Survival Rate of Implants and Mechanical Complications of 64 Implant-Supported Complete Arch Prostheses in Maxillary Edentulous Patients with a Follow-Up of up to 12 years: A Cross Sectional Analytical Study.

PURPOSE: This study aimed to identify the technical complications associated with maxillary complete-arch implant-supported fixed prostheses (ISFPs) and to evaluate the survival rates of both implants and prostheses. Additionally, we sought to analyze the impact of the presence of cantilevers, the type of prosthetic abutment, and the number of implants on the occurrence of complications. MATERIALS AND METHODS: Data were obtained from standardized clinical assessments carried out in a single appointment by two calibrated professionals using information from dental records. RESULTS: The sample consisted of 64 patients rehabilitated with ISFPs classified as hybrid prostheses (metal-resin). The survival rate for implants was 98.6% after 1 to 12 years (5.2 years ± 36.6 months) and was 100% for the prostheses after a follow-up period of 12 to 144 months (mean 48.1 ± 33.94 months). The most frequent complications were occlusal wear (82.8% of patients) and loosening of prosthetic screws (16.6%) and abutments (8.1%). Screw loosening frequency was significantly greater in 30-degree abutments compared with straight abutments (P=0.008), but no significant difference was found between 17-degree and 30-degree abutments. Prostheses with a higher occurrence of screw loosening had a greater average CL/AP spread ratios (0.9 ô€€€ 0.5). In addition, abutments installed on distal implants were more likely to loosen (P<0.001). The absence of mutually protected occlusion did not significantly influence the loosening of screws and prosthetic abutments. CONCLUSIONS: Implantsupported fixed maxillary complete-arch rehabilitations have high survival rates but are subject to technical complications.

Influence of risk factors on the long-term survival of oral rehabilitation with extra-narrow implants: a retrospective study.

OBJECTIVE: This study aimed to retrospectively collect clinical data to evaluate the influence of possible risk factors on the long-term success of implant treatment with extra-narrow (2.9 mm diameter) implants in a daily dental practice setting. METHODOLOGY: Data were collected from records of patients who received at least one extra-narrow implant from 2012 to 2017, regarding implant survival, prosthesis survival, patient characteristics, and implant characteristics. The association between the dependent variables "implant survival", "prosthesis survival," and "adverse events" related to patient and implant characteristics was statistically evaluated by chi-square tests. Moreover, implant and prosthesis survival were analyzed by Kaplan-Meier survival curves. RESULTS: The sample was constituted of 58 patients (37 women and 21 men) with a mean age of 54.8 years old (SD: 12.5), followed up for up to eight years. In total, 86 extra-narrow implants were placed within this sample. Four implants were lost, resulting in an implant survival rate of 95.3%. A total of 55 prostheses were inserted and only one (1.8%) was lost, resulting in a prosthesis survival rate of 98.2%. The mean implant and prosthesis survival time was, respectively, 7.1 years and 6.3 years, according to the Kaplan-Meier survival analysis. A correlation was found between smoking and implant loss, which makes implant loss eight times more likely to occur in smokers than non-smokers. A significant association was also found between prosthesis loss and previous need of prosthesis repair. However, it was not considered clinically relevant. No association was found between the occurrence of adverse events and later implant or prosthesis loss. CONCLUSION: High implant and prosthesis survival rates were found in the long term for treatment with extra-narrow implants. Moreover, a significant correlation between smoking and implant loss was observed.

Evaluation of the intaglio surface shape of implant-supported complete-arch maxillary prostheses and its association with biological complications: An analytical cross-sectional study.

