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(1) Objective: The aim of this study was to assess the biological behavior of bone tissue on a machined surface (MS) and modifications made by a laser beam (LS) and by a laser beam incorporated with hydroxyapatite (HA) using a biomimetic method without thermic treatment (LHS). (2) Methods: Scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (SEM/EDX) was performed before and after installation in the rabbit tibiae. A total of 20 Albinus rabbits randomly received 30 implants of 3.75 × 10 mm in the right and left tibias, with two implants on each surface in each tibia. In the animals belonging to the 4-week euthanasia period group, intramuscular application of the fluorochromes calcein and alizarin was performed. In implants placed mesially in the tibiofemoral joint, biomechanical analysis was performed by means of a removal torque (N/cm). The tibias with the implants located distally to the joint were submitted for analysis by confocal laser microscopy (mineral apposition rate) and for histometric analysis by bone contact implant (%BIC) and newly formed bone area (%NBA). (3) Results: The SEM showed differences between the surfaces. The biomechanical analysis revealed significant differences in removal torque values between the MSs and LHSs over a 2-week period. Over a 4-week period, both the LSs and LHSs demonstrated removal torque values statistically higher than the MSs. BIC of the LHS implants were statistically superior to MS at the 2-week period and LHS and LS surfaces were statistically superior to MS at the 4-week period. Statistical analysis of the NBA of the implants showed difference between the LHS and MS in the period of 2 weeks. (4) Conclusions: The modifications of the LSs and LHSs provided important physicochemical modifications that favored the deposition of bone tissue on the surface of the implants.

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BACKGROUND: Treating signs of aging requires skeletal restructuring, facial contour redefinition, and sagging skin treatment. Hence, HarmonyCa® was recently introduced in the market, combining hyaluronic acid and hydroxyapatite. However, there are no studies evaluating the physicochemical properties of this material. PURPOSE: To analyze the morphology, rheology, and clinical applicability of HarmonyCa® over a 180-day follow-up. METHODS: A morphological analysis with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) and rheology measurement with a rheometer. The clinical applicability analysis included a tissue ptosis patient who received the product and was reassessed 30 and 180 days after applying HarmonyCa®. RESULTS: SEM and EDS analyses showed two distinct morphologies related to hydroxyapatite and hyaluronic acid. The rheological measurements of HarmonyCa® showed G' and G″ of 51.56 and 44.01 Pa, respectively. The tan δ value was 0.8503, and G* was 108.1 Pa. The clinical outcomes were satisfactory. CONCLUSION: HarmonyCa® presents a good synergy between hyaluronic acid and hydroxyapatite. Also, the rheological analysis showed moderate viscosity for the product, with a clinical indication for subcutaneous application. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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The accumulation of submental fat (SMF) can negatively impact facial harmony appearance, and one alternative treatment for this condition is the application of deoxycholic acid (DOC). The objective of this systematic review was to answer the following question: "Is DOC able to reduce SMF and increase patient satisfaction when compared to the placebo groups?". Therefore, a detailed search strategy was carried out in 6 scientific databases (PubMed, Scopus, Embase, Lilacs, SciELO, and Web of Science) as primary search sources, while OpenGrey and OpenThesis were also used to capture the "grey literature". Only six studies met all inclusion criteria and were considered in this review analysis. The selected sample included prospective clinical studies published from 2014 to 2018, covering a total sample of 3488 patients, with an average age ranging from 46 to 49.5 years old. All selected articles evaluated the effect of DOC at concentrations of 1 mg/cm² or 2 mg/cm², using saline or placebo as control solutions for the comparative analysis. The application interval was 28 days in all studies analyzed, and the treatment duration ranged from 4 to 6 weeks. In all studies evaluated, there was a reduction in SMF and patient satisfaction with the application of DOC was higher than in the control groups at the end of a 12-week period. Thus, it is possible to conclude that the application of DOC has a positive effect on reducing SMF and improving patient satisfaction concerning their facial appearance.

