Evaluation of the intaglio surface shape of implant-supported complete-arch maxillary prostheses and its association with biological complications: An analytical cross-sectional study.

STATEMENT OF PROBLEM: Whether the shape of the intaglio surface of fixed implant-supported maxillary prostheses is associated with the occurrence of biological is unclear. PURPOSE: The purpose of this cross-sectional study was to evaluate the shape (convex or concave) of the intaglio surface of complete-arch implant-supported maxillary fixed prostheses and to assess the association with biofilm accumulation, hyperemia, bone loss, and patient satisfaction. MATERIAL AND METHODS: Study participants consisted of 56 individuals with fixed complete implant-supported maxillary prosthesis attending follow-up appointments. The 56 prostheses supported by 388 implants had been in place for an average of 5.5 years (range 1-14 years). The intaglio surface was divided into areas corresponding to the cantilever regions and between implants (n=442) and was assessed for shape (concave or convex) and biofilm index (0 to 3). Tissue hyperemia (redness) was assessed as absent or present. Bone loss (mm) was measured from digital periapical radiographs by 2 calibrated evaluators (kappa=94.9%). Study participant satisfaction was investigated by using a visual analog scale. Association assessments (α=.05) between the shape of each area and all these parameters were performed with the Friedman, linear regression, and logistic regression tests. RESULTS: Of the analyzed areas, 58 (13.1%) were concave, and 384 (86.9%) were convex. Biofilm was absent on 3.5% of the concave and 5.5% of the convex areas. Biofilm was detectable with a probe on 12% of the concave and 22.4% of the convex areas and clinically visible in 58.6% of the concave and 57.8% of the convex areas. Abundant biofilm was seen in 25.9% of the concave and 14.3% of the convex areas and was associated with hyperemia (P=.003). A statistically significant association was found between the shape and biofilm accumulation (P=.009). Hyperemia was present in 199 (45%) areas. The association analysis between the shape of the area and the presence of hyperemia was not significant (P>.05). The mean bone loss was 0.71 mm (0.91 mm). Implants placed near concave areas underwent greater bone loss (P=.001). Study participants reported a high level of satisfaction with the esthetics, mastication, speech, and smile provided by the prosthesis, with satisfaction scores ranging between 8.46 and 8.77. However, in relation to ease of cleaning, only 19.6% were fully satisfied. CONCLUSIONS: The shape of the intaglio surface of prostheses influenced the occurrence of biofilm accumulation and bone loss, and concave areas showed greater biofilm accumulation and bone resorption. High rates of satisfaction with treatment were identified.

Behavior of Implants and Oral Tissues in Maxillary Fixed Prostheses, with a Follow-up of 1 to 12 Years: Analytical Cross-Sectional Study.

PURPOSE: The aim of this study was to evaluate maxillary full-arch implant-supported fixed rehabilitations by identifying biologic complications, implant survival and success rates, and patient satisfaction with treatment. In addition, the study verified the influence of attendance at maintenance appointments on the occurrence of complications. MATERIALS AND METHODS: Data were collected from clinical follow-up appointments. RESULTS: The sample consisted of 52 patients (363 implants) with follow-up of 1 to 12 years (mean: 4.69). The main biologic complication was soft tissue recession (20.8%) at the implant level. Tissue hyperplasia was observed in eight patients (15.4%), and 17 (4.7%) implants had bone loss ≥ 2 mm. The peri-implantitis rate was 3.1% (11 implants). Implant survival and success rates were 97.8% and 93.4%, respectively. Rates of patient satisfaction with treatment were as follows: 21 (40.4%) completely satisfied, 28 (53.8%) satisfied with some complaint, and 3 (5.8%) expected more from treatment. The main complaint was the difficulty of cleaning (64.5%). Patients who attended annual follow-up appointments were associated with less bone remodeling and peri-implant disease, but no significant difference was found in biofilm accumulation. CONCLUSION: This type of rehabilitation is susceptible to biologic complications, but high survival and success rates and patient satisfaction were found. Periodic maintenance was associated with reduced complications, such as bone loss or peri-implantitis.

