Reabilitação do guia canino complementar ao tratamento harmônico e estético com prótese parcial fixa livre de metal / Rehabilitation of the canine guide complementary to the harmonic and aesthetic treatment with fixed partial denture of metal

Introdução: A reabilitação estética de dentes anteriores com próteses cerâmicas livres de metal proporciona excelência estética principalmente pela ausência da margem metálica. Pacientes que apresentam oclusão adequada e ausência de hábitos parafuncionais possuem menor chances de falhas catastróficas em movimentos excêntricos e bordejantes durante as excursões mandibulares. Objetivo: evidenciar, por meio de relato de um caso clínico, o reestabelecimento da estética e função de dentes anteriores, utilizando restaurações cerâmicas livres de metal. Conclusões: A utilização de cerâmicas livres de metal permitiu uma estética natural e funcional com ótimas propriedades ópticas, integrando as restaurações ao sorriso do paciente.(AU)

Introduction: The aesthetic rehabilitation of anterior teeth with metal-free ceramic prosthesis provides aesthetic excellence mainly due to the absence of metal margin. Patients with adequate occlusion and absence of parafunctional habits have a lower chance of catastrophic failure in eccentric movements and contours during mandibular excursions. Aim: to report, through a clinical case report, reestablishment of aesthetics and function of anterior teeth, using metal free ceramic restorations. Conclusions: The use of free metal ceramics allowed a natural and functional aesthetic with excellent optical properties, integrating the restorations to the patient's smile.(AU)

Effect of Low-level LASER Therapy on P6 Acupoint to Control Gag Reflex in Children: A Clinical Trial.

OBJECTIVE: To investigate the effect of low level laser therapy (LLLT) on PC6 acupuncture point in suppressing gag reflex, regulating pulse rates and oxygen saturation, thereby reducing the anxiety levels. MATERIALS AND METHOD: A total of 40 patients who demonstrated hyperactive gag reflex in the age group of 4-14 years were included in the study. In Group A (20 patients), maxillary impression was recorded. In the second step, PC6 acupuncture point was stimulated with LLLT followed by recording of second maxillary impression. In group B (20 patients), steps were reversed. Gag reflex, anxiety levels, pulse rate and oxygen saturation levels were assessed. RESULTS: Values of pulse rate and oxygen saturation were regulated to normal, signifying lowered anxiety levels. Gag reflex was also significantly decreased after stimulating PC6 acupuncture point with LLLT. CONCLUSION: LLLT on PC6 point was found to be effective in lowering anxiety levels as observed by faces modified anxiety rating scale. Further, it was authenticated as the pulse rates were significantly reduced and oxygen saturation levels were significantly increased. Also, gag reflex was significantly controlled when LASER stimulation was done at PC6.

Consideraciones periodontales y protéticas para el tallado de piezas dentarias / Periodontal and prosthetic considerations for teeth grinding

Las preparaciones dentales para prótesis fija, involucran al tejido duro, además la proximidad que existe con la encía hace necesario la comprensión de su estructura y la función del aparato de protección, para que las restauracionesno invadan el ancho biológico constituido por el epitelio de unión y las fibras gingivales; basándonos en los estudios de Gargiulo en 1961, donde la inserción del tejido conjuntivo mide 1.07 mm y la adherencia epitelial 0.97 mm en promedio, sumados al espacio del surco gingival. El biotipo periodontal es de vital importancia para la elección de la altura de terminación del hombro de la preparación, donde el mismo deberá establecerse, previo sondaje óseo a no menos de 2.5 mm de la cresta según Kois (2008). La utilización de materiales y técnicas para la toma de impresiones definitivas deben ser amigables con los tejidos blandos a fin de no producir alteraciones y que las restauraciones sean predecibles, tanto funcional como estéticamente en el transcurso del tiempo

Dental preparations fixed prosthesis, involving the hard tissue, there is also proximity to the gum is necessary to understand the structure and function of the protection device, to restorations without invading the biologic width consisting of the epithelium junction and the gingival fibers; based on Gargiulo studies in 1961, where the insertion of the connective tissue and epithelial measured 1.07 mm 0.97 mm in average adhesion, coupled with sulcular space. The periodontal biotype is of vital importance for the choice of the termination of the shoulder height of the preparation, where it must be established prior tobone sounding no less than 2.5mm crest according Kois (2008). The use of materials and techniques for making final impressions should be friendly soft so as not to alter tissues and restorations predictable, both functionally and aesthetically over time.

