Alternativas de tratamiento para pacientes jóvenes con pérdida de estructura dentaria. Parte 1: caso clínico / Treatment alternatives for young patients with loss of dental structure. Part 1: a clinical Case

El objetivo de este artículo es presentar una alternativa de tratamiento rehabilitador para pacientes jóvenes con gran pérdida de estructura dental vinculada a lesiones de origen no bacteriano. Se presenta el caso clínico de un paciente de 36 años de edad, con reflujo gastroesofágico crónico bajo tratamiento médico, que concurrió a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), en busca de un cambio estético en su sonrisa y relatando sensibilidad al calor, al frío y dolor al masticar. No manifestó sintomatología dolorosa a nivel muscular ni articular. En función de sus posibilidades económicas y de la etiología erosiva de las lesiones existentes en sus piezas dentarias, se llevó a cabo una rehabilitación oral adhesiva con resinas compuestas utilizando la sistematización de atención que sugiere la Cátedra. Las resinas compuestas actuales, en combinación con las técnicas y procedimientos desarrollados en este artículo han demostrado un adecuado comportamiento al ser utilizadas como restauraciones definitivas en pacientes que necesitan rehabilitación oral total debido a la gran pérdida de estructura dental por erosión ácida (AU)

Alternativas de tratamiento para pacientes jóvenes con pérdida de estructura dentaria. Parte 2: caso clínico / Treatment alternatives for young patients with loss of dental structure. Part 2: a clinical case

El objetivo de este artículo es presentar una alternativa de tratamiento rehabilitador para pacientes jóvenes con gran pérdida de estructura dental, vinculada a lesiones de origen no bacteriano. Se presenta el caso clínico de un paciente de sexo masculino, de 39 años de edad, que acudió a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA) relatando síntomas compatibles con hipersensibilidad dentaria y fatiga de los músculos masticadores. Al mismo tiempo, manifestó disconformidad con el aspecto estético de su sonrisa. Teniendo en cuenta la gran pérdida de sustancia en sus piezas dentarias producida por hábitos parafuncionales (bruxismo), se realizó una rehabilitación oral adhesiva con cerámicas utilizando el protocolo de abordaje terapéutico sugerido por la Cátedra. En pacientes que presentan severos desgastes (AU)

Cirugía guiada para la colocación de implantes de longitud estándar en maxilar inferior posterior atrófico, sin regeneración ósea: informe de caso / Use of guided surgery for standard length implant placement in atrophic posterior mandible, without bone regeneration: case report

Objetivo: Presentar el uso de la cirugía guiada para la resolución quirúrgico-protética de un caso clínico con colocación de implantes de longitud estándar (>7 mm) en un maxilar inferior atrófico, sin regeneración ósea guiada. Caso clínico: Una paciente que requería terapia con implantes en sectores posteroinferiores se presentó en la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires. Primero se realizó una tomografía computarizada de haz cónico del maxilar inferior para evaluar la disponibilidad ósea. La planificación se efectuó siguiendo un protocolo digital a fin de optimizar la selección de los implantes y su instalación en función de la futura rehabilitación protética y el tejido óseo disponible. Después se escanearon ambos maxilares y el registro intermaxilar; estas imágenes ­junto con las correspondientes a la tomografía (DICOM)­ fueron importadas como archivos (STL) a un software específico de diseño para determinar digitalmente la posición 3D ideal de los implantes y diseñar una guía quirúrgica de precisión. Luego se realizó la cirugía de instalación de los implantes con la guía quirúrgica, y finalmente los implantes fueron rehabilitados por medio de coronas cemento-atornilladas. Conclusión: El uso de la cirugía guiada permitió optimizar el tejido óseo disponible para la instalación de implantes en función de la futura rehabilitación protética (AU)

