Associated short and regular implants for complete denture retention in an atrophic mandible: clinical follow-up / Implantes corto y regular asociados para retención de prótesis completa en mandíbula atrófica: seguimiento clínico / Implantes curto e regular associados para retenção de prótese total em mandíbula atrófica: acompanhamento clínico

Objective: to present the radiographic clinical follow-up of the prosthetic rehabilitation of a patient with an atrophic mandible, with the installation of short implants associated with an implant of regular length. Method: case report of a completely edentulous patient with an atrophic mandible and a 6-year radiographic clinical follow-up conducted at the dental clinic of the Federal University of Piauí, Teresina, from February 2011 to January 2020. After collecting sociodemographic data, health records, clinical radiographic examinations, and prosthetic surgical planning, four dental implants were installed between the mental foramina. After three months, mini-conical abutments and a fixed prosthesis screwed onto the implants were installed and monitored every six months for a period of six years. Results: the clinical evaluation revealed tissue stability without significant peri-implant changes after the follow-up period. Radiographically, bone resorption was not observed around the implant. Stability of the prosthesis and absence of prosthetic complications were observed during the follow-up period. Conclusion: short implants associated with regular-length implants can be placed in the anterior region of an atrophic mandible for rehabilitation with fixed complete dentures.

Objetivo: apresentar o acompanhamento clínico radiográfico da reabilitação protética de um paciente com mandíbula atrófica com a instalação de implantes curtos associados a um implante de comprimento regular. Método: relato de caso de uma paciente desdentada total com mandíbula atrófica, e acompanhamento clínico radiográfico de seis anos, realizado na clínica odontológica da Universidade Federal de Piauí, Teresina, no período de fevereiro de 2011 a janeiro de 2020. Após coleta de dados sociodemográficos e registro de saúde, exames clínicos radiográficos e planejamento cirúrgico protético, foram instalados quatro implantes dentários entre os forames mentonianos. Após o período de três meses foram instalados mini pilares cônicos e uma prótese fixa aparafusada sobre os implantes que foi acompanhada a cada seis meses por um período de seis anos. Resultados: as avaliações clínicas mostraram estabilidade tecidual sem alterações peri-implantares significativas após o período de acompanhamento. Radiograficamente foi observada a manutenção sem reabsorção óssea ao redor dos implantes. A estabilidade da prótese e a ausência de complicações protéticas foram observadas clinicamente durante o período de acompanhamento. Conclusão: os implantes curtos associados a implante de comprimento regular podem ser colocados na região anterior da mandíbula atrófica para reabilitação com prótese total fixa.

Effects of the combination of Er: YAG laser and sandblasting on the shear bond strength between zirconia and resin cement

Aim: This study was conducted to determine the bond strength between zirconia ceramic and resin luting cement according to the type of surface treatment applied. Methods: Sixty zirconia cylinders measuring 4 x 4 mm were manufactured and distributed into five experimental groups and a control group (n = 10): G1 - sandblasting with 110 µm aluminum oxide; G2 - sandblasting with 30 µm Rocatec Soft®; G3 - Er:YAG laser irradiation at 400 mJ; G4 - Er:YAG laser combined with sandblasting with aluminum oxide; G5 - Er:YAG laser combined with sandblasting with Rocatec Soft®; G6 - no treatment (Control). The zirconia cylinders were bonded in the center of composite resin cylinders (6 mm diameter) using RelyX Ultimate® cement. Shear strength was measured after thermocycling (6000 cycles and 5-55° C). Data were analyzed using one-way ANOVA and Tukey's post-hoc with a 5% significance level. Results: Group 4 had a significantly higher shear strength than all the other groups, except Group 1. Group 3 had a significantly lower shear strength compared with Groups 1 and 4. Conclusion: Sandblasting with 110µm aluminum oxide particles after laser irradiation may be an effective zirconia surface treatment. The use of Er: YAG laser alone is not effective at increasing the bond between resin cement and zirconia

Percepção clínica, ética e legal de acadêmicos de Odontologia sobre gerenciamento de resíduos de serviços de saúde / Dental Students' Clinical, Ethical, and Legal Perception on Healthcare Waste Management

O objetivo desse estudo foi analisar a percepção clínica, ética e legal de acadêmicos do curso de Odontologia sobre o gerenciamento de Resíduos em Serviços de Saúde (RSS). O estudo foi do tipo observacional transversal, com amostragem censitária de acadêmicos do 8º(n=23) e 9º(n=18) períodos. No questionário aplicado abordou-se o processo de produção, manuseio e descarte dos RSS, no que concerne ao gerenciamento, legislação e questões éticas. Os dados foram organizados em planilhas e interpretados por meio de análise descritiva. Sobre as normas vigentes para o gerenciamento de RSS, 82,9% e 95,1% dos estudantes afirmaram desconhecer o tratamento/disposição final e regulamento técnico para o gerenciamento de RSS, respectivamente. Em relação ao Plano de Gerenciamento de Resíduos de Serviços de Saúde (PGRSS), 85,4% não conhecem o Código Penal e 87,8% não estão familiarizados com o Código Civil. Além de disso, a maioria dos entrevistados desconhecem as Normas da Associação Brasileira de Normas Técnicas (75,6%) e as Resoluções do Conselho Nacional do Meio Ambiente (82,9%) e da Agência Nacional de Vigilância Sanitária (95,1%). Por outro lado, 73,2% afirmam conhecer os direitos e deveres do cirurgião-dentista, presentes no Código de Ética Odontológica. Quanto à classificação dos resíduos produzidos em ambiente odontológico, 95,1% responderam corretamente sobre o hipoclorito de sódio e 97,6% sobre os roletes de algodão e gaze com sangue. Portanto, foi possível concluir que existe conhecimento satisfatório sobre os aspectos clínicos e éticos, entretanto insuficiente quanto às legislações vigentes no Brasil (AU).

