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1.
Artigo em Inglês | MEDLINE | ID: mdl-33802261

RESUMO

We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Perda do Osso Alveolar/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Leucócitos , Perda da Inserção Periodontal/cirurgia , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-33819334

RESUMO

The efficacy of the socket preservation procedure using deproteinized bovine bone mineral, bioabsorbable collagen membrane, and collagen sponge on molar extraction sites with severe periodontitis was assessed at 6 postoperative months, before implant placement. Results revealed excellent soft tissue healing without loss of keratinized tissue and no statistically significant differences in socket marginal bone changes in 20 molar extraction sockets. High levels of primary implant stability were recorded. Socket preservation using a minimally invasive surgical technique provides good soft and hard tissue healing as well as anticipated stability of implant placement at sites of extracted molars with severe periodontitis.


Assuntos
Perda do Osso Alveolar , Periodontite , Perda do Osso Alveolar/prevenção & controle , Perda do Osso Alveolar/cirurgia , Animais , Bovinos , Humanos , Dente Molar/cirurgia , Periodontite/cirurgia , Extração Dentária , Alvéolo Dental/cirurgia
3.
Int J Oral Maxillofac Implants ; 36(2): 371-378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909730

RESUMO

PURPOSE: The aim of this study was to evaluate the survival and success rates of oral rehabilitations in a shortened maxillary dental arch and expanded maxillary sinus with 4-mm extrashort implants splinted to longer ones. MATERIALS AND METHODS: One 10-mm and one/two extrashort 4-mm titanium-zirconium SLActive tissue-level dental implants were inserted into 11 patients with limited vertical bone availability due to an expanded maxillary sinus antrum. Immediately and 6 months after insertion, implant stability resonance frequency analysis (RFA) values were assessed with an Osstell device. Splinted crowns combining 4- and 10-mm implants were supplied to all 11 cases. RESULTS: In 10 cases, the bone quality was type III, and in one case, type IV. Among 17 4-mm and 11 10-mm implants, the median RFA values were 61 (interquartile ranges [IQR]: 59 to 64) and 66 (IQR: 64 to 72). One 4-mm implant failed to osseointegrate and was removed. After 6 months of healing, secondary-stability measurements of 16 of the remaining 4-mm implants increased to 68 (IQR: 62 to 72) and of 10-mm implants to 78 (IQR: 77 to 80). After 1 year, all (11/11) oral rehabilitations supported by 10-mm (11/11) and 4-mm (16/16) implants were functional. The medians and IQRs of the probing depths (median: 2.8 mm, IQR: 2.3 to 3.1 mm vs median: 2.9 mm, IQR: 2.4 to 3.1 mm) and the crestal bone loss (median: 0.75 mm, IQR: 0 to 0.9 mm vs median: 0.22 mm, IQR: 0 to 0.4 mm) for the 10-mm and 4-mm implants, respectively, were similar. CONCLUSION: Rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Estudos Prospectivos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33528445

RESUMO

Vertical bone augmentation (VBA) procedures for dental implant placement are biologically and technically challenging. Systematic reviews and meta-analyses of studies on VBA have failed to identify clinical procedures that provide superior results for treatment of the vertical ridge deficiencies. A decision tree was developed to guide clinicians on selecting treatment options based on reported vertical bone gains (< 5 mm, 5 to 8 mm, > 8 mm). The choice of a particular augmentation technique will also depend on other factors, including the size and morphology of the defect, location, and clinician or patient preferences. Surgeons should consider the advantages and disadvantages of each option for the clinical situation and select an approach with low complications, low cost, and the highest likelihood of success.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Implantes Dentários , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Árvores de Decisões , Implantação Dentária Endo-Óssea , Humanos
5.
Clin Oral Investig ; 25(5): 2461-2478, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33609186

RESUMO

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal , Retalhos Cirúrgicos/cirurgia
6.
Int J Oral Maxillofac Implants ; 36(1): 59-67, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600524

