Use of platelet concentrates in oral surgery of patients with osteonecrosis: a scoping review.

The objective of this study was to map, through a scoping review, the evidence available in the literature on the use of platelet concentrates in compromised patients undergoing oral surgeries. Searches were performed in electronic databases for clinical studies with compromised patients undergoing oral surgery who used platelet concentrates. Only studies published in English were included. Two independent researchers carried out the selection of studies. The study design and objective, surgical procedure and platelet concentrate used, systemic involvement, analyzed outcome, and main results were extracted. A descriptive analysis of the data was performed. Twenty-two studies met the eligibility criteria and were included. Case series was the most frequent study design among the included studies (41.0%). In terms of systemic disability, 19 studies reported patients with cancer and related to surgical treatment 16 studies reported patients underwent treatment for osteonecrosis related to the use of the drug. The most used platelet concentrate was pure platelet-rich fibrin (P-PRF). In general, most studies recommend the use of platelet concentrates. Thus, the results of this study suggest that the evidence related to the use of platelet concentrates in compromised patients when undergoing oral surgeries is still initial. Also, most studies assessed the use of platelet concentrates in patients with osteonecrosis.

Use of platelet concentrates in oral surgery of patients with osteonecrosis: a scoping review

Abstract The objective of this study was to map, through a scoping review, the evidence available in the literature on the use of platelet concentrates in compromised patients undergoing oral surgeries. Searches were performed in electronic databases for clinical studies with compromised patients undergoing oral surgery who used platelet concentrates. Only studies published in English were included. Two independent researchers carried out the selection of studies. The study design and objective, surgical procedure and platelet concentrate used, systemic involvement, analyzed outcome, and main results were extracted. A descriptive analysis of the data was performed. Twenty-two studies met the eligibility criteria and were included. Case series was the most frequent study design among the included studies (41.0%). In terms of systemic disability, 19 studies reported patients with cancer and related to surgical treatment 16 studies reported patients underwent treatment for osteonecrosis related to the use of the drug. The most used platelet concentrate was pure platelet-rich fibrin (P-PRF). In general, most studies recommend the use of platelet concentrates. Thus, the results of this study suggest that the evidence related to the use of platelet concentrates in compromised patients when undergoing oral surgeries is still initial. Also, most studies assessed the use of platelet concentrates in patients with osteonecrosis.

Resumo O objetivo do estudo foi mapear, através de uma revisão de escopo, as evidências disponíveis na literatura sobre o uso de agregrantes plaquetários em pacientes comprometidos e que realizaram cirurgias odontológicas. Pesquisas foram realizadas em bases de dados por estudos clínicos com pacientes comprometidos que realizaram cirurgia odontológica e usaram agragantes plaquetários. Apenas estudos em inglês foram incluídos. Dois pesquisadores independentes realizaram a seleção dos estudos. Os seguintes dados foram extraídos: desenho do estudo, objetivo, procedimento cirúrgico, agregante plaquetário usado, envolvimento sistêmico, desfecho analisado e principais resultados. Uma análise descritiva dos dados foi realizada. Vinte e dois estudos preencheram os critérios de elegibilidade e foram incluídos. Série de casos foi o desenho de estudo mais frequente entre os estudos incluídos (41,0%). Em relação ao comprometimento sistêmico, 19 estudos reportaram pacientes com câncer e em relação ao tratamento cirúrgico, 16 estudos reportaram pacientes que realizavam tratamento para osteonecrose relacionada ao uso de medicamentos. O agregante mais utilizado foi o plasma rico em fribina (P-PRF). Em geral, maioria dos estudos recomendou o uso dos agregantes plaquetários. Assim, os resultados desse estudo sugerem que a evidência relacionada ao uso de agregantes plaquetários em pacientes comprometidos que realizam cirurgia odontológica é ainda inicial. Ainda, a maioria dos estudos avaliaram o uso de agregantes plaquetários em pacientes com osteonecrose.

