento da apneia obstrutiva do sono e a utilização de implantes osseointegráveis - revisão de literatura / The treatment of obstructive sleep apnea and dental implants use - literature review

A síndrome da apneia obstrutiva atinge milhões de pessoas ao redor do mundo. Os aparelhos reposicionadores da mandíbula têm sido indicados nos casos de grau leve/moderado da síndrome, entretanto, nos pacientes edêntulos a sua utilização é deficiente, pois não há retenção. Assim, o objetivo deste estudo foi realizar uma revisão sob a utilização deste método de tratamento quando utilizado simultaneamente aos implantes osseointegráveis. Realizou-se uma revisão nas bases de dados Medline/PubMed, ISI, Cochrane, Dentistry Oral Science, Clinical Trials, Controlled Trials e Bireme-Bvs sobre o tema dental implant / sleep apnea syndrome, e localizou-se 22 artigos. Após avaliação sob os critérios de inclusão, selecionou-se 2 estudos e complementou-se a revisão com uma análise de estudos randomizados e controlados nas sete bases anteriores com os unitermos: sleep apnea syndrome and appliance oral and randomized controlled Trial, e 37 artigos foram localizados que, após os critérios de inclusão, selecionou-se 17. Os estudos abordando a utilização de implantes osseointegráveis como meio coadjuvante na estabilização de aparelhos reposicionadores da mandíbula são escassos, e são do tipo caso clínico que apontam efetividade na técnica. Os estudos analisando o efeito desses aparelhos em pacientes dentados indicam melhoria nos níveis de apneia e ronco. A utilização de aparelhos reposicionadores mandibulares em pacientes dentados é uma técnica efetiva em pacientes com síndrome da apneia obstrutiva leve/moderada. São necessários estudos com controle e randomizados para analisar a utilização de aparelhos de reposição mandibular com auxílio de implantes osseointegráveis nesta década.

The obstructive sleep apnea syndrome affects millions of people around the world. The mandibular repositioning devices have been indicated in cases of mild/moderate syndrome; however in edentulous patients its use is deficient since there is no retention. Therefore the objective of this study was to conduct a review on the use of this treatment method combined to osseointegrated implants. A search on the theme: Dental implant and sleep apnea syndromewas performed in the Medline/PubMed, ISI, Cochrane, Dentistry Oral Science, Clinical Trials, Controlled Trials, and Bireme-BvS, databases, and 22 articles were found. After an evaluation 2 studies were selected and the review was complemented with an analysis of randomized controlled trials in the previous seven bases using the key-words: Sleep apnea syndrome, Oral appliance and Randomized controlled trial. The search returned 37 articles, and after they were submitted to inclusion criteria 17 studies were selected. There are a small number of studies presenting the use of dental implants as a mean to assist the stabilization of the mandibular repositioning appliances; those that are available are case reports that focusing on the effectiveness of the technique. Studies examining the effect these appliances in dentate patients indicate improvement in the levels of apnea and snoring. The use of mandibular repositioning appliances in dentate patients is an effective technique in treatment of patients with obstructive sleep apnea syndrome mild/moderate. Randomized controlled trials are required in order to enable an analysis of the use of mandibular repositioning devices with the aid of dental implants

Uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais / Use of zygomatic implants in the fixacion of maxillofacial prothesis

A prótese bucomaxilofacial tem como objetivo a reabilitação de indivíduos com deformidades craniofaciais, decorrentes de traumatismos, más formações congênitas ou tumores. Muitas pesquisas foram realizadas para melhorar a estabilidade e retenção das próteses em pacientes mutilados. Com o advento da osseointegração, a prótese bucomaxilofacial sofreu um grande avanço tornando possível a realização de trabalhos protéticos com estabilidade, qualidade estética e resultados previsíveis. Esse trabalho faz uma revisão de literatura a respeito do uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais...

The maxillofacial prosthetic rehabilitation aims of individuals with craniofacial deformities resulting from trauma, congenital malformations or tumors. Many researches have been done to improve the stability and retention of dentures in patients. With the advent of osseointegration, the maxillofacial prosthesis suffered a major advance making possible the realization of prosthetic works with stability, aesthetic quality and predictable results. This paper reviews the literature regarding the use of zygomatic implants in the fixation of maxillofacial prostheses...