STATEMENT OF PROBLEM: Whether the shape of the intaglio surface of fixed implant-supported maxillary prostheses is associated with the occurrence of biological is unclear. PURPOSE: The purpose of this cross-sectional study was to evaluate the shape (convex or concave) of the intaglio surface of complete-arch implant-supported maxillary fixed prostheses and to assess the association with biofilm accumulation, hyperemia, bone loss, and patient satisfaction. MATERIAL AND METHODS: Study participants consisted of 56 individuals with fixed complete implant-supported maxillary prosthesis attending follow-up appointments. The 56 prostheses supported by 388 implants had been in place for an average of 5.5 years (range 1-14 years). The intaglio surface was divided into areas corresponding to the cantilever regions and between implants (n=442) and was assessed for shape (concave or convex) and biofilm index (0 to 3). Tissue hyperemia (redness) was assessed as absent or present. Bone loss (mm) was measured from digital periapical radiographs by 2 calibrated evaluators (kappa=94.9%). Study participant satisfaction was investigated by using a visual analog scale. Association assessments (α=.05) between the shape of each area and all these parameters were performed with the Friedman, linear regression, and logistic regression tests. RESULTS: Of the analyzed areas, 58 (13.1%) were concave, and 384 (86.9%) were convex. Biofilm was absent on 3.5% of the concave and 5.5% of the convex areas. Biofilm was detectable with a probe on 12% of the concave and 22.4% of the convex areas and clinically visible in 58.6% of the concave and 57.8% of the convex areas. Abundant biofilm was seen in 25.9% of the concave and 14.3% of the convex areas and was associated with hyperemia (P=.003). A statistically significant association was found between the shape and biofilm accumulation (P=.009). Hyperemia was present in 199 (45%) areas. The association analysis between the shape of the area and the presence of hyperemia was not significant (P>.05). The mean bone loss was 0.71 mm (0.91 mm). Implants placed near concave areas underwent greater bone loss (P=.001). Study participants reported a high level of satisfaction with the esthetics, mastication, speech, and smile provided by the prosthesis, with satisfaction scores ranging between 8.46 and 8.77. However, in relation to ease of cleaning, only 19.6% were fully satisfied. CONCLUSIONS: The shape of the intaglio surface of prostheses influenced the occurrence of biofilm accumulation and bone loss, and concave areas showed greater biofilm accumulation and bone resorption. High rates of satisfaction with treatment were identified.

Influence of risk factors on the long-term survival of oral rehabilitation with extra-narrow implants: a retrospective study

Abstract Objective This study aimed to retrospectively collect clinical data to evaluate the influence of possible risk factors on the long-term success of implant treatment with extra-narrow (2.9 mm diameter) implants in a daily dental practice setting. Methodology Data were collected from records of patients who received at least one extra-narrow implant from 2012 to 2017, regarding implant survival, prosthesis survival, patient characteristics, and implant characteristics. The association between the dependent variables "implant survival", "prosthesis survival," and "adverse events" related to patient and implant characteristics was statistically evaluated by chi-square tests. Moreover, implant and prosthesis survival were analyzed by Kaplan-Meier survival curves. Results The sample was constituted of 58 patients (37 women and 21 men) with a mean age of 54.8 years old (SD: 12.5), followed up for up to eight years. In total, 86 extra-narrow implants were placed within this sample. Four implants were lost, resulting in an implant survival rate of 95.3%. A total of 55 prostheses were inserted and only one (1.8%) was lost, resulting in a prosthesis survival rate of 98.2%. The mean implant and prosthesis survival time was, respectively, 7.1 years and 6.3 years, according to the Kaplan-Meier survival analysis. A correlation was found between smoking and implant loss, which makes implant loss eight times more likely to occur in smokers than non-smokers. A significant association was also found between prosthesis loss and previous need of prosthesis repair. However, it was not considered clinically relevant. No association was found between the occurrence of adverse events and later implant or prosthesis loss. Conclusion High implant and prosthesis survival rates were found in the long term for treatment with extra-narrow implants. Moreover, a significant correlation between smoking and implant loss was observed.