Photobiomodulation therapy reduces postoperative pain after third molar extractions: A randomized clinical trial / La terapia de fotobiomodulación reduce el dolor posoperatorio después de extracciones de terceros molares: un ensayo clínico aleatorizado

Background: To assess the efficacy of PBMT on reducing postoperative pain scores in patients submitted to thirdmolar extractions.Material and Methods: A randomized controlled trial (ReBEC:RBR-94BCKZ) was designed according to theSPIRIT and followed the CONSORT. Patients were randomly allocated according to control or PBMT groups.PBMT consisted of the application of GaAlAs laser (808nm;50mW) applied in six points (1.23 min;11 J/cm2) afterextraction. Pain scores were assessed using the Visual Analogue Scale (VAS) in millimeters evaluated after 6(T6), 24 (T24), and 48 (T48) hours. The Wilcoxon Mann–Whitney test was used to check for possible associationsbetween VAS scores and treatment groups.Results: A total of 101 third molar extractions were performed in 44 patients. The mean age was 28 yearsold(SD±11.54). Comparing control and intervention, PBMT group showed a significant effect on the reductionof postoperative pain at T6(mean VAS=0.9; C.I:0.63–1.16) compared to control (mean VAS=2.5;C.I:2.1–2.88)(p<0.001). The same statistically significant effect on the reduction of postoperative pain was observed at T24(PBMT mean VAS=0.72;C.I:0.51–0.93; control mean VAS=2.86;C.I:2.40–3.31;p<0.001) and T48 (PBMT meanVAS=0.64;C.I:0.36–0.92; control mean VAS=2.86;C.I:2.37–3.34;p<0.001).Conclusions: PBMT significantly reduce the postoperative pain scores when assessed 6, 24, and 48 hours afterthird molar extractions.(AU)

Multidisciplinary Approach for Reestablishing Function and Aesthetic of Unilateral Cleft Lip Defect: A Case Report.

Cleft lip and/or cleft palate defects often result in a functional deficiency in the patient's chewing, speech ability, and aesthetic appearance, usually demanding multidisciplinary effort for addressing the aesthetic and functional patient's requirements. This clinical report describes the planned oral rehabilitation of a 46-year-old woman with unilateral cleft lip defect based on the patient's peculiarities and age. Due to limitations concerning bone grafts and implant procedures, as well as orthodontic treatment, the prosthodontic rehabilitation using the metal-ceramic fixed partial denture was chosen. The treatment adequately reestablished the aesthetic and functional activities, positively impacting the patient's quality of life.

Polywave And Monowave Light-Curing Units Effects On Polymerization Efficiency Of Different Photoinitiators / Efeito Da Unidade De Cura Por Luz Polywave E Monowave Na Eficiência De Polimerização De Diferentes Fotoiniciadores

Objective: The objective of this study was to characterize and correlate the absorption spectra of three photoinitiators [camphorquinone (CQ), diphenyl(2,4,6-trimethylbenzoyl) phosphine oxide (TPO) and phenylbis (2,4,6-trimethylbenzoyl)-phosphine oxide (BAPO)], using second or third-generation light curing units (LCU), and to evaluate the degree of conversion and the physical properties of an experimental resin adhesive. Material and methods: Second-generation (Radii-cal® and Emitter D®) and third-generation (Valo® Cordless and Bluephase N®) LCU were assessed regarding spectrum and irradiance rate of emitted light. Also, the photoinitiators (CQ, TPO and BAPO) were characterized by a light absorption spectrum assessed by UV-Vis spectroscopy, degree of conversion and yellowing effect. Statistical analyzes considered two-way ANOVA and post-hoc Tukey test. Results: BAPO presented higher reactivity compared to TPO. Regarding degree of conversion of the photoinitiators activated by different light-curing units, the Emitter D® device promoted a high degree of conversion. BAPO presented the highest yellowing effect values. Conclusions: The emission and absorption characteristics of the photoinitiators were different. The polymerization reaction activated by the second-generation light-curing unit was reduced when using an experimental resin with photoinitiator TPO, and the third-generation light-curing unit showed a higher polymerization potential regardless of the photoinitiator. (AU)

