A new hydroxyapatite-alginate-gelatin biocomposite favor bone regeneration in a critical-sized calvarial defect model

Abstract This study aimed to evaluate the osteogenic potential of hydroxyapatite (HA), Alginate (Alg), and Gelatine (Gel) composite in a critical-size defect model in rats. Twenty-four male rats were divided into three groups: a negative control with no treatment (Control group), a positive control treated with deproteinized bovine bone mineral (DBBM group), and the experimental group treated with the new HA-Alg-Gel composite (HA-Alg-Gel group). A critical size defect (8.5mm) was made in the rat's calvaria, and the bone formation was evaluated by in vivo microcomputed tomography analysis (µCT) after 1, 15, 45, and 90 days. After 90 days, the animals were euthanized and histological and histomorphometric analyses were performed. A higher proportion of mineralized tissue/biomaterial was observed in the DBBM group when compared to the HA-Alg-Gel and Control groups in the µCT analysis during all analysis periods. However, no differences were observed in the mineralized tissue/biomaterial proportion observed on day 1 (immediate postoperative) in comparison to later periods of analysis in all groups. In the histomorphometric analysis, the HA-Alg-Gel and Control groups showed higher bone formation than the DBBM group. Moreover, in histological analysis, five samples of the HA-Alg-Gal group exhibited formed bone spicules adjacent to the graft granules against only two of eight samples in the DBBM group. Both graft materials ensured the maintenance of defect bone thickness, while a tissue thickness reduction was observed in the control group. In conclusion, this study demonstrated the osteoconductive potential of HA-Alg-Gel bone graft by supporting new bone formation around its particles.

Resumo Este estudo teve como objetivo avaliar o potencial osteogênico de um compósito de hidroxiapatita (HA), alginato (Alg) e gelatina (Gel) em um modelo de defeito de tamanho crítico em ratos. Vinte e quatro ratos machos foram divididos em três grupos: um controle negativo sem tratamento (grupo controle), um controle positivo tratado com osso bovino desproteinizado (grupo DBBM) e o grupo experimental tratado com o novo compósito HA-Alg-Gel (grupo HA-Alg-Gel). Um defeito de tamanho crítico (8,5mm) foi feito na calvária dos ratos, e a formação óssea foi avaliada por análise de microtomografia computadorizada in vivo (µCT) após 1, 15, 45 e 90 dias. Após 90 dias, os animais foram eutanasiados e análises histológicas e histomorfométricas foram realizadas. Uma maior proporção de tecido mineralizado/biomaterial foi observada no grupo DBBM quando comparado aos grupos HA-Alg-Gel e controle na análise de µCT durante todos os períodos de análise. Entretanto, não foram observadas diferenças na proporção tecido mineralizado/biomaterial no dia 1 (pós-operatório imediato) em relação aos períodos posteriores de análise em todos os grupos. Na análise histomorfométrica, os grupos HA-Alg-Gel e controle apresentaram maior formação óssea do que o grupo DBBM. Além disso, na análise histológica, cinco amostras do grupo HA-Alg-Gal exibiram espículas ósseas formadas adjacentes aos grânulos do enxerto contra apenas duas das oito amostras do grupo DBBM. Ambos os materiais de enxerto garantiram a manutenção da espessura óssea do defeito, enquanto uma redução da espessura do tecido foi observada no grupo controle. Em conclusão, este estudo demonstrou o potencial osteocondutor do enxerto ósseo de HA-Alg-Gel, promovendo a formação de osso novo ao redor das suas partículas.

