All-on-four híbrido - implante pterigoide para solução posterior de maxila atrófica / All-on-four hybrid - pterygoid implant for posterior solution of atrophic maxilla

O edentulismo tem uma série de consequências deletérias para a saúde bucal e geral. As consequências bucais variam desde a bem conhecida reabsorção do rebordo residual até uma função mastigatória prejudicada, uma dieta não saudável, incapacidade social e má qualidade de vida da saúde bucal. Para superar essas dificuldades, pode-se dispor de procedimentos cirúrgicos, como os implantes pterigoideos. Realizar uma análise, por meio de revisão de literatura, da técnica all-on-four híbrida com implantes pterigoideos, como alternativa a reabilitação em maxila atrófica. Foi realizada uma revisão da literatura, com seleção de artigos indexados nas bases de dados PubMed, Scielo, Cochrane e Google Acadêmico. Nesses levantamentos foram utilizados termos como: "all-on-four", "implantes inclinados", "implantes pterigoideos", "implantes zigomáticos" e "maxilla atrófica", e suas correspondentes em inglês. Com essa revisão de literatura pode-se inferir que a técnica all-on-four híbrida utilizando implantes pterigoideos para reabilitação de maxila atrófica é uma possibilidade segura, eficaz e previsível que soluciona casos que apresentam limitações ósseas. Quando bem executada pelo profissional é possível devolver ao paciente função e estética anteriormente comprometidas, consequentemente reestabelecimento da qualidade de vida do indivíduo.

Edentulism has a number of deleterious consequences for oral and general health. Oral consequences range from the well-known residual ridge resorption to impaired masticatory function, an unhealthy diet, social disability and poor oral health quality of life. To overcome these difficulties, surgical procedures can be used, such as pterygoid implants. However, these are not without complications. Through a literature review, of the hybrid all-on-four technique with pterygoid implants as an alternative to rehabilitation in atrophic maxilla. For this, bibliographic research was carried out in the databases PubMed, Scielo, Cochrane and Google Scholar, using the following search terms: "all-on-four", "tilted implants", "pterygoid implants", "zygomatic implants" e "atrophic maxilla", in both Portuguese and English languages. With this literature review, It can be inferred that the hybrid all-on-four technique using pterygoid implants for rehabilitation of atrophic maxilla is a safe, effective and predictable possibility that solves cases with bone limitations. When well performed by the professional, it is possible to return previously compromised function and aesthetics to the patient, consequently reestablishing the individual's quality of life.

Plataforma cone morse, a melhor opção para a biomecânica e estética em próteses sobre implante: uma revisão de literatura / Conemorse platform, the best option for biomechanics and aesthetics in implant-supported prostheses: a literature review

A escolha da plataforma protética em implantodontia é fundamental para garantir o sucesso a longo prazo dos procedimentos. Todos os tipos de conexão protética apresentam vantagens e desvantagens, cabendo ao cirurgião-dentista optar pelo o que melhor se adepta ao seu caso. Uma revisão de literatura foi realizada, abrangendo estudos relevantes que compararam essas duas plataformas protéticas em termos de biomecânica e estética. Foram analisadas revisões de literatura e estudos in vitro, sob as palavras-chave "cone morse", "biomechanics", "abuptment". As pesquisas foram feitas nas bases de dados Scielo e PubMed, e os artigos escolhidos deveriam abordar a estabilidade das conexões, a preservação óssea e a estética peri-implantar. Os resultados da revisão demonstram que a plataforma Cone Morse oferece uma interface mais estável, reduz o afrouxamento de parafusos e minimiza a infiltração bacteriana. Com isso, o Cone Morse contribui para a preservação das estruturas ósseas e gengivais ao redor do implante, tornando-se uma escolha valiosa, especialmente em procedimentos de reabilitação estética.

A choice of the prosthetic platform in implant dentistry is fundamental to ensure long-term success of procedures. All types of prosthetic connections have their advantages and disadvantages, and it's up to the dentist to choose what best suits their case. A literature review was conducted, encompassing relevant studies comparing these two prosthetic platforms in terms of biomechanics and aesthetics. Literature reviews and in vitro studies were analyzed using keywords such as "Cone Morse," "biomechanics," and "abutment." The research was conducted on Scielo and PubMed databases, and the selected articles should address connection stability, bone preservation, and peri-implant aesthetics. The review results demonstrate that the Cone Morse platform offers a more stable interface, reduces screw loosening, and minimizes bacterial infiltration. As a result, Cone Morse contributes to the preservation of bone and gingival structures around the implant, making it a valuable choice, especially in aesthetic rehabilitation procedures.

Full-mouth rehabilitation with lithium disilicate ceramic crowns in hypoplastic amelogenesis imperfecta: a case report and review of literature.