Objetivo: Caracterizar e correlacionar os espectros de absorção de três fotoiniciadores [canforoquinona (CQ), difenil 2,4,6-trimetilbenzil óxido de fosfina (TPO) e óxido de di (2,4,6-trimetilbenzil) difenil fosfina (BAPO)], com unidades de fotoativação (LCU) de segunda ou terceira geração, e avaliar o grau de conversão e as propriedades físicas de um adesivo experimental. Material e métodos: LCU de segunda geração (Radii-cal® e Emitter D®) e terceira geração (Valo® Cordless e Bluephase N®) foram avaliadas quanto ao espectro e taxa de irradiância da luz emitida. Além disso, os fotoiniciadores (CQ, TPO e BAPO) foram caracterizados por um espectro de absorção de luz avaliado por espectroscopia UV-Vis, avaliado o grau de conversão dos adesivos e efeito de amarelamento. A análise estatística empregada foi ANOVA duas vias e teste post-hoc de Tukey. Resultados: BAPO apresentou maior reatividade comparado ao TPO. Em relação ao grau de conversão dos fotoiniciadores ativados por diferentes aparelhos fotopolimerizadores, o dispositivo Emitter D® promoveu um alto grau de conversão. BAPO apresentou os maiores valores de efeito de amarelamento. Conclusões: As características de emissão e absorção dos fotoiniciadores foram diferentes. A reação de polimerização ativada pelas unidades de fotopolimerização de segunda geração foi reduzida com o uso de uma resina experimental com fotoiniciador TPO. As unidades de fotopolimerização de terceira geração apresentaram maior potencial de polimerização independentemente do fotoiniciador. (AU)

Dental implant therapy in the Brazilian Public System: an overview of the last decade

Aim: This retrospective study aims to describe and analyze the number of dental implants and implant-retained prostheses performed by the Unified Health System (SUS) in the last decade. Methods: This study is based on secondary data from the official government database (DATASUS) performed from January 2010 to December 2019 and is reported following the STROBE. A descriptive analysis was performed of the total sample and the stratified sample divided by Brazilian states. Results: A total of 143,037 dental implants and 93,325 implant-retained prostheses were provided by SUS. It is possible to observe that some states played a massive role on the provision of dental implants and implant-retained prostheses (Parana state: 58.4% and 55.9% and Paraiba state: 21.1% and 25.2% of the total amount of dental implants and implant-retained prostheses, respectively) while some states did not provide a single implant-retained prosthesis. Also, inland cities were mostly responsible for the number of procedures compared to the state capitals. Conclusion:Although dental implant therapy is available in SUS across the country, the number of treatments provided in the last decade is still very limited and is also mainly concentrated in the southeastern region of Brazil

Implant Inclination and Horizontal Misfit in Metallic Bar Framework of Overdentures: Analysis By 3D-FEA Method.

The aim of this study was to evaluate by three-dimensional finite element analysis (3D-FEA) the biomechanics involved in bar-framework system for overdentures. The studied factors were latero-lateral angulation in the right implant (-10, -5, 0, 5 and 10 degrees), and different bar cross-sections (circular, Hader and oval) presenting horizontal misfits (50 or 150 µm) on the opposite implant. Positive angulation (5 and 10 degrees) for implant inclination to mesial position, negative angulation (-5 and -10 degrees) for distal position, and zero degree for parallel implants. The von Mises stresses evaluated the bar, screw and the implant; maximum principal, minimum principal and shear stress analyses evaluated the peri-implant bone tissue. Parallel implants provide lower stress in alveolar bone tissue; mesial inclined bars showed the most negative effect on prosthetic structures and implants. In conclusion, bar cross-section showed no influence on stress distribution for peri-implant bone tissue, and circular bar provided better behavior to the prosthetic system. Higher stress concentration is provided to all system as the misfit increases.

