Antibiotics prescribing habits of Brazilian general dental practitioners during periodontal treatments / Hábitos de prescrição de antibióticos de dentistas brasileiros durante tratamentos periodontais

Introdução: O tratamento periodontal envolve procedimentos que visam reduzir a carga bacteriana, envolvendo ou não o uso de antibióticos locais ou sistêmicos. Objetivo: O objetivo deste estudo foi avaliar o conhecimento dos cirurgiões-dentistas brasileiros sobre a prescrição de antibióticos durante o tratamento periodontal. Material e método: Foi disponibilizado um questionário online solicitando aplicação sistêmica de prescrição de antibióticos locais ou sistêmicos (frequência e sequência com tratamento periodontal mecânico) e em relação a diferentes doenças periodontais. A utilização de serviços de diagnóstico microbiano e dados demográficos dos voluntários também foram elucidados. Os dados foram analisados estatisticamente (Teste Binomial, p<0,05). Resultado: Trezentos e noventa e três voluntários responderam ao questionário. Vinte e três por cento do sexo masculino e 76,2% do sexo feminino. A idade média foi de 27,7 anos. A minoria (19,2%) dos voluntários relatou indicar antibióticos sistêmicos para tratamento de gengivite ou periodontite estágios I e II (antiga periodontite crônica leve e moderada). A maioria dos profissionais indica para tratar abscesso periodontal, gengivite ou periodontite ulcerativa necrosante, periodontite em imunodeficiências graves, periodontite agressiva antiga e periodontite estágios III e IV (periodontite crônica grave antiga). Raramente (2,5%) a prescrição foi sem a associação com terapia mecânica. Os exames microbiológicos como método auxiliar de diagnóstico raramente (3,1%) são solicitados por falta de informação ou custo. As respostas mais frequentes sobre o número de vezes que os profissionais relataram prescrever antibióticos sistêmicos como parte do tratamento periodontal por trimestre foram "pelo menos uma vez", seguido de "2 vezes". Conclusão: Pode-se concluir que os cirurgiões-dentistas brasileiros possuem conhecimento sobre a correta prescrição de antibióticos na terapia periodontal

Introduction: Periodontal treatment involves procedures aimed to reduce bacterial load, involving or not the use of local or systemic antibiotics. Objective: The purpose of this study was to assess Brazilian dentists' knowledge about antibiotics prescription during periodontal treatment. Material and method: An online questionnaire was available asking for systemic application of local or systemic antibiotics prescription (frequency, and sequence with mechanical periodontal treatment) and in relation to different periodontal diseases. The use of microbial diagnostic services and volunteers' demographic data were also elucidated. Data were statistically analyzed (Binomial Test, p<0.05). Result: Three hundred and ninety-three volunteers answered the questionnaire. Twenty-three percent males and 76.2% females. Average age was 27.7 years. Minority (19.2%) of the volunteers reported to indicate systemic antibiotics to treat gingivitis or periodontitis stages I and II (old slight and moderate chronic periodontitis). Majority of the professionals indicate it to treat periodontal abscess, necrotizing ulcerative gingivitis or periodontitis, periodontitis in severe immunodeficiencies, old aggressive periodontitis, and periodontitis stages III and IV (old severe chronic periodontitis). Rarely (2.5%) the prescription was without the combination with mechanical therapy. Microbiological tests as an auxiliary diagnostic method are rarely (3.1%) requested due to lack of information or cost. Most frequent answers about the number of times professionals reported prescribing systemic antibiotics as part of periodontal treatment per trimester was "at least once", followed by "2 times". Conclusion: It can be concluded that Brazilian dentists have knowledge about the correct prescription of antibiotics in periodontal therapy

Biomechanical analysis of narrow dental implants for maxillary anterior rehabilitation / Análise biomecânica de implantes de diâmetro reduzido para reabilitação da região anterior da maxila

Introdução: O conhecimento da biomecânica de implantes de diâmetro reduzido indica dimensões seguras para uso clínico. Objetivo: O objetivo do presente estudo foi comparar biomecanicamente implantes de diâmetro regular e reduzido para suporte de próteses implantossuportadas unitárias na região anterior da maxila por meio de análise de elementos finitos 3D (3D-FEA). Material e método: Quatro modelos 3D-FEA foram desenvolvidos a partir de recomposição de tomografia computadorizada e dados da literatura: um bloco ósseo na região incisiva lateral superior direita com implante e coroa. M1: 3,75 x 13 mm, M2: 3,75 x 8,5 mm, M3: 2,9 x 13 mm e M4: 2,9 x 8,5 mm. Foi aplicada carga de 178 N nos ângulos 0, 30 e 60 graus em relação ao longo eixo do implante. Foram avaliados mapas de tensão de Von Mises, tensão principal máxima e microdeformação. Resultado: M3 e M4 apresentaram maiores valores de tensão e microdeformação que M1 e M2, principalmente quando foram aplicadas forças inclinadas. Porém, M3 apresentou comportamento biomecânico melhor do que M4. Conclusão: Pode-se concluir que reduzir o diâmetro dos implantes pode prejudicar a biomecânica durante a aplicação de forças, mas a distribuição e intensidade das tensões, bem como os valores de microdeformação podem ser melhorados se o comprimento do implante for aumentado

