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Background. Maxillary bone atrophy with a considerable amount of pneumatization and anterior expansion of the maxillary sinus might be a situation limiting oral rehabilitation with osseointegrated implants. Therefore, the present study aimed to biomechanically evaluate two rehabilitation techniques for maxillary bone atrophy: all-on-four and long trans-sinus implants. Methods. Two three-dimensional models consisting of atrophic maxilla with four implants were simulated. In the M1 model, two axially inserted anterior implants and two tilted implants, 15 mm in length, placed tangential to the maxillary sinus’s anterior wall were used. In the M2 model, two axially inserted anterior implants and two trans-sinus tilted implants, 24 mm in length, were used. For the finite element analysis (FEA), an axial load of 100 N was applied on the entire extension of the prosthesis, simulating a rehabilitation with immediate loading. The peri-implant bone and the infrastructure were analyzed according to the Mohr-Coulomb and Rankine criteria, respectively. Results. The results were similar when the stresses on peri-implant bone were compared: 0.139 and 0.149 for models 1 and 2, respectively. The tension values were lower in the model with trans-sinus implants (27.99 MPa). Conclusion. It was concluded that the two techniques exhibited similar biomechanical behavior, suggesting that the use of long trans-sinus implants could be a new option for atrophic maxilla rehabilitation.

Technological innovation and the development of new products is what currently boost the competitiveness between enterprises and moves the economy. The technical-scientific advances in Dentistry grow each day and there are great investments by research centers and universities in new materials, especially in dental implantology. The objective was to evaluate the patents deposited and granted in implantology at the National Institute of Industrial Property (INPI) in Brazil. This is a prospective study with searches performed during March 2020 on patents in dental implantology deposited and granted in the INPI. The research was carried out in titles and abstracts of reports on patent applications from the first deposit through to the most current using the search terms "dental implants" and "implantology". The information was extracted from documents and organized into tables and graphs. From 1988, the date of the first deposit, through to 2019 there were 139 patent application deposits. Among the deposited patents, 54% (75) were classified as utility model patents and 25% (35) as invention patents, the others 21% (29) have been in analysis. Brazil holds 80.6% (112) of deposits, and the others are from countries in Latin America, North America, Europe and Africa, and virtually all patents are of type A, which refers to products of human needs. Most deposits of patents for use in implantology in the INPI relate to implant and prosthetic component accessories, indicating greater investment by industry in Brazil in this sector. However, in 30 years there were only 134 deposited patents, suggesting that the importation of products in the area is still great, which consequently makes the products of this area more expensive. Thus, investments in patents play an important role in technological and economic development of a country. Key words: Dental implants, intellectual property, patents.

Objectives: This study aimed to evaluate vestibular gingival thickness in unitary implants located in the anterior maxilla through a cone beam tomography. Material and methods: After visual classification of the gingival biotype of the 32 patients selected for this study (16 patients with thin biotype and 16 patients with thick biotype) measurements of the vestibular tissue thickness were made at 2, 4 and 6 mm from the gingival margin in the apical direction in the most longitudinal transverse cut of the implant and the contralateral tooth through tomographic cone beam examination for soft tissue. The data of age and gender of the patients, mean buccal wall thickness of the implants and contralateral natural teeth, and the use of connective tissue graft (CTG) were tabulated for descriptive analysis. Results: For thin gingival biotype, mean vestibular gingival thickness varied between 1.26 ± 0.31 mm (teeth) and 2.65 ± 0.93 mm (implant), and for thick biotype varied from 1.77 ± 0.58 mm (teeth) and 3.01 ± 0.96 mm (implant). The use of CTG increased the buccal thickness of thick biotype when compared to thin biotype without CTG. Conclusions: It was not possible to establish a direct relationship between the classification of the gingival biotype of the contralateral teeth and the gingival biotype of the implants installed in the anterior region of the maxilla, but CTG was shown to be efficient in increasing gingival tissue thickness. La identificación del biotipo gingival es importante y debe ser tenida en cuenta durante el plan de tratamiento, de manera que se puedan predecir estrategias de manipulación tisular para mejorar los resultados estéticos. Este estudio tuvo como objetivo evaluar el espesor gingival vestibular en implantes unitarios ubicados en la maxilar anterior, mediante examen tomográfico de haz cónico para tejidos blandos. Después de la clasificación visual del biotipo gingival de los 32 pacientes seleccionados para este estudio (16 pacientes con biotipo delgado y 16 pacientes con biotipo grueso), se realizaron mediciones del espesor del tejido bucal a 2, 4 y 6 mm del margen gingival. en dirección apical en el corte transversal longitudinal del implante y el diente contralateral, mediante examen tomográfico de haz cónico para tejidos blandos. Los resultados mostraron medidas promedio de espesor gingival bucal a los dientes de 1,26 ± 0,31 mm en pacientes con biotipo gingival delgado y 1,77 ± 0,58 mm en pacientes con biotipo gingival grueso; y medidas promedio de 2,65 ± 0,93 mm y 3,01 ± 0,96 mm de espesor gingival en vestibular de los implantes analizados, para el biotipo delgado y biotipo grueso, respectivamente. Además, se destacó la importancia de utilizar un injerto de tejido conectivo, el cual, al ser utilizado, los pacientes presentaban un espesor de tejido vestibular promedio de 2,85 ± 0,93 mm y de 3,19 ± 1,08 mm para biotipo delgado y grueso. No fue posible establecer una relación directa entre la clasificación del biotipo gingival de los dientes contralaterales y el biotipo gingival de los implantes instalados en la región anterior del maxilar. A identificação do biotipo gengival é importante e deve ser levada em consideração durante o plano de tratamento, para que estratégias de manipulação tecidual possam ser previstas, a fim de melhorar os resultados estéticos.Este estudo objetivou avaliar a espessura gengival vestibular em implantes unitários localizados na maxila anterior, através de exame tomográfico cone beam para tecido mole. Após classificação visual do biotipo gengival dos 32 pacientes selecionados para este estudo (sendo 16 pacientes de biotipo fino e 16 pacientes de biotipo espesso), foram feitas medidas da espessura tecidualvestibular a2, 4 e 6 mm a partir da margem gengival em direção apical no corte transversal mais longitudinal do implante e do dente contralateral, através de exame tomográfico cone beam para tecido mole. Os resultados apresentaram medidas médias de espessura gengival vestibular aos dentes de 1,26 ± 0,31mm em pacientes de biotipo gengival fino e de 1,77 ± 0,58mm em pacientes de biotipo gengival espesso; e medidas médias 2,65 ± 0,93mm e de 3,01 ± 0,96mm de espessura gengival na vestibular dos implantes analisados, para o biotipo fino e biotipo espesso, respectivamente. Além disso, evidenciou-se a importância da utilização do enxerto de tecido conjuntivo, que quando utilizado, os pacientes apresentaram uma média de espessura tecidual vestibular de 2,85 ± 0,93 mm e de 3,19 ± 1,08 mm para biotipo fino e espesso. Não foi possível estabelecer uma relação direta entre a classificação do biotipo gengival dos dentes contralaterais com o biotipo gengival dos implantes instalados na região anterior da maxila.

