Restabelecimento de ponto de contato em dentes com coroas totais posteriores: relato de caso / Reestablishment of contact point on teeth with posterior crowns: case report

A presença do ponto de contato é essencial para manter a saúde das estruturas periodontais, além de evitar inclinações dentárias e desgastes, conservando, assim, uma oclusão ideal. Objetivo: apresentar um relato de caso clínico com restabelecimento dos pontos de contato de forma conservadora, por meio da ortodontia e da dentística restauradora, em dentes com coroas totais. Relato de caso: paciente do gênero feminino, 69 anos de idade, compareceu à clínica odontológica da universidade com queixa de impacção alimentar e desconforto na região superior posterior direita da arcada. Foi observada clinicamente ausência do ponto de contato entre os dentes 15, 16 e 17, optando-se pelo tratamento multidisciplinar envolvendo a ortodontia e a dentística restauradora. Para isso, foram utilizados bráquetes no segundo pré-molar e no primeiro molar superior direito (dentes 15 e 16, respectivamente), e botões ortodônticos nas faces palatinas desses, e do segundo molar superior (dente 17), unidos por elástico corrente tamanho médio. Quando obtidos os pontos de contato, foi realizada a restauração do primeiro pré-molar direito (dente 17) com resina composta. Considerações finais: o uso de elásticos corrente e botões ortodônticos foi satisfatório para a obtenção de pontos de contato entre os dentes.(AU)

The presence of the proximal contact is essential to maintain the periodontal structures health, besides preventing diseases and wastes, thus preserving an ideal occlusion. Aim: the aim of this article is to present a clinical case report with restoration of the proximal contact in a conservative way, through orthodontics and restorative dentistry, in teeth with total crowns. Case report: a 69-year-old female patient attended the university dental clinic with complaint of food impaction and discomfort in the upper right posterior region of the arcade. It was clinically observed absence of the point of contact between the teeth 15, 16 and 17 and opted for the multidisciplinary treatment involving orthodontics and restorative dentistry. For this, brackets were used in the second premolar and first maxillary right molar (teeth 15 and 16, respectively), and orthodontic buttons on the palatal surfaces of the same, and on the second upper molar (tooth 17), joined by the current elastic medium size. When the proximal contact was obtained, the first right premolar restoration was performed with a composite resin. Final considerations: the use of current elastics and orthodontic buttons were satisfactory for obtaining proximal contact between these teeth.(AU)

Desempenho clínico de coroas monolíticas posteriores de cerâmica infiltrada por polímero: ensaio clínico controlado e randomizado duplo cego / Clinical performance of posterior monolithic polymer-infiltrated ceramic crowns: double-blind randomized controlled clinical trial

Objetivo: avaliar por meio de um ensaio clínico controlado, randomizado e duplo-cego, o desempenho clínico de coroas monolíticas unitárias posteriores confeccionadas em cerâmica infiltrada por polímero, bem como o impacto da reabilitação na satisfação estética e qualidade de vida dos pacientes. Materiais e Métodos: Um total de 20 pacientes que receberam 36 coroas foram incluídos neste estudo. Todos os pacientes assinaram o termo de consentimento livre e esclarecido (TCLE). Os dentes sob reabilitação foram alocados por meio de um sorteio simples entre os grupos: Grupo Controle: (LD- dissilicato de lítio) e grupo Experimental (PIC -Vita Enamic/Vita Zahnfabrik). Registros fotográficos, radiográficos e informações clínicas foram coletados antes, durante e após a reabilitação. As coroas foram avaliadas quanto à taxa de sobrevida clínica (Critérios de USPSH modificados), satisfação estética (escala visual analógica- EVA), qualidade de vida (Oral Impacts on Daily Performances -OIDP), e tipo de falhas (biológicas e técnicas). A coleta de dados foi realizada por um único examinador calibrado e cego para o tipo de material, nos tempos de seguimento T0 (antes do início do tratamento), T1 (1 mês), T2 (6 meses) e T3 (12 meses). O OIDP e os critérios de USPHS foram analisados descritivamente. A satisfação estética foi analisada com MannWhitney/Teste de Friedman/ pós-testes de Wilcoxon. A análise de sobrevivência foi feita usando Kaplan-Meier seguido do teste de log-rank. O nível de significância foi estabelecido em (5%). Resultados: 36 coroas foram colocadas em 20 pacientes com uma média de idade de 47.17 anos (±13,91), sendo 22 (56,4%) coroas do grupo controle (LD) e 14 (35,9%) para o grupo experimental (PIC). A análise de Kaplan-Meier revelou uma taxa de sobrevida de 83,5% para PIC e de 86,2% para LD sem diferenças significativas entre eles (P>0.05). Quatro falhas foram registradas, 2 em cada grupo, sendo dois descolamentos, uma de PIC após 1 mês e uma de LD após 6meses. Houve também uma fratura do dente (LD) e mobilidade grau III (PIC) após 12 meses de acompanhamento. Não houve diferença significativa na satisfação estética, entre o grupo controle e grupo experimental (Mann-Whitney - P>0.05). A satisfação estética foi significativamente maior após 1(T1), 6(T2) e 12(T3) meses quando comparado ao baseline (T0) (Teste de Friedman - P<0.05). A reabilitação com coroas unitárias impactou positivamente na qualidade de vida dos pacientes. Conclusão: Este estudo demonstra que coroas monolíticas unitárias de PIC apresentaram desempenho clínico, estético e um impacto positivo na qualidade de vida dos pacientes após 12 meses, similar ao LD (AU).

