Fatores associados ao interesse de usuários de prótese total mandibular em terapia implantossuportada e impacto da reabilitação com sobredentadura com implante único / Factors associated with the interest of users of complete mandibular dentures in implant-supported therapy and the impact of rehabilitation with single-implant overdentures

Este estudo objetivou identificar os fatores que influenciam na decisão de substituir uma prótese total convencional mandibular pelo tratamento com implantes dentários, assim como avaliar a satisfação, qualidade de vida e performance mastigatória (PM) após reabilitação com sobredentaduras com implante único (SIU) em pacientes adaptados e não-adaptados a prótese total convencional (PT) mandibular. Inicialmente, foi realizado um estudo transversal com 117 usuários de PTs bimaxilares, avaliados quanto aos desfechos relacionados à prótese (número de PTs mandibulares usadas previamente, tempo de uso e profissional que confeccionou a prótese atual, e quanto ao uso regular ou não da prótese mandibular) e aspectos centrados no paciente (período de edentulismo mandibular, altura óssea mandibular e interesse do paciente em se submeter a terapia com implantes). Do total da amostra, 78 pacientes manifestaram interesse na terapia implantossuportada, e desses apenas 22 foram selecionados e reabilitados com novas PTs bimaxilares. Após critérios de elegibilidade, foram alocados após pareamento em 2 grupos: adaptados à prótese mandibular (Grupo PTA - "adaptados à PT mandibular", n:10) e não adaptados (Grupo PTN - "não adaptados à PT mandibular", n:12). Em cada paciente, foi instalado um único implante na linha média e após o período de osseointegração as próteses mandibulares foram convertidas em sobredentaduras. O desempenho mastigatório foi avaliado pelo método das tamises, a altura óssea mandibular por medição em radiografia panorâmica, satisfação por escala quantitativa com questionário validado e o impacto da saúde oral na qualidade de vida pelo questionário OHIP-Edent-19. O teste Qui-quadrado foi utilizado para análise dos dados e as razões de prevalência ajustadas por meio da regressão multivariada de Poisson no primeiro estudo; para o segundo, a análise estatística em cada grupo e entre grupos foi baseada nos testes não-paramétricos de Wilcoxon e Mann-Whitney. O intervalo de confiança para os testes foi de 95%. A amostra foi predominantemente do sexo feminino, com 66,7% (n=78) dos participantes interessados em PT mandibular implantossuportada e com idade média de 65,68±6,38 anos. A PM não influenciou a escolha pela reabilitação com implantes. A preferência pela PT implantossuportada mandibular foi associada significativamente com maior experiência prévia com PT mandibular (p=0,021) e à insatisfação quanto à retenção (p=0,005). Após a intervenção com implante, todos os pacientes não adaptados passaram a condição de adaptados. Não houve diferença entre PTA e PTN para OHIP-Edent (p=0,276) e PM (p=0,222), a satisfação foi significativa apenas para o critério "conforto em arco inferior" (p=0,043). Para comparações pré e pós-tratamento com sobredentadura, a mediana do OHIP-Edent total diminuiu significativamente em ambos os grupos. Na comparação intragrupo, essa redução foi significativa em PTA apenas para a "limitação funcional" (p=0,026), e em PTN em quase todos os domínios, exceto "disfunção social" e "incapacidade" (p>0,05). Houve aumento estatisticamente significativo para a satisfação geral de 75,41 para 90,25 (p=0,012) em PTN e de 76,10 para 90,50 (p=0,007) em PTA. Os parâmetros "mastigação", "adaptação", "retenção" e "conforto" em arco inferior foram diferentes com significância em ambos os grupos, e "gustação", "fonação" e "dor" em arco inferior foram significativos apenas para o grupo não adaptado (p<0,05). Houve diferença significativa para PM em PTN (p=0,002) e PTA (p=0,047) ao se comparar tipo de reabilitação. Não houve correlação entre PM e OHIP antes e após a reabilitação (p>0,05). Pode-se concluir que a experiência prévia com PT mandibulares convencionais e a insatisfação com a retenção dessas, influenciam o interesse pela reabilitação com sobredentadura implantossuportada mandibular, assim como, a reabilitação com sobredentadura sobre implante único apresenta-se como alternativa aos pacientes não adaptados a PT convencional mandibular, auxiliando na aceitação do uso da prótese mandibular, assim como, comprovando efeito positivo na satisfação, qualidade de vida e performance mastigatória (AU).

