RESUMO
OBJECTIVE: The aim of this study was to assess changes in the superior airway space (SAS) in Class II patients undergoing orthognathic surgery with counterclockwise rotation of the maxillomandibular complex (MMC). STUDY DESIGN: A total of 23 patients (15 females and 8 males; mean age, 33 years) with symptoms of respiratory disease (mouth breathing) were studied. The patients were subjected to computed tomography analyses at two time intervals: T1 (preoperatively) and T2 (postoperative minimum of 6 months). The computed tomography images were exported to Dolphin Imaging 11.5 software to measure the surface area, minimum axial area, and volume of the SAS. RESULTS: The surgery (including a median mandibular advancement of 14 mm with an average rotation of 8 degrees) significantly increased the static SAS, with mean postoperative increases of 178 mm(2) in SA, 76.67 mm(2) in minimum axial area, and 10118.5 mm(3) in volume. A significant increase was also observed in the three-dimensional airspace following orthognathic surgery, which provided a greater permeability of the SAS in Class II patients. CONCLUSIONS: This confirmed the efficacy of this technique in the treatment of respiratory disorders.
Assuntos
Má Oclusão Classe II de Angle/cirurgia , Avanço Mandibular/métodos , Respiração Bucal/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Adulto , Brasil , Feminino , Humanos , Masculino , Má Oclusão Classe II de Angle/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The aim of this study was to evaluate the microtensile bond strength (µTBS) of two substrates (enamel and dentin) considering two study factors: type of composite resin [methacrylate-based (Filtek Supreme) or silorane-based (Filtek LS)] and aging time (24 h or 3 months). Twenty human molars were selected and divided into 2 groups (n=10) considering two dental substrates, enamel or dentin. The enamel and dentin of each tooth was divided into two halves separated by a glass plate. Each tooth was restored using both tested composite resins following the manufacturer's instructions. The samples were sectioned, producing 4 sticks for each composite resin. Half of them were tested after 24 h and half after 3 months. µTBS testing was carried out at 0.05 mm/s. Data were analyzed by three-way ANOVA and Tukey's HSD tests at α=0.05. Significant differences between composite resins and substrates were found (p<0.05), but no statistically significant difference was found for aging time and interactions among study factors. The methacrylate-based resin showed higher µTBS than the silorane-based resin. The µTBS for enamel was significantly higher than for dentin, irrespective of the composite resin and storage time. Three months of storage was not sufficient time to cause degradation of the bonding interaction of either of the composite resins to enamel and dentin.
Assuntos
Esmalte Dentário , Dentina , Metacrilatos , Resinas de Silorano , Resistência à Tração , Humanos , Técnicas In VitroRESUMO
The current study evaluated prosthetic dental crowns obtained by optical scanning and a computer-aided designing/computer-aided manufacturing system using micro-computed tomography to compare the marginal fit. The virtual models were obtained with four different scanning surfaces: typodont (T), regular impressions (RI), master casts (MC), and powdered master casts (PMC). Five virtual models were obtained for each group. For each model, a crown was designed on the software and milled from feldspathic ceramic blocks. Micro-CT images were obtained for marginal gap measurements and the data were statistically analyzed by one-way analysis of variance followed by Tukey's test. The mean vertical misfit was T = 62.6 ± 65.2 µm ; MC = 60.4 ± 38.4 µm; PMC = 58.1 ± 38.0 µm, and RI = 89.8 ± 62.8 µm. Considering a percentage of vertical marginal gap of up to 75 µm, the results were T = 71.5%, RI = 49.2%, MC = 69.6%, and PMC = 71.2%. The percentages of horizontal overextension were T = 8.5%, RI = 0%, MC = 0.8%, and PMC = 3.8%. Based on the results, virtual model acquisition by scanning the typodont (simulated mouth) or MC, with or without powder, showed acceptable values for the marginal gap. The higher result of marginal gap of the RI group suggests that it is preferable to scan this directly from the mouth or from MC.