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PURPOSE: To evaluate the stability of interdental papilla filling using hyaluronic acid (HA) to treat black triangles in esthetic regions. METHODS: The protocol was registered in PROSPERO. Six databases (PubMed, Scopus, Embase, Lilacs, SciELO, and Web of Science) were used as primary search sources, and OpenGrey and OpenThesis were used to capture the "gray literature." Only before-after studies were included. The JBI Checklist assessed the risk of bias. Only four studies met the inclusion criteria and were considered for the analyses. The studies were published from 2010 to 2016. All studies presented a low risk of bias. Considering the studies do not have control groups, a weighted average by sample size was calculated to obtain a general estimate of the percentage of papillary filling after 6 months and the number of HA applications. RESULTS: The studies showed the percentage of papillary reconstruction after 6 months of application, the weighted average by sample size was 77.41% (SD = 20.68), with an average number of applications of 3.17 (SD = 0.31). CONCLUSION: The application of HA may be used to repair anesthetic defects in the papilla. CLINICAL SIGNIFICANCE: Interdental papilla reconstruction with injectable HA is an option of nonsurgical treatment for interdental papilla deficiencies. However, there is still concern about the quality of the evidence available, considering that studies with different experimental designs can produce contradictory results. Moreover, further understanding is required on the stability of tissue gain promoted by HA in black triangles.

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Dexamethasone has been widly used in oral and maxillofacial surgery for controlling of postoperative surgical inflammation. Despite its clinical effectiveness, several studies have demonstrated the negative impact of this drug on the healing of soft and hard tissues. This study aimed to assess the effects of different pre-operative doses of dexamethasone on alveolar repair. Sixty rats were divided into four groups of 15 animals each. Single pre-operative doses of dexamethasone equivalent to human doses of 4 mg (Group 4 mg), 8 mg (Group 8 mg), and 12 mg (Group 12 mg), calculated by allometric dose extrapolation, were administered; and rats in the Control Group were injected with saline solution. The animals were anesthetized, and their left mandibular first molars (M1) were removed. After three, seven, and 40 days, 5 animals from each group were euthanized, and bone samples of M1 alveolus were collected for radipgraphic, histomorphological and histometric evaluation of the early and late phases of alveolar healing. At three days, Group 12 mg presented reduced radiographic density, percentage of collagen, and connective matrix compared with the Control Group. At 7 days, the percentage of bone was increased in the Control Group compared to Groups 8 mg and 12 mg (P < 0.05). It can be concluded that a single pre-operative dose of 12 mg of dexamethasone affected the early stages of alveolar repair in rats.

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The aim of this study was to evaluate the linear and angular deviations of the implants installed by the computerized tomography (CT)-guided surgery technique. Eighteen patients who underwent implant insertion by means of CT-guided surgery participated in this study. Ten of these patients had a fully edentulous maxilla, and 8 had a fully edentulous mandible. The patients received a total of 115 implants, of which 81 implants were installed in the maxilla and 34 installed in the mandible. Tomographic guides were made for tomographic examination in both the upper and lower jaws. After the image acquisition, the virtual planning of the positioning of the implants was performed in relation to the previously made prosthesis. The measurement of the linear and angular deviations between the virtual planning and the final position of the implants was performed with the overlap of the planning and postoperative tomography. There were no differences in the linear and angular deviations of the implants installed in the maxilla and mandible. Compared with the coronal region, there was a trend of greater linear deviations in the apical regions of the implants and a greater tendency toward deviations in the posterior regions than in the anterior regions of both arches. The CT-guided surgery promoted the installation of implants with high accuracy and allowed the installation of straight pillars in all cases evaluated. The linear deviations were not different in the different regions of the mouth or in the different portions of the implants.