Patient-, implant- and prosthetic-related factors on peri-implant mucositis and bone loss

Abstract Peri-implant diseases, including peri-implant mucositis (PIM) and peri-implantitis, are a chronic inflammatory disorder triggered by bacterial biofilm in susceptible hosts. Potential risk factors for peri-implant diseases include smoking, dental plaque accumulation, poor oral hygiene, genetics, and absence of peri-implant keratinized mucosa. This cohort study aimed to evaluate the influence of patient-, implant-, and prosthetic-related factors on PIM and peri-implant bone loss (PBL) around dental implants after 1 year of loading. A total of 54 subjects (22 males and 32 females) were included in the study. Peri-implant clinical parameters were assessed and standardized periapical radiographs of each dental implant were obtained 15 days after the definitive prosthesis installation (baseline) and at 3, 6, and 12 months of follow-up. A total of 173 implants were evaluated. PIM affected 44.8% of the implants and no significant association was found between the investigated parameters and PIM incidence, except for type of implant connection. A significantly higher incidence of PIM (80.0%) was observed for implants with internal hexagon connection type after 1 year of follow-up (p = 0.015). Moreover, a mean PBL of 0.35 ± 1.89 mm was observed and no dental implant was affected by peri-implantitis after 1 year of function. No specific influence of patient, implant, or prosthetic factors on PBL was observed. No association was found between the occurrence of PIM/PBL and the patient-, implant-, and prosthetic-related factors investigated in this cohort study, except for the type of dental-implant connection.

Histomorphometric comparison of two different preclinical models to evaluate the bone repair in grafted areas

Aim: This study was performed to compare two different rat defect models (critical calvaria defects versus guided bone regeneration in the mandibular ramus) used to evaluate bone repair in grafted areas. Methods: A total of 12 rats were allocated in two groups according the experimental model used to evaluate the bone repair in grafted areas: a critical sized-calvaria defect of 5 mm filled with bone graft (n=6) and a mandibular ramus filled with the bone graft associated with a Teflon dome-shaped membrane (n=6). Both groups were grafted with deproteinized bovine bone graft. After 60 days, the animals were euthanized and the samples obtained were submitted to histomorphometry analysis to evaluate the relative amount of bone, remaining bone substitute, and soft tissue within the grafted areas. Results: No differences were observed between the preclinical models evaluated in relation to the amount of bone tissue formation (19.93 ± 4.55% in calvaria vs. 21.00 ± 8.20% in mandible). However, there was a smaller amount of soft tissue (43.20 ± 10.97% vs. 57.79 ± 7.61 %; p<0.01) and a greater amount of bone substitute remaining (35.80 ± 5.52% vs. 22.28 ± 4.36 %; p<0.05) in the grafted areas in the mandible compared to calvaria defect. Conclusion: Preclinical models for the analysis of bone repair in grafted areas in the mandible and critical sized-calvaria defects showed different responses in relation to the amount of soft tissue and bone substitute remnants

Root coverage with platelet-rich fibrin or connective tissue graft: a split-mouth randomized trial

Abstract: This study aimed to compare the use of connective tissue grafts (CTG) and platelet-rich fibrin (PRF) associated with the tunnel technique (TT) for the treatment of multiple gingival recessions (GR). Fourteen patients with multiple bilateral GR [type 1 recession (RT 1)] in the maxillary incisors, canines, and/or premolars were included. The TT was performed on both sides (split-mouth model); CTG (36 GR) was used on one side, and on the other, PRF (36 GR) was used. Clinical parameters, including recession depth (RD), probing depth, clinical attachment level (CAL), and keratinized gingiva thickness/width (GT/KTW), were obtained at baseline and after 1, 3, 6, and 16 months. Lower RD (0.81 ± 0.68 vs. 1.23 ± 0.71 mm) and CAL (2.54 ± 0.63 vs. 2.73 ± 0.82 mm) were observed for CTG compared to PRF after 16 months. Higher GT was obtained for CTG compared to PRF after 3 (1.81 ± 0.56 vs 1.43 ± 0.47 mm) and 6 months (1.67 ± 0.61 vs. 1.38 ± 0.55 mm, p < 0.05). The recession coverage (RC) was higher for CTG (55.42% ± 37.14) in comparison to PRF (29.53% ± 34.08) after 16 months (p < 0.05). Similarly, CTG presented a more complete coverage of the recession (15; 41.66%) than PRF (9; 24.32%). There were no significant differences between the groups in terms of surgery time, postoperative pain, or healing patterns. Greater esthetic satisfaction was obtained with CTG. It was concluded that CTG combined with TT showed clinical and esthetic results superior to those of PRF in multiple GR treatments.

