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A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.

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Sorriso gengival é comumente conhecido pela exposição excessiva das gengivas ao sorrir, acarretando assim na diminuição das coroas dos elementos. No que tange a etiologia dessa condição, ela se apresenta de maneiras diversas e sua identificação é fundamental para o desenvolvimento de um plano de tratamento eficaz. O planejamento clínico pode ser feito usando uma abordagem dinâmica e digital do sorriso, como softwares, exames de imagem, modelos virtuais 3D e guias cirúrgicos, melhorando a qualidade e precisão do tratamento, oferecendo diversos benefícios aos pacientes. Sendo assim esse estudo teve como objetivo demonstrar a importância dos processos digitais no planejamento e correção do sorriso gengival. Paciente queixou-se da desproporção do sorriso, caracterizado por coroas curtas nas regiões de pré-molares e incisivos ligadamente com a exposição excessiva da gengiva ao sorrir. Após estudos clínicos e de imagem, a etiologia foi diagnosticada como erupção passiva alterada, tipo I (fenótipo espesso). O tratamento de escolha foi o remodelamento gengival associado à osteotomia e osteoplastia obtendo assim uma maior precisão no tratamento, sendo confeccionado um guia cirúrgico duplo. Sendo assim, é possível contemplar que o planejamento digital permite uma maior previsibilidade da execução, compatibilidade em relação a expectativa do paciente e profissional, além da total individualização do caso, tornando os resultados mais favoráveis e exatos e minimizando as chances de iatrogenias(AU)

Gummy smile is commonly known for exposing the gums to the smile, thereby increasing the crowns elevation of the elements. Regarding a condition, it presents itself in different ways and its identification is fundamental for the development of a treatment plan. The clinician can be done using a dynamic and digital approach to image treatment, such as software, imaging exams, various 3D virtual models and elaborate guides, improving the quality and precision of treatment, offering benefits to patients. Therefore, this study aimed to demonstrate the importance of digital processes in planning and correcting the gummy smile. Patient complained of disproportion of the smile, facing the regions of premolar crowns and incisors of the smile, facing the exposure of the gingiva when smiling. After clinical and imaging exams, the diagnostic studies were diagnosed as passive eruption, type I (phenotype and specific). The choice of choice was remodeling associated with surgery treatment and surgery treatment, thus providing a greater precision in the treatment, being a double guide elaborated. Therefore, it is possible that the digital is possible a predictability of execution, compatibility in relation to patient and professional care, in addition to the greater possibility of individualization planning than it allows, making the results more planned as possibilities and exactly the iatrogenic(AU)

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Objective The present study aims to assess the reproducibility of digital planning for cementless total hip arthroplasty (THA) among surgeons with different levels of experience. In addition, it attempts to determine the degree of planning reliability based on a contralateral THA or on a spherical marker positioned at the greater trochanter for calibration. Methods Two evaluators with different experience levels (A1 and A2) performed independently the retrospective digital surgical planning of 64 cementless THAs. Next, we compared the planning with the implants used in the surgery. The reproducibility was excellent when planning and implants were identical; proper in case of a single-unit variation; and inappropriate if there was variation in two or more units. The present analysis also determined the calibration accuracy between the contralateral THA and the spherical marker at the greater trochanter level. Results The present study demonstrated greater success when the most experienced evaluator performed the planning and greater accuracy for the contralateral THA. When splitting the analysis per parameter (contralateral THA or spherical marker), there was a statistical difference only for the planning of A1 and the implants used in the surgery. This difference occurred in the excellent category, with 67.3% for contralateral THA compared with 30.6% for a spherical marker ( p <0.001), and in the inappropriate category, with 7.1% for contralateral THA compared with 30.6% for a spherical marker ( p <0.001). Conclusions Digital planning is more accurate when performed by an experienced evaluator. The contralateral prosthesis head was a better reference than a marker on the greater trochanter.

