15-Year Retrospective Study on the Success Rate of Maxillary Sinus Augmentation and Implants: Influence of Bone Substitute Type, Presurgical Bone Height, and Membrane Perforation during Sinus Lift.

Objectives: To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study. Results: The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years. Conclusions: Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.

Can Implant-Retained Fixed Prostheses Trigger Bone Response in the Posterior Region of Edentulous Mandibles? A 32-Month Cone-Beam Computerized Tomography Study Analyzing Bone Height and Density.

Research has shown that the presence of implants can revert bone resorption and thus contribute to a greater preservation of the residual bone ridge, especially in edentulous mandibles. Bone remodeling has yet to be extensively studied in the context of prosthetic options for edentulous arches. This study aims to evaluate the long-term behavior of bone tissue in the posterior region of edentulous mandibles rehabilitated with implant-retained fixed prostheses using cone-beam computerized tomography (CBCT). Selected individuals were rehabilitated with 5 external hexagon platform implants and an implant-retained fixed prosthesis. The CBCT scans were performed immediately after surgery and after 8, 22, and 32 months (T0, T8, T22, and T32, respectively). Implants were installed between the mental foramen. Subsequently, bone crest height and density were measured in the posterior region of the mandible on the images in 3 distinct areas at 5, 10, and 15 mm from the center of the distal implant axis. Analysis of variance and the Bonferroni post hoc test were used for multiple analyses. The results indicate a statistically significant difference in bone height between T0 and all subsequent times; the bone height at T32 was 8.85% higher than at T0 (P = .05). There was a difference in bone height between all analyzed regions. The bone growth difference between the 5-mm and 15-mm positions was 28.42% after 32 months (P = .00). A significant increase of 5.76% in bone density was observed between T0 and T22 (P = .03). Within the limitations of this study (sample size, follow-up duration), it was demonstrated that the use of implant-retained fixed prostheses in the mandible resulted in qualitative and quantitative bone growth (bone preservation) in the posterior region of the mandible. Further research is needed to identify the validity of our findings for other populations and to determine the duration of the bone-remodeling process in rehabilitated edentulous mandibles.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures.

STATEMENT OF PROBLEM: Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain. PURPOSE: The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs. MATERIAL AND METHODS: Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL. RESULTS: The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men. CONCLUSIONS: The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

Bone response after immediate placement of implants in the anterior maxilla: a systematic review.

PURPOSE: The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla. METHODS: After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochrane, and Scopus. In addition, the gray literature was also researched using Google Scholar and ProQuest. Two reviewers independently screened for eligible studies, assessed the methodological quality, and extracted the data. The inclusion criteria were observational studies and experimental studies that assessed bone response after the immediate installation of a single implant in a fresh extraction socket, immediately loaded or not, in the region between the maxillary canines. Studies were included in any language, with no publication date restrictions and with a minimum of 6 months of follow-up after the surgical procedure. RESULTS: From a total of 3272 articles, only 12 studies met the inclusion criteria and were selected for the review. Bone remodeling after immediate installation of a dental implant was assessed using standardized periapical radiographs and cone beam computed tomography (CBCT). CONCLUSION: It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation.

Implante imediato com a técnica Socket Shield ­ relato de uma complicação / Immediate implants according to Socket Shield technique ­ report of a complication

A técnica socket shield é descrita como a retenção parcial de uma raiz em combinação com a instalação imediata de implantes. Tem como justificativa principal a manutenção do tecido ósseo vestibular em áreas estéticas. O objetivo deste artigo é relatar um caso clínico no qual uma série de implantes foi instalado, entre eles, um de acordo com a técnica socket shield e descrever uma situação clínica observada. Em avaliação clínica e tomográfica, após um ano em função, observou-se o deslocamento do fragmento radicular com reabsorção da parede óssea vestibular, porém sem sintomatologia clínica ou perda de função do implante. A pressão exercida durante a instalação do implante provocou o deslocamento do remanescente dentário. Posteriormente, em acompanhamento de 3 anos, observou-se manutenção e estabilização do fragmento deslocado. Pode ser concluído que a pressão exercida durante a instalação do implante provocou o deslocamento gradativo do remanescente dentário mantido propositalmente durante a instalação de um dos implantes. Porém, a prótese implantossuportada manteve-se em função (AU).