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PURPOSE: When performing a sagittal osteotomy of the mandibular ramus, one must consider the risk of long-term postsurgical sensory abnormalities from lesions to the inferior alveolar nerve. One treatment for these changes is low-level laser therapy (LLLT). Thus, the aim of this research was to evaluate the effectiveness of LLLT on sensorineural recovery after split ramus osteotomy of the mandible. MATERIALS AND METHODS: This randomized, double-blinded, split-mouth design trial included patients who underwent advanced surgery of the mandible and then received LLLT on 1 side of the mandible (experimental) and a random placebo (control) treatment on the opposite site. Patients were divided into 2 groups: group 1 was treated during the short postoperative period (within 30 days) and group 2 was treated for persistent sensory abnormalities during the late postoperative period (6 months to 1 yr). Each patient received 5 LLLT and control sessions with intervals of 3 to 4 weeks between sessions. The experimental side in each patient received LLLT in the extraoral area (mandibular ramus and entire length of the inferior alveolar nerve to the mental region) and the intraoral area (mental foramen region). The control side received simultaneous placebo treatments. The sensorineural response was analyzed before the onset of treatment and after each LLLT and control session using the Semmes-Weinstein monofilament test. RESULTS: Twenty adult patients (mean age, 35.6 years; 70.0% women) showed improvement in the experimental and control sides during the follow-up period. However, the experimental side in groups 1 and 2 exhibited a marked improvement in sensorineural recovery over the course of the sessions, and group 1 had the best results. CONCLUSION: LLLT was effective in the recovery from sensorineural disorders after orthognathic surgery during the short postoperative period, particularly in the fifth session.

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O objetivo deste estudo foi avaliar a estabilidade primária de implantes curtos e convencionais instalados em ossos com densidades tipo I e tipo IV de origem sintética e natural. Implantes nos tamanhos (Diamêtro x Comprimento) 3,75 x 13 mm, 3,75 x 10 mm, 4,3 x 5,5 mm e 5 x 5,5 mm foram instalados em blocos ósseos seguindo uma sequência de fresagens e avaliados o torque de inserção e o coeficiente de estabilidade primária (CE) através da análise da frequência de ressonância (AFR). Os resultados mostraram que implantes de diferentes tamanhos e ossos de diferentes densidades e origens influenciam tanto nos valores de torque de inserção quanto de AFR (p<0.05). Todos os implantes instalados nos ossos tipo IV apresentaram menores torques de inserção e menores CE (p<0.05) comparados aos instalados nos ossos tipo I, e implantes curtos apresentaram maiores torques que os convencionais intalados no osso tipo I. Assim, a utilização de implantes curtos pode ser uma alternativa viável de tratamento, principalmente em sítios ósseos com maiores densidades (AU).

The aim of this study was to assess the primary stability of short and conventional implants placed in bone with type I and type IV densities of synthetic or natural origin. Implants (D x C) of 3.75 x 13 mm, 3.75 x 10 mm, 4.3 x 5.5 mm, and 5 x 5.5 mm were placed in bone blocks following a drilling sequence and assessment of insertion torque and primary stability coefficient (SC) through resonance frequency analysis (RFA). The results showed that implants of different sizes and bones of different densities and origins influence both insertion torque and RFA values (p <0.05). All implants placed in type IV bones presented lower insertion torques and lower SC (p <0.05) compared to those placed in type I bones, and short implants presented higher torques than conventional implants in type I bone. So the use of short implants may be a viable treatment alternative, mainly in bone areas with higher densities (AU).

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ABSTRACT: Considering that success of dental implants is not only related to osseointegration, but also with their survival rates, the aim of this study was to perform a literature review about bone remodeling around osseointegrated implants. A detailed search strategy was used for this, and articles published between the years 1930 and 2012 were selected. The rare data found in the literature demonstrated that implants are osseointegrated 30 days after their placement. However, active bone remodeling with osteoclasts and osteoblasts working in synchrony continues to occur. Therefore, after osseointegration, the initially formed bone, which presents characteristics of spongy bone, is gradually resorbed and replaced by compact bone after 90 days. Furthermore, other portions of bone tissue a little more distant from the interface, which establish direct contact with the implant, are also damaged during the drilling process, and therefore, they also need to be remodeled. Among the rare studies found in the literature about bone remodeling after osseointegration, there were no verified studies on the possible influence of implant surface treatments on bone remodeling that occurs after osseointegration. Only studies involving implants with machined surfaces have been conducted up to now.