This study aimed to identify the factors that influence the decision to replace a conventional mandibular complete denture by treatment with dental implants, as well as to evaluate satisfaction, quality of life and masticatory performance (MP) after rehabilitation with overdentures with a single implant in patients adapted and not adapted to conventional mandibular complete denture (CD). Initially, a cross-sectional study was carried out with 117 users of bimaxillaries CDs, who were evaluated for outcomes related to the denture (number of previous mandibular CDs, time of use and professional who made the current denture, and regarding regular use of the mandibular denture) and aspects centered patients (period of mandibular edentulism, mandibular bone height and the patient's willingness to undergo implant therapy). From the total sample, 78 patients expressed interest in implant-supported therapy, and of these, only 22 were selected and rehabilitated with new bimaxillary CDs. After eligibility criteria, they were allocated after pairing into 2 groups: adapted to mandibular prosthesis (PTA Group - "adapted to mandibular CD", n:10) and non-adapted (PTN Group - " not adapted to mandibular CD", n:12). In each patient, a single implant was installed in the midline and after the osseointegration period, the mandibular prostheses were converted into overdentures. Masticatory performance was evaluated by the sieve method, mandibular bone height by paranoid radiographic measurement, satisfaction by quantitative scale with a validated questionnaire and the impact of oral health on quality of life by the OHIP-Edent-19 questionnaire. The chi-square test was used for data analysis and the prevalence ratios adjusted by means of multivariate Poisson regression in the first study; on the second, the statistical analysis in each group and between groups was based on the non-parametric-Wilcoxon and Mann-Whitney tests. The confidence interval for the tests was 95%. The sample was composed predominantly by women, with 66.7% (n=78) of the participants interested in implantsupported mandibular CD, with mean age 65.68±6.38 years. MP was not influenced by the choice by dental implants rehabilitation. Preference for mandibular implant-supported CD was significantly associated with longer previous experience in mandibular CD (p=0.021) and with dissatisfaction regarding retention (p=0.005). After the implant intervention, all non-adapted patients became adapted. There was no difference between PTA and PTN for OHIP-Edent (p=0.276) and MP (p=0.222), satisfaction was significant only for the criteria "comfort in the lower arch" (p=0.043). For pre- and post-treatment comparisons with overdentures, the median total OHIP-Edent decreased significantly in both groups. In the intragroup comparison, this reduction was significant in PTA only for "functional limitation" (p=0.026), and in PTN in almost all domains, except "social dysfunction" and "disability" (p>0.05). There was a statistically significant increase in overall satisfaction from 75.41 to 90.25 (p=0.012) in PTN and from 76.10 to 90.50 (p=0.007) in PTA. The parameters "chewing", "adaptation", "retention" and "comfort" in the lower arch were significantly different in both groups, and "gustation", "phonation" and "pain" in the lower arch were significant only for the group not adapted (p<0.05). There was a significant difference for MP in PTN (p=0.002) and PTA (p=0.047) when comparing the type of rehabilitation. There was no correlation between MP and OHIP before and after rehabilitation (p>0.05). It can be concluded that the previous experience with conventional mandibular CD and the dissatisfaction with the retention of these, influence the rehabilitation with mandibular implant-supported overdenture, as well as the rehabilitation with overdenture on single implant presents itself as an alternative for patients not adapted to mandibular conventional CD, helping to accept the use of mandibular prosthesis, as well as proving a positive effect on satisfaction, quality of life and masticatory performance (AU).

Mandibular guidance prosthesis: Conventional and innovative approach: A case series.

Surgical resection of the lower jaw due to the presence of a benign or malignant tumor is the most frequent cause of mandibular deviation. Location and extent of the tumor decide the surgical modality of mandibulectomy to be performed. The clinician must wait for an adequate span of time for completion of the healing and acceptance of the osseous graft before considering a definitive prosthesis. During the inceptive healing period, prosthodontic intervention is of utmost priority for preventing the mandibular deviation. A corrective appliance termed "guide flange prosthesis (GFP)" is indicated to limit this clinical manifestation. The basic intention of rehabilitation is to train the mandibular muscles and to re-establish an acceptable occlusal relationship so that the patient can adequately control the opening and closing movements. This case series describes early prosthodontic management of three patients who had undergone hemimandibulectomy, with different techniques of fabrication of a GFP. The three techniques described consist of two conventional methods of fabrication while the third technique is a new innovative approach.