Dentists' perceptions and barriers to provide oral care for dependent elderly at home, long-term care institutions or hospitals

Aim: The aim of this study was to assess the perceptions and barriers to providing oral health care for the dependent elderly in unconventional settings as reported by dentists in the State of São Paulo, Brazil. The Brazilian elderly population is rapidly growing, and a larger elderly population implies an increasing number of dependent elderly patients. Therefore, investigating the perceptions and barriers reported by dentists for caring for these patients becomes important. Materials and methods: An online survey was sent by e-mail to dentists of a metropolitan area in the State of São Paulo, Brazil. Results: The response rate was 3.65% (n = 125). Only 14.4% of respondents offered home care to the elderly. Lack of experience or training (60.7%) and the small number of home visits (42.9%), were the main reported barriers to providing care for the dependent elderly. Most of the respondents (82.4%) agreed that the age of the patient did not influence their decision to provide care, and 96.8% agreed that delivering care to the elderly could be a rewarding experience. Conclusion: Few respondents offered care to the elderly and some of the most relevant factors considered in the decision to offer care were, experience and training, personal satisfaction and having gerodontology as a stand-alone course during dental school

Restabelecimento funcional e estético com coroas e facetas laminadas / Functional and aesthetic reestablishment with full crowns and laminate veneers ­ a case report

A adequada estética do sorriso é cada vez mais almejada pelo paciente e pelo profissional. Dentes escurecidos e com lesões de abfração, causadas por excessiva carga oclusal, desfavorecem o agradável aspecto dos dentes e a estética facial como um todo. Este caso clínico relatou o procedimento restaurador de dentes anteriores superiores que apresentavam cor e forma inadequadas. Foram confeccionadas facetas e coroas com cerâmica termoprensada reforçada por dissilicato de lítio (IPS e.max Press, Ivoclar), que tem sido frequentemente utilizada na confecção de restaurações em dentes anteriores e posteriores por apresentar propriedades estéticas e mecânicas satisfatórias. Após a reabilitação, pôde-se perceber que o detalhado planejamento do tratamento e a correta escolha do material restaurador resultaram no restabelecimento funcional e estético. Foi possível concluir que restaurações obtidas a partir da cerâmica de dissilicato de lítio mostraram ser uma ótima alternativa para a confecção de facetas e coroas, considerando que houve perfeita concordância de cor entre ambas as restaurações, resultando no sucesso do tratamento e satisfação do paciente.

Adequate aesthetic appearance of the smile is increasingly desired by patient and professional. Darkened teeth and abfraction injuries caused by excessive occlusal load jeopardizes the appearance of the teeth, and the facial aesthetics as a whole. This case describes the restorative treatment of upper anterior teeth that presented inadequate color and form. Crowns and laminate veneers were made with lithium disilicate ceramic, which has often been used in the fabrication of anterior tooth restorations because it presents satisfactory aesthetic and mechanical properties. After the restorative process, it can be concluded that the detailed treatment planning and the correct choice of restorative material result in the reestablishment of function and aesthetics. It was concluded that the lithium disilicate ceramic showed to be an excellent alternative for making laminate veneers and adjacent crowns, considering that there was perfect color matching between both restorations, resulting in the success of treatment and patient satisfaction.

Reabilitação de dentes anteriores: a ciência aliada à arte / Rehabilitation of anterior teeth: science combined with art

Traumatismos dentários que resultam em fratura de dentes anteriores são comumente observados no dia a dia da prática clínica, e a reabilitação de tais elementos apresenta grande demanda estética. O presente relato de caso clínico descreveu os procedimentos e decisões clínicas realizadas para restaurar dois incisivos centrais superiores com histórico de trauma/fratura há mais de cinco anos, com coroas totalmente cerâmicas de dissilicato de lítio. A queixa principal do paciente (estética), bem como publicações científicas na área de materiais dentários e prótese dental, foi considerada na seleção do tipo de material restaurador e procedimentos realizados, de modo a proporcionar ao paciente a melhor opção restauradora no momento.

Dental trauma resulting in fracture of anterior teeth is commonly observed in daily clinical practice and the rehabilitation of such elements has great aesthetic demand. This case report describes the procedures and clinical decisions made to restore two central incisors with history of trauma/fracture with all-ceramic lithium dissilicate single-tooth crowns. The major complaint of the patient (aesthetics) as well as scientific publications of dental materials and dental prosthesis were considered in the selection of restorative material and procedures performed in order to give the patient the best treatment option.