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Objective: To evaluate and correlate the values of radiographic bone density, peri-implant bone height and resonance frequency analysis (RFA) of short or conventional implants placed in the posterior region of the mandible after installing a prosthesis. Material and method: Eleven patients were selected for this prospective parallel pilot study. The prostheses were supported by two types of implants: short implants (n = 18) (5.0 x 5.5 mm and 5.0 x 7.0 mm) and conventional implants (n = 23) (4.0 x10 mm and 4.0 x 11.5 mm). The implants were evaluated by RFA, by measuring the bone height, and peri-implant bone density. The implants were evaluated at the periods T0 (immediately after installation of the prosthesis), T1 (after 90 days), and T2 (after 180 days). Result: There were no statistically significant differences between groups with respect to radiographic bone density (152.50 ± 15.39 vs. 157.60 ± 28.46, for conventional and short implants, respectively at T2), stability of the implants (Conventional implants: 66.76 ± 10.39 at T0, and 61.85 ± 8.38 at T2 vs. Short implants: 57.50 ± 12.17 at T0, and 61.53 ± 7.39 at T2) and peri-implant bone loss (0.03 mm vs.-0.17 mm, for conventional and short implants, respectively at T2). Additionally, a significant correlation between the evaluated parameters was not detected. Conclusion: The short and conventional implants presented similar stability, bone level and density after the activation of occlusion loading.

Objetivo: Avaliar e correlacionar os valores de densidade óssea radiográfica, altura óssea peri-implantar e de frequência de ressonância nos implantes curtos e convencionais instalados na região posterior da mandíbula após a instalação da prótese provisória. Material e método: Esse estudo piloto clínico prospectivo contou com a participação de 11 pacientes que foram divididos previamente em dois grupos: implantes curtos (n=18) (5,0 x 5,5 mm e 5,0 x 7,0 mm) e implantes convencionais (n=23) (4,0 x 10 mm e 4,0 x 11,5 mm). Foram executadas análise da frequência de ressonância, altura óssea e densidade óssea peri-implantar. Os implantes foram avaliados nos períodos T0 (imediatamente após a instalação do provisório), T1 (após 90 dias) e T2 (após 180 dias). Resultado: Não houve diferenças estatisticamente significativas entre os grupos com relação a densidade óssea radiográfica (152,50 ± 15,39 vs. 157,60 ± 28,46, para implantes convencionais e curtos respectivamente no período T2), estabilidade dos implantes (Implantes convencionais: 66,76 ± 10,39 no período T0 e 61,85 ± 8,38 no período T2 vs. Implantes curtos: 57,50 ± 12,17 no período T0 e 61,53 ± 7,39 no período T2) e quanto a perda óssea periimplantar (0,03 mm vs. -0,17 mm, em implantes convencionais e curtos no período T2, respectivamente). Adicionalmente a isso, não foram detectados correlação significativa entre densidade radiográfica com altura óssea peri-implantar e nem com a frequência de ressonância. Conclusão: Verificou-se que os implantes curtos apresentaram um comportamento semelhante aos implantes de comprimento convencionais com relação à frequência de ressonância, a densidade radiográfica peri-implantar e a manutenção dos níveis ósseos periimplantares.

