O USO DA CIRURGIA GUIADA NA REABILITAÇÃO UNITÁRIA EM REGIÃO ESTÉTICA

A reabilitação oral por meio dos implantes osseointegrados segundo Branemark foi tradicionalmente proposto com reabilitações múltiplas e implantes ferulizados. Após a criação de pilares unitários houve grande necessidade estética, valorizando novas formas e dimensões para os pilares protéticos e sistemas livres de metal. Este trabalho tem como objetivo o relato de caso clínico em área estética com implante tipo Cone Morse e coroa livre de metal. Paciente M. A. C., 47 anos, compareceu à clínica do Instituto latino Americano de Pesquisa e Ensino Odontológico relatando mobilidade do elemento 11, o qual foi extraído e aguardado o período de 5 meses para instalação de implante tipo Cone Morse e cicatrizador. Após osseointegração, foi instalado munhão com perfil de emergência segundo anatomia dos tecidos periimplantares e coroa provisória durante 45 dias para maturação dos tecidos. A reabilitação final foi realizada em coroa cerâmica livre de metal (In Ceran)

Modulação da expressão de miRNAs na diferenciação de osteoblastos em nanosuperfícies

Proposição: Este estudo teve como objetivo avaliar a modulação dos miRNAs que afetam o potencial osteogênico de CTMs em diferentes topografias de superfície de discos de vidro. Material e Métodos: Células tronco mesenquimais humanas foram plaqueadas nas diferentes superfícies e comparadas após 3, 7 e 14 dias para atividade de fosfatase alcalina, expressão de genes (Osteocalcina, Osteopontina, Sialo Proteína Óssea, Osterix, Runx2, BMP2 e ALP) e expressão de miRNAs. Microscopia eletrônica de varredura das superfícies com células foram obtidas para avaliação de adesão celular. Resultados: Atividade de fosfatase alcalina nas diferentes superfícies foi significantemente maior na superfície com nanotopografia. Do mesmo modo, a expressão de genes relacionados com osteoblastos foi mais elevada na superfície nano. Com 14 dias foi observado um aumento de 3.5 e 9 vezes para os genes Runx2 e Osterix, respectivamente. O gene da BMP2 e ALP também apresentou um aumento de 4 e 7 vezes comparado ao controle. Utilizando a tecnologia de sequenciamento de RNA (RNA-Seq) onde todos os RNAs existentes foram sequenciados, um total de 123 miRNAs com diferença de expressão foram encontrados comparando a superfície controle (dia 7) com a superfície nano (dia 14). 48 miRNAs apresentaram uma redução na expressão e 75 apresentaram um aumento de expressão. Alguns destes apresentaram marcadores para genes osteogênicos já identificados, tais como hsa-miR-135b-5p marcador para OCN, BSP, Runx2, CO15A1 e OSX, hsa-miR-122-5p marcador para OPN, hsa-miR-196a-5p marcador para BMP4, hsa-miR-26b-5p marcador para BMP2 e hsa-miR-148b-3p marcador para OPN. Conclusão: As superfícies com nanotopografia tem o potencial de melhorar a resposta de osseointegração de maneira a reduzir o tempo de osseointegração e também aumentar a produção de tecido ósseo ao redor dos implantes favorecendo assim áreas de qualidade óssea baixa. A utilização de miRNAs para alterar a resposta de diferenciação pode também ajudar a controlar o processo de osseointegração.Purpose: This study aimed to evaluate the modulation of miRNAs that affect the osteogenic potential of MSCs in different surface topographies of glass disks. Material and Methods: Human mesenchymal stem cells (hMSCs) were plated on different surfaces of glass disks and compared at 3,7 and 14 days for alkaline phosphatase (ALP) activity, expression of genes (Osteocalcin, Osteopontin, Bone Sialo Protein, Osterix, Runx2, BMP2 and ALP) and expression of miRNAs. Scanning electron microscopy of surfaces with cells were obtained to analyse the attachment of cells. Results: ALP activity on different surfaces was significantly greater in the nanotopography surface. At day 14 there was a 3.5-fold and a 9-fold increase for Runx2 and Osterix gene, respectively. BMP2 and ALP also increased by 4- and 7-fold compared to control. Using RNA sequencing technology (RNA-Seq) a total of 123 miRNAs were found differently expressed comparing control (day 7) to nano surface (day 14). 48 miRNAs were downregulated and 75 were upregulated. Some of them regulated osteogenic genes such as hsa-miR-135b-5p that targets OCN, BSP, RUNX2, CO15A1 and OSX, hsa-miR-122-5p wich targets OPN, hsa-miR-196a-5p targets BMP4, hsa-miR-26b-5p that targets BMP2 and hsa-miR-148b-3p that targets OPN. Conclusion: Surfaces with nanotopography have the potential to improve osseointegration response in order to reduce the time of osseointegration and also increase the production of bone tissue around the implants improving low bone quality areas. The use of miRNAs to affect differentiation response may also help control the osseointegration process.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Complications Related To The Retention Of Impression Material In The Submucosa In Immediate Loading Dental Implants Rehabilitations - A Clinical Alert.

