Evaluation of the occlusal contact area of molar dental implants comparing two different thicknesses (16 µm and 200 µm) of articulating occlusal papers and forces (200 and 250 N): a pivot in vitro study

Introduction: The goal of this pilot study was to evaluate the differences between checking occlusion on implants crowns using 16 or 200 µm thickness of articulating occlusal paper, and to compare the stained occlusal area between the groups after bite forces of 200 and 250 N. Methods: It was included 10 casts of articulated-type IV gypsum, 10 NiCr crowns, articulating occlusal papers (16 µm and 200 µm thick), and a compression test machine. Compressive forces (200 and 250 N.mm) were applied on models, to check the occlusal contact area of fixed and cemented crowns. The contact areas on the crowns were measured through images obtained by the scanning electron microscope. Statistical tests were performed considering the significant level of 5% (p≤0.05). Results: The stains found using 200 µm of articulating paper were higher than those with 16 µm, independent of the force applied. However, the stains obtained in lower teeth with different strengths (200 and 250N) marked with 16 µm articulating paper were not possible to score. The articulating paper variable had significant statistical results (p=0.002), while the variables force (p=0.443) and articulating paper-force interaction (p=0.607) were not significant. The mean area found in staining using the 200 µm and 16 µm papers was, respectively, 8.3380 mm2 and 3.4759 mm2. Conclusion: It was possible to confirm that 200 µm of articulating occlusal paper showed better and significant results to stain the occlusal area, permitting a more accurate adjustment independent of the force applied.

Diagnosis and management of intralabyrinthine schwannoma: case series and review of the literature.

Intralabyrinthine schwannoma (ILS) is a rare benign tumor affecting cochlear and vestibular nerves, whose symptoms are generally unspecific and frequently responsible for a late diagnosis. Radiological examinations, with particular reference to magnetic resonance imaging (MRI), represent the only diagnostic technique to identify ILS. On computed tomography ILS can only be indirectly suspected by the presence of surrounding bone remodeling, whereas MRI provides direct visualization of the neoplasm as a filling defect within the labyrinth with vivid contrast enhancement. At the same time, MRI is also helpful in defining ILS anatomical extension into adjacent structures and in planning therapeutic management. Here we report three representative cases of ILS with new pictorial imaging features to improve ILS early detection and optimize subsequent therapeutic management.

Otolaryngological features in a cohort of patients affected with 22q11.2 deletion syndrome: A monocentric survey.

Otorhinolaryngologic manifestations are common in 22q11.2 deletion syndrome (22q11.2DS), but poorly described. This study aimed to better define the ear-nose-throat (ENT) phenotype of 22q11.2DS patients, in the attempt to best detect subjects requiring subspecialist intervention. We enrolled 25 patients affected with 22q11.2DS. Anatomic and functional ENT findings were investigated using clinical, laboratory, and instrumental data. Immunophenotype and frequency of infections were evaluated. Univariate and multivariate analyses were performed. ENT anomalies were found in 88% of patients, and in 20% congenital palate defects required surgery. Adenoid or palatine tonsil hypertrophy was noted in 80% and 48%. Forty-eight percent of subjects had rhinolalia/phonia, severe in half of these. We also found nasal regurgitation or laryngeal penetration/aspiration in 20% and 16%, respectively. Instrumental exams revealed a mild conductive hearing loss in 32% (bilateral in most cases), tympanometric anomalies in 28%, and swallowing abnormalities in 16%. Statistical univariate analysis showed a direct association between rhinolalia/phonia and episodes of laryngeal aspiration (p = .016) and between tympanometric anomalies and increased adenoid volume (p = .044). No association between episodes of food aspiration and palatal anomalies was found. Moreover, no statistically significant association was observed between the number of airway infections and the ENT findings. This study contributes to better define the ENT phenotype in patients with 22q11.2DS, helpful to prevent potential complications. Furthermore, the identification of a subcategory of patients may allow the early adoption of specific speech therapy programs to improve the clinical outcome of 22q11.2DS patients.

Aerodynamic findings and Voice Handicap Index in Parkinson's disease.

