ABSTRACT Purpose: The study showed a patient with Ectodermal Dysplasia (ED) who was treated with implants and fixed dental prosthesis by a multidisciplinary team. Case Report: Acrylic resin dental prostheses were designed as long-term provisionals, which allowed modifications when required. After imaging and treatment planning, four implants were placed in the inter-foramenal area of the mandible and 2 years later the definitive prosthesis was fitted. In a second phase, the patient received a combination of autogenous and allogeneic bone grafts in the maxilla. The autogenous graft was removed from the retro-molar region in the mandible. He also received a fixed dental prosthesis supported by 4 implants on the position of the upper canines and second pre-molars. Conclusion: Patient reports successful outcomes and despite the long treatment, patient states is confident with his appearance and speaking improvement. Follow-up was done every six months, for 10 years, and showed encouraging post-treatment outcomes.

RESUMO Este relato de caso clínico descreve a reabilitação com implantes para o tratamento da reabsorção radicular patológica devido à movimentação ortodôntica inadequada em espaço protético reduzido, por meio implante imediato e carga imediata, pela técnica da cirurgia guiada por computador e uso da própria coroa dentária, em paciente de 21 anos. A exodontia atraumática dos incisivos laterais superiores direito e esquerdo foi realizada, em seguida realizou-se a instalação imediata dos implantes osseointegráveis, utilizando a técnica de cirurgia guiada por computador. Os próprios dentes da coroa foram usados na reabilitação estética e funcional imediata. A conclusão do tratamento resultou em sucesso funcional e estético com acompanhamento de 27 meses sem intercorrências. Os procedimentos incluídos neste complexo tratamento de reabilitação na zona estética foram adequados e essenciais para a manutenção do contorno e espessura dos tecidos moles e duros garantindo a excelência na reabilitação.

ABSTRACT This clinical report describes the implant rehabilitation for the treatment of pathological roots resorption due to inadequate orthodontic movement in prosthetic space reduced by means of load and immediate implants, computer-guided surgery and use of the own tooth crown in a 21-year-old-patient. The atraumatic exodontics of the right and left upper lateral incisors was performed, and then immediate placement of osseointegrated implants using the computer guided surgery technique. The crown teeth itself was used in the immediate aesthetic and functional rehabilitation. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 27 months follow-up presented uneventful. The procedures included in this complex rehabilitation treatment in the esthetic zone were appropriate and essential for the maintenance of the soft and hard tissues contour and thickness ensuring the excellence in rehabilitation.

ABSTRACT: Aim: Short implants are manufactured for use in atrophic regions of the jaw. Therefore, the current does not sufficiently reveal a direct correlation between the impact of implant length on implant survival. The purpose of this systematic review was to compile the evidence of short implant survival in atrophied jaws. Methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to September 2015 using the following terms in some combinations: “short implant”, “mandible/atrophied jaws”, and “implant survival/ survival rate/ survival analysis”. Results: The 19 included studies present in average 5.5 years (range 1.0-20.0 years) follow-up and 96.1% (range 73.4-100.0 percent) survival rate of the short implants in atrophied mandibular. Conclusions: This systematic review found evidences regarding to safety of short implant placement in atrophied jaws although stronger evidence is essential to confirm this finding.

RESUMO Objetivo: A avaliação pré-operatória é de fundamental importância para a prevenção das complicações cirúrgicas pós-operatórias. O objetivo do presente estudo foi estabelecer um perfil quantitativo e qualitativo das enfermidades sistêmicas e relaciona-las com complicações cirúrgicas pós-operatórias em pacientes submetidos exodontia. Métodos: Para isso foram coletados dados de 992 prontuários de paciente submetidos a exodontias no período de 2010 a 2015, por meio da análise minuciosa da ficha de anamnese. Os dados obtidos foram tabulados e transformados em porcentagem, para facilitar a discussão e comparação com os relatos da literatura. Resultados: No total de prontuários analisados, 559 apresentaram alterações sistêmicas, o que corresponde a 56,3%. Dentre elas, houve uma maior prevalência de pacientes com hipertensão (24%), tabagismo (20%) e diabetes (11%). As complicações mais frequentes foram dor (34%), inflamação (19,8%) e hemorragia (13,2%). Considerando-se a prevalência de doenças relacionadas à idade, a faixa etária de menor de 20 anos (4.7%), 20 a 29 (11.3%), 30 a 39 (16.8%), 40 a 44 (10%), 45 a 49 (10.9%), 50 a 54 (12.3%), 55 a 59 (12.9%), 60 a 64 (10.4%), 65 a 69 (4.8%), e maiores de 70 anos (5.9%). Relacionando as alterações sistêmicas com as complicações, dentre os pacientes hipertensos que apresentaram complicações (n=11), a dor foi a mais prevalente (45,4%). Já nos fumantes (n=15) a complicação mais comum foi a inflamação exacerbada (33,3%). Nos diabéticos com presença de complicações (n=8), 50% foram diagnosticados com alveolite. Conclusão: Com base na metodologia estudada foi possível concluir que houve relação das complicações pós-operatórias e alterações sistêmicas, sendo as principais dor-hipertensão, inflamação-tabagismo e alveolite-diabetes.