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Introdução:O aprimoramento das resinas compostas nos últimosanos em associação com a difusão de informações nas redes sociais tornou as facetas diretas tratamentos populares na dentística restauradora. No entanto, são procedimentos que exigem ampla destreza manual e conhecimento técnico. O fluxo digital através doescaneamento, enceramento digital e prototipagem 3D para construção de guias tem se tornado uma excelente alternativa para aumentar a previsibilidade e aumentar a longevidade destes trabalhos. Objetivo:Descrever o protocolo de confecção de facetas diretas em resina composta, através de um relato de caso, utilizando como auxílio o planejamento digital para confecção de modelo 3D, guia de silicone e paredes palatinas. Descrição do Caso:Paciente do gênero masculino, 43 anos, queixava-se do formato dos seus dentes. Ao exame clínico percebeu-se desgaste dental nos incisivos centrais e linha do sorriso levemente invertida. Após duas sessões de clareamento de consultório com Peróxido de hidrogênio (35%) e mockup direto com resina composta, foi realizada a moldagem e escaneamento do modelo de gesso no laboratório. O enceramento digital foi aprovado, o modelo 3D foi impresso para confecção da guia de silicone. Com auxílio da guia foram executadas facetas diretas nos elementos 13, 12, 11, 21, 22 e 23. Conclusão:O fluxo digital pode ser uma alternativa viável para minimizar as falhas na confecção de facetas diretas em resina composta (AU).

Introduction:The improvement of composite resins in recent years, together with information disseminated on social media, has made direct veneers popular treatments in restorative dentistry. However, these procedures require significant manual dexterity and technical knowledge. Digital work flow using scanning, digital wax-up and 3D prototyping for the construction of guides has become an excellent alternative to increase predictability and the longevity of these procedures. Objective:Describe the manufacturing protocol for direct composite resin veneers, using a case report and digital to construct the 3D model, silicone guide and palatine walls. Case description:Male patient, 43 years old, complained of the shape of his teeth. Clinical examination revealed tooth wear on the central incisors and a slightly inverted smile line. After two whitening sessions with hydroigen peroxide (35%) and direct mockup with composite resin, the plaster model was molded and scanned in the laboratory. Digital wax-up was approved, and the 3D model was printed to manufacture the silicone guide. With the help of the guide, the direct veneers were applied to elements 13, 12, 11, 21, 22 and 23.Conclusions:Digital flow may be a feasible alternative to minimize manufacturing flaws in direct composite resin veneers (AU).

Introducción: La mejora de las resinas compuestas en los últimos años, y la difusión de información en las redes sociales, ha popularizado las facetas directas en los tratamientos en odontología restauradora. Sin embargo, son procedimientos que requieren demasiado destreza manual y conocimientos técnicos. El flujo digital usando escaneo, encerado digital y prototipado 3D para la construcción de guías se ha convertido en una excelente alternativa para aumentar la previsibilidad y la longevidad de estos procedimientos. Objetivo: Describir el protocolo para la realización de carillas directas en resina compuesta, a través de un reporte de caso, utilizando el planeo digital como ayuda para la realización de un modelo 3D, guía de silicona y paredes palatinas. Descripción del caso: Paciente masculino, 43 años, se quejó de la forma de sus dientes. El examen clínico reveló desgaste dental en los incisivos centrales y una línea de sonrisa levemente invertida. Después de dos sesiones de blanqueamiento en consultorio con peróxido de hidrógeno (35%) y maqueta directa con resina compuesta, el modelo de yeso fue moldeado y escaneado en el laboratorio. El encerado digital fue aprovado, el modelo 3D fue impreso para hacer la guía de silicona. Con la ayuda de la guía se realizaron carillas directas en los elementos 13, 12, 11, 21, 22 y 23. Conclusiones: El fluxo digital puede ser una alternativa viable para minimizar fallas en la fabricación de carillas directas en resina compuesta (AU).