Nausea control by needling at acupuncture point Neiguan (PC6) during an intraoral impression-taking procedure.

The objective of this study was to evaluate the effectiveness of acupuncture point PC6 (Neiguan) in controlling nausea during intraoral impression taking. This study was conducted in Piracicaba, São Paulo, Brazil. The sample consisted of 33 adult volunteers with nausea, who were randomly divided into control and study groups, and treated with nonpenetrating sham acupuncture and real acupuncture, respectively, at acupoint PC6. The two groups had two maxillary impressions taken, one prior to acupuncture and the other after acupuncture. The nausea assessment was made using the visual analog scale, Gagging Severity Index (GSI), and Gagging Prevention Index. Volunteers' expectation that nausea would be reduced through acupuncture was also assessed. For statistical analysis, we used the t test and the Spearman correlation (p < 0.05). When assessed by Gagging Severity Index/Gagging Prevention Index, nausea was reduced in the real acupuncture group (p < 0.01). In the visual analog scale assessment, similar reductions of nausea were noted in both groups (p > 0.05). No correlation existed between the expected and the actual reductions in nausea. Our results indicate that acupoint PC6 was effective for controlling nausea during the maxillary impression-taking procedure. Patients' expectation did not influence the results.

Defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using a nonfluid wax addition technique.

The posterior palatal seal area is defined as the soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiologic limits can be applied by a removable complete denture to aid in its retention. The retention of the maxillary denture is affected by the extent and the design of the posterior palatal seal. This article discusses a method of defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using microabrasion and a nonfluid wax addition technique.

Ceramic dental biomaterials and CAD/CAM technology: state of the art.

PURPOSE: Ceramics are widely used as indirect restorative materials in dentistry because of their high biocompatibility and pleasing aesthetics. The objective is to review the state of the arts of CAD/CAM all-ceramic biomaterials. STUDY SELECTION: CAD/CAM all-ceramic biomaterials are highlighted and a subsequent literature search was conducted for the relevant subjects using PubMed followed by manual search. RESULTS: Developments in CAD/CAM technology have catalyzed researches in all-ceramic biomaterials and their applications. Feldspathic glass ceramic and glass infiltrated ceramic can be fabricated by traditional laboratory methods or CAD/CAM. The advent of polycrystalline ceramics is a direct result of CAD/CAM technology without which the fabrication would not have been possible. CONCLUSIONS: The clinical uses of these ceramics have met with variable clinical success. Multiple options are now available to the clinicians for the fabrication of aesthetic all ceramic restorations.

[Contributions of medical hypnosis to orthodontic treatment]. / Apport de l'hypnose médicale aux traitements d'ODF.

Hypnosis is making a comeback in all of the medical disciplines. But in a world where everyone wants to control everything and manage everything, it's helpful to know that hypnosis is a dynamic process that cannot be forced on anyone, a psychic reality, clearly demonstrated today by brain imaging. Hypnosis does not take any power over the individual. It is just one more tool to help ease patient's discomfort. It is also useful to avoid professional burnout to provide care without depleting our energy and without wasting our valuable time. Medical hypnosis is a real asset for providing comfortable orthodontic treatment and creating a serene atmosphere. It can be done simply and rapidly to take high quality impressions, to place braces comfortably on a patient who is sitting quietly. Orthodontic treatment requires cooperation and motivation, so let's give our patients a new sense of confidence and a willingness to cooperate.

