Neuropathic pain after a dental procedure in an older adult with Alzheimer's disease: a case report / Dor neuropática em idoso com doença de Alzheimer após procedimento odontológico: relato de caso

ABSTRACT Neuropathic pain occurs when there is damage to nervous system structures, particularly as a result of direct injury or disease. It can occur in the orofacial territory after dental implants placement. Oral rehabilitation is often performed with dental implant placement for older adults. However, the general health status should be considered, requiring a careful assessment of the patient and the identification of geriatric conditions that could lead to predictable failures. The purpose of this case report is to present the diagnosis and treatment of neuropathic pain after dental implant placement in an older adult with dementia due to Alzheimer's disease.

RESUMO A dor neuropática ocorre quando há dano às estruturas do sistema nervoso, particularmente como resultado de injúria direta ou doença. Pode ocorrer no território orofacial após colocação de implantes dentários. A reabilitação oral é frequentemente realizada por meio da colocação de implantes dentários em pessoas idosas. Entretanto, o estado de saúde geral deve ser considerado, o que requer avaliação cuidadosa do paciente e identificação de condições geriátricas que podem levar a falhas previstas. O objetivo do relato desse caso clínico é apresentar o diagnóstico e o tratamento da dor neuropática após colocação de implante dentário em um idoso com demência em função de doença de Alzheimer.

Prevalence and risk indicators of peri-implantitis after 8 to 10 years of function / Prevalência e indicadores de risco de peri-implantite após 8 a 10 anos em função

Abstract Introduction The investigation of peri-implant diseases risk indicators helps to prevent and target treatment techniques. Objective The aim of this cross-sectional study was to determine the occurrence of peri-implantitis and its potential risk indicator factors, besides to assess the long-term success and survival rates of dental implants after 8 to 10 years of function. Material and method For this, fifty individuals who had received their implant-supported rehabilitation between 2003 and 2005 were included. Data regarding demographics, medical and dental history were collected and a complete clinical examination was performed. Multivariate analysis was used to identify potential risk indicator factors related to the occurrence of peri-implantitis. Overall, 211 implants had been placed; 197 were in function, 9 were still submerged, and 5 had been lost. Result Success and survival rates were 81.5% and 97.6%, respectively. Peri-implant mucositis affected 77.1% of subjects and 52.3% of implants. Peri-implantitis was diagnosed in 14 individuals (29.2%) and 25 implants (12.7%). Subjects with osteoporosis (OR = 2.84) and generalized bleeding on probing (OR = 8.03) were significantly associated with higher odds of peri-implantitis. At the implant level, visible plaque (OR = 4.45) and deep probing depths (OR = 4.47) were significantly associated with peri-implantitis. Conclusion Through these results, our study suggests that osteoporosis and generalized periodontal/peri-implant mucosa inflammation increase the likelihood of peri-implantitis.

Resumo Introdução A investigação dos fatores indicadores de risco para as doenças peri-implantares auxilia na prevenção e direcionamento das técnicas de tratamento Objetivo O objetivo deste estudo transversal foi determinar a ocorrência de peri-implantite e seus potenciais fatores indicadores de risco, além de avaliar as taxas de sucesso e sobrevida em longo prazo dos implantes dentários após 8 a 10 anos de função Material e método Foram incluídos cinquenta indivíduos que receberam sua reabilitação implanto-suportada entre 2003 e 2005. Dados demográficos, história médica e odontológica foram coletados e um exame clínico completo foi realizado. A análise multivariada foi utilizada para identificar potenciais fatores indicadores de risco relacionados à ocorrência de peri-implantite. Ao todo, 211 implantes foram colocados; 197 estavam em função, 9 ainda estavam submersos e 5 haviam sido perdidos. Resultado As taxas de sucesso e sobrevivência foram de 81,5% e 97,6%, respectivamente. A mucosite peri-implantar afetou 77,1% dos indivíduos e 52,3% dos implantes. A peri-implantite foi diagnosticada em 14 indivíduos (29,2%) e 25 implantes (12,7%). Indivíduos com osteoporose (OR = 2,84) e sangramento generalizado à sondagem (OR = 8,03) foram significativamente associados a uma maior chance de peri-implantite. Ao nível do implante, a placa visível (OR = 4,45) e as maiores profundidades de sondagem (OR = 4,47) foram significativamente associadas à peri-implantite. Conclusão Por meio desses resultados, nosso estudo sugere que a osteoporose e a inflamação generalizada da mucosa periodontal / peri-implantar aumentam a probabilidade de peri-implantite.