Statement of problem Although the concept of angulated dental implants has been used for the rehabilitation of the completely edentulous maxilla, its use has yet to be validated with narrow-diameter implants. Proper estimation of narrow-diameter implant dimensions and angulations is essential for the correct use of these implants. Purpose The purpose of this 3D finite element analysis study was to compare the stress levels and distributions of 2 narrow-diameter angled implant arrangements supporting a maxillary fixed complete prosthesis. Material and methods Two commercially available narrow-diameter implants (3.5×11.5 mm, Unitite Prime; 2.9×11.5 mm, Unitite Slim) were compared for their performances under axial and oblique loading (masticatory force: 100 N) in simulated situations of all-on-4 treatment (2 parallel anterior implants perpendicular to the bone crest and 2 posterior implants angled at 30 degrees). An edentulous maxilla model generated from computed tomography and a prosthesis parametric computer-aided design (CAD) model were combined with computational models of implants and prosthetic components to represent implant-supported maxillary fixed complete prostheses. A condition of complete osseointegration was assumed. Peri-implant bone was analyzed by the Mohr-Coulomb criterion. Implants, abutments, and screws were analyzed by the von Mises criterion, and frameworks by the Rankine criterion. Results The 3.5-mm model showed higher axial load values for peri-implant bone, implants, and abutments than the 2.9-mm model. As for oblique load, values were higher for right-sided peri-implant bone, implants, abutments, and frameworks in the 3.5-mm model than in the 2.9-mm model. The 3.5-mm model had a 16% lower risk of peri-implant bone loss for the axial load and 4% for the oblique load. Conclusions The biomechanical behavior of an angled 2.9-mm implant was comparable with that of a 3.5-mm implant for an all-on-4 prosthesis. However, despite a lower risk of peri-implant bone loss, the 3.5-mm model had higher peak stress on implants and abutments than the 2.9-mm model.

Introdução: O implante zigomático (IC) é uma alternativa para pacientes desdentados ou parcialmente dentados que não possuem osso maxilar suficiente para reter o implante dentário convencional e para casos em que o enxerto ósseo não é adequado, apresentando uma taxa de sucesso superior a 90%. Objetivos: O objetivo deste estudo foi analisar as estruturas ósseas envolvidas na instalação do IC, considerando gênero e etnia. Material e método: Foram incluídos 96 crânios de indivíduos adultos, desdentados, de ambos os sexos, leucoderma e melanoderma. Um paquímetro digital foi utilizado para realizar as seguintes medidas: 1) RA-CPS: distância da crista alveolar no nível do segundo pré-molar superior até a margem superior posterior do osso zigomático; 2) ECPS: Espessura do osso zigomático ao nível da margem superior posterior; 3) EQM: espessura do osso zigomático em sua porção média. Resultados: Os valores médios obtidos para RA-CPS, ECPS e ECM em milímetros foram, respectivamente: leucoderma feminino 52,09, 2,04 e 4,30; mulheres com melanoderma 53,47, 1,99 e 4,93; machos leucoderma 55, 49, 2,28 e 5,33; Homens Melanoderma 57.01, 2.22 e 6.01. Conclusões: Concluímos que indivíduos leucoderma apresentam valores médios mais baixos do que indivíduos melanoderma. Além disso, as mulheres apresentam valores médios mais baixos que os homens em todas as medidas. Os valores encontrados neste estudo podem ser utilizados como parâmetro para o planejamento da técnica cirúrgica para instalação do CI, evitando riscos de complicações.

Introduction. Considering oral rehabilitation with dental implants, many studies have aimed at improving bone regeneration through the use of biomaterials. Objective. This study aimed at comparing bone neoformation in patients undergoing bilateral maxillary sinus surgery with two bovine biomaterials. Materials and Methods. This is a randomized, blinded, clinical crossover, and divided mouth study. Ten participants with an indication of maxillary sinus enlargement were selected and underwent surgical treatment with Bio-Oss® graft biomaterial (graft 1) on one side and Lumina-Porous® graft biomaterial (graft 2) on the other. The samples were collected after nine months and fixed and then decalcified in 10% ethylenediamine tetra-acetic acid (EDTA) solution for 30 days to process and make histological slides. Connective and bone tissue were further analyzed to identify the amount of newly formed bone. Results. The graft 1 group had a greater formation of vital mineralized tissue when compared to the graft 2 group ( p = 0.01). For nonvital mineralized tissue and amount of connective tissue, there was no statistical difference ( p = 0.21 and p = 0.09, respectively). The medullary spaces were larger in the graft 2 group. The group treated with graft 1 presented a higher percentage of osteoclasts and viable osteocytes compared to the graft 2 group ( p = 0.014 and p = 0.027, respectively). Conclusion. Every day, new alternative biomaterials are offered as an option in oral rehabilitation. In this study, both treatments induced bone neoformation after 9 months; however, the group treated with Bio-Oss® showed a higher percentage of vital mineralized bone tissue.

Background: Many works in Dentistry have aimed toward improving bone regeneration and oral rehabilitation through techniques, procedures and materials of Implantology. Objective of this study is to comparethe heating intensity of bovine blocks, simulating surgical beds using different drills. Materials and Methods: We evaluated 24 blocks divided into 4 groups with different KOPP brand drill models: G1-Conventional drills without irrigation; G2-Experimental drills without irrigation; G3-Conventional drills with irrigation; G4-Experimental drills with irrigation. Perforations were performed with depths of 1.0 and 5.00 mm, drill rotation speed of 150 rpm and torque of 45 N. Two K-type thermocouples were used to measure the temperature of the bone, with the first in the 1 mm deep perforation and the second in the 5 mm perforation. Results: In comparing the conventional and experimental drills treated with the same kind of protocol there was no statistical difference in the depth of 1 mm (p> 0.05), however a statistical difference was observed at the depth of 5 mm (p Key words: Bone, Dental implants, Irrigation, Osseointegration, Surgical cutters.