BACKGROUND: Amelogenesis imperfecta (AI) is a group of genetic disorders characterized by tooth discoloration and enamel defects. Patients with AI always exhibit generalized attrition and defective tooth structure, leading to the loss of occlusal vertical dimension (OVD). Appropriate rehabilitation is challenging and essential to improve patients' aesthetics and function. CASE PRESENTATION: This case report presents a comprehensive management of a 30-year-old woman with hypoplastic AI. A 52-month follow-up revealed satisfactory full-mouth rehabilitation performances of lithium disilicate ceramic crowns after clinical crown lengthening, with increased vertical dimension. CONCLUSIONS: Patients with severe hypoplastic AI require proper full-mouth rehabilitation. Using full-crown lithium disilicate restorations to increase the OVD by 2‒4 mm is a safe and predictable recommendation for such cases. In addition, patients with AI require complex and comprehensive management. The long-term effects of full-mouth rehabilitation with lithium disilicate ceramic crowns still necessitate further follow-ups.

A Systematic Method for a Full-Mouth Rehabilitation of a Dentition With Extensive Overjet and Occlusal Dysfunction.

A patient presented desiring to improve her esthetics and reduce masseter muscle pain prior to her upcoming wedding. Although the patient had a full-mouth rehabilitation with porcelain restorations at age 16, she presented with extensive overjet, unbalanced occlusion, and lack of contact from premolar to premolar. The clinician was faced with the challenge of determining the best course of treatment. After completing thorough record-taking and a detailed analysis following a systematic approach, the clinician developed a facially driven treatment plan that was carried out over eight phases. The patient's existing crowns were replaced at a reduced vertical dimension of occlusion, esthetics were enhanced, muscle pain was relieved, and her goals were achieved.

Papillon-lefèvre syndrome: clinical case of oral rehabilitation with osseointegrated implants

Papillon-Lefèvre syndrome (PLS) is a rare benign, autosomal recessive condition caused by a mutation in the cathepsin C gene. This alteration results in palmar-plantar hyperkeratosis, or thickening of the soles of the feet and palms of the hands, as well as aggressive periodontal disease resulting in the premature loss of deciduous and permanent teeth. The etiology is multifactorial, and is influenced by immunological, genetic or microbial factors. This case report presents a successful prosthetics oral rehabilitation with osseointegrated implants in a 48-year-old female patient with PLS. Although few reports of dental implants in patients with PLS have been published, it seems to be a possible approach in selected patients. (AU)

Cirugía preprotésica de torus mandibular bilateral con impedimento del movimiento lingual / Preprosthetic surgery of a bilateral mandibular torus with tongue movement dysfunction

El torus mandibular es un crecimiento exofítico óseo benigno en la parte interna de la mandíbula, generalmente presente en ambos lados. Su etiología se relaciona a diversos factores como la herencia, grado de estrés, factores ambientales, nutricionales y trauma oclusal. Puede causar problemas funcionales y estéticos, como dificultad en la pronunciación, mal aliento, molestias al comer con prótesis mal adaptadas y ulceraciones. En la mayoría de los casos no es necesario el tratamiento, excepto cuando se requiere para mejorar la función protésica o solucionar problemas funcionales. En este artículo presentamos la situación clínica que describe la escisión exitosa del torus mandibular bilateral en un paciente de 57 años para la posterior rehabilitación protésica. La escisión del torus mandibular bilateral es un procedimiento seguro y predecible que ayuda a prevenir complicaciones protésicas y biológicas, mejorando la estabilidad y la función del sistema estomatognático (AU)

The mandibular torus is a benign bony exophytic growth in the inner part of the mandible, usually present on both sides. Its etiology is related to various factors such as heredity, degree of stress, environmental and nutritional factors, and occlusal trauma. It can cause functional and aesthetic problems, such as difficulty in pronunciation, bad breath, discomfort when eating with ill-fitting prostheses, and ulcerations. In most cases, treatment is not necessary, except when it is required to improve prosthetic function or solve functional problems. In this article we present the clinical situation that describes the successful excision of the bilateral mandibular torus in a 57-year-old patient for subsequent prosthetic rehabilitation. Bilateral mandibular torus excision is a safe and predictable procedure that helps prevent prosthetic and biological complications, improving the stability and function of the stomatognathic system (AU)

Demystify Treatment Planning With a Correct Functional Diagnosis.

Obtaining an accurate assessment of the causes of severe dental destruction is crucial when planning a clinical workflow for full-mouth rehabilitation cases. Some cases that initially appear extremely challenging may be surprisingly straightforward, especially if the patient presents with an acceptable functional occlusion. In the seemingly highly complex case presented, only a Lucia jig was required to obtain a reliable restorative reference point for the full-mouth rehabilitation. Increasing the vertical dimension of occlusion allowed for predictable restoration of function and esthetics. The treatment was completed in phases for patient comfort, and the final outcome provided the patient with regained confidence in his smile and comfort when eating.