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Abstract Objective The present study aims to assess the reproducibility of digital planning for cementless total hip arthroplasty (THA) among surgeons with different levels of experience. In addition, it attempts to determine the degree of planning reliability based on a contralateral THA or on a spherical marker positioned at the greater trochanter for calibration. Methods Two evaluators with different experience levels (A1 and A2) performed independently the retrospective digital surgical planning of 64 cementless THAs. Next, we compared the planning with the implants used in the surgery. The reproducibility was excellent when planning and implants were identical; proper in case of a single-unit variation; and inappropriate if there was variation in two or more units. The present analysis also determined the calibration accuracy between the contralateral THA and the spherical marker at the greater trochanter level. Results The present study demonstrated greater success when the most experienced evaluator performed the planning and greater accuracy for the contralateral THA. When splitting the analysis per parameter (contralateral THA or spherical marker), there was a statistical difference only for the planning of A1 and the implants used in the surgery. This difference occurred in the excellent category, with 67.3% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001), and in the inappropriate category, with 7.1% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001). Conclusions Digital planning is more accurate when performed by an experienced evaluator. The contralateral prosthesis head was a better reference than a marker on the greater trochanter.

Resumo Objetivo Avaliar a reprodutibilidade do planejamento digital da artroplastia total de quadril (ATQ) sem cimento entre cirurgiões com diferentes níveis de experiência e o grau de confiabilidade no planejamento baseado na ATQ contralateral com o método de marcador esférico posicionado ao nível do trocanter maior. Método Dois avaliadores com níveis de experiência diferentes (A1 e A2) realizaram de forma independente o planejamento digital operatório retrospectivo de 64 ATQs sem cimento. O planejamento foi comparado com os implantes utilizados na cirurgia, sendo classificados como: excelentes, quando idênticos; adequados, quando houve variação de uma unidade; e inadequados, quando ocorreu variação de duas ou mais unidades. Na presente análise, também foi avaliada a acurácia do parâmetro de calibragem entre a ATQ contralateral comparada com o marcador esférico ao nível do trocanter maior. Resultados O estudo demonstrou maior êxito no planejamento quando realizado pelo avaliador mais experiente, com maior acurácia na ATQ contralateral. Ao fragmentar a análise de acordo com o parâmetro utilizado (ATQ contralateral ou marcador esférico), houve diferença estatística apenas na comparação do planejamento do avaliador A1 com os implantes utilizados na cirurgia. Esta diferença ocorreu na classificação excelente com 67,3% em ATQ contralateral como parâmetro contra 30,6% com marcador esférico (p < 0,001) e inadequado de 7,1% contra 30,6%, respectivamente (p < 0,001). Conclusões A acurácia do planejamento digital é mais precisa quando realizada por um avaliador experiente e a utilização da cabeça de prótese contralateral como referência se mostrou superior à utilização de um marcador no trocanter maior.

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PURPOSE: To evaluate the accuracy of static computer-assisted implant surgery (sCAIS) for tooth-supported free-end dental implantation with the aid/and without the aid of fixation pins to secure the surgical template through comparison between planned, 3D printed guide position and placement implant position. MATERIALS AND METHODS: Thirty-two duplicated maxillary resin models were used in the present in vitro study. Digital planning was performed and fabrication of a surgical template that allowed implant placement on the distal extension edentulous site of the model (maxillary left side). A first optical scan was performed after fitting the surgical template on the model to assess the deviation at the surgical guide level. After placing implants in the model using the surgical guide, scan bodies were attached to the implants, and a second scan was performed to record the position of placed implants. The digital representations were later superimposed to the pre-operative scan and measurements of implant deviations were performed. Global (coronal and apical), horizontal (coronal and apical), depth and angular deviations were recorded between planned implant position, guide position, and placement implant position. Three-way ANOVA was used to compare implant location (#13, 14, and 15), fixation pin (with or without pin), and guide comparison (planned, guided, and placement). RESULTS: Final implant placement based on the digital plan and based on the 3D printed guide were very similar except for depth deviation. Use of fixation pin had a statistically significant effect on the depth and angular deviation. Overall, without fixation pins and based on guide versus placement, mean global coronal (0.88 ± 0.36 mm), horizontal coronal (0.55 ± 0.32 mm), and apical (1.44 ± 0.75 mm), and angular deviations (4.28 ± 2.01°) were similar to deviations with fixation pins: mean global coronal (0.88 ± 0.36 mm); horizontal coronal (0.67 ± 0.22 mm) and apical (1.60 ± 0.69 mm); and angular deviations (4.53 ± 2.04°). Horizontal apical without pins (1.63 ± 0.69 mm) and with fixation pins (1.72 ± 0.70 mm) was statistically significant (p = 0.044). Depth deviation without pins (-0.5 ± 0.5 mm) and with fixation pins (-0.16 ± 0.62 mm) was also statistically significant (p = 0.005). Further analysis demonstrated that the final sleeve position on the 3D printed guide was on average 0.5 mm more coronal than the digital plan. CONCLUSIONS: The use of surgical guides with or without fixation pins can provide clinically acceptable outcomes in terms of accuracy in implant position. There was a statistically significant difference in the accuracy of implant position when utilizing fixation pins only for horizontal apical and depth deviation. Additionally, a statistically significant difference between the planned and the 3D printed surgical guide when considering the sleeve position was detected.