Internal fit of two all-ceramic systems and metal-ceramic crowns.

OBJECTIVES: The aim of this study was to investigate the internal fit (IF) of glass-infiltrated alumina (ICA--In-Ceram Alumina), yttria-stabilized tetragonal zirconia polycrystals (Y-TZP--IPS e.max ZirCAD), and metal-ceramic (MC--Ni-Cr alloy) crowns. MATERIAL AND METHODS: Sixty standardized resin-tooth replicas of a maxillary first molar were produced for crown placement and divided into 3 groups (n=20 each) according to the core material used (metal, ICA or Y-TZP). The IF of the crowns was measured using the replica technique, which employs a light body polyvinyl siloxane impression material to simulate the cement layer thickness. The data were analyzed according to the surfaces obtained for the occlusal space (OS), axial space (AS) and total mean (TM) using two-way ANOVA with Tukey's multiple comparison test (p<0.05). RESULTS: No differences among the different areas were detected in the MC group. For the Y-TZP and ICA groups, AS was statistically lower than both OS and TM. No differences in AS were observed among the groups. However, OS and TM showed significantly higher values for ICA and Y-TZP groups than MC group. Comparisons of ICA and Y-TZP revealed that OS was significantly lower for Y-TZP group, whereas no differences were observed for TM. CONCLUSIONS: The total mean achieved by all groups was within the range of clinical acceptability. However, the metal-ceramic group demonstrated significantly lower values than the all-ceramic groups, especially in OS.

Internal fit of two all-ceramic systems and metal-ceramic crowns

OBJECTIVES: The aim of this study was to investigate the internal fit (IF) of glass-infiltrated alumina (ICA - In-Ceram Alumina), yttria-stabilized tetragonal zirconia polycrystals (Y-TZP - IPS e.max ZirCAD), and metal-ceramic (MC - Ni-Cr alloy) crowns. MATERIAL AND METHODS: Sixty standardized resin-tooth replicas of a maxillary first molar were produced for crown placement and divided into 3 groups (n=20 each) according to the core material used (metal, ICA or Y-TZP). The IF of the crowns was measured using the replica technique, which employs a light body polyvinyl siloxane impression material to simulate the cement layer thickness. The data were analyzed according to the surfaces obtained for the occlusal space (OS), axial space (AS) and total mean (TM) using two-way ANOVA with Tukey ’s multiple comparison test (p<0.05). RESULTS: No differences among the different areas were detected in the MC group. For the Y-TZP and ICA groups, AS was statistically lower than both OS and TM. No differences in AS were observed among the groups. However, OS and TM showed significantly higher values for ICA and Y-TZP groups than MC group. Comparisons of ICA and Y-TZP revealed that OS was significantly lower for Y-TZP group, whereas no differences were observed for TM. CONCLUSIONS: The total mean achieved by all groups was within the range of clinical acceptability. However, the metal-ceramic group demonstrated significantly lower values than the all-ceramic groups, especially in OS.

Use of training dentures in management of gagging.

Gagging is a frequent impediment to the performance of dental procedures. This stimulation of the gagging reflex, or more accurately, the vomiting reflex, is a special problem in prosthodontic service. A hypersensitive gagging reflex often prevents the dentist from carrying out critical procedures or causes them to perform at a less than satisfactory level. In addition, once having suffered an unpleasant gagging experience in a dentist's office, the patients develop a fear of further visits to dentists. The purpose of this paper is to describe methods of managing the gagging patient that has a sound rationale based on modified treatment approaches starting from impression making to design of the prosthesis aided by training dentures to help the patient to tolerate prosthesis in mouth before fabrication of definite prosthesis.

Complete denture services: clinical technique, lab costs, manpower, and reimbursement. One-year review.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

Gagging during impression making: techniques for reduction.