OBJECTIVE: To verify possible relations between vocal disability and aerodynamic measures in selected Parkinson's disease (PD) patients with low/moderate-grade dysphonia. METHODS: Fifteen idiopathic dysphonic PD male patients were examined and compared with 15 euphonic subjects. Testing included the following measures: Voice Handicap Index (VHI), maximum phonation time (MPT), mean estimated subglottal pressure (MESGP), mean sound pressure level (MSPL), mean phonatory power (MPP), mean phonatory efficiency (MPE) and mean phonatory resistance (MPR). RESULTS: Statistical analysis showed: a significant reduction in MPR and MSPL in PD subjects compared to the healthy ones; a significant positive correlation between VHI score and MSPL, MPR, MPP, MESGP and a significant negative correlation between VHI and MTP within PD subjects. Test for multiple linear regression showed a significant correlation between VHI score, MPT, MPR and MSPL. CONCLUSIONS: A relationship between VHI and aerodynamic measures was shown in the present study. Compensatory mechanisms may aggravate vocal disability in PD subjects.

Relationship Between Clinical and Histologic Periodontal Biotypes in Humans.

Histologic and histomorphometric evaluations of gingival biopsy samples of patients presenting either a thick or a thin gingival biotype were performed. Full-thickness gingival biopsy samples were obtained and processed for histologic and histometric evaluations. Thickness of the keratinized mucosa or gingiva was found to be increased in the thick biotype. Specifically, the connective tissue layer was thicker with no change in epithelial thickness. In conclusion, gingival transparency appears to be an adequate, clinically useful method to classify the gingival biotype. The thin gingival biotype is manifested by reduced connective tissue thickness; therefore, biotype conversion or enhancement may be based on augmentation of the connective tissue portion of the gingival tissues.

Avaliação clínica da sobrevida de três sistemas de implantes em diferentes densidades ósseas: um estudo retrospectivo de 707 implantes em 194 pacientes / Clinical evaluation of three different dental implant systems in varied bone densities: a retrospective study of 707 implants and 194 patients

Objetivo: avaliar, através de um estudo retrospectivo, a sobrevida clínica de três sistemas de implantes em diferentes densidades ósseas. Material e métodos: dois sistemas de implantes nacionais titânio c.p. grau 2 e um sistema internacional titânio c.p. grau 3 foram utilizados conforme as recomendações dos fabricantes. Esses implantes serviram como suporte para pró teses unitá ria, parcial fixa, total fixa e removível em variados sí tios da cavidade oral. Os sí tios foram classificados de acordo com a densidade óssea. As análises uni e multivariada com regressão logística foram usadas para verificar a influência do sexo, idade, localização anatômica e tipo de implante na taxa de sobrevivência (nível de significância 5%). Resultados: 707 implantes de titânio puro com diferentes macrogeometrias e tratamento de superfície foram inseridos em 194 pacientes. Dos implantes instalados, o índice geral de sobrevivência foi 94,5%. A taxa de sobrevivência foi maior no sexo masculino do que no feminino (96,5% x 93,3%). O valor OR para o sexo feminino fi cou entre 1,96 (univariada) e 2,35 (multivariada). Conclusão: dentro dos limites deste estudo, a idade maior ou igual a 40 anos, o sexo feminino, o uso de implantes cilíndricos de titânio c.p. grau 2 com superfície tratada por ácido e jateada com óxido de alumínio, e a densidade óssea D4 que não seja na região mandibular apresentam-se como fatores de resultados estatisticamente significativos.

Objective: to perform a retrospective evaluation on the clinical survival of three implant systems placed at different bone densities. Material and methods: two grade 2 c.p. titanium national systems and one grade 3 c.p. titanium international system were used according the manufacture's recommendations. These were restored with single-tooth, partial fixed/removable prostheses in several oral cavity sites classified according to their bone densities. Uni- and multivariate logistic regression analysis were used to calculate the influence of gender, age, anatomic location, and implant type on the survival rates (5% level of significance). Results: 707 dental implants with different macrogeometries and surface treatments were inserted in 194 patients. The overall survival rate was 94.5%. The survival was higher for male and females (96.5% versus 93.3%). The Odds ratio for female gender was 1.96 (univariate) and 2.35 (multivariate). Conclusion: within the limits of this study, age ≥ 40 years, female, cylindrical shaped Grade 2 c.p titanium, acid-etched and aluminum oxide blasted, and the D4 bone density (except for the mandibular arch) can be considered factors with signifi cant influence on the survival results.