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Resonance frequency analysis (RFA) has become the main tool used to assess the osseointegration of dental implants. The objective of this study was to verify the relationship between the ISQ values with different prosthetic abutments and with the implant platform. The hypothesis was that ISQ values changes according to the abutment height. Twelve patients were included, whose contribution to the study was 31 dental implants (external hexagon connection implants, 4.1x10 mm). The temporary implant-supported crown and prosthetic components were removed and the following smartpegs were inserted, one at a time: type 1, in the implant platform (G1); type A3, in the microunit component with 1mm transmucosal height (G2) and type A3, in the microunit component with 5mm transmucosal height (G3). In all the smartpegs, RFA measurements were taken on mesial, distal, buccal and lingual surfaces. All evaluations were performed by a single calibrated examiner (ICC = 0.989). Data were analyzed by Friedman and Spearman correlation tests and log-linear marginal regression (p<0.05). The mean age of participants was 52.83 (± 3.77) years. There was statistically significant difference (p<0.001) among the mean ISQ of G1 (88.27 ±5.70); G2 (72.75 ±4.73) and G3 (66.33 ±3.67). There was statistically significant negative correlation between the ISQ and the measurement distance (rs:-0.852; p<0.001; R2:0.553). Measurement distance was significantly associated (p<0.001) with ISQ value in the log-linear regression. The abutment height has a significant impact on resonance frequency analysis measurements. The higher the transmucosal abutment height, the lower the implant stability quotient value. Clinically, the ISQ measured on the abutment cannot be compared with values measured on the implant platform.

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OBJECTIVE: We aimed to assess the surfaces of commercially pure titanium implants (cp Ti) with modified surfaces by laser beam (LS) with and without hydroxyapatite (HA) deposition, without (HAB) and with (HABT) thermal treatment. Furthermore, we have compared them with implants with surfaces modified by acid treatment (AS) and with machined surfaces (MS) utilizing histomorphometric and descriptive histologic analyses. MATERIAL AND METHODS: Surface topography characterization was analyzed by scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDX), and surface roughness (Ra) before implant installation. Forty-five rabbits received seventy-five implants in their left and right tibias and were randomly divided into five groups (n = 5 implants per group): (1) cp Ti implant modified by LS, (2) cp Ti implant modified by laser beam associated with HA deposition without heat treatment (HAB), (3) cp Ti implant modified by laser beam associated with HA deposition with heat treatment (HABT), (4) cp Ti implant with modified surface by means of acid treatment (Master Porous) commercially available (AS), and (5) cp Ti implant with MS commercially available. After 30, 60, and 90 days, the animals were euthanized and the implants and surrounding bone were removed and prepared by a non-decalcified histological process. The percentage of bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) between the first three threads was evaluated to the higher cortical region. RESULTS: BIC (%) was statistically superior (p < 0.001) on the LS (69.36 ± 7.91, 71.67 ± 8.79, and 79.69 ± 3.3), HAB (73.22 ± 3.75, 69.48 ± 1.89, and 75.7 ± 4.62), and HABT (65.41 ± 5.51, 71.3 ± 2.5, and 79.68 ± 5.01) compared with AS (49.15 ± 5.76, 41.94 ± 2.85, and 57.18 ± 7.81) and MS (36.69 ± 7.24, 52.52 ± 2.75, and 51.31 ± 6.96) in the 30, 60, and 90-day periods, respectively. BAFO (%) of HAB at 30 days (90.17 ± 6.24) was statistically superior (p < 0.01) to all the other groups. At 60 and 90 days, BAFO of LS (87.17 ± 5.9 and 87.99 ± 2.52), HAB (85.95 ± 3.93 and 82.17 ± 3.65), and HABT (83.27 ± 1.44 and 88.67 ± 2.67) was higher than the AS (77.49 ± 5.83 and 76.42 ± 5.98) and MS (74.01 ± 4.68 and 73.81 ± 4.91). CONCLUSIONS: Collectively, our data indicate that the modified surfaces LS, HAB, and HABT favored the interaction between bone and implant and increased bone formation. In addition, HAB showed higher biological behavior favoring the osseointegration. CLINICAL RELEVANCE: Our study provides evidence that LS, HAB, and HABT-modified surfaces improved bone-to-implant contact and increased bone formation around osseointegrated implants compared to conventional machined implants favoring the osseointegration process.