Como o cirurgião dentista pode ajudar fumantes no abandono desse hábito / How the dentist can help smokers to quit this habit

Smoking is a chronic disease, and it is considered a global epidemic associated with adverse effects on general and oral health. There is evidence that smoking cessation can improve health-related aspects and benefit the outcomes of dental treatments. Thus, it is important that dentists encourage smokers to stop smoking and provide care to those who wish to quit smoking. There are effective strategies that can be used by dental professionals to help smokers to quit and, consequently, obtain more favorable outcomes in the dental treatment. The aim of this literature review is to discuss the effect of smoking cessation on general and oral health, and to describe effective strategies to combat this important public health problem. Dentists should encourage their patients to quit smoking and they have an important role in this. There are many strategies available for health professionals to assist smokers that are willing to quit. (AU)

O tabagismo é uma doença crônica, considerada uma epidemia global, que leva à desfechos adversos na saúde geral e bucal. Por outro lado, há evidências de que a cessação desse hábito pode melhorar aspectos relacionados a saúde como um todo e beneficiar resultados de tratamentos odontológicos. Dessa forma, é fundamental que o cirurgião dentista motive fumantes a pararem de fumar e forneça assistência àqueles que desejam abandonar esse hábito. Para isso, existem estratégias eficazes que podem ser utilizadas para ajudar fumantes nessa difícil missão e, consequentemente, obter resultados mais favoráveis nos tratamentos realizados no consultório odontológico. O objetivo desta revisão de literatura foi discutir os efeitos da cessação do tabagismo sobre a saúde geral e bucal, bem como descrever estratégias eficazes para combater esse importante problema de saúde pública. Cirurgiões dentistas devem estimular seus pacientes a pararem de fumar e possuem um papel fundamental nessa questão. As estratégias disponíveis para assistir esses pacientes a parar de fumar podem e devem ser utilizadas por profissionais de saúde bucal. (AU)

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

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

Clinical and sociodemographic evaluation of peri-implant health of implant retained prostheses fabricated with an immediate oclusal loading protocol / Avaliação clínica e sociodemográfica da saúde peri-implantar de próteses retidas em implantes fabricadas com um protocolo de carga oclusal imediata

ABSTRACT Introduction Dental implant therapy, when well planned, can contribute to the patient's quality of life and is an important tool for solving a serious public health problem in various parts of the world. Objective This study investigated peri-implant health in fixed implants supported by an immediate loading technique and to associate those outcomes with sociodemographic conditions. Material and method After the disassembly of the prostheses on implants with the "Branemark Model" the peri-implant health of 93 patients was evaluated using dental plaque index (DPI), probing pocket depths (PPD), bleeding on probing (BOP), clinical attachment levels (CAL), and presence of gingival hyperplasia. Patients also answered a questionnaire about their gender, age, socioeconomic status (Brazilian Association of Research Companies - ABEP), general health and tobacco use. Result The most constant clinical findings were the presence of plaque, followed by gingival hyperplasia and periimplantitis, which was associated with disease progression. Most of the patients in the study were female, Caucasian, and under 60 years of age, with prostheses located in their lower arch, and they belonged to social classes A and B. Conclusion The presence of dental biofilm occurred in almost all implants and was not related to the presence of periimplantitis. The progression of periimplantitis with bone loss was related to sub gingival bleeding. The sociodemographic characteristics in the study did not present great correlations with the clinical variables of the dental implants studied.

