O condicionamento de tecido peri-implantar na reabilitação estética de próteses unitárias sobre implantes: relato de caso clínico / Peri-implant tissue conditioning in the esthetic rehabilitation of unitary prostheses on implants: Clinical case report / Acondicionamiento del tejido periimplantario en la rehabilitación estética de prótesis unitarias sobre implantes: Informe de caso clínico

Introdução:A reabilitação protética implantosuportada de espaços edêntulos na região do sorriso é um desafio para o cirurgião-dentista. Para obtenção da estética em próteses unitárias sobre implante é necessário considerar aspectos como o correto posicionamento do implante e sua harmonia com os tecidos moles e duros. Objetivo:relatar o resultado estético e funcional de um tratamento com auxílio de coroa provisória associada ao condicionamento gengival na reabilitação final com coroa unitária implantossuportada. Relato de caso clínico: Paciente MJFA, 36 anos, sexo feminino, compareceu à clínica de Prótese Dentária do Departamento de Odontologia/UFRN queixando-se de trauma dentário com perda do elemento dentário 15 e necessidade de "ficar com sorriso mais bonito". Após instalação de implante com conexão cônica e período de osseointegração, foi realizada a confecção da coroa provisória sobre implante e iniciada sessões de condicionamento gengival por meio de acréscimos com resina acrílica, utilizando a técnica de pressão gradual sob a margem gengival. Observou-se uma melhora no tecido periimplantar e um perfil de emergência adequado. O caso possui proservação de 3 anos. Conclusões:a realização de condicionamento gengival previamente a prótese final é uma etapa importante para alcançar umareabilitação com característicasestéticas e funcionais semelhantes à de dentes naturais (AU).

Introduction:Implant-supported prosthetic rehabilitation of edentulous spaces in the smile areais a challenge for dental surgeons. To achieve pleasing esthetics in single implant prostheses it is necessary to consider aspects such as the correct positioning of the implant and its harmony with the soft and hard tissues.Objective:to report the esthetic and functional results of a treatment with the aid of a provisional crown associated with gingival conditioning in the final rehabilitation with a single implant-supported crown.Clinical case report:Patient MJFA, 36 years old, female, attended the Prosthodonticsclinic of the Department of Dentistry/UFRN complaining of dental trauma with loss of tooth 15 and the need to "havea more beautiful smile". Afterinstalling an implant with a conical connection and a period of osseointegration, a temporary crown was made on the implant and gingival conditioning sessions were initiatedby means of acrylic resin augmentations, using the gradual pressure technique under the gingival margin. An improvement in the peri-implant tissue and an adequate emergenceprofile were observed. The case has a 3-year follow-up period.Conclusions:performing gingival conditioning prior to the final prosthesis is an important step in achieving rehabilitation with esthetic and functional characteristics similar to those of natural teeth (AU).

Introducción: La rehabilitación protésica implantosoportada de espacios edéntulos en el áreade la sonrisa es un desafío para el cirujano dentista. Para conseguir una buena estética en las prótesis unitarias sobre implanteses necesario tener en cuentaaspectos como el posicionamiento correctodel implante y su armonía con los tejidos blandos y duros.Objetivo: informar losresultadosestéticosy funcionalesde un tratamiento con ayuda de coronas provisionales asociado al acondicionamiento gingival en la rehabilitación final con corona única implantosoportada.Relato de caso clínico: Lapaciente MJFA, 36 años, sexo femenino, se dirigióa la clínica de Prostodonciadel Departamento de Odontología/UFRN quejándose de un traumatismodental con pérdida del diente 15 y de la necesidad de "tener una sonrisa más bonita". Después de la colocación de un implante con conexión cónica y de un período de osteointegración, se realizó una corona provisional sobre el implante y se iniciaron sesiones de acondicionamiento gingival con aumentos de resina acrílica, utilizando la técnica de presión gradual bajo el margen gingival. Se observó una mejora del tejido periimplantario y un perfil de emergencia adecuado. El caso tiene un seguimiento de 3 años. Conclusiones: el acondicionamiento gingival previo a la prótesis definitiva es una etapaimportante para conseguiruna rehabilitación con características estéticas y funcionales similares a las de los dientes naturales (AU).

The effect of multiple enamel conditioning on enamel micro-hardness.