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O planejamento virtual para cirurgia guiada é uma técnica que vem sendo cada vez mais utilizada na Implantodontia. Sendo assim, o objetivo desse estudo foi realizar uma revisão da literatura sobre a técnica de planejamento virtual para cirurgia guiada sem retalho em reabilitação oral com implantes osseointegráveis, de modo a fornecer informação sobre as características, vantagens e limitações dessa modalidade. Diversos estudos demonstraram a confiabilidade e vantagens da técnica quanto à precisão do planejamento, inserção dos implantes, fabricação da prótese e satisfação do paciente. No entanto, alguns autores relataram que desvios podem ocorrer quanto ao posicionamento dos implantes em relação ao planejamento virtual, o que ressalta a importância da utilização do guia cirúrgico, bem como precisão durante a execução de todas as etapas clínicas e laboratoriais. Concluiu-se que, apesar das limitações relatadas por alguns autores, o método apresenta diversas vantagens que garantem a sua previsibilidade quando indicado e executado corretamente (AU).

The virtual planning for guided surgery has been a widely used technique in Implantology. Thus, the aim of this study was to conduct a literatura review about the virtual planning for flapless guided surgery in oral rehabilitation with dental implants regarding its characteristics, advantages, and limitations. Several studies demonstrated the reliability and advantages of this approach as a consequence of accuracy during treatment planning, implants insertion, prosthesis fabrication, and patient's satisfaction. However, some authors reported deviations of implants positioning compared to the virtual planning, which highlighted the importance of using the surgical guide as well as the accuracy during all clinical and laboratorial steps. Despite of the limitations demonstrated by some authors, it was concluded that this method presents several advantages to enhance its predictability when the procedures are well indicated and performed (AU).

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OBJECTIVE: This study aimed to perform a review of the literature regarding the survival rate of dental implants with immediate loading using insertion torque of 30 Ncm. MATERIAL AND METHODS: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (PROSPERO CRD42014015323). The search was performed in the PubMed, Web of Science, Cochrane Library electronic, OVID, and Scielo databases. Manual searches were also performed. The articles identified were assessed independently by 3 researchers. Clinical trials reporting dental implants with immediate loading and 30 Ncm torque in patients ages 18 years or older were included. RESULTS: The searches yielded 589 studies. Six studies were included in the systematic review. The survival rate of dental implants was 96.8%. Three studies showed a low potential risk of bias. CONCLUSION: There is not strong evidence that insertion torque of 30 Ncm is enough for implant survival in cases of immediate loading.

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PURPOSE: We sought to evaluate the effectiveness of bone substitutes in circumferential peri-implant defects created in the rabbit tibia. METHODS: Thirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant (4.1 mm × 8.5 mm) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss(®) (BI), and Bio-Oss(®) Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated. RESULTS: For biomechanics, BC showed a better biological response (61.00±15.28 Ncm) than CO (31.60±14.38 Ncm) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group. CONCLUSIONS: Collectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps.

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The placement of dental implants and subsequent placement of immediate temporary dentures after extractions has become a treatment modality accepted by the scientific community. In addition to the functional factor, the surgical procedure in a single stage in the anterior region of the maxilla offers an esthetic appearance, and relieves the psychological concerns of patients. To guarantee the success and longevity of treatments performed, the fabrication of surgical guides is a helpful method in these situations. Guided surgery has gained attention because it restores esthetics with immediate restoration, provides the patient with comfort in addition to dispensing with the need for performing surgical flaps. This auxiliary method allows the position and design of the implant, as well as the perforation sequence to be programmed, thus optimizing the clinical results. In this study, the authors present a clinical case of a patient who was submitted to extraction and subsequent implant placement with immediate loading in the anterior region of the maxilla, performed in a satisfactory manner.