RESUMO

PURPOSE: Short dental implants serve as a valuable alternative for patients with limited bone height. Immediate or early provisionalization facilitates a more physiologic environment for the gingival tissues to be modeled. The purpose of this meta-analysis was to systematically review and evaluate the implant survival and marginal bone loss with immediate and early loading protocols of short dental implants (≤ 6 mm). MATERIALS AND METHODS: A literature search (electronic and manual) was conducted to identify studies with a focused PICO question: "In patients with short dental implants, does loading time affect treatment outcomes?" Studies using an immediate or early loading protocol for restoration of short implants with a mean follow-up of at least 1 year, and refraining from the use of advanced surgical procedures (sinus floor elevation, bone augmentation), were included. After evaluating patient selection and outcome reporting biases, a meta-analysis was conducted to assess implant survival and bone loss for studies fulfilling the inclusion criteria. Bone loss differences between immediate and early loading protocols were evaluated by Student t test, and Spearman correlation analysis was used to analyze the trends between crown-to-implant (C/I) ratio and bone loss. RESULTS: A total of 396 studies with patients receiving short implants (≤ 6 mm) with immediate or early prosthetic loading protocols were identified. For the 7 included studies, the pooled implant survival rate for 322 implants with a follow-up ranging from 1 to 10 years (5 years) was 91.63% (95% CI: 88% to 94%), with a mean bone loss effect estimate of 0.52 ± 0.1 mm (z = 3.07, P < .002). The differences observed in the mean bone loss for studies using immediate loading as opposed to early loading were not statistically significant. A moderate but significant positive correlation was observed between the C/I ratio and mean bone loss levels (r = 0.67, P = .02). CONCLUSION: Short implants with immediate or early loading protocols have satisfactory long-term treatment prospects with satisfactory implant survival rates and minimal bone loss.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Carga Imediata em Implante Dentário , Levantamento do Assoalho do Seio Maxilar , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Resultado do Tratamento
7.
Quintessence Int ; 0(0): 308-316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533237

RESUMO

OBJECTIVES: In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. METHOD AND MATERIALS: Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation. RESULTS: The HA (2.43 ±â€¯1.25 mm) and HA/CM (2.60 ±â€¯0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups. CONCLUSION: Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs.


Assuntos
Perda do Osso Alveolar , Procedimentos Cirúrgicos Reconstrutivos , Perda do Osso Alveolar/cirurgia , Animais , Regeneração Óssea , Colágeno , Cães , Regeneração Tecidual Guiada Periodontal , Ácido Hialurônico , Cicatrização
8.
J Int Acad Periodontol ; 23(1): 31-56, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512340

RESUMO

AIMS: To determine the differences in the long-term clinical outcomes between Regeneration (REG) and Conservative Surgery (CS) in infra-bony defects. MATERIALS AND METHODS: Three databases were searched [PubMed, Medline and Embase] up to April 2019. Following screening, 17 studies were included. Randomized Controlled Clinical Trials, Controlled Clinical Trials and retrospective studies with long-term clinical observations (≥ 24-months) were selected. After subgrouping the studies regarding the grafting material and the used flap, meta-analysis was performed for different outcomes [clinical attachment level gain (CALGain), probing pocket depth reduction (PPDRed), recession increase (RECInc) and bone fill (BF)] at different follow-ups (24-, 36-, 48- to 60- and 120- to 240-months). RESULTS: The time-related meta-analysis favoured REG at every interval for every outcome. In subgroup analysis, enamel matrix derivative (EMD) performed significantly better for both CALGain [24- (p less than 0.0001), 36- (p=0.02) and 60-months (p less than 0.00001)] and PPDRed [24- (p=0.0004), 36- (p=0.003) and 60-months (p less than 0.00001)]. For Ceramic Grafts (CGs), CALGain at 48-months (p less than 0.00001) and PPDRed at 24- (p=0.0006), 36- (p less than 0.00001) and 48-months (p less than 0.00001) follow-up showed better results. CONCLUSION: The better outcomes from REG using EMD or CGs can be maintained for a longer duration, suggesting a potential longevity of the occurred healing.


