The Effect of Surface Treatment on Shear Bond Strength between Y-TZP and Veneer Ceramic: A Systematic Review and Meta-Analysis.

PURPOSE: The objective of this systematic review with meta-analysis was to evaluate surface treatment in yttria-stabilized tetragonal zirconia polycrystal ceramic (Y-TZP) on the shear bond strength (SBS) values between Y-TZP (core ceramic) and veneer ceramic, compared to untreated specimens. MATERIALS AND METHODS: This review was registered at PROSPERO platform under the number CRD42016036493. The systematic review of the extracted publications was performed to compare the effect of surface treatment on SBS between Y-TZP ceramic and veneering ceramic. A comprehensive review of the literature from the earliest available dates through January 2017 was performed in the PubMed/Medline, Embase, Scopus, and Cochrane Library databases. RESULTS: A total of 15 studies were identified for the inclusion of data, with only in vitro studies. A random-effect model found statistically significant differences between untreated and treated surfaces of Y-TZP (p < 0.00001; MD: 2.84; 95% CI: 2.19 to 3.49). In another analysis, a random-effect model found statistically significant differences between the groups that only performed the associations of treatments and control group (p < 0.00001; MD: 3.19; 95% CI: 2.11 to 4.28). CONCLUSIONS: Surface treatment in Y-TZP improved the values of SBS between the Y-TZP and veneer ceramic. The associations between two or more treatments also showed positive effect on the bond strength due the cumulative effect of the treatments.

Stress Analysis of Axial and Tilted Implants in Full-arch Fixed Dentures Under Different Abutment Conditions.

The aim of this study was to evaluate the stress distribution on full-arch prostheses, considering axial implants and tilted implants with or without abutments. Two photoelastic models were made, being that in 1 model the implants were inserted perpendicular, whereas in the other model 2 implants were inserted perpendicular and 2 implants were inserted with tilting 30° to the distal area. The prosthetic situations were evaluated: A-axial implants and nonsegmented full-arch prosthesis; B-axial implants and segmented full-arch prosthesis; C-tilted distal implants and nonsegmented full-arch prosthesis; D-tilted distal implants and segmented full-arch prosthesis, and was applied an axial load of 100 N at 5 points. The results showed greater stress concentration for axial implants than tilted implants in anterior and posterior loading. There was no difference in stress distribution to the use of abutment in the tilted implants. Shorter cantilever with tilted implants improved the stress distribution; the use of abutment did not influence the stress distribution.

An esthetics rehabilitation with computer-aided design/ computer-aided manufacturing technology.

AIM: This paper describes a case of a rehabilitation involving Computer Aided Design/Computer Aided Manufacturing (CAD-CAM) system in implant supported and dental supported prostheses using zirconia as framework. BACKGROUND: The CAD-CAM technology has developed considerably over last few years, becoming a reality in dental practice. Among the widely used systems are the systems based on zirconia which demonstrate important physical and mechanical properties of high strength, adequate fracture toughness, biocompatibility and esthetics, and are indicated for unitary prosthetic restorations and posterior and anterior framework. CASE DESCRIPTION: All the modeling was performed by using CAD-CAM system and prostheses were cemented using resin cement best suited for each situation. CONCLUSION: The rehabilitation of the maxillary arch using zirconia framework demonstrated satisfactory esthetic and functional results after a 12-month control and revealed no biological and technical complications. CLINICAL SIGNIFICANCE: This article shows the important of use technology CAD/CAM in the manufacture of dental prosthesis and implant-supported.

CAD/CAM vs Conventional Technique for Fabrication of Implant-Supported Frameworks: A Systematic Review and Meta-analysis of In Vitro Studies.

PURPOSE: To compare the marginal vertical misfit between implant-supported frameworks fabricated using CAD/CAM systems and the conventional technique (lost-wax casting). MATERIALS AND METHODS: This review was performed according to PRISMA criteria and registered on PROSPERO (CRD42017055685). An electronic search was performed independently by two examiners in the MEDLINE (Pubmed), Embase, Web of Science, and Cochrane Library databases to find studies published up to April 2018. RESULTS: The database search yielded 507 references. After removing duplicate references, 384 studies remained. Eleven in vitro studies were selected according to the eligibility criteria (inter-reader κ = 0.88). Nine different CAD/CAM systems were used to fabricate 172 frameworks of different materials, including zirconia, monolithic lithium disilicate, and metallic alloys. Subgroup analyses were performed for different types and retention systems of the frameworks. In the general analysis, marginal misfit observed with the CAD/CAM systems was lower than with the conventional method (P = .003), as was observed in the subgroup analysis for single-unit frameworks (P < .00001). For fixed (P = .89), cemented (P = .60), and screwed (P = .18) frameworks, no significant difference was observed between the evaluated techniques. CONCLUSION: The CAD/CAM systems showed improved marginal fit over the conventional lost-wax casting technique for fabricating single-unit frameworks; however, in the subgroup analyses, no difference was observed for the fixed implant-supported type or for the retention systems evaluated.

Vertical and Horizontal Misfit Analysis of 3-unit FDP Fabricated with Different Techniques and CAD/CAM Systems.

