Instalação do implante dentário após levantamento do seio maxilar com ß-tricálcio fosfato: relato de caso com resultados histológicos / Dental implant placement after maxillary sinus floor elevation using ß-tricalcium phosphate: a case report with histological results

Este relato de caso clínico descreveu o uso do beta-tricálcio fosfato para levantamento do seio maxilar e instalação do implante dentário. Uma paciente de 38 anos de idade apresentou-se com ausência dos elementos 26 e 27. Após a remoção da parede vestibular e levantamento do assoalho sinusal, uma membrana de colágeno foi interposta antes da deposição do biomaterial (granulação 1-2 mm). Oito meses depois, uma trefina foi usada para biopsia, e dois implantes dentários foram instalados. Os resultados histológicos mostraram a formação de tecido ósseo sadio. Mais tarde, as coroas defi nitivas foram confeccionadas e instaladas. O beta-tricálcio fosfato (Cerasorb) mostrou-se satisfatório como material para enxerto, mesmo sem o uso de osso autógeno concomitante

This case report describes the use of beta-tricalcium phosphate for maxillary sinus lifting and dental implant placement. A 38 years-old patient presented with the absence of the elements 26 and 27. After removing the buccal bone wall for sinus floor lifting, a collagen membrane was adapted before the biomaterial (1-2 mm granules) being inserted. Eight months later, a trephine bur was used for biopsy, and two dental implants were installed. Histological results showed the formation of healthy bone tissue. Later, the definitive crowns were made and installed. The betatricalcium phosphate (Cerasorb) was satisfactory as a biomaterial for grafting, even that no concomitant use of autogenous bone has been performed

Cone-beam computed tomography as a diagnostic method for determination of gingival thickness and distance between gingival margin and bone crest.

The objective of the present study was to assess cone-beam computed tomography (CBCT) as a diagnostic method for determination of gingival thickness (GT) and distance between gingival margin and vestibular (GMBC-V) and interproximal bone crests (GMBC-I). GT and GMBC-V were measured in 348 teeth and GMBC-I was measured in 377 tooth regions of 29 patients with gummy smile. GT was assessed using transgingival probing (TP), ultrasound (US), and CBCT, whereas GMBC-V and GMBC-I were assessed by transsurgical clinical evaluation (TCE) and CBCT. Statistical analyses used independent t-test, Pearson's correlation coefficient, and simple linear regression. Difference was observed for GT: between TP, CBCT, and US considering all teeth; between TP and CBCT and between TP and US in incisors and canines; between TP and US in premolars and first molars. TP presented the highest means for GT. Positive correlation and linear regression were observed between TP and CBCT, TP and US, and CBCT and US. Difference was observed for GMBC-V and GMBC-I using TCE and CBCT, considering all teeth. Correlation and linear regression results were significant for GMBC-V and GMBC-I in incisors, canines, and premolars. CBCT is an effective diagnostic method to visualize and measure GT, GMBC-V, and GMBC-I.

Alteração da altura papilar interincisiva devido a movimentação ortodôntica: avaliação em modelos de estudo e imagens tridimensionais / Change of incisive papilla height due to orthodontic movement: an evaluation in study models and three-dimensional images

The presence of gingival papillae in the anterior maxilla is essential to the aesthetics of the smile. The aim of this study was to evaluate alterations in the height of the upper central incisive papilla, before and after orthodontic movement, using study casts and cone beam computed tomography (CBCT). Sixteen patients between the ages of 13 and 18 years underwent orthodontic treatment. The height of the papillae was calculated in both initial and final study casts by drawing a horizontal line tangent to the zenith of the central incisors and inscribing a vertical line perpendicular to the horizontal line. Papilla height was defi ned as the distance from the tip of the papilla to the point of intersection between the two lines. Initial and final (after orthodontic treatment) CBCT images were analyzed, and the height of interproximal papillae was calculated by measuring the distance from the tip of the papilla to the alveolar bone crest. This measurement was performed in both sagittal and coronal plane views. Data were statistically analyzed using the Student t test. The level of significance was 5%. Initial mean papilla height was 4.6 ± 0.8 mm, and the final value in study casts was 4.3 ± 1.2 mm; there was not a statistically significant difference between initial and final values (p = 0.309). In the CBCT coronal sections, initial mean papilla height was 3.5 ± 1.2 mm vs. 3.1 ± 0.7 mm after treatment (p = 0.094); again, no statistically significant differences were observed. In the sagittal plane, there was a significant difference (p = 0.05) between initial (3.7 ± 1.1 mm) and final (3.1 ± 0.6 mm) mean papilla height. According to our findings, and to the different measuring techniques employed, the height of the papilla changed little as a result of orthodontic therapy.