Background: White spot formation is one of the common side effects in orthodontic treatments and multiple enamel conditioning might happen even during on session of fixed orthodontic treatments. The aim of the present study was to evaluate the impact of multiple enamel conditioning with different methods on enamel micro-hardness (MH). Materials and Methods: In this In vitro experimental study, the buccal surfaces of 105 extracted premolars were evaluated in seven groups: One control and six experimental groups. The enamel conditioning was performed in three ways: Etching with phosphoric acid 37%, etching with phosphoric acid 37% followed by primer application and conditioning with self-etch primer. The conditioning process in each way was also performed twice consecutively. The specimens were submitted in pH cycling model with demineralization and re-mineralization solutions for 14 days. Afterward Vickers MH test was applied with 0.981N force on the teeth for 10 s indentation time. Data were analyzed using One-Way ANOVA and Tukey HSD (honestly significant difference) test for multiple comparisons. A value of P < 0.05 was considered statistically significant. Results: MH analysis showed statistically significant differences between the control group and the other conditioned groups (P < 0.05). The groups conditioned with acid-etch and primer, particularly twice, showed the lowest amount of MH in comparison to other groups. Self-etch primer had the least effect on MH of the enamel. Single time etching without using primer, made no considerable difference when compared to multiple etching. Conclusion: Etching process and covering the enamel with primer decrease enamel MH. Using self-etch primer is a more conservative method of enamel conditioning.

Prosthetic and surgical management of a sizeable epulis fissuratum: a case report.

This case report describes the management of a large-sized Epulis Fissuratum (EF) in a 70-year-old female patient using an original prosthetic technique. It consists of a combination of a tissue conditioning and a resection surgery. The patient´s main concern was a mucogingival tissue growth located on the left mandibular area. The interesting clinical findings deriving from this technique are: tissue conditioning is an important phase prior to the surgical resection of a large EF and occlusal functions can be maintained during the procedures with patient´s corrected dentures. After clinical, radiological and pathological examinations, the diagnosis was of an EF induced by an ill fitted mandibular denture. The intervention carried out was a combination of a 2 weeks tissue conditioning period followed by a cold blade surgical resection. After a 3 months follow-up period, a completely healed vestibular sulcus was observed with no scar tissue. The present technique facilitates the resection surgery by removing the inflammatory component of the EF. It also guides the post-surgical tissue healing, allowing the obtention of a deep vestibular sulcus, thus creating a better bearing surface for subsequent renewed dentures. Not depriving the patient of her dentures during the healing process helped to improve her quality of life and her cooperation.

Physico-Mechanical Properties of Commercially Available Tissue Conditioner Modified with Synthesized Chitosan Oligosaccharide.

This study aims to compare the hardness, sorption and solubility of commercially available tissue conditioner [TC] modified with chitosan [CS] and synthesized chitosan oligosaccharide [COS] in antifungal concentration. COS was synthesized by acid hydrolysis and characterized by FTIR and XRD. Experimental materials were formulated by incorporating each per gram of TC powder with effective antifungal concentration of chitosan 1.02 mg (Group 1: TC-CS) and 0.51 mg COS (Group 2: TC-COS). A commercially available TC was used as control (Group 0: CTC). Shore A hardness test was performed according to ASTM D 2240-05 (2010) standards on samples stored in dry environment, distilled water (DW) and artificial saliva (AS) at 37 °C (n = 5 per group). Percent weight changes (n = 5 per group) after storage in DW and AS was used to record sorption and solubility. One-way Anova with post hoc Tukey's test was applied. FTIR and XRD confirmed low molecular weight and amorphous nature of COS. Experimental groups had higher Shore A hardness values; however, these changes were not significant. Greatest variations in durometer values (p ≤ 0.05) were observed during the first 24 h. Experimental groups had higher (p ≤ 0.05) percentage sorption and solubility. Samples stored in DW had significantly higher (p = 0.019) sorption, whereas material had higher (p = 0.005) solubility in AS. Mean solubility values in both immersion mediums was highest for Group 2, followed by group 1 and group 0. In addition, significant (p ≤ 0.05) increase in solubility upon aging was noted for each material. Experimental tissue conditioner had higher hardness, sorption and solubility. However, these changes are not substantial to interfere with their tissue healing property. Therefore, these materials may be considered and explored further as potential antimicrobial drug delivery agent for denture stomatitis patients.

Is there an optimal method to detach Candida albicans biofilm from dental materials?