Solução estética para prótese sobre implante / Aesthetic solution for implant supported prosthesis

Próteses sobre implantes esteticamente favoráveis estão diretamente relacionadas com a condição dos tecidos moles e duros que as envolvem. A preservação dos tecidos mucogengivais ao redor de implantes dentários instalados na maxila anterior propicia um sorriso harmonioso, com uma estética bastante agradável. No entanto, em alguns casos, isso não ocorre principalmente pela grande reabsorção tecidual na região, na qual deveria ter sido realizado enxerto ósseo, antes mesmo da instalação dos implantes. Desse modo, o objetivo deste trabalho foi apresentar uma solução reabilitadora estética para essas possíveis falhas durante o planejamento com reabilitações sobre implantes, por meio de gengiva artificial cerâmica

Implant supported prosthesis aesthetically favorable are directly related to the condition of the hard and soft tissues that surround them. The mucogengival tissue preservation around dental implants installed in the anterior maxilla provides a harmonious smile, with a pretty nice aesthetic. However, in some cases, this does not occur primarily by large tissue resorption on the region, in which should have been performed bone graft, even before the installation of the implants. Thus, the aim of this paper was to present a solution for these aesthetic rehabilitative potential failures during the planning of rehabilitation with implants through ceramic artificial gingiva

Colour change of soft denture liners after storage in coffee and coke.

This study was to evaluate the colour change of soft denture liners after thermocycling and storage in coffee and coke. Four liners, two silicone-based (Sofreliner S and Reline GS) and two acrylic resin-based (Soft Confort and Dentuflex), were evaluated in this study. Ten samples were obtained for each group. After 2000 cycles of thermocycling with baths of 5°C and 55°C, five samples were stored in coffee and the remaining samples in coke. The colour alteration was evaluated in a reflection spectrophotometer before and after thermocycling, and after 1, 3, 24, 48 and 96h of storage in coffee and coke. Data were submitted to anova and Tukey's HSD test (α=0.05). Thermocycling and storage period represented a higher statistically significant influence for the resin liners than for the silicone materials. Coke did not influence the colour stability of the materials during storage. However, the coffee solution generated statistically significant colour alteration in the material Soft Confort. In the comparison between the coffee and coke solutions, there was no statistically significant difference for colour alteration only for the material Dentuflex. The silicone liners presented better colour stability following thermocycling and storage independent of the solution. The coffee solution was a statistically significant factor for colour alteration of the material Soft Confort.

Management of orbital reconstruction.

One of the concerns after a major trauma to the orbit is to be rebuilt. This can be achieved with care in management of orbital reconstruction, techniques, types of materials, and osseointegrated implants; it allows satisfactory aesthetic recuperation and well-being, whereas psychological therapy allows for patients' reinsertion in social and family environment to make them feel happier and safer.

Care required when using bisphosphonates in dental surgical practice.

Bisphosphonates are pharmacologic compounds characterized by high tropism to bone tissue. They affect bone metabolism by inhibition of osteoclast recruitment, proliferation, differentiation, and function. Because they can reduce bone resorption, bisphosphonates are used mainly for the treatment of osteometabolic conditions. However, the use of bisphosphonates has been associated with the onset of osteonecrosis of the jaws and indication of dental implants. As a result of this, the aim of this study was to present the risks and the care that health professionals should take in cases of surgical procedures such as placement of dental implants in patients who make use of bisphosphonates.

Color stability of polymers for facial prosthesis.

Color stability of resin and silicone is an important factor for longevity of facial prostheses. The aim of this study was to evaluate the color stability of resins and silicone for facial prostheses. Three brands of acrylic resin and 1 of facial silicone were evaluated considering pigment incorporation for the colorless materials. Ten samples of each material were fabricated and submitted to measurements of chromatic alteration initially and after 252, 504, and 1008 hours of weathering through visual analysis and spectrophotometry. Data were evaluated by analysis of variance and Tukey test (P < 0.05). Results showed a statistically significant difference in color alteration among materials independent of aging. According to visual analysis, the color difference between pigmented and colorless Silastic MDX4-4210 and between pigmented and colorless Classico acrylic resin was statistically significant for the 3 weathering periods. Aging for 1008 hours represented a significant influence on color alteration of all resins. All materials presented chromatic alteration after accelerated artificial aging.