The increasing use of osseointegrated dental implants and modifications in surgical techniques has increased the number of unpredictable events during and after surgery. Complications are described as intercurrences in the course of the treatment and, when resolved, do not compromise the outcome. However, when unresolved, they lead to the failure of the rehabilitation. A new clinical complication that has arisen in cases of full arch immediate loading implants is the presence of impression material inside the tissues, that can cause dehiscence of the sutures, infection and severe postoperative pain. Therefore, a careful suture should be carried out using the correct suture thread and the correct positioning of the tip of the impression syringe so that the material is not inserted into the tissues. The aim of this short communication is to highlight the necessary care and alert colleagues to the signs and symptoms of this type of complication.El uso cada vez mayor de implantes dentales osteointegrados y los cambios en las técnicas quirúrgicas han aumentado el número de eventos impredecibles durante y después de la cirugía. Las complicaciones se describen como complicaciones durante el tratamiento y, cuando se resuelven, no comprometen el resultado. Sin embargo, cuando no se resuelven, conducen al fracaso de la rehabilitación. Una nueva complicación clínica que ha surgido en los casos de implantes de arcada completa de carga inmediata es la presencia de material de impresión dentro de los tejidos, lo que puede provocar dehiscencia de la sutura, infección y dolor postoperatorio intenso. Por lo tanto, se debe realizar una sutura cuidadosa utilizando el hilo de sutura correcto y la correcta posición de la punta de la jeringa moldeadora para que el material no se inserte en los tejidos. El propósito de esta breve comunicación es resaltar los cuidados necesarios y alertar a los colegas sobre los signos y síntomas de este tipo de complicación.The increasing use of osseointegrated dental implants and modifications in surgical techniques has increased the number of unpredictable events during and after surgery. Complications are described as intercurrences in the course of the treatment and, when resolved, do not compromise the outcome. However, when unresolved, they lead to the failure of the rehabilitation. A new clinical complication that has arisen in cases of full arch immediate loading implants is the presence of impression material inside the tissues, that can cause dehiscence of the sutures, infection and severe postoperative pain. Therefore, a careful suture should be carried out using the correct suture thread and the correct positioning of the tip of the impression syringe so that the material is not inserted into the tissues. The aim of this short communication is to highlight the necessary care and alert colleagues to the signs and symptoms of this type of complication

Reabilitação Maxilar com Uso do Fluxo Digital – do planejamento a execução: Reabilitação Maxilar com Uso do Fluxo Digital