Introduction. Candida albicans can produce a complex, dynamic and resistant biofilm on the surface of dental materials, especially denture base acrylic resins and temporary soft liners. This biofilm is the main aetiological factor for denture stomatitis, an oral inflammatory condition characterized by chronic and diffuse erythema and oedema of the denture bearing mucosa.Gap Statement. There is no consensus in the literature regarding the best method to detach biofilms from dental materials. In order to assess the antifungal efficacy of new materials and treatments, the biofilm needs to be properly detached and quantified.Aim. This study compared different methods of detaching C. albicans biofilm from denture base acrylic resin (Vipi Cril) and temporary soft liner (Softone) specimens.Methodology. Specimens of each material were immersed in an inoculum of C. albicans SC5314 and remained for 90 min in orbital agitation at 75 r.p.m. and 37 °C. After the removal of non-adherent cells, the specimens were immersed in RPMI-1640 medium for 48 h. Biofilm formation was evaluated with confocal laser scanning microscopy (n=5). Then, other specimens (n=7) were fabricated, contaminated and immersed in 3 ml of sterile phosphate-buffered saline (PBS) and vortexed or sonicated for 1, 2, 5, or 10 min to detach the biofilm. The quantification of detached biofilm was performed by colony-forming unit (c.f.u.) ml-1 count. Results were submitted to one-way analysis of variance (ANOVA)/Tukey HSD test (α=0.05).Results. A mature and viable biofilm was observed on the surfaces of both materials. For both materials, there was no significant difference (P>0.05) among detachment methods.Conclusion. Any of the tested methods could be used to detach C. albicans biofilm from hard and soft acrylic materials.

Influência do intermediário protético sobre a estética e a satisfação de pacientes reabilitados com próteses unitárias provisórias sobre implantes: um ensaio clínico / Influence of the prosthetic intermediary on the aesthetics and satisfaction of patients rehabilitated with temporary single prostheses on implants: a clinical trial

Objetivos: Avaliar a influência do tipo de intermediário protético e do condicionamento tecidual sobre a estética de coroas unitárias provisórias sobre implantes instalados na região do sorriso. Material e Métodos: Trinta implantes foram alocados sequencialmente: 15 foram reabilitados provisoriamente sobre um intermediário protético pré-fabricado em titânio (GT) e 15 sobre um intermediário protético preparável provisório (GP). Em ambos os grupos foi realizado condicionamento tecidual (CT) pela técnica não-cirúrgica de pressão gradual e a estética periimplantar foi avaliada antes e após esse processo, por meio do Pink Esthetic Score (PES). O PES também foi aplicado no dente homólogo à reabilitação. A satisfação estética foi analisada pela escala visual analógica (EVA) após o procedimento de CT. Dados clínicos da mucosa gengival também foram coletados. Resultados: 22 pacientes, totalizando 24 implantes, concluíram o estudo, sendo 14 implantes do GT e 10 do GP. A estética periimplantar antes e após o CT, bem como a satisfação dos pacientes foi semelhante entre os grupos, p>0,05. Diferenças significativas foram encontradas para os valores de PES antes e após o CT, e para a comparação com o dente homólogo em ambos os grupos, p<0,05. O processo de condicionamento tecidual não foi influenciado pelo tempo de implantação, tempo de carga e fenótipo periimplantar, p>0,05. Conclusão: O intermediário protético não influenciou nem no processo de condicionamento tecidual e nem na satisfação dos pacientes. A etapa de condicionamento tecidual foi capaz de melhorar os resultados estéticos periimplantares, entretanto, a estética gengival dos dentes naturais homólogos apresenta resultados significativamente superior (AU).

Objective: To evaluate the influence of prosthetic abutment and tissue conditioning on the esthetics of single implants' temporary crowns. Materials and Methods: Thirty implants were allocated sequentially: fifteen implants were provisionally rehabilitated with a titanium prefabricated prosthetic abutment (GT) and 15 with a provisional preparable prosthetic abutment (GP). In both groups, tissue conditioning (TC) was performed by the non-surgical gradual pressure technique and peri-implant aesthetics were assessed before and after this process, using the Pink Esthetic Score (PES). PES was also applied on homologous tooth. Aesthetic satisfaction was assessed using the visual analog scale (EVA) after the conditioning process. Clinical data on the gingival mucosa were also collected. Results: 22 patients (24 implants) completed this study, 14 implants from GT and 10 from GP. Peri-implant aesthetics before and after TC, as well as patient satisfaction was similar between groups, p> 0.05. Significant differences were found for PES values before and after TC, and for comparison with the homologous tooth in both groups, p <0.05. The TC process seems not be influenced by the implantation time, loading time and peri-implant biotype, p> 0.05. Conclusion: The prosthetic abutment seems not influence neither the TC process nor patient satisfaction. The TC step is able to improve the peri-implant aesthetic results, however, the gingival aesthetics of the natural teeth is still significantly greater (AU).