Aim: To present the use of guided surgery for the prosthetic resolution of a clinical case with placement of implants of standard length (>7 mm) in an atrophic posterior mandible, with no need of bone regeneration. Clinical case: A patient who required implants in the posterior sectors of the mandible attended to the department of Odontología Integral Adultos, Facultad de Odontología, Universidad de Buenos Aires, Argentina. A dental cone beam computed tomography (CBCT scan) of the lower jaw was done to assess bone availability and was decided to perform guided surgery for accurate implant placement. Both maxillaries and intermaxillary occlusal registration were scanned and imported into files (STL) together with those of the CBCT scan (DICOM) into specific design software. Following the digital protocol using a surgical guide the implants were placed and then restored with cemented-screwed crowns. Conclusion: Guided surgery allowed planning implant placement, guided by the final position of the prosthetic restoration, and optimizing the available bone (AU)

Factores morfofuncionales de interés en prostodoncia que dependen de los biotipos craneofaciales / Morphofunctional factors of interest in prosthodontics depending on the craniofacial biotypes

El presente es un trabajo de investigación bibliográfica que busca establecer la posibilidad de utilizar las cefalometrías como elementos de diagnóstico pronóstico y elaboración de prótesis. Centra su objeto de estudio en encontrar y clasificar los factores morfológicos y funcionales que varían con los biotipos craneofaciales y que son de interés en la prostodoncia. La metodología empleada fue la revisión de la literatura histórica hasta la actualidad en la que se relacionan temas de prostodoncia a los biotipos craneofaciales. Si bien solo dos autores relacionaron la prostodoncia con los biotipos cráneo faciales, sí se encontraron varios temas de interés asociados directamente a la prostodoncia. Se clasificaron en temas de oclusión: Curva de Spee, plano de oclusión, movimientos mandibulares, dimensión vertical oclusiva y de especio libre interoclusal. Tema de maloclusiones. Tema de fuerza muscular. Tema variaciones morfológicas de procesos alveolares, corticales ósea y de la forma dentaría. Encontrándose para cada uno de ellos alguna correlación positiva con los distintos tipos faciales. De este estudio, se concluye que es necesario sistematizar el estudio de los conocimientos que puede aportar la cefalometría como una importante herramienta de diagnóstico al prostodoncista a partir de haberse encontrado variaciones muy importantes en los aspectos mencionados que hacen al interés de la rehabilitación prostodóncica (AU)

This Work is a bibliographic research that seeks to establish the use of cephalometries as elements of diagnosis prognostic and prosthesis elaboration. Its focus is to find and classify morphological and functional factors that vary with facial types which are of interest in prosthodontics. This was a review of the historical literature to date, in which prosthodontics are related to facial types. Although only two authors related prosthodontics to facial ypes, they did find several topics of interest directly associated with prosthodontics. They were classified into occlusion themes: Spee curve, occlusion plane, mandibular movements, occlusive vertical dimension and interocclusal free space. Malocclusion issue. Muscle strength theme. Morphological variations of alveolar processes, cortical bone and dental morphology. They found some positive correlation with the different facial types for each of them. From this study, it is concluded that it is necessary to systematize the study of cephalometries because they can provide to be an important diagnostic tool to the prosthodontist because there were found very important variations in the mentioned aspects that are of interest in prosthodontic rehabilitation (AU)

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

Impact on the Quality of Life of Older Adults Who Use Inadequate Dental Prostheses: A Cross-Sectional Study

Abstract Objective: To investigate the impact of inadequate prostheses on older adult's quality of life at the Integrated Health Center for Older Adults in the northeastern city of Brazil. Material and Methods: A cross-sectional study involving 147 older adults aged 60-90 years old in João Pessoa, Brazil. Interviews and oral examinations were carried out to collect demographic characteristics (age and gender) and clinical dental measures (use of inadequate upper and/or lower dental prosthesis) and Oral Health Impact Profile (OHIP-14 Questionnaire). The Pearson Chi-square and Fisher's exact tests were used to evaluate the association between the OHIP-14 dimensions and the use of unsatisfactory prostheses (p<0.05). Results: The sample consisted of 90.5% of women being a mean age of 69.86 (± 6.60) years. Individuals with inadequate prostheses had a higher impact on quality of life, with a predominant prevalence ratio for developing physical pain (PRR = 3.52; CI = 4.69-2.65), psychological discomfort (PRR = 5.0; CI = 5.85-4.26) and psychological inability (PRR = 1.71; CI = 2.56-1.14). Conclusion: The use of inadequate prostheses had a negative impact on the quality of life of the older adult population. Therefore, services, which provide health care for older adults, should overcome this reality by providing broad access to oral rehabilitation that is appropriate to the needs of each individual.