The aim of this is was evaluate the vertical and horizontal marginal adaptation of 3-unit fixed partial denture frameworks fabricated using different techniques and CAD/CAM systems. A total of 40 framework specimens were fabricated and divided into four groups as follows: lost-wax casting (G1); lost-wax casting with welding (G2); extraoral optical scanning of models (3S/DWOS) (G3); intraoral optical scanning (Cerec Bluecam/Sirona) (G4). A reference model was used to simulate a fixed partial denture with three elements (with a central pontic). The frameworks of G1 and G2 were cast in nickel-chromium (NiCr) alloy, whereas those of G3 and G4 were milled in zirconia. In all groups, vertical and horizontal marginal adaptation (over-contour and under-contour) was evaluated using a three-dimensional optical microscope (Quick Scope, Mitutoyo). The results showed higher vertical marginal misfit in G1 than in the other groups (p<0.001). Regarding horizontal marginal misfit, higher over-contour values occurred in G3 than in the other groups (p<0.001). G3 did not show under-contour at all, whereas the other groups did not differ from each other in this regard (p>0.05). Within the limitations of this study, it can be concluded that lost-wax casting with welding is a viable alternative to the use of CAD/CAM systems to fabricate frameworks of three-unit FPDs, since the techniques yielded similar vertical misfit values. Extra-oral CAD/CAM systems showed the highest horizontal misfit (over-contour) compared to other groups.

Biomechanical Three-Dimensional Finite Element Analysis of Single Implant-Supported Prostheses in the Anterior Maxilla, with Different Surgical Techniques and Implant Types.

PURPOSE: The aim of this study was to use three-dimensional finite element analysis to analyze the stress distribution transferred by single implant-supported prostheses placed in the anterior maxilla using different connections (external hexagon, internal hexagon, or Morse taper), inclinations of the load (0, 30, or 60 degrees), and surgical techniques for placement (monocortical/conventional, bicortical, or bicortical with nasal floor elevation). MATERIALS AND METHODS: Nine models representing a bone block of this region were simulated by computer-aided design software (InVesalius, Rhinoceros, SolidWorks). Each model received one implant, which supported a cemented metalloceramic crown. Using FEMAP software, finite elements were discretized while simulating a 178-N load at 0, 30, and 60 degrees relative to the long axis of the implant. The problem was solved in NEi Nastran software, and postprocessing was performed in FEMAP. Von Mises stress and maximum principal stress maps were made. RESULTS: The von Mises stress analysis revealed that stress increased with increasing inclination of the load, from 0 to 30 to 60 degrees. Morse taper implants showed less stress concentration around the cervical and apical areas of the implant. The bicortical technique, associated or not with nasal floor elevation, contributed to decreasing the stress concentration in the apical area of the implant. Maximum principal stress analysis showed that the increase in inclination was proportional to the increase in stress on the bone tissue in the cervical area. Lower stress concentrations in the cortical bone were obtained with Morse taper implants and the bicortical technique compared with other connections and surgical techniques, respectively. CONCLUSION: Increasing the inclination of the applied force relative to the long axis of the implant tended to overload the peri-implant bone tissue and the internal structure of the implants. The Morse taper connection and bicortical techniques seemed to be more favorable than other connections or techniques, respectively, for restoring the anterior maxilla.

Complete overdentures retained by mini implants: A systematic review.

OBJECTIVE: The purpose of this systematic review was to evaluate the use of mini implants to retain complete overdentures in terms of survival rates of mini implants, marginal bone loss, satisfaction, and quality of life. DATA: This report followed the PRISMA Statement and PICO question. This review has been registered at PROSPERO under the number CRD42016036141. SOURCE: Two independent reviewers performed a comprehensive search of studies published until September 2016 and listed in the PubMed/MEDLINE, Embase, and The Cochrane Library databases. The focused question was: is the use of mini implants feasible for prosthodontic rehabilitation with complete overdentures? RESULTS: The 24 studies selected for review evaluated 1273 patients whose mean age was 65.93 years; these patients had received 2494 mini implants and 386 standard implants for retaining overdenture prosthesis. The mean follow-up time was 2.48 years (range: 1-7 years). There was a higher survival rate of mini implants (92.32%). More frequent failures for maxillary (31.71%) compared with mandibular arches (4.89%). The majority of studies revealed marginal bone loss values similar to those of standard implants (<1.5mm). All studies verified an increase in satisfaction and quality of life after rehabilitation treatment with mini dental implants. CONCLUSION: The present systematic review indicates that the use of mini implants for retaining overdenture prosthesis is considered an alternative treatment when standard treatment is not possible, since it presents high survival rates, acceptable marginal bone loss, and improvements in variables related to satisfaction and quality of life. CLINICAL SIGNIFICANCE: Based on the results of this study, the use of a minimum 4 and 6 mini implants can be considered a satisfactory treatment option for rehabilitation of the mandibular and maxillary arches respectively with a complete overdenture.

Analysis of the biomechanical behavior of short implants: The photo-elasticity method.

The aim of this study was to analyze the stress distribution of short implants supporting single unit or splinted crowns by the photo-elasticity method. Four photo-elastic models were produced: A (3.75×7 mm); B (3.75×7 mm, 3.75×7 mm and 3.75×7 mm); C (3.75×10 mm, 3.75×7 mm and 3.75×7 mm); D (3.75×13 mm, 3.75×7 mm and 3.75×7 mm). The prostheses were made with Ni-Cr alloy. A load of 100 N in the axial and oblique directions was applied, totaling 380 applications, individually capturing their images in each model. The data were randomized and analyzed qualitatively and quantitatively by 2 examiners. The oblique loading was significantly more damaging. The increase in length was favorable for stress distribution (p<0.05). The splinting was beneficial for the transmission of stresses mainly (p<0.05). The splinting of the crowns, as well as increasing the length of the first implant and axial loading was most beneficial in the stress distribution. Short splinted implants behaved better than single unit implants. Increasing of the length of the first implant significantly improved the stress distribution in all analyzed situations.