Purpose This prospective clinical study evaluated the influence of an interposed bone graft with inferior alveolar nerve lateralization in terms of rates of sensory disturbance, mean sensation recovery time, and survival rates for placement of osseointegrated implants. Materials and methods Patients with an atrophic posterior mandible were enrolled in this study and randomized into two groups: bone graft group (a bone graft was placed between the implant and inferior alveolar nerve after lateralization) and control group (implants were placed in direct contact with the inferior alveolar nerve after lateralization). Neurosensory disturbances were evaluated via questionnaire 1 week after surgery and at the end of each month during the first year after surgery. Results Eighty-two implants were placed, with a survival rate of 97.56%. Two implants were removed due to mandibular fracture. All patients reported initial sensory disturbances arising from the surgical procedure. In the control group, the mean time for recovery from sensory disturbance was 3.95 ± 2.33 months, compared with 4.11 ± 4.68 months in the bone graft group (P = .587). Conclusion The interposition of a bone graft between implants and the inferior alveolar nerve after lateralization did not prevent sensory disturbances and did not influence the sensation recovery time or implant survival rates.

This study aims to evaluate the screw removal torque on prosthetic platforms of Cone Morse (CM) and External Hexagon (EH) implants in crowns with anterior cantilever. Materials and Methods: in vitro study with a sample consisting of 20 test specimens of 2 elements (21 and 22), with n = 40; load is simulated on element 21 or on cantilever of 22. Samples were divided into 4 groups consisting of 10 test specimens on CM implants (groups 1 and 2), and 10 test specimens on EH implants (groups 3 and 4). The test specimens were manufactured using cylindrical PVC pipes measuring 22 x 19.05 mm filled with acrylic resin. The implants were fixed with a centralization device. Components used were EUCLAs and UCLAs with a chrome-cobalt alloy molten base. The metal bases were scanned, the crowns were digitally waxed, made on CAD/CAM system, and cemented on the metal bases with Panavia cement. Torque was applied using 20N for CM and 32N for EH, according to the manufacturers’ instructions. The test specimens were then subjected to a cycling process consisting of 1,000,000 cycles at a frequency of 2 Hz. The cyclic process applied axial forces to the surface (palate face of 21 and 22). Two cycling processes were carried on, the first on the palate face of 21 and the second on the palate face of 22. Between the two, screws were removed and replaced by new ones. The screw removal torque was measured using a digital torque meter. Results were analyzed with Student’s t test and variance analysis. Statistical calculations were conducted in SPSS 23 using 5% of significance. Results: Student’s t test showed significantly lower removal torque values in comparison with initial torque for both CM and EH connection implants and force applied to elements 21 and 22 (p < 0.001) or 22 (p < 0.001). Considering torque loss, there was no significant effect of the interaction between type of implant connection and site of force application (p = 0.094). Removal torque was significantly lower than initial torque for both implants (CM and EH). Conclusion: Torque loss occurred both in CM and EH. There was no significant effect of the interaction between connections and site of force application.

The aim of this study was to clinically and radiographically compare extra short and standards implants. Forty-two implants were installed in 10 selected patients. They received prosthetic loading only after the conventional waiting time for osseointegration and the prostheses were made ferulized. Radiographic shots were performed to evaluate vertical and horizontal bone losses at times T1 (prosthetic installation), T2 (6 months follow-up) and T3 (12 months follow-up). Biological parameters such as bone level around the implants (CBL) were evaluated, CBL alteration (CBLC), total crown length (TCL) and implant/crown ratio (ICR) were digitally calculated. All implants included in the study were submitted to the analysis of the implant stability quotient (ISQ) at the time of implant installation (T0) and at 12 months of prosthetic function (T3). Data were statistically tested. The ICR was higher in the test group than in the control group (p0.05). No correlation was found between CBLC and ICR parameters, as well as between ISQ and implant length. We may conclude that standards and extra short implants can provide similar clinical results in prosthetic rehabilitation of the atrophic jaw over 12 months of follow-up. Resumo O objetivo deste estudo foi comparar clínica e radiograficamente implantes extra curtos e padrões. Quarenta e dois implantes foram instalados em 10 pacientes selecionados. Eles receberam carga protética somente após o tempo de espera convencional para a osseointegração e as próteses foram feitas ferulizadas. As imagens radiográficas foram realizadas para avaliar as perdas ósseas verticais e horizontais nos tempos T1 (instalação protética), T2 (6 meses de acompanhamento) e T3 (12 meses de acompanhamento). Parâmetros biológicos como nível ósseo ao redor dos implantes (CBL) foram avaliados, alteração CBL (CBLC), comprimento total da coroa (TCL) e relação implante / coroa (ICR) foram calculados digitalmente. Todos os implantes incluídos no estudo foram submetidos à análise do quociente de estabilidade do implante (ISQ) no momento da instalação do implante (T0) e aos 12 meses de função protética (T3). Os dados foram testados estatisticamente. A ICR foi maior no grupo teste do que no grupo controle (p0,05). Não foi encontrada correlação entre os parâmetros CBLC e ICR, bem como entre o ISQ e o comprimento do implante. Podemos concluir que padrões e implantes extra curtos podem fornecer resultados clínicos semelhantes na reabilitação protética da mandíbula atrófica ao longo de 12 meses de acompanhamento.

Purpose The aim of this study was to evaluate volumetric stability of autologous and xenogeneic block grafts and primary stability of implants in maxillary grafted areas. Materials and methods Each patient received one autologous block and xenogeneic block, both covered with a membrane. Bone thickness measurements clinically and tomographically were made before, immediately, and 6 months postoperatively. After 6 months, identical implants were placed in each grafted area, and primary stability was measured. Results Eight patients with anterior horizontal bone defects were selected. Clinical outcomes at 6 months postgrafting in the autologous block revealed a mean thickness of 7.4 ± 1.6 mm, with an initial mean measurement of 3.4 ± 1.7 mm and 2.6% resorption, whereas the mean in the xenogeneic block was 8.9 ± 1.5 mm, 3.3 ± 1.6 mm, and 7.3%, respectively. Tomographic evaluation of the thickness at 6 months postgrafting in the autologous block was a mean 7.8 ± 1.8 mm, with an initial mean of 3.7 ± 1.6 mm and resorption of 0%, while the mean in the xenogeneic block was 9.3 ± 1.6 mm, 3.6 ± 1.4 mm, and 2.1%, respectively. No significant difference in bone thickness was observed immediately or 6 months after the procedure. The mean implant placement torque was 32 ± 22 Ncm in the autologous block and 18 ± 9 Ncm in the xenogeneic block (P = .004). Conclusion Xenogeneic block was shown to be a suitable alternative to reconstruct horizontal defects in the alveolar ridge that had undergone extensive resorption, though lower insertion torques were obtained during implant placement.