Plan nacional de atención integral para la rehabilitación oral en personas adultas mayores "Perú sonríe" 2019-2022 / National Comprehensive Care Plan for Oral Rehabilitation in Older Persons "Peru Smiles" 2019-2022

El documento contiene la finalidad, objetivos, ámbito de aplicación, base legal, consideraciones generales y específicas y responsabilidades con el fin de contribuir en la mejora de la calidad de vida de las personas adultas mayores mediante su abordaje integral de salud y rehabilitación oral, potenciando su rol en la familia y comunidad con el modelamiento conductual de los ejes temáticos alimentación, higiene y habilidades para la vida.

Técnica de disyunción horizontal del reborde alveolar con bisturí piezoeléctrico y colocación de implantes en el maxilar inferior: informe de casos clínicos / Horizontal split crest technique using a piezoelectric scalpel and immediate implant placement in the jaw: report of clinical cases

Objetivo: Presentar una técnica quirúrgica de disyunción con bisturí piezoeléctrico y expansión de rebordes delgados en maxilar inferior que permita la colocación de implantes en la posición tridimensional correcta en el mismo acto quirúrgico. Casos clínicos: Se presenta la resolución de dos casos clínicos de pacientes que acudieron a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires. Ambos requerían la colocación de implantes en sectores posteroinferiores. Las imágenes tomográficas mostraban adecuada altura del reborde alveolar pero deficiente espesor para la colocación de implantes en la posición tridimensional correcta. Se decidió realizar una técnica de disyunción horizontal del reborde alveolar con bisturí piezoeléctrico, expansión del reborde y colocación de implantes e injerto óseo particulado de forma simultánea. Luego de 3 meses, se efectuó la segunda cirugía para iniciar la rehabilitación protésica. Conclusión: La técnica de disyunción horizontal del reborde alveolar mediante el uso del bisturí piezoeléctrico permitió ubicar al implante en la posición tridimensional correcta dentro del tejido óseo nativo sin la necesidad de realizar regeneraciones complejas en rebordes alveolares delgados (AU)

Aim: Present the horizontal split crest technique with a piezoelectric scalpel and the immediate implant placement in the correct tridimensional position, in thin mandibular alveolar ridges. Cases report: The surgical resolutions of 2 clinical cases of patients who attended the Adult Integral Dentistry Chair of the Faculty of Dentistry of the UBA, are presented. Both patients required implant placement in posterior madibular residual ridge. The tomographic images showed adequate height of the alveolar ridge but poor thickness for implants placement in a correct three-dimensional position. It was decided to perform a horizontal split crest technique of the alveolar ridge with piezoelectric scalpel, ridge expansion, and immediate implant placement with xenograft. After 3 months, the second surgery was performed to start with the prosthetic rehabilitation. Conclusion: The horizontal split crest technique using a piezoelectric scalpel, allowed immediate implant placement in the correct tridimensional position within native bone tissue, avoiding a guided bone regeneration technique, in these cases with thin alveolar ridges (AU)

Coronas de zirconia para la rehabilitación oral en odontología pediátrica: una nueva alternativa estética / Zirconia crowns for oral rehabilitation in pediatric dentistry: a new aesthetic alternative

For decades, stainless steel crowns have been considered the easiest and most durable restoration. However, due to the poor aesthetics they offer, these crowns are no longer acceptable to patients and/ or their parents. Currently, use of crowns as a rehabilitative treatment is common and the pediatric dentist requires practical knowledge, which is why innovative aesthetic alternatives such as zirconia crowns have emerged. For this reason, the objective of this article is to offer a clinical guide to the management of zirconia crowns in the anterior and posterior regions of deciduous dentition. (AU)

