Effect of cantilever extension on bone loss in mandibular complete-arch implant-supported fixed prosthesis about 3 and 4 implants.

STATEMENT OF PROBLEM: The assessment of bone loss around implants has been widely studied, but the effect of cantilever length as a risk factor is not fully understood. PURPOSE: The objective of this randomized controlled clinical trial was to compare the peri-implant bone loss of mandibular complete-arch implant-supported fixed prosthesis supported (FPS) by 3 and 4 implants and to correlate with the size of the horizontal and vertical distal cantilever at prosthesis installation (T1) and after one year (T2). MATERIALS AND METHODS: 72 external hexagon (EH) type implants were installed in 20 participants. Of these, 24 support FPS with 3 implants (GI3) and 48 with 4 implants (GI4). The inferior implants were named 1, 2, 3, and 4 according to their location in the mandibular arch, in a clockwise direction. Digital periapical radiographs were taken at times T1 and T2 for analysis and measurement of peri-implant bone loss. The horizontal and vertical distal cantilevers were measured with a digital caliper and correlated with peri-implant bone loss. RESULTS: The survival rate of implants in GI3 was 91.66%, in GI4 it was 97.91%. The mean bone loss in GI3 was 0.88 (± 0.89) mm and in GI4 it was 0.58 (± 0.78) mm (P = 0.225). There was no correlation between distal horizontal cantilevers and bone loss in the studied groups, with GI3 being -0.25 (P=0.197) and GI4-0.22 (0.129). Larger vertical cantilevers of implants 1 (P=0.018), 3 (P=0.015) and 4 (P=0.045) correlated with greater bone loss in GI4. CONCLUSION: The number of implants in FPS did not influence peri-implant bone loss after 1 year of follow-up. Larger vertical cantilevers influenced greater bone loss in complete-arch implant-supported fixed prosthesis supported by 4 implants. Int J Prosthodont. 10.11607/ijp.8347.

A Case of Doxycycline-induced Melanin in the Gingiva Tissue: Case Report.

BACKGROUND: Gingival pigmentation is a discoloration of the gingiva due to a variety of lesions and conditions associated with several endogenous and exogenous etiologic features. OBJECTIVE: The purpose of this study is to describe a report of gingival pigmentation in a patient who used doxycycline. CASE REPORT: A 21-year-old Caucasian female was under dermatological treatment and antibiotic therapy with doxycycline 100 mg (one time a day) for 90 days. She presented brown pigmentation at the gingival margin on the facial surfaces of the upper and lower anterior incisors and premolars. The patient was evaluated by immunohistochemical (S-100, Melan-A, and HMB-45) and histopathologic analyses, and clinical history. Blood levels of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) were analyzed by UV/Vis spectroscopy. The adrenaline, noradrenaline, and dopamine in blood were analyzed by high-performance liquid chromatography (HPLC); dehidroepiandrosterone (DHEA) in serum by radioimmunoassay; and luteinizing hormone (LH) and 25-Hydroxyvitamin D by chemiluminescence. Hematoxylin-eosin stained sections revealed keratinocytes with pigment compatible with melanin. The Fontana-Masson staining was positive in melanophages and in some basal keratinocytes. S-100, Melan A and HMB-45 were confirmed as positive markers of melanocytic differentiation in gingival tissue. We observed a significant increase in malondialdehyde (p˂0.05) and a decrease in superoxide dismutase levels (p˂0.05). The dopamine value was found to be 15 pg/ml (reference value ≤ 10 pg/ml). CONCLUSION: The use of doxycycline is associated with an increase in oxidative stress and of dopamine with melanin pigments in the gingival tissue. This case report showed a cause-effect relationship between exposure to doxycycline and pigmentation of the marginal gingiva.

Masticatory Performance And Impact On Oral Health-Related Quality Of Life In Patients Treated With Immediately Loaded Implant-Supported Prosthesis.

PURPOSE: To compare oral health-related quality of life (OHRQoL) and masticatory performance (MP) in patients treated with a mandibular complete denture (CD) and immediately loaded implant-supported prostheses (ISP). MATERIALS AND METHODS: Forty patients were divided into CD and ISP groups. Initially, all patients were treated with a mandibular CD. Then, 23 patients remained with a CD while 17 patients were treated with an ISP after wearing the CD for 3 months. OHRQoL was measured using the OHIP-EDENT questionnaire, and MP was evaluated by sieving. Data were recorded before treatment (T0) and after 3 months wearing the CD and ISP (T1). RESULTS: CD treatment did not affect OHRQoL and PM; however, patients treated with an ISP presented improvement in OHRQoL (P < .001) and MP (P < .001) with a high effect size (ES) (Cohen's d = 2.49 and 2.47, respectively). For intergroup analysis, ISP treatment presented improvement in OHRQoL and MP compared to CD treatment (P < 0.001) at T1 with a high ES (Cohen's d = 1.80 and 3.29, respectively). The correlation between MP and OHRQoL was positive only for psychologic discomfort in the CD group at T0 (P = .035), suggesting that poor MP increased psychologic discomfort. CONCLUSION: Converting a CD into an ISP had a positive impact on OHRQoL and MP with high ES.