Assuntos
Dente Pré-Molar/anatomia & histologia , Desenho Assistido por Computador/instrumentação , Coroas , Adaptação Marginal Dentária , Planejamento de Prótese Dentária/instrumentação , Imageamento Tridimensional/instrumentação , Ajuste de Prótese/instrumentação , Dente Pré-Molar/cirurgia , Análise de Falha de Equipamento , Humanos , Impressão Tridimensional/instrumentação , Radiografia Dentária/métodos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The aim of this study was to evaluate the long-term skeletal stability of counterclockwise maxillomandibular complex rotation in patients undergoing orthognathic surgery for long-face pattern. METHODS: This retrospective study consisted of 10 patients who underwent the procedure between September 2002 and April 2008. To assess the skeletal stability, 30 preoperative (T1), recent postoperative (T2), and late postoperative (T3) cephalometric radiographs of the 10 patients were digitized and traced. To measure the stability in the occlusal plane and mandibular plane, the cephalometric points and planes were determined 3 times. RESULTS: In the long term, on average, the A-point moved 0.21 mm backward (AYT3-AYT2), the B-point moved 0.57 mm backward (BYT3-BYT2), and the posterior nasal spine moved 0.31 mm backward (PNSYT3-PNSYT2). On average, the anterior maxillary area (A-point) moved 0.14 mm downward (AXT3-AXT2), the mandible (B-point) moved 0.07 mm downward (BXT3-BXT2), and the posterior nasal spine moved approximately 0.18 mm upward (PNSXT3-PNSXT2). The occlusal plane increased by 0.75 degrees (OPT3-OPT2), and the mandibular plane increased by 0.45 degrees (MPT3-MPT2). CONCLUSIONS: It was observed that the counterclockwise rotation of the maxillomandibular complex produces stable results in patients with long-face pattern undergoing orthognathic surgery.
Assuntos
Deformidades Dentofaciais/cirurgia , Mandíbula/cirurgia , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Adolescente , Adulto , Cefalometria/métodos , Oclusão Dentária , Deformidades Dentofaciais/patologia , Feminino , Seguimentos , Mentoplastia/métodos , Humanos , Masculino , Mandíbula/patologia , Avanço Mandibular/métodos , Maxila/patologia , Osso Nasal/patologia , Osso Nasal/cirurgia , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Estudos Retrospectivos , Rotação , Resultado do Tratamento , Dimensão Vertical , Adulto JovemRESUMO
The present study aimed to establish the profile of patients who underwent orthognathic surgery in a private clinic by evaluating their demographic characteristics, their facial types, and aspects related to the surgical procedures that were performed. The sample consisted of 419 medical records from male and female patients aged 15 to 62 years who underwent orthognathic surgery between 2001 and 2011. A single examiner collected data by evaluating a database of information extracted from medical records, particularly radiographic and photographic analyses. The following criteria were evaluated: gender, age, skin color, type of orthognathic surgery, type of associated temporomandibular joint (TMJ) surgery, complications, and recurrences. Seventeen patients were rejected because they had incomplete records. The average age of the patients was 28.5 years old; most were females (255 patients) and faioderm (295 patients). The most prevalent facial pattern was Pattern III (n = 166, 41.3%). Orthognathic surgery that affected the maxilla, jaw, and chin was the most prevalent type (n = 199, 49.5% of cases). A genioplasty was performed concurrently with combined surgeries and single-jaw surgery in 76.86% of patients (n = 309). TMJ surgery was performed concomitantly with orthognathic surgery in 4% of cases (n = 16). The most common postoperative complication was infection/inflammation (n = 12). We concluded that there was a higher frequency of orthognathic surgery among women and young people, the brunette skin phenotype was prevalent, and most patients had a combination of maxillary and mandibular problems.