RESUMO Introdução A terapia de implantes dentais, quando bem planejada, pode contribuir para a qualidade de vida do paciente e é uma ferramenta importante para solucionar um sério problema de saúde pública em várias partes do mundo. Objetivo Este estudo investigou a saúde peri-implantar em implantes fixos apoiados por uma técnica de carga imediata e associou esses resultados a condições sociodemográficas. Material e método Após a desmontagem das próteses sobre implantes com o "Modelo de Branemark", a avaliação peri-implantar de 93 pacientes foi avaliada por meio do índice de placa dental (IPD), profundidade de sondagem (PS), sangramento à sondagem (SS), níveis clínicos de fixação (NCF) e presença de hiperplasia gengival. Os pacientes também responderam a um questionário sobre sexo, idade, nível socioeconômico (Associação Brasileira de Empresas de Pesquisa - ABEP), saúde geral e tabagismo. Resultado Os achados clínicos mais constantes foram a presença de placa, seguida de hiperplasia gengival e periimplantite, que esteve associada à progressão da doença. A maioria dos pacientes do estudo era do sexo feminino, caucasiana e com idade inferior a 60 anos, com próteses localizadas na arcada inferior, pertencentes às classes sociais A e B. Conclusão A presença de biofilme dentário ocorreu em quase todos os implantes e não foi relacionado à presença de periimplantite. A progressão da peri-implantite com perda óssea foi relacionada ao sangramento subgengival. As características sociodemográficas do estudo não apresentaram grandes correlações com as variáveis clínicas dos implantes dentários estudados.

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants

Abstract There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. Objective: To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. Material and Methods: Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). Results: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). Conclusion: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant.

Quality of life and mastication in denture wearers and cleft lip and palate adults

Abstract The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses

Abstract This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

Short-term quality of life change perceived by patients after transition to mandibular overdentures

Abstract The aim of this longitudinal observational study was to evaluate the oral health-related quality of life (OHRQoL) following patient rehabilitation with implant-retained mandibular overdentures (IMO) and to identify the contribution of the different domains to OHRQoL. The Oral Health Impact Profile (OHIP-EDENT), Dental Impact on Daily Living (DIDL), and Geriatric Oral Health Assessment Index (GOHAI) questionnaires were completed twice by 25 patients: after 3 months of rehabilitation with complete dentures (CD) and after 3 months of IMO loading using stud abutments. The evaluation after IMO rehabilitation showed significant improvement in three DIDL domains: appearance (p = 0.011), eating and chewing (p = 0.003), and general performance (p = 0.003). The GOHAI results showed significant differences in two domains: psychosocial (p = 0.005) and pain and discomfort (p = 0.0004). The OHIP-EDENT outcomes showed significant improvements in five domains: functional limitation (p = 0.0001), physical pain (p = 0.0002), physical disability (p = 0.0010), and psychological disability and handicap (p = 0.032). The largest observed effect sizes were close to one standard deviation and were observed in the eating and chewing domain (0.93) of the DIDL; the pain and discomfort domain (0.83) of the GOHAI, and the functional limitation (0.89), physical pain (1.02), physical disability (0.84) domains of the OHIP-EDENT. The percentage of satisfied patients increased in all domains. Self-reported OHRQoL of CD wearers was significantly improved after 3 months of treatment with IMO, especially concerning the functional and pain-related aspects.

O significado de uma diferença elevada na pressão arterial entre os dois braços e antes dos implantes dentários: um alerta preocupante, reflexões e tratamento / The significance of intearm arterial blood pressure high difference before dental implant placement: shocking alert, lessons, and case management