A presença de papila gengival na região anterior da maxila é essencial para a estética do sorriso. O objetivo deste estudo foi avaliar as alterações na altura papilar dos incisivos centrais superiores, antes e após movimentação ortodôntica, utilizando modelos de estudo e tomografia computadorizada de feixe cônico (TCFC). Dezesseis pacientes, com idades entre 13 e 18 anos, foram submetidos a tratamento ortodôntico. A altura da papila foi calculada nos modelos de estudo iniciais e finais. Para isso, uma linha horizontal foi traçada tangente ao zênite dos incisivos centrais e uma linha vertical foi inscrita perpendicularmente à linha horizontal. A altura papilar foi definida como a distância entre a ponta da papila até o ponto de intersecção entre as duas linhas . Nas imagens TCFC inicial e final de cada paciente, a altura da papila foi caldulada com base na distância do ponto de contato interproximal até a crista do osso alveolar. Esta medida foi realizada em cortes sagitais e coronais. Os dados foram analisados estatisticamente utilizando teste t de Student. O nível de significância foi de 5%. A altura média inicial papilar foi de 4,6± 0,8 mm, e a final, de 4,3 ± 1,2 mm; não houve diferença estatisticamente significativa entre as medidas (p = 0,309). No corte coronal da TCFC, a altura média inicial papilar foi de 3,5 ± 1,2 mm, e a final, de 3,1 ± 0,7 mm final (p = 0,094); novamente, não houve diferença estatisticamente significativa. No corte sagital, houve uma diferença significativa (p = 0,05) entre as alturas inicial (3,7 ± 1,1 mm) e final (3,1 ± 0,6 mm) média papilar. De acordo com nossos resultados e com os diferentes métodos de medição empregados, a altura da papila sofreu pouca alteração após terapia ortodôntica.

O uso do mock-up na otimização e precisão do resultado da cirurgia plástica periodontal / The use of a mock-up for achieving precision and optimization of the outcome of periodontal plastic surgery

Um planejamento reabilitador estético-funcional envolve a integração de diversas especialidades da odontologia, com destaque para a atuação da periodontia, na otimização dos resultados. O objetivo deste trabalho é, por intermédio da descrição de duas técnicas de mock-up, destacar a importância deste para o planejamento cirúrgico periodontal e para a previsibilidade do resultado.

The esthetic and functional rehabilitation involves the integration of several specialties of dentistry, with emphasis on the role of periodontics on the optimization of results. The aim of this work is to highlight the importance of surgical planning for the predictability of periodontal outcomes through the description of two mock-up techniques.

Enxerto gengival livre prévio a reabilitação com implantes osseointegrados: um relato de caso / Free gingival graft previous to rehabilitation with endosseous implants: a case report

Introdução: Reabilitações orais com implantes osseointegrados requerem um planejamento integrado essencial para o sucesso do tratamento. A ausência de tecido queratinizado ao redor dos implantes favorece o desencadeamento de doenças Peri-implantares pelo acúmulo de placa e o trauma provocado pela escovação que pode causar desconforto ao paciente durante a higiene bucal. A reparação dos tecidos moles por meio de técnicas de cirurgia plástica periodontal pode conduzir à melhor estética, função, higienização e saúde da mucosa peri-implantar. Objetivo: descrever a utilização de enxerto gengival livre previamente a reabilitação oral com implantes osseointegrados para criação de área de tecido queratinizado, por meio de um relato de caso. Caso clínico: paciente do gênero masculino, 54 anos de idade, apresentou ao exame intrabucal ausência de tecido queratinizado na região edêntula (dentes 43 ao 47). Uma cirurgia de enxerto gengival livre foi realizada para criação de faixa de tecido queratinizado sendo o palato o sítio doador. Resultados: após 24 meses de acompanhamento observou-se uma média de cinco milímetros de faixa de tecido queratinizado, saúde dos tecidos peri-implantares, estética favorável além de promover mais conforto para o paciente durante higienização bucal e função. Tais resultados tendem a se manter estáveis em longo prazo favorecendo o sucesso do tratamento

Background: Oral rehabilitations with endosseous implants require an integrated planning what is essential for the treatment success. The absence of keratinized tissue around implants favors the onset of periimplant disease by the accumulation of plaque and trauma caused by brushing may cause discomfort to the patient during oral hygiene. The repair of soft tissues through periodontal plastic surgery techniques may lead to better esthetics, function, hygiene and periimplant mucosa health. Aim: To describe the use of free gingival graft previous to oral rehabilitation with endosseous implants for creating area of keratinized tissue by means of a case report. Case report: A 54-year-old male patient, presented during the intra-oral examination absence of keratinized tissue in the edentulous area (43 to 47 teeth). A free gingival graft surgery was performed to create a strip of keratinized tissue and the palate was the donor site. Results: After 24 months of follow-up it was observed an average of five milimiters of keratinized tissue strip, peri-implantar tissue health, favorable aesthetics besides promoting more confort to the patient during oral hygiene and function. Such results tend to be stable in long term favoring the treatment success.