Multidisciplinary full-mouth rehabilitation using minimally invasive dental implant therapy: a report on three different clinical scenarios.

Conventional operative dental procedures are being revisited with an approach that seeks to preserve the original tissue as much as possible. Implant dentistry has also seen the advent of various techniques which make minimal alteration to natural tissue. The flapless technique involves implant placement either through a freshly extracted socket or through a tansmucosal punch hole, without elevating mucoperiosteal flap. This paper presents a report on three cases of patient centric, conventional dental implant-based full-mouth rehabilitation, which was successfully carried out using the flapless technique, under varied clinical situations. Each case showed a favourable outcome in terms of restoration of the form and function of the patient's dentition.

Dental approaches in children with congenital heart disease treated under general anesthesia for oral rehabilitation.

BACKGROUND: Children with congenital heart disease (CHD) are at high risk of contracting oral diseases. The aim of this study is to investigate dental procedures to prevent the risk of infective endocarditis in children with CHD. MATERIAL AND METHODS: 146 patients aged 2-14 years, in need of prophylaxis before cardiovascular surgery and who had filled out anamnesis records, were considered. Dental caries in all the children with CHD was reported as the number of decayed, missing and filled teeth (DMFT). RESULTS: There was a significant strong positive relationship between the pre-oral rehabilitation DMF-T/dmf-t scores and the number of caries patients (r=0.95, p=0.01). There was no significant correlation between the pre-oral rehabilitation DMF-T/dmf-t scores and both tooth loss (r=0.14, p=0.09) and the number of restorations (r=0.11, p=0.17). In addition, there was no significant correlation between the post-oral rehabilitation DMF-T/dmf-t scores and the prevalence of dental caries. A positive and moderately strong correlation was found between the post-oral rehabilitation DMF-T/dmf-t scores and the number of missing teeth (r=0.56, p=0.01), while there was a positive and strong relationship between the post-treatment DMF-T/dmf-t scores and the number of fillings (r=0.62, p=0.01). CONCLUSIONS: Extraction should be considered when providing oral rehabilitation, rather than endodontic and deep restorative treatments.

Pain assessment, cognitive and cortical changes with full mouth rehabilitation in a group of children.

BACKGROUND: A change in professionals' perspectives on the value of general anesthesia (GA) for pediatric patients, including those with disabilities, medical conditions, severe oral issues, and challenging behaviors. Full-mouth rehabilitation under GA allows for the comprehensive treatment of all oral health problems in a single visit, without requiring the child's active participation. Extensive dental problems are often associated with severe dental pain, which can impact cognitive function, including perception, attention, memory, reasoning, language, communication, and executive functions. Individuals experiencing pain tend to perform less optimally cognitively. AIM: This study aimed to investigate changes in cognition, brain function, and cortical alterations in children who underwent extensive dental rehabilitation under GA. PATIENTS ANDMETHODS: Thirty uncooperative, healthy children aged 6-12 with extensive dental issues were enrolled. Pain levels were assessed using the FLACC and WBFPS scales before treatment, one week after, and three months later. Cognitive assessments, including the WCST, processing speed, digit span, and Trail Making Test, as well as EEG measurements, were also performed. RESULTS: The results showed a significant improvement in pain levels reported by the children or their caregivers after the dental procedures, both at one week and three months. All cognitive measures, such as digit span, processing speed, and WCST performance, demonstrated substantial improvements after the treatment. The Trail Making Test also exhibited statistically significant variations before and after the dental procedures. Additionally, the MOCA test revealed a notable improvement in cognitive skills following the treatment. Furthermore, the EEG power ratio, an indicator of changes in the power balance within each frequency band, showed a statistically significant difference after the dental procedures. CONCLUSION: the findings of this study suggest that full-mouth rehabilitation under GA can lead to improved pain management, as well as enhanced cognitive and brain functions in children. FUTURE PERSPECTIVES: More clinical studies with a longer follow-up period and a different age range of children are required to investigate the connection between brain function and oral rehabilitation involving restorations or occlusion issues.

