Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: A randomized controlled clinical trial with a minimum follow-up of 7 years.

STATEMENT OF PROBLEM: Long-term clinical studies are lacking on the influence of the type of abutment, titanium or zirconia, on peri-implant tissues. PURPOSE: The purpose of this randomized clinical trial was to evaluate peri-implant tissues with titanium or zirconia abutments. MATERIAL AND METHODS: A total of 26 single-tooth implant-supported prostheses in 14 participants were analyzed. They received either a titanium abutment with a metal-ceramic crown (TAG) or a zirconia abutment with a ceramic crown (ZAG). Data were collected immediately, at 5 months, and at a minimum of 7 years after crown delivery. The success rate, plaque and bleeding indexes, bleeding on probing, white and pink esthetic scores, and the relationships of the gingival phenotype with the pink esthetic score were analyzed. Statistical analyses were conducted with the t test for paired and independent data (α=.05). RESULTS: The mean follow-up time was 95.2 ±2.6 months, showing an implant success rate of 96.7%. No statistically significant differences were found between TAG and ZAG among the time intervals evaluated for plaque or bleeding indexes (P>.05). A statistically significant difference was found for peri-implant probing depths in the mid-buccal sites between the groups at all the time intervals evaluated (TAG, P=.008; ZAG, P=.021): TAG showed an increase between 5 months (3.65 ±0.93 mm) and over 7 years (4.47 ±1.32 mm); and ZAG showed a reduction (5 months=5.22 ±1.71 mm; over 7 years=4.25 ±1.28 mm) in values. For the pink (PES) and white esthetic score (WES), ZAG (PES: immediately=6.33 ±1.41; 5 months=7.44 ±1.81; over 7 years=8.25 ±1.03; WES: immediately=7.67 ±1.50; over 7 years=8.38 ±0.74) showed higher mean values than TAG (PES: immediately=5.94 ±2.35; 5 months=6.53 ±2.15; over 7 years=7.44 ±1.81; WES: immediately=7.00 ±1.17; over 7 years=8.35 ±1.27) (P<.05). Statistically significant differences were found for gingival phenotype and for PES in TAG (P=.031), and the participants with thick phenotype showed higher PES in the 3 time intervals studied. CONCLUSIONS: Zirconia abutments exhibited better results than titanium abutments in terms of the peri-implant tissues. Moreover, in those with a thin phenotype, zirconia provided improved gingival esthetics.

Percepção dos acadêmicos de Odontologia em relação ao teste de progresso / Perception of Dental students with regard to Progress Tests

Este estudo teve como objetivo analisar a percepção dos acadêmicos de Odontologia em relação aoTeste de Progresso (TP). Após o término do TP, os 284 estudantes do cursoreceberam um questionário, que abordava a percepção do grau de dificuldade do teste na área básica e específica; a extensão da prova; clareza e objetividade dos enunciados; adequação das informações/instruções fornecidas para a resolução das questões; confirmação da abordagem dos conteúdos durante o curso; estudo dos conteúdos pelos estudantes e avaliação do tempo ofertado e utilizado pelos estudantes na resolução das questões. Empregou-se o coeficiente de correlação de Spearmane análise de correspondência. Desta forma, observou-se que o grau de dificuldade da prova na área básica e na área específica foi maior nos primeiros períodos e quanto à percepção do estudante em relação à extensão da prova, a maioria considerou adequada, bem como a clareza e objetividade do teste. Quanto à dificuldade na realização do teste, os primeiros períodos relataram o desconhecimento de todo o conteúdo e para os últimos períodos, houve falta de motivação. Amaioria dos estudantes respondeu que utilizou entreuma e duas horaspara realizar o teste. Conclui-seque a percepção dos acadêmicos demonstra que o TP está sendo realizado de forma adequada. Observou-se ainda que os períodos iniciais relataram desconhecimento do conteúdo,o que corrobora com o objetivo do teste,que é avaliar o ganho cognitivo dos estudantes àmedida que avançamno curso (AU).