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El trasplante dentario autólogo se define como el po-sicionamiento de una pieza dentaria autóloga en un alvéolo post extracción o en un lecho formado qui-rúrgicamente. Actualmente, siguiendo los criterios de selección adecuados y una técnica quirúrgica mi-nuciosa, resulta una alternativa terapéutica ideal en ciertos pacientes. La gran variabilidad de implantes dentales y alternativas de injertos óseos han resuelto el problema de sustituir una pieza dentaria perdida. En los pacientes en crecimiento o con potencial de crecimiento residual del proceso alveolar, se pone en evidencia el inconveniente que puede representar la colocación de implantes, lo que hace necesario ree-valuar la conservación de dientes y la utilización de técnicas quirúrgicas clásicas. Las tasas de éxito de los autotrasplantes autólogos han aumentado con el tiempo, alcanzando cifras mayores al 90%. En el pre-sente artículo se reporta un caso clínico de autotras-plante dentario con planificación digital y una réplica tridimensional de la pieza a trasplantar (AU)

Autologous tooth transplantation is defined as the positioning of an autologous tooth in a post-extraction socket or in a surgically formed bed. Currently, following the appropriate selection criteria and a meticulous surgical technique, it is an ideal therapeutic alternative in certain patients. The great variability of dental implants and bone graft alternatives have solved the problem of replacing a lost tooth. In growing patients or with potential for residual growth of the alveolar process, the inconvenience that implant placement can represent is evident, which makes it necessary to reevaluate tooth conservation and the use of classic surgical techniques. The success rates of autologous autologous transplants have increased over time, reaching figures greater than 90%. This article reports a clinical case of dental autotransplantation with digital planning and a three-dimensional replica of the piece to be transplanted (AU)

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A exposição excessiva de gengiva durante o sorriso é denominada como sorriso gengival. O fator etiológico dessa alteração é variado e sua identificação é fundamental para confecção de um plano de tratamento eficaz. O planejamento clínico pode ser realizado utilizando uma abordagem dinâmica e digital do sorriso. Sendo assim, software, exames imaginológicos, modelo virtual 3D e guia cirúrgico aumentam a qualidade e a precisão do tratamento, trazendo inúmeros benefícios para o paciente. Objetivo: demonstrar a importância do fluxo digital no planejamento e na correção do sorriso gengival. Relato de caso: paciente apresentou queixas em relação ao tamanho dos dentes e ao excesso de exposição de gengiva durante o sorriso. Após exames clínico e radiográfico, foi possível realizar o diagnóstico do fator etiológico como erupção passiva alterada (EPA). O tratamento de escolha foi o recontorno gengival associado à realização de osteotomia e osteoplastia. Para uma maior precisão do tratamento, foi confeccionado um guia cirúrgico duplo. Após o procedimento, a paciente foi orientada e medicada. Considerações finais: a abordagem digital do sorriso favoreceu um tratamento cirúrgico preciso, eficaz e satisfatório para a paciente, reestabelecendo assim a harmonia dento-gengivo-facial.(AU)