Tratamento reabilitador com prótese obturadora em paciente acometido por maxilectomia parcial: relato de caso / Rehabilitative treatment with obturator prosthesis in a patient suffering from partial maxillectomy: case report

Introdução: O tratamento de tumores malignos ou benignos, podem resultar em procedimentos cirúrgicos, como a maxilectomia parcial ou total, gerando comunicação bucosinusal nos pacientes. Uma forma de resolver estas alterações maxilofaciais é através do tratamento reabilitador com próteses obturadoras a fim de restabelecer a função mastigatória, estética, fonética e psicológica. Objetivo: o objetivo deste trabalho foi relatar o caso clínico de um paciente oncológico que foi reabilitado com prótese obturadora devido à maxilectomia por neoplasia maligna de seio maxilar. Relato de caso: Paciente de 62 anos, sexo masculino, procurou atendimento odontológico no Centro de Oncologia Bucal da Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) de Araçatuba ­ SP após a realização de uma maxilectomia parcial com comunicação bucosinusal e foi encaminhado para o Curso de Especialização em Prótese Dentária da Faculdade de Odontologia ­ Unesp/Araçatuba-SP para a reabilitação. Foi proposto, primeiramente a realização da prótese obturadora para fechar a comunicação bucosinusal e uma prótese total inferior para o arco antagonista e, posteriormente, a realização de uma prótese facial. Conclusão: O tratamento reabilitador com próteses obturadoras possui um bom resultado estético e funcional, favorecendo uma melhor função mastigatória e fonética, e melhorando consideravelmente a condição psicológica que é muito afetada nos pacientes submetidos a maxilectomia total ou parcial, sendo necessário uma boa interação com toda a equipe multiprofissional envolvida para que haja um melhor tratamento integrado para a reabilitação e melhora da qualidade de vida(AU)

Introduction: The treatment of malignant or benign tumors can result in surgical procedures, such as partial or total maxillectomy, generating oral communication in patients. One way to resolve these maxillofacial changes is through rehabilitative treatment with obturator prostheses in order to reestablish masticatory, aesthetic, phonetic and psychological function. Objective: the objective of this work was to report the clinical case of a cancer patient who was rehabilitated with an obturator prosthesis due to maxillectomy for malignant neoplasia of the maxillary sinus. Case report: A 62-year-old male patient sought dental care at the Oral Oncology Center of the Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) in Araçatuba ­ SP after undergoing a partial maxillectomy with oral cavity and was referred for the Specialization Course in Dental Prosthesis at the Faculty of Dentistry ­ Unesp/Araçatuba-SP for rehabilitation. It was proposed, firstly, to create an obturator prosthesis to close the bucosinusal communication and a total lower prosthesis for the antagonistic arch and, later, to create a facial prosthesis. Conclusion: Rehabilitative treatment with obturator prostheses has a good aesthetic and functional result, favoring better chewing and phonetic function, and considerably improving the psychological condition that is greatly affected in patients undergoing total or partial maxillectomy, requiring good interaction with the entire the multidisciplinary team involved so that there is better integrated treatment for rehabilitation and improved quality of life

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia.

AIM: To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia. MATERIALS AND METHODS: A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23. RESULTS: All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child. CONCLUSION: Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene. CLINICAL SIGNIFICANCE: Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

Fluxo de trabalho digital no planejamento de reabilitações orais estéticas: uma revisão de literatura / Digital workflow in the planning of aesthtetic oral rehabilitations: a review of literature

A Odontologia Estética baseia- se em princípios de estética com condutas e técnicas de procedência lógica, como também intuitiva, para planejar um sorriso harmônico. Com seu atual perfil mais conservador atrelado às inúmeras ferramentas disponíveis no mercado, é possível arquitetar procedimentos priorizando o sucesso do tratamento, restabelecendo a função e harmonia, com maior segurança e previsibilidade. O fluxo digital inclui Softwares e equipamentos automatizados que podem otimizar o tempo clínico, apresentando benefícios tanto para o Cirurgião Dentista como para o paciente. Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia reabilitadora, pois, possibilita um planejamento mais minucioso em cada estágio do tratamento reabilitador estético com o uso de desenhos e linhas de referência para comparações entre as imagens geradas do antes e depois, avaliando se concordam com o planejamento e anseios do profissional e do paciente, ou se serão necessárias modificações. Com isso, o objetivo do presente trabalho foi realizar uma revisão de literatura sobre os avanços do fluxo de trabalho digital em reabilitação oral estética, analisando-se a influência na qualidade do atendimento atrelado ao conforto dos pacientes. Foi realizada uma revisão de literatura nas bases de dados PubMed, Scielo e Wiley Library, utilizando os descritores "Digital Smile Design", "Dental Esthetic," EstheticTreatment". Foram buscados artigos entre 2009 até 2022. Com base na revisão de literatura, foi possível concluir que a técnica se apresenta como uma ferramenta valiosa para tratamentos restauradores, otimizando a compreensão das dificuldades estéticas e aumentando a aceitação do tratamento pelo paciente. E, por trás destes resultados, existem diversas variáveis influenciando-os, como a maior previsibilidade dos procedimentos, reduzindo o tempo para a finalização, além de trabalhos mais conservadores, com estrutura dental preservada.