Effect of Adjunctive Probiotic Therapy on the Treatment of Peri-implant Diseases - A Systematic Review.

AIM: The aim of this study was to determine the effects of probiotics on peri-implant diseases. MATERIALS AND METHODS: PubMed-MEDLINE, Scopus, Literature in the Health Sciences in Latin America and the Caribbean (LILACS) and Science Direct were searched until September 2019. Three authors independently carried out this search, using the following search algorithm to explore databases using Boolean operators ("peri-implant diseases" OR "dental implants") AND ("probiotics" OR "lactobacillus"). Randomized clinical trials were included. No limits were applied to the year and articles were restricted to those in the English, Spanish and Portuguese languages. Review articles, reports of clinical cases and works without mention of the topic were excluded. RESULTS: Five randomized clinical trials were analyzed in the final review process. For the primary outcomes - Periodontal probing depth (PPD) and bleeding on probing (BOP); and for the secondary outcames - plaque index, gingival index, gingival crevicular fluid and microbiological tests - no significant clinical effects of probiotics were observed. CONCLUSION: Probiotics could be used during the treatment of peri-implant diseases. However, the most appropriate form of probiotic administration or the effectiveness of this approach are still unclear. There is currently insufficient evidence to demonstrate the benefits of the use of probiotics as an adjunctive therapy in patients with peri-implant diseases.

Oral Health Implications of Bariatric Surgery in Morbidly Obese Patients: An Integrative Review.

BACKGROUND: To identify the implications of bariatric surgery on the oral health of patients with morbid obesity. METHODS: Two reviewers independently performed a search of the electronic databases: MedLine, PubMed, SciELO, LILACS, and Scopus, for clinical trials in humans and cohort studies. The search strategy used was Bariatric Surgery and Oral Health or Mouth Disease and Humans and Periodontitis. A total of 26 articles were obtained, and after title screening and full reading, 8 articles were included in this review. RESULTS: Increased food intake at shorter intervals and increased frequency of regurgitation in these patients were associated with the increased development of dental caries, dental erosion, and increased salivary flow rate. CONCLUSION: Intense oral control is recommended for the prevention and early treatment of these conditions and to avoid nonsystemic effects in these patients.

Caracterização tomográfica das áreas edêntulas previamente à reabilitação com implantes unitários / Tomographic characterization of edentulous areas before rehabilitation with single implant

Introdução: Recursos de imagem são indispensáveis para o diagnóstico e preparação de um plano de tratamento adequado, sendo imprescindível para o sucesso reabilitador com implantes dentários. Objetivo: O objetivo deste estudo seccional foi caracterizar áreas edêntulas de pacientes candidatos à reabilitação com um implante dentário osseointegrado unitário em região estética da maxila por meio das tomografias computadorizadas de feixe cônico (TCFC) e correlacionar parâmetros de interesse. Material e método: Catorze TCFC foram avaliadas em um programa de computador de acordo com os seguintes parâmetros: distância da Junção Cemento-Esmalte (JCE) até a crista óssea (CO), distância entre as CO e distância entre as coroas dentárias dos dentes adjacentes ao espaço protético (EP), largura e altura óssea do EP, espessura do palato na região dos segundos pré-molares e molares bem como a espessura horizontal e vertical do tecido mole na região do EP. Resultado: Os resultados foram analisados por meio de estatística descritiva e do teste de Correlação de Spearman. Correlações fracas e moderadas e sem diferenças estatísticas significativas foram encontradas na maioria das comparações (≤ 0,29 e ≥ 0,30 ≤ 0,49, respectivamente). Apenas para a correlação espessura da mucosa do EP versus distância entre JCE e CO no dente mesial ao EP foi encontrada diferença estatística significativa (p= 0,03) e correlação moderada (r = 0,56). Conclusão: A TCFC é uma ferramenta viável para a região maxilofacial, pois permitiu a mensuração de diversos parâmetros de tecido mole e duro da cavidade bucal úteis para o planejamento e previsibilidade de tratamento reabilitador com implantes dentários.