Influence of the fixed implant-supported provisional phase on the esthetic final outcome of implant-supported crowns: 3-year results of a randomized controlled clinical trial.

OBJECTIVES: The aim of this investigation was to evaluate whether the use of a provisional implant-supported crown improves the final esthetic outcome of implant crowns that are placed within esthetic sites. MATERIALS AND METHODS: Twenty endosseous implants were inserted in sites 13 to 23 (FDI) in 20 patients. Following the reopening procedure, a randomization process assigned them to either cohort group 1: a provisional phase with soft tissue conditioning using the "dynamic compression technique" or cohort group 2: without a provisional phase. Screw-retained all ceramic crowns were inserted. Clinical follow-up appointments were completed at 36 months evaluating clinical, radiographic outcomes, and implant success and survival. RESULTS: After 3 years, all implants survived; one implant-supported crown was excluded from the study due to adjacent tooth failure replaced with a further implant supported crown. Modified pink esthetic score (ModPES) scores were significantly different between groups 1 and 2 (P = .018); white esthetic scores (WES) were not statistically different between both groups (P = .194). Mean values of combined modPES and WES were 15.6 for group 1, with a SD of 3.20. Group 2 had a mean combined modPES and WES of 12.2, with a SD of 3.86. Mean bone loss after 3 year was -0.05 and -0.04 mm for groups 1 and 2 respectively, without being statistically significant. CONCLUSION: Fixed implant-supported provisionals improve the final esthetic outcome of the peri-implant mucosa.

All-ceramic versus titanium-based implant supported restorations: Preliminary 12-months results from a randomized controlled trial.

PURPOSE: The aim of the present randomized controlled study was to compare prefabricated all-ceramic, anatomically shaped healing abutments followed by all-ceramic abutments and all-ceramic crowns and prefabricated standard-shaped (round-diameter) titanium healing abutments followed by final titanium abutments restored with porcelain-fused-to-metal (PFM) implant crowns in the premolar and molar regions. MATERIALS AND METHODS: Forty-two patients received single implants restored either by all-ceramic restorations (test group, healing abutment, final abutment, and crown all made of zirconia) or conventional titanium-based restorations. Immediately after prosthetic incorporation and after 12 months of loading, implant survival, technical complications, bone loss, sulcus fluid flow rate (SFFR) as well as plaque index (PI) and implant stability (Periotest) were analyzed clinically and radiologically. RESULTS: After 12 months of loading, an implant and prosthetic survival rate of 100% was observed. Minor prosthetic complications such as chipping of ceramic veneering occurred in both groups. No statistical significant differences were observed between both groups with only a minimum of bone loss, SFFR, and PI. CONCLUSION: All-ceramic implant prostheses including a prefabricated anatomically shaped healing abutment achieved comparable results to titanium-based restorations in the posterior region. However, observational results indicate a benefit as shaping the peri-implant soft-tissue with successive provisional devices and subsequent compression of the soft tissue can be avoided.

All-ceramic versus titanium-based implant supported restorations: Preliminary 12-months results from a randomized controlled trial

PURPOSE: The aim of the present randomized controlled study was to compare prefabricated all-ceramic, anatomically shaped healing abutments followed by all-ceramic abutments and all-ceramic crowns and prefabricated standard-shaped (round-diameter) titanium healing abutments followed by final titanium abutments restored with porcelain-fused-to-metal (PFM) implant crowns in the premolar and molar regions. MATERIALS AND METHODS: Forty-two patients received single implants restored either by all-ceramic restorations (test group, healing abutment, final abutment, and crown all made of zirconia) or conventional titanium-based restorations. Immediately after prosthetic incorporation and after 12 months of loading, implant survival, technical complications, bone loss, sulcus fluid flow rate (SFFR) as well as plaque index (PI) and implant stability (Periotest) were analyzed clinically and radiologically. RESULTS: After 12 months of loading, an implant and prosthetic survival rate of 100% was observed. Minor prosthetic complications such as chipping of ceramic veneering occurred in both groups. No statistical significant differences were observed between both groups with only a minimum of bone loss, SFFR, and PI. CONCLUSION: All-ceramic implant prostheses including a prefabricated anatomically shaped healing abutment achieved comparable results to titanium-based restorations in the posterior region. However, observational results indicate a benefit as shaping the peri-implant soft-tissue with successive provisional devices and subsequent compression of the soft tissue can be avoided.