Esthetic dentistry is based on aesthetic principles with logical, also intuitive procedures and techniques, in order to plan a harmonic smile. With its more consecutive current profile linked to the numerous tools available on the market, it is possible to design procedures prioritizing the success of the treatment restoring the function and harmony with greater safety and predictability. The digital flow includes software and automated equipment that can optimize clinical time, presenting benefits for both, the dental surgeon and the patient. Currently, the DSD (digital smile design) has been used as a resource of great prominence for Rehabilitative Dentistry, because it allows a more detailed planning in each stage of the aesthetic rehabilitation treatment with the use of drawings and reference lines, in order to compare between the images generated before and after the procedure, assessing whether they are in accordance with the planning and desires of the professional and the patient, or if modifications are necessary. With this, the objective of the present work was to carry out a literature review of the advances in the digital workflow in aesthetic oral rehabilitation. Analyzing the influence on the quality of care linked to the comfort of patients. A literature review was carried out in PubMed, Scielo and Wiley Library databases, using the descriptors "Digital Smile Design", "Dental Esthetic", "Esthetic Treatment". Articles were searched between 2009 and 2022. Based on the literature revie, it was possible to conclude that the technique presents itself as a valuable tool for restorative treatments, optimizing the understanding of aesthetic difficulties and increasing the acceptance of the treatment by the patient. And, behind these results, there are several variables influencing them, such as greater predictability of procedures, reducing the time for completion in addition to more conservative works, with preserved tooth structure.

A novel approach to full-mouth rehabilitation of dentinogenesis imperfecta type II: Case series with review of literature.

RATIONALE: Dentinogenesis imperfecta (DI) is an autosomal-dominant disorder. The most common clinical manifestations, including obliterated tooth tissues and severe tooth wear, usually lead to tooth extractions. It remains a great challenge for dentists to preserve the residual tooth tissue and establish the esthetics and occlusion of dentitions. PATIENTS CONCERNS: 25-year-old twin sisters, who had suffered from dentinogenesis imperfecta type II for more than 10 years, presented with continuous tooth wear and discomfort from wearing a removable partial denture for more than 3 years. DIAGNOSIS: Intraoral examination showed extensive tooth wear with enamel exfoliation and typical amber-brown color with an opalescent discoloration. Their panoramic radiographs revealed completely obliterated tooth tissues and severe tooth wear. INTERVENTIONS AND OUTCOMES: The dentitions were restored with post-and-core crowns and pin lays after preparing root post paths and pin holes guided by computer-aided design/computer-aided manufacturing (CAD/CAM) procedures, resulting in a successful repair. LESSONS: Severe tooth wear and tooth tissue obliteration are typical clinical manifestations in DI-affected dentitions, increasing the complexity and difficulty in dental restorations. Early diagnosis and appropriate treatments are essential to achieve a favorable prognosis. CAD/CAM procedures, permitting accurate and effective treatment, possess promising potential in the treatment of DI-affected dentitions.

An esthetic minimally invasive rehabilitation performed with a fully digital workflow and hybrid restorative approach.

AIM: The aim of the present study was to demonstrate that fully digital workflows can provide predictable esthetic and functional outcomes. MATERIALS AND METHODS: The present clinical case report provides a step-by-step documentation of a full-mouth rehabilitation planned and performed with a fully digital approach utilizing an adhesive and no-prep method. After assessing the patient's needs, a treatment plan was established that considered the patient's functional and esthetic requests. The overlap of 2D images and 3D models and facial scans of the patient allowed the digital previsualization of the esthetic result by implementing the "copy-paste" approach to restore the maxillary anterior sextant. CONCLUSION: The final outcome was satisfactory in terms of esthetics, function, and soft tissue health.

CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology.

OBJECTIVE: This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS: Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION: The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE: Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

Is scanning under rubber dam isolation a feasible approach for the execution of indirect restorations? / O escaneamento sob isolamento absoluto é uma técnica viável para execução de restaurações indiretas?

Objective: The aim of the study was to report the aplicability of intraoral scanning while rubber dam isolation is in place. Material and Methods: Female patient, 50 years old, required restorative procedures on teeth 35 and 37. An intraoral scan was initially performed on both arches. Isolation was carried out from 33 to 37, tooth preparation and immediate dentin sealing were carried out. A new scan with the rubber dam in place was performed and a CAD/CAM lithium disilicate hybrid block was digitally designed, milled, crystallized and cemented under the tooth surface with the rubber dam still in position. After completing this stage, the rubber dam was removed, the occlusion was verified, presenting excellent aesthetic and functional results. Results: The absolute isolation process used in the present study works as an excellent device for gingival retraction. Conclusion: The absolute isolation can be recommended in clinical activities of intraoral scanning favoring the quality of the final result of treatments (AU)