Fluxo digital para planejamento de reabilitação / Digital workflow for rehabilitation planning

Resumo O fluxo de trabalho digital para o planejamento e execução da reabilitação oral já é uma realidade na prática profissional e pode beneficiar a conversa multidisciplinar para a compreensão e resolução dos casos que apresentam maior complexidade e certas limitações. Com base nisso, este relato tem a intenção de discutir uma reabilitação oral que integra o uso do protocolo fotográfico e traçado, a reabilitação oral por fluxo digital no aumento da dimensão vertical de oclusão (DVO), recursos cirúrgicos para melhorias de ângulo nasolabial.(AU)

Abstract The digital workflow for planning and executing oral rehabilitation is already a reality in professional practice and can benefit the multidisciplinary dialogue to understand and resolve cases that present greater complexity and certain limitations. Based on this, this report intends to discuss an oral rehabilitation that integrates the use of the photographic and tracing protocol, the oral rehabilitation by digital workflow in the increase of the vertical dimension of occlusion (VDO), surgical resources for improvements of the nasolabial angle. (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.

Manejo de complicações protéticas de implantes zigomáticos ­ relato de caso com 1 ano de acompanhamento / Management of prosthetic complications of zygomatic implants - 1-year followup case report

A ancoragem de implantes em osso zigomático tem sido reconhecida como uma abordagem terapêutica menos invasiva quando comparada às grandes reconstruções para a reabilitação de maxilas severamente atróficas. Apesar de alcançar sucesso clínico elevado do ponto de vista cirúrgico e protético, melhorando a qualidade de vida e satisfação dos pacientes, problemas relacionados ao conforto da prótese são algumas vezes relacionados. Este caso clínico apresenta a resolução de 2 problemas: i) implantes zigomáticos do tipo cone morse em nível gengival, o que deixava a região côncava dos intermediários exposta ao meio oral e ii) hipersensibilidade na região de fossa nasal pela presença de implantes na região. A sensibilidade e trauma na língua, em decorrência dos implantes posteriores, foram solucionados pela personalização de um componente protético, enquanto a sensação de pressão na região anterior da maxila foi eliminada após a remoção de 2 implantes convencionais sem prejuízo à biomecânica da prótese implantossuportada (AU).

The anchorage of implants in the zygomatic bone has been recognized as a less invasive approach when compared to large reconstructions of severely atrophic maxilla. Although high rates of surgical and prosthetic success have been reached improving the patient life quality and satisfaction, problems in terms of prosthesis comfort are sometimes reported. This case report presents the resolution of 2 problems: i) morse taper zygomatic implants at the gingival level, resulting in the exposure of the concave area of the abutments and ii) hypersensitivity at the nasal cavity region, due to implants nearby this site. Sensitivity and tongue trauma, as a result of posterior implants, were solved by prosthetic component customization , while the pressure in the maxilla anterior area was eliminated after removing 2 conventional implants with no damage to the biomechanics of the implant supported prosthesis (AU).

Avaliação da satisfação de reabilitações com implantes zigomáticos / Satisfaction of rehabilitation with zygomatic implants

Introdução: A reabilitação oral de pacientes com atrofia óssea maxilar representa um grande desafio por estes pacientes apresentarem comprometimento da qualidade de vida, dificuldades alimentares, complicações nutricionais, dificuldades sociais e emocionais. Propostas de reabilitações de maxilas mutiladas e/ou atróficas com próteses totais fixas implantossuportadas, utilizando implantes zigomáticos, foram relatadas. Objetivo: O objetivo deste estudo foi avaliar o grau de satisfação dos pacientes reabilitados com implantes zigomáticos e convencionais, em função de carga imediata com prótese do tipo protocolo através de um estudo retrospectivo, por meio de questionário respondido pelos pacientes. Material e método: Foram incluídos dezenove pacientes, tratados na clínica do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO) em Curitiba, PR (Brasil), entre dezembro de 2005 e junho de 2010. Os pacientes foram reabilitados com 41 implantes zigomáticos e 73 implantes convencionais, todos do tipo cone Morse. As próteses, tipo híbridas, foram instaladas em carga imediata. Resultado: O índice de satisfação encontrado foi de 100%. Conclusão: Pode-se concluir que esta técnica de reabilitação restabelece fatores primordiais ao ser humano como mastigação, fonética e estética. Os pacientes relataram satisfação com o resultado do tratamento, conseguindo desenvolver atividades sociais dentro da normalidade, elevando sua autoestima.