Improvement of local microcirculation through intermittent Negative Pressure Wound Therapy (NPWT).

BACKGROUND: Negative Pressure Wound Therapy (NPWT) is widely used across different kinds of surgical disciplines. A controversial debate was raised by diverging results from studies that were conducted to examine the impact of NPWT on local perfusion. Thus, there is a lack of evidence for one important underlying factors that influences the physiology of wound healing under an applied NPWT-dressing. OBJECTIVE: To investigate the immediate local perfusion changes due to an applied intermittent NPWT protocol. MATERIAL AND METHODS: A NPWT dressing was applied to the antero-lateral thigh of seven healthy volunteers with two probes of both pressure and microcirculatory measuring devices. One of each probe was placed under the NPWT dressing, the other one in close proximity next to it. A protocol consisting of two cycles of 10 min of -125 mmHg pressure, followed by 10 min of 0 mmHg pressure was applied. Measurements of local pressure to the underlying tissue, as well as microcirculatory changes were performed continuously. RESULTS: Applied vacuum caused compressional forces (27.33 mmHg, p < 0.05) towards the underlying tissue. Blood Flow was increased after both suction periods (+52.5%, +108.7%; p < 0.05) and continued increasing until the end of measurements (+145.3%). This was accompanied by significant increase in Oxygen Saturation (+21.6%; p < 0.05) and Relative Hemoglobin Content (+16.7%). Red Blood Cell Velocity was found to be increased without statistical significance. Next to the dressing, changes were also significant but less pronounced. CONCLUSION: Intermittent NPWT improves local microcirculation with consecutive enhancement of oxygen supply.

Condicionamento gengival em coroas provisórias sobre implantes em área estética: um ensaio clínico / Gingival conditioning in provisional crowns on implants in the aesthetic area: a clinical trial

INTRODUÇÃO: O fator estético é um dos critérios utilizados na definição do sucesso de reabilitações implantossuportadas. Os critérios estéticos dos profissionais para essa característica variam a depender da sua área de especialização e vivência clínica. O objetivo desse trabalho é mensurar a influência do condicionamento gengival no resultado estético, bem como avaliar a percepção de diferentes especialidades no resultado dessa intervenção em restaurações provisórias unitárias sobre implante na região do sorriso. METODOLOGIA: Dez pacientes foram submetidos a cirurgia de instalação de implante com conexão cônica. Todos os pacientes receberam próteses provisórias sobre implante em resina acrílica. O processo de condicionamento gengival foi realizado pela técnica não-cirúrgica de pressão gradual. Fotografias da região reabilitada foram realizadas na instalação da coroa provisória e na última sessão de condicionamento gengival. Três avaliadores especialistas e um clínico geral, mascarados com relação a fase da restauração provisória, aplicaram o Pink Esthetic Score (PES) a partir dos critérios observados nas fotografias. Cada avaliador repetiu o PES três vezes num espaço de 3 dias entre as avaliações, nas quais a sequência de fotografias era diferente. Os resultados foram avaliados estatisticamente utilizando o Coeficiente de Correlação Intraclasse (CCI), o teste não-paramétrico de Wilcoxon e o teste de qui-quadrado de Pearson. RESULTADOS: Os avaliadores tiveram uma concordância média para os valores de PES e todos os critérios constituintes (entre 40% e 75%), no qual o clínico geral apresentou maior grau de discordância em todos os parâmetros. O protesista foi o mais criterioso para as avaliações enquanto o clínico geral e o periodontista apresentaram medianas semelhantes para os escores antes e depois. Existiu diferença significativa entre a avaliação do PES antes e depois do condicionamento gengival para todos os avaliadores (p<0,05), indicando que houve melhora na estética após a realização do condicionamento gengival. CONCLUSÃO: O condicionamento gengival influencia positivamente no escore do PES e de seus parâmetros constituintes e essa diferença pode ser notada por todos os avaliadores (AU).