Introduction: Narrow diameter implants biomechanics knowledge indicates safe dimensions for clinical use. Objective: Purpose of the present study was biomechanically to compare regular and narrow diameter implants to support single implant-supported prosthesis in the anterior region of the maxilla by 3D finite element analysis (3D-FEA). Material and method: Four 3D-FEA models were developed form CT scan recompositing and literature data: a bone block in the right upper lateral incisive region with implant and crown. M1: 3.75 x 13 mm, M2: 3.75 x 8.5 mm, M3: 2.9 x 13 mm and M4: 2.9 x 8.5 mm. It was applied load was of 178 N at 0, 30 and 60 degrees in relation to implant long axis. Von Mises stress, maximum principal stress and microdeformation maps were evaluated. Result: M3 and M4 did show higher tension and higher microdeformation values than M1 and M2, especially when inclined forces were applied. However, M3 presented enhanced biomechanical behavior than M4. Conclusion: It can be concluded that reduce the diameter of the implants can disadvantage to the biomechanics during the application of forces, but the distribution and intensity of the stresses, as well as the micro deformation values can be improved if the length of the implant is increased

Are intraoral stents effective in reducing oral toxicities caused by radiotherapy? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral stents have been provided to minimize acute and chronic toxicities induced by radiotherapy, including oral mucositis, salivary changes, trismus, radiation-related caries, and osteoradionecrosis. However, a systematic review and meta-analysis is necessary to determine their effectiveness. PURPOSE: The purpose of this systematic review and meta-analysis was to determine the effectiveness of intraoral stent use and determine whether these prosthetic devices can reduce radiation dosage to nontargeted oral tissues and adverse effects related to head and neck radiation. MATERIAL AND METHODS: Two independent reviewers made a systematic search for articles published from January 2010 to March 2020 in 3 databases, supplemented by a manual search. Studies were included if they were clinical trials (randomized controlled trials, both prospective and retrospective), published in English, and evaluated radiation dose and oral adverse side effects (acute or chronic) induced by radiotherapy of participants with and without intraoral stents. RESULTS: The search strategy identified 201 studies; of which, 9 were included. A total of 251 participants were evaluated; of whom, 168 (77.3%) used intraoral stents and 57 (22.7%) were treated with radiotherapy without a prosthetic device. A statistically significant difference was found regarding the use of intraoral stents for preventing oral mucositis (P<.001), salivary changes (P=.003), and trismus (P<.02). A funnel plot showed asymmetry among the differences of means in all selected studies. CONCLUSIONS: Intraoral stents have a positive effect on preventing oral mucositis. Further clinical trials are needed to address the flaws identified in the present systematic review.

Survey based assessment of diagnosis through periapical radiograph and CBCT and treatment of root resorption with Brazilian and American dentists and endodontists.

BACKGROUND: This study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations. MATERIAL AND METHODS: A cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %. RESULTS: Most answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p<0.05); USA presented higher level of adequate responses than Brazil (p<0.05). CONCLUSIONS: END achieved a level of knowledge of the diagnosis and treatment of root resorption superior to the GP. Comparing the results obtained in both countries, it was observed that the USA had a higher correct response rate than Brazil. Key words:Internal root resorption, external root resorption, management, diagnosis, treatment.

Platelet-rich fibrin for wound healing of palatal donor sites of free gingival grafts: Systematic review and meta-analysis.

BACKGROUND: Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate, associated with improvements on the healing of palatal wounds followed by FGG harvesting. The aim of this systematic review and meta-analysis was to assess the complete wound epithelialization and postoperative pain when PRF was used in palatal wounds following free gingival graft (FGG) harvesting. MATERIAL AND METHODS: PubMed (Medline), EMBASE and Scopus were searched by two independent individuals up to and including March 2020 in order to identify controlled and randomized controlled clinical trials on the use of PRF at palatal donor sites of FGG. The outcomes assessed were epithelialization and postoperative pain. The risk of bias of the included studies was evaluated using Cochrane Collaboration's domain-based two-part tool. Random effects meta-analyses were conducted with 95% confidence intervals. RESULTS: The search strategy identified 555 potentially eligible articles, of which 6 randomized controlled clinical trials were included. In the qualitative analysis, most studies (83.3%) reported lower postoperative pain in treatment groups, while all studies accessing epithelialization demonstrated earlier complete wound closure in groups treated with PRF. The discomfort and complete re-epithelialization were more favorable in groups PRF when compared to control groups (P<0.00001). CONCLUSIONS: Within the limits of the present study, it can be concluded that the use of PRF for wound healing of palatal donor sites of FGG may decrease postoperative pain and induce earlier complete wound epithelialization. Key words:Wound healing, oral surgery procedures, pain, postoperative.