Objective: To evaluate, through a controlled, randomized and double-blind clinical trial, the clinical performance of posterior single monolithic crowns made ceramic infiltrated polymer, as well as the impact of rehabilitation on patients' aesthetic satisfaction and quality of life. Materials and Methods: A total of 20 patients who received 36 crowns were included in this study. All patients signed an informed consent form. The teeth under rehabilitation were allocated using a simple draw between the groups: Control Group: (LD- lithium disilicate) and Experimental group (PIC -Vita Enamic). Photographic, radiographic, and clinical information records were collected before, during, and after rehabilitation. The crowns were assessed for clinical survival rate (modified USPSH criteria), aesthetic satisfaction (visual analog scale - VAS), quality of life (Oral Impacts on Daily Performances - OIDP), and type of failures (biological and technical). Data collection was performed by a single examiner calibrated and blinded to the type of material, at the follow-up times T0 (before the start of treatment), T1 (1 month), T2 (6 months), and T3 (12 months). The OIDP and USPHS criteria were analyzed descriptively. Aesthetic satisfaction was analyzed with the Man-Whitney/Friedman test/Wilcoxon post-tests. Survival analysis was performed using Kaplan-Meier followed by the log-rank test. The level of significance was set at (5%). Results: 36 crowns were placed on 20 patients (17 women and 3 men) with a mean age of 47.17 years (± 13.91), with 22 (56.4%) crowns from the control group (LD) and 14 (35.9%) for the group experimental (PIC). The Kaplan-Meier analysis revealed a survival rate of 83.5% for PIC and 86.2% for LD with no significant differences between them (P>0.05). Four failures were recorded, 2 in each group, two detachments after 1(PIC) and 6 months (LD), a tooth fracture (LD), and grade III mobility after (PIC) 12 months of follow-up. There was no significant difference in aesthetic satisfaction between the control group and the experimental group (Mann-Whitney, P>0.05). Aesthetic satisfaction was significantly higher after 1 (T1), 6 (T2), and 12 (T3) months when compared to baseline (T0) (Friedman test - P <0.05). Rehabilitation with single crowns had a positive impact on patients' quality of life. Conclusion: This study demonstrates that single monolithic crowns of PIC presented a good clinical, aesthetic performance and a positive impact on patients' quality of life after 12 months, similarly to PIC (AU).

Tratamiento de la osteítis condensante en molar: informe de caso / Molar condensing osteitis treatment: Case report

En la actualidad, la principal causa por la que acuden los pacientes al odontólogo es el dolor dental, endonde la mayoría presenta un padecimiento pulpar o periapical irreversibles, que pueden estar asociados a factores traumáticos e irritativos. Sin embargo, pocosde ellos son asintomáticos, como la osteítis condensante que es escasamente mencionada en elámbito de la Endodoncia; por lo tanto, el objetivo de este caso clínico es el de proporcionar información acerca de la osteítis condensante siguiendo los lineamientos internacionales de Case Report (CARE). La osteítis condensante tiene una incidencia muy baja en pacientes y se debe diagnosticar correctamente al momento de tratar este tipo de lesiones con las diferentes herramientas de diagnóstico que se conocen. En este caso, se presenta un paciente del sexo femenino de 58 años de edad con un estado prediabético, que refiere un fractura del segundo molar inferior derecho, al cual radiográficamente se le encontróuna lesión periapical radiopaca en la raíz distal. Se muestra la secuencia del tratamiento, el manejo clínico y la rehabilitación.