Our experience in the treatment of Malignant Fibrous Hystiocytoma of the larynx: clinical diagnosis, therapeutic approach and review of literature.

Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hemotologic diseases. They are rarely seen to occur simultaneously in one individual patient. Here we demonstrate a case of HS associated with CML in this study. The patient is a young female, diagnosed with HS in 2005, and was given partial embolization of the splenic artery. She got significant remission after the procedure. In 2008, she was found abnormal in blood routine test, after bone marrow routine, chromosome and fusion gene tests, she was diagnosed with CML (chronic phase). She did not receive regular treatment until 3 months prior, and is currently being treated with Dasatimib. She achieved hematological remission, but had no significant improvement in chromosome and fusion gene figures. Due to her severe condition of hemolysis, a splenectomy or an allogeneic hematopoietic stem cell transplantation is considered.

Medical liability, defensive medicine and professional insurance in otolaryngology.

BACKGROUND: This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Italian otolaryngologists, defensive medical behaviour and their understanding of professional liability insurance in matters of civil liability. One hundred specialists replied to a questionnaire pertaining to the psychological impact of medico-legal issues and to specific queries regarding insurance coverage, either privately stipulated or provided by the employer. Statistic analysis was carried out by χ(2) test and ANOVA multiple variance regression test, assuming P = 0.05 as the value of minimum statistical significance. RESULTS: It was found that in 50% of cases the behaviour of the doctor towards the patient had been decidedly influenced by concerns over medico-legal implications. In 29% of the sample these concerns had "often to always" influenced the choice of diagnostic procedures or treatment options, in order to safeguard themselves in case of legal dispute. The data obtained showed a statistically significant correlation between the level of concern (regarding potential medico-legal disputes) experienced by specialists on the one hand and variations in the doctor/patient relationship (P < 0.05) and the choice of defensive medical procedures (P < 0.05) on the other. Furthermore, the perception of the medico-legal problem was statistically related to the absence or poor knowledge of some insurance clauses, regarding posthumous coverage (72%), informed written consent (89%), and the coverage provided by the healthcare centre where the specialist is employed (32%) (P < 0.05). CONCLUSIONS: The results of this study indicate the necessity for a greater awareness of the actual guarantees provided by the insurance policy stipulated by specialists, to avoid inadequate coverage in the case of medico-legal disputes.

Cavernous hemangioma of rhinopharynx: our experience and review of literature.

Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and left-sided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, allowed removal of the mass, without complications, after careful hemostasis of arterial branches. It was possible to establish the precise site of origin of the tumor only during the surgical procedure. Histopathological study showed mucosa with extensive vascular proliferation, with framework of lacunar/cavernous haemangioma, also present at lamellar bone tissue level. An unusual site and an unspecific clinical appearance can make diagnosis and treatment of a cavernous hemangioma of the nasopharynx difficult. The nasal endoscopic technique proved to be reliable in terms of adequate exposure and visualization of the lesion, control of bleeding, and complete removal of the mass.

Osteonecrose induzida pelo uso de bisfosfonatos após instalação de implantes dentários – relato de dois casos / Bisphosphonate-associated osteonecrosis of the jaw following dental implant placement – a report of two cases