BACKGROUND: The esthetic outcome is one of the criteria used to build a definition of success in implant-supported restorations. The esthetic criteria of professionals for these characteristics vary depending on their area of specialization and clinical experience. The aim of this study is to measure the influence of soft tissue conditioning on esthetic outcome as well as to evaluate the perception of different specialties in the result of this intervention in provisional crowns on single implants in the smile zone. METHODS: Ten patients underwent an implant placement surgery to insert a morse tapered implant. All patients received an acrylic resin implantsupported provisional crown. The soft tissue conditioning process was performed with a non-surgical technique of gradual pressure. Photographs of the rehabilitated region were taken at the first provisional crown insertion and at the last session of soft tissue management. Three specialists and a general practitioner were selected as blinded examiners and applied the Pink Esthetic Score (PES) based on the criteria observed in the photographs. Each examiner repeated the PES three times within three days between analyses. Each evaluation had a different sequence of photos. The results were analyzed using the Intraclass Correlation Coefficient (ICC), the nonparametric Wilcoxon signed-rank test, and the Pearson's chi-square test. RESULTS: The evaluators had a mean agreement for PES values and all the constituent criteria (between 40% and 75%), in which the general practitioner showed the greater degree of disagreement in all parameters. The prosthodontist gave the lowest scores for the evaluations while the general practitioner and the periodontist presented similar results (highest scores) for the before and after scores. There was a significant difference between the evaluation of PES before and after gingival conditioning for all evaluators (p <0.05), indicating that there was an improvement in aesthetics after gingival conditioning. CONCLUSION: Soft tissue conditioning positively influences the PES score and its constituent parameters and this difference could be noticed by all the evaluators (AU).

Efeito do condicionamento tecidual peri-implantar durante reabilitação unitária com coroa temporária implantossuportada em região estética / Effect of peri-implant tissue conditioning during single-tooth rehabilitation with implant-supported temporary crown in esthetic region

Objetivo: Analisar o comportamento dos tecidos peri-implantares durante o tratamento reabilitador com coroa temporária unitária implantossuportada em região estética superior. Metodologia: Estudo intervencionista longitudinal prospectivo, avaliou a condição periimplantar e periodontal de 16 pacientes reabilitados com coroas unitárias temporárias sobre implantes em área estética por meio dos parâmetros: Índice de Placa Visível (IPV), Índice de Sangramento Gengival (ISG) e Espessura Gengival Horizontal (EG) dos dentes adjacentes e do espaço protético (EP) em T0 (momento anterior a implantação), T1 (momento da instalação da coroa temporária) e T2 (durante fase de condicionamento gengival). Os parâmetros: Profundidade de Sondagem (PS), Transparência a Sondagem (TS), Relação Altura/Largura da papila interdental (AP/LP), Relação Altura/Largura da coroa provisória (AC/LC), Faixa de Mucosa Ceratinizada (MC) foram realizadas em T1 e T2. Os parâmetros da região reabilitada foram ainda comparados às médias dos mesmos parâmetros para os dentes adjacentes. A análise dos dados entre os tempos foi feita utilizando os testes de Friedman e Wilcoxon, enquanto a comparação entre a região reabilitada com os dentes adjacentes foi feita através do teste de Wilcoxon para amostras relacionadas, ambos com nível de significância de 5%. Resultados: O tempo médio de condicionamento tecidual foi de 40 dias (2,6 sessões em média). Comparando o tecido peri-implantar entre os tempos, observou-se um aumento do IPV entre T0 (31,1%) e em T2 (40,5%), porém sem diferenças significativas (p>0,05), quanto ao ISG, não foram observadas diferenças significativas ao longo do tempo (T0 - 21%; T2 - 20,8%). Quanto a EG, houve uma diminuição estatisticamente significativa entre os períodos (T0 - 1,66mm; T1 - 1,22mm; T2 - 1,16mm). A PS aumentou de T1 (1,76mm) para T2 (1,86 mm) sem significância (p>0,05), o mesmo tendo acontecido com a AC/LC (de 1,06 para 1,19) e AP/LP (0,62 para 0,84), tendo esses aumentos apresentado significância estatística para ambos (p<0,05). Na comparação entre a região reabilitada e a média dos dentes adjacentes, os parâmetros que apresentaram diferença significativa (p<0,05) de médias foram: AP/LP em T1 apresentou menor média (0,62) que os dentes adjacentes (0,79) e os parâmetros de EG no tempo T0 apresentou média (1,66 mm) maior que os dentes adjacentes (1,18 mm). Conclusão: A reabilitação utilizando coroa temporária sobre implantes promoveu alteração no tecido periimplantar nos parâmetros EG, AP/LP e AC/LC (AU).