Association between platelet-rich fibrin and collagen matrix for root coverage: Case Series

ABSTRACT: The aim of this case series was to evaluate the effectiveness of the collagen matrix (CM) associated with platelet-rich fibrin (PRF) in the treatment of gingival recession (GR). Six non-smoker patients that presented at least one site with single GR in the maxilla were included. Four GR were treated with conventional coronally advanced flap and six GR were treated with a modified coronally advanced tunnel technique. In both techniques, the PRF was immobilized above the CM. A reduction in the GR depth (2.00 mm (1.50-3.50) to 0.00 (0.00-0.00)) and pocket probing depth (1.25 mm (1.00-2.00) to 1.00 mm (1.00-1.62)) resulting in complete root coverage in all GR after 1 month. However, a displacement of the marginal gingival of 0.50 (0.00-1.00) associated with a gingival thickness reduction (1.35 (0.90-1.82)) was observed after 12 months. The association of the CM and PRF was effective in the GR coverage.

Color stability of conventional and bulk fill composite resins / Estabilidade cromática de resinas convencionais e resinas bulk fill

ABSTRACT Objective: This study compared the color stability of different dental composite resins after prolonged exposure to a coffee solution. Methods: Sixty-four cylindrical discs (10 mm diameter x 2 mm thickness) were prepared using 8 different dental composite resins (n=8, per group). The specimens were first immersed in artificial saliva for 24 h followed by immersion in a coffee solution for 14 days. The assessment of chromatic variation (ΔE) was performed with the aid of a Vita Easyshade Advanced spectrophotometer (VITA Zahnfabrik, Bad Sackingen, Germany). The color of each specimen was calculated based on the L*, a* and b* coordinates of the CIELab system. Results: Grandio SO had the lowest average chromatic variation (ΔE=7.77) after immersion in coffee solution. Durafill VS, Grandio and Z350 XT (ΔE=8.58; ΔE=9.52; ΔE=10.39, respectively) showed similar chromatic variation, with no statistical difference in relation to Grandio SO. However, the other dental composite resins evaluated showed statistically higher values of ΔE compared to Grandio SO, and Enamel HRi (ΔE=20.56) demonstrated the highest chromatic variation. Conclusion: The Bulk Fill and hybrid composite resins from the same manufacturer (Micerium, Avegno, Italy) showed greater chromatic variation than the other composite resins tested. Grandio SO (Voco, Cuxaven, Germany) had the lowest ΔE variation.

RESUMO Objetivo: Comparar diferentes resinas compostas em relação á estabilidade de cor após exposição prolongada em solução de café. Métodos: Sessenta e quatro discos cilíndricos (10mm x 2mm) foram confeccionados a partir de 8 diferentes marcas comerciais de compósitos (n= 8 por grupo); os espécimes foram imersos em saliva artificial, e posteriormente em café, sendo por conseguinte feita a avaliação da variação cromática (ΔE), utilizando espectrofotômetro Vita Easyshade Advanced (VITA Zahnfabrik, Bad Sackingen, Germany). O padrão de cada espécime foi medido examinando as coordenadas L*, a* e b* do sistema CIELab. Resultados: A resina composta Grandio SO apresentou a menor média de variação cromática (ΔE= 7,77) após a imersão em solução de café. Semelhantemente, a variação cromática das resinas compostas Durafill VS, Grandio e Z350 XT (ΔE=8,58; ΔE=9,52; ΔE=10.39) que não apresentaram diferença estatística. Todavia, as demais resinas compostas avaliadas apresentaram valores estatisticamente maiores de ΔE em relação a resina Grandio SO, sendo que a resina Enamel HRi (ΔE= 20,56) apresentou a maior variação cromática registrada. Conclusão: As resinas da categoria bulk fill e as resinas híbridas produzidas pelo mesmo fabricante (Micerium, Avegno, Itália) tiveram alterações cromáticas superiores às demais resinas testadas sendo que a resina GrandioSO (Voco, Cuxaven, Alemanha) foi a que apresentou menor alteração de ∆E.