Influence of one- or two-stage methods for polymerizing complete dentures on adaptation and teeth movements / Influência dos métodos de um ou dois estágios para polimerização de próteses totais na adaptação e movimentação de dentes

Introduction: The quality of complete dentures might be influenced by the method of confection. Objective: To evaluate the influence of two different methods of processing muco-supported complete dentures on their adaptation and teeth movements. Material and method: Denture confection was assigned in two groups (n=10) for upper and lower arches according to polymerization method: 1) conventional one-stage - a wax trial base was made, teeth were arranged and polymerized; 2) two-stage method - the base was waxed and first polymerized. With the denture base polymerized, the teeth were arranged and then, performed the final polymerization. Teeth movements were evaluated in the distances between incisive (I-I), pre-molars (P-P), molars (M-M), left incisor to left molar (LI-LM) and right incisor to right molar (RI-RM). For the adaptation analysis, dentures were cut in three different positions: (A) distal face of canines, (B) mesial face of the first molars, and (C) distal face of second molars. Result: Denture bases have shown a significant better adaptation when polymerized in the one-stage procedure for both the upper (p=0.000) and the lower (p=0.000) arches, with region A presenting significant better adaptation than region C. In the upper arch, significant reduction in the distance between I-I was observed in the one-stage technique, while the two-stage technique promoted significant reduction in the RI-RM distance. In the lower arch, one-stage technique promoted significant reduction in the distance for RI-RM and two-stage promoted significant reduction in the LI-LM distance. Conclusion: Conventional one-stage method presented the better results for denture adaptation. Both fabrication methods presented some alteration in teeth movements.

Introdução: A qualidade das próteses totais pode ser influenciada pelo método de confecção. Objetivo: Avaliar a influência de diferentes métodos de confecção de próteses totais na adaptação e movimentação de dentes. Material e método: A confecção das próteses foi dividida em dois grupos (n=10) para arcadas superior e inferior de acordo com o método: 1) convencional de uma etapa - realizada uma base de prova em cera onde foram montados os dentes e levada para a termopolimerização; 2) Método de duas etapas - a base foi encerada e termopolimerizada. Com a base da prótese polimerizada, os dentes foram montados e em seguida realizou a polimerização da outra porção. Para movimentação de dentes foram avaliadas as distâncias entre incisivos (I-I), pré-molares (PM-PM), molares (M-M), incisivo esquerdo a molar esquerdo (IE-ME) e incisivo direito a molar direito (ID-MD) antes e após polimerização final. As próteses foram seccionadas em três posições para análise de adaptação: (A) face distal de caninos, (B) face mesial de primeiros molares, e (C) face distal de segundos molares. Resultado: As bases das próteses demonstraram melhor adaptação quando polimerizadas no processo de uma etapa, tanto superiores (p< 0,05) quanto inferiores (p< 0,05), com a região A apresentando melhor adaptação que a região C. Na arcada superior uma redução na distância entre I-I foi observada na técnica de uma etapa, enquanto que na técnica de duas etapas houve redução na distância ID-MD. Na arcada inferior, na técnica de uma etapa houve redução na distância ID-MD e houve redução significativa na distância IE-M pelo método de duas etapas. Conclusão: O método de uma etapa apresentou melhores resultados para a adaptação da prótese. Ambos os métodos de confecção apresentaram alteração na movimentação de dentes.