Introduction: Rehabilitation of patients with atrophic maxilla is challenging. Atrophic maxilla patients present compromised quality of life, impaired function, deficient nutrition, social and emotional difficulties. The rehabilitation of atrophic maxilla by zygomatic fixtures has been previously proposed. Objective: This retrospective study evaluated the degree of satisfaction of patients rehabilitated by immediately loaded conventional and zygomatic fixtures supporting full-arch fixed dental prosthesis. A satisfaction questionnaire was used for patient assessment. Material and method: Nineteen patients treated at the Latin American Institute for Dental Research and Education (ILAPEO) between December 2005 and June 2010 were evaluated. Patients were rehabilitated with 41 zygomatic implants and 73 conventional implants under immediate load. Result: All assessed patients were completely satisfied with the provided rehabilitation. Conclusion: It can be concluded that rehabilitation with zygomatic fixtures is capable of restoring function, phonetics, and esthetic for patients with atrophic maxilla. The patients were satisfied with the treatment outcomes and showed increased self-esteem after the rehabilitation.

Effect of different implant placement depths on crestal bone levels and soft tissue behavior: a randomized clinical trial.

OBJECTIVES: This randomized clinical trial analyzed crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the mandible anterior region at different depths (equicrestal and subcrestal). MATERIALS AND METHODS: Eleven edentulous patients (five implants per patient) were randomly divided in a split-mouth design: G1, 28 equicrestal implants; and G2, 27 subcrestal implants. All implants were immediately loaded. Correlation between keratinized tissue width (KTW) and vertical mucosa thickness (MT) with soft tissue recession was analyzed. Intraoral radiographs were used to evaluate crestal bone changes. Patients were assessed immediately, 4-, and 8-months after implant placement. Rank-based ANOVA-type statistical test was used for comparison between groups (α = 0.05). RESULTS: Fifty-five implants (G1 = 28 and G2 = 27) were assessed in 11 patients. Implant survival rate was 100% for both groups. Both tested implant placement depths presented similar crestal bone loss (P > 0.05). Significant crestal bone loss for each group was found in the different measurement times (T4 and T8) (P < 0.05). Implant placement depths, KTW, and vertical MT had no effect on soft tissue recession (P > 0.05). CONCLUSIONS: Different implant placement depths do not influence crestal bone changes. Soft tissue behavior is not influenced by different implant placement depths or by the amount of keratinized tissue.

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.

Remoção, regeneração e reinstalação de implante osseointegrável em área estética: relato de caso / Removal, regeneration and reinstallation of osseointegrated implant in the esthetic zone: a case report

Há muitos anos os implantes estão sendo utilizados para reabilitar pacientes edêntulos. Atualmente, há uma grande exigência estética envolvida nessas reabilitações. O objetivo do presente artigo é descrever, por meio do relato de um caso clínico, o tratamento realizado para solucionar a queixa estética de uma paciente que apresentava um implante mal posicionado na região anterior da maxila. A paciente, com 39 anos de idade, compareceu à clínica de Implantodontia do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO) relatando insatisfação com o implante da região do elemento 22, que “aparecia ao sorrir”. Após avaliação, verificou-se que o implante estava vestibularizado, com perda óssea, comprometimento dos tecidos moles e com a coroa clínica maior que a do elemento 12. Para a resolução do caso, foi realizada, no primeiro procedimento cirúrgico, a remoção do implante, seguida de enxerto ósseo autógeno na região. Após cinco meses de cicatrização, um novo implante foi instalado e feito enxerto ósseo com GenOx Inorgânico (Baumer - São Paulo, Brasil) na vestibular, para melhorar o contorno. A reabertura foi realizada com técnica de manipulação de tecidos moles, o intermediário foi instalado e a coroa provisória, confeccionada. A paciente foi encaminhada para a clínica de prótese para finalização do caso. Diante das características do caso, a forma de tratamento realizada se mostrou eficaz, uma vez que solucionou a queixa estética da paciente, com previsibilidade e funcionalidade...