Abordagem, diagnóstico e tratamento das disfunções temporomandibulares: relato de caso / Approach, diagnosis and treatment of temporomandibular dysfunctions: case report / Enfoque, diagnóstico y tratamiento de las disfunciones temporomandibulares: relato de caso

Introdução: Dentre as dores orofaciais, a disfunção da articulação temporomandibular (DTM) apresenta alta prevalência na população mundial. A dor é a principal queixa, e o acometimento mais comum para a busca de tratamento. Sintomas como fadiga muscular, dificuldade de abertura, zumbido entre outros, podem estar associados a outras comorbidades como o distúrbio de sono e cefaléia. Não raro, as queixas psicológicas como ansiedade e depressão podem ainda atuar como fatores iniciantes, perpetuantes ou predisponentes do quadro. O diagnóstico e plano de tratamento está apoiado na anamnese cuidadosa buscando descrever detalhadamente os sintomas, duração, tipo, ou seja, todas as informações possíveis sobre o desenvolvimento e manifestação da DTM. O exame físico deve incluir a palpação dos músculos mastigatórios, avaliação dos movimentos mandibulares e região da articulação temporomandibular. Exames de imagens como radiografias panorâmica e seriada da ATM, tomografia e ressonância magnética completam o arsenal para avaliação das estruturas envolvidas. Objetivo: descrever a resolução do caso clínico de um paciente que apresenta DTM detalhando os fundamentos do diagnóstico e estabelecimento de um plano de tratamento adequado, em busca de resultados satisfatórios no tratamento proposto para o paciente. Descrição de caso clínico: o diagnóstico do caso clínico em questão foi iniciado pela aplicação da anamnese detalhada utilizando o questionário "RDC" ­ Critério Diagnóstico para Pesquisa, posteriormente foi realizado o exame físico minucioso e a avaliação das radiografias panorâmica e seriada da ATM. O diagnóstico estabelecido foi de dor miofascial com espalhamento. Após o diagnóstico definitivo de disfunção temporomandibular, foi instituído um tratamento multidisciplinar para a resolução dos sinais e sintomas da paciente, e melhora na sua qualidade de vida. Um adequado diagnóstico e um minucioso planejamento são etapas cruciais para o sucesso em reabilitações protéticas envolvendo pacientes com sinais e sintomas de DTM. Por apresentar uma etiologia multifatorial as DTMs devem ser abordadas de maneira multidisciplinar(AU)

Introduction: Among the orofacial pains, temporomandibular joint dysfunction (TMD) presents a high prevalence in the world population. Pain is the main complaint, and the most common involvement in the search for treatment. Symptoms such as muscle fatigue, difficulty opening, tinnitus among others, may be associated with other comorbidities such as sleep disorder and headache. Not infrequently, psychological complaints such as anxiety and depression may still act as initiating, perpetuating or predisposing factors of the condition. The diagnosis and treatment plan is supported by careful anamnesis seeking to describe in detail the symptoms, duration, type, ie all possible information about the development and manifestation of TMD. Physical examination should include palpation of the masticatory muscles, assessment of mandibular movements, and temporomandibular joint region. Imaging tests such as panoramic and serial X-ray of the TMJ, tomography and MRI complete the arsenal to evaluate the structures involved. Objective: to describe the resolution of the clinical case of a patient with TMD detailing the fundamentals of diagnosis and establishing an adequate treatment plan, in search of satisfactory results in the proposed treatment for the patient. Description of the clinical case: the diagnosis of the clinical case in question was initiated by the application of the detailed anamnesis using the "RDC" questionnaire - Diagnostic Criteria for Research, followed by a detailed physical examination and evaluation of the panoramic and serial radiographs of the TMJ. The established diagnosis was myofascial pain with spreading. After the definitive diagnosis of temporomandibular dysfunction, a multidisciplinary treatment was instituted to resolve the patient's signs and symptoms and improved their quality of life. Adequate diagnosis and thorough planning are crucial steps for success in prosthetic rehabilitation involving patients with TMD signs and symptoms. Because of the multifactorial etiology, TMDs should be approached in a multidisciplinary way(AU)

Introducción: Entre los dolores orofaciales, la disfunción de la articulación temporomandibular (DTM) presenta alta prevalencia en la población mundial. El dolor es la principal queja, y el acometimiento más común para la búsqueda de tratamiento. Síntomas como fatiga muscular, dificultad de apertura, zumbido entre otros, pueden estar asociados a otras comorbilidades como el disturbio de sueño y cefalea. No es raro que las quejas psicológicas como ansiedad y depresión pueden todavía actuar como factores iniciantes, perpetuantes o predisponentes del cuadro. El diagnóstico y plan de tratamiento está apoyado en la anamnesis cuidadosa buscando describir detalladamente los síntomas, duración, tipo, es decir, toda la información posible sobre el desarrollo y manifestación de la DTM. El examen físico debe incluir la palpación de los músculos masticatorios, la evaluación de los movimientos mandibulares y la región de la articulación temporomandibular. Exámenes de imágenes como radiografías panorámicas y seriadas de la ATM, tomografía y resonancia magnética completan el arsenal para la evaluación de las estructuras involucradas. Objetivo: describir la resolución del caso clínico de un paciente que presenta DTM detallando los fundamentos del diagnóstico y establecimiento de un plan de tratamiento adecuado, en busca de resultados satisfactorios en el tratamiento propuesto para el paciente. El diagnóstico del caso clínico en cuestión fue iniciado por la aplicación de la anamnesis detallada utilizando el cuestionario "RDC" - Criterio Diagnóstico para Investigación, posteriormente fue realizado el examen físico minucioso y la evaluación de las radiografías panorámica y seriada de la ATM. El diagnóstico establecido fue de dolor miofascial con esparcimiento. Después del diagnóstico definitivo de disfunción temporomandibular, se instituyó un tratamiento multidisciplinario para la resolución de los signos y síntomas de la paciente, y mejora en su calidad de vida. Un adecuado diagnóstico y una minuciosa planificación son etapas cruciales para el éxito en rehabilitación protética que involucra a pacientes con signos y síntomas de DTM. Por presentar una etiología multifactorial las DTMs deben ser abordadas de manera multidisciplinaria(AU)