Introduction: Imaging resources are indispensable to assist the professional dental surgeon in the formulation of the diagnosis and preparation of an adequate treatment plan for the patient, being essential for the successful rehabilitation with dental implants. Objective: The purpose of this cross-sectional study was to characterize the edentulous areas of patients who will be rehabilitated with single osseointegrated dental implant in the aesthetic area of the maxilla by means of computerized tomography and correlate parameters of interest. Material and method: Fourteen cone beam computerized tomographies were evaluated in a program according to the following parameters: distance from the cementoenamel junction (CEJ) to the bone crest (BC), distance between the BC and distance between the dental crowns of the teeth adjacent to the prosthetic space (PS), bone width and height of PS, thickness of the palate in the region of the second premolars and molars as well as the horizontal and vertical thickness of the soft tissue in the PS region. Result: The results were analyzed by means of descriptive statistics and the Spearman Correlation test. Weak and moderate correlations and no statistically significant differences were found in most comparisons (≤ 0.29 and ≥ 0.30 ≤ 0.49, respectively). Only for the correlation between PS mucosa thickness versus distance between CEJ and BC in the mesial tooth to PS was found significant statistical difference (p = 0.03) and moderate correlation (r = 0.56). Conclusion: Cone beam computerized tomography is a viable tool for the maxillofacial region because it allowed the measurement of several parameters of soft and hard tissue of the buccal cavity useful for planning with dental implants, which may increase the predictability of successful rehabilitation treatments.

Toxina botulínica na correção do sorriso gengival: há evidências? / Botulinum toxin for gummy smile correction: is there evidence?

A toxina botulínica tem sido amplamente utilizada para o controle da hiperatividade labial, porém estudos com um acompanhamento longitudinal e criterioso são poucos na literatura. Objetivo: realizar uma revisão integrativa da literatura através da busca de estudos clínicos que mostrem resultados relativos à longevidade e grau de satisfação dos pacientes em relação ao uso da toxina botulínica, o Botox, para correção de sorriso gengival. Material e métodos: dois revisores realizaram a busca eletrônica nas bases de dados Pubmed/Medline, Lilacs, Scopus e Web of Science, além da busca manual nos artigos selecionados. Resultados: foram identificados 149 estudos, dos quais 65 foram excluídos por duplicidade. Onze artigos que abordavam o tema proposto foram lidos na íntegra e apenas dois permaneceram pelos critérios de elegibilidade. Contudo apenas um estudo fez o acompanhamento da correção da exposição gengival durante 24 semanas, e observou-se que houve uma redução da exposição gengival, a qual foi gradualmente aumentando com o passar do tempo, mas não retornou aos valores do baseline. O grau de satisfação dos pacientes foi significativo, alcançando 4,66 em escala de satisfação de 1 a 5 pontos e 9,75, na escala de 10 pontos. Conclusão: a toxina mostrou-se eficaz, porém com efeito transitório no período de 24 semanas. É necessária a realização de estudos clínicos controlados randomizados que acompanhem em longo prazo o seu efeito na redução do sorriso gengival.

Botulinum toxin has been widely used to control lip hyperactivity, however, studies with a longitudinal and solid follow-up are only a few in literature. Objective: to review the literature in search for clinical studies that show results related to the longevity and degree of patient satisfaction regarding the use of botulinum toxin Botox for gingival smile correction. Material and methods: two reviewers performed an electronic search in the Pubmed/Medline, Lilacs, Scopus and Web of Science databases, as well as a manual search of the selected articles. Results: 149 were identified, of which 65 were excluded for duplicity. Eleven articles that addressed the proposed theme were read in full, with only two of them meeting the eligibility criteria. However, only one study did monitor the correction of gingival exposure for 24 weeks and found that it had a reduction of gingival exposure, that gradually increased over time and did not return to baseline values. The degree of patient satisfaction was significant and reached 4.66 on a satisfaction scale of 1 to 5 points and 9.75 on the 10-point scale. Conclusion: the toxin proved to be effective, however, with transient effect in a 24 weeks time. Randomized controlled clinical studies are necessary to test its effect on gingival smile reduction in the long-term.