At present, the main reason for patients to visit adentist is dental pain, where most of them presenta pulp or periapical irreversible condition, whichmay be associated with traumatic and irritative factors. However, few of them are asymptomatic as osteitiscondensing that is barely mentioned in thefield of endodontics. The aim of this case report isto provide information about the condensing osteitisfollowing international Case Report (CARE)guidelines. Condensing osteitis has a very low incidence in patients and should be correctly diagnosed with the different available diagnostic tools. In thiscase a 58-years-old female patient, with prediabeticstate, referred of a right lower second molar fracturewhich radiographically showed a radiopaque periapicallesion in the distal root of the molar. The sequence of treatment, clinical management and rehabilitation is presented.

Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 1 / Post-endodontic restoration and social condition as afactor of tooth preservation. part 1

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos, compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia del Círculo Odontológico de Córdoba y al servicio de la Cátedra“B” de Endodoncia de la Facultad de Odontología de la Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. Sólo asistieron a control el 48,6 por ciento de los pacientes, de los cuales se evaluaron 89 dientes. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sinrestauración, 21 con fracturas y 1 se perdió. Se observó un incremento de fracturas en control a los 18 meses. La tasa de fracturas evidenció un mayor porcentaje en pacientes con nivel de estudio alto, menor en pacientes sin trabajo, y mayor en pacientes con trabajo estable y precario. El tipo de atención no se diferenció, pero los porcentajes observados sugieren que los atendidos en asistencia pública tendrían más probabilidad de fracturas. Se observó un mayor porcentaje de restauraciones definitivas enatención privada y menor en consultorios públicos. El elevado porcentaje de inasistencia a controlesmotivó un análisis específico, del cual se pudo concluir que a mayor estabilidad laboral, de estudios yde asistencia privada, mayor fue la asistencia a controles. Estos datos revelan información importantepara establecer políticas públicas de la atención posendodoncia.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, level of study, employment status and access to dental services.To do so, we analyzed a population composed of subjects who participated in two different graduate courses at the Círculo Odontológico de Córdoba and the “Chair B” of Endodontics of the Faculty ofDentistry, National University of Córdoba. Treatments were clinically and radiographically controlled for eighteen months. The total sample included 144 patients and 174 treatments. Only 48.6% patients attended the control, 89 teeth of whom were evaluated. The study showed 37 cases with definitivecoronary restoration without fractures, 52 teeth without restoration, 21 with fractures, and 1 was lost.The fracture rate showed an increase in patients with high level of study, a decrease in unemployed patients, and an increase in both patients with stable and precarious work. The kind of attention didnot differ, but the observed percentages suggest that patients treated in public services would be morelikely to suffer from fractures. There was a higher percentage of definitive restorations in private services,and lower in public ones. The high percentage of non-attendance to controls motivated a specific analysis, from which it is possible to conclude that the more job stability, studies and private access todental services, the more the attendance to controls. These data reveal important evidence in order to establish public policies of post-endodontic services.

Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 2 / Post-endodontic restoration and social condition asa factor of tooth preservation. Part 2