Assuntos
Perda do Osso Alveolar , Proteínas do Esmalte Dentário , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Proteínas do Esmalte Dentário/uso terapêutico , Seguimentos , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
Quintessence Int ; 0(0): 402-410, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491386

RESUMO

Objective: The aim was to evaluate the efficacy of periodontal regenerative therapy using enamel matrix derivatives (EMDs) in aggressive periodontitis patients, and to determine the contribution of maintenance via periodic supportive periodontal treatment. Method and materials: In total, 28 patients were evaluated, comprising 74 intrabony sites. In 50 sites EMD gel was applied, and in 24 sites EMD was combined with deproteinized bovine xenograft. Patients were assigned to a supportive periodontal treatment program; 18 patients fulfilled the program, defined as the well-maintained (WM) group; 10 did not comply, defined as the nonmaintained (NM) group. Probing depth (PD), clinical attachment level (CAL), and radiographic bone level (BL) were recorded. Data were compared presurgically (T0), 6 months postsurgery (T1), and 3 to 10 years posttreatment (T2). Results: Both surgical modalities achieved similar PD reduction, CAL gain, and BL gain, maintained over time. T1 to T2 showed a mean gain/loss of 0.21 ±â€¯0.5 mm and 0.04 ±â€¯1.1 mm, and -0.65 ±â€¯3.0 mm and -0.73 ±â€¯3.0 mm for PD and CAL, respectively, at the WM/NM groups, respectively. BL gain was 21.6% and 11.5% for the WM/NM groups, respectively (P < .05). The courses of the PD, CAL, and BL differed between the WM and NM groups during the observation periods (P < .05). Conclusion: Periodontal regeneration via EMD with/without the combination of deproteinized bovine xenograft can be maintained in aggressive periodontitis cases. It appears that periodic supportive periodontal treatment is a determinant factor in achieving this task.


Assuntos
Periodontite Agressiva , Perda do Osso Alveolar , Proteínas do Esmalte Dentário , Retração Gengival , Periodontite Agressiva/cirurgia , Perda do Osso Alveolar/cirurgia , Animais , Bovinos , Seguimentos , Retração Gengival/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal/cirurgia , Bolsa Periodontal/cirurgia , Resultado do Tratamento
10.
Quintessence Int ; 52(2): 112-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33433077

RESUMO

OBJECTIVE: Retrograde peri-implantitis (RPI) is defined as bone loss around an osseointegrated implant apex that usually appears within the first few months of its placement. This retrospective study aimed to evaluate the relationships between RPI and demographic factors, local bone and intraoral factors, and implant and surgery-related factors. METHOD AND MATERIALS: A retrospective study was conducted in 116 patients with a total of 369 implants placed between January and June 2019. The associations between RPI and the following data were evaluated: location of the recipient site, bone quality, reason for previous tooth loss, condition of adjacent teeth, marginal bone loss, immediate or late placement of implants, implant brand and size, activation of lesions, and treatment modality.
Results: Among the 14 (3.8%) implants that showed RPI, 10 (5.8%) were in the maxilla and four (?2.0%) were in the mandible, which were detected before prosthetic loading. There was no significant difference in terms of RPI between the arches. Of the 14 RPI implants, four (28.?6%) were placed into a previously periapical lesion site, three (21.4%) had endodontically treated adjacent teeth, two (14.3%) were immediately placed following extraction, three (?21.4%) revealed marginal bone loss, and one (7.1%) was lost at the abutment connection. Eight RPI implants healed spontaneously, while the remaining six were subjected to treatment (P = .05).
Conclusion: Local bone and intraoral factors, particularly the reason for tooth loss at the recipient site and the condition of the adjacent teeth, had stronger effects on RPI than other factors. (Quintessence Int 2021;52:112-121; doi: 10.3290/j.qi.a45264).