The digital workflow in dentistry has evolved a lot in recent years. The combined use of Cone-Beam tomography, extra and intraoral photographs and intraoral scanners, associated with prosthetic and surgical software has generated more accurate planning, surgical and prosthetic guides of excellent quality with faster installation of final rehabilitation. The aim of this paper is to report the treatment of an oral full upper arch rehabilitation with a hybrid implant-supported prosthesis, in which digital workflow was used in all stages of prosthetic and surgical planning. Digital equipment such as Cone Beam tomography, digital photos, intraoral scanner, surgical and prosthetic planning software made it possible to work in a completely virtual environment, allowing safer planning and execution of each stage of treatment before the procedure on the patient. The hybrid implant-supported prosthesis was manufactured using analog workflow, but collected all the information from the digital workflow, which allowed installation within a few postoperative hours and reproduced correct function and occlusion, and the most natural tooth shape possible. Based on the experience collected in conducting this case, it seems reasonable to conclude that new digital techniques allowed better positioning of implants associated with better diagnosis of the space required for the prosthesis. Furthermore, they allow the reduction in surgical time, which can be very important for patients with compromised health. Cases with dental references allow information to be easily passed on to the laboratory, which reduces the number of consultations, without loss of quality. This results in a good experience for both the professional and the patient.El flujo digital en odontología ha evolucionado mucho en los últimos años. El uso combinado de tomografía Cone-Beam, fotografías extra e intraorales y escaneos intraorales, asociados con software protésico y quirúrgico, ha generado guías de planificación, quirúrgicas y protésicas más precisas, de excelente calidad y con una entrega más rápida de la rehabilitación final. El objetivo de esta descripción es informar el tratamiento de una rehabilitación oral completa de la arcada superior con una prótesis híbrida implantosoportada, en la que se utilizó flujo digital en todas las etapas de la planificación protésica y quirúrgica. Equipos digitales como tomografía Cone Beam, fotografías digitales, escáner intraoral, software de planificación quirúrgica y protésica permitieron trabajar en un entorno completamente virtual, permitiendo una planificación y ejecución más segura de cada etapa del tratamiento antes del procedimiento en el paciente. La prótesis híbrida implantosoportada se fabricó utilizando flujo analógico, pero recogió toda la información del flujo digital, lo que permitió la entrega dentro de unas pocas horas postoperatorias y reprodujo la función y oclusión correctas y la forma del diente más natural posible. A partir de la experiencia recogida en la realización de este caso, parece razonable concluir que las nuevas técnicas digitales permiten un mejor posicionamiento de los implantes asociado a un mejor diagnóstico del espacio necesario para la prótesis. Además, permiten reducir el tiempo quirúrgico, lo que puede ser muy importante para pacientes con salud comprometida. Los casos con referencias odontológicas permiten transmitir fácilmente la información al laboratorio, lo que reduce el número de consultas, sin pérdida de calidad. Esto se traduce en una buena experiencia tanto para el profesional como para el paciente.O fluxo digital na odontologia tem evoluído muito nos últimos anos. O uso combinado de tomografias do tipo Cone-Beam, fotografias extra e intraorais e escaneamentos intraorais, associados aos softwares protéticos e cirúrgicos têm gerado planejamentos mais precisos guias, cirúrgicos e protéticos, de ótima qualidade com a entrega mais rápida da reabilitação final. O objetivo desta descrição é relatar o tratamento de uma reabilitação oral de arco total superior com prótese implantossuportada híbrida, em que o fluxo digital foi utilizado em todas as etapas do planejamento protético e cirúrgico. Equipamentos digitais como tomografia Cone Beam, fotos digitais, escaner intraoral, software de planejamento cirúrgico e protético possibilitaram o trabalho em um ambiente totalmente virtual permitindo planejamento mais seguro e execução de cada estágio do tratamento antes do procedimento no paciente. A prótese implantossuportada híbrida foi confeccionada por fluxo analógico, mas coletou todas as informações do fluxo digital, o que permitiu a entrega em poucas horas pós-operatórias e reproduziu função e oclusão corretas, e formato de dentes o mais natural possível. Com base na experiência coletada na condução deste caso, parece lícito concluir que as novas técnicas digitais permitem melhor posicionamento dos implantes associado a melhor diagnóstico do espaço necessário para a prótese. Além disso, permitem redução do tempo cirúrgico, o que pode ser muito importante para pacientes com saúde comprometida. Casos com referências dentárias permitem que as informações sejam facilmente passadas ao laboratório, o que reduz a quantidade de consultas, sem perda de qualidade. Isso resulta em boa experiência para o profissional e para o paciente

Tilted implants and prototyping: A security option for improving the anchorage in atrophic maxilla