Aim: To analyze the behavior of peri-implant tissues during rehabilitation with provisional crowns in superior esthetic region. Methods: This longitudinal prospective interventional study evaluated the perimplantar and periodontal condition of 16 patients rehabilitated with implantsupported provisional crowns in esthetic area using the parameters of Visible Plaque Index (VPI), Bleeding on probing (BoP) and Gingival Thickness (GT) of the adjacent teeth and the prosthetic space (PS) in T0 (before implant placement surgery), T1 (installation of provisional crown), and T2 (during soft tissue conditioning). The parameters: Probing Depth (PD), Transparency in Probe (TP), Height/Width of the interdental papilla (HP/WP), Height/Width of the provisional crown (HC / WC), and keratinized mucosa (KM) were performed on T1 and T2. The parameters of the implant-supported prosthesis were compared to the same aspects of adjacent teeth. Friedman and Wilcoxon tests were applied to analyze data from the follow-ups. The comparison between the rehabilitated region and the adjacent teeth were achieved using Wilcoxon test for paired sample. Both analyses showed significance level of 5%. Results: The mean time of soft tissue conditioning was 40 days (mean of 2.6 sessions). There was an increase on the VPI between T0 (31.1%) and T2 (40.5%), but without statistically significant difference (p> 0.05). Regarding the BoP, it was not observed statistically significant differences over time (T0 - 21%, T2 = 20.8%). For GT, there was statistically significant difference between follow up periods (T0 - 1.66mm, T1 - 1.22mm, T2 - 1.16mm). The PD increased from T1 (1.76 mm) to T2 (1.86 mm) without statistically significant difference. The same was observed with an HC / WC (from 1.06 to 1.19) and HP / WP (0.62 to 0.84). The Wilcoxon test showed a not significant result between T1 and T2 for HP / WP (p <0.05) and HC / WC (p <0.05). When comparing the implant and the adjacent teeth area, the parameters that showed statistically difference (p<0,05) of means were: HP/WP in T1, with a lower mean (0,62) than the adjacent teeth (0.79); and GT at T0, when the implant area had a higher mean (1,66) than the adjacent teeth (1,18). Conclusion: For this study, the provisional implant-supported crown promoted alterations on the adjacent peri-implant soft tissue on GT, HP/WP, and HC/WC (AU).

Provisionalização em implantes imediatos / Immediate implants provisionalization

A provisionalização imediata, em que o provisório é adaptado diretamente no implante recém-instalado, é uma ótima alternativa para temporização. A indicação depende do posicionamento tridimensional correto, estabilidade primária do implante e o perfil oclusal do paciente. O manejo da prótese é essencial para a estética e o desenho do pilar protético (provisório ou definitivo) pode influenciar favorável ou negativamente os resultados.

Immediate provisionalization, in which the provisional is adapted directly into the newly installed implant, is a great alternative for temporization. Its indication depends on correct three-dimensional positioning, implant primary stability and patient's occlusal profile. Prosthesis handling is essential for prosthetic abutment (provisional or definitive) aesthetics and design and can favorably or negatively influence the results.

Aspectos relacionados às restaurações de lesões cervicais não cariosas com resinas compostas ­ relato de caso / Aspects related to noncarious cervical lesions restorations with composite resins ­ case report

As lesões cervicais não cariosas (LCNCs) têm sido consideradas pela comunidade odontológica um grande desafio para diagnóstico e tratamento restaurador. Não obstante os avanços no campo dos materiais dentários, melhorando a adesividade entre dente e restauração, as falhas ainda são significativas para os cirurgiões-dentistas (CDs), que não aceitaram a multidisciplinaridade envolvida em seu diagnóstico e restauração. O emprego de uma metodologia diagnóstica específica, associada a materiais e métodos restauradores adequados, deve ser considerado de forma minuciosa e objetiva, além da compreensão das limitações aplicadas a cada caso. O presente artigo relata um caso abordado de forma reconstrutiva, permeada por uma análise crítica dos métodos diagnósticos e restauradores (AU).

Non-carious cervical lesions (NCCLs) have been considered by dental community a great challenge for diagnosis and restorative treatment. Despite the advances in dental materials, improving adhesion between tooth and restoration, gaps are still significant for dental surgeons (DS), who did not accept the multidisciplinarity involved in their diagnosis and restoration approach. The use of a specific diagnostic methodology associated to appropriate adequate restorative materials and methods should be considered in a thorough and objective manner in addition to an understanding of the limitations applied to each case. This article presents a case report using a reconstructive approach permeated by diagnosis and restorative methods critical analysis (AU).