Assuntos
Deformidades Dentofaciais/epidemiologia , Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Queixo/cirurgia , Deformidades Dentofaciais/classificação , Estudos Epidemiológicos , Feminino , Mentoplastia/estatística & dados numéricos , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores Sexuais , Pigmentação da Pele/fisiologia , Infecção da Ferida Cirúrgica/epidemiologia , Articulação Temporomandibular/cirurgia , Adulto JovemRESUMO
PURPOSE: The aim of this retrospective study was to evaluate the long-term survival rates and the frequency of complications associated with single implants and their associated restorations. MATERIALS AND METHODS: A retrospective cohort study was performed in patients who received dental implants between 1997 and 2007. The cohort included patients who had a single implant restored with a cemented or screwed restoration that had been in function for more than 2 years. The cumulative implant survival rates and peri-implant conditions (marginal bone loss, pocket depth, and plaque, gingival, and bleeding indices), as well as prosthodontic maintenance requirements, were evaluated. Descriptive statistics, the chi-square test, and regression models were used. RESULTS: Seventy-three implants were placed in 44 patients (32 women, 12 men; mean age, 48 years). All implants were available for follow-up after 2 to 13 years (mean follow-up, 60 months). The overall cumulative 5-year survival rates for implants were 95.9%, and most of the prostheses (98.6%) remained functional throughout the observation period. The overall frequency of complications was 29.6% (4.3% inflammatory, 22.5% prosthetic, 2.8% operative). The average peri-implant marginal bone loss was 1.8 mm. Peri-implant soft tissue conditions such as plaque and bleeding indices and pocket depths were also satisfactory. However, the presence of inflammation was significantly associated with pocket depth and gingival keratinized mucosa. The need to retighten loose abutment screws (21%) was the most frequent prosthodontic maintenance performed. However, all loose abutment screws occurred in prostheses retained with titanium screws, and 92.9% of the prostheses had a UCLA-type abutment. CONCLUSION: The implants and the associated prosthetic constructions used in this study showed excellent survival rates. However, there was a high frequency of prosthetic complications associated with titanium screws and UCLA cast abutments. Other prosthetic components may have yielded different results.
Assuntos
Perda do Osso Alveolar/etiologia , Implantes Dentários para Um Único Dente/efeitos adversos , Índice de Placa Dentária , Falha de Restauração Dentária , Índice Periodontal , Bolsa Periodontal/etiologia , Adulto , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Falha de Restauração Dentária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: The aim of this study was to verify quality of life related to oral health and satisfaction with dentures. Conventional mandibular complete dentures were converted to overdentures retained by two implants with immediate loading (bar-clip system, n = 16). MATERIALS AND METHODS: The Brazilian short version of the Oral Health Impact Profile (OHIP-14Br) was used to evaluate the impact of oral health on quality of life. Satisfaction with the prostheses was obtained by means of a questionnaire addressing satisfaction with the present prostheses and through use of a visual analog scale (VAS). RESULTS: The results of the OHIP-14Br questionnaire were verified at 3 and 6 months after conversion from complete dentures to a mandibular overdenture. The satisfaction questionnaire for the mandibular prostheses obtained 43.75% satisfaction before conversion and 100% satisfaction at 1 week and 3 and 6 months after conversion. The satisfaction results of the prostheses, both maxillary and mandibular, were 68.75% before conversion, 93.75% at 1 week and 3 months after conversion, and 87.5% at 6 months. There was an immediate improvement in patients' satisfaction with the mandibular overdenture prostheses regarding stability and retention (Friedman test, P = .000) and quality of life (Friedman test, P = .001). CONCLUSION: The improvement seen justifies the immediate loading approach used in this study.