For many years the implants are being used to rehabilitate edentulous patients. Currently, there is a great aesthetic requirements involved in these rehabilitations. The purpose of this article is to describe, through the report of a case, the treatment performed to solve the aesthetic complaint from a patient with a poorly positioned implant in the anterior maxilla. The patient, 39 years old, attended the clinic Implantology of the Latin American Institute of Research and Dental Education (ILAPEO) reporting dissatisfaction with the implant of the element 22 region, which "appeared to smile." After evaluation, it was found that the implant was buccally with bone loss, breakdown of soft tissue and the greater the clinical crown element 12. For the resolution of the case, was carried out, the first surgical procedure, removal of the implant followed by autogenous bone graft in the region. After five months of healing, a new implant was installed and made bone graft with GenOx Inorganic (Baumer - São Paulo, Brazil) in the entrance exam to improve the contour. The reopening was performed with soft tissue manipulation technique has been installed intermediate and provisional crown made. The patient was referred to the clinic prosthesis for completion of the case. Before the case characteristics, the form of treatment performed was effective, since resolved the aesthetic complaint of patient, predictability and functionality...

Influence of bruxism on the indication and follow- up of rehabilitations with dental implants

AIM: The objective of this study was to report a clinical case highlighting the main recommendations of the literature to minimize forces applied on implants. MATERIAL AND METHODS: A decision was made to increase the number and size of implants installed. Screwed and cemented prostheses were used, combined with an occlusal bruxism night guard. RESULTS: Four months after the prosthesis installation, no biological or biomechanical complications were encountered. CONCLUSION: There are cases of patients with parafunctional habit who require oral rehabilitation with implants. There are guidelines that enable planning and rehabilitation. It is important to monitor cases to assess the behavior of implants and their suprastructures.

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.

Resources to achieve esthetics in anterior teeth / Recursos para se obter estética em áreas anteriores

As dentistry has evolved, the search for good esthetics has become increasingly frequent. Professionals must be constantly up-to-date regarding the latest advances. When a tooth is lost, there are several possible rehabilitation techniques. Adequate contour of the bone and gingiva is an essential factor if good esthetic results are to be achieved. In order to maintain the contour, techniques for immediate placement of implants, bone and gum grafting techniques and care in the correct establishment of the ideal position of the implant have been advocated. Sometimes dentists have to treat a patient whose implants have already been installed and are osseointegrated. This report was carried out in order to highlight the importance of understanding the information that is available to obtain appropriate gingival contours in such clinical conditions. A review of the literature was carried out on methods for obtaining gingival papilla and esthetics in the anterior maxilla, and on methods to construct a prosthesis for the clinical case described. The analysis of the outcome and of the degree of patient satisfaction suggests that the resources described can be successfully applied.

Devido às mudanças ocorridas pela evolução da Odontologia, a busca pela estética tem se tornado cada vez mais frequente. A constante atualização dos profissionais é uma necessidade. Quando ocorre a perda de um elemento dental, várias técnicas têm sido sugeridas para a correta reabilitação do mesmo. Manutenção do contorno ósseo e gengival já é um fator entendido como imprescindível para que a mesma possa ser alcançada. Em busca dessa manutenção de contorno, técnicas de posicionamentos imediatos de implantes, técnicas de enxertia óssea e/ou gengival e cuidados no correto estabelecimento da posição ideal do implante tem sido descritos. No entanto, alguns casos chegam para reabilitação com implantes já instalados e osseointegrados. Entendendo a importância de se conhecer os recursos descritos para obtenção de contornos gengivais adequados frente a essa condição clínica esse estudo foi idealizado. Foi realizada uma revisão de literatura e alguns dos métodos descritos para obtenção de papilas gengivais e estéticas em maxila anterior, assim como para confecção da prótese foram utilizados para resolução de um caso clínico que é apresentado. A análise do caso finalizado e a observação do grau de satisfação da paciente com o resultado alcançado permitem concluir que os recursos descritos são aplicáveis e permitem a otimização dos resultados.