ABSTRACT Objective: The preoperative evaluation is essential to prevent postoperative surgical complications. The present study aimed to establish quantitative and qualitative profiles of systemic disorders and relate them to postoperative surgical complications in patients subjected to dental extraction Methods: Data were collected from the medical records of 992 patients subjected to dental extractions from 2010 to 2015 through a detailed analysis of anamnesis files. The data collected were tabulated and converted to percentages to facilitate the discussion and comparison with reports in the literature Results: From all the medical records analyzed, 559 presented systemic changes, which corresponds to 56.3%. Among them, there was a higher prevalence of patients with hypertension (24%), smoking habits (20%), and diabetes (11%). The most frequent complications were pain (34%), inflammation (19.8%), and hemorrhage (13.2%). The prevalence of diseases related to age shows patients under the age of 20 (4.7%), 20 to 29 (11.3%), 30 to 39 (16.8%), 40 to 44 (10%), 45 to 49 (10.9%), 50 to 54 (12.3%), 55 to 59 (12.9%), 60 to 64 (10.4%), 65 to 69 (4.8%), and older than 70 years old (5.9%). As for systemic changes with complications, hypertensive patients with complications (n=11) showed higher prevalence of pain (45.4%), the most common complication in smokers (n=15) was exacerbated inflammation (33.3%), and 50% of diabetic patients with complications (n=8) were diagnosed with alveolitis Conclusion: The method studied allowed concluding there was a relationship between postoperative complications and systemic changes, and the main ones were pain-hypertension, inflammation-smoking, and alveolitis-diabetes.

ABSTRACT: Background: Hyaluronic acid is a treatment option for this deficiency gingival papilla, since it aims to increase tissue volume in the region of loss of interdental papilla, minimally invasive. Aim this study was to describe the application of Hyaluronic acid in a deficient gingival papilla. Case report: Patient presented absence of interdental papilla in the maxillary arch around upper anterior teeth. A comprehensive exam was performed, plus 2D photographs taken with a professional camera coupled to a device for image standardization, and an intraoral scanning with the OMNICAM scanner. Three applications of Hyaluronic acid were performed to fill the black spaces, at an interval of four weeks. The patient was followed-up for three months, and the recovery of papilla was observed. Conclusion: The Hyaluronic acid as gingival filling material can be considered as a treatment option for augmenting interdental papilla in aesthetic area.

ABSTRACT: The pigmented lesions of the oral cavity may be endogenous or exogenous. Endogenous lesions are benign and usually caused by melanin, and they are called gingival melanin pigmentations. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary and mandibular portions. After local anesthesia, we started depigmentation with high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory postoperative results.

RESUMEN: Las lesiones pigmentadas de la cavidad oral pueden ser endógenas o exógenas. Las endógenas son benignas y generalmente causadas por la melanina, denominándose pigmentaciones melánicas gingivales. Entre las opciones para la despigmentación de estas regiones, se destaca la laserterapia, por ser un procedimiento poco invasivo. Este trabajo tuvo como objetivo relatar un caso clínico de la técnica de despigmentación gingival utilizando láser de diodo de alta intensidad en la región anterior de los maxilares para ablación del tejido pigmentado con la finalidad de mejorar la estética gingival. El paciente presentaba como queja estética el aspecto oscurecido de la encía en la región anterior de la maxila y de la mandíbula. Tras aplicar anestesia local, se inició la despigmentación con láser de diodo de alta intensidad, siendo que la ablación se realizó a partir de la encía insertada hacia la encía marginal libre. El paciente regresó tras 30 y 180 días, presentando encía saludable y con ausencia de repigmentación melánica. Así fue posible concluir que el láser de diodo mostró ser una buena alternativa para la despigmentación melánica, ya que se presentó como un procedimiento con menor morbidad y buen resultado postoperatorio.