A osteonecrose dos maxilares é uma das principais complicações relacionadas ao uso de medicamentos antirreabsortivos. Este artigo teve como objetivo relatar dois casos clínicos nos quais as pacientes desenvolveram osteonecrose dos maxilares induzida por bisfosfonatos, após instalação de implantes dentários. Em ambos os casos, as pacientes não relataram uso de bisfosfonatos. No primeiro caso, a região afetada foi a maxila, tendo sido utilizado o tratamento para infecção durante muitos meses até que, após remoção de sequestro ósseo, obteve-se o diagnóstico da patologia. O tratamento conservador com laser de baixa potência e antibioticoterapia obteve sucesso. No segundo caso, a paciente apresentou sequestro ósseo na região dos implantes dentários após realizar clareamento de um dente vizinho à região. O tratamento conservador não foi bem-sucedido, e a cirurgia para ressecção em bloco foi necessária. Nas duas situações, as pacientes só revelaram ter feito uso de medicação antirreabsortiva após serem questionadas diretamente, quando apresentaram sequestro ósseo. Uma anamnese dirigida e medidas para prevenção da complicação devem ser tomadas em pacientes que fazem ou fi zeram uso deste tipo de droga.

The osteonecrosis of the jaws is the main complication related to the use of anti-resorptive drugs. This article aims to report two clinical cases where the patients developed bisphosphonate-associated osteonecrosis of the jaw following dental implant installation. In both cases, both patients did not report use of bisphosphonates. In the first case, the affected region was the maxilla and it was treated as an infection for several months, until removal of bone sequestration, with the pathology diagnosed. The conservative treatment with low intensity laser and antibiotic therapy achieved success. In the second case, the patient presented bone sequestration around dental implants after performing internal tooth whitening in the neighboring region. The conservative treatment was not successful and surgery for bone resection was necessary. In both cases, the patients revealed to have used anti-resorptive drugs only after being directly questioned when bone sequestration was observed. A directed medical history and preventive measures should be taken with patients that use or have used this medication.

Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy.

BACKGROUND: Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review. METHODS: The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value. RESULTS: The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied. CONCLUSIONS: The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

O efeito do tratamento da superfície na molhabilidade do Ti cp / Effect of surface treatments on cp Ti wettability

O aumento da energia da superfície dos implantes osseointegráveis aumenta a capacidade de adsorção de íons pela superfície e, consequentemente, eleva a absorção celular e maximiza a osseointegração. O objetivo do presente trabalho foi analisar a influência da morfologia da superfície do titânio comercialmente puro (Ti cp) na molhabilidade quantificada pelo ângulo de contato entre a superfície do titânio e a água. No presente estudo, 82 discos de Ti cp foram tratados por seis fabricantes de implantes dentários. As amostras foram tratadas com ácido, jateadas com e sem tratamento com ácido e anodizadas. Amostras de Ti cp puro usinadas foram usadas como grupo controle. Todas as superfícies foram caracterizadas por microscopia eletrônica de varredura (MEV). Para as análises estatísticas empregou-se Anova e o teste Tukey hoc com significância p < 0,05. Todos os grupos experimentais apresentaram ângulo de contato superior a 45 graus, exceto as amostras anodizadas. Pôde-se concluir que o tratamento da superfície influencia na molhabilidade do titânio, justificando a ocorrência da diferença na osseointegração dos implantes com diferentes tipos de superfície...

Increased implant surface wettability generates increased ion adsorption capacity, which consequently enhances cell absorption and maximizes osseointegration. The aim of this study was to determine, in vitro, the influence of different implant surface topography on wettability by the contact angle between Ti surface and water. Materials and Methods: In this study, 82 commercially pure titanium (cp Ti) disks, 5-mm in diameter and 3-mm thick, were provided by 6 titanium dental implants manufacturers. Samples were assigned to one of the following experimental groups according to surface treatment process: Group 1 – acid-etched implant surfaces; Grupo 2 – sandblasted/acid-etched implant surfaces; Group 3 - acid-etched implant surfaces; Group 4 - sandblasted/acid-etched implant surfaces; Grupo 5 - sandblasted/acid-etched/ gamma irradiated implant surfaces; Group 6 – acidetched implant surfaces; Group 7 - acid-etched implant surfaces; Group 8 – anodized implant surface. Machined cp Ti samples were used as control group (Group 9). All surfaces were characterized by scanning electron microscopy (SEM). The contact angle of a drop of distilled water on each of the prepared surfaces was used as the measure of wettability with a goniometer microscope. One-way Anova and Turkey’s post hoc test were used to assess statistical signifi cance (p < 0.05). Results: all experimental groups showed contact angles higher than 45 degrees, except anodized samples. The contact angle of water on the anodized surface (Group 8) was lower than 45 degrees, thus indicating a significant difference in wettability when compared to the other surfaces studied. Conclusion: within the limits of this investigation, the anodized surface produced the greatest increase in the wettability by decreasing the contact angle to less than 45 degrees...