Tratamento das recessões gengivais utilizando o enxerto de tecido conjuntivo isolado e associado às proteínas derivadas da matriz do esmalte ­ uma revisão integrativa / Gingival recession treatment using subepithelial connective tissue graft isolated and associated to enamel matrix protein ­ an integrative review

Objetivos: A utilização do enxerto de tecido conjuntivo subepitelial é considerada o tratamento padrão-ouro para o recobrimento das recessões gengivais classe I e II de Miller. Porém, alguns fatores como a necessidade de um segundo sítio cirúrgico para a obtenção do enxerto, a limitada quantidade de tecido a ser doado, um maior tempo cirúrgico, e um possível desconforto pós-operatória, tem incentivado pesquisas utilizando biomateriais. Em função disso, o objetivo desta revisão integrativa foi realizar uma comparação entre os tratamentos da recessão gengival utilizando o enxerto de tecido conjuntivo isoladamente, e quando associado às proteínas derivadas da matriz do esmalte, buscando avaliar o benefício da sua utilização em relação aos parâmetros de profundidade de sondagem, nível de inserção clínica, espessura e largura do tecido queratinizado, cobertura de raiz e estabilidade da cobertura radicular ao longo do tempo. Material e métodos: Dois revisores de forma independente realizaram a pesquisa em bases de dados eletrônicas, entre os anos de 2000 e 2016, buscando ensaios clínicos randomizados em humanos. Foram encontrados 266 artigos no total, que após a leitura de título e resumo, e leitura na íntegra, foram selecionados para compor esta revisão 3 artigos. Resultados: Não foram observadas diferenças estatisticamente significativas entre o tratamento com o enxerto de tecido conjuntivo subepitelial isolado e em associação com o Emdogain®, para os parâmetros apresentados. Conclusão: Apesar de ambos os tratamentos apresentarem resultados clínicos satisfatórios, não se apresentam benefícios adicionais da associação do enxerto de tecido conjuntivo com o Emdogain®. (AU)

Objective: The use of subepithelial connective tissue graft is considered the gold standard treatment for the coverage of gingival recessions Miller's Class I and II. However, some considerations as the need of a second surgical procedure to obtain the graft, a limited amount of tissue that can be donated, a longer surgical duration, and a possible post-operative discomfort have improved researches using biomaterials. According to that, the objective of this integrative review was to compare treatments to gingival recession using only subepithelial connective tissue grafts and grafts associated to enamel matrix protein, aiming to evaluate the benefits of its usage considering the probing depths parameters, clinical insertion levels, thickness and width of keratinized tissue, root coverage and its stability through time. Material and methods: Two reviewers searched independently in electronic databases for clinical trials in humans from 2000 to 2016 that were related to this approach. It was found initially 266 articles in total. After title, abstract and full-text reading, three articles were selected to compose this review. Results: It was not observed statistically significant difference between the subepithelial connective tissue graft isolated and associated with Emdogain®. Conclusion: Even though both treatments showed satisfactory clinical results, there is no additional benefit associating the graft and Emdogain®

Comparative evaluation of peri-implant tissues in patients wearing mandibular overdenture with different implant platforms.

BACKGROUND: The poor hygiene of peri-implant tissues causes inflammation at tissue-implant interface, which may impair the rehabilitation success. The aim of this study was to evaluate the influence of external hexagon and Morse taper implants on peri-implant health in patients wearing mandibular overdentures for 1 year. MATERIALS AND METHODS: A total of 46 implants were evaluated, 28 external hexagon and 18 Morse taper. Plaque index in the mini-abutment, bleeding index, peri-implant inflammation, keratinized mucosa zone, probing depth, and marginal mucosa level were evaluated after 3 months and 1 year of prostheses insertion. RESULTS: Deeper probing was found in the external hexagon group compared with Morse taper (P = 0.024) after 1 year of rehabilitation. Although the Morse taper group exhibited worse scenario of peri-implant inflammation than the external hexagon group (P = 0.001), both groups showed reduced inflammation after 1 year. A larger keratinized mucosa zone was observed with external hexagon implants (P = 0.020). No significant difference was found between the groups for plaque index in the mini-abutment, bleeding index, and marginal mucosa level. CONCLUSION: In a follow-up period of 1 year, it was concluded that the external hexagon group had a larger probing depth than the Morse taper group. However, better periodontal conditions about inflammation and keratinized mucosa zone were found in external hexagon implants. It was found no influence of implant platform on plaque index in the mini-abutment, bleeding index, and marginal mucosa level.