Este relato de caso mostra os perigos que uma diferença significativa assintomática na pressão arterial pode trazer à Implantodontia. Paciente do sexo feminino com 75 anos de idade, com perdas de elementos dentais na região posterior de maxila, recebeu como plano de tratamento cirurgias de enxertia e posterior instalação de implantes. Exames pré-operatórios e avaliação cardiológica foram requisitados, sendo autorizadas as cirurgias. Dois atos cirúrgicos foram realizados sem intercorrências. Na terceira cirurgia, no pré-operatório, constatou-se uma diferença de pressão arterial entre os braços direito e esquerdo quando optou-se pelo cancelamento da cirurgia e novo encaminhamento com urgência ao cardiologista em posse do relatório clínico. A pressão arterial mais baixa no braço esquerdo era causada por uma estenose na artéria subclávia com risco aumentado para acidentes vasculares e morbidade cardíaca. Uma angioplastia foi realizada com a instalação de stent, medicações anti-hipertensivas foram mantidas e um antiagregante plaquetário foi introduzido. A paciente foi liberada para continuidade de seu tratamento, com orientações do cardiologista e cirurgião vascular a serem seguidas. Diante do ocorrido e das observações apontadas na literatura pesquisada, pôde-se concluir que o cirurgião terá um melhor panorama das condições físicas dos pacientes se na anamnese ele tomar como rotina a correta aferição da pressão arterial nos dois braços e, diante de qualquer anormalidade, fazer os encaminhamentos necessários para sua segurança e de seus pacientes.

This case report demonstrates how a significant difference at the interarm blood pressure can bring risks to implant dentistry. A 75 years-old female patient with loss of posterior maxillary teeth received a treatment planning grafting surgeries and further implant placement. The pre-operative exams and a cardiologic evaluation were requested, and dental surgeries authorized. The first two separate operations were made without complications. However, in the third surgical appointment, a high difference in blood pressure was detected between the left and right arms. In this way, the surgery was cancelled and the patient urgently referred to the physician. The medical report demonstrated low blood pressure at the left arm caused by the subclavian steal syndrome with risk of vascular accident and cardiac morbidity. An angioplasty was made and a stent was placed, in addition to antihypertensive medications. A platelet anticoagulant was introduced. The patient was released for dental procedures under guidance of the cardiologist and the vascular surgeon. It can be concluded that routine check of blood pressure in both arms can better screen the patient's physical condition and to improve necessary referrals for the patient's safety.

Carga inmediata con rehabilitación definitiva en maxilar inferior: reporte de caso / Immediate load with definitive prosthesis in the lower jaw: a case report

El objetivo de este artículo es presentar un protocolo simplificado para la instalación inmediata de una prótesis definitiva sobre 4 implantes mandibulares. Fue realizado en una paciente de sexo femenino de 72 años, desdentada total. Se inició el tratamiento con la confección de una prótesis removible convencional hasta la prueba de articulación dentaria, a partir de lo cual se obtuvo una guía multifuncional. En la cirugía se instalaron 4 implantes Strong SW (SIN®, Sao Paulo, Brasil) entre agujeros mentonianos. Se atornillaron pilares Mini-Abutment y se tomó la impresión utilizando la guía. Al segundo día se probó la estructura metálica con el enfilado dentario en cera y al tercer día se realizó la instalación de la prótesis terminada con torque manual. A los 10 días se retiró la sutura y se dio torque a los tornillos protésicos (10 N/cm). La paciente ha asistido a controles, sin presentar complicaciones hasta este momento.

The aim of this paper is to present a simplified protocol for immediate installation of a definitive prosthesis over four jaw implants. This was performed on a totally edentulous female patient of 72 years. The treatment was initiated with the preparation of a conventional removable prosthesis until the dental articulation test from which a multifunctional guide was obtained. At surgery, four Strong SW (SIN®, Sao Paulo, Brazil) implants were installed between mental foramen. Mini-Abutments were screwed and the impression was made using the guide. On the second day the metal structure was tested with the dental articulation in wax and on the third day the definitive prosthesis was installed with manual torque. The suture was removed 10 days after surgery, and the torque was given to prosthetic screws (10 N/cm). The patient was followed up every 6 months, with no complications so far.