Surgical treatment of acute recurrent throat infections in children.

OBJECTIVE: The purpose of this study was to define the contribute of surgery and watchful waiting in the treatment of feverish episodes and other clinical manifestations related to acute recurrent throat infections in children. METHODS: An observational, retrospective and multi-centric study was carried out on 407 subjects, aged 2-11, with a minimum two-year follow-up. Chi square test and Fisher's test were used for the statistical analysis. RESULTS: Watchful waiting prevented, similarly to surgery, recurrences of feverish episodes, but did not favourably impact on other clinical manifestations (respiratory obstruction, otitis media, group A beta hemolyticus streptococcus positive laboratory findings) as compared to surgery (p<0.001). CONCLUSIONS: The higher effectiveness of surgical treatment, as compared to watchful waiting, was documented in the study patients, considering all the clinical manifestations related to acute recurrent throat infections.

Análise da capacidade sensorial mastigatória de pacientes com próteses sobre implantes / Analysis of masticatory sensory capacity of patients with implant prostheses

Um dos requisitos de sucesso para as próteses sobre implante é a satisfação estética e funcional. Esta pode ser avaliada objetivamente medindo a análise protéica do sangue e urina e subjetivamente o tamanhos das partículas processadas na mastigação e questionário de sensibilidade mastigatória pré e pós prótese instalada. Este trabalho avaliou o ultimo tópico apresentando questionário de sensibilidade que varia de 0 a 2 e do prontuário de atendimento no qual foi feito levantamento de dados de próteses unitárias parciais e removíveis e sua capacidade de mastigar alimentos sólidos suaves e duros no qual foram aplicados testes estatísticos. Observou que a maioria dos casos é de mulheres entre 60 a 69 anos, que existia diferença na sensibilidade de mastigação entre diferentes tipos de alimentos. Todos os pacientes apresentavam melhoras da capacidade sensorial de interpretar os alimentos independente da prótese, quanto maior a estabilidade do trabalho protético maior o índice de eficiência e sensibilidade mastigatória.

One of the requirements for successfull on implant prostheses is thee esthetic and functional satisfaction. This can be objectively evaluated by measuring the protein analysis of blood and urine and subjectively the particle sizes processed sensitivity and masticatory questionnaire before and after prosthesis installed. This study evaluated the questionnaire last topic featuring a sensitivity ranging from 0 to 2 and the records of service, in which data collection was made prosthesis, partial and removable unit and its ability to chew soft and hard solid element on which tests were used statistics. He noted that most cases are in women aged 60 to 69 years, that there was difference in sensitivity between different types of chewing food. All patients showed improvements in sensory capacity of food independent of the protheses. The greater stability of the prosthetic work, the largest index of masticatory eficienty and sensibility.

Comportamento biomecânico de implantes de hexágono interno e externo / Biomechanical behavior of internal and external hex implants

Objetivo: Verificar o comportamento biomecânico por meio de análises retrospectivas e prospectivas da interface implante/pilar de casos clínicos de próteses parciais e unitárias sobre implantes, avaliando a instabilidade dos componentes protéticos de hexágono interno e externo, levando em consideração as condições à carga mastigatória de cada paciente. Métodos: Estudo retrospectivo e prospectivo de casos de pacientes que chegaram à emergência do Centro de Pós-Graduação da Academia de Odontologia do Estado do Rio de Janeiro, clínica Clivo, entre os meses de novembro de 2008 e janeiro de 2009. Quarenta e quatro pacientes foram atendidos e foram registradas as ocorrências por quatro dentistas. Desses, 16 pacientes foram submetidos ao atendimento de emergência protética de soltura de parafuso das próteses sobre 90 implantes. Resultados: Clinicamente 84% dos afrouxamentos ocorreram, a maioria em mulheres com idade entre 49 e 69 anos, em implante de hexágono externo, sendo 78% em próteses parafusada, 70,3% prótese ferulizada, 41% na mandíbula posterior, tendo 43% como antagonista os dentes naturais. Conclusão: Existe associação significante, de acordo com os testes mencionados, entre as falhas dos implantes e os tipos de hexágonos com relação ao tipo de prótese confeccionada e com relação ao tipo de antagonista utilizado. Muitos estudos clínicos e biomecânicos, além de ensaios mecânicos, precisam ser publicados para que seja possível comparar as diferenças existentes entre cada um desses tipos de conexões.