Purpose To evaluate the fracture resistance after the thermal and mechanical fatigue of feldspathic, lithium disilicate, and resin-modified CAD/CAM monolithic crowns cemented onto a universal post abutment. Materials and methods A right second mandibular molar was designed in CAD/CAM software, and 30 crowns were machined using three different materials (n = 10): feldspathic ceramic, finished only with a glaze cycle (G1); lithium disilicate, sintered and finished with a glaze cycle (G2); and resin, modified by nanoceramic and finished with rubber (G3). All crowns were cemented under a constant 50 N load, the excess cement was removed, and the crowns were light-cured for 30 seconds. After being immersed in deionized water for 7 days, the crowns were submitted to thermal cycling, which consisted of varying the temperature from 2 to 50°C for 350,000 cycles, and mechanical cycling in a fatigue simulator, where a 250 N load was applied for 1,000,000 cycles at 2 Hz. The resistance of each crown was verified in a compression-to-failure test at 1 mm/min in a universal test machine. The groups were compared using one-way ANOVA with a Bonferroni post hoc test and Weibull statistics. Results The resin-modified group was the least resistant group (1755 ± 124 N), followed by the feldspathic (2147 ± 412 N) and lithium disilicate groups (2804 ± 303 N). The Weibull statistics demonstrated that lithium disilicate is the most reliable material and has the lowest fracture probability. Conclusions It was possible to conclude that all of the tested CAD/CAM materials can be used as monolithic, implant-supported molar crowns.

Introduction When stress and strain levels in the bone-implant system exceed It's capacity, a mechanical fatigue occurs, resulting in collapse and loss of osseointegration. Objective Analyze biomechanical behavior in single implant-supported prosthesis with implants of different diameters in the posterior mandible. Material and method Three different finite element models of Cone-Morse implants with the same height were created, varying the diameter (3.3 mm, 4.1 mm and 4.8 mm). The mandibular first molar area was the location of the implant, with It´s component and overlying prosthetic crown. The jawbone was composed of cortical and cancellous bone. Refined mesh of 0.5 mm was created in the critical interfaces to be analyzed. The loading of the models was performed at the point of occlusal contact with an occlusal load of 400 N. Result Maximum stress and strain occurred in the cervical regions of the implants in all groups, either in the implants or in components as well as in the analysis of cortical bone. The greater the diameter, the lower the stress and strain found in the implant. The 3.3 mm group had the highest strain in peri-implant cortical bone, and the 4.1 mm group had the smallest deformation, significantly lower than in the 4.8 mm group. Conclusion Although the biggest implant diameter (4.8 mm) appears to have lower values of stress and strain, the group of intermediate implant diameter (4.1 mm) showed less deformation rate in the cortical peri-implant bone. Therefore it is concluded that the 4.1 mm implant platform presented a more biomechanically effective peri-implant bone maintenance. Resumo Introdução Quando os níveis de tensão e compressão gerados no sistema osso-implante excederem a capacidade óssea ocorre uma fadiga mecânica, resultando em colapso e perda da osseointegração. Objetivo Analisar o comportamento biomecânico em próteses unitárias implanto-suportadas com implantes de diferentes diâmetros na região posterior de mandíbula. Material e método Foram criados três modelos de elementos finitos de implantes cone-Morse de mesmo comprimento, variando-se o diâmetro: 3,3 mm, 4,1 mm e 4,8 mm. A localização do implante foi a região de primeiro molar inferior, com componente e coroa protética sobrejacentes. A mandíbula foi composta por osso cortical e medular. Foi criada malha refinada de 0,5 mm nas interfaces criticas a serem analisadas. O carregamento dos modelos foi realizado nos pontos de contatos oclusais, com uma carga oclusal de 400 N. Resultado Tensão e deformação máximas ocorreram nas regiões cervicais dos implantes em todos os grupos, tanto na análise dos implantes e componentes quanto na análise do osso cortical. Quanto maior foi o diâmetro, menores foram tensão e deformação encontradas no implante. O grupo 3,3 mm apresentou a maior deformação em osso cortical periimplantar, tendo o grupo 4,1 mm a menor deformação, significantemente menor em relação ao grupo 4,8 mm. Conclusão Apesar de o implante de maior diâmetro (4,8 mm) ter apresentado os menores valores de tensão e deformação, o grupo do implante de diâmetro intermediário (4,1 mm) mostrou menor taxa de deformação em osso cortical periimplantar. Portanto conclui-se que o implante de plataforma 4,1 mm apresentou-se mais efetivo biomecanicamente para manutenção óssea periimplantar.

Generally being considered as a safe area for surgical approaches, the region between the mental foramina presents important anatomical structures. The objective of this study was to measure the dimensions of the genial plexus and its three-dimensional location in CBCT images, correlating the characteristics of this structure with dental presence, sex and age of patients. A total of 149 cone beam computer tomography (CBCT) scans of dentate (n = 74) and edentulous patients (n = 75) were selected, 59 male and 90 female, aged 18 - 86 years. Measurements of width and length of the genial canal were performed, and the shortest distances of the genial plexus were determined in relation to the alveolar bone crest, the buccal cortical bone and the base of the mandible. The results indicated significant differences between the dentate and edentulous groups for the mandibular canal length (p = 0.030), distance from alveolar crest (p < 0.001), and distance from buccal cortical bone (p < 0.001), with significantly higher values in dentate patients. As for gender, the distances between the genial plexus and the alveolar bone crest (p < 0.001) and the buccal cortical bone (p = 0.028) were significantly shorter for females. Regarding age, only the distance between the genial plexus and the alveolar crest showed a significant difference (p < 0.001), and the smallest values were measured in the older patients. It can be concluded that there are variations of the genial plexus in relation to gender, age and between edentulous and dentate patients. Therefore, the anterior region of the mandible, especially the midline should be observed with caution when undergoing surgical procedures, such as removal of bone grafts and installation of dental implants.

Peri-implant bone remodeling occurs in all osseointegrated implants and can be defined as an adaptive process of bone around the implant in response to functional loading. This retrospective study evaluated the marginal bone remodeling around dental implants with external hexagonal connections in function for more than 10 years. The sample consisted of 17 implants placed in the posterior region of the mandible to replace one or several teeth. For all cases, the initial periapical radiograph was assessed together with a subsequent follow-up periapical radiograph. Image analysis was performed using ImageJ software to establish the initial bone measurements and subsequent bone loss. The data were statistically analyzed using paired t test at a significance level of 5%. There was significant bone remodeling when the baseline and follow-up were compared (P < .001). The mean values of peri-implant bone remodeling on the mesial aspect were 0.90 ± 0.63 mm vertically and 1.17 ± 0.60 mm horizontally. The distal aspect of the implants showed 1.01 ± 0.82 mm and 1.06 ± 0.75 mm of marginal bone remodeling vertically and horizontally, respectively. Within the limitations of this study, marginal bone remodeling was visible, and bone levels around the external hexagon implants remain stable after 10 years of function.