Socket shield technique is described as the partial retention of a root fragment combined to the immediate installation of an implant. It is justified by the maintenance of bone tissue in aesthetic areas. The aim of this paper is to report a clinical case in which a series of implants was inserted, one of them according to the socket shield technique, and to describe a related complication. In a clinical and tomographic evaluation, after one year in function, it was observed the displacement of the root fragment with reabsorption of the vestibular bone wall, but with no clinical symptomatology or loss of implant function. Afterwards, in the 3-year follow-up, it was observed maintenance and stabilization of the displaced fragment. It can be concluded that there was a complication in the technique observed by the buccal displacement of the intentionally left root fragment during the insertion of one implant. Nevertheless, the implant supported prosthesis remained in function (AU).

Retrospective evaluation of the survival rate of single tooth prostheses supported in external hexagonal implants: mean follow-up of 9 years / Avaliação retrospectiva do índice de sobrevivência de próteses unitárias suportadas em implantes de hexágono externo: média de acompanhamento de 9 anos

Introduction: The use of osseointegrated dental implants for the rehabilitation of patients has revolutionized dentistry. Objective: To retrospectively evaluate the survival rate and the frequency of complications with external hexagon platform supporting single crowns. Material and method: Dental forms of 110 patients who received 143 implants at the Ilapeo College (2004-2015) were used. The variables were: age, gender, systemic involvement at the time of surgery, region, implant design, type of surface, fixation system, pillar type and prosthesis material. The outcome variables were the incidence of complications in the implant or prosthesis and time in use. The mean follow-up period was 9 years. Result: 32.8% had some systemic disease. Ninety-six implants (67.1%) were installed in the maxilla and 47 (32.9%) in the mandible, 87 (60.8%) were in the posterior region and 56 (39.2%) in the anterior region, while 40 (28%) were placed in regions that had received bone reconstruction. The majority (97.2%) of the implants presented surface treatment, 42% had a cylindrical design and 58% were tapered. The majority of the prosthetic components (89.6%) used were UCLAs and most of the prostheses were fused-to-metal (79.7%). The rate of prosthetic complications was 19.58% and three implants had been lost (97.9% survival rate). There was no statistical difference between the variables analyzed for both the occurrence of prosthetic complications and for the loss of the implant. Conclusion: Implants with external hexagon connection were an effective and predictable option to support crowns and had high survival rates.

Introdução: O uso de implantes dentários osseointegrados para a reabilitação de pacientes revolucionou a Odontologia. Objetivo: Avaliar retrospectivamente o índice de sobrevivência e a frequência de complicações com plataformas de hexágono externo suportando coroas unitárias. Material e método: Foram utilizados prontuários de 110 pacientes que receberam 143 implantes na Faculdade Ilapeo (2004-2015). As variáveis foram: idade, sexo, envolvimento sistêmico no momento da cirurgia, região, desenho do implante, tipo de superfície, sistema de fixação, tipo de pilar e material da prótese. As variáveis de desfecho foram a incidência de complicações nos implantes e/ou próteses e o tempo em função. O tempo médio de acompanhamento foi de 9 anos. Resultado: 32,8% apresentavam alguma alteração sistêmica. Noventa e seis implantes (67,1%) foram instalados na maxila e 47 (32,9%) na mandíbula, 87 (60,8%) estavam em região posterior e 56 (39,2%) em região anterior, enquanto 40 (28%) necessitaram reconstrução óssea prévia. A maioria dos implantes (97,2%) apresentava tratamento de superfície, 42% eram cilíndricos e 58% cônicos. A maioria dos componentes protéticos (89,6%) eram UCLAs e a maioria das próteses fundidas em metal (79,7%). O índice de complicações protéticas foi de 19,58% e 3 implantes foram perdidos (97,9% de índice de sobrevivência). Não houve diferença estatística em relação às variáveis estudadas e a ocorrência de complicações protéticas e perda de implantes. Conclusão: Implantes com plataforma de hexágono externo são uma opção efetiva e previsível de reabilitação unitária e apresenta elevado índice de sobrevivência.