A randomized controlled trial comparing interim acrylic prostheses with and without cast metal base for immediate loading of dental implants in the edentulous mandible.

OBJECTIVES: This randomized controlled trial used resonance frequency analysis (RFA) to assess the effects of the presence or absence of a cast rigid bar splinting multiple implants in the stability of immediately loaded implants. MATERIAL AND METHODS: Twenty-nine edentulous patients were randomly divided into two groups: G1 with full-arch implant-fixed prostheses and G2 with multiple implant splinting via acrylic resin denture bases. All implants were immediately loaded. RFA measurements assessed implant stability at three different times (T0--at baseline, T1--4 months, and T2--8 months. Wilcoxon and Friedman tests and a multivariate model with repeated measures for longitudinal data were used for statistical comparison (α = 0.05). RESULTS: Twenty-nine patients were assessed (G1 = 15 and G2 = 14). Implant and prostheses survival rates were 100% for both groups after the 8-month observation period and no significant differences in the mean ISQ values were found at the different implant stability assessment times (P > 0.05). CONCLUSIONS: The different splinting protocols did not appear to affect implant stability during the 8-month observation period.

Análise comparativa da desadaptação obtida por diferentes sistemas usados para a fabricação de coroas cerâmicas suportadas por implantes / Comparative evaluation on the misfits of different all-ceramic implant-supported crown systems

Objetivo: comparar a precisão da adaptação de infraestruturas para coroas unitárias implantossuportadas, em zircônia e alumina, fabricadas por dois diferentes sistemas de fabricação. Material e métodos: implantes cone-morse Neodent foram utilizados, associados a componentes protéticos em zircônia (4,5 x 6 mm). Foram fabricadas 15 infraestruturas e divididas em três grupos (n=5): G1 – Zircônia (Neodent Digital); G2 – Alumina (Neodent); e G3: Zircônia (Zirkonzahn M5). Foram analisadas as discrepâncias horizontal e vertical em microscópio ótico (25x). Os resultados foram submetidos à Anova e teste de Tukey-Kramer (α=0,05). Resultados: os valores médios de desadaptação encontrados foram: Horizontal – G1 - 25,2 ± 12,86 μm, G2 - 79,5 ± 12,76 μm, e G3 - 130,0 ± 8,42 μm; Vertical – G1 - 4,1 ± 2,46 μm, G2 – 12,8 ± 9,62 μm, e G3 – 153,5 ± 83,92 μm. Na comparação estatística entre os grupos, o G3 apresentou os maiores valores de desadaptação (p < 0,05), enquanto que os outros grupos não apresentaram diferenças entre si (p > 0,05). Conclusão: dentro das limitações deste estudo, podemos concluir que as infraestruturas em zircônia fabricadas pelo sistema CAD/CAM Neodent Digital apresentaram adaptação adequada, seguida pelas infraestruturas em alumina e zircônia fabricadas pelo sistema CAD/CAM Zirkonzahn M5.