A 3-D finite element study of the influence of crown-implant ratio on stress distribution.

The purpose of this study was to assess the influence of the crown height of external hexagon implants on the displacement and distribution of stress to the implant/bone system, using the three-dimensional finite element method. The InVesalius and Rhinoceros 4.0 softwares were used to generate the bone model by computed tomography. Each model was composed of a bone block with one implant (3.75 x 10.0 mm) with external hexagon connections and crowns with 10 mm, 12.5 mm and 15 mm in height. A 200 N axial and a 100 N oblique (45°) load were applied. The models were solved by the NeiNastran 9.0 and Femap 10.0 softwares to obtain the results that were visualized by maps of displacement, von Mises stress (crown/implant) and maximum principal stress (bone). The crown height under axial load did not influence the stress displacement and concentration, while the oblique loading increased these factors. The highest stress was observed in the neck of the implant screw on the side opposite to the loading. This stress was also transferred to the crown/platform/bone interface. The results of this study suggest that the increase in crown height enhanced stress concentration at the implant/bone tissue and increased displacement in the bone tissue, mainly under oblique loading.

Vertical and horizontal misfit analysis of 3-unit fdp fabricated with different techniques and cad/cam systems

Abstract The aim of this is was evaluate the vertical and horizontal marginal adaptation of 3-unit fixed partial denture frameworks fabricated using different techniques and CAD/CAM systems. A total of 40 framework specimens were fabricated and divided into four groups as follows: lost-wax casting (G1); lost-wax casting with welding (G2); extraoral optical scanning of models (3S/DWOS) (G3); intraoral optical scanning (Cerec Bluecam/Sirona) (G4). A reference model was used to simulate a fixed partial denture with three elements (with a central pontic). The frameworks of G1 and G2 were cast in nickel-chromium (NiCr) alloy, whereas those of G3 and G4 were milled in zirconia. In all groups, vertical and horizontal marginal adaptation (over-contour and under-contour) was evaluated using a three-dimensional optical microscope (Quick Scope, Mitutoyo). The results showed higher vertical marginal misfit in G1 than in the other groups (p<0.001). Regarding horizontal marginal misfit, higher over-contour values occurred in G3 than in the other groups (p<0.001). G3 did not show under-contour at all, whereas the other groups did not differ from each other in this regard (p>0.05). Within the limitations of this study, it can be concluded that lost-wax casting with welding is a viable alternative to the use of CAD/CAM systems to fabricate frameworks of three-unit FPDs, since the techniques yielded similar vertical misfit values. Extra-oral CAD/CAM systems showed the highest horizontal misfit (over-contour) compared to other groups.

Resumo O objetivo deste estudo foi avaliar a adaptação marginal vertical e horizontal de infraestruturas de prótese fixas de três elementos confeccionadas por diferentes técnicas e diferentes sistemas CAD/CAM. Um total de 40 infraestruturas foram confeccionadas e divididas em quatro grupos: fundição por cera perdida (G1); fundição por cera perdida com ponto de solda (G2); escaneamento óptico extraoral para escaneamento do modelo (3S/DWOS); escaneamento óptico intraoral (Cerec Bluecam/Sirona) (G4). Uma matriz metálica foi utilizada para simular uma prótese fixa de três elementos (com pôntico central). As infraestruturas do G1 e G2 foram fundidas em liga metálica de níquel-cromo (NiCr), enquanto que as infraestruturas de G3 e G4 foram fresadas em zircônia. Todos os grupos foram analisados quanto à adaptação marginal vertical e horizontal (sobrecontorno e subcontorno) em microscópio óptico tridimensional (Quick Scope, Mitutoyo). Os resultados apresentaram maiores valores de desadaptação marginal vertical no G1 comparados aos outros grupos (p<0,001). Em relação a desadaptação marginal horizontal, maiores valores de sobrecontorno foram observado no G3 em comparação com os demais grupos (p<0,001). Não foi observado valores de subcontorno para o G3, enquanto que os demais grupos não apresentaram diferença significante para o subcontorno (p> 0,05). Dentro das limitações do presente estudo, pode-se concluir que a técnica convencional após ponto de solda é uma alternativa viável para confecção de infraestruturas de próteses fixas de três elementos comparado ao uso de sistemas CAD/CAM, uma vez que as técnicas apresentaram valores de adaptação marginal vertical similares. Os sistemas CAD/CAM extraoral apresentou o maior desajuste horizontal (sobrecontorno) em comparação com outros grupos.