This study aimed to analyze the perception of students of the Dentistry of Progress Test (TP) 2014. Therefore, after completion of the TP, 284 students received a questionnaire, which addressed the perception of the degree of difficulty of the test in the basic and specific areas; the extent of the test; clarity and objectivity of statements; adequacy of the information / instructions provided to resolve the issues; confirmation of the content approach during the course; study of the contents by the students and evaluation of the time offered and used by the students to solve the questions. Spearman's correlation coefficient and correspondence analysis (SPSS-15 ©) were used. Thus, it was observed that the degree of difficulty of the test in the basic area and in the specific area was higher for the students of the first periods.With regard tothestudents'perception of extentof the test, the majorityconsideredthis,as well as the clarity and objectivity of the testto be adequate. Regarding the difficulty in performing the test, the students in the first periods reported ignorance of all content;and for the last periods, theyreporteda lack of motivation. Based on the results obtained, it couldbe concluded that thestudents'perception of the test demonstratedthat it was being performed properly. Moreover, students in theinitial periodswere observed toreport a lack of knowledge about the content, thuscorroboratingthe objective of the test, which is to evaluate the cognitive gain of students as theyprogressedin the course (AU).

Objective structured clinical examination, OSCEs: an advance in the teaching and learning process in the student's perception / Exame clínico objetivo estruturado, OSCE: um avanço no processo de ensino e aprendizagem sob a percepção do estudante

Abstract Introduction The OSCE is a method of clinical competencies evaluation that has gained international popularity in medical and dental education. Objective The purpose of the present study was to describe the stages of development of the OSCE for the undergraduate course in Dentistry and to report the students' perception about this method of evaluation, regarding the degree of difficulty, time for each stage, importance of each station, number of stations, organization of the exam, as well as the total time for the OSCE. Material and method This research was an observational and cross-sectional study, composed of the carry out of an OSCE and later application of an evaluative questionnaire to the students who were in the fourth semester of the Dentistry course. These students had basic knowledge and an intermediate level of competences, compatible with their stage of education. Result As regards the number of stations, 43(97.7%) of the students responded that this was appropriate, OSCE process as a whole was very well organized (n=25; 56.8%), organized (n=17; 38.6%) or not very organized (n=1; 2.27%) and about the total time of the OSCE process, 29(65.9%) reported that it was appropriate; 10 (2.27%) said that it was short; 4 (9.09%), that it was long. Conclusion The student's perception was positive especially regarding to organization and the time attributed to each station. Furthermore, the students considered that the topics and questions applied in each station were relevant.

Resumo Introdução O OSCE é um método de avaliação de competências clínicas que tem obtido popularidade internacional na educação em Medicina e Odontologia. Objetivo O objetivo do presente estudo foi descrever as etapas de desenvolvimento do OSCE para o curso de graduação em Odontologia e relatar a percepção dos estudantes sobre este método de avaliação, em relação ao grau de dificuldade, tempo para realização de cada etapa, importância de cada estação, número de estações, organização do exame, bem como o tempo total para a realização do OSCE. Material e método Esta pesquisa foi um estudo observacional e transversal, composto pela realização do OSCE e posterior aplicação de um questionário avaliativo aos alunos que cursavam o quarto semestre do curso de Odontologia. Esses alunos possuíam conhecimentos básicos em um nível intermediário de competências, compatíveis com sua etapa de ensino. Resultado No que diz respeito ao número de estações, 43 (97,7%) dos estudantes responderam que era apropriado, o processo da OSCE como um todo estava muito bem organizado (n = 25; 56,8%), organizado (n = 17; 38,6%) ou não muito organizado (n = 1; 2,27%) e sobre o tempo total do processo do OSCE, 29 (65,9%) relataram que era apropriado; 10 (2,27%) disseram que foi curto; 4 (9,09%), que foi longo. Conclusão A percepção do aluno foi positiva, especialmente em relação à organização e ao tempo atribuído a cada estação. Além disso, os alunos consideraram que os tópicos e questões aplicados em cada estação eram relevantes.