The aim of this study was to analyze the dental students' clinical, ethical and legal perception on the management of health services waste (HSW). This was a cross-sectional observational study, with census sampling of students from the 8th (n=23) and 9th (n=18) terms. The applied questionnaire addressed the process of production, handling and disposal of HSW, regarding management, legislation and ethical issues. Data were organized in spreadsheets and interpreted by descriptive analysis. Regarding the current rules for the management of WHS, 82.9% and 95.1% of the students stated that they did not know the final treatment/disposition and technical regulation for HSW management, respectively. Regarding the Health Services Waste Management Plan (HSWMP), 85.4% did not know the Criminal Code and 87.8% were not familiar with the Civil Code. In addition, most respondents were unaware of the principles of the Brazilian Association of Technical Standards (75.6%) and the Resolutions of the National Environmental Council (82.9%) and the National Health Surveillance Agency (95.1%). On the other hand, 73.2% claimed to know the rights and duties of the dental surgeon, present in the Code of Dental Ethics. Regarding the classification of residues produced in a dental environment, 95.1% answered correctly about sodium hypochlorite and 97.6% about cotton and blood gauze rollers. Therefore, it was possible to conclude that there is satisfactory knowledge about the clinical and ethical aspects, however insufficient regarding the current legislation in Brazil (AU).

Conhecimento dos cirurgiões-dentistas sobre Banco de Dentes Humanos / Knowledge of dental surgeons about Human Teeth Bank

Banco de dentes humanos (BDH) é uma entidade sem fins lucrativos que tem a finalidade de recepcionar, armazenar, catalogar e manter em boa conservação dentes humanos para pesquisa e treinamento laboratorial pré-clínico de estudantes. No entanto, muitos cirurgiões-dentistas desconhecem a importância do BDH. O objetivo deste estudo foi avaliar o conhecimento dos cirurgiões-dentistas das Unidades Básicas de Saúde (UBS) do município de Teresina/PI sobre condutas diversas relacionadas aos BDHs. O presente estudo é do tipo observacional com amostragem probabilística estratificada com alocação proporcional, que utilizou entrevistas. Mais da metade dos cirurgiões-dentistas afirmaram ter conhecimento da existência de BDHs no Brasil, porém 81% desconheciam a existência do BDH da Universidade Federal do Piauí (UFPI). Todos os entrevistados foram a favor da doação e consideram o dente como um órgão, entretanto 95,2% nunca fez doação de dentes para um BDH. O lixo foi o destino mais comum após exodontias. Diante disto, foi possível concluir que não há doação de dentes humanos pelos cirurgiões-dentistas entrevistados, possivelmente, devido ao desconhecimento da existência do BDH da UFPI e suas peculiaridades (AU).

Human teeth bank (BDH) is a non-profit organization whose purpose is to receive, store, catalog and maintain human teeth for research and pre-clinical laboratory training of students. However, many dental surgeons are unaware of the importance of BDH. The objective of this study was to evaluate the knowledge of dental surgeons of the Basic Health Units of the city of Teresina/PI about their behaviors related to BDHs. We performed an observational study with probabilistic sampling stratified with proportional allocation, which used interviews. More than half of the dental surgeons reported knowing of the existence of BDHs in Brazil, but 81% were unaware of the existence of the BDH of the Federal University of Piauí (UFPI). All interviewees were in favor of the donation and considered the tooth as an organ. However, 95.2% never donated teeth to a BDH. Trash was the most common destination after exodontia. Given this, it was possible to conclude that there is no donation of human teeth by the dentists interviewed, possibly due to the lack of knowledge of the existence of the UFPI's BDH and its peculiarities (AU).

Influence of a new method of sterilization on the morphology and physical properties of extracted human teeth / Influência de um novo método de esterilização na morfologia e propriedades físicas de dentes humanos extraídos

Introduction: Sterilization methods adopted in Human Teeth Bank can promote structural changes in enamel and dentin. Thus, the ideal method should combine the antimicrobial efficacy and preservation of the substrate biomechanical properties. Aim: Evaluated the morphology and physical properties of enamel and dentin of extracted human teeth, after being submitted to different sterilization methods. Method: Sixteen extracted third molars were sectioned in the following tooth regions: mesio-distal, vestibular-lingual and at the cement enamel junction. Forty specimens were selected according to values of microhardness and roughness initials, and distributed in four experimental groups (n = 10/group): Group 1 = Autoclave 121 °C (30 minutes); Group 2 = 2.5% Sodium hypochlorite (07 days); Group 3 = 5.25% Sodium hypochlorite (07 days); Group 4= 30% Acetic Acid (7 days). After sterilization, the microhardness, roughness and morphology of enamel and dentin were evaluated. Data were analyzed by paired t-test, Wilcoxon, Kruskal-Wallis and Analysis of Variance. A significance level of 5% was adopted. Result: All sterilization methods altered the microhardness and roughness of the dentine (p <0.05). Regarding to enamel, the microhardness was affected only by Autoclave and 2.5% Sodium hypochlorite treatment (p <0.05). A large aperture of the enamel pores and dentinal tubules was verified in the micrographs. Conclusion: The sterilization methods adopted altered the morphology and/or physical properties of enamel and dentine.