Tratamento de recessões múltiplas bilaterais com matriz colágena (Mucograft) e enxerto de conjuntivo / Treatment of bilateral multiple recessions with connective tissue graft and collagen matrix (Mucograft)

Atualmente, várias abordagens cirúrgicas têm sido propostas para o tratamento das recessões gengivais. Dentre as técnicas descritas, o uso do enxerto de tecido conjuntivo demonstrou ser efi caz e previsível, sendo considerado o padrão-ouro para o recobrimento radicular. No entanto, essa técnica demanda mais tempo operatório devido à necessidade de um segundo sítio cirúrgico para a remoção do enxerto, podendo aumentar a morbidade e o desconforto ao paciente. Visando reduzir essa possibilidade, novos biomateriais têm sido propostos, incluindo as membranas de colágeno de origem suína. O objetivo desse relato de caso foi comparar o recobrimento radicular de recessões múltiplas, utilizando a matriz de colágeno Mucograft e o enxerto de tecido conjuntivo, após 12 meses de acompanhamento.

Currently several surgical approaches have been proposed for the treatment of gingival recessions. Among the techniques described, the use of the connective tissue graft was shown to be effective and predictable, being considered the gold standard for root coverage. However, this technique requires more operative time due to the need for a second surgical site for graft removal, which may increase morbidity and discomfort for the patient. Aiming to reduce discomfort to the patient, new biomaterials have been proposed including porcine collagen membranes. The objective of this clinical case report was to compare the root coverage of multiple recessions using the Mucograft collagen matrix and the connective tissue graft after 12 months of follow-up.

Analysis of polymorphisms in Interleukin 10, NOS2A, and ESR2 genes in chronic and aggressive periodontitis

Abstract The objective of this study was to investigate the association between single nucleotide polymorphisms (SNPs) in the IL10, NOS2A, and ESR2 genes and chronic periodontitis (CP) and aggressive periodontitis (AgP). Three groups of patients underwent periodontal and radiographic evaluations: CP (n = 61), AgP (n = 50), and periodontally healthy (control group=61). Genomic DNA was extracted from oral epithelial cells and used for genotyping by real-time polymerase chain reaction using TaqMan® probes. The investigated SNPs were: -1087G > A, -819C > T and -592C > A in the IL10; +2087G > A in the NOS2A, and +1730G > A in the ESR2 gene. Differences in genotype and allele frequencies of each polymorphism and some individual characteristics were analyzed using the chi-square test and multivariate logistic regression analysis. Analysis of SNPs and haplotypes in the IL10 and SNP in the ESR2 gene did not present any significant association with AgP or CP. The +2087G allele of the NOS2A gene tended to be significantly associated with periodontal disease. Patients carrying the genotype +2087GG in the NOS2A gene were genetically protected against the development of CP (p = 0.05; OR = 0.44; 95%CI = 0.20-0.95). This result showed greater significance when patients with AgP and CP were combined (total PD) (p = 0.03; OR = 0.46; 95%CI = 0.23-0.92). In conclusion, the studied Brazilian population had a significantly higher frequency of the GG genotype for the +2087 SNP in the NOS2A gene in individuals without periodontitis, although statistical significance was not maintained after multiple logistic regression.