Diminuindo tempo e aumentando a qualidade de vida do paciente com o uso de protocolo de carga imediata / By decreasing time and increasing the patient's quality of life with the use of immediate loading protocol

Este artigo consiste na reabilitação protética através do protocolo I de Brånemark em mandíbula submetido a carga imediata. A instalação de implantes imediatos pós-exodontia tem como principais indicações a preservação da arquitetura dos tecidos peri-implantares e a redução de tempo total de tratamento. Após a cirurgia, foram escolhidos o uso de pilares protéticos multi base e, para reabilitação superior, prótese total, visando a melhoria e conforto do paciente portador de próteses totais removíveis convencionais, onde as mesmas prejudicam a função, a estética, saúde psicológica e as relações sociais de seus usuários.

This article consists of prosthetic rehabilitation through the Branemark protocol I, in mandible submitted to immediate loading. The installation of immediate post-exodontic implants has as main indications the preservation of the architecture of the peri-implant tissues and the reduction of total time of treatment, where after the surgery, the use of multi-prosthetic abutments and for superior rehabilitation, prosthesis total. aiming at the improvement and comfort of the patient with conventional removable total dentures, where they impair the function, aesthetics, psychological health and social relations of its users.

Prótese total mandibular imediata sobre implantes cone-morse / Immediate mandibular full arch prosthesis with Morse taper connection implant: clinical case

A perda total dos dentes ainda é um problema enfrentado por grande parcela da população. Nesse sentido, a Odontologia vem desenvolvendo novos métodos para a reabilitação desses pacientes. As próteses totais mucossuportadas foram amplamente utilizadas sem apresentarem, no entanto, estabilidade e retenção satisfatórias, principalmente na mandíbula. Com os estudos desenvolvidos por Brånemark, que culminaram com o aparecimento dos implantes osseointegráveis, um novo conceito de tratamento de pacientes desdentados totais surgiu: próteses totais implantossuportadas. A partir desse conceito, modificações foram realizadas no protocolo original com o intuito de tornar o tratamento mais rápido, efetivo, barato e menos traumático. Assim, pesquisas foram desenvolvidas para viabilizar o carregamento imediato dos implantes. Outro novo conceito que busca a melhora dos resultados em reabilitações orais é o sistema cone-morse, que apresenta maior resistência mecânica, melhor distribuição e transmissão de forças ao longo do implante para o tecido ósseo, redução do gap, com diminuição da possiblidade de invasão bacteriana na interface do implante intermediário, além da redução do afrouxamento e fraturas de parafusos. Fundamentado nessas considerações, este artigo tem como objetivo apresentar um caso clínico de reabilitação com prótese total imediata implantossuportada por implantes do tipo cone-morse na mandíbula. O resultado mostrou-se bastante satisfatório tanto em relação à estética quanto à função e, principalmente, ao conforto do paciente.

The edentulous condition is still a problem faced by most of the population. In this sense, dentistry has developed new methods for the rehabilitation of these patients. Initially, mucoussupported total prostheses have been widely used however without demonstrating satisfactory stability and retention, particularly in the jaw. With the studies developed by Brånemark culminating in the appearance of modern dental implants, a new concept emerged to treat edentulous patients: total implant-supported fixed prosthesis. From this concept, modifications were made in the original protocol in order to make the treatment faster, effective, inexpensive, and less traumatic. Thus, research has been developed to enable the immediate implant activation. Another new concept that aims to provide better results in the oral rehabilitation is the Morse taper system that has greater mechanical strength, better force distribution and transmission along the implant to the bone tissue, reducing the gap with less chance of bacterial invasion in the prosthetic-implant interface, and still with less loosening and screw fractures. Based on these considerations, this article aims to present a case of an immediate implant-supported mandibular total prosthesis on Morse taper implants. The result was quite satisfactory both in relation to aesthetics, function, but especially for patient's comfort.

Mandibular reconstruction using customized three-dimensional titanium implant

Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.