Reabilitação oral estética anterior envolvendo implantes e gengiva cerâmica / Aesthetic rehabilitation of anterior region using implants and ceramic gum

O objetivo deste trabalho foi relatar um caso clínico de reabilitação oral maxilar superior anterior que necessitou para correção estética uma prótese implantossuportada com cerâmica gengival. Paciente OTG, sexo feminino, 59 anos, compareceu à clinica de reabilitação oral da FOA-UNESP queixando de estética desfavorável na região anterior superior. Após anamnese, análise clínica e radiográfica, foi observada presença de implantes nos elementos 11, 12 e 21, com desadaptação das coroas e com perda óssea marginal significativa em todos os implantes, presença de núcleos metálicos curtos com coroas de cor desagradável à paciente, além da necessidade de tratamento periodontal. Após discussão do caso com a paciente, foi planejado o tratamento periodontal com raspagem dos quatro quadrantes, substituição dos núcleos metálicos condenados e confecção de coroas sobre dentes e implantes, mantendo- -os. A reabilitação incluiu enceramento diagnóstico para previsão do tratamento final, troca dos núcleos condenados e confecção de provisórios, seguindo enceramento e, finalmente, fase protética que incluiu sistema CAD/CAM e prótese totalmente cerâmica. Alteração ao tratamento anterior foi a esplintagem das coroas sobre implante, uma vez que a perda óssea estava severa e não indicava a individualização dos elementos. Após o tratamento, a paciente mostrou-se bastante satisfeita, relatando que a estética ficou satisfatória mesmo com o uso da gengiva cerâmica, já planejada desde a fase de enceramento. Além do aspecto periodontal que melhorou com o tratamento, a prótese esplintada ficou bastante estética pela possibilidade de reproduzir a área gengival satisfatoriamente, além de melhorar a distribuição de cargas oclusais quando comparadas às próteses unitárias (AU).

The aim of this study was to report a clinical case of oral rehabilitation of anterior region of the maxilla that required an implant-supported prosthesis with ceramic gum for aesthetic correction. Patient OTG, female, 59 years old, sought care at the oral rehabilitation clinic from FOA-UNESP and reported dissatisfaction with the esthetics of anterior maxillary region. After anamneses, clinical and radiographic analysis, it was observed the presence of implants for tooth reposition of #11, #12 and #21 with misfit crowns and significant marginal bone loss of all implants, short metallic cores and unpleasant color of crowns in some teeth as well as the need of periodontal scaling. After a discussion with the patient, a treatment plan was developed. It consisted on the endodontic scaling of all quarters; replacement of inappropriate metallic cores and fabrication of new crowns of teeth and implants. Rehabilitation included: diagnostic wax-up for final treatment preview; correction of unpleasant colors and provisional restorations following diagnostic waxing and prosthetic fabrication of all ceramic restorations using CAD/CAM system. An alteration in relation to the prior treatment was the splinting of implant-supported crowns because bone loss was severe and therefore single crowns were contraindicated. After treatment the patient was very pleased and reported satisfactory esthetics even with the ceramic gum, planned since diagnostic waxing. Moreover, periodontal status showed improvement and the splinted prosthesis allowed the distribution of occlusal loads compared to single crowns with a satisfactory aesthetic outcome due to good reproduction of gingival area (AU).

Harmonização estética de dentes anteriores utilizando cirurgia periodontal com auxílio do proporcionador dental de Chu ­ relato de caso / Creating aesthetic harmony of anterior teeth through periodontal surgery using Chu's proportion gauge ­ case report

O presente estudo teve como objetivo relatar um caso clínico de paciente que procurou tratamento e foi submetido à gengivoplastia na região anterior superior, utilizando-se régua de Chu para regularização da altura das coroas e possibilitar instalação de próteses fixas com estética otimizada. Para realização da gengivoplastia e regularização da altura das coroas, inicialmente foi verificada a profundidade de sondagem com sonda periodontal milimetrada e altura das coroas com proporcionador de Chu. A quantidade de gengiva a ser removida foi determinada através da confecção de pontos sangrantes marcados com sonda exploradora. Foram realizadas incisões em bisel interno e intrassulcular para permitir remoção do colar cervical de gengiva com curetas periodontais, seguindo as marcações prévias. Em seguida, descolamento de retalho foi realizado para regularização do tecido ósseo e raspagem radicular. Os tecidos foram reposicionados e suturados e consultas de acompanhamento foram realizadas aos 7 e 15 dias pós-operatórios. Aos 7 dias, o tecido gengival encontrava-se em processo inicial de cicatrização, e aos 15 dias o tecido gengival encontrava-se nos períodos finais da cicatrização, já apresentando as características de normalidade e saúde, demonstrando sucesso inicial do tratamento. Após 45 dias dos procedimentos cirúrgicos, foram realizados os preparos para colocação de próteses nos incisivos e confeccionadas provisórias (fase atual). A paciente já demonstrou satisfação com os resultados iniciais obtidos. Pelo exposto, concluiu-se que uma abordagem passo a passo para regularização estética de coroas, utilizando a régua de Chu, pode ser opção viável para controle do resultado restaurador bem-sucedido, previsível e estético (AU).

The purpose of the present study is to report a case of gingivoplasty in the region of the upper incisors using the Chu aesthetic gauges to guide crown lengths and allow subsequent installation of unitary fixed prosthesis with satisfactory aesthetic result. To perform the gingivoplasty and regulate crown length, the probing depth (PD) was assessed using a periodontal probe and the length of the crowns was measured using Chu aesthetic gauges. The amount of gum to be removed was determined by making bleeding points with an explorer. Then, one inner bezel and one intrassulcular incision were performed to enable the removal of gum cervical collar with periodontal curettes. Tissues were repositioned and sutured with follow-up visits 7 and 15 days after surgery. At 7 days, the gingival tissue was in the initial healing process, and after 15 days the gum tissue found itself in the final period of healing, already showing normal and health characteristics, indicating the success of the treatment. After 45 days teeth were prepared, temporary prosthesis were installed (current phase) and the patient showed complete satisfaction with the results. It can be concluded that a step by step approach to periodontal aesthetic crown regularization using Chu aesthetic gauge can viable option for a predictable and aesthetic restorative outcome (AU).