Microinfiltração em restaurações de resina composta e sua relação com o ultrassom / Microleakage of composite resin restorations and its relationship with ultrasonic devices

As microinfiltrações em restaurações de resina composta constantemente são referidas como principal motivo de insucesso do procedimento restaurador. Com a necessidade de otimizar o tempo de atendimento aos pacientes e torná-lo menos desconfortável, passou-se a utilizar os aparelhos de ultrassom como instrumentos atuantes no auxílio de procedimentos de raspagem periodontal. Este artigo discorre sobre estudos na literatura que abordam a relação entre o uso da instrumentação ultrassônica em procedimentos periodontais e as deficiências no selamento marginal das restaurações em resina composta(AU)

Microleakage of composite resin restorations is consistently reported as the main reason for failure of this restorative procedure. Ultrasonic devices have been developed to reduce patient's chair time and to make periodontal scaling procedures less uncomfortable. This article discusses studies that address the relationship between the use of ultrasonic instrumentation used for periodontal procedures and failure of the marginal sealing of composite resin restorations(AU)

Clinical Efficacy of Fluoride Varnish and Low-Level Laser Radiation in Treating Dentin Hypersensitivity.

The objective of this study was to compare the efficacy of fluoride varnish (Fluorniz(r)) and irradiation with a gallium-arsenide-aluminum diode laser in the treatment of cervical dentin hypersensitivity. Cervical dentin hypersensitivity (CDH) is a painful condition that is highly prevalent in the world's adult population, with one in six patients presenting this symptom. Eighty-six teeth were divided into two groups: Group 1, teeth treated with Fluorniz; Group 2, teeth irradiated with a GaAlAs laser at a 4 J/cm2 dose. The two treatments were applied to the buccal cervical region in four sessions, at intervals of 72 to 96 h. The response of the patient to tactile and thermal-evaporative stimuli was rated on a visual analog scale. The results showed a reduction of hypersensitivity in response to tactile and thermal-evaporative stimulation at the end of treatment in both groups. In conclusion, short-term treatment with Fluorniz was found to be more effective than low-level laser radiation in reducing cervical dentin hypersensitivity.

Clinical Efficacy of Fluoride Varnish and Low-Level Laser Radiation in Treating Dentin Hypersensitivity

Abstract The objective of this study was to compare the efficacy of fluoride varnish (Fluorniz(r)) and irradiation with a gallium-arsenide-aluminum diode laser in the treatment of cervical dentin hypersensitivity. Cervical dentin hypersensitivity (CDH) is a painful condition that is highly prevalent in the world's adult population, with one in six patients presenting this symptom. Eighty-six teeth were divided into two groups: Group 1, teeth treated with Fluorniz; Group 2, teeth irradiated with a GaAlAs laser at a 4 J/cm2 dose. The two treatments were applied to the buccal cervical region in four sessions, at intervals of 72 to 96 h. The response of the patient to tactile and thermal-evaporative stimuli was rated on a visual analog scale. The results showed a reduction of hypersensitivity in response to tactile and thermal-evaporative stimulation at the end of treatment in both groups. In conclusion, short-term treatment with Fluorniz was found to be more effective than low-level laser radiation in reducing cervical dentin hypersensitivity.

Resumo Este trabalho teve o objetivo de comparar a efetividade das terapias com verniz fluoretado (Fluorniz) e com laser diodo de arseneto de gálio e alumínio (AsGaAl) no tratamento da hipersensibilidade dentinária cervical (HSDC). Foram selecionados 86 dentes divididos em dois grupos. No Grupo I foi aplicado Fluorniz e no Grupo II realizou-se irradiação com laser AsGaAI com dosimetria de 4 J/cm2, ambos na região cervical da face vestibular, em quatro sessões com intervalos de 72 a 96 horas. O registro da resposta do paciente quanto aos estímulos tácteis e termo-evaporativos foi realizado através da escala visual numérica. Os resultados demonstraram que houve uma redução da hipersensibilidade ao final do tratamento tanto para estímulo táctil quanto para o estímulo termo-evaporativo, para ambos os grupos. Concluiu-se que, em curto prazo, a terapia com Fluorniz demonstrou-se mais efetiva que o laser de baixa potência para diminuição da HSDC.

Fatores associados ao sucesso do tratamento cirúrgico das recessões gengivais: revisão da literatura / Factors associated with success of surgical treatment of gingival recessions: literature review