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O presente artigo apresenta um caso clínico de reabilitação total de mandíbula atrófica empregando-se implantes curtos em carga imediata com avaliação longitudinal de cinco anos. Paciente do sexo feminino, 70 anos, compareceu ao consultório particular queixando-se de prótese total inferior insatisfatória, sendo diagnosticada severa atrofia óssea maxilomandibular. Planejou-se a instalação de 4 implantes curtos inferiores e a confecção de prótese do tipo protocolo com carga imediata associada à nova prótese total removível superior. A paciente manteve-se em reavaliações anuais para manutenção e controle do trabalho realizado e não se observou nada digno de nota, demonstrando a previsibilidade e sucesso desta técnica para resolução de casos limítrofes (AU).

The present article reports a case of complete rehabilitation of atrophic mandible with immediate loading short implants with longitudinal assessment of five years. A female patient, 70 years old, attended to the private practice complaining of unsatisfactory lower removable denture, being diagnosed as severe maxillo-mandibular bone atrophy. It was planned to install four lower short implants and to make protocol prosthesis with immediate loading associated with the new upper removable denture. The patient remained in annual reassessments for maintenance and control of the work done, it was observed nothing noteworthy, demonstrating the predictability and success of this technique for resolving borderline cases (AU).

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Defeitos mucogengivais em decorrência do avanço da doença periodontal resultam em perda óssea alveolar e consequente migração apical da papila interdental, levando à formação de triângulos negros que comprometem a estética do paciente. O tratamento de defeitos mucogengivais e peri-implantares vem sendo amplamente estudado no sentido de otimizar os resultados clínicos alcançados e são considerados um grande desafio na prática clínica. Assim, o presente estudo buscou avaliar a eficácia clínica de um novo método para eliminar ou reduzir pequenos defeitos de papila, utilizando-se o gel de ácido hialurônico (AH). A utilização de gel de AH, comercialmente disponível, foi utilizado em dois casos clínicos como um método possível de formação de papila entre implantes, e em áreas de pôntico de prótese fixa sobre implantes em regiões estéticas da maxila. Os pacientes incluídos neste estudo apresentavam- -se com pelo menos um defeito de papila na região anterior. Antes do tratamento, fotografias da condição inicial dos pacientes foram obtidas. O procedimento clínico para aplicação do gel de AH (0,2 mL) foi realizado com anestesia tópica, após profilaxia, utilizando-se um dispositivo apropriado, 2-3 mm apical à borda coronária da papila envolvida. Reavaliações periódicas a cada 3 semanas foram conduzidas, e a aplicação do gel de AH foi repetida por três vezes. Os pacientes foram acompanhados durante um período de seis meses após a aplicação do gel e fotografias foram obtidas para comparação dos resultados alcançados. Os resultados mostraram satisfatório aumento do volume tecidual nos dois casos tratados, os quais resultaram em um maior preenchimento tecidual e consequente melhora das condições estéticas dos pacientes. Em conclusão, os resultados do presente estudo são encorajadores, evidenciando que pequenos defeitos de papila interdentária entre pônticos e entre implantes podem ser solucionados por meio da aplicação clínica do gel de AH, resultando em satisfatório ganho tecidual com baixa morbidade ao paciente (AU)

Mucogingival defects as a consequence of the advancement of periodontal disease result in bone loss and subsequent apical migration of the interdental papilla, leading to the formation of black triangles that compromise the patient aesthetics. The treatment of mucogingival and peri-implant defects is considered a major challenge in clinical practice and has been widely studied in order to optimize clinical results. Thus, the present study sought to evaluate the clinical effectiveness of a new method to eliminate or reduce small papillary defects, using the hyaluronic acid gel (HA). The HA gel, commercially available, was used in two cases as a possible method for the formation of papilla between implants and in pontics region of implant-supported prostheses in the anterior maxillary region. The patients included in this study had at least one papillary defect in the anterior region. Before treatment, photographs of the initial condition of all patients were obtained. The clinical procedure for the application of the HA gel (0.2 mL) was performed under topic anesthesia, after dental prophylaxis, using an appropriate device, 2-3 mm apical to the coronal tip of the involved papilla. Patients were seen every 3 weeks, and the application of the HA gel was repeated three times. Patients were followed for a period of six months after the HA gel application and photographs were taken for results comparison. Satisfactory increased tissue volume was observed in all cases, which resulted in greater tissue filling and consequent improvement of aesthetic conditions. In conclusion, the results of the present study are encouraging, showing that small defects of interdental papilla between implants and prosthetic pontic can be solved through clinical application of HA gel resulting in satisfactory tissue gain with low morbidity to the patient (AU)