Influence of Resin Cements on the Tension Force of Cast Frameworks Made by the Technique of Framework Cemented on Prepared Abutments

This study evaluated the tension force of cast frameworks made by the technique of framework cemented on prepared abutments using two different resin cements. Forty multi-unit abutment analogs were individually fixed with chemically cured acrylic resin inside PVC cylinders using a parallelometer. Brass cylindrical abutments were tightened to the multi-unit abutments to be used as spacers and then castable UCLA abutments were positioned above. These abutments were cast with Ni-Cr and then divided into 4 groups (n=10): cemented with RelyX U100(r); cemented with RelyX U100(r) and simulation of acrylic resin polymerization process; cemented with Multilink(r); and cemented with Multilink(r) and simulation of acrylic resin polymerization process. Abutments were cemented according to manufacturers' instructions. In a universal testing machine, tensile strength was applied in the direction of the long axis of the abutments at 1 mm/min crosshead speed until displacement of the luted abutments was obtained. The values of maximum tensile force (N) required for the displacement of the luted abutments were tabulated and analyzed statistically by one-way ANOVA with a 95% confidence level. No statistically significant difference was found among the groups (p>0.05). There was an increase in mean tension force when the specimens were subjected to the simulation of acrylic resin polymerization process, but the results did not differ statistically. Both resin cements presented positive results as regards the retention of luted abutments on their respective multi-unit abutments. Both materials may be indicated for the technique of framework cemented on prepared abutments when professionals pursuit better adaptation of implant-supported frameworks.

Este estudo avaliou a força de tração de infraestruturas fundidas confeccionadas pela técnica da infraestrutura cimentada sobre pilares preparados utilizando dois diferentes cimentos resinosos. Quarenta análogos de pilares multi-unit foram individualmente fixados com resina acrílica quimicamente ativada em cilindros de PVC utilizando um delineador. Pilares cilíndricos foram torqueados aos pilares multi-unit para serem usados como espaçadores e, então, pilares calcináveis UCLA foram posicionados sobre eles. Estes pilares foram fundidos em liga de Ni-Cr e divididos em 4 grupos (n=10): cimentados com RelyX U100(r); cimentados com RelyX U100(r) e simulação do processo de polimerização da resina acrílica; cimentados com Multilink(r); e cimentados com Multilink(r) e simulação do processo de polimerização da resina acrílica. Os pilares foram cimentados de acordo com as recomendações dos fabricantes. Em máquina universal de ensaio, a resistência à tração foi aplicada na direção do longo eixo dos pilares a uma velocidade de 1 mm/min até o deslocamento do pilar cimentado ser obtido. Os valores da tração máxima (N) necessária para o deslocamento dos pilares cimentados foram tabulados e analisados estatisticamente pela ANOVA de 1 fator com 95% de nível de confiança. Diferença estatisticamente significativa não foi encontrada entre os grupos (p>0,05). Houve um aumento na força média de tração quando os espécimes foram submetidos à simulação de processo de polimerização da resina acrílica, mas os resultados não diferiram estatisticamente. Ambos os cimentos resinosos apresentaram resultados positivos no que diz respeito à retenção dos pilares cimentados em seus respectivos pilares multi-unit. Ambos os materiais podem ser indicados para a técnica da infraestrutura cimentada sobre pilares preparados quando os profissionais buscam melhor adaptação de infraestruturas de próteses implanto-suportadas.

Patients' Expectation Before and Satisfaction After Full-Arch Fixed Implant-Prosthesis Rehabilitation.

This study evaluated patients' expectation before and satisfaction after full-arch fixed implant-prosthesis rehabilitation. Other variables that could influence patient satisfaction with this therapy were also evaluated. Using a visual analog scale (VAS), a sample of 28 patients assigned scores for their expectation before and satisfaction after therapy regarding chewing, esthetics, comfort, and phonetics. They also completed a questionnaire concerning their evaluation of the dentists' conduct. The average VAS scores were high for both expectation prior to treatment and satisfaction after treatment, and there was no statistical difference between them. Women presented higher expectations than men regarding esthetics (P = 0.040), phonetics (P = 0.043) and comfort (P = 0.013). Significant differences were not found between VAS scores with clinical variables (arch, radiographic bone quality, surgical bone quality, and implant inclination), educational level, and patients' evaluation of the dentists' conduct. Considering the results obtained in this study, expectation before implant-supported, full-arch fixed prosthesis therapy were met following treatment, with women having higher expectations than men.