Clinical Evidence for Treatment of Class II Periodontal Furcation Defects. Systematic Review and Meta-analysis.

BACKGROUND: This systematic review evaluated the most effective therapeutic approach to treat periodontal furcation defects with a minimum follow-up of 12 months. The primary outcome was clinical attachment level (CAL). Secondary outcomes were probing pocket depth, gingival margin level, gingival index and plaque index. METHODS: A comprehensive search of studies published up to December 2019 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. Two reviewers independently searched eligible studies, made a final article selection, and extracted the data of the selected studies to evaluate qualitatively and quantitatively (meta-analysis). RESULTS: Overall, 19 studies were selected for the analysis. Six hundred and eighteen patients (mean age, 45.3) were treated. More commonly used treatment was polytetrafluoroethylene barrier (ePTFE), followed by enamel matrix derivative (EMD) and open-flap debridement (OFD). Only one study evaluated maxillary arch and remaining evaluated mandibular arch. All treatments provided CAL gain, but meta-analysis did not show significant difference among more commonly used treatments and controls (P=0.91; P=0.47; P=0.08, respectively). CONCLUSION: There is no difference on effectiveness of main therapeutic approaches evaluated for treatment of Class II periodontal furcation defects.

Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The survival and/or success of post-retained restorations is influenced by the amount of residual coronal structure, known as the "ferrule effect." PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate whether the presence or absence of the ferrule effect influences the failure rate of fiber-reinforced composite post-and-core restorations. MATERIAL AND METHODS: A comprehensive review of the literature was performed using the PubMed/Medline, Embase, Scopus, and Cochrane Library databases for articles published up to May 2018. The risk ratio with 95% confidence interval was estimated using the Mantel-Haenszel method. Potentially eligible studies were selected based on the reading of the abstracts and full text of prospective clinical trials, randomized clinical trials, or prospective randomized studies, all with a minimum of 10 participants in each group, with a follow-up period longer than 6 months, and published in English. RESULTS: Of the 380 studies retrieved, 4 were included in this meta-analysis. A total of 297 teeth were evaluated, 157 with a ferrule and 140 without a ferrule. The mean survival rate was 88.35% in the ferrule group and 78.05% in the nonferrule group. No statistically significant difference was noted in the general failure analysis (risk ratio: 0.71 [95% confidence interval: 0.47 to 1.06]; P=.09), although a higher number of failures occurred in nonferrule restorations. More controlled and randomized clinical trials are needed to establish a clinical protocol for the use of post-retained restorations. CONCLUSIONS: Despite the limited number of available studies, the results of this meta-analysis suggest that the ferrule effect does not significantly reduce the failure rate in fiber-reinforced composite post-and-core restorations.

Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis.

This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: -0.05; 95%CI: -0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.

Retention System and Splinting on Morse Taper Implants in the Posterior Maxilla by 3D Finite Element Analysis

Abstract The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.

Resumo O objetivo deste estudo foi avaliar diferentes sistemas de retenção (cimentada x parafusada) e configuração da coroas (unitárias x esplintadas) de próteses fixas implantossuportadas em relação a distribuição de tensões nos implantes/componentes e tecido ósseo pela análise de elementos finitos 3D. Quatro modelos 3D foram simulados com auxílio dos programas Invesalius, e Rhinoceros 3D, e SolidWorks. Os modelos foram confeccionados simulando bloco ósseo de região posterior da maxila (tipo ósseo III), com 3 implantes cone Morse com 4,0 mm de diâmetro e diferentes comprimentos, suportando prótese metalocerâmica de 3 elementos. Os modelos foram processados pelos programas FEMAP e NEiNastran sob força axial de 400 N e oblíqua de 200N. Os resultados foram plotados através de mapas de tensão de von Mises (vM) (implantes e componentes) e tensão máxima principal (TMP) (tecido ósseo). Sobre o carregamento axial, não foi observada diferenças entre os diferentes sistemas de retenção e tipo de prótese na distribuição das tensões nos implantes/componentes, porém, sobre o carregamento oblíquo as próteses cimentadas apresentaram melhor distribuição de tensões em comparação com as próteses parafusadas, enquanto que as próteses esplintadas apresentou uma tendência de redução das tensões no implante do primeiro molar. No tecido ósseo as próteses cimentadas apresentaram melhor distribuição das tensões em comparação com as próteses parafusadas, independente do carregamento. A esplintagem foi favorável somente para as próteses parafusadas, não havendo influência sobre as próteses cimentadas. As próteses cimentadas sobre implantes cone Morse apresentam melhor comportamento biomecânico nos implantes/componentes e tecido ósseo. A esplintagem foi efetiva somente nas próteses parafusadas sob carregamento oblíquo.