Introdução: Métodos de esterilização adotados em Banco de Dentes Humanos podem promover mudanças estruturais no esmalte e na dentina. Assim, o método ideal deve combinar a eficácia antimicrobiana e a preservação das propriedades biomecânicas do substrato. Objetivo: Avaliar a morfologia e propriedades físicas do esmalte e dentina dos dentes humanos extraídos, após serem submetidos a diferentes métodos de esterilização. Método: Dezesseis terceiros molares extraídos foram seccionados nas seguintes regiões dentárias: mesio-distal, vestibulo-lingual e na junção amelocementária. Quarenta espécimes foram selecionados de acordo com valores de microdureza e rugosidade iniciais, e distribuídos em quatro grupos experimentais (n = 10 / grupo): Grupo 1 = Autoclave 121 °C (30 minutos); Grupo 2 = 2,5% de hipoclorito de sódio (07 dias); Grupo 3 = 5,25% Hipoclorito de sódio (07 dias); Grupo 4 = ácido acético a 30% (7 dias). Após a esterilização, foi avaliada a microdureza, rugosidade e morfologia do esmalte e dentina. Os dados foram analisados ​​pelo teste t pareado, Wilcoxon, Kruskal-Wallis e Análise de Variância. Um nível de significância de 5% foi adotado. Resultado: Todos os métodos de esterilização alteraram a microdureza e a rugosidade da dentina (p <0,05). Em relação ao esmalte, a microdureza foi afetada apenas pela Autoclave e pelo tratamento com 2,5% de hipoclorito de sódio (p <0,05). Foi verificada nas micrografias, uma grande abertura dos poros do esmalte e dos túbulos dentinários. Conclusão: os métodos de esterilização adotados alteraram a morfologia e / ou propriedades físicas do esmalte e da dentina.

Functional and esthetic rehabilitation of a child with amelogenesis imperfecta: a case report.

Amelogenesis imperfecta (AI) is a tooth disorder characterized by the abnormal development of the enamel in response to mutations in the genes involved in amelogenesis. The objective of this article is to present the clinical case of a child with AI in the primary dentition phase. A 4-year-old boy was presented to a clinic by his mother, who complained that her son's smile esthetics were compromised by "weak and yellow teeth." All the teeth showed yellowish discoloration as well as crumbling or missing enamel. Due to the absence of carious lesions and the presence of normal pulp in the teeth, it was decided to restore the dentition with indirect crowns of ceramic-optimized polymer, also known as ceromer. No preparations were performed on the teeth. For this patient, indirect ceromer restorations presented a good treatment option for the rehabilitation of primary teeth affected by AI.

FEA of Peri-Implant Stresses in Fixed Partial Denture Prostheses with Cantilevers.

PURPOSE: To compare stresses in the peri-implant bone produced by fixed partial prostheses with mesial and distal cantilevers, when cemented or screwed onto implants. MATERIALS AND METHODS: The experimental design consisted of four 3D models obtained by volumetric computerized tomography and analyzed using finite element analysis (FEA). Stresses were simulated in two stages. Stage 1 consisted of application of the preload. A 288 N load was applied to pillar screws of the cemented prosthesis, resulting in 389 MPa peak; 257 N was applied to the intermediate screw (multi-unit) resulting in 390 MPa peak; and 111 N was applied to the prosthesis infrastructure screw in the screwed prostheses, resulting in 390 MPa peak. In stage 2, the axial and oblique loads were applied. The axial load consisted of 50 N for molar implants and 30 N for premolar implants. The oblique load (on the buccal slope of the buccal cusp of each crown) consisted of 30 N for premolar implants and 50 N for molar implants, with a buccolingual vector at a 45° angle with the occlusal plane. The response variables were the axial and oblique stresses on the peri-implant bone, according to the following groups: group 1-models of fixed partial prostheses cemented onto implants with mesial or distal cantilevers; group 2-models of fixed partial denture screwed onto implants with mesial or distal cantilevers. Data were recorded, evaluated, and compared. RESULTS: Oblique loads produced higher peak values than axial loads, and were located at the bone crest of the implant closest to the cantilever, regardless of the prosthesis type. In the cemented prosthesis models, oblique loads produced the highest peaks in the primary implant region when compared with the screwed prosthesis models. CONCLUSION: The screwed fixed prostheses caused less stress on peri-implant bone regardless of whether the cantilever was located mesially or distally.

Effect of internal hexagonal index on removal torque and tensile removal force of different Morse taper connection abutments.