Assuntos
Prótese Dentária Fixada por Implante/psicologia , Revestimento de Dentadura/psicologia , Carga Imediata em Implante Dentário , Satisfação do Paciente , Qualidade de Vida , Adulto , Idoso , Brasil , Retenção em Prótese Dentária , Prótese Total Inferior/psicologia , Humanos , Pessoa de Meia-Idade , Perfil de Impacto da Doença , Inquéritos e QuestionáriosRESUMO
Lower conventional complete dentures were converted to overdentures retained by two implants with an immediately loaded bar-clip system (n 16). The masticatory performance test was carried out using 'Optocal' after forty chewing strokes. Nutritional condition was evaluated by means of a Mini-Nutritional-Assessment questionnaire. No individual was classified as malnourished. The masticatory performance test demonstrated a statistically significant difference before conversion (baseline) and 3 and 6 months after conversion of the lower conventional complete denture to an implant-retained overdenture (paired-samples t test; P < 0·05). A statistically significant difference before and after 6 months of conversion for nutritional condition (Wilcoxon test; P < 0·05) was also observed. The association between masticatory performance and nutritional assessment demonstrated that a statistically significant difference between masticatory performance of the subgroups classified at baseline as nourished (22·43 %) and those at risk of malnutrition (3·9 %) was only evidenced before conversion (P = 0·006). After the conversion from a lower conventional complete denture to an implant-retained overdenture, at 3 months, the risk of malnutrition and nourished at baseline did not present significant differences in masticatory performance. Nonetheless, the mean masticatory performance potential was 19·86 and 31·98 % for subgroups classified at baseline as at risk of malnutrition and nourished, respectively (P = 0·187). The results before conversion were less favourable for masticatory performance and nutritional condition. The increased retention of the mandibular prosthesis allowed improvement in masticatory performance and nutritional condition.
Assuntos
Revestimento de Dentadura , Desnutrição/prevenção & controle , Mastigação , Avaliação Nutricional , Adulto , Idoso , Prótese Total Inferior , Humanos , Desnutrição/etiologia , Mandíbula/cirurgia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
PURPOSE: The aim of this study was to evaluate the effect of an oral rehabilitation program on masticatory performance and ability as a function of the number of masticatory cycles. Subjects with a mandibular fixed implant-supported prosthesis (ISP), complete dentures (CDs), or a natural dentition (ND) were evaluated. MATERIALS AND METHODS: Masticatory performance was tested with an artificial test food (Optocal). Optocal was provided to subjects in two portions of 17 cubes and collected after both 20 and 40 masticatory cycles. The particles were collected on stacks of eight sieves. The geometric mean diameter of the chewed particles was calculated using the sieves. Questionnaires were used to assess masticatory ability before and after the fixed mandibular rehabilitation program. The geometric mean diameter of the chewed particles was compared by two-way analysis of variance followed by the Tukey test (P < .05). RESULTS: The geometric mean diameter for all groups was lower after 40 cycles versus 20 cycles. When compared to the ND group, masticatory performance for the CD and ISP groups was 12% and 28% after 20 cycles and 31% and 61% after 40 cycles, respectively. The data for the masticatory ability of the ISP group before and after fixed mandibular rehabilitation were compared by the McNemar test (P < .05), and showed that 100% of these subjects were satisfied with their chewing capacity after fixed mandibular rehabilitation. CONCLUSIONS: These results quantify the differences in masticatory function among different types of dentition. Greater masticatory function for fixed mandibular rehabilitation versus CDs was demonstrated.
Assuntos
Prótese Dentária Fixada por Implante , Dentição , Prótese Total , Prótese Parcial Fixa , Mandíbula/cirurgia , Mastigação/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Retenção de Dentadura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Satisfação do Paciente , Silicones , Fatores de Tempo , Adulto JovemRESUMO
The esthetic and functional rehabilitation of patients with multiple missing teeth can be performed with several techniques and materials. Ceramic restorations provide reliable masticatory function and good esthetics. However, fracture can occur in some cases due to their brittle behavior. In some cases, the replacement of an extensive prosthesis is a problem due to the high treatment cost. In this paper, two cases are presented, in which fractures occurred in extensive metal-ceramic fixed partial dentures, and their replacement was not possible. Ceramic repair was chosen and the sequences of treatment with and without presence of the ceramic fragment are also discussed. The cases illustrate that, in some situations, fractured metal-ceramic partial dentures can be successfully repaired when prosthetic replacement is not a choice. Prosthodontists must use alternatives that allow a reliable repair to extensive metal-ceramic fixed partial dentures. Surface preparation of the ceramic with hydrofluoric acid in conjunction with a silane coupling agent is essential for a predictable bonding of composite resin. The repair performed with composite resin is an esthetic and functional alternative when extensive fixed partial dentures cannot be replaced.