Objective: This study used retrospective and prospective analyses to verify the biomechanical behavior of the implant/abutment interface in clinical cases of partial and single prostheses on implants, assessing the instability of the prosthetic internal and external hex components and considering the masticatory load of each patient. Methods: This is a retrospective and prospective study of patients who attended the emergency room of the Dental Academy Graduate Center of the State of Rio de Janeiro, Clivo clinic, from November 2008 to January 2009. A total of 44 patients were seen and the occurrences were recorded by four dentists. Of these, 16 patients underwent prosthetic emergency care, loosening the screw of the prosthesis of 90 implants. Results: Clinically, most (84%) of the loosening were done in women aged 49 to 69 years with external hex implants; 78% were screwed prostheses, 70.3% were splinted prostheses, 41% were in the posterior mandible and 43% were opposite to natural teeth. Conclusion: According to the abovementioned tests, there is a significant association between implant failure and hex types regarding the type of prosthesis and antagonist used. Many clinical and biomechanical studies and mechanical assays need to be published to allow the differences between these types of connections to be compared.

Reabilitação em 24 horas / Rehabilitation after 24 hours

A instalação de implantes dentários é viável, segura e previsível, desde que os critérios de seleção dos pacientes sejam obedecidos, a técnica cirúrgica seja realizada adequadamente e observado o protocolo de inserção e colocação da prótese. Com o acúmulo de conhecimentos e observações clínicas e laboratoriais tem sido possível realizar tratamentos reabilitadores com implantes dentários e próteses imediatas em tempo de tratamento inferior ao preconizado nos primórdios da implantodontia. Para que este protocolo possa ser utilizado com segurança, torna-se necessário uma seleção cuidadosa dos pacientes, destreza manual do cirurgião-dentista, observação de critérios como: planejamento cirúrgico e protético, emprego de implantes com comprimentos maiores que 10 mm e diâmetro mínimo de 3,75 mm, estabilidade primária (45 N.cm), qualidade óssea adequada, mesa oclusal reduzida e oclusão protegida. O presente trabalho apresenta uma análise de casos de utilização da carga imediata sobre implantes múltiplos em maxila e mandíbula, com ênfase na avaliação dos critérios de seleção dos pacientes, apresentação dos critérios cirúrgicos que favorecem o sucesso da carga imediata sobre implantes osseointegráveis. A análise é complementada pelo relato de um caso clínico de carga imediata e pela descrição de um protocolo cirúrgico que permite maior previsibilidade dos resultados. O trabalho foi baseado no levantamento estatístico dos dados registrados durante oito anos em curso de pós-graduação. Com base nos dados apresentados é possível concluir que para obter êxito no tratamento com carga imediata dos implantes é necessário observar os princípios biológicos, cirúrgicos, mecânicos e protéticos, com esclarecimento para o paciente das vantagens e desvantagens do procedimento