The Implant Biologic Pontic Designed Interface: Description of the Technique and Cone-Beam Computed Tomography Evaluation.

PURPOSE: The study aims to evaluate clinically the thickness of the alveolar ridge mucosa underneath a zirconia implant-supported restoration with a modified ovate pontic. MATERIALS AND METHODS: Sixty-five patients, 32 women and 33 men (mean age: 65.5 years; range 38-81), were included. A total of 383 implants (303 in the maxilla; 80 in the mandible), supporting 81 full or partial fixed dental prostheses (65 in the maxilla; 16 in the mandible), were either cement- or screw-retained. Three years after loading, a total of 219 pontic sites (153 in the maxilla; 66 in the mandible) were measured, and the thickness of the alveolar ridge mucosa between the prosthetic surface and the underlying bone crest were recorded. RESULTS: The overall implant and prosthesis survival rates at 3 years were 98.7% and 100%, respectively. No implant complications were reported, scoring a cumulative implant success rate of 100%. In the maxilla, the overall mean thickness of the alveolar ridge mucosa was 2.32 ± 0.57 mm. In the mandible, the overall mean thickness of the alveolar ridge mucosa was 2.20 ± 0.62 mm. There was no statistical difference between the overall mean values in the maxilla and mandible (p = .471). CONCLUSION: This radiologic retrospective study suggests the existence of a physiological barrier, named prosthetic biological width, underneath a novel pontic-designed restoration.

Condicionamento gengival em áreas de pôntico / Gingival conditioning in pontic areas

A relação do pôntico com o tecido gengival é um dos fatores críticos ao tratar pacientes com queixas estéticas e funcionais em reabilitações com próteses parciais fixas. Em situações em que essa relação está deficiente, podem existir alterações estéticas pela formação de espaços negros, perda do contorno do rebordo vestibular e problemas funcionais, como alterações fonéticas e impacção alimentar sob as áreas de pôntico. O objetivo deste artigo é relatar um caso clínico em que a paciente apresentava queixa do aspecto de sua gengiva e da forma e coloração de sua prótese. Por meio de condicionamento tecidual e reabilitação da paciente com prótese parcial fixa, foi possível otimizar o aspecto dentário e o contorno gengival e, consequentemente, obter melhor relacionamento entre prótese e tecido gengival.

The relationship between gingival tissue and the pontic is one of many critical factors in the treatment of patients with esthetic and functional complaints usinf fixed partial dentures. In situations where this relation is inadequate there may be alterations due to the formation of black spaces, loss of buccal contour and functional problems such as phonetic modifications and food impaction underneath the pontic areas. The aim of this paper is to demonstrate a clinical case where the patient presented a complaint regarding the gingival appearance and the color and contour of a fixed bridge. Tissue conditioning and patient’s rehabilitation with a new fixed partial denture allowed the improvement of the gingival and tooth aspect, therefore, obtaining a better relationship between the prosthesis and the gingival tissue.

Comparative evaluation of physical properties of four tissue conditioners relined to modeling plastic material.

OBJECTIVE: Little is known about the interaction of tissue conditioners and modeling plastics. This study evaluates the influence of a variety of commercial tissue conditioners on alteration of viscoelastic properties of modeling plastics. MATERIALS AND METHODS: In this in vitro study, the dynamic viscoelastic properties of four commercially available tissue conditioners (TC), Visco-gel (VG), GC Soft-Liner (SL), FITT (FT), and Coe Comfort (CC), relined to modeling plastics with a thickness of 2mm were evaluated after 1 and 7 days of water immersion with the use of storage modulus, loss modulus, and tan delta parameters. Values for these three parameters for each tissue conditioner were statistically analyzed by Kruskal Wallis and Mann Whitney tests with P value sets at<0.05. RESULTS: Complex modulus and loss tangent values of TC were not significantly different among specimens containing 0, 2, 5 and 10 wt.%-SZ, respectively. In FT and TC containing 2 wt.%-SZ, these values were not significantly different between 1 and 28 days in both water- and saliva immersions. CONCLUSION: The results suggest that relining with modeling plastics does affect TC's inherent dynamic viscoelastic properties, while the other tissue conditioners investigated may be found to have changed viscoelastic properties as a consequence of vicinity to the modeling plastics.