Soft tissue behavior around dental implants placed in fresh extraction sockets and immediately restored in esthetic area: a preliminary short-term evaluation / Comportamento dos tecidos moles ao redor de implantes instalados em alvéolos frescos e imediatamente restaurados em área estética: uma avaliação preliminar a curto-prazo

Objective: To assess the behavior of the peri-implant soft margin after immediate implant placement with immediate function, by (1) direct clinical measurements of peri-implant soft margin height and thickness, (2) measurements of peri-implant soft margin height on photographs and (3) the perception of dental professionals regarding the results considering esthetic parameters. Material and method: The study included 8 patients with central or lateral incisors indicated to be extracted. Direct measurements of peri-implant soft margin height and thickness were done immediately before extraction (T0) and 1 (T1), 4 (T2), 8 (T3) and 12 (T4) months after the flapless insertion of the implant. Photographs were taken at the same time intervals. A questionnaire was filled in by implantology professionals regarding their visual perception of color and peri-implant soft margin architecture and harmony in the implant region using the photographs obtained at T4. Result: The clinical results showed significant changes to the height of the peri-implant soft margin, but the photographic results did not show significant changes for this measurement. The thickness of the attached gingiva was maintained during all the observation period. Of the professionals interviewed, 35.2% noticed an altered peri-implant soft margin color of the implant region, 39.8% noticed a change in the peri-implant soft margin architecture and 12.5% ​​noticed a change in the peri-implant soft margin harmony. Conclusion: The soft tissues around immediate implants changed during this period, but did not affect the aesthetic outcome and in the opinion of professionals, the aesthetic results were satisfactory for these cases.

Objetivo: Avaliar o comportamento do tecido gengival após a instalação de implantes imediatos em função imediata, por meio de (1) medidas clínicas diretas de altura e espessura da margem de tecido mole peri-implantar, (2) medidas de altura gengival em fotografias, e (3) percepção de profissionais da área de odontologia em relação a parâmetros estéticos. Material e método: O estudo incluiu 8 pacientes com incisivo central ou lateral indicados para extração. Medidas diretas de altura e espessura da margem de tecido mole peri-implantar foram realizadas imediatamente antes da extração (T0) e 1 (T1), 4 (T2), 8 (T3) e 12 (T4) meses após a instalação de implante sem abertura de retalho. Fotografias foram tiradas nos mesmos tempos. Um questionário foi respondido por Implantodontistas em relação à percepção visual dos mesmos sobre coloração, arquitetura da margem de tecido mole peri-implantar e harmonia na região do implante usando fotografias obtidas no T4. Resultado: Os resultados clínicos mostraram alterações significantes na altura da margem de tecido mole peri-implantar, mas nas fotografias não foi observada diferença estatisticamente significante para essa mesma medida. A espessura da gengiva inserida se manteve durante todo o período de observação. Dos profissionais entrevistados, 35,2% observaram coloração alterada na região do implante, 39,8% identificaram alteração na arquitetura da margem de tecido mole peri-implantar e 12,5% ​​alteração na harmonia da margem de tecido mole peri-implantar. Conclusão: Os tecidos moles ao redor de implantes imediatos sofreram alterações durante o período estudado, mas não afetaram o resultado estético e na opinião dos profissionais os resultados foram satisfatórios.