UNLABELLED: In everyday dental practice one encounters patients who either believe themselves, or subsequently prove themselves, to be gaggers. Gagging is most frequently experienced during impression making, but is also reported during the taking of radiographs, in the placement of restorations in posterior teeth and, in some individuals, the insertion of a finger for examination purposes. This paper describes some techniques that can easily be mastered by clinicians that may help both operator and patient avoid this unpleasant occurrence. Techniques such as acupressure, the adaptation of trays, or even the use of alternative impression materials and breathing techniques all have their place, and clinicians may have to try several of these, perhaps in conjunction, in order to assist their patients. CLINICAL RELEVANCE: A significant number of patients attend for dental treatment that require impressions, and for those with gagging problems it can be a horrendous experience. Being able to make the procedure less of an ordeal is better for all involved.

In vitro evaluation of marginal adaptation in five ceramic restoration fabricating techniques.

OBJECTIVE: To compare in vitro the marginal adaptation of crowns manufactured using ceramic restoration fabricating techniques. METHOD AND MATERIALS: Fifty standardized master steel dies simulating molars were produced and divided into five groups, each containing 10 specimens. Test specimens were fabricated with CAD/CAM, heat-press, glass-infiltration, and conventional lost-wax techniques according to manufacturer instructions. Marginal adaptation of the test specimens was measured vertically before and after cementation using SEM. Data were statistically analyzed by one-way ANOVA with Tukey HSD tests (a = .05). RESULTS: Marginal adaptation of ceramic crowns was affected by fabrication technique and cementation process (P < .001). The lowest marginal opening values were obtained with Cerec-3 crowns before and after cementation (P < .001). The highest marginal discrepancy values were obtained with PFM crowns before and after cementation. CONCLUSION: Marginal adaptation values obtained in the compared systems were within clinically acceptable limits. Cementation causes a significant increase in the vertical marginal discrepancies of the test specimens.

The role of acupuncture in the treatment of orthodontic patients with a gagging reflex: a pilot study.

The aim of this study was to investigate two different acupuncture approaches in the treatment of orthodontic patients with a gagging reflex (GR). Forty-five patients (mean age 10.1 + or - 2.6 years) had an upper dental alginate impression taken prior to receiving laser stimulation. GR assessment was evaluated by using the Gagging Severity Index (GSI). Fifteen patients in Group A underwent a red-light soft magnetic field laser stimulation of conception vessel 24 (CV 24) for 1 min. Fifteen other patients in Group B undertook a combination of laser stimulation of CV 24 and acupressure pericardium 6 (PC 6). Group C, which consisted of the remaining 15 patients, formed the placebo group. After the laser stimulation and acupressure, a second impression was taken. The Gagging Prevention Index (GPI) was used to evaluate gagging reflex after the laser stimulation and acupressure. Both GSI and GPI were recorded at three stages of the dental impression taking procedure, ie with an empty impression tray, with a loaded tray and the ability to keep the impression in the mouth until set. A significant decrease in GPI values compared to GSI values, was observed at the three stages of the impression taking process and after the laser stimulation in Group A and B (p <0.05). The average improvement between the GSI and GPI scores was 58.9% before and after the laser stimulation in Group B 37.9% in Group A and 11.2% in Group C. Both acupuncture points CV 24 and PC 6 were found to be effective in controlling GR in orthodontic patients.

Comparison of the fit of Procera crowns made from stone with those made from polyurethane resin.

This study compared the average marginal gap of Procera crowns fabricated from a definitive cast made from polyurethane resin with those made from type IV stone. A metallic maxillary central incisor and first premolar were prepared according to the Procera guidelines and incorporated into a U-shaped definitive cast. From this definitive cast, 20 primary casts were made in polyurethane resin. Two sets of impressions (10 with type IV stone and 10 with polyurethane resin) were made and poured onto these casts. Forty pure aluminum oxide substructures for Procera crowns were made for these groups, with 10 incisors and 10 premolars in each group. Each substructure was cemented on the respective primary die and sectioned. Using an optical microscope and special software, sections were measured and compared for marginal adaptation. Based on the findings, both materials were equally adequate for producing a Procera crown. However, the mean margin gap was consistently larger for type IV stone dies than for polyurethane resin dies.