Evaluation of the inclination effect of non-splinted implants on the prosthetic behavior of overdentures in mandible edentulous patients / Evaluación del efecto de la inclinación de implantes no ferulizados sobre el comportamiento protésico de sobredentaduras en pacientes desdentados mandibulares

ABSTRACT. Introduction: the aim of this study was to evaluate the sagittal inclination of implants with respect to the occlusal plane of mandibular overdentures and their effect on the prosthetic behavior of the overdentures. Methods: 52 implants were evaluated in 26 fully mandible edentulous adults (two interforaminal implants per patient), rehabilitated with ball attachments and overdenture. Cephalometric tracing was conducted, evaluating the sagittal inclination of the implant to mandibular plane (MI), occlusal plane (OI), compensation angle (CA), and anterior facial height. The following clinical variables of prosthetic behavior were assessed: the need for prosthesis rebasing, changes in prosthetic accessories, and loosening of the prosthetic attachment. The variables were described with measurements of central tendency and dispersion. Intragroup comparisons were made with the Student's t test (p < 0.05) and correlations with the Pearson coefficient. Results: 26 patients were evaluated: 70.4% females and 29.6% males. The average age was 67.93 ± 8.6 years. The follow-up period ranged from 24 to 30 months. The average MI was 78.89 ± 10.9 degrees. There was a statistically significant correlation (r = 0.6) between MI and OI in patients who underwent a change in accessories and between MI and bone loss (r = 0.557) (p = 0.007). The average MI was higher in patients subjected to rebasing (89.70 ± 11.7 degrees), compared with those who were not subjected to rebasing (76.91 ± 9.8 degrees). A relationship with prosthetic pillar loosening could not be determined. Conclusions: the sagittal inclination of implants with respect to the occlusal plane in overdentures affects bone loss, leading to a change of accessories as well as prosthesis rebasing after two years of service.

RESUMEN. Introducción: el objetivo del presente estudio consistió en evaluar la inclinación sagital de los implantes con respecto al plano oclusal de sobredentaduras mandibulares y su efecto sobre el comportamiento protésico de las mismas. Métodos: se evaluaron 52 implantes en 26 adultos desdentados totales inferiores (dos implantes interforaminales por paciente), rehabilitados con pilares tipo bola y sobredentadura. Se realizaron trazos cefalométricos y se evaluó la inclinación sagital del implante con respecto al plano mandibular (MI), el plano oclusal (OI), el ángulo de compensación (CA) y la altura facial anterior. Se evaluaron variables clínicas de comportamiento protésico: necesidad de rebase de la prótesis, cambio de aditamentos retentivos y aflojamiento del pilar protésico. Las variables se describieron con medidas de tendencia central y dispersión. Las comparaciones intragrupales se hicieron con prueba t de Student (p < 0,05), y las correlaciones con el coeficiente de Pearson. Resultados: se evaluaron 26 pacientes: 70,4% mujeres y 29,6% hombres. La edad promedio fue de 67,93 ± 8,6 años. El rango de seguimiento fue de 24 a 30 meses. El MI promedio fue de 78,89 ± 10,9 grados. Hubo una correlación (r = 0,6) estadísticamente significativa entre MI y OI en los pacientes a quienes se les realizó cambio de aditamentos y entre MI y la pérdida ósea (r = 0,557) (p = 0,007). La MI promedio fue mayor en aquellos pacientes a quienes se les hizo rebase (89,70 ± 11,7 grados), en comparación con los que no tuvieron rebase (76,91 ±9,8 grados). No se pudo determinar la relación con el aflojamiento del pilar protésico. Conclusiones: la inclinación sagital de los implantes con respecto al plano oclusal de las sobredentaduras tiene un efecto sobre la pérdida ósea, lo que conlleva al cambio de aditamentos y rebase de la prótesis después de dos años de observación.

Mandibular Rami Implant: A New Approach in Mandibular Reconstruction.

PURPOSE: The mandible is an essential esthetic and functional component of the lower third of the face and its reconstruction has always been a challenge, especially after severe post-traumatic injuries. The purpose of the present report was to introduce a new approach of mandibular reconstruction in a patient who had lost the entire mandible except for the rami after being severely injured in a blast. MATERIALS AND METHODS: A new approach using a titanium mandibular rami implant technique was applied using computer-aided 3-dimensional virtual planning and rapid prototyping technology. A prosthetic component was supported by the mandibular implant, which achieved occlusion and dedicated function for the patient. RESULTS: This method offered precise adaptation of the implant and prosthesis and an easier surgical procedure, providing a shortened operation time, no donor site morbidity, and more predictable outcomes. CONCLUSION: This new technique allows reconstruction of large-scale mandibular defects that is not possible by conventional surgical methods.