MMP13, TIMP2 and TGFB3 Gene Polymorphisms in Brazilian Chronic Periodontitis and Periimplantitis Subjects

Abstract Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of peiimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of peiimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

Resumo Indivíduos susceptíveis à periodontite crônica (CP) apresentam alto risco para o desenvolvimento de periimplantite (PI). Ambas doenças são multifatoriais e apresentam similaridades na patofisiologia e perfil poligênico. A MMP-13 (metaloproteinase da matriz tipo 13) é uma enzima colagenolítica cuja expressão é induzida por TGF beta 3 (fator transformador do crescimento tipo 3) nos fibroblastos gengivais humanos e inibida por TIMP-2 (inibidor tecidual de metaloproteinase tipo 2). O objetivo deste estudo foi investigar a ocorrência de periimplantite em sujeitos com periodontite crônica e a frequência dos polimorfismos nos genes MMP13, TIMP2 e TGFB3. Cento e sessenta e três voluntários submetidos à instalação de implantes endósseos foram analisados clínica e radiograficamente quanto à presença de histórico de CP e PI, sendo divididos em 4 grupos: Controle (sem história de CP e PI, n=72), CP (com CP e sem PI, n=28), PI (com PI e sem CP, n=28) e Doentes (com CP e PI, n=35). O teste do qui-quadrado correlacionou os genótipos nas regiões dos genes MMP13 (rs2252070), TIMP2 (rs7501477) e TGFB3 (rs2268626), considerando a interação entre CP e PI. Os resultados mostraram que voluntários com CP possuem 3.2 vezes mais chances de desenvolver PI (p=0.0004) comparados aos sem CP. Nenhuma associação significativa foi observada entre os genes MMP13, TIMP2 e TGFB3 e CP ou PI. A CP é um fator de risco ao desenvolvimento de PI, no entanto, não há associação entre ambas as doenças com polimorfismos nos genes MMP13, TIMP2 e TGFB3.

Rehabilitación oral mediante implantes dentales en paciente con síndrome de Sjõgren / Oral rehabilitation with dental implants in patients with Sjõgren's syndrome

El Síndrome de Sjögren (SS) es una patología autoinmune caracterizada por un proceso crónico inflamatorio de las glándulas exocrinas, cuya manifestación fenotípica es la queratoconjuntivitis seca y la xerostomía, lo que trae consigo el desarrollo de caries, enfermedad periodontal e infecciones bacterianas y fúngicas. Estos pacientes presentan alto riesgo cariogénico, siendo de gran interés y preocupación en la práctica odontológica, donde el tratamiento es principalmente sintomático. El caso a presentar es de una paciente de 65 años de edad diagnosticada con SS hace 8 años; la cual presenta múltiples caries y restos radiculares en dientes mandibulares y maxilares, a la cual se indican exámenes radiográficos y médicos, se realizan exodoncias múltiples en sector inferior y en el mismo acto quirúrgico se instalan cinco implantes, se esperan tres meses para permitir la oseointegración para posteriormente rehabilitar con una prótesis sobre implantes tipo ad-modum en palafito y en el sector superior se rehabilitará con resinas compuestas previo encerado diagnóstico y prueba de Mock-up para llegar al plano oclusal y así recuperar funcionalidad y estética

Sjõgren's syndrome (SS) is an autoimmune disease characterized by a chronic inflammatory process of the exocrine glands, whose phenotypic expression is keratoconjunctivitis sicca and xerostomia, which entails the development of caries, periodontal disease and bacterial and fungal infections. These patients are at high risk cariogenic, being of great interest and concern in dental practice, where treatment is mainly symptomatic. The present case is a patient of 65 years of age diagnosed with SS 8 years; which has multiple cavities and root fragments in mandibular teeth and jaws, which radiographic examinations anddoctors indicated, multiple extractions are performed in lower sector and in the same operation five implants are installed, three months are expected to allow osseointegration to further rehabilitate a prosthesis implantsad modum type on stilts and in the upper section will be rehabilitated with wax composites prior diagnosisand test mock up to reach the occlusal plane and recover functionality and aesthetics...

Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency

Abstract The aim of this non-randomized controlled clinical trial was to evaluate the oral health-related quality of life and masticatory efficiency of patients rehabilitated with mandibular two-implant overdentures with immediate loading or conventional dentures. Fifty completely edentulous patients wearing bimaxillary conventional dentures, for at least one year, were recruited. The patients were then assigned to either two treatment groups: mandibular overdentures supported by two implants with bar-clip system and a maxillary conventional denture (n = 25), and new maxillary and mandibular conventional complete dentures (n = 25). Masticatory efficiency and oral health-related quality of life were assessed before and 3 months after denture insertion. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral health-related quality of life. Masticatory efficiency was evaluated with chewing capsules through a colorimetric method. The results revealed fewer oral health-related quality of life problems in patients wearing mandibular two-implant overdentures compared to the conventional dentures group. In addition, the implant overdenture group presented statistically significant improvement in masticatory efficiency (p = 0.001). There was no correlation between masticatory efficiency and OHIP in the implant group (p > 0.05), however a correlation was found in the conventional denture group (p < 0.05). Therefore, these short-term results suggest that mandibular overdenture retained by 2 implants with immediate loading combined with maxillary conventional dentures provide better masticatory efficiency and oral health-related quality of life than mandibular conventional dentures.

Prevalence of peri-implant disease on platform switching implants: a cross-sectional pilot study

The objective of this study was to assess the prevalence of mucositis and peri-implantitis associated with the use of two types of implants—conventional versus platform switching after one year of loading. A longitudinal study of 64 implants in 25 patients was performed. Clinical variables, such as clinical pocket depth and bleeding upon probing, plaque, mobility, gingival recession, clinical attachment loss, and radiographic bone loss, were analyzed. The case definition for peri-implantitis was established as pockets of ≥ 5 mm with bleeding and bone loss ≥ 2 mm. One year after implant loading, the prevalence of mucositis and peri-implantitis with conventional implants (CIs) was 81.2% and 15.6%, respectively. For platform switching implants (PSIs) the prevalence was 90% and 6.6%, respectively. These differences were not statistically significant (p = 0.5375). However, there was a trend towards a lower prevalence of peri-implantitis with platform switching Implants.

Patient satisfaction concerning implant-supported prostheses: an observational study

The aim of this observational study was to assess the degree of patient satisfaction toward implant-supported prostheses. A questionnaire was used with two scales (one consisting of detailed adjectival and the other of numerical responses) regarding chewing, esthetics, speaking, comfort and overall satisfaction. The scales were administered to a sample of 147 patients treated with implants and prostheses. The data were submitted to the Kappa statistic and the Chi-square test to analyze the association between dependent and independent variables. High degrees of satisfaction (greater than 91%) were found for all categories evaluated, regardless of gender, age, number of implants or type of prosthesis. “Comfort” was associated significantly with the number of implants (p = 0.038), and “speaking” was associated significantly with the type of prosthesis (p = 0.029). Positive agreement was found between the scales for all categories evaluated, without statistically significant differences regarding respondent preference (p = 0.735). Patients treated with implant-supported prostheses were highly satisfied with the treatment.

Avaliação eletromiográfica dos músculos masseter e temporal, força de mordida e qualidade de vida em pacientes desdentados antes, durante e após a instalação e adaptação de novas próteses - total maxilar e overdenture mandibular sobre implante / Evaluation of electromyography of masseter and temporalis, bite force and quality of life in edentulous patients during and after the adaptation of new prostheses – complete dentures in the maxilla and mandibular overdentures