Retention System and Splinting on Morse Taper Implants in the Posterior Maxilla by 3D Finite Element Analysis.

The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.

Análise biomecânica de opções protéticas para reabilitação de maxila posterior com próteses implantossuportadas de três elementos: estudo pelo método dos elementos finitos 3D / Biomechanical analysis of prosthetic options for rehabilitation of posterior maxillary area with three-unit fixed prosthesis supported by implants: a 3D finite element analysis

Proposição: O propósito do estudo foi estudar o comportamento biomecânico de próteses de três elementos implantossuportadas diante das seguintes variáveis: união (coroas unitárias e esplintadas: em linha reta e em posicionamento tripoidal), comprimento e diâmetro do implante, além da redução do número de implantes (pôntico central), utilizando a metodologia de elementos finitos 3D. Material e Método: Vinte e seis modelos tridimensionais foram simulados com o auxílio dos programas InVesalius, Rhinoceros 4.0 e Solidworks 2016. Cada modelo representou uma seção de osso da região posterior maxilar, na forma de um bloco de osso tipo IV (cortical e esponjoso), com a presença de prótese de três elementos suportada por dois ou três implantes, do tipo hexágono externo, em diferentes situações clínicas, variando os fatores união (coroas unitárias e esplintadas: em linha reta e em posicionamento tripoidal), comprimento, diâmetro e número de implantes. Os desenhos tridimensionais foram exportados ao programa de pré- e pósprocessamento FEMAP 11.1.2 para a geração da malha e aplicação de carga de 400N axial e 200N oblíqua (45°). Após a resolução do problema matemático por meio do programa de elementos finitos Nei Nastran 11.1, os resultados foram visualizados através de mapas de Tensão Máxima Principal (MPa) e Microdeformação (µÎµ) para tecido ósseo cortical e mapas de Tensão von Mises (MPa) para parafuso de fixação. Resultados: De um modo geral, modelos com coroas esplintadas associadas ao posicionamento tripoidal apresentaram os melhores comportamentos biomecânicos. A redução do número de implantes gerou um comportamento biomecânico desfavorável. O aumento do diâmetro da região do molar foi benéfico para melhorar o desempenho biomecânico da reabilitação. Conclusões: Planejamentos considerando a instalação de um implante para cada dente perdido ofereceram os menores valores de tensão nos parafusos de fixação e menores valores de tensão/microdeformação no tecido ósseo cortical. A esplintagem associada ao posicionamento tripoidal dos implantes foi benéfica para melhorar o comportamento biomecânico das reabilitações, bem como o aumento do diâmetro do implante da região do molar(AU)

Objective: The aim of this study was to analyze the biomechanical behavior of three-unit fixed prosthesis varying the union (single crowns and splinted crowns: straight-line and offset implant configurations), length, diameter, and the number of implant (supported by two or three implants) by 3D finite element analysis. Material and Methods: Twenty-six 3-D models were simulated with the software's In Vesalius, Rhinoceros 4.0, SolidWorks 2010 and. Each model represented a posterior maxillary bone section simulating type IV bone (cortical and spongy), with presence of 3-units fixed prosthesis supported by two or three dental implants, external hexagonal connection, in different clinical situations, varying the factors union (single crowns and splinted crowns: straight-line and offset implant configurations), length and diameter. The 3D models were exported to the software FEMAP 11.1.2 for pre- and post- processing and mesh generation besides load definition (400N vertical and 200N oblique,45°). After, the models were solved by NeiNastran 11.1 finite element software and the results were visualized by maximum principal stress (MPa) and microstrain (µÎµ) maps to cortical bone tissue and von Mises stress (MPa) map to fixation screws. Results: Overall, the models with splinted crowns associated with offset implant placement showed the best biomechanical behavior. The reduction in the number of implants generated a biomechanical behavior. The increase of the implant diameter in the molar region was beneficial to improve the biomechanical behavior of the dental rehabilitation. Conclusion: Planning considering the placement of an implant for each lost tooth offered the lowest values of stress in the fixation screws and the lowest values of strain/microdeformation in the cortical bone tissue. The splinting associated with offset implant configuration was beneficial to improve the biomechanical behavior of the rehabilitations, as well as the increase of the implant diameter of the molar region(AU)

Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis

Abstract This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: −0.05; 95%CI: −0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.

Influence of low-level laser therapy on the healing of human bone maxillofacial defects: A systematic review.