Estudo observacional retrospectivo sobre o índice de sobrevivência de implantes com superfície com aumento de molhabilidade / A retrospective observational study of the survival rate of implants with larger wettability surface

O propósito desse estudo foi avaliar, retrospectivamente, o índice de sobrevivência de implantes com tratamento de superfície para aumento de molhabilidade instalados em ambos os maxilares e submetidos ou não à carga imediata. Um total de 78 pacientes (17 homens e 61 mulheres), nos quais 182 implantes foram instalados, compuseram a amostra. Todos os implantes foram instalados em pacientes com diferentes situações clínicas, podendo ser reabilitações unitárias, parciais ou totais, nos cursos de pós-graduação do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO), entre 2011 e 2015. Cento e dezenove implantes (65,38%) foram instalados em maxila e 63 (34,61%) em mandíbula, sendo que em 156 (85,71%) foi aplicada carga imediata. O índice de sobrevivência total foi de 98,90% (180 implantes). Houve perda de apenas 2 implantes instalados em maxila. A perda foi constatada após 5 semanas em ambos os casos. Consideradas as características do estudo, a metodologia aplicada, o tamanho e as características da amostra, o tempo de acompanhamento, bem como a diversidade de variáveis daí decorrentes, parece aceitável concluir, com base nos resultados aqui encontrados e discutidos, que os implantes com tratamento de superfície com aumento de molhabilidade, ora observados, apresentaram altas taxas de sobrevivência dentro dos critérios estabelecidos neste estudo (AU).

The aim of this study was to evaluate, retrospectively, the survival rates of implants with surface treatment that increased wettability, installed in both jaws, and submitted or not to immediate loading. The sample was composed of 78 patients (17 men and 61 women), in which 182 implants were installed. All implants were installed by dentists in post-graduate courses of the Latin American Institute of Research and Dental Education (ILAPEO), between 2011 and 2015. One hundred and nineteen implants (65.38%) were installed in the maxilla and 63 (34.61%) in the mandible, and 156 (85.71%) was applied immediate load. The overall survival rate was of 98.90% (180 implants). Only 2 implants placed in the maxilla were lost, and in both cases the loss was noticed after 5 weeks. Considering the parameters of the study, the methodology, sample size and characteristics, follow-up period and diversity of the variables, it seems acceptable to conclude, based on the present discussed results, that the implants with surface treatment with increased wettability, presented high survival rates according to the criteria considered in this study (AU).

Simplifying the Treatment of Bone Atrophy in the Posterior Regions: Combination of Zygomatic and Wide-Short Implants-A Case Report with 2 Years of Follow-Up.

The rehabilitation of maxillary and mandibular bone atrophy represents one of the main challenges of modern oral implantology because it requires a variety of procedures, which not only differ technically, but also differ in their results. In the face of limitations such as deficiencies in the height and thickness of the alveolar structure, prosthetic rehabilitation has sought to avoid large bone reconstruction through bone grafting; this clinical behavior has become a treatment system based on evidence from clinical scientific research. In the treatment of atrophic maxilla, the use of zygomatic implants has been safely applied as a result of extreme technical rigor and mastery of this surgical skill. For cases of posterior mandibular atrophy, short implants with a large diameter and a combination of short and long implants have been recommended to improve biomechanical resistance. These surgical alternatives have demonstrated a success rate similar to that of oral rehabilitation with the placing of conventional implants, allowing the adoption of immediate loading protocol, a decrease in morbidity, simplification and speed of the treatment, and cost reduction. This case report presents complete oral rehabilitation in a patient with bilateral bone atrophy in the posterior regions of the maxilla and mandible with the goal of developing and increasing posterior occlusal stability during immediate loading.

Risk factors associated with the failure of miniscrews - A ten-year cross sectional study.