Interação entre odontologia restauradora e periodontia. Parte 2: reanatomização dentária / Periodontics and restorative dentistry integrated. Part 2: dental reanatomization

O avanço no desenvolvimento de novos materiais odontológicos ampliou as modalidades terapêuticas, garantindo excelência nos tratamentos restauradores estéticos. Sendo assim, os procedimentos restauradores diretos têm sido utilizados em casos de reanatomização dentária, possibilitando tratamento eficaz, de baixo custo, além de preservar estrutura dentária sadia. No entanto, domínio clínico do material e das técnicas a ser realizadas é necessário pra garantir longevidade e sucesso no procedimento restaurador direto. O objetivo do artigo é descrever, após a finalização dos procedimentos cirúrgicos periodontais, a etapa restauradora direta realizada para reanatomização dentária e fechamento das diastemas presentes. A integração entre a Odontologia Restauradora e a Periodontia possibilitou o restabelecimento da harmonia do sorriso de forma conservadora, garantindo estética e satisfação da paciente

The development of new dental materials has expanded dental therapeutic modalities ensuring excellence in aesthetic restorative treatments. Thus, the direct restorative procedures have been used in cases of dental reconstruction allowing an effective treatment with a low cost, while preserving healthy tooth structure. However, the clinician must be used to the techniques and the material in order to ensure longevity and success in the direct restorative procedure. The aim of this paper is to describe, after completion of periodontal surgical procedures, the direct restorative step performed for dental reconstruction and diastema closure. The integration between Restorative Dentistry and Periodontics enabled the restoration of a harmonious smile in a conservative manner, ensuring aesthetics and patient satisfaction

Interação entre odontologia restauradora e periodontia. Parte 1: planejamento e protocolo cirúrgico / Interaction of periodontics and restorative dentistry. Part 1: treatment planning and surgical protocol

Os tratamentos odontológicos atuais buscam alternativas terapêuticas para obtenção da estética bucal e do restabelecimento funcional. O aumento da exigência por altos padrões estéticos estimula uma interação entre as diversas especialidades odontológicas, propondo um tratamento global que resulta na efetiva resolução do caso. Além disso, o conhecimento dos elementos responsáveis pela harmonia do sorriso é essencial para o planejamento e execução do tratamento, além do domínio das alterações que podem afetar a aparência geral responsável pela insatisfação estética do paciente. O artigo refere-se a um tratamento multidisciplinar que envolve a interação entre as áreas da periodontia e odontologia restauradora. Após o planejamento cirúrgico-restaurador, os procedimentos periodontais foram realizados, om o objetivo de recuperar o equilíbrio entre o arranjo dentário e o tecido gengival.

Current dental treatments search for alternatives to achieve reestablishment of esthetics and function. The increased demand for high esthetic patterns stimulates an interaction between the dental specialties towards a comprehensive treatment in order to solve clinical cases effectively. Knowing the components involved in the dental smile harmony is essential for treatment planning and implementation. It is also important to be aware of the changes that may impair such harmony and become a patient’s complaint. This article addresses a multidisciplinary treatment that involved the integration between periodontics and restorative dentistry. After the surgical-restorative planning, periodontal procedures were performed to obtain an adequate balance between the teeth and soft tissues.

Interação multidisciplinar para reabilitação de um dente posterior com sistema IPS E. MAX / Multidisciplinary approach to restore a posterior teeth with IPS e. max system

A Odontologia atual está constantemente aprimorando os tratamentos odontológicos com terapias conservadoras que restabelecem a função, preservando a saúde dos tecidos bucais e a estética. No entanto, as novas terapias também exigem a realização de planos de tratamentos multidisciplinares para obtenção de sucesso clinico e satisfação do paciente. A Periodontia tem ampliado sua abordagem terapêutica para facilitar/possibilitar a realização de tratamentos restauradores, visando à manutenção da integridade dos dentes após o procedimento restaurador. O caso clinico relata um tratamento multidisciplinar envolvendo Dentística, Endodontia e Periodontia, para reabilitação de um elemento unitário posterior afetado por uma lesão de cárie extensa com invasão do espaço biológico. Realizou-se aumento de coroa com osteotomia no dente 36 para recuperar este espaço biológico. Além disso, foi necessária a realização do tratamento endodôntico seguido do procedimento restaurador. Indicou-se realização de uma onlay cerâmica do sistema IPS e.max Press (Ivoclar), devido às exigências mecânicas do caso. O tratamento planejado garantiu função e resistência adequada, preservando os tecidos bucais. Concluiu-se que a abordagem multidisciplinar possibilitou a realização de um tratamento conservador que ofereceu satisfação ao paciente, preservando sua saúde bucal.