Introdução: A recessão gengival é uma condição de alta prevalência que leva a exposição radicular causando queixas estéticas e sintomáticas e cujo tratamento pode ser de difícil execução caso fatores complicadores estejam associados. Objetivo: Realizar uma revisão da literatura para discutir a influência de determinados fatores sobre os resultados dos procedimentos para recobrimento radicular. Métodos: Artigos foram selecionados nas bases de dados Pubmed, Scopus, Web of Science, Scielo e LILACS. Os critérios de escolha dos artigos foram: escritos em Inglês, Espanhol, Francês ou Português e que fossem classificados como ensaios clínicos. Resultados: A busca resultou em 20 artigos selecionados que avaliaram e discutiram sobre os possíveis fatores influenciadores como fumo (11), lesão cervical não cariosa (5), biótipo periodontal (4) e anatomia local (1). Discussão: O fumo foi o fator mais discutido na literatura cujos resultados mostram que pode interferir negativamente no tratamento cirúrgico da recessão gengival, embora pacientes fumantes possam apresentar bons resultados desde que façam um bom controle do biofilme dentário. Os artigos sobre lesão cervical não cariosa mostram que os resultados do recobrimento radicular são iguais, em curto e em longo prazo, independente da lesão cervical não cariosa estar restaurada ou não ou com qual material restaurador. Indivíduos que apresentam biótipo periodontal espesso apresentaram melhor prognóstico quanto ao recobrimento radicular. Conclusão: O tratamento da recessão gengival é complexo devido estar ligado a vários fatores relacionados ao indivíduo, desde fatores anatômicos a hábitos que o mesmo apresente. A literatura demonstra que o fumo é um dos fatores que limitam a previsibilidade do tratamento das recessões gengivais (AU).

Introduction: Gingival recession is a high prevalence condition that leads to root exposure causing aesthetic and symptomatic complaints and whose treatment can be difficult to perform when factors are associated with. Objective: To perform a literature review to discuss the influence of some factors on the results of root coverage procedures. Methods: Articles were selected in data basis Pubmed, Scopus, Web of Science, Scielo, and LILACS. The inclusion criteria were the language in English, Spanish, French, and Portuguese as well as classified as clinical trials. Results: The search resulted in twenty articles selected which was evaluated and discussed about possible influencing factors such as smoking (11), non-carious cervical lesion (5), periodontal biotype (4), and local anatomy (1). Discussion: Smoking was the most discussed factor whose results demonstrate that it can adversely affect the result of surgical treatment for gingival recession, although smokers can present good results as long as they present a good control of the biofilm. Non-carious cervical lesion articles showed that the results of root coverage are the same, in short and long follow-up, regardless of whether the noncarious cervical lesion was restored or not as well as which restorative material was used. Individuals with thick periodontal biotype have a better prognosis regarding root coverage. Conclusions: The treatment of gingival recession is complex because it is linked to several factors related to the individual, anatomical factors and patients' habits. The literature demonstrates that smoking is one of the factors that limit the predictability of treatment of gingival recessions (AU).

Phenytoin-induced gingival overgrowth management with periodontal treatment.

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

Phenytoin-Induced Gingival Overgrowth Management with Periodontal Treatment

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

O crescimento gengival induzido pela fenitoína é uma complicação comum do uso contínuo da medicacão. Este artigo apresenta um caso de crescimento gengival excessivo que dificultava a função oral e comprometia a higiene oral e a estética, o qual foi tratado com uma combinação de terapias periodontais não-cirúrgicas e cirúrgicas. Paciente masculino de 39 anos de idade foi encaminhado para tratamento odontológico com várias queixas, especialmente do crescimento gengival superior e inferior que prejudicava a fala e deglutição. Profundidades de sondagens severas generalizadas e perda óssea foram detectadas. Diagnóstico de crescimento gengival induzido pela fenitoína e periodontite crônica foi estabelecido. O plano de tratamento consistiu de terapia conservadora com educação, motivação e meticulosa instrução de higiene oral em associação com raspagem e alisamento corono-radicular. Durante o período de reavaliação, uma acentuada redução nos parâmentros clínicos foi observada, principalmente uma redução das profundidades de sondagem. Terapia cirúrgica para remoção do excesso de tecido gengival também foi realizada para conseguir redução das bolsas. Terapia periodontal de suporte foi proposta e o paciente está atualmente sob acompanhamento por um período de 4 anos. O manejo do crescimento gengival induzido pela fenitoína pode ser obtido pelo uso de procedimentos periodontais combinados com uma boa higiene oral e cuidados periodontais de suporte.

Long-term periodontal tissue outcome in regenerated infrabony and furcation defects: a systematic review.