Uma atualização sobre biomateriais em implantodontia / Biomaterials in Implantology: an update

O processo alveolar é uma estrutura dente dependente que sofre alterações dimensionais após a exodontia. Defeitos ósseos resultantes prejudicam a colocação de implantes e o sucesso em longo prazo. Diversas técnicas cirúrgicas e biomateriais tem sido apresentados como opções terapêuticas para preservação e recuperação dos rebordos edêntulos. Assim, o objetivo desta revisão narrativa é evidenciar o estado atual dos biomateriais disponíveis bem como as possíveis perspectivas futuras. A utilização de biomateriais para cirurgias de reconstrução e manutenção de rebordo alveolar com sucesso é evidente. As cirurgias de reconstrução e preservação de rebordo alveolar com a utilização de novos biomateriais apresentam sucesso evidente. A impressão em 3D de estruturas biocompatíveis, fatores de crescimento, a matriz de dentina desmineralizada (DDM), parafusos e membranas reabsorvíveis podem ser as perspectivas futuras.

The alveolar bone depends on the presence of teeth and dimensional changes occurs after tooth extraction. The resulting bone defects impair both implant installation and long term success. Surgical procedures and biomaterials are considered as treatment options for maintenance and recovery of edentulous ridge. Thus, the aim of this narrative review is to present the current biomaterials as well as future perspectives. Surgical procedures for alveolar ridge preservation and reconstruction with new biomaterials are successful. 3D-Printed biocompatible scaffolds, growth factors, decellularized extracellular matrix (dECM), resorbable pins and membranes could be the future perspectives.

Three-dimensional analysis of impacted maxillary third molars: A cone-beam computed tomographic study of the position and depth of impaction.

PURPOSE: The classification of impacted maxillary third molars (IMTMs) facilitates interdisciplinary communication and helps estimate the degree of surgical difficulty. Thus, this study aimed to develop a 3-dimensional classification of the position and depth of impaction of IMTMs and to estimate their prevalence with respect to gender and age. MATERIALS AND METHODS: This cross-sectional retrospective study analyzed images in sagittal and coronal cone-beam computed tomography (CBCT) sections of 300 maxillary third molars. The proposed classification was based on 3 criteria: buccolingual position (buccal, lingual, or central), mesial-distal position (mesioangular, vertical, or distoangular), and depth of impaction (low, medium, or high). CBCT images of IMTMs were classified, and the associations of the classifications with gender and age were examined using analysis of variance with the Scheffé post-hoc test. To determine the associations among the 3 classifications, the chi-square test was used (P<.05). RESULTS: No significant association of the classifications with gender was observed. Age showed a significant relationship with depth of impaction (P=.0001) and mesial-distal position (P=.005). The most common positions were buccal (n=222), vertical (n=184), and low (n=124). Significant associations among the 3 tested classifications were observed. CONCLUSION: CBCT enabled the evaluation of IMTMs in a 3-dimensional format, and we developed a proposal for a new classification of the position and depth of impaction of IMTMs.

Zirconia Abutment Supporting All Ceramic Crowns in the Esthetic Zone: Interim Results of a Prospective Study.

AIM: This prospective study evaluated peri-implant tissues around all-ceramic crowns fabricated using CAD/CAM technology. MATERIAL AND METHODS: Twenty-five patients received pre-fabricated zirconia implant abutments with CAD/CAM zirconia copings in the esthetic zone. Implants were evaluated at baseline, and at 3 and 6 months in function. RESULTS: Radiographic analyzes showed stable bone crest around the implants. Esthetics were more favorable as time lapsed (p > 0.05). Bleeding Index was constant in all time intervals. Plaque index reduced from 3 to 6 months. CONCLUSION: The all-ceramic CAD/CAM crowns were clinically, radiographically and esthetically stable during the study period.

Development of estimation models of bone height considering the potential presence of anterior extension of the mandibular canal.

PURPOSE: To evaluate the presence of the anterior extension (AE) of the mandibular canal and to measure the bone height (BH) at different points along the extension. MATERIALS AND METHODS: Cone-beam computed tomography examinations of 108 patients were bilaterally evaluated regarding the presence of the AE, and linear measurements of the AE and BH were obtained. For comparisons between sides and genders, Student t test was applied. Variations in BH measurements were assessed by a 2-way analysis of variance. Through a simple linear regression analysis, formulas were determined for calculations of the BH in the AE. RESULTS: A right AE was detected in 76.9% and left AE in 77.8% of the samples. In the majority of the cases, the extension was of the rectilinear type. The mean length of the AE was 8.5 mm, and there was no statistically significant difference observed in relation to gender or side. It was observed that the BH increases as it approaches the midline. CONCLUSION: The AE of the mandibular canal must be evaluated during presurgical planning. The formulae presented in this study provide a method to calculate BH values in the interforaminal region and can be used to assist in presurgical planning, especially in the cases in which the identification of the hipodense site, which corresponds to the AE, is not evident.