The aims of this study were to identify (1) patient-related factors (sex, age, craniofacial pattern and smoking habit), (2) miniscrews implants (MSI)-related factors (length and diameter) and (3) location-related factors [bone (maxilla or mandible) and area (buccal, lingual and alveolar ridge)] that may be associated with MSI loss of stability. A total of 1356 MSI were installed in 570 patients (423 females and 147 males) with mean age of 42.7 during a 10-year period and were clinically evaluated once a month until the end of the proposed movement. Length (5, 7, 9 and 11 mm) and diameter (1.3, 1.4 and 1.6 mm) of the MSI were selected according to insertion site. The evidence of clinical mobility during treatment or fracture during insertion was considered as failure. A total success rate of 89.1% was observed. There was no statistically significant difference in loss of stability when considering age, sex, craniofacial pattern or smoking habit. Considering diameter, there was no statistically significant difference (p = 0.645), but the shorter miniscrews (5 mm) showed higher failure rates (p < 0.001) than the longer ones. There were more loses (p < 0.001) in the mandible than in the maxilla, but the area (buccal, lingual or alveolar ridge) did not interfere in the results (p = 0,421). It can be concluded that MSIs are effective for skeletal anchorage in orthodontics. Patient-related factors, such as sex, age, smoking habit and craniofacial pattern, did not affect MSI success. However, the use of shorter MSIs (5 mm) was inversely proportional to failure probability, and loss of stability was greater in the mandible.

Estudo comparativo entre dois diferentes métodos de ancoragem esquelética para intrusão de molares superiores / Comparative study of two different methods of skeletal anchorage for upper molar intrusion

O objetivo deste trabalho foi comparar a efetividade de dois dispositivos de ancoragem ortodôntica, nos movimentos de intrusão de molares superiores. Neste estudo clínico prospectivo, 12 indivíduos que necessitavam de intrusão de molares superiores receberam miniplacas e mini-implantes para proporcionar ancoragem esquelética temporária. Observaram-se os aspectos clínicos e os sintomas pós-operatórios, bem como a efetividade dos métodos. Houve a perda de uma miniplaca por infecção e de mini-implantes palatinos, por falta de higiene local. Os dois tipos de dispositivos de ancoragem se mostraram capazes de auxiliar o movimento ortodôntico de intrusão sem causar nenhum tipo de prejuízo aos pacientes.

The aim of this study was to compare the effectiveness of two orthodontic anchorage devices for upper molar intrusion. In this prospective clinical study, 12 subjects received miniplates and mini-implants to provide temporary skeletal anchorage. Clinical and postoperative symptoms were observed as well as the effectiveness of both methods. One miniplate and palatal mini-implants were lost due to lack of local hygiene. Both types of anchoring devices can help orthodontic intrusion movement without patient compromising.

Prótese híbrida mandibular imediata confeccionada pela técnica do assentamento passivo: cinco anos de acompanhamento clínico e radiográfico / The immediate mandibular hybrid prosthesis fabricated with the passive fit technique: five years of clinical and radiographic follow-up

O objetivo deste artigo foi descrever a técnica do assentamento passivo para confecção da estrutura metálica de próteses híbridas, por meio do relato de um caso clínico com acompanhamento em longo prazo. Paciente do sexo masculino, 44 anos, compareceu à clínica de Implantodontia do Instituto Latino Americano de Pesquisa e Ensino Odontológico (Ilapeo) relatando insatisfação devido à instabilidade da prótese total inferior. Foi planejada e executada a reabilitação do paciente com a instalação de cinco implantes entre os forâmenes mentuais, e uma prótese híbrida no sistema de carga imediata. O procedimento cirúrgico e a instalação da prótese definitiva foram realizados no mesmo dia. A agilidade de entrega da prótese foi possível devido à técnica utilizada para a confecção da estrutura metálica, denominada técnica do assentamento passivo, a qual elimina a necessidade de prova e solda da estrutura. A prótese permanece com a caraterística de reversibilidade, por ser parafusada, mas com a passividade das próteses cimentadas. O paciente foi acompanhado durante cinco anos e oito meses, não apresentou complicação e está totalmente satisfeito com o tratamento. Concluiu-se que a técnica do assentamento passivo reduz o tempo clínico e simplifica as etapas laboratoriais. Além disso, garante um adequado ajuste entre implante e prótese, favorecendo a longevidade da reabilitação.