The use of endoprotheses for patients with complex asymmetry: A clinical case study.

Facial asymmetry requires multidisciplinary management. In some cases, predictable problems due to congenital abnormalities can be corrected by early orthodontic treatment. Orthodontics is nevertheless often part of an orthosurgical treatment plan. The solutions are conventional and familiar: maxillomandibular rotation osteotomy and genioplasty. Many cases can be treated in this way, but there is often persistent residual asymmetry due to loss of volume that is not corrected by these techniques. The use of maxillo-acial endoprostheses designed on the basis of three-dimensional craniofacial analyses can rebalance volumes simply and with due regard to the patient's anatomy. This multistage management will be illustrated here through a complex clinical case.

Is 2 mm a safe distance from the inferior alveolar canal to avoid neurosensory complications in implant surgery?

AIM: The aim of the present study was to compare the neurosensory complications related to implants inserted closer than 2 mm to the inferior alveolar canal (IAC) with those inserted further than 2 mm. MATERIALS AND METHODS: A total of 474 implants in 314 patients placed posterior to mental foramen area were evaluated retrospectively on panoramic radiographs. Patients were divided into two groups regarding implant proximity to the IAC (Group 1, distance ≤2 mm, Group 2, distance >2 mm). Postoperative neurosensory complications (pain and paresthesia) were recorded. Chi-square test was used for statistical comparison and P ≤ 0.05 was considered significant. RESULTS: One hundred and fifty-three implants (32.2%) were inserted closer than 2 mm to the IAC whereas 321 implants (67.8%) were inserted further than 2 mm. Three implants which had a distance of 0 mm to the IAC (0.63%) caused paresthesia after surgery. Implant distance to IAC did not show a significant difference regarding pain and paresthesia (P = 0.06 and P = 0.08, respectively). CONCLUSION: When 2 mm is considered as a safety distance, the distance of the implants to the IAC did not yield any statistical difference regarding postoperative neurosensory complications.

Antibacterial Effect of Bacteriocin Isolated From Lactobacillus Plantarum ATCC 8014 on Postoperative Infection of Mandibular Fracture In Vivo.

OBJECTIVE: The primary objective of this study was to verify the effects of bacteriocin in treatment of postoperative infection of mandibular fracture in vivo. METHODS: Eighty-two mice were inoculated intravenously with staphylococcal suspensions. Bacterial cultures were obtained from implants. Blood samples were collected at 1, 2, 4, 6, and 8 hours after the injection of bacteriocins. RESULTS: Bacteriocins have significant inhibitory effects on Staphylococcus aureus (P < 0.05) and there are significant differences interleukin (IL)-8 and IL-10 in serum (P < 0.05). CONCLUSIONS: Bacteriocin isolated from L plantarum may be one of promising ways to control postoperative infection of mandibular fracture in vivo.

Reconstruction of a mandibular segmental defect with a customized 3-dimensional-printed titanium prosthesis in a cat with a mandibular osteosarcoma.

CASE DESCRIPTION A 12-year-old neutered male domestic shorthair cat had been treated for a mass arising from the lingual aspect of the caudal right mandibular body. Cytoreductive surgery of the mass had been performed twice over a 2-year period, but the mass recurred following both surgeries. The mass was diagnosed as an osteosarcoma, and the cat was referred for further evaluation and treatment. CLINICAL FINDINGS Clinical findings were unremarkable, except for a 2-cm-diameter mass arising from the lingual aspect of the right mandible and mild anemia and lymphopenia. Pre- and postcontrast CT scans of the head, neck, and thorax were performed, revealing that the osteosarcoma was confined to the caudal right mandibular body, with no evidence of lymph node or pulmonary metastasis. TREATMENT AND OUTCOME The stereolithographic files of the CT scan of the head were sent for computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Segmental mandibulectomy was performed, and the mandibular defect was reconstructed in a single stage with the 3-D-printed titanium prosthesis. The cat had 1 minor postoperative complication but had no signs of eating difficulties at any point after surgery. The cat was alive and disease free 14 months postoperatively. CLINICAL RELEVANCE Reconstruction of the mandible of a cat following mandibulectomy was possible with computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Cats have a high rate of complications following mandibulectomy, and these initial findings suggested that mandibular reconstruction may reduce the risk of these complications and result in a better functional outcome.

Prosthetic rehabilitation of a patient with a resected right temporomandibular joint.