Evaluation of color stability of different temporary restorative materials / Avaliação da estabilidade de cor de diferentes materiais restauradores provisórios

Introduction: Temporary restorative materials are widely used, however, little is know about their color stability. Objective: to evaluate the color stability of the following temporary restorative materials: acrylic and bis-acrylic resins after immersion in pigmenting solutions for different periods of storage. Material and method: Four materials were tested (Dêncor/Clássico, Protemp 4/3M ESPE; Structur 2 SC/Voco; Luxatemp AM Plus/DMG) and 30 test specimens (15 mm in diameter and 2 mm thick) per material were fabricated. They were divided according to the storage medium (artificial saliva, saliva + cola type soda, and saliva + coffee) and storage time intervals (2, 5, 7 and 15 days). Color measurements were made before and after immersions, with use of a spectrophotometer, by means of the CIE L*a*b* system. The data were analyzed by the analysis of variance and the Tukey Test, at a level of significance of 5%. Result: Acrylic resin presented greater color stability in comparison with bis-acrylic resins (p<0.001). When bis-acrylic resins were compared no significant difference was observed between the resins Structur and Luxatemp (p=0.767). As regards solutions tested, coffee showed the highest color change values (p<0.001), and the longer the storage time interval, the greater was the color change in all the temporaryrestorative materials analyzed (p<0.001). Conclusion: Acrylic resin presented greater color stability in comparison with bis-acrylic resins (p<0.001). Coffee caused the greatest color change, and immersion time was determinant in color stability of the temporary materials analyzed.

Introdução: Os materiais restauradores provisórios são amplamente utilizados, porém pouco se sabe a respeito de sua estabilidade de cor. Objetivo: Avaliar a estabilidade de cor de materiais restauradores provisórios: resina acrílica e resinas bisacrílicas, após a imersão em soluções pigmentantes, durante diferentes períodos de armazenamento. Material e método: Quatro materiais foram testados (Dêncor/Clássico, Protemp 4/3M ESPE; Structur 2 SC/Voco; Luxatemp AM Plus/DMG) sendo confeccionadas 30 amostras (15 mm de diâmetro e 2 mm de espessura) por material. Estes foram divididos de acordo com o meio de imersão (saliva artificial, saliva + refrigerante tipo cola e saliva + café) e período de armazenamento (2, 5, 7 e 15 dias). As mensurações de cor foram realizadas antes e após as imersões, com auxílio de um espectrofotômetro, através do sistema CIE L*a*b*. Os dados foram analisados com análise de variância (ANOVA) e Tukey, com nível de significância à 5%. Resultado: A resina acrílica apresentou maior estabilidade de cor quando comparada às resinas bisacrílicas (p<0,001). Comparando as resinas bisacrílicas, não foi observado diferença significativa entre as resinas Structur e Luxatemp (p=0,767). Em relação as soluções testadas, o café apresentou os maiores valores de alteração de cor (p<0,001), sendo que quanto maior o período de armazenamento, maior foi a alteração de cor de todos os materiais provisórios analisados (p<0,001). Conclusão: A resina acrílica apresentou maior estabilidade de cor, quando comparada às bisacrílicas. O café causou a maior alteração de cor, e o tempo de imersão foi determinante na estabilidade de cor dos materiais provisórios analisados.

Avaliação dos fatores críticos para seleção e aplicação clínica dos pinos de fibra: relato de caso / Evaluation of the critical factors for selection and clinical application of fiber posts: case report

Dentes que perderam grande parte de sua estrutura coronária, necessitam de dispositivos intrarradiculares para alcançar uma retenção desejada do material restaurador, devolvendo estética e função ao paciente. Com esta finalidade, diversos tipos de pinos intrarradiculares vêm sendo estudados, dos quais os pinos de fibra vem se destacando com seu crescente uso no mercado odontológico. O propósito deste estudo foi apresentar um relato de caso clínico com a utilização de pino de fibra de vidro, assim como analisar criticamente os trabalhos publicados e os pontos de controvérsias descritos por diversos autores relacionados a fatores como os diferentes protocolos de cimentação, os tratamentos de superfície dos pinos, a resistência à fratura e compressão, a possibilidade de microinfiltração, diâmetro e comprimento do pino, bem como os diversos materiais utilizados em conjunto com os retentores intrarradiculares. Dessa forma, concluímos que os pinos de fibra apresentam-se como excelente alternativa para dentes anteriores, desde que tenha no mínimo 2mm de remanescente dentário

Teeth that have lost much of their coronal tooth structure need intraradical devices to achieve a desired retention of the restorative material, restoring aesthetics and function to the patient. For this purpose, various types of intracanal posts have been studied, of wich the fiber posts have been highlighted with its increasing use in the dental market. The purpose of this study was to present a clinical case of using fiberglass post. As well as critically analyze the published works and points of controversy described by different authors related to factors such as different protocols cementation, surface treatments pins, fracture toughness and compression, the possibility of microleakage, diameter and length of the pin, and the various materials used in conjunction with the intracanal retainers. Thus, we concluded that fiber posts showed as an excellent alternative for anterior teeth, since have least 2 mm of tooth remaining