An alternative approach for augmenting the anterior maxilla using autogenous free gingival bone graft for implant retained prosthesis.

Numerous factors may keep surgeons from placing implants in the anterior maxilla in order to avoid suboptimal restorative outcomes. This paper describes a technique of an autogenous-free gingival-bone block graft, which allows bone and gingival augmentation and a primary seal to be achieved simultaneously. Additionally, it describes a technique for achieving primary soft tissue closure of maxillary extraction sockets using a rotated pedicle palatal connective tissue flap.

Resistance of three implant-abutment interfaces to fatigue testing

The design and retentive properties of implant-abutment connectors affect the mechanical resistance of implants. A number of studies have been carried out to compare the efficacy of connecting mechanisms between abutment and fixture. Objectives: The aims of this study were: 1) to compare 3 implant-abutment interfaces (external hexagon, internal hexagon and cone-in-cone) regarding the fatigue resistance of the prosthetic screw, 2) to evaluate the corresponding mode of failure, and 3) to compare the results of this study with data obtained in previous studies on Nobel Biocare and Straumann connectors. Materials and METHODS: In order to duplicate the alternating and multivectorial intraoral loading pattern, the specimens were submitted to the rotating cantilever beam test. The implants, abutments and restoration analogs were spun around their longitudinal axes while a perpendicular force was applied to the external end. The objective was to determine the force level at which 50 percent of the specimens survived 10(6) load cycles. The mean force levels at which 50 percent failed and the corresponding 95 percent confidence intervals were determined using the staircase procedure. RESULTS: The external hexagon interface presented better than the cone-in-cone and internal hexagon interfaces. There was no significant difference between the cone-in-cone and internal hex interfaces. Conclusion: Although internal connections present a more favorable design, this study did not show any advantage in terms of strength. The external hexagon connector used in this study yielded similar results to those obtained in a previous study with Nobel Biocare and Straumann systems. However, the internal connections (cone-in-cone and internal hexagon) were mechanically inferior compared to previous results.

Resistance of three implant-abutment interfaces to fatigue testing.

UNLABELLED: The design and retentive properties of implant-abutment connectors affect the mechanical resistance of implants. A number of studies have been carried out to compare the efficacy of connecting mechanisms between abutment and fixture. OBJECTIVES: The aims of this study were: 1) to compare 3 implant-abutment interfaces (external hexagon, internal hexagon and cone-in-cone) regarding the fatigue resistance of the prosthetic screw, 2) to evaluate the corresponding mode of failure, and 3) to compare the results of this study with data obtained in previous studies on Nobel Biocare and Straumann connectors. MATERIALS AND METHODS: In order to duplicate the alternating and multivectorial intraoral loading pattern, the specimens were submitted to the rotating cantilever beam test. The implants, abutments and restoration analogs were spun around their longitudinal axes while a perpendicular force was applied to the external end. The objective was to determine the force level at which 50% of the specimens survived 10(6) load cycles. The mean force levels at which 50% failed and the corresponding 95% confidence intervals were determined using the staircase procedure. RESULTS: The external hexagon interface presented better than the cone-in-cone and internal hexagon interfaces. There was no significant difference between the cone-in-cone and internal hex interfaces. CONCLUSION: Although internal connections present a more favorable design, this study did not show any advantage in terms of strength. The external hexagon connector used in this study yielded similar results to those obtained in a previous study with Nobel Biocare and Straumann systems. However, the internal connections (cone-in-cone and internal hexagon) were mechanically inferior compared to previous results.