STATEMENT OF PROBLEM: The maintenance of the mechanical stability of implant-abutment connections is relevant to the clinical success of implant-supported restorations. However, the reduction in the conical area of abutments with an internal hexagonal index may result in a biomechanical disadvantage in Morse taper connections. PURPOSE: The purpose of this in vitro study was to evaluate the influence of an internal hexagonal index on the removal torque and tensile removal force of different Morse taper connection abutments submitted to thermomechanical cycling. MATERIAL AND METHODS: Forty Morse taper implants with their respective abutments were divided into 4 groups (n=10): straight abutment without index (PRNI); straight abutment with index (PRI); angled abutment without index (PANI); and angled abutment with index (PAI). Each abutment received an insertion torque of 15 Ncm, and the removal torque was recorded before and after thermomechanical cycling (106 cycles, 2 Hz, load of 130 N). After cycling, the groups were submitted to tensile testing at 0.5 mm/min under a load of 500 N until displacement of the abutment. A paired t test was performed for the intragroup analysis of removal torque before and after cycling and 2-way ANOVA followed by the Tukey Honestly Significant Difference (HSD) test was used for intergroup comparison (α=.05). RESULTS: Statistical analysis showed significant differences in intragroup removal torque values before compared with after thermomechanical cycling (P<.05). No statistically significant differences were found between the experimental groups in the removal torque of the prosthetic screw after cycling. The index factor (P=.028) was significant for tensile removal force. CONCLUSIONS: The type of abutment did not significantly influence the removal torque or tensile removal force after cycling. However, the presence of the internal hexagonal index significantly reduced the force necessary to dislodge the abutment from the implant.

Análise da eficácia antimicrobiana do ácido peracético na desinfecção de moldes de hidrocoloide irreversível / Analysis of the antimicrobial effectiveness of peracetic acid for the disinfection of irreversible hydrocolloid impressions

Introdução: Nos últimos anos, o ácido peracético tem sido utilizado na Odontologia para desinfecção de moldes de hidrocoloide irreversível. Objetivo: Avaliar a eficácia antimicrobiana do ácido peracético nas técnicas de nebulização e pulverização, em moldes de hidrocoloide irreversível. Material e método: Oitenta moldes de hemiarcos de voluntários foram distribuídos aleatoriamente em quatro grupos experimentais (n=20), com respectivos controles. Os moldes foram submetidos à desinfecção por dez minutos com ácido peracético 0,2% e hipoclorito de sódio 1%, pelos métodos de nebulização, com atmosfera de 100% de umidade relativa, e pulverização. Após desinfecção, cada molde foi imerso em solução salina e submetido à vibração ultrassônica para dispersão de possíveis microrganismos. Para análise microbiológica desta solução, foi realizada contagem de colônias que cresceram em meio de cultura estéril BHI-ágar após 24 h em estufa incubadora a 37°C. Resultado: Em todos os grupos, foi significante a diferença no número médio de colônias decorrentes da análise estatística do controle e do grupo experimental correspondente (p<0,05). Comparando-se o ácido peracético (0,2%) nos dois métodos, não houve diferença significativa (p=0,420); no entanto, comparando-se o hipoclorito de sódio (1%) nos dois métodos, a diferença foi estatisticamente significante (p=0,010). No mesmo método e com soluções diferentes, a nebulização com ácido peracético 0,2% foi mais eficaz que o hipoclorito de sódio 1% (p=0,030). Conclusão: Ácido peracético 0,2% pode ser usado para desinfecção de moldes de hidrocoloide irreversível nos métodos de pulverização e nebulização. Hipoclorito de sódio 1% mostrou ser mais eficaz quando se usou o método de pulverização.

Introduction: In recent years, peracetic acid has been used in dentistry for disinfection of irreversible hydrocolloid. Objective: To evaluate the antimicrobial effectiveness of peracetic acid using nebulization and spray techniques on irreversible hydrocolloid impressions. Material and method: 80 impressions of the hemi-arches of volunteers were randomly divided into four experimental groups (n = 20), with respective controls. The impressions were disinfected for 10 minutes with 0.2% peracetic acid and 1% sodium hypochlorite using the methods of nebulization in a 100% relative humidity atmosphere, and spraying. After disinfection, each impression was immersed in saline solution and subjected to ultrasonic vibration to disperse possible microorganisms. For the microbiological analysis of the solution, bacterial colonies, grown in sterile BHI-agar culture after 24h in an oven incubator at 37 ° C, were counted. Result: There was a statistically significant difference between the mean number of colonies of the control and each experimental group (p <0.05). There was no statistically significant difference between the two methods when using 0.2% peracetic acid (p = 0.420). However, there was a statistically significant difference between the two methods when using 1% sodium hypochlorite (p = 0.010). Nebulization with 0.2% peracetic acid was more effective than 1% sodium hypochlorite (p=0.030). Conclusion: 0.2% peracetic acid can be used for disinfection of irreversible hydrocolloid impressions using the methods of spraying or nebulization. Sodium hypochlorite (1%) proved to be more effective using the spraying method.

Conducts of disinfection, pouring and storage of irreversible hydrocolloid impressions by undergraduate students / Condutas de desinfecção, vazamento e acondicionamento de moldes de hidrocolóide irreversível por alunos de graduação

Introduction: Obtaining dental models that accurately represent the molded oral tissue requires professional attention, especially when using irreversible hydrocolloid as a molding material. Objective: To evaluate the conducts of undergraduate dental students at different internships for the disinfecting procedures, pouring, and storage of irreversible hydrocolloid impressions. Material and method: This is an observational, cross-sectional and descriptive study with a census sample of 89 students enrolled in the supervised internships I, II, III and IV. Data collection was performed using a structured questionnaire containing eight questions. Data were analyzed at the 5% significance level. Result: Most of the students (88.8%) performed the disinfection procedure, for which the most widely used method (64.6%) was the application of sodium hypochlorite 1% spray stored in a sealed container. The most common disinfection time was 10 minutes (86.1%). Students in the early internships performed better in regard to the proportion of water/plaster to be used compared with students in the final internships. At all internships, pouring and storage of the ensemble of mold and model were neglected during the setting reaction. There was a statistically significant association between the stage and the disinfection method, the ratio of water/powder and pouring of the model (p< 0.05). Conclusion: Students exhibited appropriate conduct of disinfection; however, they should be encouraged to use evidence-based clinical practices in order to improve the procedures of pouring and storage of irreversible hydrocolloid molds.