OBJECTIVES: To evaluate and compare the magnitude and distribution of stresses generated on implants, abutments and first molar metal-ceramic crowns using finite element analysis. METHODS: Preliminary three-dimensional models were created using the computer-aided design software SolidWorks. Stress and strain values were observed for two distinct virtual models: model 1 - Morse taper and solid abutment; model 2 - Morse taper and abutment with screw. A load (250 N) was applied to a single point of the occlusal surface at 15° to the implant long axis. Von Mises stresses were recorded for both groups at four main points: 1) abutment-retaining screws; 2) abutment neck; 3) cervical bone area; 4) implant neck. RESULTS AND CONCLUSION: Model 1 showed a higher stress value (1477.5 MPa) at the abutment-retaining screw area than the stresses found in model 2 (1091.1 MPa for the same area). The cervical bone strain values did not exceed 105 µm for either model.

ABSTRACT: Aim: This study aimed to report the clinical case of an immediate implant-supported rehabilitation in infected alveolar socket with buccal bone resorption and apical periodontitis in the teeth 42 and 43. Case Report: The patient was rehabilitated with implants associated with guided bone regeneration and immediate provisionalization. After 4 months, the custom molding was made in order to receive the metal-ceramic prosthesis. The follow-up lasted 24 months and there was no painful symptomatology, infection, implant mobility or marked peri-implant bone loss in this period. Conclusion: Therefore, the placement of immediate implants on fresh infected alveolar sockets is viable for the implant-supported rehabilitation.

ABSTRACT: Objective: This study was reduction of a bilateral mandibular fracture through the installation of dental implants with immediate loading, re-establishing the stomatognathic function of the patient. Case Report: A 58-year-old male patient seek the emergency room from hospital after suffering a motorcycle accident. After physical and imaging examinations was diagnosed with bilateral mandibular fracture. The treatment of choice, once the patient was edentulous, was the reduction and stabilization of the fracture with the installation of 5 dental implants with immediate loading. After 1 year of postoperative follow-up, the facial contour along with the occlusion were reestablished. Radiographically, it was found the proper placement of plates and screws with correct baseline realignment and maintenance of implant-supported prosthesis. Conclusion: In this case report with follow-up of 18 months, the functional prosthetic rehabilitation and immediate aesthetic with immediate loading system, after reduction and fixation of mandibular fractures proved to be a good treatment option.

Abstract Purpose: To evaluate the influence of subcutaneous injection nicotine in osseointegration process on different implant surfaces. Methods: Twenty-two male rabbits were distributed into two groups according to the subcutaneous injections: (1) nicotine 3 mg/day/kg and (2) 0.9 % NaCI 3 mL/day/kg, three times a day; subgroups were then designated-machined and anodized implants were placed in the right and left tibia bones, respectively. The animals were submitted euthanasia after periods of eight weeks to determine nicotine and cotinine levels, alkaline phosphatase and biomechanical analysis. Results: The plasmatic levels of nicotine and cotinine were 0.5 ± 0.28 ng/mL and 9.5 ± 6.51 ng/mL, respectively. The alkaline phosphatase analyses in blood levels in control group were observed 40.8 ± 11.88 UI/L and 40.75 ± 12.46 UI/L, for the surfaces machined and anodized, respectively. In the test group was observed levels 37.9 ± 4.84 UI/L, for both implant surfaces. No significant differences were observed between control and test groups and between the implant surfaces regarding alkaline phosphatase blood levels. For biomechanics, no significant differences were observed in control group between the machined (25±8.46 Ncm) or anodized (31.2 ± 6.76 Ncm) implants. However, the treatment with nicotine induced higher torque than control in both machined (38.3 ± 13.52 Ncm) and anodized (35.5 ± 14.17 Ncm) implants, with p = 0.0024 and p = 0.0121, respectively. Conclusion: Subcutaneous injection of nicotine following implant insertion didn’t have effect on osseointegration, independently from the implant surface.