La odontología restauradora integral y la estética / Comprehensive restorative dentistry and esthetics

La planificación es una de las etapas más importantes del tratamiento y también una de las más difíciles. Si lo hacemos de manera específica, parcial y no integral, no vamos a avanzar ni a terminarlo correctamente. Además, es preciso cumplir con las expectativas de los pacientes, quienes buscan restauraciones permanentes que duren toda la vida. Si tenemos en cuenta los estudios clínicos de cualquier tipo de tratamiento, veremos que la tasa de supervivencia a largo plazo nunca es del 100 por ciento. El plan de tratamiento es la base del éxito de la rehabilitación. Después de haber almacenado los datos necesarios de forma integral, el profesional tiene la capacidad de ejecutar un plan de trabajo en detalle, lo cual puede facilitar el desarrollo de las actuaciones y dar lugar a un tratamiento exitoso.

Comprehensive Risk-Based Diagnostically Driven Treatment Planning: Developing Sequentially Generated Treatment.

The clinical example presented in this article demonstrates a risk-based, diagnostically driven treatment planning approach by focusing on 4 key categories: periodontal, biomechanical, functional, dentofacial. In addition, our unique approach allowed the comprehensive clinical management of a patient with complex restorative needs. A full-mouth rehabilitation was completed sequentially without sacrificing the amount of dentistry necessary to restore health, comfort, function, and esthetics. The result exceeded the patient's expectation and was made financially possible by extending treatment over numerous years.

Treatment planning and dental rehabilitation of periodontally compromised partially edentulous patient: a case report - part II.

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment that would provide long-term successful outcomes in function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this second part of a two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed according to the literature.

Treatment planning and dental rehabilitation of a periodontally compromised partially edentulous patient: a case report - Part I.

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment modality that would provide a long-term longevity in terms of function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined and the final outcome is discussed according to the literature.

Atención odontopediátrica del niño con fisura labio alveolo palatina / Pediatric dental care for children with cleft lip, alveolous and palate

La intervención del odontopediatra es fundamental en los primeros días de vida del niño, debido al problema de falta de succión y los trastornos que causan en la alimentación. El logro de un tratamiento eficaz en elniño fisurado dependerá del trabajo multidisciplinario y de lograr instruir y concientizar a los padres en la importancia de la permanente atención del niño, cumpliendo todos los pasos indicados por el equipo de trabajo para lograr el correcto tratamiento interdisciplinario, teniendo en cuenta además que son tratamientos muy largos con control y atención del niño afectado, prácticamente hasta la adolescencia, por parte de cada uno de los integrantes de este equipo de trabajo...

Cosmetic concerns provide opportunity for comprehensive dentistry.

This case involved a woman with occlusal dysfunction who was dissatisfied with her smile because of the unsightly display of gold crowns in her posterior and unattractive mottling on her anterior teeth. Factors such as a significant history of clenching and grinding, the management of active disease and infection, and the patient's desire for an ideal or "media-generated" smile increased the difficulty of the case. As part of a comprehensive restorative plan that included disease control treatment, root canal therapy, and orthodontics to idealize tooth positioning, a Kois deprogrammer was used to evaluate the patient's increasingly symptomatic, unacceptable function. In addition to reducing functional and biomechanical risks, the case resulted in improved esthetics with which the patient was highly pleased.

Oral rehabilitation with dental implants after cancer treatment.