Objetivo: O objetivo do estudo foi relatar a aplicabilidade do escaneamento intraoral sob isolamento absoluto. Material e Métodos: Paciente do sexo feminino, 50 anos, necessitou de procedimentos restauradores nos dentes 35 e 37. Uma varredura intraoral foi inicialmente realizada em ambos os arcos. O isolamento absoluto foi feito de 33 a 37, permitindo a realização do preparo dentário e selamento imediato da dentina. Um novo escaneamento com o dique de borracha colocado foi realizado e um bloco híbrido de dissilicato de lítio CAD/CAM foi projetado digitalmente, fresado, cristalizado e cimentado sob a superfície dentária ainda com o dique de borracha em posição. Após a finalização dessa etapa, o dique de borracha foi removido, a oclusão foi verificada apresentando ótimos resultados estéticos e funcionais. Resultados: O isolamento absoluto utilizado no presente estudo funciona como um excelente dispositivo para retração gengival. Conclusão: O isolamento absoluto pode ser recomendado em atividades clínicas de escaneamento intraoral favorecendo a qualidade do resultado final dos tratamentos (AU)

Rehabilitation of a Full-Arch Patient with Cemented Metal-Ceramic Multiple Prostheses on Implants: A Case Report / Reabilitação de paciente de arco completo com Próteses Múltiplas Metalocerâmicas Cimentadas sobre Implantes ­ relato de caso

Objective: To report a clinical case of a female patient rehabilitated with Cemented Metal-Ceramic Multiple Prostheses on Implants in the upper arch. Materials and Methods: A multidisciplinary approach was employed, utilizing various clinical skills to achieve satisfactory outcomes in the rehabilitation of a fully edentulous patient. The treatment plan involved the use of cemented metal-ceramic prostheses, with a focus on optimizing the positioning of the crown margins to ensure periodontal health. Results: The use of cemented metal-ceramic multiple prostheses effectively addressed the patient's aesthetic concerns by eliminating screw access holes and ensuring the continuity of the ceramic material. The supragingival positioning of the crown margins prevented excess cement in the peri-implant sulcus, promoting periodontal health. The final prostheses provided excellent aesthetics and functionality, leading to enhanced patient satisfaction. Conclusion: The choice of cemented implant-supported prostheses represents a highly effective approach for treating edentulism. This method offers clinical benefits, such as increased retention and improved esthetic outcomes, while also positively impacting the patient's quality of life (AU)

Objetivo: Relatar um caso clínico de uma paciente feminina reabilitada com Próteses Metálicas-Cerâmicas Cimentadas em Implantes na arcada superior. Materiais e Métodos: Foi empregada uma abordagem multidisciplinar, utilizando várias habilidades clínicas para alcançar resultados satisfatórios na reabilitação de um paciente totalmente edêntulo. O plano de tratamento envolveu o uso de próteses metálicas-cerâmicas cimentadas, com foco na otimização do posicionamento das margens das coroas para garantir a saúde periodontal. Resultados: O uso de próteses metálicas-cerâmicas cimentadas abordou efetivamente as preocupações estéticas da paciente ao eliminar os orifícios de acesso para parafusos e garantir a continuidade do material cerâmico. O posicionamento supragengival das margens das coroas preveniu o excesso de cimento no sulco peri-implantar, promovendo a saúde periodontal. As próteses finais proporcionaram excelente estética e funcionalidade, resultando em maior satisfação do paciente. Conclusão: A escolha de próteses suportadas por implantes cimentadas representa uma abordagem altamente eficaz para o tratamento da edentulismo. Este método oferece benefícios clínicos, como maior retenção e melhores resultados estéticos, além de impactar positivamente a qualidade de vida do paciente(AU)

Reabilitação protética de indivíduos maxilectomizados com prótese obturadora: análise pelo método de elementos finitos e revisão sistemática / Prosthetic rehabilitation of individuals maxillectomized with obturator prostheses: finite element analysis and systematic review