PURPOSE: This systematic review evaluates the effectiveness of low-level laser therapy (LLLT) to enhance maxillofacial area bone repair. METHODS: A comprehensive search of studies published up to February 2017 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: The 15 selected studies evaluated a total of 374 patients (mean age, 28.5years) who were treated with LLLT. Gallium-arsenide (GaAs) and gallium aluminium arsenide (GaAlAs) were the most commonly used devices, and LLLT parameters varied greatly. Wavelengths varied from 500 to 1000nm. Tooth extraction, distraction osteogenesis, maxillary expansion, periodontal defects, orthodontic movement and maxillary cystic defects were evaluated. From the 15 selected studies, six evaluated bone repair (primary outcomes). Of these, four studies showed improvement in bone formation after using LLLT, two demonstrated improved results for only one follow up period, and one showed no additional benefits. The other 9 studies evaluated secondary parameters related to healing (secondary outcomes) in the maxillofacial area after applying LLLT, including anti-inflammatory, analgesic, and healing accelerator effects, and quality of life related to oral health. There were no adverse or negative effects of LLLT reported. CONCLUSION: Within the limitation of this review, a possible improvement in bone density can be found when LLLT is applied postoperatively in maxillofacial bony defects. LLLT also seems to promote anti-inflammatory and analgesic effects and accelerate healing, as well as enhance quality of life related to oral health. However, LLLT use protocols need to be standardized before more specific conclusions can be drawn about this subject.

Complete overdentures retained by mini implants: A systematic review.

OBJECTIVE: The purpose of this systematic review was to evaluate the use of mini implants to retain complete overdentures in terms of survival rates of mini implants, marginal bone loss, satisfaction, and quality of life. DATA: This report followed the PRISMA Statement and PICO question. This review has been registered at PROSPERO under the number CRD42016036141. SOURCE: Two independent reviewers performed a comprehensive search of studies published until September 2016 and listed in the PubMed/MEDLINE, Embase, and The Cochrane Library databases. The focused question was: is the use of mini implants feasible for prosthodontic rehabilitation with complete overdentures? RESULTS: The 24 studies selected for review evaluated 1273 patients whose mean age was 65.93 years; these patients had received 2494 mini implants and 386 standard implants for retaining overdenture prosthesis. The mean follow-up time was 2.48 years (range: 1-7 years). There was a higher survival rate of mini implants (92.32%). More frequent failures for maxillary (31.71%) compared with mandibular arches (4.89%). The majority of studies revealed marginal bone loss values similar to those of standard implants (<1.5mm). All studies verified an increase in satisfaction and quality of life after rehabilitation treatment with mini dental implants. CONCLUSION: The present systematic review indicates that the use of mini implants for retaining overdenture prosthesis is considered an alternative treatment when standard treatment is not possible, since it presents high survival rates, acceptable marginal bone loss, and improvements in variables related to satisfaction and quality of life. CLINICAL SIGNIFICANCE: Based on the results of this study, the use of a minimum 4 and 6 mini implants can be considered a satisfactory treatment option for rehabilitation of the mandibular and maxillary arches respectively with a complete overdenture.

Influence of diameter and intraradicular post in the stress distribution. Finite element analysis / Influência do diâmetro e do retentor intrarradicular na distribuição de tensões. Análise pelo método dos elementos finitos

Introduction: The biomechanical behavior of endodontically treated teeth depending on the selected restorative material and tooth situation to be restored. Objective: To analyze by the two-dimensional finite element method the biomechanical behavior of different diameters in intraradicular posts and teeth with coronal remaining of 2mm. Material and method: Six models were made with three types of posts, as follows: Glass fiber post, carbon fiber post, and cast metal post, both with diameter # 1 (1.1 mm in diameter) and # 2 (1.3 mm of diameter). The modeling was performed using the Rhinoceros 4.0 program. The FEMAP 10.2 and NEiNastran 9.2 programs were used to develop finite element models. The loading used was 100N for axial and oblique forces. The results were visualized using the von Mises stress map. The statistical analysis was made using analysis of variance (ANOVA) and Tukey post-test, with a significance level of 5%. Result: The oblique loading stress values were higher than the axial loading (p< 0.001) for both situations. The glass fiber post showed the lowest concentrations of stress on both loads (p< 0.001). The carbon fiber post presented significant difference compared to the cast metal post, only in the oblique load (p=0.007). The diameter did not increase the stress of the evaluated posts (p=0.302). Conclusion: The fiber posts were more favorable for restoration of endodontically treated teeth; the increase of diameter did not influence the increase of tension; the oblique load was more harmful for both posts and tooth structure.