The aim of this article was to describe the passive fit technique for the framework fabrication of hybrid prostheses through a clinical case presentation. A female, 44 years-old patient was examined at the Ilapeo clinics concerning about the instability of her lower mandibular denture. Five implants were planned and placed between the mental foramina to receive the mandibular hybrid prosthesis under immediate loading. The surgical and prosthodontic procedures were performed in the same day. This quick procedure to fabricate the metallic framework is known as the passive fit technique, which eliminates the try-in and soldering. Its retrievability is maintained, but with the advantage of a passive, cemented prosthesis. The patient has been followed-up for 5 years and 8 months, with no complications identifi ed, being completely satisfi ed with the proposed treatment. Besides, an adequate fit between the dental implants and the prosthesis is warranted, which favors the longevity of this rehabilitation procedure.

Risk factors associated with the failure of miniscrews - A ten-year cross sectional study

Abstract The aims of this study were to identify (1) patient-related factors (sex, age, craniofacial pattern and smoking habit), (2) miniscrews implants (MSI)-related factors (length and diameter) and (3) location-related factors [bone (maxilla or mandible) and area (buccal, lingual and alveolar ridge)] that may be associated with MSI loss of stability. A total of 1356 MSI were installed in 570 patients (423 females and 147 males) with mean age of 42.7 during a 10-year period and were clinically evaluated once a month until the end of the proposed movement. Length (5, 7, 9 and 11 mm) and diameter (1.3, 1.4 and 1.6 mm) of the MSI were selected according to insertion site. The evidence of clinical mobility during treatment or fracture during insertion was considered as failure. A total success rate of 89.1% was observed. There was no statistically significant difference in loss of stability when considering age, sex, craniofacial pattern or smoking habit. Considering diameter, there was no statistically significant difference (p = 0.645), but the shorter miniscrews (5 mm) showed higher failure rates (p < 0.001) than the longer ones. There were more loses (p < 0.001) in the mandible than in the maxilla, but the area (buccal, lingual or alveolar ridge) did not interfere in the results (p = 0,421). It can be concluded that MSIs are effective for skeletal anchorage in orthodontics. Patient-related factors, such as sex, age, smoking habit and craniofacial pattern, did not affect MSI success. However, the use of shorter MSIs (5 mm) was inversely proportional to failure probability, and loss of stability was greater in the mandible.

Immediate Loading of Edentulous Mandible With Prefabricated Bars: A Long-Term Study of 7 Years.

PURPOSE: To present clinical data from a 7-year follow-up study of edentulous mandibles rehabilitated according to an immediate loading protocol with prefabricated bars. MATERIALS AND METHODS: Forty-four implants were inserted in 11 patients and were evaluated by means of resonance frequency analysis (RFA) and clinical and radiographic examination. RESULTS: Ten patients returned for the 7-year evaluation and presented no implant loss. The stability measurements were performed immediately after implant placement (T0 = 64.5 ± 6.6 ISQ) and 1 year (T1 = mean 66.8 ± 4.2 ISQ), and 7 years (T7 = mean 62.8 ± 5.4) after being in function. The analysis of the RFA values showed a statistically significant decrease in implant stability after 7 years in function, although the final values are considered adequate for treatment success. Panoramic x-ray examination showed bone loss greater than the first thread in 10 implants. CONCLUSION: According to the obtained data, it can be concluded that immediate loading according to this protocol with prefabricated bars is a valid treatment option for edentulous patients providing sufficient long-term success.

Peri-implant bone response following immediate implants placed in the esthetic zone and with immediate provisionalization--a case series study.