The protocol of installation of dental implants is viable, secure and predictable, since the patients' selection criteria may be observed and the surgical procedure can be carried out correctly, following the surgery protocol. Nowadays, is possible to perform a dental implant rehabilitation treatments and immediate prosthesis in a lesser treatment time than the early beginnings of implantology. The exit is function of a careful selection of patients, ability of the surgeon and observance of some criteria – such as surgical-prosthetic planning, employment of dental implants with length higher than 10 mm and 3,75 mm of diameter, primary stability (45 N.cm), osseous quality, reduced occlusal ridge and protected occlusion. The aim of this study is to perform a retrospective analysis of the cases present a review about the use of immediate loading over multiple osseointegrated implants in the maxilla and mandible. It was done an emphasis on the evaluation of the criteria in the patient’s selection to receive immediate loading, exhibition of the relevant surgical criteria that promote the success of immediate loading and the description of a surgical protocol that allows a higher result exit. A clinical case reports was described and presented eight years statistical data obtained in a post-graduate dentistry course. It was necessary that prosthetic, mechanical, surgical and biological principles were followed so that the implants and the prosthesis execution could become viable, as well as the clarification to the patient of the advantages and disadvantages of the procedure

Implantes curtos na mandíbula são seguros? / Are short implants in the mandible safe?

Objetivo: Analisar a importância da bioengenharia e do aperfeiçoamento de técnicas cirúrgicas, demonstrando através dos índices alcançados a prevalência do sucesso na instalação de implantes dentais em região posterior da mandíbula, em qualidades ósseas D3, em pacientes entre 52 e 60 anos, com próteses fixas sobre implantes de 8,5 mm. Métodos: Este estudo retrospectivo teve os dados estatísticos coletados no Centro de Pós-Graduação do Centro Integrado de Odontologia, Faculdades Sarandi da Academia de Odontologia do Rio de Janeiro, na clínica CLIVO, dentre um total de 2 294 implantes instalados na mandíbula, no período de 1999 a 2007. Os implantes curtos totalizavam 1 056, com comprimento menor ou igual a 10 mm, dos quais vinte implantes foram escolhidos de forma aleatória e analisados. Resultados: Os dados sofreram tratamento estatístico e a comparação destes foi consubstanciada em análise construtiva de dados através dos Métodos Estatísticos no reconhecimento de padrões de cada variável em estudo. O índice de sucesso obtido foi de 85% e verificou-se a necessidade de tomar certos cuidados na indicação do seu uso. Conclusão: A bioengenharia e o desenvolvimento de técnicas cirúrgicas atuais otimizaram o uso dos implantes curtos com o objetivo de evitar cirurgias avançadas. Para compensar o menor tamanho devem-se observar alguns fatores, como: qualidade óssea, proporção coroa/implante, número de implantes e diâmetro, geometria macroscópica e microscópica dos implantes, magnitude de forças e mesa oclusal.

Objective: To analyze the importance of bioengineering and the improvement in surgical techniques demonstrated by the rates attained of the prevalence of successful placement of dental implants in the posterior region of the mandible, in D3 bone quality in patients between the ages of 52 and 60 years, with dentures fixed on 8.5 mm implants. Methods: The statistical data for this retrospective study were collected at the Post-Graduation Center of the Integrated Dentistry Center, Faculty of Sarandi / Academy of Dentistry - Rio de Janeiro, at the CLIVO clinic, from among a total of 2 294 implants placed in the mandible, in the period from 1999 to 2007. There was a total of 1 056 short implants, of a length shorter than or equal to 10 mm, among which 20 implants were randomly chosen and analyzed. Results: The data were treated statistically and comparison of these data was consubstantiated in constructive data analysis by means of Statistical Pattern Recognition Methods for each variable under study. A success rate of 85% was obtained, and the need to take certain care when indicating the use of short implants was verified. Conclusion: Bioengineering and the development of present day surgical techniques have optimized the use of short implants, with the aim of avoiding advanced surgeries. To compensate the smaller size, there are some factors that must be observed, such as: Bone quality, crown/implant ratio, number and diameter of implants, macroscopic and microscopic geometry of the implants, magnitude of mesial occlusal forces.