Efeito Cluster em implantes dentários / Cluster effect on dental implants

O objetivo desta revisão fundamentou-se em pesquisar o efeito do efeito cluster em implantes dentários osseointegráveis visando obter informações clínicas e científicas sobre este fenômeno. Implantes dentais osseointegráveis têm demonstrado uma ascensão em sua utilização clínica nos últimos anos. Trata-se de uma opção para reabilitar pacientes que apresentam dentes ausentes, considerando os aspectos funcionais e estéticos. Altos índices de falha de implantes dentais parecem estar concentrados em grupos específicos de indivíduos, sugerindo que a resposta do hospedeiro pode modular o sucesso dos implantes. A concentração das perdas de implantes, denominada clusterização, pode indicar uma resposta imunoinflamatória do hospedeiro. Falhas relacionadas aos implantes dentais é um traço complexo que pode envolver vários fatores etiológicos. O conhecimento da etiologia e de fatores associados à falha de implantes pode ajudar no reconhecimento nos pacientes de risco e auxiliar o desenvolvimento de um tratamento adequado em conjunto com estratégias de prevenção

This review was based on research the effect of cluster effects in osseointegrated dental implants in order to obtain clinical and scientific information about this phenomenon. Osseointegrated dental implants have shown a rise in its clinical use in recent years. This is an option to rehabilitate patients with missing teeth, considering the functional and aesthetic aspects. High rates of failures of dental implants seem to be concentrated in specific groups of individuals, suggesting that the host response may modulate the success of implants. The concentration of lost implants, called clustering, may indicate a host immunoinflammatory response. A failure related to dental implants is a complex trait that can involve multiple etiological factors. The knowledge of the etiology and factors associated with implant failure can help us in recognizing patients at risk and help develop an appropriate treatment in conjunction with strategic prevention

Implantodontia estética na região anterior da maxila - pilar metálico ou cerâmico? Uma revisão de literatura / Aesthetics implantology in maxillary anterior region - metallic or ceramic abutment? A review

Atualmente a exigência estética é predominante na odontologia inclusive na implantodontia. Este fato tem levado ao desenvolvimento de novas técnicas e materiais. Os pilares cerâmicos surgem como uma alternativa concreta nas reabilitações protéticas em regiões onde a estética é essencial. O objetivo desta revisão de literatura é avaliar e comparar as indicações, propriedades mecânicas, biocompatibilidade, adaptação e longevidade clínica dos pilares estéticos e metálicos. Os resultados deste estudo mostraram que os pilares metálicos ainda são os mais indicados na grande maioria dos casos protéticos, sem comprometimento da estética e da função, com exceção nos casos de linha de sorriso alto com gengiva delgada e/ou recessões

Currently the aesthetic is predominant in dentistry, even in implantology. This fact has led to development of new techniques and materials. Ceramics abutment appears to be a viable alternative in prosthetic rehabilitations in esthetic regions where the esthectic is important. The purpose of this review is to evaluate and compare the indications, mechanical properties, biocompatibility, adaptation and clinical performance of aesthetic and metal abutments. The results of this study showed that the metal abutments are the most suitable in most cases prosthetic, without compromising the aesthetics and function, except in cases of high smile line with thin gingival thin and / or recessions

Dental implant rehabilitation of a patient with down syndrome: a case report.

Implant-supported rehabilitations show higher patient satisfaction when compared with conventional prostheses. Systemic conditions, however, can affect treatment planning of dental implant supported rehabilitations. The oral structures that are commonly affected in patients with Down syndrome include the tongue (macroglossia), teeth (number and shape), and poor quality alveolar and jaw bones (osteoporotic-like). This clinical case presents an interdisciplinary team approach aimed at achieving functional, phonetic, and esthetic outcomes in a patient with Down syndrome.

Levantamento do seio maxilar em fumantes: revisão de literatura / Maxillary sinus lifting in smokers: review of literature