A prótese obturadora (PO) permite o restabelecimento estético e funcional de indivíduos maxilectomizados. Os objetivos deste estudo foram: 1. avaliar pelo método de elementos finitos (MEF), o comportamento biomecânico de infraestruturas metálicas de próteses parciais removíveis obturadoras (PPRO) para uma maxila com ressecção do tipo Classe II de Aramany, variando o tipo de conector maior; 2. realizar uma revisão sistemática com meta-análise em rede sobre a eficácia da PO, e outros tratamentos na qualidade de vida de seus usuários. No primeiro estudo, um modelo virtual simulando uma maxila Classe II de Aramany com ressecção óssea do lado esquerdo, e ausência dos dentes 24, 25, 26 e 27 foi construído no programa Rhinoceros® 7.0, a partir de duas tomografias. Em seguida, três infraestruturas de PPRO digitais foram confeccionadas variando o tipo de conector maior: grupo controle com conector maior tipo placa palatina com extensão reduzida (GC), conector maior tipo placa palatina com extensão total (ME), e conector maior tipo barra anteroposterior com extensão reduzida (AP). A análise de elementos finitos foi realizada no software Optistruct 2022, e os resultados analisados no HyperView 2022. Os resultados foram avaliados de forma qualitativa por meio da observação visual das imagens gráficas com variação dos gradientes de cores, de acordo com a distribuição de tensão, e quantitativa por meio da tensão de von Mises (σVM), tensão máxima principal (σmax), tensão mínima principal (σmin) e deslocamento (mm). No segundo estudo foi realizada uma revisão sistemática com meta-análise em rede (PROSPERO #CRD42023430827). Foram incluídos ensaios clínicos randomizados (ECRs) e estudos de intervenção não randomizados (EINRs) com pacientes reabilitados com prótese obturadora como um dos tratamentos de reabilitação. Sete desfechos reportados pelos pacientes foram analisados separadamente para cada desenho de estudo, de acordo com os questionários de QV: aparência, mastigação, dor, contato social, fala, deglutição e QV geral. Os dados foram convertidos para o questionário UW-QOL v4, exceto o contato social que foi convertido para o EORTC QLQ-H&N35. Foi usada meta-análise em rede Bayesiana modelo randômico para calcular as diferenças médias, e intervalos de credibilidade de 95% (Crl) para cada comparação entre tratamentos. A interpretação seguiu a certeza da evidência por meio da abordagem GRADE para meta-análise e a diferença mínima importante (DMI). A revisão incluiu 4 ECRs e 9 EINRs. Sete tratamentos foram avaliados: pré-cirúrgico (considerado sem tratamento), obturador pós-cirúrgico, obturador provisório, obturador convencional, obturador suportado por implante, obturador magnético e retalho, totalizando 120 comparações de tratamentos em todos os sete desfechos. Verificou-se pelos resultados do primeiro estudo que CG e AP apresentaram comportamentos semelhantes, já ME apresentou maiores valores de tensão para praticamente todos os componentes do sistema. Nenhum dos grupos apresentou valores de deslocamento significativos. Para a revisão sistemática, observou-se que a estimativa de efeito de alguns tratamentos alcançou a DMI, entretanto, o intervalo de credibilidade cruzou a linha de efeito nulo, com certeza da evidência muito baixa, portanto, nenhum tratamento foi mais eficaz que o outro. Para ambos os estudos, mais estudos laboratoriais e ensaios clínicos randomizados são incentivados para confirmar as evidências encontradas.

The obturator prosthesis (OP) allows the restoration of speech, aesthetics, and oral function in patients with maxilectomized individuals. The objectives of the study were: 1. to evaluate, using the finite element analysis (FEA) methodology, the biomechanical behavior of metallic infrastructures of removable partial denture obturator (RPDO) for a maxilla with Aramany Class II resection, varying the type of major connector; 2. carry out a systematic review with network meta-analysis on the effectiveness of the OP and other treatments on the quality of life of its users. In the first study, a virtual model simulating an Aramany Class II maxilla with bone resection on the maxillary left side and absence of teeth 24, 25, 26 and 27 was developed using the Rhinoceros® 7.0 program based on two tomography scans. After obtaining the virtual model, three infrastructures digital RPDOs were created varying the type of major connector: major connector with reduced coverage (RPDO1), major connector with extensive coverage (RPDO2) and major connector with anteroposterior bar (RPDO3). The FEA analysis was carried out using the Optistruct 2022 software, and the results were analyzed using the HyperView 2022 software. The results were evaluated qualitatively through visual observation of graphic images with variation of color gradients according to the stress distribution and quantitative von Mises stress (σVM), maximum principal stress (σmax), minimum principal stress (σmin) and displacement (mm). For the second study, the systematic review with network meta-analysis (PROSPERO #CRD42023430827). Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSIs) with obturator prosthesis as one of the treatments were included. Seven patient-reported outcomes were analyzed separately for each study design, according to the QOL questionnaires: appearance, chewing, pain, social contact, speech, swallowing and general QOL. Data were converted to the UW-QOL v4 questionnaire, except social contact, which was converted to the EORTC QLQ-H&N35. Network meta-analysis (NMA) Bayesian random model was used to calculate mean differences (MD) and 95% credibility intervals (Crl) for each treatment comparison. Interpretation followed the certainty of evidence through the GRADE approach for NMA and the least important difference (DMI). The review included 4 RCTs and 9 NRSIs. Seven treatments were evaluated: presurgical (considered no treatment), surgical obturator, interim obturator, obturator, implant-supported obturator, magnet obturator, and flap, totaling 120 treatment comparisons in all seven outcomes. The results of the first study indicate that RPDO1 and RPDO3 showed similar behaviors, while RPDO2 presented the highest stress values for all system components. None of the groups presented significant displacement values. In the systematic review, it was observed that the effect estimates of some treatments reached the DMI, however, for all treatment comparisons, the credibility interval crossed the null effect line with very low certainty of evidence. No treatment showed superiority compared to another for any outcome. For both studies, further laboratory studies and RCTs are encouraged to confirm the evidence.