Introdução: O comportamento biomecânico de dentes tratados endodonticamente é variável conforme o material restaurador selecionado e situação do dente a ser restaurado. Objetivo: Analisar por meio do método dos elementos finitos bidimensional o comportamento biomecânico de diferentes retentores intrarradiculares e diâmetros em dentes com 2mm de remanescente coronário. Material e método: Foram confeccionados seis modelos com três tipo de retentores: pino de fibra de vidro, pino de fibra de carbono e núcleo metálico fundido, ambos com diâmetro #1 (1,1mm de diâmetro) e #2 (1,3mm de diâmetro). A modelagem foi realizada através do programa Rhinoceros 4.0, e em seguida nos programas FEMAP 10.2 e NeiNastran 9.2 para desenvolvimento d os modelos de elementos finitos. Nos carregamentos foram utilizadas forças de 100N axial e oblíquo. Os resultados foram visualizados pelo mapa de tensão von Mises, e pela análise de variância (ANOVA) e pós-teste Tukey, com nível de significância à 5%. Resultado: O carregamento oblíquo apresentou maiores valores de tensões (p< 0,001). O pino de fibra de vidro apresentou menores concentrações de tensões em ambos os carregamentos (p< 0,001). O pino de fibra de carbono apresentou diferença significativa em relação ao núcleo metálico somente no carregamento oblíquo (p=0,007). O diâmetro não influenciou para o aumento de tensões dos retentores avaliados (p=0,302). Conclusão: Os pinos de fibras são mais favoráveis para restaurações de dentes tratados endodonticamente; O aumento do diâmetro não influenciou no aumento de tensões; A carga oblíqua é mais prejudicial à tanto para o retentor quanto para a estrutura dentária.

Correção estética dental associada a melhoria da autoestima em paciente idoso / Correção estética dental associada a melhoria da autoestima em paciente idoso

A aplicação dos conceitos da Odontologia Estética nos procedimentos protéticos tornou-se rotina para profissionais que realizam grandes reabilitações orais e isso ocorreu, em grande parte, devido à evolução das cerâmicas odontológicas e sua adesão ao substrato, bem como o desenvolvimento de novas técnicas protéticas e novos equipamentos. Essas tecnologias permitiram a otimização do tempo clínico e possibilitaram a finalização de casos complexos em intervalo de tempo bem curto. Assim, o objetivo deste artigo foi relatar um caso clínico de correção estética utilizando coroas livre de metal que gerou melhoria da autoestima do paciente idoso, muito em virtude do curto tempo de tratamento. Paciente do sexo masculino, 62 anos, compareceu à clínica de reabilitação da FOA-UNESP queixando-se de problemas estéticos e demonstrando interesse em reabilitação oral da arcada superior. Na fase de anamnese, o paciente relatou ter depressão severa, não apresentando motivação suficiente para a execução do tratamento; porém, ele aceitou a proposta planejada quando estava acompanhado dos familiares. Coroas livres de metal foram planejadas para a resolução do caso, que também foi associado à confecção de um elemento unitário sobre implante. Por fim, o tratamento proposto foi capaz de corrigir os problemas estéticos identificados inicialmente, promovendo melhoria expressiva na autoestima do paciente, que inclusive se mostrou motivado para complementar o tratamento das demais áreas não contempladas no planejamento inicial.

The application of the cosmetic dentistry concepts in prosthetic procedures has become a routine for professionals who perform oral rehabilitation. That occurred mostly due to the improvement of dental ceramics and their bonding to dental substrate, as well as to the development of new prosthetic techniques and new equipment. These technologies allowed the optimization of clinical time and enabled the completion of complex cases in a very short time. Thus, the aim of this article was to report a case of aesthetic correction using metal free crowns that improved the self-esteem of an elderly patient mostly because of the very short treatment time. A 62-year-old man presented to the oral rehabilitation clinic of FOA-UNESP complaining about aesthetic problems and showing interest in oral rehabilitation of the upper arch. In the anamnesis phase, the patient reported having severe depression, no sufficient motivation for the implementation of treatment; however, he accepted the planned proposal when accompanied by family. Metal free crowns were planned for the resolution of the case, which was also associated with a single element on the implant. finally, the proposed treatment was able to correct the identified aesthetic problems promoting significant improvement of patient's self-esteem who was also motivated to complement the treatment including other areas that were not included in the initial planning.