Rehabilitating atrophic maxilla poses many challenges. Reconstructive techniques that require sinus grafting are viable and acceptable; however, these techniques also are considered to be expensive, invasive, and time-consuming. Tilted implants anchored in distal areas using available bone have been reported as a less invasive and highly predictable treatment option. This article presents a case involving implant anchorage via tilted implants as an alternative technique to bone grafting procedures. Copyright © 2013 by the Academy of General Dentistry

Evaluation of Satisfaction of Patients Rehabilitated With Zygomatic Fixtures

Purpose: The aim of this study was to evaluate the satisfaction of patients rehabilitated with zygomatic fixtures and prosthesis with immediate loading.Materials and Methods: The study selected patients who were rehabilitated with zygomatic implants at the clinic of the Latin American Institute for Dental Research and Education (ILAPEO. Curitiba-PR. Brasil) between 2005 and 2009. The patients were asked to answer a control-questionnaire during their follow-up visits. Data were collected regarding the level of patient satisfaction, reason for dissatisfaction, number of post-operative clinical sessions, and the type of complication. Sixteen patients were selected: 10 females and 6 males.Results: Half of the patients were completely satisfied while the other half were satisfied with some complaints. The complaints were related to hygiene, esthetics, phonetics, and discomfort during chewing. Regarding the post-operative evaluation, 50% of the patients were attended due to the prosthesis (62.5%) and the implant (37.5%).Conclusions: The treatment with zygomatic fixtures is predictable and reliable. The patients were satisfied both with implants and prosthesis. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70: 314-319, 201

Evaluation of Deformation, Mass Loss, and Roughness of Different Metal Burs After Osteotomy for Osseointegrated Implants

Purpose: This study used bovine ribs to comparatively assess the deformation, roughness, and mass loss for 3 different types of surface treatments with burs, used in osteotomies, for the installation of osseointegrated implants.Materials and Methods: The study used 25 bovine ribs and 3 types of helical burs (2.0 mm and 3.0 mm) for osteotomies during implant placement (a steel bur [G1], a bur with tungsten carbide film coating in a carbon matrix [G2], and a zirconia bur [G3]), which were subdivided into 5 subgroups: 1, 2, 3, 4, and 5, corresponding to 0, 10, 20, 30, and 40 perforations, respectively. The surface roughness (mean roughness [Ra], partial roughness, and maximum roughness) and mass (in grams) of all the burs were measured, and the burs were analyzed in a scanning electron microscope before and after use. Data were tabulated and statistically analyzed by use of the Kruskal-Wallis test, and when a statistically significant difference was found, the Dunn test was used.Results: There was a loss of mass in all groups (G1, G2, and G3), and this loss was gradual, according to the number of perforations made (1, 2, 3, 4, and 5). However, this difference was not statistically significant (P .05) between G1 and G2. The scanning electron microscopy analysis found areas of deformation in all the 2.0-mm samples, with loss of substrates, and this characteristic was more frequent in G3.Conclusions: The 2.0-mm zirconia burs had a greater loss of substrates and abrasive wear in the cutting area. They also presented an increased roughness when compared with the steel and the tungsten carbide coating film in carbon matrix. There was no statistically significant difference (P < .05) between G1 and G2 in any mechanical test carried out. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:e608-e621, 201

Influence of Implant Drill Materials on Wear, Deformation, and Roughness After Repeated Drilling and Sterilization

Purpose:The aim of this study was to evaluate deformation, roughness, and mass loss of stainless steel, diamond-like carbon (DLC)-coated and zirconia drills after multiple osteotomies with sterilization procedures.Materials and Methods:Drilling procedures were performed using stainless steel (G1), DLC-coated (G2), and zirconia (G3) drills. All groups were divided in subgroups 1, 2, 3, 4, and 5, corresponded to drills used 0, 10, 20, 30, and 40 times, respectively.Results:No significant differences in mass and roughness were detected among all groups and subgroups. In SEM images, all groups revealed signs of wear while coating delamination was detected in G2. Drills from G1 displayed more irregular surface, whereas cutting edges were more regular in G3.Conclusion:Zirconia drills presented more regular surfaces whereas stainless steel drills revealed more severe signs of wear. Further studies must be performed to evaluate the putative influence of these findings in heat generation