Success and survival rates of mandibular overdentures supported by two or four implants: a systematic review.

This systematic review evaluated the influence played by the number of implants on the results of rehabilitation treatment with mandibular overdentures on 2 or 4 implants. The literature search was conducted using PubMed, Embase and Cochrane databases. Specific terms were used in performing a search from January 1980 to January 2013. The search strategy was applied by two reviewers who extracted the data and compared the results. Discrepancies were resolved by discussion. Great heterogeneity was seen among the selected studies, in regard to survival rates, prosthesis failure and function rates. A medium degree of quality and methodological consistency was found in one study, and no studies showed a high degree. When considering the prosthesis success rate for 2 implants, there was a variation of 23% to 100%. However, when considering the survival rate, the result was 92% to 100%. For 4 implants, prosthesis survival rates showed less variation, i.e., 97.7% to 100%. Ball attachments were the most common type of abutment for 2 implants; however, there was a higher prevalence of bar abutments for 4 implants. Rehabilitations with 2 implants showed more complications and required more maintenance according to the connection type. Given the limitations of this review, mandibular overdentures with 4 implants showed better results with respect to survival and success rates, especially those with a bar connection. Further studies comparing these two treatment types are necessary to improve the scientific evidence in this area.

Success and survival rates of mandibular overdentures supported by two or four implants: a systematic review

This systematic review evaluated the influence played by the number of implants on the results of rehabilitation treatment with mandibular overdentures on 2 or 4 implants. The literature search was conducted using PubMed, Embase and Cochrane databases. Specific terms were used in performing a search from January 1980 to January 2013. The search strategy was applied by two reviewers who extracted the data and compared the results. Discrepancies were resolved by discussion. Great heterogeneity was seen among the selected studies, in regard to survival rates, prosthesis failure and function rates. A medium degree of quality and methodological consistency was found in one study, and no studies showed a high degree. When considering the prosthesis success rate for 2 implants, there was a variation of 23% to 100%. However, when considering the survival rate, the result was 92% to 100%. For 4 implants, prosthesis survival rates showed less variation, i.e., 97.7% to 100%. Ball attachments were the most common type of abutment for 2 implants; however, there was a higher prevalence of bar abutments for 4 implants. Rehabilitations with 2 implants showed more complications and required more maintenance according to the connection type. Given the limitations of this review, mandibular overdentures with 4 implants showed better results with respect to survival and success rates, especially those with a bar connection. Further studies comparing these two treatment types are necessary to improve the scientific evidence in this area.

Differential diagnosis between post-poliosyndrome symptoms and temporomandibular disorder – Clinical case

Post-poliomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients several years after their acute poliomyelitis paralysis. Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. The diagnosis is essentially clinical after excluding other neurological, orthopedic or rheumatologic problems. Temporomandibular disorders (TMD) are usually diagnosed by means of comprehensive review of patient history and clinical examination and the symptoms are pain/ discomfort in the jaw, mainly in the region of the temporomandibular joints (TMJs) and/or masticatory muscles, limitation of mandibular function and/or TMJ sounds. In the same way as PPS, the diagnosis of TMD is challenging. This study reports the case of a patient that presented thesymptoms of both conditions in the stomatognathic system, and discusses how to achieve the differential diagnosis for proper management of the cases.

Enxerto de conjuntivo em implantes imediatos na região anterior / Connective graft in immediate implants in the anterior region - literature review

A evolução da Implantodontia está relacionada com o restabelecimento dos aspectos funcionais e estéticos dos pacientes que apresentam ausências dentárias, principalmente em regiões anteriores superiores. A devolução ou preservação da estética dos pacientes reabilitados com implantes dentários têm permitido o emprego de novas abordagens cirúrgicas, e a sua avaliação ajuda a determinar o comportamento dos tecidos peri-implantares. Desta forma, este artigo teve o objetivo de apresentar uma revisão de literatura referente ao uso do enxerto de tecido conjuntivo, associado a implantes imediatos na região estética, e discutir suas indicações e previsibilidade. De acordo com os estudos analisados, sugere-se que o uso de implantes imediatos em região anterior, associado à colocação do enxerto de tecido conjuntivo subepitelial, pode melhorar o aspecto estético da região anterior superior. Desta forma, esta pode ser uma opção de tratamento para reabilitação daqueles casos em que a função e a estética devem ser priorizadas.

Previsibilidade do recobrimento radicular de recessão gengival classe III de Miller – uma revisão de literatura / Predictability of root coverage of Miller Class III gingival recessions- Review of the literature

As recessões gengivais têm sido consideradas um dos principais objetivos da terapia cirúrgica periodontal com a intenção de atingir a cobertura completa da raiz. Diversas modalidades de tratamento têm sido desenvolvidas, mas poucas técnicas podem obter a cobertura total da raiz em uma recessão gengival classe III de Miller. A solução para o recobrimento de superfícies radiculares expostas a este nível envolve a realização de um procedimento cirúrgico bem executado e por um grau de previsibilidade ainda mais crítico. Diante do exposto, o objetivo deste artigo foi avaliar, por meio de uma revisão de literatura, a previsibilidade e taxas de recobrimento radicular em recessões gengivais Classe III. Os resultados dos estudos mais recentes revelaram que as taxas de sucesso de recobrimento radicular têm aumentado, próximo a 80%, semelhante às técnicas para recessões Classes I e II. Apesar dos poucos estudos disponíveis, tem havido uma modificação na indicação dos procedimentos de recobrimento radicular, modifcação da previsibilidade da sua utilização e melhora dos resultados alcançados. Torna-se uma abordagem disponível ao tratamento das recessões gengivais com perda de inserção interdental