Didática no ensino superior: desafios e perspectivas dos docentes de Odontologia da Universidade Estadual de Ponta Grossa / Didactics in higher education: challenges and perspectives of Dentistry teachers of the State University of Ponta Grossa

O objetivo deste trabalho foi avaliar a percepção de docentes do curso de Odontologia quanto as principais dificuldades enfrentadas e as habilidades imprescindíveis para o exercício do magistério superior. Para tal, foi realizada uma pesquisa qualitativa com 47 professores do curso de Odontologia da Universidade Estadual de Ponta Grossa, divididos em dois grupos: a) tempo de atuação docente inferior a 5 anos; b) tempo de atuação docente maior que 5 anos. Após a validação do questionário, este foi encaminhado para os participantes da pesquisa responderem questões abertas sobre o exercício do magistério no ensino superior. Posteriormente à coleta dos dados, foi feita a análise descritiva das informações, exploração do material e interpretação dos resultados. Nos desafios enfrentados, os docentes com mais de 5 anos de atuação citaram a responsabilidade em formar um profissional, dificuldade em motivar os alunos e aquisição de segurança para docência como os principais. Por outro lado, docentes com atuação inferior a 5 anos apontaram o relacionamento com o aluno, insegurança profissional e obtenção do equilíbrio entre a teoria e a prática como principais desafios. Com relação às dificuldades enfrentadas atualmente, as respostas foram semelhantes para os dois grupos, sendo a falta de interesse dos alunos, falta de infraestrutura e de material de apoio para ministrar as aulas, as mais citadas. As habilidades mais mencionadas pelos professores como essenciais para o exercício da profissão incluíram a paciência, didática e necessidade de constante atualização. Pôde-se concluir que os professores enfrentam dificuldades na prática docente, independentemente do tempo de atuação (AU).

The objective of this study was to evaluate the perception of teachers of the Dentistry course regarding the main difficulties faced and the skills essential for the exercise of the higher education teaching profession. For that, a qualitative research was carried out with 47 professors of the Dentistry course at the State University of Ponta Grossa, divided into two groups: a) less than 5-year teaching experience; b) over 5-year teaching experience. After the validation of the questionnaire, it was sent to the participants of the research to answer open questions about teaching in higher education. After data collection, a descriptive analysis of the information, exploration of the material and interpretation of the results were carried out. Among the challenges faced, teachers with more than 5 years of work experience cited the responsibility to train a professional, difficulty motivating students and developing selfconfidence for teaching as the main points. On the other hand, teachers with less than 5 years of experience pointed out the relationship with the student, professional insecurity and obtaining a balance between theory and practice as the main challenges. With regard to the difficulties currently faced, the responses were similar for the two groups, namely, students' lack of interest, lack of infrastructure and support material to teach classes were the most cited. The most mentioned skills by the teachers as essential to the practice of the profession included patience, didactics and the need for constant updating. The results led to the conclusion that teachers face difficulties in teaching practice regardless of the time of performance (AU).

Retrospective, cross-sectional study on immediately loaded implant-supported mandibular fixed complete-arch prostheses fabricated with the passive fit cementation technique.

STATEMENT OF PROBLEM: Mandibular fixed complete-arch dental prostheses on dental implants have been benefiting patients for a long time, but problems with passive fitting between the metallic framework of the prostheses and the implants might influence its long-term success. PURPOSE: The purpose of this cross-sectional study of immediately loaded mandibular fixed complete-arch dental prostheses was to evaluate the survival and success rates of prostheses, the survival rates of dental implants, the occurrence of complications in the prostheses and implants, participant satisfaction, and the association between cantilever length and prosthesis complications. MATERIAL AND METHODS: Data were collected from the participants' records. The exposure variables were participant related (sex and age) and treatment related (number of implants and length of cantilever). The outcome variables were the survival and success of the prostheses and implants, complications, and participant satisfaction. The Fisher or chi-square tests was used for the association between 2 qualitative variables (α=.05). RESULTS: Two hundred ninety consecutive participants (1429 implants) with a mean follow-up time of 4.4 years were included. The survival rate for the prostheses was 98.6 and the success rate was 96.6%. The implant survival rate was 99.6%. Sixty-seven participants experienced a prosthetic complication, the most common being tooth fracture. Only 2.45% (n=35) of the implants were associated with screw loosening. Of the total number of participants, 86.9% were completely satisfied with their treatment. The length of the cantilever (up to 25 mm) was not associated with complications (P>.05). CONCLUSIONS: Implant-supported mandibular fixed complete-arch dental prostheses fabricated with a passive fit technique provide successful treatment for patients with edentulism. The success and survival rates of implants and prostheses were high. Only straightforward complications were observed. Cantilever length was not associated with complications.