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Protocolos Clínicos , Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Humanos , Mandíbula , Peri-Implantite/diagnóstico por imagem , Peri-Implantite/terapia , Estudos Retrospectivos
11.
Clin Oral Investig ; 25(3): 807-821, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33438084

RESUMO

AIM: The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. MATERIALS AND METHODS: An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. RESULTS: Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. CONCLUSION: The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. CLINICAL RELEVANCE: In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.


Assuntos
Perda do Osso Alveolar , Defeitos da Furca , Perda do Osso Alveolar/cirurgia , Regeneração Óssea , Transplante Ósseo , Seguimentos , Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Membranas Artificiais , Perda da Inserção Periodontal , Resultado do Tratamento
12.
J Periodontal Res ; 56(2): 298-305, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33314140

RESUMO

BACKGROUND AND OBJECTIVE: Following tooth extraction, bone resorption is especially severe in cases complicated with buccal dehiscence bone defects. To minimize this, various bone graft materials have been used for alveolar ridge preservation. This study aimed to evaluate additional effects of the concomitant use of recombinant human fibroblast growth factor-2 (rhFGF-2) with ß-tricalcium phosphate (ß-TCP) on ridge preservation in a dehiscence defect model after tooth extraction in dogs. MATERIALS AND METHODS: The maxillary first premolars of six beagle dogs were extracted and dehiscence defects of 4 × 4 × 5 mm (mesio-distal width × bucco-palatal width × depth) were created. Bilateral defects were filled with ß-TCP combined with 0.3% (w/v) rhFGF-2 (test sites) or the scaffold alone (control sites). Twelve weeks post-surgery, histologic and histometric evaluations were performed. RESULTS: Morphological measurements using micro-computed tomography revealed a significantly greater bone volume at the test sites (48.9 ± 9.06 mm3 ) than at the control sites (38.8 ± 7.24 mm3 ). Horizontal widths of the alveolar ridge at the coronal and middle position at the test sites (2.18 ± 0.71 mm, 2.93 ± 0.53 mm) were significantly greater than those at the control sites (1.47 ± 0.41 mm, 2.36 ± 0.45 mm, respectively). Regarding the histological parameters, the occupation rate of mineralized bone in the original defects was slightly higher at the test sites (44.07 ± 10.19%) than that at the control site (41.15 ± 6.56%). CONCLUSIONS: These results indicate that the adjunct use of rhFGF-2 with ß-TCP is effective for alveolar ridge preservation in fresh extraction sockets with dehiscence defects.


Assuntos
Perda do Osso Alveolar , Fator 2 de Crescimento de Fibroblastos , Perda do Osso Alveolar/cirurgia , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Animais , Fosfatos de Cálcio/uso terapêutico , Cães , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Humanos , Extração Dentária/efeitos adversos , Alvéolo Dental/cirurgia , Microtomografia por Raio-X
13.
J Clin Periodontol ; 48(3): 464-477, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33316099