This case report presents the prosthodontic rehabilitation of a patient with a resected right mandible, caused by an accident. Right condyle, ramus, and the posterior part of ramus were affected by the accident. These structures were resected, and the mandible was positioned toward the surgical area and a facial asymmetry was occurred. The patient was treated with a bar-retained maxillar denture with a guide ramp and an implant-supported fixed mandibular prosthesis.

Segundos molares mandibulares permanentes impactados en pacientes de 8 a 15 años del programa de presupuesto participativo de Medellín, Colombia / Impactation of Permanent Mandibular Second Molars in 8 to 15 Year-Old Patients from the Participative Budget Program in Medellín, Colombia

Antecedentes: La impactación de segundos molares mandibulares permanentes (2MM) se presenta con variaciones considerables según el grupo poblacional. Además de los problemas asociados a esta alteración, podrían requerir tratamientos múltiples y complejos. Por lo tanto, el diagnóstico temprano de una alteración en el proceso de erupción del 2MM es imperativo para reducir el riesgo de impactación, la dificultad de tratamiento y la aparición de problemas asociados en las poblaciones. Propósito: Describir las características de impactación del 2MM en pacientes de 8 a 15 años en una muestra de Medellin, Colombia. Métodos: En este estudio descriptivo retrospectivo se evaluaron 1756 radiografias panorámicas de las cuales 95 presentaron impactación de 2MM. Estas se analizaron según sexo, localización en la mandíbula y tipo de inclinación, y se realizaron 13 mediciones lineales y angulares para identificar parámetros dentoesqueléticos característicos del lado de la impactación. Para el análisis de los datos se utilizó estadística descriptiva y la prueba T (p < 0,05). Resultados: La prevalencia de impactación fue del 5,4 %. La impactación bilateral con inclinación mesial fue la más frecuente. El lado izquierdo predominó en impactaciones unilaterales. El único parámetro dentoesquelético característico de impactación fue el ángulo de inclinación del 2MM con respecto al plano oclusal, con mayor severidad en el lado izquierdo. Conclusiones: Un ángulo igual o mayor a 112,94° podría indicar riesgo de impactación contra el primer molar mandibular permanente. Por lo tanto, este parámetro debería incluirse en el análisis radiográfico para el diagnóstico temprano de impactación del 2MM.

Background: Impactation of permanent mandibular second molars (2MM) occurs with significant variations according to the population group. In addition to the problems associated with it, they could require multiple and complex treatments. Therefore, the early diagnosis of an alteration in the 2MM eruption process is a must to reduce the impactation risk, the treatment difficulty and the occurrence of related problems in the populations. Purpose: To describe the 2MM impactation characteristics in an 8 to 15 year-old patient sample in Medellin, Colombia. Methods: This retrospective descriptive study evaluated 1 756 panoramic radiographs and 95 of them showed 2MM impactation. The latter were analyzed based on the sex, location in the mandible and type of inclination; 13 linear and angle measurings were then carried out in order to identify dental-skeletal parameters characteristic in the impactation side. The data analysis used descriptive statistics and a T test (p < 0.05). Results: The impactation prevalence was 5.4% and the bilateral impactation with mesial inclination was the most frequently found. Unilateral impactations prevailed in the left side of the mandible/maxilla. The only dental-skeletal parameter of impactation was the 2MM inclination angle regarding the occlusal plane, with a greater severity on the left side. Conclusions: An angle of 112.94° or greater could indicate an impactation risk on the permanent mandibular first molar. Therefore, this parameter should be included in the radiographic analysis when diagnosing the early 2MM impactation.

Comparação dos sistemas de retenção para overdenture / Comparison of different attachment systems for overdenture

As próteses totais convencionais inferiores são as mais difíceis de adaptar, devido à perda óssea ser maior e consequentemente à baixa estabilidade e pouca retenção. Entretanto, com o aparecimento dos implantes osse-ointegráveis surgiram os tratamentos com próteses do tipo overdenture, as quais oferecem melhor estabilidade e retenção. O objetivo deste trabalho foi comparar os três principais tipos de sistemas de retenção para a pró¬tese overdenture encontrada na literatura. Para isso, foram realizadas pesquisas com os termos "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" e "oral rehabilitation" nas bases de dados PubMed, Science Direct e Scielo. Os sistemas barra-clipe e esférico apresentaram semelhanças estatísticas quanto à retenção e estabilidade. Já o sistema magnético apresentou pouca retenção e baixa estabilidade