Avaliação de compósitos à base de celulose bacteriana-hidroxiapatita com peptídeo osteogênico para reparação óssea / Evaluation of bacterial cellulose/hydroxyapatite nanocomposite with osteogenic growth factor for bone repair

A celulose bacteriana (CB) é um biopolímero sob a forma de hidrogel nanoestruturado, o qual é uma excelente matriz para incorporação de outros compostos, e nos últimos anos a CB tem demonstrado resultados promissores para reparação tecidual. Além disso, compósitos baseados em CB e hidroxiapatita (CB-HA) são osteocondutores, e quando este compósito associado a peptídeos como OGP (osteogenic growth peptide) e a sua sequência C-terminal o pentapeptídeo OGP(10-14) poderão proporcionar-lhe propriedade osteoindutora. O presente estudo avaliou os compósitos CB-HA associados ou não a estes peptídeos para reparação óssea de defeitos críticos em calvária de camundongos. Os grupos experimentais avaliados foram CB-HA, CB-HA OGP, CB-HA OGP(10-14) e controle, nos respectivos períodos de análise: 3, 7, 15, 30, 60 e 90 dias. Após 3 dias de pós-operatório, as membranas CB-HA OGP e CB-HA OGP(10-14) promoveram maiores níveis de expressão dos principais genes marcadores de formação óssea. Além disso, após 7 dias foi observado na análise histomorfométrica que as membranas CB-HA e CB-HA OGP(10-14) promoveram maior neoformação óssea. Semelhantemente, essas membranas apresentaram maiores porcentagens de neoformação óssea como foi observado na microtomografia computadorizada nos períodos de 60 e 90 dias. Maiores níveis de expressão de alguns biomarcadores ósseos, como Alpl, Spp1 e Tnfrsf11b também foram observados para as mesmas membranas em 60 e 90 dias de pós-operatório. Conclui-se que os materiais CB-HA e CB-HA OGP(10-14) apresentaram melhor potencial na reparação óssea em defeitos críticos em calvária de camundongos, destacando o papel osteoindutor nos períodos iniciais de formação óssea da membrana de CB-HA OGP (10-14).

Bacterial cellulose (BC) is a biopolymer in the form nanostructured hydrogel, which is an excellent matrix for the incorporation of others compounds, and at last years, BC has demonstrated promising results for tissue repair. In addition, composites based on BC and hydroxyapatite (BC-HA) is osteoconductor; and when this BC-HA composite associated with the osteogenic growth peptide (OGP) or its C-terminal sequence the pentapeptide OGP (10-14) could be provide osteoinductive properties. This study aimed to evaluate the potential of BCHA composites with or without OGP and OGP (10-14) in bone repair in critical-size calvarial defect in mice. The analyzed experimental groups were BC-HA, BC-HA-OGP, BC-HA-OGP (10-14) and control group in the respective periods: 3, 7, 15, 30, 60 and 90 days of postoperative. After 3 days of postoperative, bone biomarkers were upregulated mainly by BCHA OGP and BC-HA OGP (10-14) membranes. In addition, a higher new bone formation was observed in the histomorphometric analysis for BC-HA and BC-HA OGP (10-14) membranes 7 days of postoperative. Similarly, in 60 and 90 days, high percentage of bone formation could be observed in micro-computed tomography analysis for BC-HA and BC-HA OGP (10-14) membranes. High expression of some bone biomarkers, such as Alpl, Spp1 and Tnfrsf11b were also observed for the same membranes 60 and 90 days of postoperative in mice calvarial. In conclusion, the BC-HA and BC-HA OGP (10-14) membranes promoted a better bone formation in critical-size calvarial defects in mice, mainly the BC-HA OGP (10-14) nanocomposite in the early periods of bone repai