Apesar dos avanços da odontologia preventiva mundial, o número de indivíduos desdentados ainda é grande. Muitos pacientes têm dificuldades na utilização das próteses totais convencionais, principalmente, as mandibulares. Uma alternativa de tratamento nessas situações é a instalação de overdentures implanto suportadas. Esse tratamento já é bem estabelecido na literatura, mas ainda não há estudos que comparem o que ocorre com a atividade elétrica, força de mordida e qualidade de vida dos pacientes até o momento da adaptação com as novas dentaduras. Avaliamos a eficiência do tratamento bem como sua evolução em cinco etapas distintas, com as próteses totais antigas (I), após a cirurgia de instalação dos implantes com as próteses mandibulares reembasadas (II), após a instalação dos cicatrizadores (III), no momento da instalação das novas próteses (IV) e após três meses de uso (V). Foram selecionados 12 pacientes completamente desdentados, de acordo com critérios de inclusão e exclusão preestabelecidos, para a instalação de overdentures retidas por dois implantes mandibulares e próteses totais maxilares como antagonistas. Em cada etapa avaliamos os pacientes por meio da eletromiografia de temporal e masseter, da força de mordida e também aplicamos o questionário OHIP edent para avaliar a qualidade de vida desses pacientes. Nos resultados encontramos uma diminuição da atividade elétrica para a mastigação habitual de uvas passas, repouso e movimento de lateralidade, a força de mordida e a qualidade de vida dos pacientes aumentaram progressivamente durante o estudo (p ˂ 0,05). Comprovando que essa reabilitação deveria se tornar padrão para indivíduos desdentados e que seus benefícios já são observados antes mesmo de sua completude.

Despite advances in preventive dentistry in Brazil, the number of edentulous individuals is still great. Many patients present difficulty when using conventional dentures, especially towards the mandibular one. A treatment option for these situations is the installation of implant-retained prostheses. Although this treatment is well established in the literature, there are no studies comparing what happens to muscles and quality of life of patients during the treatment. We selected 12 completely edentulous patients, according to pre-established inclusion and exclusion criteria, to rehabilitate with mandibular overdentures retained by two dental implants and a complete denture as antagonists. We evaluated the efficacy of the treatment and its evolution in five distinct steps, initially with the old complete dentures (I) after the implants placement with the mandibular prosthesis relined (II) after the placement on of the healing abutments (III), after the installation and adaptation of new prostheses (IV) and after three months of its use (V). At each stage, we evaluated patients through the temporal and masseter electromyography (EMG), bite force and the questionnaire OHIP Edent to assess the quality of life of these patients. The results for EMG found a decrease in muscle activity during the mastication of raisins, rest and lateral movements, while the bite force and the quality of life of patients gradually improved during the study (p ˂ 0.05). Proving that this rehabilitation should become standard for edentulous individuals and that the benefits of treatment are observed even before its completion.

Avaliação e prevenção da hipertensão arterial por vasos constritores em Implantodontia – estudo clínico prospectivo / Evaluation and preventive measures against arterial hypertension (AHT) provoked by vasoconstrictors in dental implant practice – a clinical prospective study

Objetivo: alertar os profissionais da Implantologia sobre a alta incidência de hipertensão arterial (HTA) nos pacientes da terceira idade que se submeterão ao procedimento cirúrgico, considerando-se também os protocolos de carga imediata. Material e métodos: foram realizados 113 procedimentos com anestesia parenteral com a finalidade de reabilitação oral por meio de protocolos de carga imediata entre os anos de 2010 e 2014. A idade dos pacientes variou entre 65 e 75 anos, salientando que todos eles eram portadores de hipertensão arterial de grau leve, moderado e grave. Destes pacientes, 90 eram hipertensos sintomáticos que usavam medicamentos hipotensores, e 23 eram hipertensos assintomáticos. No caso dos pacientes que optaram pelas cargas imediatas de dupla arcada, por escolha própria, os procedimentos foram efetuados em hospitais, já que poderiam ser realizados em clínicas odontológicas, desde que gozassem de boa saúde. Os pacientes com avaliação física A.S.A. III somente podem passar por procedimentos realizados em hospitais. Todos os procedimentos foram catalogados em fichas de anestesia, que consistem em um documento de responsabilidade do anestesiologista e que contém os dados clínicos do paciente, orientando os procedimentos da futura anestesia. Resultados: nos pacientes de carga imediata, foram identificados 90 portadores de HTA de grau leve, moderado e grave. Ainda, dois casos demonstraram níveis críticos de pressão arterial elevada (180 e 200 mmHg) logo no começo da infiltração, e providências imediatas foram realizadas, como o uso de um hipotensor de ação rápida via sublingual de Adalat de 10 mg. Conclusão: é importante aferir a pressão arterial, em curtos intervalos de tempo, em procedimentos odontológicos nos pacientes da terceira idade, com história pregressa de HTA. A prevenção da HTA na fase pré-cirúrgica consiste em diminuir a ansiedade com o uso de medicamento com finalidade ansiolítica...