Objective: the purpose of this in vitro study was to compare the precision of fi t of implant-supported copings milled from semi-sintered Zirconia blocks fabricated by two different computer-assisted designs (CAD)/computer-assisted manufacturing (CAM) systems and using a suspension plasma spray Alumina injection process. Material and methods: the Neodent Morse Cone implant system (Neodent, Brazil) was used in the study associated with Zirconia implant-abutments (4.5 x 6 mm). Fifteen standardized copings were fabricated for the 3 test groups (n=5): G1 – Neodent Digital Zr copings; G2 – Neodent Alumina coping; and G3 – Zirkonzahn M5 copings. Horizontal and vertical discrepancies were measured and the misfi t values were evaluated in an optical microscope (25x). Data were submitted to Anova and Tukey-Kramer’s test (α=0.05). Results: the average misfi t levels found for the groups were: Horizontal – G1 - 25.2 ± 12.86 μm, G2 – 79.5 ± 12.76 μm, and G3 – 130 ± 8.42 μm; Vertical – G1 – 4.1 ± 2.46 μm, G2 - 12.8 ± 9.62 μm, and G3 - 153.5 ± 83.92 μm. In the statistical comparison between groups, G3 presented signifi cantly higher misfi t levels than the other groups (p < 0.05). The other groups had no signifi cant differences between each other (p > 0.05). Conclusion: Within the limitations of this study, it can be concluded that zirconia copings fabricated by Neodent Digital CAD/CAM system presented adequate fit followed by alumina and zirconia copings fabricated by the Zirkonzahn M5 CAD/CAM system.

Retrospective analysis of 2244 implants and the importance of follow- up in implantology

AIM: A retrospective clinical analysis evaluated the clinical behavior of the prosthetic restorations, screw joint stability, peri-implant bone level and soft tissues, implant survival rate and patient satisfaction. MATERIAL AND METHODS: Data was collected from follow-up visits of 444 patients, aged from 26 to 88 years, that were rehabilitated with 2,244 implants placed between 2005 and 2010. RESULTS: The implant survival rate was 99.73%, 94.78% for prosthetic screws, and 96.70% for abutment screws. Peri-implant bone levels remained stable (bone loss equal or less than 1 mm) in 96.21% of the implants. Plaque accumulation was present in 275 patients and was associated with gingival bleeding in 66 patients. Three hundred and thirty patients were satisfied, 103 were somewhat satisfied, 7 patients expected more from their restorative treatment, and 4 patients were dissatisfied. CONCLUSION: Continuous follow-up of patients with implant restorations provides essential information on the behavior of implants and prosthetic components, enbling the early intervention in minor prosthetic complications (e.g. screw loosening) to avoid future major complications (e.g. implant failure).

Odontogenic myxoma in children: case report

Odontogenic myxoma is a rare tumor, often diagnosed during routine radiographs or when it is so severe that it causes pain, a noticeable increase in volume or tooth displacement and mobility. Young adults (25-30 years of life) are more often affected by the lesion but all ages are vulnerable. The mandible is more commonly involved than the maxilla and the tumors usually grow slowly and silently. However, growth can be rapid and destructive. The radiographic aspect of a myxoma is that of a uni or multilocular, radiolucent lesion reminiscent of honeycomb or soap bubbles, depending on its size. It is an expansive tumor that may cause displacement or resorption of the teeth involved. Microscopically, the tumor is composed of round and spindle cells, with a star arrangement, arranged in a loose abundant myxoid stroma, containing only a few collagen fibrils. The treatment of choice is radical surgical excision because myxomas are not encapsulated and tend to infiltrate the surrounding bone. However, small tumors can be treated by curettage. Periodic reassessment is required for at least five years due to the high rate of recurrence. Larger tumors may need to be treated using a more extensive resection with a safety margin. This study reports a clinical case of odontogenic myxoma in a child aged 7 years. The tumor was located in the posterior region of the mandible and was surgically treated with an en bloc resection with preservation of the base of the mandible. The follow-up of the case is ongoing and no recurrence has been observed to date.

Bone behavior in atrophic edentulous mandibles after rehabilitation with immediate loaded implant: a short-term radiographic and tomographic study.