BACKGROUND: Patients who undergo surgical management of oral cancer may greatly benefit from an implant-supported prosthesis. This study reports on the clinical experience of dental implant placement in patients following resection of oral cancer over a 15-year period. Controversies including the use of dental implants in irradiated tissues, and hyperbaric oxygen treatment will also be discussed. METHODS: Thirty-one patients who had dental implants placed as part of their oral rehabilitation between 1992 and 2007 were investigated. Demographic data and factors including implant survival, type of prosthesis provided, radiotherapy and the hyperbaric oxygen therapy were analysed. RESULTS: In this retrospective study, there was a retention rate of 110 implants from a total of 115 implants placed. A high rate of implant retention was found, with 5 implant failures from a total of 115 implants placed. The 5 failed implants occurred in free flap bone that had been irradiated. CONCLUSIONS: Dental implants provide an important role in the oral rehabilitation of oral cancer patients. There may be an increased risk of implant failure in free flap bone that has been irradiated.

Tratamento interdisciplinar com sistemas adesivos e implantes dentários / Interdisciplinary treatment using adhesive systems and dental implants

O presente artigo tem por objetivo apresentar uma reabilitação multidisciplinar na qual foram utilizadas técnicas e materiais adesivos para os elementos dentários, e implantes osseointegráveis nas áreas edêntulas e nas regiões de necessidades exodônticas.

Effect of a multi-faceted intervention on gingival health among adults with systemic sclerosis.

OBJECTIVES: To evaluate the effect of adaptive oral hygiene devices and orofacial exercise to improve gingival health among adults with systemic sclerosis (SSc). METHODS: Forty-eight patients with SSc were assigned randomly to the multifaceted oral health intervention or usual dental care control group. Participants in the intervention group received a rechargeable, powered Oral-B® oscillating-rotating-pulsating toothbrush and a Reach® Access™ Flosser that has a toothbrush-like handle. For those with an oral aperture of less than 40 mm, orofacial exercises were taught. Participants in the control group were each given a manual toothbrush and dental floss. Participants in both groups received instructions and demonstration on the use of the devices, and were requested to perform the respective intervention twice a day for 6 months. Evaluations were at baseline, 3-, and 6-months. The main outcome was gingival index (GI), an indicator of gingival inflammation. RESULTS: Both groups showed significant reduction in GI scores at 6 months (ps<0.005). Reduction in GI scores of the intervention group at 6 months was 20.8% which is considered to be clinically significant. Compared to the control group, the intervention group showed a significant and larger reduction in GI score by 8% at 6 months (p=0.0007). CONCLUSIONS: Results support the use of adaptive devices and orofacial exercise to improve gingival health in adults with SSc when compared to use of manual toothbrushing and finger-held flossing. Recommending and educating patients with SSc to use adaptive devices to clean the tooth surfaces looks promising for long-term oral health improvement.

[Study of alternating magnetic field influence on rates of rehabilitation of patients after dental implantation].

New way of using alternating magnetic field is described. Basic functional description of new treatment and diagnostic offered (patents of RF No75294 and 75314), which included digital plethysmograph and regulation of angiotonic microcirculation channel device. Comparative estimation of clinical and functional indiced of regional blood flow of patients in the main group and in the control group showed a positive correlation. Expressed influence of alternating magnetic field on frequency of oscillations pulse vessels microcircution channel and acceleration of leveling disorder of blood circulation in tissue after surgical treatment was proved.

Rehabilitación implantológica en pacientes oncológicos irradiados: presentación de un caso clínico / Implant rehabilitation in irradiated oncological patients: a case report

La radioterapia es usada para el tratamiento de los tumores de cabeza y cuello; la radiació emitida no sólo actúa sobre el tumor, sino que también afecta a los tejidos sanos prodouciendo alteraciones como xerostomía, dermatisis, trismus, candidiasis, necrosis de los tejidos blandos y osteorradionecrosis. La cámara hiperbárica se utiliza para prevenir los efectos no deseados de las radiaciones sobre los tejidos sanos aledaños al tumor. Se presenta un caso clínico de un paciente de sexo masculino de 60 años de edad tratado con radioterapia por un CA epidermoide de cavum y paladar blando. El pacientes requería extracciones múltiples y rehabilitación implantológica. Se realiza un plan de tratamiento con terapia de oxígeno hiperbárica para la prevención de la osteorradionecrosis y a fin de favorecer la preparación del terreno óseo para la colocación de implantes dentales.