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, estado periodontal, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia, del Círculo Odontológico de Córdoba, y al servicio de la Cátedra “B” de Endodoncia de la Facultad de Odontología, Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sin restauración, 21 con fracturas y 1 se perdió. De los dientes restaurados, el55,6 por ciento mostraron periodonto normal; 22,2 por ciento gingivitis, y 22 por ciento periodontitis leve. De los dientes sin restauración, el 3,9 por ciento mostraron periodonto normal; 7,8 por ciento gingivitis; 31,4 por ciento periodontitis leve; 35,3 por ciento periodontitis grave y 21,6 por ciento periodontitis complicada. De los dientes fracturados, el 16,7 por ciento mostraron periodonto normal o gingivitis; 35,3 por ciento periodontitis leve y grave, y un 72,7 por ciento periodontitis complicada. No se demostró asociación entre nivel de estudios, condición laboral y tipo de atención con fracturas de los pacientes, pero los porcentajes sugieren más probabilidad de sufrir fractura en los pacientes de la asistencia pública. El elevado porcentaje de inasistencia a control motivó un análisis específico, del cual se pudo concluir que cuanto más grave la patología periodontal, mayor el porcentaje de inasistencia. El estudio permitió observar desigualdad en el acceso a los servicios odontológicos, dientes no rehabilitados y con compromiso periodontal.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, periodontic condition, level of study, employment status and access to dental services. A population composed of patients treated in two different postgraduate courses at the Círculo Odontológico de Córdoba and Chair “B” of Endodontics, Faculty of Dentistry,National University of Córdoba were analyzed. Treatments were clinically and radiographicallycontrolled for eighteen months. The total sample included 144 patients and 174 treatments. The studyshowed 37 cases with definitive coronary restoration without fractures, 52 teeth without restoration,21 with fractures, and 1 was lost. From restored teeth, 55.6% showed normal periodontium, 22.2%gingivitis, and 22% mild periodontitis. From teeth without restoration, 3.9% showed normalperiodontitis, 7.8% gingivitis, 31.4% mild periodontitis, 35.3% severe periodontitis and 21.6%complicated periodontitis. From fractured teeth, 16.7% showed normal periodontitis or gingivitis, 35.3% had mild and severe periodontitis, and 72.7% had complicated periodontitis. There has beenno correlation between level of education, work status, and kind of service on patient with fractures,but the percentage suggest that patients in public assistance are more likely to suffer fracture. The highpercentage of non-attendance to control led to a specific analysis, from which it is possible to concludedthat the more severe the periodontal disease, the greater the percentage of non-attendance. The study showed inequality in access to dental services, un rehabilitated teeth and with periodontal compromise.

Incidência de fraturas em próteses fixas: estudo retrospectivo. Análise da sobrevivência de próteses metalocerâmicas após um período mínimo de quatro anos em função / Fractures incidence on fixed prostheses: a retrospective study

As próteses metalocerâmicas ainda são apontadas como o tratamento de escolha em reabilitação oral por apresentarem altas taxas de sobrevivência, mesmo que o fator estético possa ser comprometido devido às propriedades óticas relacionadas à infraestrutura metálica. Além disso, há pouca informação na literatura científica sobre os fatores que levam às fraturas das próteses fixas metalocerâmicas. Com isso, o presente estudo teve como objetivo avaliar se a quantidade de elementos que compõe uma prótese, se a quantidade de elementos por retentor, se o tipo de prótese, se o tipo de pilar, se a localização da prótese, se o bruxismo e se a utilização de placa miorrelaxante influenciam na incidência de fraturas em próteses fixas metalocerâmicas. Para este estudo, foram selecionados 16 pacientes, totalizando 74 próteses metalocerâmicas, instaladas entre 2000 e 2010, que tiveram um acompanhamento mínimo de 4 anos. Foram coletados dados, como: gênero, idade, data de instalação das próteses e sistema cerâmico utilizado. Foi realizada a avaliação clínica considerando integridade da prótese, características do elemento antagonista e coleta da história odontológica em caso de fratura, além de um questionário para identificar provável ou possível bruxismo. Foram determinadas as taxas de sucesso, insucesso e sobrevivência da mesma. Os resultados mostraram que a taxa de sucesso das próteses metalocerâmicas instaladas foi de 87,8% e a taxa de sobrevivência foi de 89,1%. Além disso, a taxa de sucesso não foi influenciada pela idade (p=0,903), tempo de instalação (p=0,830), número de próteses na boca (p=0,872), número de elementos (p=0,937) e número de pilares (p=0,064). Para as variáveis qualitativas também não houve diferença estatística significante (p>0,05) entre as proporções das taxas de sucesso e insucesso. Contudo, os resultados mostraram que pacientes que não usavam placa miorrelaxante tiveram taxa maior de sucesso que os pacientes usuários de placa (p=0,004). Assim, pode-se concluir que as próteses metalocerâmicas apresentam altas taxas de sucesso e sobrevida garantindo a longevidade desse tipo de reabilitação.(AU)