Influência do aumento do comprimento de implantes dentários / Influence of increasing the length in dental implants

A utilização dos implantes de maior comprimento pode ser mais favorável para a previsibilidade dos implantes dentários. Essa afirmação é pertinente, uma vez que a causa dos fracassos em implantes osseointegrados está mais relacionada às complicações biomecânicas. Assim, o objetivo deste estudo foi avaliar a influência da ampliação do comprimento ao redor da superfície do implante. Seis modelos foram criados com a presença apenas de um implante (Conexão Master Screw, Sistemas de Próteses, São Paulo, Brasil) do tipo hexágono externo de 3.75 mm x 7.0 mm (Modelo A), 3.75 mm x 8,5 mm (Modelo B), 3.75 mm x 10.0 mm (Modelo C), 3.75 mm x 11.5 mm (Modelo D), 3.75 mm x 13 mm (Modelo E), 3.75 mm x 15 mm (Modelo F) utilizando a metodologia de fotoelasticidade. Os resultados foram visualizados através de uma análise qualitativa de tensões (número e intensidade de franjas). O modelo A apresentou um padrão de distribuição de tensões menos favorável; o carregamento oblíquo foi o mais prejudicial para as estruturas relacionadas. Conclusão: O aumento do comprimento permitiu uma melhor distribuição de tensões. O carregamento oblíquo foi o mais prejudicial, quando comparado com o carregamento axial.

The use of implants of greater length may be more favorable for the predictability of dental implants. This statement is relevant, since the cause of failures in dental implants are more related to biomechanical complications. The aim of this study was to evaluate the influence of increase of the length around the entire body of the implant. Six models were created with the presence of only one hexagonal implant (Master Screw connection, Implant Systems, São Paulo, Brazil) of 3.75 mm x 7.0 mm (Model A), 3.75 mm x 8.5 mm (Model B ), 3.75 mm x 10.0 mm (Model C) 3.75 mm x 11.5 mm (Model D) 3.75 mm x 13.0 mm (Model E) 3.75 mm x 15.0 mm (Model F) using the method of photoelasticity. The results were visualized through a qualitative analysis of stresses (number and intensity photoelastic fringes). The model A showed a pattern of less favorable stress distribution, the oblique loading was the most detrimental to the related structures. Conclusion: The increased length allowed for a better distribution of stresses. The oblique loading was more detrimental when compared to axial loading.

A influência de diferentes materiais de revestimento oclusal em implantes regulares / The influence of different occlusal coating materials in regular implants

Fatores biomecânicos estão relacionados com a perda de implantes osseointegráveis, e, assim, uma análise rigorosa na seleção do melhor material oclusal para dissipação de tensões é necessária. Dessa forma, o objetivo deste estudo foi avaliar a influência de diferentes materiais oclusais no sistema coroa-implante, com destaque para o parafuso da coroa. Para isso, quatro modelos tridimensionais foram criados com um implante (Conexão Master Screw, Sistemas de Próteses, São Paulo, Brasil) do tipo hexágono externo de 3.75 mm x 10 mm com as seguintes coroas: NiCr, metalo-cerâmica (porcelana), resina composta e resina acrílica. Os resultados foram visualizados através dos mapas de tensão von Mises de cada modelo proposto. Os diferentes modelos analisados apresentaram um padrão de distribuição de tensões semelhantes. Assim, concluiu-se que os diferentes materiais oclusais foram semelhantes entre si, na coroa e no parafuso. O carregamento oblíquo foi o mais prejudicial quando comparado com o carregamento axial.

Biomechanical factors are related to the loss of dental implants, and a rigorous analysis in selecting the best material for occlusal stress distribution is required. In addition, it was suggested that occlusion material can also influence the distribution of stresses. The aim of this study was to evaluate the influence of different occlusal materials on the crown-implant system, especially the screw crown. Thus, four dimensional models were created with a hexagonal implant (Master Screw connection, Implant Systems, São Paulo, Brazil) of 3.75 mm x 10 mm with the following crowns: NiCr, metal-ceramic (porcelain) resin and composite acrylic resin. The results were visualized through von Mises stress maps of each model. The different models analyzed showed a pattern of similar tensions distribution. Thus, it was concluded that the different occlusal materials were similar among themselves regarding the crown and screw. The oblique loading was more detrimental when compared to axial loading.

A 3-D Finite Element Study of the Influence of Crown-Implant Ratio on Stress Distribution

The purpose of this study was to assess the influence of the crown height of external hexagon implants on the displacement and distribution of stress to the implant/bone system, using the three-dimensional finite element method. The InVesalius and Rhinoceros 4.0 softwares were used to generate the bone model by computed tomography. Each model was composed of a bone block with one implant (3.75x10.0 mm) with external hexagon connections and crowns with 10 mm, 12.5 mm and 15 mm in height. A 200 N axial and a 100 N oblique (45°) load were applied. The models were solved by the NeiNastran 9.0 and Femap 10.0 softwares to obtain the results that were visualized by maps of displacement, von Mises stress (crown/implant) and maximum principal stress (bone). The crown height under axial load did not influence the stress displacement and concentration, while the oblique loading increased these factors. The highest stress was observed in the neck of the implant screw on the side opposite to the loading. This stress was also transferred to the crown/platform/bone interface. The results of this study suggest that the increase in crown height enhanced stress concentration at the implant/bone tissue and increased displacement in the bone tissue, mainly under oblique loading.