Objective: The aim of this study was to evaluate the efficacy of two formulations of alprazolam (ALP) in patients undergoing oral implantology surgical procedures. Methods: A single-blinded randomized clinical study was performed with 52 volunteers (both genders) divided into 2 groups: G1 (n = 26) – oral administration of ALP (0.5 mg) 1h before surgical procedures; and G2 (n = 26) – sublingual administration of ALP (0.5mg) 30 minutes before surgery. Blood pressure (BP) and heart rate (HR) were evaluated. Corah dental anxiety scale (COR), visual analogic scale (VAS), Trieger test (TRI) and the perception questionnaire (PQ) were used to assess the level of anxiety and responses to formulations, respectively. All parameters were evaluated at three times (be-fore, during and postoperative). Results: For BP and HR no statistically significant differences were observed between periods for G1 and G2 (p> 0.05). For COR, most volunteers were classi-fied such as anxious or very anxious. For VAS, decreased anxiety was significant (p< 0.05) and no statistically significant differences between the two groups both in the period “pre” (p= 0.18) and “post” (p= 0.12) were observed. For TRI, there were no significant differences between the periods considering the number of points lost (p> 0.05). The anxiety reduction was significant (p< 0.05) for both formulations. As for PQ, both formulations showed good volunteers’ acceptance (p> 0.05), and they have not reported anterograde amnesia. Conclusion: It was concluded that both formulations were effective for sedation of the evaluated volunteers.

Purpose: The aim of this study was to evaluate the influence of the implant diameter on marginal bone remodeling around dental implants replacing single molars after a follow-up period of 3 to 6 years. Materials and Methods: Patients who received dental implants with an external hexagon platform in healed sites to support a single metal-ceramic crown in the molar region were recalled to the office. The implantation sites and implant length information were recorded, and the implants were divided according to the implant diameter: regular (RP) or wide (WP). Each implant was assessed by digital periapical radiography, using a sensor holder for the paralleling technique. The marginal bone remodeling was determined as the distance from the implant platform to the first bone-to-implant contact, and the known implant length was used to calibrate the images in the computer software. The follow-up measurements were compared with those obtained from the radiograph taken at the time of prosthetic loading to determine the late bone remodeling. The independent t test was used to compare data. Results: A total of 67 implants from 46 patients were evaluated with a mean follow-up period of 4.5 ± 1.0 years. The RP group comprised 36 implants from 29 patients (mean age: 58.3 ± 10.6 years), while 31 implants from 17 patients (mean age: 56.9 ± 11.5 years) were included in the WP group. The RP group presented lower survival rates (86.1%) than the WP group (100.0%). Similar marginal bone loss (P < .05) was identified for the RP and WP groups (1.35 ± 0.96 mm and 1.06 ± 0.70 mm, respectively). Conclusion: Although wide-diameter implants exhibited lower incidence failures, the bone levels were similar after the prosthetic loading around regular- and wide-diameter implants supporting single molar crowns.

Purpose: To evaluate the influence of the collar surface topography on peri-implant marginal bone preservation. Materials and Methods: A total of 156 patients who received at least one cylindrical implant of regular diameter with an external-hexagon platform in the posterior region of the maxilla or mandible were recalled to the office for a retrospective evaluation. Implantation sites and implant length information were recorded, and implants were divided according to the collar surface topography: machined (M) or rough (R) surface. Each implant was assessed by digital periapical radiography, using a sensor holder for the paralleling technique. The marginal bone remodeling was determined as the distance from the implant platform to the first bone-to-implant contact, and the known implant length was used to calibrate the images in the computer software. The follow-up measurements were compared with those obtained from the radiograph taken at the time of prosthetic loading to determine the late bone remodeling. An independent t test was used to compare data. Results: From 138 patients who attended the recall, 242 implants (M = 126; R = 116) were evaluated with a mean follow-up period of 4.6 ± 0.9 years. Similar success rates were found in both groups (M = 95.0%; R = 95.9%). Late bone remodeling in the maxilla was not influenced by the implant collar (P = .504); however, lower marginal bone loss was observed in the R group (1.20 ± 0.52 mm) compared with the M group (1.58 ± 0.73 mm) in the mandible (P = .007). Conclusion: Although the implant collar design did not influence the success rate of dental implants, the rough collar design reduced the late marginal bone remodeling around external-hexagon implants in the mandible. The maxilla was not benefited by the rough collar design.

Objectives: The aim of this study was to evaluate the 12-year clinical performance of sintered (Duceram, Dentsply-Degussa, Dentsply International Inc., PA, USA)—D and pressable (IPS Empress, Ivoclar-Vivadent, Schaan, Leichtenstein)—IPS ceramic inlay and onlay restorations. Methods: Eighty-six restorations were placed in 35 patients with a median age of 33 years by a single operator. The restorations were luted with dual-cured resin luting material (Variolink II, Ivoclar-Vivadent, Schaan, Leichtenstein) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at the baseline, 1, 2, 3, 5, and 12 years using the modified USPHS criteria. Results: At the 12-year recall, 22 patients were evaluated (62.86 %), totalling 48 (55.81 %) restorations. Seven restorations were fractured (one from Duceram and six from IPS), eight restorations presented secondary caries (three from Duceram and five from IPS), nine restorations showed unacceptable defects at the restoration margin and needed repair or replacement (two from Duceram and seven from IPS), and four IPS restorations presented pulp sensitivity. Conclusion: Chi-square and Mann-Whitney tests revealed that IPS Empress system showed the best results for color match and surface texture (p < 0.05) but a significant worse result for fracture (p = 0.05). Wilcoxon test showed significant differences in relation to color match, surface texture, marginal discoloration, and marginal integrity between the baseline and 12-year recall for both ceramic systems. Clinical significance: This long-term clinical study observed that the main reasons for failure of ceramic restorations were related to fracture, recurrent caries, and decreased marginal integrity over time. Carefully monitoring of the ceramic-tooth interface may extend their clinical longevity.

To evaluate the fracture resistance after the thermal and mechanical fatigue of feldspathic, lithium disilicate, and resin-modified CAD/CAM monolithic crowns cemented onto a universal post abutment.A right second mandibular molar was designed in CAD/CAM software, and 30 crowns were machined using three different materials (n = 10): feldspathic ceramic, finished only with a glaze cycle (G1); lithium disilicate, sintered and finished with a glaze cycle (G2); and resin, modified by nanoceramic and finished with rubber (G3). All crowns were cemented under a constant 50 N load, the excess cement was removed, and the crowns were light-cured for 30 seconds. After being immersed in deionized water for 7 days, the crowns were submitted to thermal cycling, which consisted of varying the temperature from 2 to 50°C for 350,000 cycles, and mechanical cycling in a fatigue simulator, where a 250 N load was applied for 1,000,000 cycles at 2 Hz. The resistance of each crown was verified in a compression-to-failure test at 1 mm/min in a universal test machine. The groups were compared using one-way ANOVA with a Bonferroni post hoc test and Weibull statistics.The resin-modified group was the least resistant group (1755 ± 124 N), followed by the feldspathic (2147 ± 412 N) and lithium disilicate groups (2804 ± 303 N). The Weibull statistics demonstrated that lithium disilicate is the most reliable material and has the lowest fracture probability.It was possible to conclude that all of the tested CAD/CAM materials can be used as monolithic, implant-supported molar crowns.