RESUMO

OBJECTIVE: To verify whether ridge preservation is effective in the reduction of dimensional loss and in bone formation compared to spontaneous healing in extraction sockets of periodontally compromised teeth. METHODS: Twenty-six subjects requiring tooth extraction for stage III/IV periodontitis were randomly assigned to one of two interventions: alveolar ridge preservation using collagenated bovine bone mineral and a resorbable collagen membrane (test, RP) or spontaneous healing (control, SH). Six months later, postoperative cone-beam computed tomography (CBCT) was performed to measure the linear and volumetric changes of the sockets compared to baseline scans. Biopsies were retrieved at the implant site for histomorphometric calculations. Nonparametric tests were applied for statistical analysis. RESULTS: Significantly less shrinkage occurred in RP compared to SH, mainly in the crestal zone. The width loss difference between groups was 3.3 mm and 2.2 mm at 1 mm and 3 mm below the crest, respectively (p < .05). RP yielded a gain in socket height of 0.25 mm, whereas a loss of -0.39 mm was observed in SH (p < .05). The percentage of volume loss recorded in RP was also less than that recorded in SH (-26.53% vs -50.34, p < .05). Significantly less bone proportion was detected in biopsies from RP (30.1%) compared with SH (53.9%). A positive association between baseline bone loss and ridge shrinkage was found in SH but not in RP. CONCLUSION: Ridge preservation in extraction sockets of periodontally compromised teeth was effective in reducing the amount of ridge resorption.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Animais , Bovinos , Extração Dentária , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia
14.
Dent Clin North Am ; 65(1): 229-239, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33213712

RESUMO

Restoring the dentition of an edentulous patient is often challenging. Endosseous dental implants have allowed for far more versatility in this area but still require adequate maxillary and mandibular alveolar bone. Often, unless significant bone grafting techniques are used, true restoration of the dentition can be impossible with traditional endosseous implants. The advent of zygomatic implants, however, may provide a viable, predictable, and stable alternative for the restoration of the dentition in patients with severe maxillary alveolar bone loss.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Arcada Edêntula , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Arcada Edêntula/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia
15.
Cient. dent. (Ed. impr.) ; 17(3): 209-214, sept.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198603

RESUMO

La regeneración localizada de grandes defectos horizontales en los procesos alveolares, previa a la inserción de implantes dentales, sigue siendo un procedimiento quirúrgico desafiante en cirugía bucal. Entre los procedimientos quirúrgicos más utilizados para tal propósito se encuentran la corticotomía con expansión, injerto en bloque "onlay" y la regeneración ósea guiada (ROG), todos ellos con sus diferentes grados de predictibilidad. El uso de micromalla de titanio en combinación con injertos y sustitutos óseos es un método eficiente para la contención, estabilización y protección de estos injertos, permitiendo así una mejor regeneración de los tejidos. Esta técnica no queda exenta de posibles complicaciones asociadas como pueden ser la infección, necrosis del injerto o exposición de la malla de titanio. En el presente artículo se pretende mostrar la evidencia clínica de la efectividad del uso del colgajo pediculado de rotación palatina como método válido para evitar la exposición de la malla de titanio durante la regeneración ósea guiada


Localized regeneration of large horizontal defects in alveolar processes prior to the insertion of dental implants remains a challenging surgical procedure in oral surgery. Among the most widely used surgical procedures for this purpose are expansion corticotomy, onlay block graft and guided bone regeneration all of them with their different degrees of predictability. The use of titanium micromesh in combination with bone grafts and bone substitutes is an efficient method for the containtment, stabilization and protection of these grafts, thus allowing better tissue regeneration. This technique is not exempt from associated complications such as infection, graft necrosis or exposure of the titanium micromesh.This article aims to show the clinical evidence of the effectiveness of using the palatal rotated pedicle graft as an effective method to avoid exposing the micromesh during guide bone regeneration procedure


Assuntos
Humanos , Masculino , Idoso , Regeneração Óssea , Implantação Dentária Endo-Óssea/métodos , Odontologia Baseada em Evidências/métodos , Resultado do Tratamento , Retalhos Cirúrgicos , Perda do Osso Alveolar/cirurgia , Plasma Rico em Plaquetas , Cirurgia Bucal
16.
Rev. Asoc. Odontol. Argent ; 108(3): 129-137, dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1147924