Taste alteration, mouth dryness and teeth staining as side effects of medications taken by elderly

Elderly patients generally use several types of medication, some of which may cause oral side effects. Aim: To investigate the oral side effects caused by medication in an elderly sample. Methods: Three hundred patients were interviewed about their use of medication and were divided in two groups: institutionalized (n=150) and community-dwelling (n=150) elderly. Results: The most used drugs were antihypertensives (53%) for community-dwelling elders and antiulceratives (76%) for the institutionalized ones. The more prevalent side effects were taste alterations that occurred in 19%, dry mouth in 17% and teeth staining in 2%. Conclusions: A high prevalence of oral side effects from medications used by the elderly was found in this study. The health professionals should be aware of the possible side effects caused by prescribed medications.

Stress analysis of different configurations of 3 implants to support a fixed prosthesis in an edentulous jaw.

This study's aim was to evaluate the stress distribution in a mandibular implant-supported prosthesis and peri-implant bone considering implant quantity, diameter and position using linear 3-D finite element analysis. Models of an anterior jaw comprised 4 groups according to implant quantity, diameter, and position: control group C, 5 regular implants; R, 3 regular implants; W, 3 wide implants; and DTR, 3 regular implants with the distal ones tilted 30° distally. The cantilever was loaded with an axial load of 50 N. Data was evaluated using von Mises stress on implants and maximum principal stress and microstrain on the bone. The W group showed the lowest value of maximum principal stress in peri-implant bone of the loaded side (4.64 MPa) when compared to C (5.27 MPa), DTR (5.94 MPa), and R (11.12 MPa). Lower stress values in the loaded implants were observed in the experimental groups when compared to the C group. However, the unloaded implants presented opposite results. All the screws of the W group presented lower stress values when compared to the C group. However, the R and DTR groups presented an increase in stress values with the exception of the loaded screw. A reduction in the number of implants associated with wider implants reduced the stress in the bone and prosthetic components.

Prosthetic improvement of pronounced buccally positioned zygomatic implants: a clinical report.

This report presents a prosthetic technique for the improvement of surgically positioned, buccally placed zygomatic implants with the use of custom abutments for improved retention screw position and an esthetic implant reconstruction. The patient presented four zygomatic implants with pronounced buccal inclination. The anterior implants were inclined toward the location where the anterior artificial teeth should be placed during rehabilitation. As the manufacturer does not provide angulated abutments, we attempted the waxing and overcasting of a prosthetic abutment, repositioning the access holes of the prosthetic screws to a more palatal position. This clinical report demonstrates that abutment customization could be an interesting way to relocate the access holes of the prosthetic screws in cases of zygomatic implants with pronounced buccal inclination.

Evaluation of health parameters, use of drugs, and alcohol intake among an elderly population in São José dos Campos, SP, Brazil

AIM: To evaluate health parameters (blood pressure, heart rate and blood glucose), the use of medicines and alcohol consumption in elderly residents in the city of São José dos Campos, SP, Brazil. METHODS: A sample of 500 elderly individuals (98 men and 402 women, with mean age of 69.5 years) was examined. Personal data and medicines used by the patients were recorded, general health aspects were assessed and the Alcohol Use Disorders Identification Test (AUDIT) was applied to survey alcohol consumption. RESULTS: Two hundred and four patients (40.8%) presented high blood pressure and 93 patients (18.6%) had hyperglycemia. The most used pharmacological groups were antihypertensive drugs, antilipidemics, drugs to control hypothyroidism and hypoglycemic agents. Possible pharmacological interactions with alcohol were present in 60.9% of the used medicines. The AUDIT results showed that 91% of the sample presented a low-level intake of alcohol and only 1% presented characteristics of alcohol addiction. Associations were found among AUDIT scores with age (p=0.037), since a larger number of alcohol addicts were found among younger patients, and use of drugs (p=0.046), since patients who consumed more daily medicines made less use of alcohol (low-level). CONCLUSIONS: The studied sample presented a high prevalence of hypertension and relatively low incidence of diabetes. A low use of drugs was verified and women made more use of daily medications than men. Low alcohol consumption was also observed, and women consumed less alcohol than men.