Algorithmic models have been proposed to explain adaptive behavior of bone to loading; however, these models have not been applied to explain the biomechanics of short dental implants. Purpose of present study was to simulate bone remodeling around single implants of different lengths using mechanoregulatory tissue differentiation model derived from the Stanford theory, using finite elements analysis (FEA) and to validate the theoretical prediction with the clinical findings of crestal bone loss. Loading cycles were applied on 7-, 10-, or 13-mm-long dental implants to simulate daily mastication and bone remodeling was assessed by changes in the strain energy density of bone after a 3, 6, and 12 months of function. Moreover, clinical findings of marginal bone loss in 45 patients rehabilitated with same implant designs used in the simulation (n = 15) were computed to validate the theoretical results. FEA analysis showed that although the bone density values reduced over time in the cortical bone for all groups, bone remodeling was independent of implant length. Clinical data showed a similar pattern of bone resorption compared with the data generated from mathematical analyses, independent of implant length. The results of this study showed that the mechanoregulatory tissue model could be employed in monitoring the morphological changes in bone that is subjected to biomechanical loads. In addition, the implant length did not influence the bone remodeling around single dental implants during the first year of loading.

Purpose To compare the fracture resistance before and after cyclic fatigue assays of ceramic crowns with customized zirconia abutments when screw retained and cemented onto implants. Materials and Methods The sample of this study consisted of 40 ceramic crowns with zirconia infrastructure fixed onto external hexagonal implants. The crowns were distributed into two groups (n = 20): Screw-retained and cemented crowns. Half the crowns of each group (n = 10) underwent compression until fracture and the other half (n = 10) underwent cyclic fatigue and subsequent compression until fracture. The cyclic fatigue test was carried out using an electromechanical fatigue device (loads from 0 to 100 N, 2 Hz frequency, in distilled water, at 37°C for a period of 1 million cycles). The compression test was carried out using a universal testing machine with a 0.5 mm/min speed and 5 KN load cell. After fracture, the crowns were classified according to the type of fracture. Student's t test (p < 0.05) was used for statistical analysis. Results The cyclic fatigue altered neither the mean fracture resistance of the screw-retained crowns (before = 1068.31 N, after = 891.49 N; p > 0.05) nor that of the cemented crowns (before = 2117.78 N; after = 2094.81 N; p > 0.05); however, the mean fracture resistance of the cemented crowns was higher than that of the screw-retained crowns both before (p < 0.001) and after (p < 0.001) the cyclic fatigue. Fractures occurred most frequently in the ceramic veneer, followed by fracture of some of the copings. Conclusion The ceramic crowns cemented onto the customized zirconia abutments offered greater fracture resistance than ceramic crowns with customized zirconia abutments screw retained onto implants. The cyclic fatigue did not seem to influence the fracture resistance of these crowns, whether cemented or screw retained onto implants. Fracture of the veneering ceramic was the predominant failure in this study.

The aim of this study was to verify whether screw abutment lubrication can generate higher preload values compared to non-lubricated screws, a titanium abutment was screwed onto an implant analog and scanned with the Procera System to generate 20 zirconia abutments. MKIII Brånemark implants were clamped to a precision torque device, and the abutments were distributed in dry and wet groups with 10 specimens each. In the wet groups, the inner threads of the implants were filled with artificial saliva. All abutments were fastened with a Torqtite screw under 32 Ncm. Ten detorque measurements were performed per group pushing the reverse button of the Torque controller soon after screw tightening with values registered. The mean detorque values were calculated and compared by a Student's t test (?=0.05). The wet condition presented significantly higher mean detorque than the dry condition (31.5 ± 1.2 versus 27.5 ± 1.5 Ncm, respectively; p=0.0000024). In conclusion, there was always a loss in the initial torque values when the removal torque was measured under both conditions. The wet condition presented higher mean torque than the dry condition. Better preload values were established in the wet group, suggesting that the abutment screw must be lubricated in saliva to avoid further loosening. A fim de verificar se a lubrificação do parafuso do pilar pode gerar valores maiores de pré-carga do que nos parafusos não lubrificados, um pilar de titânio foi parafusado no análogo do implante e escaneado pelo Sistema Procera para gerar 20 pilares de zircônia. Depois, os implantes MKIII Brånemark foram presos num dispositivo de torque. Os pilares foram distribuídos em grupos seco e úmido com 10 amostras cada. No grupo úmido, as roscas internas dos implantes foram preenchidas com saliva artificial. Então, todos os pilares foram apertados com parafuso Torqtite a 32 Ncm. Dez medidas de destorque foram realizadas por grupo apertando-se o botão reverso do Torque Controller logo depois do parafusamento, e os valores foram registrados. As medias de destorque foram calculadas e comparadas pelo teste t de Student (?=0,05). Os valores médios obtidos nas condições seca e úmida foram 27,5 ± 1,5 Ncm e 31,7 ± 1,2 Ncm, respectivamente. Diferenças estatisticamente significantes foram observadas (p=0,0000024). Observou-se sempre existir uma perda do torque inicial quando o torque de remoção é mensurado em ambas as condições. A condição úmida demonstrou um valor médio maior de torque do que a condição seca. Valores melhores de pré-carga podem ser estabelecidos no grupo úmido, sugerindo que o parafuso do pilar deve ser lubrificado em saliva para evitar seu afrouxamento.

The aim of this prospective case series was to evaluate the stability of esthetic treatment after single tooth replacement in compromised sockets using the immediate dentoalveolar restoration (IDR) concept. Eighteen patients underwent immediate implant placement and IDR of bone defects. Clinical photographs were used to evaluate the gingival contour and papillae. The mean soft tissue dimensions at baseline and final follow-up were 12.85 ± 2.33 mm and 12.79 ± 2.48 mm, respectively, revealing no recession. The mean mesial and distal papillary heights increased slightly over time. Stable periimplant soft tissues and satisfactory esthetic outcomes were achieved.