Gingival recessions have been considered one of the main goals of periodontal surgical therapy in attempt to achieve full root coverage. Several treatment modalities have been developed, but few techniques can achieve full root coverage in a Miller class III gingival recession. The solution for the covering of exposed root surfaces at this level involves a well performed surgical procedure and a predictability even more critical. According to this, the aim of this paper was to evaluate, through a literature review, the predictability and rates for root coverage in Miller Class III gingival recessions. The results of recent studies have shown that the success rate has increased root coverage percentage, close to 80%, similar to techniques for Classes I and II gingival recessions. Despite the few studies available, there has been a change in the indication for root coverage procedures as well as the predictability of its use and the results achieved have increased. It becomes an available approach for the treatment of gingival recessions with interdental attachment loss

Avaliação do tecido peri-implantar comparando as técnicas com retalho e sem retalho: revisão da literatura / Evaluation of peri-implant tissue comparing techniques with flap and flapless: literature review

Na tentativa de preservação dos tecidos mole e duro, a implantodontia tem optado por uma abordagem cirúrgica sem retalho (técnica flapless). Essa técnica minimamente invasiva destaca-se por suas vantagens como menor sangramento durante a cirurgia, menor tempo cirúrgico e melhor pós-operatório para o paciente. Diante disto, o objetivo desta revisão de literatura é trazer informações sobre o comportamento dos tecidos Peri-implantares nas reabilitações implantossuportadas bem como comparar as técnicas cirúrgicas com e sem retalho. Realizou-se uma busca na base de dados Pubmed/Medline e foram incluídos na revisão estudos clínicos controlados que apresentaram relevância clínica publicados no período de 2008 a 2013. De acordo com os resultados, pode-se observar que a técnica sem retalho proporciona a manutenção da mucosa peri-implantar ao redor dos implantes. Entretanto, não existe diferença significativa quanto à perda óssea entre as técnicas estudadas. Além disso, ambas apresentaram previsibilidade nos resultados do tratamento com implantes. Pode-se concluir que não existem estudos clínicos controlados em longo prazo suficientes quanto à utilização da técnica flapless, entratanto, os resultados em curto prazo sugerem que é uma técnica previsível

In an attempt to preserve the soft and hard tissues, implant dentistry has opted for a flapless surgical approach (flapless technique). This minimally invasive technique is distinguished by its advantages such as less bleeding during surgery, shorter operative time and best postoperative for the patient. Hence, the purpose of this literature review is to provide information about the behavior of the peri-implant tissues in implant restorations and to compare surgical techniques with and without flaps. A search was conducted in the database PubMed/Medline and controlled clinical trials that showed clinical relevance published in the period 2008-2013 were included in this review. According to the results, it could be observed that the flapless surgical approach provides maintenance of the peri-implant mucosa around implants. However, no significant difference in bone loss between techniques was also observed. Besides that, both techniques, with or without flaps, showed predictability in the results of implant treatment. It can be concluded that there are not enough controlled clinical studies regarding the long term use of flapless technique. However, short term results suggest that it is a predictable technique

Os exercícios terapêuticos de suporte em disfunções temporomandibulares / The support therapeutic exercises in the temporomandibular dysfunctions

Os exercícios terapêuticos têm sido utilizados no tratamento das desordens músculo-esqueléticas. O programa de terapia por exercícios tem como objetivo final, a obtenção de movimento e função, livres de sintomas, devendo o mesmo ser empregado, tanto para o alívio da dor, quanto para o auxílio da restauração da função normal depois da doença ou lesão, diminuindo, o número de visitas clínicas, e consequentemente, o custo final do tratamento para o paciente. A terapia por exercícios pode ser benéfica aos pacientes que não obtiveram melhoras somente com o tratamento convencional. Tal programa pode ser dividido em exercícios ativos, exercícios ativos resistidos e alongamento passivo manual. Este trabalho tem como objetivo, descrever a utilização do programa de exercícios terapêuticos nas disfunções temporomandibulares (DTMs) e relatar um caso clínico utilizando os mesmos

The therapeutic exercises have been used for the muscle-skeletal disorders treatment. The therapeutic exercise program aims the acquisition of movement and function, free of symptoms, being employed both for pain relief as well as aiding the reestablishment of normal function after the occurrence of disease or lesion, reducing also the number of clinical visits, and consequently, the final cost of the treatment for the patient. The exercises therapy can be beneficial to the patients who had not presented improvements only with the conventional treatment. Such a program can be divided in active exercises, active resistance exercises and manual passive stretching. This study purposes to present the therapeutic exercise program efficacy in the support therapy of the temporomandibular dysfunction (TMD), and report a clinical case