Introdução: A obtenção de modelos odontológicos que representam com precisão os tecidos moldados requer do profissional muita atenção, principalmente quando se utiliza o hidrocolóide irreversível como material de moldagem. Objetivo: Avaliar as condutas dos alunos de graduação em Odontologia em diferentes estágios sobre os procedimentos de desinfecção de moldes de hidrocolóide irreversível, vazamento e acondicionamento dos modelos odontológicos. Material e método: Trata-se de um estudo observacional, transversal e descritivo, com amostra censitária constituída por 89 alunos matriculados nos estágios supervisionados I, II, III e IV. A coleta de dados foi realizada por meio de um formulário estruturado contendo 8 questões. Os dados foram analisados com nível de significância de 5%. Resultado: A maioria dos graduandos (88,8%) realizavam o procedimento de desinfecção, sendo o método de desinfecção mais utilizado (64,6%) o spray de hipoclorito de sódio a 1% acondicionado em recipiente fechado. O tempo de desinfeção por 10 minutos foi o mais relatado (86,1%). Os alunos dos estágios iniciais apresentaram melhores condutas referente a proporção água/gesso, quando comparados com os alunos dos estágios finais. Em todos os estágios as condutas de vazamento e acondicionamento do conjunto molde e modelo durante a reação de presa foram negligenciadas. Verificou-se associação estatisticamente significativa entre o estágio cursado e o método de desinfecção, proporção água/pó e método de vazamento dos moldes (p< 0,05). Conclusão: Os alunos apresentam condutas adequadas de desinfeção, no entanto devem ser estimulados a utilizar a prática clínica baseada em evidências a fim de melhorar as condutas de vazamento e acondicionamento dos moldes de hidrocolóide irreversível.

Fracture Strength of Implant-Supported Ceramic Crowns with Customized Zirconia Abutments: Screw Retained vs. Cement Retained.

PURPOSE: To compare the fracture resistance before and after cyclic fatigue assays of ceramic crowns with customized zirconia abutments when screw retained and cemented onto implants. MATERIALS AND METHODS: The sample of this study consisted of 40 ceramic crowns with zirconia infrastructure fixed onto external hexagonal implants. The crowns were distributed into two groups (n = 20): Screw-retained and cemented crowns. Half the crowns of each group (n = 10) underwent compression until fracture and the other half (n = 10) underwent cyclic fatigue and subsequent compression until fracture. The cyclic fatigue test was carried out using an electromechanical fatigue device (loads from 0 to 100 N, 2 Hz frequency, in distilled water, at 37 °C for a period of 1 million cycles). The compression test was carried out using a universal testing machine with a 0.5 mm/min speed and 5 KN load cell. After fracture, the crowns were classified according to the type of fracture. Student's t test (p < 0.05) was used for statistical analysis. RESULTS: The cyclic fatigue altered neither the mean fracture resistance of the screw-retained crowns (before = 1068.31 N, after = 891.49 N; p > 0.05) nor that of the cemented crowns (before = 2117.78 N; after = 2094.81 N; p > 0.05); however, the mean fracture resistance of the cemented crowns was higher than that of the screw-retained crowns both before (p < 0.001) and after (p < 0.001) the cyclic fatigue. Fractures occurred most frequently in the ceramic veneer, followed by fracture of some of the copings. CONCLUSION: The ceramic crowns cemented onto the customized zirconia abutments offered greater fracture resistance than ceramic crowns with customized zirconia abutments screw retained onto implants. The cyclic fatigue did not seem to influence the fracture resistance of these crowns, whether cemented or screw retained onto implants. Fracture of the veneering ceramic was the predominant failure in this study.

Crown-root fracture with pulp exposure: a case report with 16-year follow-up.

A 12-year-old boy presented for dental care 35 days after he fell from his bicycle. Clinical and radiographic examinations revealed a longitudinal crown-root fracture with pulp exposure in the maxillary left central incisor. The radiograph also suggested necrosis of the maxillary right central incisor. Urgent treatment of the left central incisor involved gingivectomy followed by autogenous bonding of the tooth fragment with self-curing composite resin. Immediately after bonding, coronal access was prepared, chemical and mechanical preparation was completed, and a calcium hydroxide intracanal dressing was placed. One week after the initial appointment, endodontic treatment was initiated in the right central incisor. The root canal of the maxillary left central incisor was maintained with calcium hydroxide paste (replaced at 45-day intervals) for 1 year and then definitively obturated. At the 16-year follow-up, satisfactory periodontal, esthetic, and clinical conditions were observed, and a radiograph revealed no resorption or periapical changes.