Objective To evaluate healing time before loading, areas compression and tension and location of insertion on mini-implant stability. Design Six minipigs were used. Each animal received 3 mini-implants in each quadrant: 1 mini-implant was used as an unloaded control (G1, n = 24); the other 2 were loaded with 150 g-force at three time intervals (G2: immediate loading, G3: after 15 days and G4: after 30 days), with 16 mini-implant in each experimental group. After 120 days, tissue blocks of the areas of interest were harvested. Clinical analysis (exact Fisher test) determined the survival rate. Histological analysis (Kontron KS 300™, Zeiss) quantified the fractional bone-to-implant contact (%BIC) and bone area (%BA) at each healing time point, areas of interest, and insertion site (ANOVA and t tests for dependent and independent samples). Results The mini-implant survival rates were G1: 71%, G2: 50%, G3: 75% and G4: 63%, with no statistical differences between them. The groups presented similar %BIC and %BA. There were no differences between the compression and tension sides or maxillary and mandibular insertion sites. Conclusions These results suggest that low-intensity immediate or early orthodontic loading does not affect mini-implant stability, because similar histomorphometric results were observed for all the groups, with partial osseointegration of the mini-implants present.

Purpose To characterize the surface of implants from Brazilian companies by light interferometry and evaluate the level of control of the surface treatment process. Materials and methods Oral implants from the five largest Brazilian companies were evaluated topographically. The surfaces of the implants were analyzed on the tops, valleys, and flanks of the threads, totaling nine measurements for each unit. The implants and results were separated in groups by their types of surface treatment and compared with well known international implants used as references. Results The implants examined presented a mean height deviation of less than 1 μm, which was considered minimally rough, except for the SIN-SW implant (1.01 μm) and the Vulcano Actives design (1.26 μm). The surface enlargement values varied considerably in relation to the reference implant, with lower values noted in the group of implants subjected to sandblasting and acid-etching and with higher values obtained in the group treated by acid-etching and anodizing. There were statistically significant differences between batches of implants from all companies assessed, indicative of a substantial variance in implant topography from one batch to another. Conclusions The low values of roughness found in the measurements and the differences between the values of the batches suggest that these companies should consider improving their surface treatments to achieve more uniform roughness.

The rapid prototyping biomodels manufacturing is a recent technology with great importance in oral and maxillofacial surgery. It provides a better surgical planning, decrease of anesthesia time and great functional and esthetic results. The aim of this experimental study was to evaluate the accuracy of rapid prototyping biomodels built by three-dimensional printing (3DP) technique, since this is one of the least expensive methods available. Linear measurements of standardized bone defects and anatomic distances were compared using a digital caliper of high precision in nine dry mandibles (gold standard) and their respective biomodels. The Bland-Altman test was used for statistical analysis (5% level of significance). The results showed strong concordance between the dry mandibles and their respective biomodels, with discrepancies smaller than 2 mmin most cases (97.4%). We can conclude that the biomodels built by 3DP technique can be used for surgical planning in Dentistry.

This prospective case series proposes a method for selecting the diameter of immediate postextraction anterior implants and guiding the placement position of the implant based on the buccolingual dimension with the goal of preserving the buccal bone wall. The socket buccolingual distance was measured to determine the appropriate implant diameter, considering a 3-mm gap to the buccal wall. Pre- and postoperative cone-beam computed tomography images were compared to evaluate the buccal bone. The socket width measurements were not significantly different (P = .931). The mean widths of the postoperative buccal bone were 3.01 ± 0.18 mm, 2.92 ± 0.38 mm, and 2.83 ± 0.42 mm for the crestal bone at the implant platform and at 2 and 4 mm apically, respectively, after 35 months of follow-up. This new diameter selection method for implants demonstrated predictable buccal plate preservation.

An important parameter for the clinical success of dental implants is the formation of direct contact between the implant and surrounding bone, whose quality is directly influenced by the implant surface roughness. A screw-shaped design and a surface with an average roughness of Sa of 1-2 µm showed a better result. The combination of blasting and etching has been a commonly used surface treatment technique. The versatility of this type of treatment allows for a wide variation in the procedures in order to obtain the desired roughness. OBJECTIVES: To compare the roughness values and morphological characteristics of 04 brands of implants, using the same type of surface treatment. In addition, to compare the results among brands, in order to assess whether the type of treatment determines the values and the characteristics of implant surface roughness. MATERIAL AND METHODS: Three implants were purchased directly from each selected company in the market, i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01 Korean company (Oneplant). The quantitative or numerical characterization of the roughness was performed using an interferometer. The qualitative analysis of the surface topography obtained with the treatment was analyzed using scanning electron microscopy images. RESULTS: The evaluated implants showed a significant variation in roughness values: Sa for Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for the surfaces examined. CONCCLUSIONS: The surface treatment alone is not able to determine the roughness values and characteristics.

The aim of this study was to evaluate the long-term success rate of immediate occlusal loading of extrasinus zygomatic implants after an 8-year follow-up. From 62 patients who needed implant treatment in 2003, 25 patients who presented with maxillary atrophy met the inclusion criteria and agreed to participate in the study. All patients received fixed dentures under immediate occlusal loading supported by extrasinus zygomatic implants associated with anterior standard implants. No bone grafting procedures were performed. During the 8-year follow-up period, 21 patients underwent clinical evaluation and radiographic examinations every 6 months. This study conforms to the STROBE guidelines regarding prospective cohort studies. 40 extrasinus zygomatic and 74 anterior standard implants were evaluated. All patients were clinically free of signs and symptoms of sinus disturbance at all follow-up appointments. After 8 years, the success rates of extrasinus zygomatic implants, standard anterior implants and definitive prostheses were 97.5%, 95.9% and 95.2%, respectively. Within the limits of this study, immediate occlusal loading of extrasinus zygomatic implants presents a predictable treatment option for the atrophic maxilla.

Background: Immediate implant function has become an accepted treatment modality for fixed restorations in totally edentulous mandibles, whereas experience from immediate function in the edentulous maxilla is limited. Purpose: The purpose of this study was to report on the medium- and long-term outcomes of a protocol for immediate function of four implants (All-on-4™, Nobel Biocare AB, Goteborg, Sweden) supporting a fixed prosthesis in the completely edentulous maxilla. Materials and Methods: This retrospective clinical study included 242 patients with 968 immediately loaded implants (Branemark System® TiUnite™, Nobelspeedy™, Nobel Biocare AB) supporting fixed complete-arch maxillary all-acrylic prostheses. A specially designed surgical guide was used to facilitate implant positioning and tilting of the posterior implants to achieve good bone anchorage and large interimplant distance for good prosthetic support. Follow-up examinations were performed at 6 months, 1 year, and thereafter every 6 months. Radiographic assessment of the marginal bone level was performed after 3 and 5 years in function. Survival was estimated at patient level and implant level using the Kaplan–Meier product limit estimation with 95% confidence intervals. Results: Nineteen immediately loaded implants were lost in seventeen patients, giving a 5-year survival rate estimation of 93% and 98% at patient and implant level, respectively. The survival rate of the prosthesis was 100%. The marginal bone level was, on average, 1.52 mm (standard deviation [SD] 0.3 mm) and 1.95 mm (SD 0.4 mm) from the implant/abutment junction after 3 and 5 years, respectively. Conclusion: The high survival rates at patient and implant level indicates that the immediate-function concept for completely edentulous maxillae using the present protocol is viable in the medium- and long-term outcomes.