O sucesso dos implantes osseointegrados está diretamente relacionado com a correta seleção do paciente para este tipo de tratamento, devendo ser observadas as indicações e contra-indicações de cada caso. Em situações onde o rebordo ósseo maxilar apresenta-se com pouca qualidade e/ou quantidade óssea, cirurgias adicionais como a elevação do seio maxilar podem ser necessárias. O tabagismo é considerado uma contra-indicação para a cirurgia de levantamento do seio maxilar, pois os componentes tóxicos do fumo interferem nos processos de cicatrização e osseointegração. Alterações causadas pelo fumo incluem a diminuição do suprimento sanguíneo através da vasoconstricção e aumento da adesividade plaquetária, inibição da síntese de fibroblastos, alteração da atividade osteoblástica, entre outros. Como a literatura demonstra índices de sucesso dos implantes realizados em área de enxerto maxilar nos pacientes fumantes, inferiores àqueles observados nos pacientes que não tem o hábito de fumar, deve-se considerar a possibilidade de alertar o paciente para a cessação do hábito antes da realização da cirurgia para que o risco de insucesso seja minimizado

The success of dental implants is directly related to proper patient selection for this type of treatment should be observed indications and contraindications of each case. In situations where the jaw bone edge is presented with poor quality and/or quantity of bone, additional surgeries as the elevation of the maxillary sinus may be necessary. Smoking is considered a contraindication for surgery of maxillary sinus, because the toxic components of smoke interfere with wound healing and osseointegration. Alterations caused by smoking include reduced blood supply by vasoconstriction and increased platelet adhesion, inhibition of fibroblasts, alteration of osteoblastic activity, among others. As the literature shows success rates of implants in the jaw area of the graft in smokers, lower than those observed in patients who do not have the habit of smoking, should consider the possibility of alerting the patient to stop smoking prior to surgery so that the risk of failure is minimized

Acompanhamento de dois anos de caso clínico realizado sobreimplante com interface cônica e hexagonal externa / A clinical report on the 2-year follow-up of implants with internal conical and external hex type systems

A possibilidade de se eliminar a reabsorção óssea pós-operatória ao redor dos implantes constitui um fator essencial na estabilização da papila. O objetivo deste relato clínico foi comparar a perda óssea e o resultado estético de dois diferentes sistemas de implantes após dois anos em função e, também, observar as complicações ocorridas durante este período. Uma situação clínica foi descrita onde dois implantes foram inseridos com o objetivo de substituir os dentes 12 e 22, respectivamente: um implante com interface do tipo cônica (Ankylos, Friadent, Alemanha) e um com interface do tipo hexágono externo (Conexão Sistema de Próteses, São Paulo). A redução ou eliminação da perda óssea na região da crista óssea pode resultar em significantes benefícios estéticos e clínicos. No acompanhamento descrito neste artigo, a comparação entre a perda óssea associada a cada implante mostrou que a diferença entre os níveis ósseos desde a segunda fase cirúrgica até dois anos de função, para ambos os sistemas, não são significativas ao ponto de comprometer o sucesso estético das próteses unitárias.

The avoidance of postoperative bone resorption around an implant collar constitutes a vital factor in papillary stabilization. The aim of this clinical trial was to evaluate the comparative bone loss and esthetic outcome of two different systems of implant after two years in function and also to observe any complications occurring during this period. A specific clinical situation is described in which two implants were placed substituting for missing teeth 12 and 22 respectively: a morse taper connection type implant (Ankylos, Friadent, Germany) and an external hex connection type implant (Conexão Sistemas de Prótese, Brazil). Reducing or eliminating crestal bone loss can result in significant esthetic and clinical benefits. In the follow-up described in this report, comparing the bone loss associated with each implant showed that the difference between bone levels from the second stage surgery to 2 years of function for both systems are not significant in such a way to compromise the aesthetic success in single implant prosthesis.

Comparative analyses of the rotational freedom of UCLA-typeabutments before and after casting with cobalt-chromium alloy andafter application of porcelain / Análise comparativa da liberdade rotacional de pilares protéticos dehexágono externo e interno em três estágios: inicial, após a fundição eapós a aplicação da porcelana

Screw loosening is a common occurrence in implant-retained prosthesis. One of the causes of the high frequency of screw loosening is greater rotational freedom in the implant/abutment interface. The aim of this study was to assess the influence of various laboratory steps on the rotational freedom at the implant/abutment interface and to point out a new methodology to measure the rotational freedom. Cobalt-chromium metal base UCLA-type abutments were divided into two groups: group A (10 abutments for the internal hex implants) and group B (9 abutments for the external hex implants). The rotational freedom was analyzed under three conditions: in the original state, after casting with cobalt-chromium alloy (Degudent, Guarulhos, São Paulo, Brazil) and finally, after porcelain OMEGA 900 (Vita Zahnfabrik H. Raulter GmbH & Co. KG, Germany) application. The rotational freedom values for group B did not show variance between the intervals (with a mean value of 3.333º before casting; 3.089º after casting and, 3.044º after coating with porcelain). In group A, the values increased significantly after coating with porcelain. Only the porcelain application step influenced the interface passivity, and a new device that was developed in this study to assess the rotational freedom between the implant and abutment may be effective and applicable in further studies.