Reposicionamento labial com cimento ortopédico associado a aumento estético de coroa clínica / Lip repositioning by application of bone cement associated with esthetic crown lengthening

O sorriso gengival é uma causa comum de insatisfação entre os pacientes. Em alguns casos, o lábio superior pode não ter suporte ósseo adequado na dinâmica do sorriso, encurtando-se ao se alojar em uma depressão óssea no fundo de vestíbulo, em sorrisos mais amplos ou mesmo durante a fala. Este artigo descreve um tratamento inovador, indicado em casos de falta de suporte labial causado por depressão óssea no fundo de vestíbulo: o aumento estético de coroa clínica e reposicionamento labial com cimento ortopédico...

Gingival smile is a common reason of disatisfaction between patients. In some cases, the upper lip may not have adequate bone support when smiling, and gets shrinked as it lodges in the sub-nasal bone depression, whether in an open smile or when the patient is speaking. This paper describes a novel treatment indicated for cases of lacking support of the upper lip caused by a sub-nasal bone depression: clinical crown lengthening associated with lip repositioning using bone cement...

Influence of lateral pressure to the implant bed on osseointegration: an experimental study in dogs.

AIM: To study osseointegration and bone-level changes at implants installed using either a standard or a reduced diameter bur for implant bed preparation. MATERIAL AND METHODS: In six Labrador dogs, the first and second premolars were extracted bilaterally. Subsequently, mesial roots of the first molars were endodontically treated and distal roots, including the corresponding part of the crown, were extracted. After 3 months of healing, flaps were elevated and recipient sites were prepared in all experimental sites. The control site was prepared using a standard procedure, while the test site was prepared using a drill with a 0.2 mm reduced diameter than the standard one used in the contra-lateral side. After 4 months of healing, the animals were euthanized and biopsies were obtained for histological processing and evaluation. RESULTS: With the exception of one implant that was lost, all implants were integrated in mineralized bone. The alveolar crest underwent resorption at control as well as at test sites (buccal aspect ∼1 mm). The most coronal contact of bone-to-implant was located between 1.2 and 1.6 mm at the test and between 1.3 and 1.7 mm at the control sites. Bone-to-implant contact percentage was between 49% and 67%. No statistically significant differences were found for any of the outcome variables. CONCLUSIONS: After 4 months of healing, lateral pressure to the implant bed as reflected by higher insertion torques (36 vs. 15 Ncm in the premolar and 19 vs. 7 Ncm in the molar regions) did not affect the bone-to-implant contact.

Acellular dermal matrix as a barrier in guided bone regeneration: a clinical, radiographic and histomorphometric study in dogs.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of the acellular dermal matrix (ADM) as a membrane for guided bone regeneration (GBR), in comparison with a bioabsorbable membrane. MATERIAL AND METHODS: In seven dogs, the mandibular pre-molars were extracted. After 8 weeks, one bone defect was surgically created bilaterally and the GBR was performed. Each side was randomly assigned to the control group (CG: bioabsorbable membrane made of glycolide and lactide copolymer) or the test group (TG: ADM as a membrane). Immediately following GBR, standardized digital X-ray radiographs were taken, and were repeated at 8 and 16 weeks post-operatively. Before the GBR and euthanasia, clinical measurements of the width and thickness of the keratinized tissue (WKT and TKT, respectively) were performed. One animal was excluded from the study due to complications in the TG during wound healing; therefore, six dogs remained in the sample. The dogs were sacrificed 16 weeks following GBR, and a histomorphometric analysis was performed. Area measurements of new tissue and new bone, and linear measurements of bone height were performed. RESULTS: Post-operative healing of the CG was uneventful. In the TG membrane was exposed in two animals, and one of them was excluded from the sample. There were no statistically significant differences between the groups for any histomorphometric measurement. Clinically, both groups showed an increase in the TKT and a reduction in the WKT. Radiographically, an image suggestive of new bone formation could be observed in both groups at 8 and 16 weeks following GBR. CONCLUSION: ADM acted as a barrier in GBR, with clinical, radiographic and histomorphometric results similar to those obtained with the bioabsorbable membrane.

Tratamento das doenças periimplantares - mucosite e periimplantite - parte 2: terapia reconstrutiva / Treatment of periimplantar diseases - mucositis and periimplantitis. Part 2: reconstructive therapy

Os implantes de titânio ósseointegrados se tornaram uma parte integral da reabilitação oral, sobretudo quando se busca substituir dentes perdidos. Apesar dos altos índices de sucesso obtidos, essa terapia pode apresentar complicações, entre elas a periimplantite. A periimplantite é definida como um processo inflamatório que afeta os tecidos em torno de implantes osseointegrados em função, resultando na perda do suporte ósseo. O tratamento cirúrgico das lesões periimplantares pode ser realizado nos casos onde há formação de bolsas associadas a defeitos ósseos, após a resolução do processo infecciosos agudo e instituição apropriada das medidas de higiene. O propósito deste artigo é oferecer uma compreensão básica sobre as formas de procedimentos regenerativos visando à resolução da periimplantite e a re-osseointegração dos implantes acometidos por este processo inflamatório.