Prótese híbrida mandibular imediata confeccionada pela técnica do assentamento passivo: cinco anos de acompanhamento clínico e radiográfico / The immediate mandibular hybrid prosthesis fabricated with the passive fit technique: five years of clinical and radiographic follow-up

O objetivo deste artigo foi descrever a técnica do assentamento passivo para confecção da estrutura metálica de próteses híbridas, por meio do relato de um caso clínico com acompanhamento em longo prazo. Paciente do sexo masculino, 44 anos, compareceu à clínica de Implantodontia do Instituto Latino Americano de Pesquisa e Ensino Odontológico (Ilapeo) relatando insatisfação devido à instabilidade da prótese total inferior. Foi planejada e executada a reabilitação do paciente com a instalação de cinco implantes entre os forâmenes mentuais, e uma prótese híbrida no sistema de carga imediata. O procedimento cirúrgico e a instalação da prótese definitiva foram realizados no mesmo dia. A agilidade de entrega da prótese foi possível devido à técnica utilizada para a confecção da estrutura metálica, denominada técnica do assentamento passivo, a qual elimina a necessidade de prova e solda da estrutura. A prótese permanece com a caraterística de reversibilidade, por ser parafusada, mas com a passividade das próteses cimentadas. O paciente foi acompanhado durante cinco anos e oito meses, não apresentou complicação e está totalmente satisfeito com o tratamento. Concluiu-se que a técnica do assentamento passivo reduz o tempo clínico e simplifica as etapas laboratoriais. Além disso, garante um adequado ajuste entre implante e prótese, favorecendo a longevidade da reabilitação.

The aim of this article was to describe the passive fit technique for the framework fabrication of hybrid prostheses through a clinical case presentation. A female, 44 years-old patient was examined at the Ilapeo clinics concerning about the instability of her lower mandibular denture. Five implants were planned and placed between the mental foramina to receive the mandibular hybrid prosthesis under immediate loading. The surgical and prosthodontic procedures were performed in the same day. This quick procedure to fabricate the metallic framework is known as the passive fit technique, which eliminates the try-in and soldering. Its retrievability is maintained, but with the advantage of a passive, cemented prosthesis. The patient has been followed-up for 5 years and 8 months, with no complications identifi ed, being completely satisfi ed with the proposed treatment. Besides, an adequate fit between the dental implants and the prosthesis is warranted, which favors the longevity of this rehabilitation procedure.

O uso de gengiva artificial para melhorar a estética de dentes naturais e implantes / The use of artificial gum to improve aesthetic of natural teeth and implants

Apesar dos grandes esforços feitos para alcançar o resultado estético das restaurações implantossuportadas, complicações podem ocorrer. Para o tratamento destas complicações, correções podem ser necessárias, sendo elas cirúrgicas (reconstrução óssea e do tecido mole) ou protéticas. Quando muito extensas e diante da recusa dos pacientes pelos procedimentos cirúrgicos, a alternativa para estas situações clínicas é a prótese gengival. Esta pode ser fixa ou removível e feita a partir de acrílico, resinas e materiais à base de porcelana. Pode ser utilizada para reconstruir proteticamente regiões onde houve perda de estrutura óssea e/ou de tecido mole, para minimizar defeitos estéticos de exposição da cinta metálica em componentes angulados, e em casos de doença periodontal com migração apical da margem gengival, provocando sensibilidade, dificuldades fonéticas por escape do ar e espaços negros na região de dentes anteriores. Compreender os métodos usados para incorporar próteses gengivais em tratamento protético é vital para assegurar que aos pacientes sejam oferecidas todas as possíveis opções no início do planejamento do tratamento. É procedimento de baixo custo e confecção, ao alcance de qualquer laboratório e facilmente aceito pelos pacientes pela facilidade de manutenção (AU)