RESUMO

Objetivo: Presentar el uso de la cirugía guiada para la resolución quirúrgico-protética de un caso clínico con colocación de implantes de longitud estándar (>7 mm) en un maxilar inferior atrófico, sin regeneración ósea guiada. Caso clínico: Una paciente que requería terapia con implantes en sectores posteroinferiores se presentó en la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires. Primero se realizó una tomografía computarizada de haz cónico del maxilar inferior para evaluar la disponibilidad ósea. La planificación se efectuó siguiendo un protocolo digital a fin de optimizar la selección de los implantes y su instalación en función de la futura rehabilitación protética y el tejido óseo disponible. Después se escanearon ambos maxilares y el registro intermaxilar; estas imágenes ­junto con las correspondientes a la tomografía (DICOM)­ fueron importadas como archivos (STL) a un software específico de diseño para determinar digitalmente la posición 3D ideal de los implantes y diseñar una guía quirúrgica de precisión. Luego se realizó la cirugía de instalación de los implantes con la guía quirúrgica, y finalmente los implantes fueron rehabilitados por medio de coronas cemento-atornilladas. Conclusión: El uso de la cirugía guiada permitió optimizar el tejido óseo disponible para la instalación de implantes en función de la futura rehabilitación protética (AU)


Aim: To present the use of guided surgery for the prosthetic resolution of a clinical case with placement of implants of standard length (>7 mm) in an atrophic posterior mandible, with no need of bone regeneration. Clinical case: A patient who required implants in the posterior sectors of the mandible attended to the department of Odontología Integral Adultos, Facultad de Odontología, Universidad de Buenos Aires, Argentina. A dental cone beam computed tomography (CBCT scan) of the lower jaw was done to assess bone availability and was decided to perform guided surgery for accurate implant placement. Both maxillaries and intermaxillary occlusal registration were scanned and imported into files (STL) together with those of the CBCT scan (DICOM) into specific design software. Following the digital protocol using a surgical guide the implants were placed and then restored with cemented-screwed crowns. Conclusion: Guided surgery allowed planning implant placement, guided by the final position of the prosthetic restoration, and optimizing the available bone (AU)


Assuntos
Humanos , Feminino , Idoso , Perda do Osso Alveolar/cirurgia , Cirurgia Assistida por Computador , Implantação Dentária Endo-Óssea , Mandíbula , Argentina , Faculdades de Odontologia , Regeneração Óssea , Prótese Parcial Fixa , Tomografia Computadorizada de Feixe Cônico , Reabilitação Bucal
17.
Niger J Clin Pract ; 23(12): 1767-1771, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355833

RESUMO

Alveolar bone loss subsequent to long-term edentulism and trauma may be severe and treatment plan is always an esthetic and functional challenge. Implant supported hybrid prosthesis is widely regarded as an effective treatment option for patients with excessive and irregular bone loss. However, implant placement is occasionally impossible without surgical procedures in such cases. This case report presents rehabilitation of 19-year-old maxillary anterior edentulous male patient with maxillary anterior bone defect and excessive cross-bite anterior closure with multidisciplinary approach. The patient was rehabilitated with implant supported hybrid prosthesis with Malo Bridge design following autogeneous iliac bone augmentation, teeth leveling with orthodontic treatment, and surgical placement of three implants. Esthetics, pleasing phonetics and function were achieved as desired with this treatment option and no complications were observed.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Implantes Dentários , Arcada Edêntula , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Prótese Dentária Fixada por Implante , Humanos , Arcada Edêntula/cirurgia , Masculino , Maxila/cirurgia , Resultado do Tratamento , Adulto Jovem
18.
Int J Periodontics Restorative Dent ; 40(6): e235-e240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33151196

RESUMO

This case report describes the rehabilitation of an extremely atrophic posterior mandible using 4-mm ultrashort implants and reports clinical and radiographic outcomes 7 years after loading. The patient refused to undergo any other treatment, from the removable prosthesis to the reconstructive surgery, and asked for a fixed, minimally invasive solution in the shortest possible time. The residual bone height above the alveolar nerve was an average of about 5 mm, so it was decided to treat the patient with four 4-mm ultrashort implants. Within the limitations of this case report, this procedure appears successful at 7 years after loading in this specific case and could reduce invasiveness, rehabilitative times, and costs. However, longer follow-ups on a large number of patients coming from randomized controlled clinical trials are necessary before making more reliable recommendations.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Implantes Dentários , Perda do Osso Alveolar/cirurgia , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Resultado do Tratamento
19.
Rev. ADM ; 77(5): 252-256, sept.-oct. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1146848