Uso de reforço metálico para resolução de fraturas recorrente em reabilitação com prótese total superior ­ relato de caso / Use of metallic reinforcement for resolution of recurrent fractures in rehabilitation with maxillary complete denture ­ case report

Tratamentos envolvendo Prótese Total (PT) baseiam-se na devolução da qualidade de vida pela recuperação da função mastigatória e estética; porém, um problema cotidiano são as fraturas das bases e/ou dentes de resina acrílica, que podem gerar problemas inclusive psicológicos. Assim, a presente descrição tem por objetivo relatar um caso clínico no qual foi utilizado reforço metálico na PT superior, associado à confecção de uma PPR convencional inferior, para reabilitação estética e funcional. Paciente de 58 anos, feminino, branca, compareceu a clínica de Reabilitação Oral da faculdade de Odontologia de Araçatuba, com queixa estética da prótese superior, além de fraturas recorrentes. Após anamnese observou-se que a prótese apresentava regiões de fratura, com excessivo desgaste nos dentes e vários consertos. Assim, foi planejado confecção de uma PT com reforço metálico além de uma PPR na arcada inferior. foram realizados procedimentos convencionais de confecção da PT superior e PPR inferior incluindo registro para pequeno aumento da dimensão vertical. Após a aprovação durante a prova funcional, foi realizada a inclusão da prótese, sendo realizada então a fase laboratorial da confecção da barra metálica que, após construída, recebeu uma camada de opacificador cerâmico para favorecer a estética. Após o tratamento foi possível observar que o procedimento atingiu seu objetivo, eliminando o problema de fraturas recorrentes sem interferência estética, e devolveu qualidade de vida para a paciente. Após 2,5 anos de controle foi possível constatar que a utilização de reforço metálico foi uma alternativa viável para redução das fraturas sem comprometimento estético quando bem indicada.

Treatments involving complete dentures (CD) consist on the recovery of patients' quality of live restoring booth function and aesthetics. however fractures on the saddle or of the resin elements are common and may result on psycological problems. Therefore this study aims to report a clinical case that used metallic reinforcement of upper CD associated to fabrication of a conventional lower removable partial denture (RPD) for aesthetic and functional rehabilitation. A 58 years-old female Caucasian patient sought treatment at Clinics of Oral Rehabilitation of Dental School of Araçatuba complaining of poor aesthetics and recurrent fractures of upper CD. Anamnesis showed many fractures and repairs on the prostheses with excessive wear of teeth. Thus were planned the fabrication of a CD with metallic reinforcement and a RPD for lower jaw. Standard procedures for fabrication of the prostheses were performed, including record for a little increase of vertical dimension. After approval of the patient, in the clinical test the prostheses was included and followed by the laboratorial phase of the manufacture of a metallic bar that covered in opaque ceramic to preserve aesthetics. After treatment it was possible to observe that the procedure has achieved its objective eliminating the problem of recurrent fractures without compromising dental aesthetic restoring patient's quality of life. After a 2.5 years follow-up it was possible to find that when properly indicated the use of metallic reinforcement was a viable alternative for reducing recurrent fractures without compromising aesthetic.

Reabilitação estética envolvendo diferentes substratos e sistemas metal free ­ relato de caso / Aesthetic rehabilitation using different dental substrates and metal free systems ­ case report

O objetivo deste trabalho foi relatar um caso clínico de reabilitação oral utilizando diferentes materiais estéticos em tratamento reabilitador, envolvendo implante dentário e restaurações metal free na região maxilar anterior. Paciente M.S.S. compareceu à clínica de reabilitação com queixa estética da região anterior e desconforto por uso de aparelho móvel. Primeiramente, foi solicitada tomografia da região, que mostrou tecido ósseo suficiente para implantação. Após criterioso exame clínico, foi planejado confecção de coroas estéticas nos elementos 13 a 23, sendo uma coroa implantossuportada no dente 22. Uma vez aceito o tratamento pela paciente, este se iniciou através do enceramento diagnóstico para planejamento estético e confecção de guias para auxiliar no controle do desgaste dentário e confecção dos provisórios. Inicialmente foi instalado um implante cone morse (3,5 x 13 mm) na região do dente 22, aguardando-se 6 meses para sua osseointegração. Após esse período, foram removidas coroas protéticas antigas e confeccionados núcleos de fibra de vidro nos dentes 11 e 21 e de preenchimento com pino intradentinário no dente 12. Posteriormente foram realizados os preparos dentários e moldagem pela técnica do duplo fio. Para os elementos 13, 12, 11, 23 e 24 foram confeccionadas restaurações de dissilicato de lítio (sistema IPS e.max) e para o 22 coroa implantossuportada em zircônia (sistema IPS e.max). Após prova e cimentação das coroas, o caso foi finalizado e pode-se observar harmonia estética na região anterior maxilar, além de uma ótima saúde periodontal.