Despite the great efforts to achieve good aesthetic results of dental implants restorations, complications can occur. For the treatment of these complications, corrections may be necessary. This corrections can be surgical (bone and soft tissue reconstruction) or prosthetic. When major reconstructions are required and the patient refuses to submit to surgical procedures, the prosthetic gingival reconstruction is an alternative. This prosthesis can be fixed or removable and made of acrylic, resin materials and porcelain. It can be used to reconstruct prosthetic regions with bone and/or soft tissue loss, to minimize metal exposure of angulated abutments in aesthetic regions, and in cases of periodontal disease and apical migration of gingival margin, causing sensitivity, phonetic problems due to air escape, and black spaces in the region of anterior teeth. Understanding the methods used to incorporate gingival prostheses in prosthetic treatments is vital to ensure that patients all possible options are presented to the patient at the beginning of treatment planning. It is a low cost procedure that can be manufactured by any laboratory and easily accepted by patients due to its simple maintenance (AU)

Remoção, regeneração e reinstalação de implante osseointegrável em área estética: relato de caso / Removal, regeneration and reinstallation of osseointegrated implant in the esthetic zone: a case report

Há muitos anos os implantes estão sendo utilizados para reabilitar pacientes edêntulos. Atualmente, há uma grande exigência estética envolvida nessas reabilitações. O objetivo do presente artigo é descrever, por meio do relato de um caso clínico, o tratamento realizado para solucionar a queixa estética de uma paciente que apresentava um implante mal posicionado na região anterior da maxila. A paciente, com 39 anos de idade, compareceu à clínica de Implantodontia do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO) relatando insatisfação com o implante da região do elemento 22, que “aparecia ao sorrir”. Após avaliação, verificou-se que o implante estava vestibularizado, com perda óssea, comprometimento dos tecidos moles e com a coroa clínica maior que a do elemento 12. Para a resolução do caso, foi realizada, no primeiro procedimento cirúrgico, a remoção do implante, seguida de enxerto ósseo autógeno na região. Após cinco meses de cicatrização, um novo implante foi instalado e feito enxerto ósseo com GenOx Inorgânico (Baumer - São Paulo, Brasil) na vestibular, para melhorar o contorno. A reabertura foi realizada com técnica de manipulação de tecidos moles, o intermediário foi instalado e a coroa provisória, confeccionada. A paciente foi encaminhada para a clínica de prótese para finalização do caso. Diante das características do caso, a forma de tratamento realizada se mostrou eficaz, uma vez que solucionou a queixa estética da paciente, com previsibilidade e funcionalidade...

For many years the implants are being used to rehabilitate edentulous patients. Currently, there is a great aesthetic requirements involved in these rehabilitations. The purpose of this article is to describe, through the report of a case, the treatment performed to solve the aesthetic complaint from a patient with a poorly positioned implant in the anterior maxilla. The patient, 39 years old, attended the clinic Implantology of the Latin American Institute of Research and Dental Education (ILAPEO) reporting dissatisfaction with the implant of the element 22 region, which "appeared to smile." After evaluation, it was found that the implant was buccally with bone loss, breakdown of soft tissue and the greater the clinical crown element 12. For the resolution of the case, was carried out, the first surgical procedure, removal of the implant followed by autogenous bone graft in the region. After five months of healing, a new implant was installed and made bone graft with GenOx Inorganic (Baumer - São Paulo, Brazil) in the entrance exam to improve the contour. The reopening was performed with soft tissue manipulation technique has been installed intermediate and provisional crown made. The patient was referred to the clinic prosthesis for completion of the case. Before the case characteristics, the form of treatment performed was effective, since resolved the aesthetic complaint of patient, predictability and functionality...