Evaluation of hardness and surface roughness of two maxillofacial silicones following disinfection

The purpose of this study was to evaluate the Shore A hardness and surface roughness of two silicones for maxillofacial prosthetic treatment, under the influence of chemical disinfection and storage. Twenty-eight specimens were obtained, half of which were made of Silastic MDX 4-4210 silicone and, the other half were made of Silastic 732 RTV silicone. The specimens were divided into four groups: Silastic 732 RTV and MDX 4-4210 with disinfection 3 times a week with Efferdent tablets and the same materials without disinfection. The hardness of the materials was analyzed with a Shore A Durometer. The surface roughness was established by a digital portable roughness tester, initially and 2 months after the confection of the specimens. A variance test was applied (2-way ANOVA), followed by Tukey test (the level of significance was set at 1%). The storage time factor statistically influenced (p < 0.01) the materials' properties of hardness and roughness. MDX 4-4210 (28.59 Shore A, 0.789 Ra) presented higher values than Silastic 732 RTV (18.08 Shore A, 0.656 Ra) for both properties. Regarding the disinfection period, there was no significant difference in any of the materials tested.

Análise dos aspectos biomecânicos e biológicos na reabilitação oral com união dente/implante / Biological and Biomechanical aspects of tooth/implant rehabilitation

Os critérios bem como as conseqüências das reabilitações orais protéticas envolvendo união de dentes a implantes osseointegrados apresentam na literatura resultados controversos. Por um lado, alguns estudos consideram viável a união de elementos dentais com implantes, enquanto outros a condenam, visto a diferença biomecânica e fisiológica dos dois sistemas. Deste modo, este trabalho teve como objetivo selecionar estudos literários que possam padronizar soluções quando esse tipo de reabilitação for necessária. O levantamento mostrou que a maioria dos estudos aplicados à bioengenharia condena a união enquanto os estudos longitudinais clínicos resultam em baixo índice de fracasso, entretanto, em curto período de acompanhamento.

The consequences as well the criteria for the prosthetic oral rehabilitations with tooth/implant connection come in the literature, in most of the cases, with controversial results. On one side, many studies consider the connection viable, while the others studies consider impracticable because of the difference biomechanics and physiologic of the two systems. The purpose of this study was to organize, to synthesize and to select literary studies that can standardize solutions when this rehabilitation type is necessary. The study showed that the clinical follow-up result in a high survival rate in a short period and the bioengineering studies did not accept the tooth/implant connection.

Influence of storage period and effect of different brands of acrylic resin on the dimensional accuracy of the maxillary denture base

The aim of this study was to evaluate the dimensional changes of denture bases made from different resins after different storage periods. For this purpose, 25 sets of plaster models/resin bases were prepared using 4 acrylic resins submitted to two types of polymerization: 1- QC-20 submitted to polymerization by microwave energy; 2- QC-20 submitted to polymerization by water hot bath; 3- Vipi Cril submitted to polymerization by water hot bath; 4- Vipi Wave submitted to polymerization by microwave energy; and 5- Onda Cryl submitted to polymerization by microwave energy. After polymerization, the specimens were sectioned for accuracy readings using a comparison microscope. Readings were taken at 3 points: the crests of the right (A) and left (B) ridges, and the median region of the palate, in 4 different periods. The data obtained were submitted to two-way ANOVA and Tukey's test at 5 percent significance level. The greatest distortions were found in the posterior palatal region of the base (M), with statistically significant difference (p<0.05) for the studied resins. All acrylic resins presented dimensional changes and the storage period influenced these alterations.

O objetivo deste estudo foi avaliar a alteração dimensional de bases de prótese total confeccionadas com diferentes resinas após diferentes períodos de armazenagem. Para isso foram confeccionados 25 conjuntos modelo de gesso/base de resina, utilizando-se quatro resinas acrílicas: QC-20 submetida à polimerização convencional e por energia de microondas, Vip Cril submetida à polimerização convencional, Vip Wave e Onda Cryl submetida à polimerização por energia de microondas. Após a polimerização, as amostras foram seccionadas para realização de leituras de adaptação com auxílio de um microscópio comparador. As leituras foram realizadas em três pontos: crista do rebordo direito (A) e esquerdo (B), e região mediana do palato, em quatro diferentes períodos. Os resultados foram submetidos à análise de variância e ao teste de Tukey com nível de significância de 5 por cento. A pior adaptação foi verificada na região palatina posterior da base (M) com diferença estatisticamente significante (p<0,05) para as resinas estudadas. Todas as bases de resinas apresentaram alteração dimensional e o período de armazenagem foi um fator que influenciou essa alteração.