The conventional lower total prosthesis is the most difficult dental prosthesis to adapt in the patients mouth, due to bone loss be greater in this region, which consequently decreases stability and retention of the prosthe¬sis. However, the appearance of osseointegrated implants gave rise to treatments with overdenture prostheses, which offer better stability and retention to the prostheses. The aim of this study was to compare the three main types of overdenture prosthesis restraint systems found in the literature. For this research, we used the terms: "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" and "oral rehabilitation" in the databases of PubMed, Science Direct and Scielo. The clip bar and spherical systems presented statistical similarities regarding retention and stability. Already, the magnetic system presented little retention and low stability

Comparación de proporciones áuricas encontradas antes y después de la rehabilitación con prótesis totales / Comparative study of auric proportions found before and after rehabilitation with dentures

Introducción: La belleza tiene una "proporción ideal" que se presenta en ciertas formas geométricas de la naturaleza con las características de ser armónicas, simétricas y equilibradas. Según Ricketts "es necesario utilizar proporciones áuricas ya que son atractivas y recordadas en el sistema límbico como bellas, armónicas y equilibradas". Objetivo: comparar proporciones faciales en el paciente desdentado sin prótesis y después de la rehabilitación con prótesis totales. Métodos: se obtuvieron los datos de 41 pacientes rehabilitados en la Clínica Odontológica de Prótesis Totales del Departamento de Prótesis, de la Universidad de Chile. Ellos fueron fotografiados mediante el equipo de Cone beam computed volumetric tomography con escaneo facial integrado y luego se midieron y compararon tres proporciones faciales antes y después de la rehabilitación con prótesis removible, y se observó cómo estas proporciones se acercaban o alejaban de la proporción áurica. El análisis estadístico de los datos obtenidos se realizó utilizando el software STATA 11. Se aplicaron las pruebas de Shapiro-Wilk y t de Student. Resultados: en la proporción 1 antes de la rehabilitación, se observó que 51,2 por ciento de los pacientes presentó proporción áurica y después de la rehabilitación se obtuvo que 63,4 por ciento presentó proporción áurica. En la proporción 2 antes de la rehabilitación, se observó que 22 por ciento de los pacientes presentó proporción áurica y después de la rehabilitación se obtuvo que 17,1 por ciento presentó proporción áurica. En la proporción 3 antes de la rehabilitación, se observó que ningún paciente presentó una proporción áurica y después de la rehabilitación se obtuvo que 7,3 por ciento presentó proporción áurica. Conclusiones: en esta muestra se presenta un cambio significativo en las proporciones faciales encontradas antes y después de la rehabilitación con prótesis en el paciente adulto mayor. La proporción ángulo externo del ojo a Stomion, en proporción con Stomion a Menton es la que muestra mayor cercanía a la proporción áurica antes y después de la rehabilitación con prótesis totales(AU)

Introduction: beauty has an "ideal proportion" that occurs in certain shapes of nature with the characteristics of being harmonious, symmetrical and balanced. According to Ricketts, you need to use auric proportions as they are attractive and remembered in the limbic as beautiful, harmonious and balanced system. Objective: to compare facial auricle proportions in the edentulous patient without dentures and after rehabilitation with dentures. Methods: we obtained data of 41 patients rehabilitated with total dental prostheses at the Clinic Department of Prosthodontics, University of Chile. They were photographed by the team of Cone beam computed volumetric tomography with facial scanning integrated and then measured and compared three facial proportions before and after rehabilitation with removable prosthesis, watching these ratios approaching or receding from the auric proportion. Statistical analysis of the data was performed using software STATA version 11. The tests Shapiro-Wilk and Student-T test were applied. Results: in the facial proportion 1 before rehabilitation, was observed that 51.2 percent of patients have auric proportion and after rehabilitation was obtained that 63.4 percent had auric proportion. In the facial proportion 2 before rehabilitation, was observed that 22 percent of patients had auric proportion and after rehabilitation was obtained that 17.1 percent had auric proportion. In the facial proportion 3 before rehabilitation, was observed that no patient had auric proportion and after rehabilitation we found that 7.3 percent had auric proportion. Conclusions: in this sample shows a significant change in facial proportions found before and after prosthetic rehabilitation in the elderly patients. Proportion external angle of the eye Stomion in proportion to Stomion Menton is showing closer to the auric ratio before and after rehabilitation with dentures(AU)