PURPOSE: To evaluate bone response in the posterior area of edentulous mandibles rehabilitated with fixed prosthesis supported on dental implants considering baseline severity of mandibular atrophy. MATERIAL AND METHODS: The sample included 15 patients in whom 5 implants were inserted between the mental foramens. The prosthesis followed a cantilever extension from 15 to 20 mm. They were divided into 2 groups (severe and moderate) according to the degree of the atrophy presented. Panoramic x-ray and computerized tomography were obtained immediately after rehabilitation (T0) and after 8 months (T8). Linear measurements of the alveolar bone height at the posterior area of the mandible, 5, 10, and 15 mm from the long axis of the most distal implants, were recorded. Density measurements were also achieved at the same sites. RESULTS: A slight bone increase in both groups was observed but with no statistically significant difference according to the baseline degree of atrophy. CONCLUSIONS: There was slight qualitative and quantitative bone improvement in the posterior area of the mandibles with the use of immediately loaded implant-supported fixed prostheses during the observed period. These results suggest that long-term follow-up is very important to understand bone behavior after rehabilitation.

Efeito de diferentes níveis de torques na resistência ao destorque do parafuso e dos pilares de duas peças em junções cone-morse. Estudo in vitro / The effect of different torque levels on detorque resistance of a two-piece, cone Morse abutment and screw. An in vitro study

Objetivos: determinar se a quantidade da pré-carga influencia a resistência ao destorque do parafuso e pilar de duas peças com junção cone-morse indexada. Material e métodos: foram utilizados 60 análogos de implantes conexão tipo cone-morse de 11,5° com indexador hexagonal e 60 munhões universal cone-morse parafuso passante (4,5 mm de diâmetro, 2,5 mm de altura cinta de transmucoso e 4 mm de altura, não indexados), divididos em três grupos segundo o torque aplicado: 15 Ncm (G1); 20 Ncm (G2) e 25 Ncm (G3). A análise de variância fator único (Anova) e o teste LSD foram usados para as comparações entre os grupos (nível de significância 5%). Imagens em MEV foram realizadas na cabeça do parafuso e na chave de aplicação de torque. Resultados: os valores médios para os destorques dos parafusos foram: G1=17,48 Ncm, G2=21,16 Ncm e G3=26,42 Ncm, com diferencas estatisticamente significativas (p < 0,001) entre todos os grupos. Os valores médios para os destorques nos pilares foram: G1=15,17 Ncm, G2=19,58 Ncm e G3=21,64 Ncm, sendo (G1 e G2) e (G1 e G3) (p < 0,001); e G2 e G3 (p=0,02). Conclusão: 1) o aumento do torque no parafuso gerou valor médio aumentado do destorque em todos os grupos; 2) o aumento do torque gerou valor médio de destorque equivalente ao torque inicial dado para o G1 e G2, sendo este aumento menor no G3; 3) torques maiores do que os indicados pelo fabricante foram capazes de promover a deformação plástica na cabeça do parafuso após apertos repetidos

Objectives: to determine whether the applied preload influences on detorque resistance of abutment and abutment screw of a two-piece, indexed cone-morse taper connection. Material and methods: Sixty implant analogs (cone-morse taper=11,5 degrees) with internal hexagonal indexing and sixty cone morse universal abutments (4.5 mm diameter, 2.5 mm collar height, and 4 mm in height, non-indexed), were divided into three groups according to applied torques: 15 Ncm (G1); 20 Ncm (G2), and 25 Ncm (G3). The one-way Anova and LSD tests were used for comparisons among groups (at 5% level). Representative SEM images were obtained from screw heads and key drivers. Results: mean detorque abutment screw values were as follows: G1=17.48 Ncm, G2=21.16 Ncm, and G3=26.42 Ncm, with statistically significant differences (p < 0,001) among all tested groups. Also, the mean detorque abutment levels were: G1=15.17 Ncm, G2=19.58 Ncm, and G3=21.64 Ncm, being (G1 and G2); (G1 and G3) (p < 0.001); and G2 and G3 (p=0.02). Conclusion: 1) an increase on abutment screw torque level also increases detorque values for all groups; 2) an increase on abutment torque level provided detorque values proportional to that found in G1 and G2, being this lower for G3; 3) torque values higher than those preconized by the manufacturer lead to plastic deformation at screw heads after repeated tightening sequences