Excessive gum exposure during a smile is called a gum smile. The etiologic factor of this alteration is varied, the identification is essential to create an effective treatment plan. Clinical planning can be performed using a dynamic and digital smile approach. Therefore, software, imaging tests, 3D virtual model and the surgical guide increase the quality and precision of the treatment thus bringing numerous benefits to the patient. Objective: this case report aims to demonstrate the importance of digital flow in smile planning and correction of a gum smile. Case report: the patient presented complaints regarding tooth size and excessive gum exposure during the smile. After the clinical and radiographic examination, the etiological factor was diagnosed as an altered passive eruption (APE). The treatment of choice was the gingival contour associated with osteotomy and osteoplasty. For the precision of the treatment, a double surgical guide was made. After the procedure the patient was guided and medicated. Conclusion: the digital smile approach favored an accurate, effective and satisfactory surgical treatment for the patient thus restoring the tooth-gingival-facial harmony.(AU)

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Uma tomografia de feixe cônico total do crânio associada a um software tridimensional de planejamento digital permite um diagnóstico mais completo e a simulação de diferentes planos de tratamento para a reabilitação oral multidisciplinar de pacientes adultos edêntulos parciais portadores de má oclusão. Um total de 305 cirurgiões-dentistas especialistas, simultaneamente em Ortodontia e em Implantodontia, foram entrevistados e responderam a um questionário com o objetivo de coletar informações importantes sobre a integração da Ortodontia com a Implantodontia para a instalação de implantes dentários em pacientes adultos edêntulos parciais que também necessitam de tratamento ortodôntico. Este estudo foi dividido em uma trilogia de artigos científicos. Esta, a Parte 1, refere-se a perguntas sobre a solicitação de uma tomografia de feixe cônico total do crânio e o uso de softwares tridimensionais de planejamento digital para diagnosticar e planejar reabilitações orais multidisciplinares em pacientes adultos edêntulos parciais portadores de má oclusão. Como a tecnologia já está disponível, era de se esperar uma maior solicitação de tomografias de feixe cônico total do crânio e um maior uso de softwares tridimensionais de planejamento digital por cirurgiões-dentistas, especialistas simultaneamente em Ortodontia e em Implantodontia, mas os resultados mostram o contrário.(AU)

A total skull cone beam tomography associated to a three-dimensional digital planning software permits a more complete diagnostic and the simulation of different treatment plans for the multidisciplinary oral rehabilitation of partially edentulous adult patients with malocclusion. A total of 305 dental specialists in both orthodontics and implantology were interviewed and answered a questionnaire in order to collect relevant information about the integration of orthodontics to implantology for the placement of dental implants on partially edentulous adult patients that also need orthodontic treatment. This study was divided in a trilogy of scientific articles. This, the Part 1, refers to questions about the request of a total skull cone beam tomography and the use of three-dimensional planning softwares to diagnose and plan a multidisciplinary oral rehabilitation for partially edentulous adult patients with malocclusion. As technology is already available, it was expected a higher number of dental specialists in both orthodontics and implantology requesting a total skull cone beam tomography and a greater use of three-dimensional digital planning softwares. But results show the opposite. (AU)

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Tratamentos híbridos associados à Ortodontia Digital são uma eficiente opção para tratamentos de casos clínicos simples e complexos. O propósito desse trabalho é atualizar os ortodontistas sobre a realidade e oportunidade de realizar tratamentos combinados, assim como usufruir das últimas tecnologias da odontologia digital para modernizar sua prática ortodôntica e consultório.(AU)

Hybrid treatments associated to Digital Orthodontics are an efficient treatment option to moderate and complex clinical cases. The aim of this paper is to offer an update to orthodontists about the reality and opportunity to perform combined treatments and to present the latest dental digital technologies for their practice as well.(AU)

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