Stress analysis of different configurations of 3 implants to support a fixed prosthesis in an edentulous jaw

This study's aims was to evaluate the stress distribution in a mandibular implant-supported prosthesis and peri-implant bone considering implant quantity, diameter and position using linear 3-D finite element analysis. Models of an anterior jaw comprised 4 groups according to implant quantity, diameter, and position: control group C, 5 regular implants; R, 3 regular implants; W, 3 wide implants; and DTR, 3 regular implants with the distal ones tilted 30º distally. The cantilever was loaded with an axial load of 50 N. Data was evaluated using von Mises stress on implants and maximum principal stress and microstrain on the bone. The W group showed the lowest value of maximum principal stress in peri-implant bone of the loaded side (4.64 MPa) when compared to C (5.27 MPa), DTR (5.94 MPa), and R (11.12 MPa). Lower stress values in the loaded implants were observed in the experimental groups when compared to the C group. However, the unloaded implants presented opposite results. All the screws of the W group presented lower stress values when compared to the C group. However, the R and DTR groups presented an increase in stress values with the exception of the loaded screw. A reduction in the number of implants associated with wider implants reduced the stress in the bone and prosthetic components.

Tratamento endodôntico na terceira idade / Endodontic treatment in elderly

A odontogeriatria é um ramo que cada vez mais vem tomando espaço na odontologia. Este segmento vem acompanhado de uma maior conscientização, tanto de profissionais quanto de pacientes, que passam a ter maiores preocupações com a saúde bucal, chegando à terceira idade com um maior número de dentes do que as gerações anteriores. Dessa forma, o cirurgião-dentista deve estar preparado para qualquer tipo de procedimento necessário para manter os seus pacientes com uma boa qualidade de saúde bucal. A endodontia, que em décadas passadas era muito pouco realizada em pacientes idosos, tem apresentado um crescente número de casos. Baseado nesse aumento de demanda, o presente trabalho realizou uma revisão da literatura quanto aos aspectos histológicos da polpa dental senil, do tratamento endodôntico propriamente dito e de aspectos sistêmicos que podem alterar o tratamento convencional, com o intuito de orientar o profissional que se dispõe a realizar estes procedimentos na prática diária.

Geriatric dentistry is in continuous diffusion in dentistry. It is followed by professionals conscious raising and by the patients preoccupations about oral health quality, keeping into their elderly which more teeth than the past generations. In this way the professional should be prepared to do any necessary procedure to patients keep their oral health quality. The endodontics, which few decades ago were rarely done in elderly is showing a considerable arouse in number of cases. Based on that increment on endodontics procedures the present paper reviewed the literature about the histological aspects of the elderly dental pulp, the endodontic procedure itself and some systemic aspects that may interfere anyhow in comparison with the conventional treatment, to guide the professional about these procedures in the daily practice.

Efeitos da plataforma switching em reabilitações implantossuportadas - revisão de literatura / Effects of platform switching in implant-supported rehabilitations - a literature review

Objetivo: o objetivo deste estudo foi avaliar os efeitos do uso da plataforma switching em reabilitações implantossuportadas. Esse tipo de sistema consiste em utilizar um componente protético de menor diâmetro, conectado à plataforma de implante com maior diâmetro, portanto, não combinados como de maneira convencional. Revisão de literatura: foram selecionados 13 artigos publicados no período de 2006 a 2011 abrangendo as consequências do uso da plataforma switching em relação aos fatores biológicos e biomecânicos das reabilitações implantossuportadas. Considerações finais: ficaram claros os benefícios e a indicação do uso de tal sistema, destacando-se a redução na reabsorção inicial da crista óssea peri-implantar e manutenção desse nível ósseo ao longo dos anos, bem como a diminuição nas forças sobre o tecido ósseo adjacente à região cervical do implante. Sendo assim, mesmo na presença de possíveis inconvenientes causados por este sistema, como o aumento das tensões na região do parafuso e componente protético, o uso da plataforma switching torna-se um atrativo para as reabilitações protéticas implantossuportadas.