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O traumatismo dentário desperta atenção na Odontologia, devido ao comprometimento estético e funcional que ocasiona. Dentre os traumas, a avulsão é uma das principais questões por ser uma lesão grave e envolver danos complexos ao ligamento periodontal. O tratamento de escolha é o reimplante dentário. O objetivo deste estudo foi apresentar a abordagem do trauma dental em um paciente que sofreu avulsão dos dentes 11 e 21. Os elementos foram reimplantados duas horas após o trauma, caracterizando o caso como reimplante tardio. Foi realizada endodontia de ambos os dentes e, após 12 anos de acompanhamentos clínico e radiográfico, houve necessidade de extração dos elementos 11 e 21 devido à presença de grandes áreas de reabsorção por substituição na porção radicular. Implantes osseointegráveis foram instalados na mesma sessão, a fim de reabilitar o paciente que nesse momento apresentava maturidade óssea, estando apto a receber o implante. O caso se encontra com quatro anos de acompanhamento e nenhuma sintomatologia clínica foi observada. Frente à avulsão dentária, o reimplante ainda é a conduta ideal mesmo quando há necessidade de um futuro implante devido à ocorrência das reabsorções dentárias, pois quanto maior a permanência do dente reimplantado no alvéolo, maior a preservação do osso alveolar que mantém sua forma e espessura, favorecendo assim também a estética e pela possibilidade de postergar as cirurgias para colocação dos implantes.

Tooth trauma demands attention in Dentistry due to its esthetic and functional impairments. Avulsion is one of the main issues regarding its severity and complex damage to the periodontal ligament. The treatment of choice is reimplantation. The aim of this article is to present an approach to avulsed teeth 11 and 21. Both elements were reinserted 2 hours later, which characterizes a delayed reimplantation. After endodontic treatment, as well as 12 years of clinical and radiographic follow-up, those teeth were extracted due to large root resorption areas. Dental implants were installed in the same session but now the patient presented with excellent bone maturity to receive the implants. This case now has 4 years of follow-up and no clinical symptomatology was reported. In case of tooth avulsion, the reimplantation is the ideal option aiming for further implant placement due to tooth resorption, because the longer a tooth can be kept in its alveolar socket, the more the bone contour and width preservation are seen, also favoring esthetics and postponing of dental implant surgeries.

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RESUMEN

Embora a pr¢tese sobre implantes e a pr¢tese sobre dentes naturais compartilhem diversas caracter¡sticas devido ao diferente comportamento biomecƒnico entre os implantes e os dentes, alguns princ¡pios devem ser diferenciados, dentre eles a oclusÆo, pois esta ‚ um dos principais fatores respons veis pelo sucesso da osseointegra‡Æo. Considerando a quantidade de tratamentos poss¡veis de serem realizados com implantes e tendo em vista que ainda nÆo h  um consenso sobre o padrÆo oclusal ideal para essas pr¢teses, o objetivo deste trabalho foi realizar uma revisÆo de literatura, procurando abordar os aspectos oclusais relevantes para o sucesso do tratamento com pr¢teses sobre implantes.

Although implant-supported prosthesis and prosthesis over natural teeth share several characteristics some aspects should be distinguished due to the different biomechanical behavior between implants and teeth. Occlusion is one of these aspects and is one of the main factors responsible for the success of osseointegration. Considering the diversity of treatments that can be performed with implants and aware that there is still no consensus on the ideal occlusal pattern for these prostheses, the objective of the study was to conduct a literature review seeking to address the occlusal aspects relevant to the success of treatment with prosthetic implants.

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