O afrouxamento de parafusos é uma ocorrência bastante comum na prótese sobre implantes. Uma das causas desta freqüência elevada de afrouxamento de parafuso é a presença de uma maior liberdade rotacional na interface implante/pilar. O objetivo deste estudo foi avaliar a influência das diversas fases laboratoriais sobre a liberdade rotacional na interface implante/pilar e, ainda estabelecer uma nova metodologia para medir a liberdade rotacional. Pilares do tipo UCLA com cinta metálica em cromo-cobalto foram divididos em dois grupos: grupo A (10 pilares para implantes de hexágono interno) e grupo B (9 pilares para implantes de hexágono externo). Foi realizada a avaliação da liberdade rotacional em três fases: estágio inicial, após a fundição em liga cobalto-cromo (Degudent, Guarulhos, São Paulo, Brasil) e, finalmente, após a aplicação da porcelana OMEGA 900 (Vita Zahnfabrik H. Raulter GmbH & Co. KG, Alemanha).Os valores da liberdade rotacional para o grupo B não variaram significativamente entre os períodos (com média antes de fundir de 3,333º; após a fundição de 3,089º e após a aplicação da porcelana de 3,044º). No grupo A, os valores aumentaram significativamente após a aplicação da porcelana. Somente o procedimento da aplicação da porcelana influenciou a passividade da interface (grupo A) e o novo instrumento desenvolvido neste estudo para avaliação da liberdade rotacional entre o implante e o pilar pode ser um método eficiente que pode ser usado em futuros trabalhos.

Provisionalização imediata de implante anterior unitário e posterior associação a enxerto de tecido conjuntivo subepitelial: relato de caso clínico / Immediate provisionalization of maxillary anterior single implant and posterior association to a connective tissue autograft: clinical case report

A substituição e restauração de dentes ausentes com implantes dentais têm se tornado um procedimento rotineiro. Os autores descrevem uma situação clínica onde um implante (interface do tipo hexágono interno-Conexão Sistemas de Prótese, Brasil) foi colocado imediatamente após a exodontia do dente 62 e realizada a provisionalização imediata. Após 8 meses, foi associado um enxerto de tecido mole devido à presença de um tecido extremamente fino na região vestibular. Substituição unitária e posterior associação a enxerto de tecido conjuntivo demonstraram ser um procedimento seguro. Além disso, este tratamento pode ser considerado com o objetivo de se obter uma restauração com excelência funcional e estética

The replacement and restoration of missing single teeth with dental implants are routine procedures. The authors describe a clinical situation where an implant (internal hex connection type implant – Conexão Sistemas de Prótese, Brasil) was placed and immediately provisionalized after the removal of teeth 62. After 8 months, is was associated to a soft tissue graft due to an extremely thin tissue in the buccal region. Single-tooth replacement by immediate implant and posterior association to a connective tissue autograft was demonstrated to be a predictable procedure. Moreover, this treatment can be considered in order to reach an excellent functional and harmonious aesthetic restoration

Provisionalização imediata na região anterior: protocolo clínico para implantes Cone-Morse / Immediate placement and provisionalization of maxillary anterior single implant: clinical protocol to Morse Taper implants

A popularidade dos implantes dentais tem aumentado nas substituições unitárias estéticas. Extração, colocação imediata do implante e restauração podem ser benéficos na manutenção da integridade dos alvéolos e contribuir para manutenção da papila interdental ao redor das próteses sobreimplantes. Este artigo descreve um protocolo clínico onde obtém-se uma resposta tecidual periimplantar e estética favoráveis através da colocação de implante imediato tipo Cone-Morse e provisionalização de dentes anteriores superiores.