The aim of this study was to describe a case report of oral rehabilitation using different aesthetic materials for oral rehabilitation involving implant and metal-free restorations in the anterior maxillary region. Patient M.S.S. attended the rehabilitation clinic with aesthetic complaint of poor aesthetic in the anterior region and discomfort due to the use of remov-able appliance. A CT scan was requested and showed sufficient bone tissue for implantation. Thus, after careful clinical examination it was planned fabrication of aesthetic single crowns on #13 to #23 teeth being an implant-supported crown on tooth #22. With patient's consent the rehabilitation started with planning through diagnostic wax-up for aesthetic planning and fabrication of guides to assist in the control of dental preparation and fabrication of provisional crowns. Initially, a morse taper implant (3.5x13 mm) was installed in region of tooth #22, waiting for osseointegration for 6 months. Then old crowns were removed and glass fiber posts were installed in the #11 and #21 teeth as well as a core build-up with mini screw metallic pin in the #12 tooth. Subsequently dental preparations and impression were performed using the double retraction cord technique. Lithium disilicate (IPS e.max) restorations were manufactured for elements #13, #12, #11, #23 and #24 while for #22 it was made a zirconia implant-supported crown (IPS e.max). After prove and cementation of crowns, the case was finalized resulting on good aesthetics and periodontal health in the anterior maxillary region.

Prótese nasal implantorretida por magnetos ­ relato de caso com cinco anos de acompanhamento / Magnet-retained nasal prosthesis ­ case report with 5-year follow-up

O objetivo do presente estudo foi relatar, por meio de um caso clínico, a reabilitação de uma paciente com uma prótese nasal implantorretida. A mesma possuía 68 anos de idade e foi encaminhada para a reabilitação nasal pela equipe que realizou a cirurgia oncológica de um tumor de pele na região do seu nariz. A paciente reportou queixa com relação à estética da face e problemas no convívio social. Foi proposta reabilitação com prótese nasal, com implantes osseointegráveis associados ao sistema de retenção por magnetos. Após cinco anos e dez meses, três novas próteses foram fabricadas devido a queixas da paciente em relação à descoloração da peça. Na última consulta, a prótese foi removida e inspecionada, e se constatou problemas na higienização, motivo das pigmentações escurecidas na superfície interna da peça e do exsudato no tecido mole ao redor dos pilares protéticos. Foram realizadas a limpeza da barra e do tecido mole, e a confecção de novas próteses nasais implantorretidas à base de silicone elastomérico, além de instrução sobre a necessidade de higienização. Constatou-se que próteses nasais implantorretidas à base de silicone elastomérico são eficientes e seguras para a reabilitação de defeitos na região do nariz. Além disso, é extremamente necessário que o profissional transmita aos pacientes a necessidade de uma higienização satisfatória, solicitando retornos periódicos para obter o máximo do desempenho clínico de suas próteses e implantes.

The aim of present study was to report the rehabilitation of a patient with magnet-retained nasal prosthesis. A 68-year-old female patient was referred to nasal rehabilitation by the surgical team that performed the removal of a skin nose tumor. The patient complained about her facial aesthetics and also reported fearing social interactions. The rehabilitation with nasal prosthesis associated with osseointegrated implants, and retained by magnets was proposed to the patient. After 5 years and 10 months, 3 new prostheses have been fabricated because the patient complained about their discoloration. In the last check-up, the prosthesis was removed and visual inspection revealed lack of hygiene maintenance, which resulted in dark pigments in the intaglio surface as well as exudate in the peri-implant soft skin. The prosthetic components and soft tissue were cleaned, the fabrication of new magnet-retained nasal prosthesis was performed and instructions about the necessity of oral hygiene were also transmitted. The implant-retained nasal prosthesis is an effi cient and safe method for the rehabilitation of defects in the nasal area. Furthermore, it is extremely necessary that clinicians advise patients to perform satisfactory hygiene maintenance and periodic controls in order to obtain long-term success in such cases.

Obturator prostheses versus free tissue transfers: A systematic review of the optimal approach to improving the quality of life for patients with maxillary defects.

STATEMENT OF PROBLEM: Patient perspectives on the treatment options for maxillary defects, which include free tissue transfers or obturator prostheses, may help eliminate current uncertainty as to the best choice of treatment plan. PURPOSE: The purpose of this systematic review was to evaluate the quality of life (QoL) of patients with maxillary defects who had undergone restoration with obturator prostheses and/or free tissue transfers. MATERIAL AND METHODS: A systematic search of Medline/PubMed and Web of Science databases for articles published before April 2015 was performed by 2 independent reviewers. A manual search of articles published from January 2005 to March 2015 was also conducted. Studies published in English that evaluated the QoL in patients with head and neck cancers were included. The Cohen kappa method was used to calculate inter-reviewer agreement. RESULTS: Ten studies were included. The University of Washington Head and Neck Questionnaire (UW-QOL) was most commonly used to measure QoL. The majority of maxillary defects were Class IIa-b. Two studies reported that the global QoL for patients with obturator prostheses is equivalent to or even better than that of other chronic disease populations. One study revealed no significant difference in QoL when the 2 treatment options were compared. CONCLUSIONS: The limited data indicate that the QoL of patients treated with obturator prostheses and that of patients free of tumors is similar. Well-designed clinical studies are necessary to draw definitive conclusions about how obturator prostheses compare with free tissue transfers in terms of affecting patient QoL.