A proposta deste estudo foi avaliar a influência da altura da coroa de implantes de hexágono externo sobre o deslocamento e distribuição de tensões para o sistema implante/osso utilizando o método de elementos finitos. Os softwares InVesalius e Rhinoceros 4.0 foram usados para gerar o modelo de osso por meio de uma tomografia computadorizada. Cada modelo foi composto de um bloco ósseo com um implante (3.75 x 10.0 mm) com conexão de hexágono externo e coroas de 10 mm, 12.5mm e 15 mm em altura. Uma carga axial de 200 N e oblíqua (45°) de 100 N foram aplicadas. Os modelos foram resolvidos pelo software NeiNastram 9.0 e Femap 10.0 para obtenção dos resultados que foram visualizados por meio de mapas de deslocamento, de von Mises (coroa/implante) e tensão máxima principal (osso). A altura da coroa sob carga axial não influenciou o deslocamento e concentração de tensões, enquanto que a carga oblíqua aumentou a ação destes fatores. A maior concentração de tensões foi observada no pescoço do parafuso do implante no lado oposto à aplicação de carga. Esta tensão foi transferida para a interface coroa/plataforma/interface óssea. Os resultados deste estudo sugerem que o aumento da coroa amplia a concentração de tensões no tecido ósseo/implante, aumentando o deslocamento no tecido ósseo, principalmente sob carga oblíqua.

Manutenção em próteses implantossuportadas: peri-implantite / Maintenance in implant-supported prostheses: peri-implantititis

A identificação e o tratamento das infecções peri-implantares é uma etapa essencial na manutenção dos implantes osseointegráveis, refletindo na longevidade da reabilitação. Assim, o objetivo deste estudo foi realizar uma revisão de literatura abordando o tema peri-implantite em implantes osseointegráveis com o intuito de nortear um planejamento de longevidade para as reabilitações orais. Realizou-se uma estratégia de busca detalhada para as bases de dados PubMed/Medline e Dentistry Oral Science, com os descritores: “peri-implantitis” e “dental implant”, até julho de 2013. De um total de 566 artigos, após uma análise, segundo o critério de inclusão, foram selecionados 34 artigos. Os resultados foram agrupados em tópicos (conceito, etiologia, diagnóstico, tratamento cirúrgico e não cirúrgico e, aspectos relativos à reabilitação oral) para posterior discussão e conclusões. Concluiu-se que o acúmulo de placa bacteriana tem sido associado com maior propensão a peri-implantites. Existe maior incidência da doença entre pacientes que já apresentaram periodontites. A administração local de antibióticos e associação com bochechos/uso tópico tem sido indicada como satisfatória para o tratamento de peri-implantites moderadas

The identification and treatment of peri-implant infections are an essential stage in the maintenance of dental implants, reflecting the longevity of rehabilitation. Therefore, the aim of the study was to conduct a literature review addressing peri-implantitis in dental implants in order to guide planning for the longevity of oral rehabilitation. It was conducted a detailed search strategy by the PubMed / Medline Dentistry and Oral Science, it was used as descriptors: “peri-implantitis” and “Dental Implant”, until July 2013. From 566 articles, after a review, according to the inclusion criteria, 34 articles were selected. The results were grouped together in topics (concept, etiology, diagnosis, surgical and nonsurgical, and aspects of oral rehabilitation) for further discussion and conclusions. Conclusions: The accumulation of plaque has been associated with a higher propensity to peri-implantitis. There is a higher incidence of the peri-implantitis disease among patients with previous history of periodontal disease. The local administration of antibiotics and association with mouthwashes / topical use are indicated as suitable for the treatment of moderate peri-implantitis

Manutenção em próteses implantossuportadas: higiene oral / Maintenance in implant-supported prostheses: oral hygiene

A manutenção das próteses implantossuportadas é essencial para o sucesso dos implantes osseointegráveis. Assim, o objetivo deste estudo foi realizar uma revisão de literatura abordando o tema manutenção em próteses implantossuportadas com o intuito de nortear um planejamento de longevidade para as reabilitações orais. Realizou-se uma estratégia de busca detalhada para as bases de dados Pubmed/Medline e Dentistry Oral Science, foram utilizados como descritores: “Oral Hygiene“ e “Dental Implant‘‘, até Julho de 2013. Os resultados foram agrupados em tópicos (Exame Clínico e Higienização Oral) e discutidos. Concluiu-se que um programa de manutenção oral regular para o paciente com prótese implantossuportada é essencial para a longevidade do tratamento. Os diferentes métodos e dispositivos para higienização são eficientes, entretanto uma orientação cuidadosa por escrito deve ser oferecida ao paciente, para que não se crie indesejadamente regiões de abrasão nas superfícies dos implantes osseointegráveis e pilares protéticos

The maintenance of Implant-supported Prosthesis is essential to the success of dental implants. Therefore, the aim of the study was to conduct a review the literature addressing maintenance Implant-Supported Prosthesis in order to guide planning for the longevity of oral rehabilitation. We conducted a detailed search strategy for the Pubmed / Medline Dentistry and Oral Science, used as descriptors: “Oral Hygiene“ and “Dental Implant until July, 2013. The results were grouped together in topics (Clinical Exam and Oral Hygiene) and discussed. Conclusion: A regular maintenance program for oral patient implantprosthesis is essential to the longevity of the treatment. Different methods and devices are effective for cleansing. However one orientation (in writing) must be offered to patients, since inadequate cleaning can create regions of abrasion on the surfaces of abutments and dental implants