OBJECTIVES: This study aimed to systematically evaluate the long-term results of periodontal tissues in regenerated infrabony and furcation defects. MATERIAL AND METHODS: A search of the Medline database was performed (1960 to 2012), complimented by an additional hand search. For inclusion in the review, clinical trials had to include the long-term evaluation of infrabony and furcation defects submitted to periodontal regeneration for up to 3 years of follow-up. Changes in clinical attachment level (CAL) from pre-surgery, at the first post-surgical, and final evaluations were used to analyze the effects of regenerative treatments over time. RESULTS: A total of 866 articles were found using the descriptors employed. Of these, 216 papers were selected for abstract reading by two evaluators. One hundred and eighty-nine were excluded for not fulfilling the eligibility criteria. Twenty-seven papers were selected for the analysis of the full texts, and 13 were excluded. Two studies were included after a manual search. Finally, 16 papers were selected for the present review. CONCLUSIONS: Regenerative techniques for the treatment of infrabony and furcation defects resulted in improved CAL during long-term follow-up periods, even when attachment losses occurred during this period. This improvement should be carefully evaluated with regard to its clinical relevance for dental longevity. CLINICAL RELEVANCE: The improvement in clinical attachment level achieved by regenerative techniques with biomaterials demonstrated satisfactory results over the long-term. However, regenerative techniques still present different success rates with regard to gain in clinical attachment level.

Tratamento da hipersensibilidade dentinária cervical com laser de baixa potência: revisão de literatura / Low-level laser therapy for treating cervical dentinal hipersensitivity: literature review

A Hipersensibilidade Dentinária Cervical (HSDC) é uma patologia bastante prevalente, sendo, na maioria dos casos, de difícil diagnóstico e tratamento. Existem várias formas de tratamento, porém seus resultados são parciais e não duradouros. Nos últimos anos, os lasers têm merecido especial atenção, tanto os de alta como os de baixa intensidade. Tendo em vista uma grande variação nas formas de utilização desses lasers, constitui propósito deste estudo avaliar os trabalhos encontrados na literatura quanto às metodologias empregadas e os seus resultados. Diante dos poucos trabalhos encontrados, podemos concluir que a terapia a laser tem-se demonstrado promissora para o tratamento da HSDC, porém mais estudos devem ser realizados, visando ao estabelecimento de uma metodologia reprodutível e confiável para pesquisas na área, o que levará a resultados mais confiáveis.

The dentinal hipersensibility (HSDC) is a very prevalent pathology that, in most of the cases presents a hard diagnostic and difficulty of treatment. There are many forms of treatment, however with parcial results. In these past few years laser therapy have been in focus, as much as low and high power. The purpose of this study is to inquire into the methodology and results found in suitable literature. In front of a little amount of articles avaliable in literature we have to conclude that laser therapy have been shown a promising way to treat dentinal hipersensibility. Therefore, we should go deeper into the studies to establish a reproducible methodolgy in aid of research, providing reliable results.

A importância do restabelecimento da dimensão vertical de oclusão na reabilitação protética / The importance of restoring occlusal vertical dimension in the prosthetic rehabilitation

Introdução: O restabelecimento da dimensão vertical de oclusão (DVO) é de grande importância para a confecção de trabalhos protéticos, embora não seja levada em consideração na maioria dos planejamentos. Objetivo: Este trabalho teve o propósito de, através de uma revisão da literatura, discutir aspectos relacionados com os danos causados pela alteração da DVO, métodos para a sua determinação e técnicas para o seu restabelecimento. Conclusão: Após a análise da literatura se observou que: caso a DVO não for restabelecida corretamente, permanecendo o aumento ou a diminuição desta, haverá a produção de danos aos dentes, músculos, articulação, deglutição e fonação, e até mesmo na postura do paciente, podendo afetar seu equilíbrio. Em relação aos métodos de determinação da DVO, dentre os mais comumente utilizados são o métrico, o fonético e o das proporções faciais, sendo que todos têm suas limitações e devem ser utilizados associados, para diminuir a possibilidade de erros. A utilização de próteses provisórias antes do tratamento protético definitivo é indicada para uma melhor avaliação da resposta do paciente ao restabelecimento da DVO. Sendo assim, o estabelecimento de um protocolo de atuação aproximando a prática clínica com a ciência é a melhor forma de se desenvolver um tratamento reabilitador de excelência.

Introduction: Restoration of occlusal vertical dimension (OVD) is of great importance for the preparation of prosthetic works, although it is not taken into consideration in most treatment planning. Aim: This study aimed to, through a literature review, discuss issues related to the damage caused by the change in OVD, methods for their determination and techniques for its restoration. Conclusion: It was conclude that: if the OVD is not properly restored, remaining the increase or decrease of this, they will produce damage to teeth, muscles and TMJ, in swallowing and speech, and even the posture of the patient and may affect your balance, there are several methods for the OVD determination and are classified as metric, phonetic or facial proportions. They all have their limitations and can be used associated to decrease the possibility of errors, the use of temporary prosthesis before definitive prosthetic treatment is indicated for a better assessment of the patient’s response to the restoration of DVO, and establishing a protocol of action approaching science with clinical practice is the best way to develop a rehabilitation treatment for excellence.