PURPOSE: The aim of this case series was to evaluate success and peri-implant bone response around Morse taper immediate implants with an immediate provisionalization. METHODS: Twelve immediate implants were inserted in the maxilla of nine consecutively treated patients. Proximal bone response was evaluated with digital periapical radiographs, and the buccal wall height and width were evaluated with computed tomography. RESULTS: A slight decrease in the marginal bone crest (0.14 ± 0.41 mm) at the mesial face and an increase (0.07 ± 1.58 mm) at the distal face were observed. Considering the point where bone tissue meets the implant surface, there was a statistically significant increase at the mesial face (0.92 ± 1.29 mm) and a not significant increase at the distal face (0.43 ± 1.63 mm). Buccal bone wall width showed a statistically significant bone loss at the level of the implant/abutment junction (0.77 ± 0.75 mm) and at 3 mm (0.59 ± 0.76 mm) and 6 mm (0.46 ± 0.81 mm) apically to the implant/abutment junction. The height of the buccal wall showed a not statistically significant resorption (0.20 ± 0.51 mm). CONCLUSION: Based on the preliminary results (8 months) of this case series study, it can be concluded that there was bone loss on the mesial bone crest level and on the buccal face and bone increases on the mesial and distal faces in the area where the bone meets the implant surface. Nevertheless, this is just a case series study, and long-term controlled clinical trials are essential for a definitive conclusion.

Considerações mecânicas sobre a verticalização de molar inferior associada à ancoragem esquelética temporária: relato de caso / Mechanical considerations about mandibular molar uprighting with skeletal anchorage: case report

A verticalização de molares é um movimento frequente na clínica ortodôntica, no entanto, a maioria das mecânicas empregadas causa a extrusão do molar, gerando interferências oclusais, abertura de mordida e problemas periodontais. O propósito deste artigo é a resolução de um caso clínico de verticalização do segundo molar inferior e a apresentação e discussão do sistema de forças do cantilever duplo. As vantagens da técnica do arco segmentado utilizando cantileveres, associadas à ancoragem esquelética com mini-implante, foram abordadas no presente artigo como uma alternativa mecânica para obter maior controle das forças que atuam na verticalização do molar e redução dos efeitos indesejáveis gerados nos dentes adjacentes. Como consideração final, pode-se afirmar que a verticalização de dentes posteriores utilizando um sistema de forças estaticamente determinado, como o cantilever duplo associado à ancoragem esquelética temporária, mostrou-se uma opção de mecânica eficiente com excelente controle vertical.

Molar uprighting is a common movement in orthodontic practice, however, most of the applied mechanical cause molar extrusion, creating occlusal interferences, bite opening, and periodontal problems. The purpose of this paper is to present a case of a lower second molar uprighting and a discussion about force system with double cantilevers. The advantages of the segmented arch technique using cantilevers, associated with skeletal anchorage with mini-implants, were addressed in this article as a mechanical alternative to obtain greater control of the forces acting on the molar uprighting and reduction of the undesirable effects on the adjacent teeth. As a final consideration, it can be said that the uprighting of posterior teeth using a statically determined system of forces, as double cantilever associated with temporary skeletal anchorage, proved to be an efficient mechanical option with excellent vertical control.

Benefits of rehabilitation with implants in masticatory function: is patient perception of change in accordance with the real improvement?

This study aimed to compare the index of satisfaction and masticatory function of edentulous patients before and after rehabilitation and to evaluate if patients' perception of the changes in their oral health status is in agreement with the results of masticatory performance test. Fourteen edentulous patients were rehabilitated with lower implant-supported fixed prosthesis and upper removable dentures. Index of satisfaction and masticatory capacity (subjective analysis) and performance test (objective analysis) were evaluated before and 20 days and 8 months after rehabilitation. The patients were asked to respond a yes/no masticatory capacity questionnaire and to rate their oral satisfaction on a 0 to 10 Visual Analogue Scale (VAS). Masticatory performance test comprised the ability of the individual to pulverize an artificial test food (Optocal), after 20 and 40 masticatory strokes. When baseline answers were compared to answers 8 months after treatment, all questions, excepting the ones that considered pain and social disability, were statistically different. Wilcoxon test was used to compare index of satisfaction before and after treatment. All answers showed statistically significant differences, excluding the one that referred to ease of cleaning the prostheses. Considering the masticatory performance test, Student t test (normally distributed) and Wilcoxon test (non-normally distributed) were used to test the null hypothesis that the weight of the particles of the test food left in sieves were equal in all times of evaluation. In the larger sieve with 20 cycles, statistically significant differences were observed between baseline and 8 months, 20 days and 8 months. With 40 strokes, baseline and 20 days, baseline and 8 months and 20 days and 8 months showed significant differences. It was concluded that oral rehabilitation leads to better masticatory function in edentulous patients and there is a coincidence between patient perception and real improvement on masticatory function.