Accuracy of impression techniques for implants. Part 1--Influence of transfer copings surface abrasion.

PURPOSE: This study evaluated the influence of surface abrasion of transfer copings to obtain a precise master cast for a partially edentulous restoration with different inclinations. MATERIALS AND METHODS: Replicas (N = 30) of a metal matrix (control group) containing two implants at 90 degrees and 65 degrees in relation to the benchtop were obtained using a polyether impression material and three impression techniques: square impression copings splint with dental floss and autopolymerizing acrylic resin (TRS), square impression copings abraded with aluminum oxide (TA), and square impression copings abraded with aluminum oxide and adhesive-coated (TAA). The replicas obtained in type V stone were digitalized, and the images were exported to AutoCAD software to perform the readings of possible degree alterations in implant inclinations. The results were submitted to analysis of variance (ANOVA) and Tukey test (alpha < 0.05). RESULTS: Comparing the techniques with regard to the 90 degrees implant inclination, no statistical difference was observed between the three techniques and the control group. Analyzing the three techniques with regard to the 65 degrees implant inclination, no significant difference was seen between technique TA and the control group. CONCLUSIONS: Technique TA presented more accurate master casts than TRS and TAA techniques. The angulated implant (65 degrees ) tended to generate more imprecise master casts than implants perpendicular to the surface.

Prosthetic transfer impression accuracy evaluation for osseointegrated implants.

PURPOSE: : The objective of this study was to evaluate and compare 3 impression techniques for osseointegrated implant transfer procedures. MATERIALS AND METHODS: : (1) Group Splinted with Acrylic Resin (SAR), impression with square copings splinted with prefabricated autopolymerizing acrylic resin bar; (2) Group Splinted with Light-Curing Resin (SLR), impression with square copings splinted with prefabricated light-curing composite resin bar; (3). Group Independent Air-abraded (IAA), impression with independent square coping aluminum oxide air-abraded. Impression procedures were performed with polyether material, and the data obtained was compared with a control group. These were characterized by metal matrix (MM) measurement values of the implants inclination positions at 90 and 65 degrees in relation to the matrix surface. Readings of analogs and implant inclinations were assessed randomly through graphic computation AutoCAD software. Experimental groups angular deviation with MM were submitted to analysis of variance and means were compared through Tukey's test (P < 0.05). RESULTS: : There was no statistical significant difference between SAR and SLR experimental groups and MM for vertical and angulated implants. Group IAA presented a statistically significant difference for angulated implants. CONCLUSION: : It was concluded within the limitations of this study, that SAR and SLR produced more accurate casts than IAA technique, which presented inferior results.

Preservación de márgenes gingivales mediante la utilización de implante de carga diferida / Preservation of gingival margins using delayed implant loading

Se presenta la rehabilitación de un sector estético involucrando pieza dentaria a implante unitario, realizado mediante la técnica convencional de carga diferida y 2 tiempos quirúrgicos. A los 6 meses se instala mesoestructura maquinada y se cementan 2 coronas obtenidas por tecnología CAD/CAM. Se establece una discusión entre las distintas alternativas que podrían haberse elegido para resolver esta situación clínica

Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety.

This study aimed to determine the level of dental anxiety before different dental care procedures. A group of 116 adults presenting for the first time at a French dental hospital were included in the study. These patients completed a French-language version of Corah's Dental Anxiety Scale 1 and used a visual analogue scale to score their perception of the level of difficulty generated by 13 different dental treatments. The acts perceived as the most difficult to face were root canal and restorative treatment without local anaesthesia (LA), followed by oral surgery. There was a positive correlation between DAS score and level of difficulty experienced during dental treatment. Healthy subjects declared difficulty in coping with dental care. Dental procedures may be a factor of co morbidity in terms of the psychological status of dental patients. A classification of dental procedures is given according to the level of difficulty generated.