Morfologia, resistência à fadiga e à compressão dos implantes Nobel Biocare de corpo único e dois corpos / Fatigue loading, fracture resistance and morphological characteristics of one and two-piece Nobel Biocare dental implants

Devido à alta taxa de sucesso os implantes dentários são usados como excelente opção para a reabilitação de pacientes parcialmente e totalmente edentados. Entretanto, existem aspectos biomecânicos que podem trazer complicações e que precisam ser investigados. O objetivo deste estudo foi avaliar a morfologia, a resistência à fratura sob compressão e à fadiga de implantes dentários de corpo único e de dois corpos da empresa Nobel Biocare. Para os ensaios mecânicos as amostras foram divididas em três grupos: grupo 1- implante de corpo único submetido à carga compressiva com inclinação de 10 graus em relação ao seu eixo longitudinal; grupo 2- implante de dois corpos com componente reto e cargas compressivas inclinadas em 10 graus; e grupo 3- implantes de dois corpos com carga compressiva formando 15 graus com o eixo longitudinal do implante. Os três grupos foram submetidos à análise morfológica através de microscópio eletrônico de varredura e ao teste de resistência à fadiga e à fratura sob compressão. Os ensaios de fadiga foram realizados com a máquina servohidráulica MTS e os de compressão com a máquina de ensaio universal EMIC DL1000. As superfícies dos implantes apresentaram morfologia heterogênea e saliências características do tratamento de anodização. As amostras dos três grupos não apresentaram fratura, porém o grupo I apresentou maior resistência mecânica à compressão. A análise estatística usando o teste Anova indicou que os implantes de corpo único e os de dois corpos não apresentaram diferença estatística significativa quanto à resistência à fadiga.

Dental implants are an excellent option for the rehabilitation of total and partially edentulous patients due to their high success rates. However, there are biomechanical aspects, which may bring about complications and thus should be better investigated. The objective of this study was to evaluate the morphology, resistance to fracture and fatigue of one and two-piece dental implants. The samples were divided into three groups: group 1- one-piece implant tilted at a 10 degree angle and loaded longitudinally; group 2- two-piece implant with esthetic abutment tilting the sample at a 10 degree angle and loaded longitudinally; and group 3- two-piece with esthetic abutment tilting the sample at a 15 degree angle and loaded longitudinally. The three groups were submitted to morphological analysis using scanning electron microscopy and to a fracture and fatigue resistance tests. Fracture resistance was performed in the universal testing machine EMIC DL1000 and fatigue at the dynamic servo-hydraulic test system MTST. The results showed porosity and protrusions on the analyzed surfaces characteristic to the anodizing treatment. The samples from all groups did not show fracture failure, but group I presented greater resistance to fracture. In conclusion, the Anova test did not show a noticeable statistical difference between one-piece and two-piece dental implants regarding biomechanical performance.

Avaliação do sucesso de implantes osseointegráveis em enxerto de seio maxilar / Evaluation the success of osseointegrated implants in maxillary sinus grafts

Objetivo: Analisar implantes instalados em enxertos de seio maxilar com biomaterial de origem bovina e plasma rico em plaquetas, observando a neoformação óssea e o índice de sucesso clínico e histológico apresentado. Métodos: A análise dos achados clínicos foi baseada em 36 enxertos de seio maxilar com 101 implantes instalados em 30 pacientes com idade média de 47 anos, e a histológica, em nove amostras dos 36 enxertos realizados, com intervalo médio de tempo do enxerto de 7,5 meses, sendo a maioria homens com idade média de 42 anos. Resultados: Clinicamente, 91 implantes instalados estavam osseointegrados. Conclusão: Com base nos resultados apresentados conclui-se que, quando instalados em região de seio maxilar enxertado com biomaterial, os implantes apresentam um alto índice de sucesso. ISRCTN24003246.

Objective: To analyze implants placed in maxillary sinus grafts with biomaterial of bovine origin and platelet-rich plasma, observing bone neoformation and the clinical and histologic success rate presented. Methods: Analysis of the clinical findings was based on 36 maxillary sinus grafts with 101 implants placed in 30 patients with a mean age of 47 years, and the histologic analysis, based on nine samples of the 36 grafts performed, with a mean interval of 7.5 months time of the graft, the majority of patients being men with a mean age of 42 years. Results: Clinically, 91 implants placed were osseointegrated. Conclusion: Based on the results presented, it was concluded that when implants are placed in the maxillary sinus region grafted with biomaterial, they present a high success rate. ISRCTN24003246.