ABSTRACT: Ameloblastoma is a rare tumor that affects the maxillomandibular region. Surgical resection is often indicated, and oral rehabilitation becomes a challenge. This study aims to report on the mandibular rehabilitation with implant supported prosthesis using immediate loading with subsequent resection. A patient with a confirmed diagnosis of multicystic ameloblastoma in the left jaw underwent a partial resection of the mandible and a reconstruction with a titanium plate. After 2 years of follow-up with clinical examinations and imaging testing and with no signs of recurrence, the patient underwent the technique of immediate load implants, rehabilitating the mandible with an implant supported fixed prosthesis and the maxilla with a conventional complete denture. During the seven years of follow-up with the patient, there was no sign of recurrence of ameloblastoma. The rehabilitation with oral implants under immediate loading demonstrated to be successful, and the cemented cylinder technique used in this study coupled with passivity showed a favorable prognosis for the longevity of implants.

This study aimed to histometrically evaluate the presence of gingival recession in the mesial surface of the teeth of rats experimentally subjected to primary occlusal trauma. This evaluation verified the distance from the cement-enamel junction (CEJ) to the free marginal gingiva (FMG) and to the height of the alveolar bone crest (CEJ-crest bone distance). There were 10 animals, randomly divided into 2 groups: occlusal trauma (OT) (n = 5) - creation of an occlusal interference by fixing an orthodontic wire segment on the mandibular first molar occlusal face, which was randomly chosen, and a Control Group (CG) (n = 5) - five animals with no exposure to the OT variable were euthanised after 14 days to obtain the initial parameters. The inter-group evaluation showed there was no significant difference between OT × CG when the CEJ-FGM distance (P = 0.192) was evaluated after 14 days, but there was a significant difference between the two groups as regards the CEJ-alveolar crest bone distance (P = 0.0142). Thus, it can be concluded that the OT induction model, after 14 days of experiment, promoted bone resorption. This was observed by the increase in the CEJ-alveolar crest bone distance. It also did not promote gingival recession, which was evaluated by the CEJ-FGM distance.

El objetivo de este estudio fue evaluar histométricamente en ratas la presencia de recesión gingival en la superficie mesial de los dientes sometidos experimentalmente a trauma oclusal primario a partir de la evaluación de la distancia desde la unión esmalte cemento (CEJ) a la encía marginal libre y la altura de la cresta ósea restante (distancia de la CEJ-cresta ósea) Con este fin, 10 animales fueron divididos al azar en 2 grupos: trauma oclusal (TO) (n = 5) - creación de una interferencia oclusal mediante la fijación de un segmento de alambre de ortodoncia en la superficie oclusal del primer molar elegido al azar; y un grupo control (CO) (n = 5) -5 animales sin la introducción de la variable TO fueron sometidos a eutanasia después de 14 días para obtener los parámetros iniciales. La evaluación intergrupo no mostró diferencias significativas entre los grupos TO × CO al evaluar después de 14 días la distancia de la CEJ-encía marginal libre (p = 0,192) pero mostró una diferencia significativa entre los grupos TO × CO en cuanto a distancia de la CEJ-cresta ósea alveolar (p = 0,0142). Por lo tanto, se concluye que el modelo de inducción del TO después de 14 días del experimento promueve reabsorción ósea siendo observado por el aumento en la distancia de la CEJ-cresta ósea alveolar y no promueve la recesión gingival evaluada a partir de la distancia de la CEJ-encía marginal.

Dental implant fixation techniques are widely studied in order to reduce surgical morbidity. Computer-guided flapless surgery has been considered an efficient alternative that presents several advantages and some limitations. This technique allows the virtual planning and simulation of the prosthetic-surgical treatment that can help predict the difficulties and limitations in order to reduce possible errors. In addition to the prosthetic predictability, computer-guided surgery enhances accuracy and reduces surgical morbidity. Thus, the aim of this study was to report on a 7-year follow-up of immediately loaded implants inserted into an edentulous maxilla using virtual planning and flapless surgery.

Las técnicas de fijación del implante dental se estudian ampliamente para reducir la morbilidad quirúrgica. La cirugía sin flapless guiada por ordenador ha sido considerada como una alternativa eficiente con varias ventajas y algunas limitaciones. Esta técnica permite la planificación virtual y simulación del tratamiento protésico quirúrgico con la predicción de las dificultades y limitaciones para reducir posibles errores. Además de la previsibilidad de prótesis, la cirugía guiada por ordenador mejora la precisión y reduce la morbilidad quirúrgica. Por lo tanto, el objetivo de este estudio fue reportar a 5 años de seguimiento de los implantes de carga inmediata insertados en un maxilar desdentado utilizando la planificación virtual y la cirugía sin colgajo. El presente caso prospectivo informó el éxito del tratamiento y destacó la importancia de la planificación, lo que justifica el costo de esta tecnología.

ABSTRACT PURPOSE : To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.