RESUMO

Una de las causas de la evolución de la periodontitis es la formación de defectos óseos y pérdida de inserción clínica. Una manera de eliminar el defecto intraóseo y su bolsa periodontal es eliminar las paredes de hueso que componen el defecto para colocar el complejo dentogingival en una posición más apical. La cirugía ósea es un procedimiento periodontal resectivo que involucra la modificación del tejido óseo del soporte dental, la cual es una modalidad del tratamiento periodontal quirúrgico que puede utilizarse para eliminar eficazmente los defectos óseos periodontales para estabilizar la inserción periodontal. El objetivo del presente estudio es realizar una revisión de la literatura sobre las consideraciones actuales, técnicas y principios de la cirugía ósea resectiva en el paciente periodontalmente comprometido (AU)


One of the causes of the evolution of periodontitis is the formation of bone defects and loss of clinical attachment, where one way to eliminate the intraosseous defect and its periodontal pocket is to eliminate the bone walls that make up the defect to place the dentogingival complex in a more apical position. Bone surgery is periodontal surgery that involves the modification of the supporting bone tissue of the teeth, which is a modality of surgical treatment that can be used to effectively eliminate periodontal defects and stabilize the periodontal insertion. The aim of the present study is to conduct a literature review about the considerations, techniques and principles of resective bone surgery in the periodontally compromised patient (AU)


Assuntos
Humanos , Periodontite/cirurgia , Perda do Osso Alveolar/cirurgia , Processo Alveolar/cirurgia , Osteotomia/métodos , Bolsa Periodontal/cirurgia , Retalhos Cirúrgicos , Aumento da Coroa Clínica/métodos
20.
Clin Oral Implants Res ; 31(10): 1010-1024, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32799365

RESUMO

OBJECTIVES: The objective of this randomized controlled trial was to compare alveolar ridge preservation using a bone substitute material and covered with a synthetic or porcine collagen membrane. MATERIALS AND METHODS: Thirty-two sockets in the aesthetic maxillary region of 30 patients were randomized into two groups. Randomization was stratified according to bone wall defect. Flapless technique was used, and sockets were grafted with bi-phasic calcium phosphate particulate bone substitute and covered by synthetic polyethylene glycol (PEG; test group) or porcine-derived collagen membrane (CM; control group). No primary closure was attempted. A cone beam computed tomography (CBCT) scan was performed immediately after the surgical procedure and repeated 22 weeks later. OnDemand3D was used to superimpose scan images and assess changes. The mean vertical and horizontal percentage bone loss were calculated and implants placed after 6 months with or without additional augmentation. RESULTS: There were no baseline differences between groups or dropouts. The mean percentage loss at the labial plate and at the coronal part of the sockets was statistically significantly lower in the test group compared with controls (-2.86% [SD = 13.48] versus 7.42% [SD = 11.95]; 13.45% [SD = 11.97] versus 28.59% [SD = 16.97]). Implants were placed after 6 months, and there was no difference in need for further augmentation between PEG (n = 5) or CM (n = 4). CONCLUSION: Sites treated with PEG membrane showed less percentage loss in horizontal and vertical measurements in this trial.


Assuntos
Perda do Osso Alveolar , Aumento do Rebordo Alveolar , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/prevenção & controle , Perda do Osso Alveolar/cirurgia , Animais , Colágeno , Tomografia Computadorizada de Feixe Cônico , Estética Dentária , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Suínos , Extração Dentária , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia
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