Background: The aim of this study was to evaluate the cardiovascular effects of maxillary infiltration using 2% lidocaine with 1:100 000 adrenaline, 4% articaine with 1:200 000 adrenaline, and 4% articaine with 1:100 000 adrenaline in different stages during restorative dental procedures. Methods: Twenty healthy patients randomly received 1.8 mL of the three local anaesthetics. Systolic blood pressure, average blood pressure, diastolic blood pressure, and heart rate were evaluated by the oscillometric and photoplethysmograph methods in seven stages during the appointment. Results: Statistical analysis by ANOVA and Tukey tests of cardiovascular parameters did not show significant differences between the anaesthetic associations. There were significant differences for the parameters among different clinical stages. Conclusions: The variation of cardiovascular parameters was similar for lidocaine and articaine with both adrenaline concentrations and showed no advantage of one drug over the other. Cardiovascular parameters were influenced by the stages of the dental procedures, which showed the effect of anxiety during restorative dental treatment.

Surface topography and porosity of barrier membranes is suggested to impact the soft and hard tissue response. In this study, the specific soft and hard tissue response characteristics of a synthetic polylactide membrane are evaluated including soft tissue inflammation, osteogenesis, and osteopromotion.Analysis of porosity and surface topography of the test material was performed by scanning electron microscopy. Transosseous parietal defects were surgically created bilaterally in 32 BalbC/ByJ mice and treated either with the barrier (test) or sham-operated (control). Healing was assessed histologically and histomorphometrically with quantification of bone bridging.Scanning electron microscopy analyses of the barrier revealed a microstructure resembling cancellous bone. Interconnecting pores and channels, measuring between 6 and 60 microm in diameter, formed by smooth internal walls were observed throughout the device. Two distinct patterns of porosity were observed. The external surface of the membrane was characterized by a highly porous structure, with minimal interporous nodes and average pore sizes ranging between 6 and 20 microm in diameter. The internal surface was characterized by a minimal porous structure, with significant interporous nodes and average pore sizes ranging between 18 and 60 mum in diameter. Histomorphometric analyses demonstrated increased bone bridging by 60% and 300% in membrane-treated sites after 14 and 28 days of healing, respectively. The rough surface of the barrier contained significantly more giant cells, whereas the smooth surface contained significantly more inflammatory cells.The surface topographies engineered on different sides of the barrier promote differential soft tissue responses leading, however, to similar amounts of enhanced bone formation.

Background: The existing approaches to the treatment of the atrophic maxilla are difficult and involve an element of risk. Purpose: The aim of the present study was to establish a new surgical/prosthetic protocol for the treatment of extremely atrophic maxillae using four zygomatic implants (ZIs) in an immediate loading system. Materials and Methods: Twelve patients were treated with the surgical placement of 48 ZIs, and the totally edentulous maxillae were rehabilitated with protocol-type maxillary prostheses rigidly fixed to the ZIs in an immediate loading system. Follow-up was conducted at 6 months and again at 30 months. Results: Of the 48 ZIs inserted, one implant failed to achieve osseointegration. The prosthetic components fitted well and no sinus pathology was detected in any of the patients. Conclusion: The surgical/prosthetic protocol showed that it was possible to insert four ZIs in an immediate loading system and achieve stability for up to 30 months.

OBJETIVO: este trabalho apresenta um método para expansão ortopédica da maxila, na dentadura permanente, utilizando implantes como ancoragem. METODOLOGIA: detalharam-se os procedimentos cirúrgicos e laboratoriais da confecção de um expansor com ancoragem dento-óssea em crânio seco humano. Dois implantes de titânio foram colocados na região anterior do palato, e o parafuso Hyrax adaptado de modo que a expansão ancorou-se nos implantes e nos primeiros molares permanentes. RESULTADOS: o experimento laboratorial em crânio seco mostrou que o procedimento apresenta-se anatômica e operacionalmente viável. Os implantes suportaram a força gerada pela ativação do parafuso expansor, redundando na separação transversal das hemimaxilas. CONCLUSÕES: vislumbra-se que a expansão rápida da maxila ancorada em implantes (ERMAI) poderá potencializar a eficiência da expansão ortopédica, assim como reduzir o custo periodontal dos procedimentos convencionais de expansão. Futuros estudos clínicos são necessários para testar essas hipóteses.AIM: This study presents a method for maxillary orthopedic expansion, in the permanent dentition, using implants as anchorage. METHODS: Surgical and laboratorial procedures for the construction of a tooth-bone-borne expansor was detailed in a human dry skull. Two titanium implants were placed in the anterior region of the palate and a Hyrax screw was adapted in a way that the expansion was anchored both on the palatal implants and on permanent first molars. RESULTS: The laboratorial experiment in dry skull showed that the procedure is operationally and anatomically possible. The implants supported the force generated by the expansion screw activation and the maxilla halves were transversally split. CONCLUSIONS: Rapid maxillary expansion anchored on implants can increase the efficiency of orthopedic expansion and decrease the periodontal sequela caused by conventional RME. Further clinical studies are necessary to verify these hypotheses.

OBJETIVO: este trabalho apresenta um método para expansão ortopédica da maxila, na dentadura permanente, utilizando implantes como ancoragem. METODOLOGIA: detalharam-se os procedimentos cirúrgicos e laboratoriais da confecção de um expansor com ancoragem dento-óssea em crânio seco humano. Dois implantes de titânio foram colocados na região anterior do palato, e o parafuso Hyrax adaptado de modo que a expansão ancorou-se nos implantes e nos primeiros molares permanentes. RESULTADOS: o experimento laboratorial em crânio seco mostrou que o procedimento apresenta-se anatômica e operacionalmente viável. Os implantes suportaram a força gerada pela ativação do parafuso expansor, redundando na separação transversal das hemimaxilas. CONCLUSÕES: vislumbra-se que a expansão rápida da maxila ancorada em implantes (ERMAI) poderá potencializar a eficiência da expansão ortopédica, assim como reduzir o custo periodontal dos procedimentos convencionais de expansão. Futuros estudos clínicos são necessários para testar essas hipóteses.