Attachment-retained gingival prosthesis for implant-supported fixed dental prosthesis in the maxilla: a clinical report.

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant-fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant-fixed dental prosthesis associated with an attachment-retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.

Análise radiográfica e tomográfica do reparo ósseo na instalação e carga imediata de implantes cone-morse, com provisionalização imediata e uso de biomaterial: série de casos / Radiographic and tomographic analysis of bone repair in the immediate placement and loading of morse taper implants with immediate provisional restoration and use of biomaterial: case series

Objetivo: avaliar o comportamento ósseo ao redor de implantes cone-morse, imediatamente instalados após exodontia e carregados com prótese provisória imediata e biomaterial concomitante. Material e métodos: oito pacientes tiveram seus dentes extraídos por motivo de cárie ou fratura radicular, sem levantamento de retalho. A presença de 4 mm de osso apical ao alvéolo foi critério de inclusão. Implantes cone-morse (3,5 mm e 4,3 mm) foram instalados seguindo a parede palatina (torque > 35 Ncm). O gap foi preenchido com biomaterial (hidroxiapatita e fosfato tricálcio). Coroas em resina acrílica foram cimentadas provisoriamente. Radiografi as periapicais foram realizadas imediatamente (T0) e quatro meses depois (T4), nas faces mesial e distal, considerando a crista óssea (COA) e o ponto de contato ósseo com a face lateral do implante (FLI). TCFCs com afastamento labial foram usadas para avaliar a altura, a espessura óssea da face vestibular em três níveis e a plataforma do implante 3 mm e 6 mm em direção apical. Resultados: não houve alteração estatisticamente significativa nas alturas ósseas proximais (COA e FLI), tanto na face mesial como distal. Em relação à altura da face vestibular, não foi observada alteração estatisticamente significante (0,16 + 0,64 mm). Observou-se redução estatisticamente significante na espessura óssea medida 3 mm aquém da porção cervical do implante (0,58 + 0,54 mm). Conclusão: ao final do tempo de acompanhamento de quatro meses, e de acordo com a metodologia empregada, pôde-se concluir que houve contribuição para minimização dos efeitos de reparo ósseo ao redor desse tipo de implante, apesar do acompanhamento a médio e longo prazo ser necessário para consolidação desses dados.

Lower molar uprighting with miniscrew anchorage: direct and indirect anchorage.

Lower molar uprighting has been increasingly indicated in clinical orthodontics, mainly because of adult patients with rehabilitation needs. The aim of this study was to determine the success rate of miniscrew use for lower molar uprighting and to compare the use of direct and indirect anchorage. One hundred and eighty-one miniscrews were inserted in 102 rehabilitation patients, with a mean age of 42.24 years. In 71 patients, indirect anchorage was used (116 miniscrews); in the other 31 patients, direct anchorage was employed (65 miniscrews). The choice of direct or indirect anchorage was determined by the orthodontist according to the force system that would be used for the movement and the bone availability. The overall success rate for miniscrews was 90. 05%; 18 miniscrews failed, including 15 that were used as indirect anchorage and 3 that were used as direct anchorage. Considering the results of this study, it can be concluded that both direct and indirect anchorage can be successfully used for molar uprighting.