Influência do laser de baixa intensidadeem sítios de instalação de implantesdentários: revisão de literatura / Influence of low-level laser on dentalimplant sites: a literature review

A terapia com laser de baixa intensidade tem sido utilizada como coadjuvante na bioestimulação do reparo ósseo. Objetivo: o objetivo desse artigo é revisar estudos que avaliaram os efeitos do laser de baixa intensidade no processo de reparo ósseo em sítios de instalação de implantes dentários. Métodos: foi realizada busca eletrônica no PubMed, periódicos CAPES e Scopus, no período de 2002 a 2013, utilizando os descritores “Laser therapy, Low-level”, “Laser phototherapy”, “Laser therapy”, “Dental implants”. Publicações estruturalmente incompletas ou que não se adequaram aos critérios de inclusão foram excluídas. Resultados: dezesseis artigos relevantes foram selecionados, quinze realizados em modelo animal e um ensaio clínico randomizado. Catorze estudos in vivo mostraram melhor cicatrização óssea nos sítios irradiados com laser de baixa intensidade. Conclusão: a terapia com laser de baixa intensidade parece acelerar o processo de reparo ósseo em sítios de instalação de implantes dentários. Apesar dos resultados promissores obtidos a partir de estudos em modelo animal, evidências científicas obtidas em estudos clínicos ainda são limitadas.

Low-level laser therapy has been used as adjuvant in biostimulation of bone repair. Objective: The aim of this paper is to review studies assessing the effects of low-levellaser therapy on the process of bone repair at dental implants sites. Methods: an electronic search of papers published between 2002 and 2013 was conducted on PubMed, Scopus and CAPES databases using the keywords “Laser therapy, Low-level”, “Phototherapy”, “Laser therapy”, and“Dental implants”. Publications structurally incomplete or not meeting the inclusion criteria were excluded. Results: Sixteen relevant articles were selected, fifteen of which were conducted in ananimal model and one randomized clinical trial. Fourteen in vivo studies showed better bone healing in sites irradiated with low-level lasers. Conclusion: Low-level laser therapy seems to acceleratethe process of bone repair at dental implant sites. Despite promising results obtained in studieswith animal models, scientific evidence from clinical trials remains limited.

Alterações dimensionais em modelos de gessos com fraturas e colagem com cianocrilato / Dimensional change in gypsum models with fractures and collage with cyanocrylate

Objetivo: avaliar a precisão dimensional de modelos de gesso tipos III e IV submetidos a diversos tipos de fraturas, seguidas de colagem com cianoacrilato. Materiais e mé-todo: a amostra foi constituída por 80 modelos de gesso obtidos a partir de moldes de silicone de adição Zetala-bor Platinum®, provenientes de um modelo mestre em aço inox, com dois pilares. Foram formados 2 grupos (n = 40): Grupo 1-Modelos de gesso tipo III e Grupo 2-Mo-delos de gesso tipo IV. Cada grupo foi subdividido em: Controle (n = 10) Modelos de gesso sem fratura; Experi-mental 1 (n = 10) Modelos de gesso colados com adesi-vo a base de cianoacrilato SuperBonder® após fratura no espaço protético, entre os dois pilares; Experimental 2 (n = 10) Modelos de gesso colados após fratura horizontal nos pilares, simulando fratura, ocorrida durante a remo-ção do modelo do molde; Experimental 3 (n = 10) Mo-delos de gesso colados após fratura simulando acidente de queda de uma bancada de laboratório. As unidades amostrais foram mensuradas com paquímetro digital. Os dados foram processados e submetidos à análise estatís-tica (teste de Shapiro-Wilk e teste t student). Resultados: os modelos de gesso fraturados e colados com cianoacri-lato exibiram alterações dimensionais lineares quando comparados aos respectivos controles. Os modelos de gesso tipo III do Grupo 1, se comportaram de forma di-ferente, quando comparados aos modelos de gesso tipo IV do mesmo grupo. Conclusão: a colagem de pilares em modelos de gesso de prótese fixa, sem padronização, põe em risco a precisão dimensional desses.

Padrão facial e indicação de cirurgia ortognática / Facial Pattern and Indication for Orthognathic Surgery

Objetivo: Classificar os indivíduos quanto ao padrão facial e às relações dentárias, associando-os à indicação de cirurgia ortognática como opção terapêutica. Métodos: Trata-se de um estudo transversal analítico no qual dois examinadores previamente calibrados avaliaram documentações ortodônticas quanto ao padrão facial, às relações dentárias e à indicação de tratamento ortodôntico cirúrgico. Foram excluídas as documentações incompletas, as pertencentes a pacientes que haviam realizado tratamento ortodôntico ou cirurgias faciais prévias, além dos que se apresentavam em fase de dentição decídua e mista. Resultados: A amostra foi composta por 841 documentações. O gênero não demonstrou qualquer influência nas demais variáveis do estudo. O Padrão I apresentou maior prevalência, seguido do II, III, Face Longa e Curta. Indicou-se cirurgia em 228 casos, sendo os Padrões III, Face Longa e Curta os de maiores taxas. A relação dentária de maior prevalência foi classe I. Houve forte tendência de relações dentárias seguirem o padrão facial, principalmente entre os indivíduos Padrão II e a classe II e entre o Padrão III e a classe III. Conclusão: O Padrão I foi o mais prevalente. Cerca de um terço dos indivíduos teve indicação de tratamento ortodôntico-cirúrgico... (AU)

Objective: Classify the subjects according to standard facial and dental relations, associating them with the indication of orthognathic surgery as a treatment option.Methods: This was a cross-sectional analytical study in which two calibrated examiners evaluated orthodontic records as the standard facial and dental relations indication of surgical orthodontic treatment.Exclusion criteria were incomplete documentation, the pertaining to patients who had undergone orthodontic treatment or previous facial surgeries, and those presented in the phase of deciduous and mixed dentition. Results : The sample comprised 841 documentation. Gender did not show any influence over other study variables. The standard I was the most prevalent, followed by II, III, Face Long and Short. Surgery was indicated in 228 cases, and standards III, Face Long and Short of the higher rates. The higher prevalence of dental relation was Class I. There was strong trend of dental relations follow the facial pattern, especially among individuals Standard II and class II and Pattern III and class III. Conclusion: The Pattern I was the most prevalent. There was a strong tendency of dental relations following the facial pattern. About one third of individuals were referred for orthodontic-surgical treatment... (AU)