Metal-ceramic prosthesis are still the treatment choice in oral rehabilitation because they present high survival rates, even if the aesthetic can be compromised due to optical properties related to metallic infrastructure. In addition, there is little information on scientific literature about factors that lead to fractures of fixed metalceramic prosthesis. The purpose of this study was to evaluate if prosthesis elements number, number of elements per prosthetic abutment, type of prosthesis, type of prosthetic abutment, the prosthesis location, bruxism and myorelaxant plaque influences on incidence of fractures in fixed metal-ceramic prosthesis. For this study, 16 patients were selected totaling 74 metal-ceramic dentures installed between 2000 and 2010 with a follow-up of at least 4 years. Data were collected, such as: gender, age, prosthesis installation date and the ceramic system used. Besides a questionnaire to identify probable or possible bruxism, a clinical evaluation was performed to evaluate prosthesis integrity, antagonist element characteristics and dental history in case of fracture. Success, failure and survival rates were determined. The results showed that the success rate of metal-ceramic prosthesis was 87.8% and the survival rate was 89.1%. In addition, the success rate was independent of age (p=0.903), installation time (p=0.830), number of prosthesis (p=0.872), elements (p=0.937) and abutments (p=0.064). The qualitative variables also did not show significant statistical results (p> 0.05) between success and failure rates. However, the results showed that patients who did not use myorelaxant plaque had a higher success rate than plaque users (p=0.004). Thus, it can be concluded that the metal-ceramic prosthesis has high success and survival rates, ensuring longevity of this type of rehabilitation.(AU)

A 3-year follow-up study of all-ceramic single and multiple crowns performed in a private practice: a prospective case series

OBJECTIVES: Zirconia-based prostheses are commonly used for aesthetic crown and fixed restorations, although follow-up data are limited, especially for implant-supported crowns. The aim of this study was to evaluate the threeyear clinical results of the installation of 463 zirconia core crowns by a general dental private practice. METHODS: This study followed 142 patients (69 men and 73 women; aged 28-82 years) who had received 248 single crowns (202 tooth-supported, 36 implant-supported) and 225 multiple units of up to six elements (81 toothsupported, 144 implant-supported). Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The overall failure rate was computed for the fractured and lost prostheses. Aesthetic, functional, and biological properties were rated, and patient satisfaction was investigated. RESULTS: During the three-year follow-up period, four patients were lost from the study (18 crowns, 4 percent of the total crowns). Three of the zirconia prostheses suffered fractures in more than three units (11 crowns; one- vs. three-year follow-up, p,0.05, Wilcoxon signed-rank test), and the cumulative prosthesis survival rate was 98.2 percent. Twelve units lost retention and were re-cemented, and no secondary caries of the abutment teeth were reported. The aesthetic, functional, and biological properties were generally well-rated, and there were no differences between tooth- and implant-supported crowns. The lowest scores were given regarding the anatomical form of the crowns, as some minor chipping was reported. Relatively low scores were also given for the periodontal response and the adjacent mucosa. Overall, patient satisfaction was high. CONCLUSIONS: At the three-year follow-up, the zirconia-core crowns appeared to be an effective clinical solution as they had favorable aesthetic and functional properties. Only the marginal fit of the prostheses should be improved upon.

Immediate implants placed into infected sockets: a case report with 3-year follow-up

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

A integridade estética/funcional do tecido periodontal pode ser comprometida pela perda do elemento dental. Os implantes imediatos tornaram-se uma opção viável na manutenção da arquitetura periodontal, desde que haja a compatibilidade com o alvéolo e a possibilidade da contaminação local ser totalmente eliminada. O objetivo deste estudo foi descrever o procedimento de instalação de implantes imediatos na região anterior de maxila usados na reposição de dentes com lesões crônicas periapicais, discutindo a relação entre o procedimento e lesões periapicais. A remoção dos dentes condenados (11, 12 e 21) foi feita de forma conservadora a fim de preservar a estética e arquitetura periodontal. Um segundo acesso cirúrgico foi obtido a nível apical, permitindo: o debridamento da loja cirúrgica, orientação visual dos implantes e o preenchimento com enxerto ósseo bovino. A loja óssea foi coberta por uma membrana absorvível e uma prótese parcial removível provisória foi instalada e após 6 meses os implantes foram reabilitados. Após 3 anos de reabilitação, os implantes se apresentam em condições satisfatórias de estética/função, sugerindo que a instalação de implantes imediatos combinados com a regeneração tecidual guiada em lesões periapicais crônicas podem ser indicados para repor dentes perdidos devido a lesões periapicais crônicas com história de insucesso endodôntico na maxila anterior.