Tratamiento de fracturas mandibulares / Treatment of mandibular fractures

Las fracturas y secuelas mandibulares son de difícil resolución en el ámbito de la cirugía maxilofacial, sus componentes hacen que su reducción no solo sea anatómica, sino también funcional. El objetivo de este artículo es realizar una revisión de los conocimientos más actuales en el tratamiento de fracturas y secuelas mandibulares y la presentación de un caso de secuela de trauma mandibular. El trata-miento de estas fracturas ha ido cambiando durante los últimos años, sirviéndose de nuevas tecnologías para lograr una mejor reducción a través de elementos de osteosíntesis, que propician abordajes más pequeños y con menor comorbilidad. Así el los nuevos sistemas de placas de titanio como miniplacas, placas de reconstrucción o autobloqueantes brindan excelentes resultados en traumas de alta energía con reducciones anatómicas más estables. La tecnología a través de sistemas de reconstrucción 3D y TAC intraoperatorios han logrado mejores resultados en la resolución de estos traumas.

Treatment of mandibular fractures and their sequelae are difficult to resolve in the maxillofacial surgery field, their components cause that reduction must not only be anatomic, but functional as well. The aim of this article is to present a review about actual knowledge in mandibular fracture treatmentand report a case of mandibular trauma. The treatment of these fractures has been changing through theyears; the new technologies achieve better reduction with the osteosynthesis systems, which results inreduced approaches and lesser morbidity. Presently, titanium plates systems like mini-plates, reconstruction plates or blocking plates offer excellent results in high energy traumas through anatomic and stable reductions. The technology of 3D reconstruction systems and intra-operatory CT accomplishes better results in trauma treatment.

Peri-implant defect regeneration in the diabetic pig: A preclinical study.

OBJECTIVES: The study aims to establish a peri-implant dehiscence-type bone defect in a diabetic animal model of human bone repair and to quantify the influence of diabetes on peri-implant bone regeneration. MATERIAL AND METHODS: Experimental diabetes was induced in three domestic pigs by streptozotocin. Three animals served as healthy controls. After 12 months four standardized peri-implant dehiscence bone defects were surgically created in the ramus mandibulae. The animals were sacrificed after 90 days. Samples were histologically analyzed to quantify new bone height (NBH), bone-to-implant-contact (BIC), area of newly formed bone (NFB), bone-density (BD), and bone mineralization (BM) in the prepared defect (-D) and in a local control region (-L). RESULTS: After 90 days, diabetic animals revealed a significantly lower BIC (p = 0.037) and BD (p = 0.041) in the defect area (-D). NBH and BM-D differences within the groups were not significant (p > 0.05). Significant more NFB was measured in the healthy control group (p = 0.046). In the region of local bone BIC-L was significant less in the diabetic group (p = 0.028). In the local control region BD-L and BM-L was lower in the diabetic group compared to the healthy control animals (p > 0.05). CONCLUSION: Histological evidence indicates impaired peri-implant defect regeneration in a diabetic animal model.

Simple prosthesis for a cancer patient with a segmental mandibulectomy and free fibula flap reconstruction: a clinical report.

Tumors of the mandible often necessitate the resection of a major portion of the body of the mandible as well as tissue from the tongue. Resection of the body of the mandible often leads to discontinuity of the mandible, affecting function to a large extent. While the rehabilitation of such defects with free fibula flaps may provide a certain level of stability to the mandible and aid in the prosthetic rehabilitation of these patients, the bulk of these flaps may create difficulties during prosthetic rehabilitation. The economic constraints of patients and/or their fear of implant surgery may also rule out prosthetic rehabilitation with implant-retained prostheses. This case report describes a simple and cost-effective method of prosthetic rehabilitation for a cancer patient who had undergone a segmental mandibulectomy followed by reconstruction with a free fibula flap.

Management of severe mandibular deviation following partial mandibular resection: a case report.

Extensive mandibular resection commonly leads to a deviation of the mandible, facial disfigurement, and difficulty with speech and mastication. The rehabilitation of these patients is a prosthodontic challenge. This article presents the case of a 60-year-old man who sought prosthetic rehabilitation after a right segmental mandibulectomy. The prosthetic rehabilitation was planned in 2 phases. A palatal ramp was constructed, followed by a mandibular guiding flange. After 4 months, the patient's chewing ability, tongue movement, and facial esthetics were improved.