Precisão dimensional de moldes de hidrocoloide irreversível manipulado com solução de clorexidina / Dimensional accuracy of irreversible hydrocolloid impressions manipulated with chlorhexidine solution

Objetivo: avaliar a precisão dimensional de modelos de gesso obtidos em moldes de hidrocoloide irreversível contendo agente antimicrobiano, manipulado com água ou solução aquosa de digluconato de clorexidina 0,2%. Materiais e método: para as medições das dimensões lineares, foram utilizados moldes de hidrocoloide irreversível de um modelo mestre de aço inox, simulando preparos de uma prótese fixa com dois pilares separados por um espaço protético. Com esses moldes, obteve-se vinte modelos de gesso designados aos grupos: controle - modelos de gesso obtidos em moldes de hidrocoloide irreversível contendo clorexidina no pó manipulado com água destilada (n = 10); experimental - modelos de gesso obtidos em moldes de hidrocoloide irreversível contendo clorexidina no pó e manipulado com solução de clorexidina em substituição à água (n = 10). As distâncias entre pilares e os diâmetros dos pilares foram mensuradas com paquímetro digital e os dados, submetidos ao teste t student. Resultado: as medições das distâncias entre pilares e do diâmetro dos pilares dos modelos do grupo experimental não resultaram em diferenças dimensionais estatisticamente significantes quando comparadas com as do grupo controle (p > 0,05). Conclusão: de acordo com os resultados deste estudo e considerando as suas limitações, pôde-se concluir que as diferenças dimensionais entre modelos de gesso obtidos com moldes de hidrocoloide irreversível manipulado com água ou com solução aquosa de digluconato de clorexidina a 0,2% não foram estatisticamente significantes.

Objective: to assess the dimensional accuracy of plaster casts obtained from irreversible hydrocolloid impressions containing anti-microbial agent, which was mixed with either water or 0.2% chlorhexidine digluconate aqueous solution. Materials and method: the linear dimensions were measured with irreversible hydrocolloid impressions of a stainless steel master cast simulating cavity preparations for a fixed prosthesis with two abutments separated by a prosthetic space. From these molds, twenty plaster casts were made and assigned to the following groups: control - plaster casts obtained from irreversible hydrocolloid impressions made with powder containing chlorhexidine, and manipulated with distilled water (n = 10); experimental - plaster casts obtained from irreversible hydrocolloid impressions made with powder containing chlorhexidine, and manipulated with chlorhexidine solution instead of water (n = 10). The distances between the abutments and their diameters were measured with a digital caliper and data were submitted to the Student's t test. Result: there were no statistically significant differences in the measurements of distances between the abutments and their diameter in the experimental group when compared to the measurements of the control group (p > 0.05). Conclusion: according to the results of this study and considering its limitations, the dimensional differences between plaster casts obtained from irreversible hydrocolloid impressions manipulated with either water or 0.2% chlorhexidine digluconate were not statistically different.

Prevalência de dentes supranumerários em pacientes atendidos no Hospital Universitário da UFPI: um estudo retrospectivo de cinco anos / Prevalence of supernumerary teeth in patients attended at the University Hospital of UFPI: a retrospective study of five years

Introdução: Variações no desenvolvimento dentário podem implicar em alterações no número de dentes, como, por exemplo, a hiperdontia, que é caracterizada pela formação de dentes em excesso, que são chamados de supranumerários. Sua ocorrência está frequentemente associada a patologias e interferências na erupção dos dentes permanentes, que podem comprometer a estética e a oclusão. Portanto, é importante descrever seu perfil epidemiológico. Objetivo:Este estudo objetivou analisar dados epidemiológicos, em prontuários, avaliando a prevalência dos dentes supranumerários. Material e Método: A amostra constituiu-se de 1511 prontuários de pacientes atendidos no Hospital Universitário da Universidade Federal do Piauí, entre janeiro de 2006 e janeiro de 2011, observando-se a prevalência dos dentes supranumerários segundo número de pacientes, gênero, faixa etária, cor da pele, localização, posição no arco dentário, tipo e tratamento. Resultado: A prevalência dos dentes supranumerários foi de 1,99%, ocorrendo em pacientes de cor parda (78,57%), com dentição permanente (86,96%), do gênero masculino (53,33%), localizados em região posterior de maxila (35%) e mandíbula (35%), e do tipo paramolar (38,10%). A maioria das cirurgias foi realizada por indicação ortodôntica (62,96% dos casos). Conclusão: De acordo com os resultados, a presença de dentes supranumerários foi um achado incomum com predominância pela maxila, sendo o tipo paramolar o mais frequente. Todos os casos foram tratados por remoção cirúrgica, sendo a maioria por indicação ortodôntica.