Avaliação do ganho ósseo em espessura nas reconstruções de pré-maxila com transplantes homógenos / Evaluation of thickness improvement after grafting at the pre-maxillary region with homogenous transplants

Dentre as técnicas mais utilizadas para as reconstruções ósseas encontram-se os transplantes homógenos, pois têm grau de confiabilidade elevado, além de ser uma técnica menos invasiva, mais rápida e sem necessidade de uma área doadora. O objetivo do estudo foi avaliar quantitativamente, por meio de mensurações em tomografias computadorizadas, o ganho em espessura, observado quando do uso de enxertos homógenos. Foram avaliados oito pacientes, quatro do sexo feminino e quatro do sexo masculino, na faixa etária de 33 a 66 anos, submetidos a transplante ósseo homógeno na pré-maxila. Foram obtidas as mensurações na região de fossa canina tendo-se como base a face distal da fossa nasal. Após o período de seis meses do transplante, os pacientes foram submetidos a cirurgia de instalação de implantes, onde se pode observar clinicamente a qualidade óssea durante a perfuração e a estabilização primária por meio do torque. Para análise estatística, os dados foram avaliados com auxílio do programa GraphPad Prism 4.0, através de teste pareado test-t e teste não paramétrico com valor de p: 0,05. Os resultados mostraram diferença estatisticamente significante na espessura após os seis meses (p < 0,001), representada por um ganho médio de 5,9 mm no lado direito, bem como ganho de 5,8 mm no lado esquerdo. Concluiu-se que houve ganho considerável em espessura, além de excelente aspecto final ao exame clínico, juntamente com boa estabilização primária dos implantes, justificando a utilização dos enxertos homógenos como alternativa viável nas reconstruções ósseas em perdas maxilares.

Homogenous transplants are among the most used techniques used for bone reconstruction, having a high degree of reliability, less invasiveness, and not requiring a donor site as well. The purpose of this study was to evaluate by means of CT scans the thickness improvement after grafting at pre-maxilla regions. Eight patients (four female, four male) aged between 33 and 66 years-old, undergone homogenous bone transplantation. CT measurements were taken at the canine fossa region, based on the distal surface of the nasal cavity. After six months the implants were placed in areas of good clinical bone quality and adequate stability measured on torque values. Data were analyzed with paired t-test and non-parametric tests (p = 0.05) using the GraphPad Prism 4.0. The results showed a statistically significant difference in thickness after six months (p < 0.001), represented by an average gain of 5.9 mm on the right side, and a gain of 5.8 mm on the left side. It was concluded that there was a considerable gain in thickness along with excellent final clinical examination and good implant primary stability, being the homogenous graft a viable alternative to reconstruct maxillary bone loss

Efeito Antiálgico do Laser AsGaAl na Punção Anestésica / Analgesic Effect of GaAlAs Laser on Anesthetic Action

Objetivo: Este trabalho teve como objetivo avaliar a capacidade do laser de baixa potência em reduzir a sensação dolorosa durante a injeção da substância anestésica. Metodologia: Para isso, foram selecionados sessenta pacientes que iriam receber anestesia na região do palato. Esses pacientes foram divididos em três grupos: o grupo I recebeu irradiação com laser de AsGaAl antes da anestesia; o grupo II recebeu irradiação com a luz do fotopolimerizador antes da anestesia (placebo), e o grupo III não recebeu nenhum tratamento. A sensibilidade foi registrada por meio de uma escala visual numérica (EVN). Resultados: Após a análise dos resultados, pôde-se concluir que o laser de baixa potência de Arseniato de Gálio-Alumínio, segundo protocolo utilizado, promoveu uma redução da dor resultante da aplicação do anestésico na região do palato, quando utilizado previamente ao ato anestésico.

Porpuse: The aim of this study was to evaluate the low level laser capacity in reducing the pain during the anesthetic injection. Metodology: Sixty patient that would receive anesthesia in palate area were selected. Those were divided in three groups: the group I received irradiation with Gallium/Aluminium/Arsenide (GaAlAs) laser before the anesthesia, the group II received irradiation with the light curing unit device before the anesthesia (placebo) and the group III didn't receive treatment. The sensibility was registered through a numeric visual scale (NVS). Results: After the analysis of the results it can be ended that the GaAlAs low level laser, according the parameters used, promoted a pain reduction resulting from the anesthetic application in palate area, when previously used to the anesthetic action.