Facetas em resina composta com fechamento de diastemas para harmonização do sorriso: relato de caso / Composite resin veneers with diastema closure for smile harmonization: A case report / Facetas de resina compuesta con cierre de diastemas para harmonización de la sonrisa: Informe de caso

Introdução:A estética do sorriso é um aspecto valorizado pela sociedade atual, o que demanda que os profissionais de odontologia estejam atualizados sobre materiais dentários e novas técnicas para alcançar resultados estéticos restauradores de alta qualidade. A resina composta é frequentemente utilizada para simplificar a reabilitação oral, pois oferece facetas dentárias que combinam excelente estética e durabilidade. Objetivo:Este artigo tem como objetivo relatar um caso clínico de reabilitação estética utilizando facetas em resina composta com fechamento de diastemas.Relato de caso:Uma paciente do sexo feminino, com 24 anos de idade, procurou a clínica escola de odontologia com insatisfação em relação à estética do seu sorriso. A pacienteapresentava diastemas, restauração defeituosa e desproporção no tamanho dos dentes anteriores. O tratamento consistiu em um clareamento caseiro prévio, seguido pela confecção de facetas diretas em resina composta para fechamento dos diastemas e correção da desproporção dentária. Foram utilizados um Jig Estético e o software Digital Smile Design (DSD)para o planejamento, além de um mock-up em resina bisacrílica. Após a confecção das facetas, foi obtido um resultado estético final satisfatório. O caso incluiu um total de oito facetas,dos dentes 14 ao 24. Conclusão:O tratamento utilizando restaurações em resina composta proporcionou à paciente uma reabilitação estética, funcional e biológica (AU).

Introduction:Smile aesthetics is an aspect valued by today's society, which demands that dental professionals are up to date on dental materials and new techniques to achieve high-quality restorative aesthetic results. Composite resin is often used to simplify oral rehabilitation, as it offers dental veneers which combine excellent aesthetics and durability. Objective:This article aims to report a clinical case of aesthetic rehabilitation using composite resin veneers with diastema closure. Case report:A24-year-old female patient came to the dental school clinic with dissatisfaction regarding the aesthetics of her smile. The patient had diastemas, defective restoration and disproportionate anterior teeth size. The treatment consisted of prior at-home tooth bleaching, followed by creating direct composite resin veneers to close the diastemas and correct tooth disproportion. An Aesthetic Jig and the Digital Smile Design (DSD) software program were used for planning, in addition to a mock-up in bisacrylic resin. After treatment, a satisfactory final aesthetic result was obtained. The case included a total of eight veneers, from teeth 14 to 24. Conclusion:Treatment using composite resin restorations provided the patient with aesthetic, functional and biological rehabilitation (AU).

Introducción: La estética de la sonrisa es un aspecto valorado por la sociedad actual, hecho que demanda de los profesionales de odontología actualización constante sobre los materiales dentarios y nuevas técnicas para alcanzar resultados estéticos restauradores de altacualidad. La resina compuesta es frecuentemente utilizada para simplificar la rehabilitación oral, pues ofrece facetas dentarias que combinan excelente estética y durabilidad.Objetivo: Este artículo tiene como objetivo relatar un caso clínico de rehabilitación estética a partir de la utilización de facetas en resina compuesta con cierre de diastemas. Informe de caso: Una paciente, del sexo femenino, con 24 años de edad, buscó la clínica-escuela de odontología insatisfecha con la estética de su sonrisa. La paciente presentaba diastemas, restauración dentaria defectuosa y desproporción en el tamaño de los dientes anteriores. El tratamiento consistió en un blanqueamiento casero previo, seguido por la confección de facetas directas de resina compuesta para cierre de los diastemas y corrección de la desproporción dentaria. Fueron utilizados un Jig Estético y el software Digital Smile Design(DSD) para el planeamiento, además de un mock-upen resina bisacrílica. Tras la confección de las facetas, fue obtenido un resultado estético final satisfactorio. El caso incluyó un total de ocho facetas, de los dientes 14 al 24.Conclusión: El tratamiento a partir de restauraciones en resina compuesta proporcionó a la paciente una rehabilitación estética, funcional y biológica (AU).