Introduction: Variations in tooth development may result in changes in the number of teeth, for example, hyperdontia, which is characterized by the formation of teeth in excess, that is called supernumerary. Its occurrence is frequently associated to pathologies and interferences in the eruption of permanent teeth which can implicate the esthetics and occlusion. So, it is important to describe its epidemiological profile. Objective: This study aimed to analyze epidemiological data in medical records, assessing the prevalence of supernumerary teeth. Material and method:The sample consisted in 1511 records of patients treated at the Hospital of Federal University of Piauí, between January 2006 and January 2011, noting the prevalence of supernumerary teeth in number of patients, gender, age, ethnicity, location, position in the dental arch, type and treatment. Result: The prevalence of supernumerary teeth was 1.99%, occurring in patients of mixed ethnicity (78.57%), with permanent dentition (86,96%), male (53.33%), located in the posterior maxilla (35%) and mandible (35%), and the paramolar type (38,10%). The majority of the surgeries were performed by indication orthodontic (62.96% of cases). Conclusion: According to the results, the presence of supernumerary teeth was an uncommon finding with predominance for the maxilla and the paramolar type the most common. All patients were treated by surgical removal and the majority by orthodontic indication.

Autogenous bonding of lower incisors: case report and 17-year follow-up.

Among injuries that affect permanent teeth, the most prevalent is an uncomplicated crown fracture. Currently, autogenous bonding of the fragments is still the procedure of choice to restore fractured anterior teeth if the fragments are recovered by the patient and taken to a dental office within a reasonable time in an appropriate storage medium. There is no study or case report in the literature regarding autogenous bonding of lower incisors. This study presents a case with a 17-year follow-up for a 9-year-old patient who underwent uncomplicated crown fractures of the permanent mandibular central incisors and was treated by autogenous bonding of the tooth fragments. After 17 years, clinical and radiographic dental elements present vitality, and the restorations remain without major cosmetic changes. This case shows that autogenous bonding can be considered as a treatment option in the management of fractured lower incisors.

Reabilitação total do arco superior com implantes e prótese cerâmica de infraestrutura em zircônia - Relato de caso clínico / Full upper arch rehabilitation using implants and a ceramic prosthesis with a zirconia infrastructure - Case report

A estética é exigência crescente dos pacientes que procuram tratamentos com próteses implantossuportadas, o que tem levado ao desenvolvimento de sistemas cerâmicos com infraestrutura em zircônia como alternativa aos metais. O principal diferencial oferecido pelos sistemas cerâmicos sem metal está em se aproximar da dentição natural no que diz respeito à passagem da luz. Sendo assim, os autores relatam um caso clínico de reabilitação oral de um paciente de 60 anos com implantes imediatos e prótese fixa total no arco superior em cerâmica com infraestrutura de zircônia, confeccionada após remoção de dentes remanescentes que apresentavam suporte ósseo comprometido por perda óssea horizontal acentuada e generalizada. As exodontias foram seguidas de instalação de implantes com temporização imediata e posterior fixação de prótese preliminar. As diversas etapas docaso clínico foram descritas e ilustradas. É possível, com o acompanhamento do referido caso, avaliar a sobrevida em próteses fixas sobre implantes, determinada pela longevidadedos materiais utilizados e possíveis causas de falhas coesivas das porcelanas de cobertura presentes nos sistemas à base de zircônia. A impossibilidade de solda na infraestrutura de zircônia e também seu alto custo, constituem-se desvantagens, entretanto, o excelenteresultado na estética, o conforto e a fácil higienização desse tipo de prótese, resultaram em vantagens e satisfação para o paciente e o profissional.

Patients are becoming ever more demanding regarding aesthetics when they seek treatments with implant-support prostheses, which has led to the development of ceramic systemswith zirconia infrastructure as an alternative to metals. The main advantage offered by the metal-free ceramic systems is that they are more similar to natural dentition withregard to the light transmition. Thus, the authors report a case of oral rehabilitation of a 60 year-old patient with immediate implants and complete ceramic fixed prosthesis in the upper arch with zirconia infrastructure, made after removal of remaining teeth thathad compromised bone support due to severe and widespread horizontal bone loss. The extractions were followed by implant placement with immediate provisional restorations and later fixation of the preliminary prosthesis. The various stages of the clinical case were described and illustrated. It is possible, with the follow-up consultations of this case, to assess the survival in fixed prostheses on implants, which is determined by the longevityof the materials used and possible causes of cohesive failures in porcelain coverage to which zirconia-based systems are susceptible. The impossibility to joint onto a zirconiainfrastructure and its high cost are disadvantages, however, the excellent aesthetic result, comfort and ease of cleaning this type of prosthesis, result in benefits and satisfaction for both patient and professional.

Dimensional accuracy of stone casts obtained with multiple pours into the same mold.

Aim. The aim of the present study was to compare the dimensional accuracy of stone casts obtained with vinyl polysiloxane molds through the double-impression technique with three pours into the same mold. Methods. A stainless steel master model was constructed simulating a three-unit fixed prosthesis. Twelve impressions were taken of this master model with addition silicone, using the double-impression technique. Three pours of type IV gypsum were then made into each mold, thus producing 36 casts. The pours were made 1 hour, 6 hours and 24 hours after the impression procedure. Next, intra- and interabutment measurements were made in a coordinate measuring machine. Results. Comparative analysis of the dimensional accuracy of stone casts resulting from multiple pours was not statistically significant in pours first and second (P > 0.05). These values, however, were statistically significant at third pour in the height in abutment 1 and upper distance interabutment. Conclusion. The wait time (1 hour, and 6 hours) observed before pouring the stone into the same molds did not cause significant dimensional accuracy of the casts.