Objective: to alert implant dental practitioners on the high incidence of arterial hypertension (AHT) on third age patients undergoing surgical procedures, also considering the immediate loading protocols. Material and methods: between the years of 2010 to 2014, 113 procedures were performed with parenteral anesthesia for oral rehabilitation treatment. The patient´s age ranged from 65 to 75 years, all demonstrating mild, moderate, and severe AHT. From these, 90 were hypertensive under appropriate medication, while 23 were asymptomatic. For patients preferring immediate loading in both jaws, all procedures were performed in a hospital setting. Patients under A.S.A. III category cannot be operated at dental clinics. All procedures were recording in appropriate anesthesiology files with all clinical data for further anesthetic administration. Results: 90 patients were considered with mild, moderate, and severe AHT levels. Also, two cases demonstrated critical levels of arterial pressure (180 and 200 mmHg) at the beginning of infi ltration, and immediate maneuvers were provided with a fast hypotensive sublingual agent (Adalat 10 mg). Conclusion: it is important to check arterial pressure at short periods of time during dental procedures for third age patients with a reported history of AHT. Prevention of ATH at the pre-surgical moment can reduce the anxiety by use of appropriate medication. ATH levels can be diminished with an hypotensive agent and a boosting dose also reducing epinephrine doses relative to ATH classification.

Does the number of implants have any relation with peri-implant disease?

Objective: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. Material and Methods: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. Results: Clinical parameters were compared between groups using Student’s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 – 19 (20.43%) – compared with G2 – 26 (38.24%) – showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). Conclusion: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis. .

Tratamento de doença peri-implantar e regeneração óssea guiada associada a osso autógeno: relato de caso / Treatment of peri-implantitis and guided bone regeneration associated with autogenous bone: a case report

Os implantes osseointegráveis foram incorporados como importantes aliados para o tratamento reabilitador, servindo de forma bastante satisfatória quer em tratamentos unitários ou em reabilitações mais extensas. Entretanto, algumas situações adversas à saúde podem acontecer, como, por exemplo, a peri-implantite, que é uma doença infecciosa semelhante à periodontite crônica, que afeta os tecidos peri-implantares, cujo tratamento visa a restauração funcional e estética, restabelecendo a condição de saúde. A maioria dos tratamentos busca a redução da carga bacteriana do ambiente da bolsa peri-implantar por meio da descontaminação dasuperfície do implante, seguida ou não da tentativa de regenerar osso. Vários protocolos de tratamento já foram sugeridos, porém, ainda se sabe pouco se essas terapias são capazes de devolver a osseointegração dos implantes. Objetivo: o objetivo desse relato de caso foi apresentar alguns aspectos da doença peri-implantar, com ênfase em seu tratamento, apresentando os resultados favoráveis da correção da perda de suporte por meio de enxerto ósseo autógeno associado a regeneração óssea guiada, podendo resultar em um alto índice de ganho ósseo e completo recobrimentodos implantes.

Dental implants have been considered important allies in the rehabilitation treatment of lost teeth, either in single-unit cases or in more complex rehabilitations. However, adverse outcomes may occur, for instance, peri-implantitis, which is an infectious disease similar to chronic periodontitis, affecting peri-implant tissues of which treatment aims at restoring health, as well as function and esthetics. Most treatments focus on reducing the microbiological burden of the peri-implant environment pocket by decontaminating the implant surface. In many cases, treatment of infection is followed by bone regeneration with fairly good results. Several treatment protocols have been suggested, however, little is yet known whether these therapies are able to lead to new osseointegration of implants. Objective: The aim of this case report was to show some aspects of peri-implantitis with emphasis on its treatment, and to show the outcomes of associating autogenous bone graft with guided bone regeneration. Our results reveal that the association between both techniques might result in high bone gain rates and complete implant cover.