Una Nueva Alternativa para la Creación de Papilas en Implantes de Carga inmediata: Reporte de Caso / A New Alternative for the Creation of Papillae in Immediate Loading Implants: Case Report

RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.

ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.

Extracellular calcium increases fibroblast growth factor 2 gene expression via extracellular signal-regulated kinase 1/2 and protein kinase A signaling in mouse dental papilla cells

Abstract We previously reported that elevated extracellular calcium (Ca2+) levels increase bone morphogenetic protein 2 expression in human dental pulp (hDP) cells. However, it is unknown whether extracellular Ca2+ affects the expression of other growth factors such as fibroblast growth factor 2 (FGF2). Objective: The present study aimed to examine the effect of extracellular Ca2+ on FGF2 gene expression in hDP and immortalized mouse dental papilla (mDP) cells. Materials and Methods: Cells were stimulated with 10 mM CaCl2 in the presence or absence of cell signaling inhibitors. FGF2 gene expression was assessed using real-time polymerase chain reaction. The phosphorylation status of signaling molecules was examined by Western blotting. Results: Extracellular Ca2+ increased FGF2 gene expression in mDP and hDP cells. Gene expression of the calcium-sensing receptor and G protein-coupled receptor family C group 6 member A, both of which are extracellular Ca2+ sensors, was not detected. Ca2+-mediated Fgf2 expression was reduced by pretreatment with the protein kinase A (PKA) inhibitor H-89 or extracellular signal-regulated kinase (ERK) 1/2 inhibitor PD98059 but not by pretreatment with the protein kinase C inhibitor GF-109203X or p38 inhibitor SB203580. Extracellular Ca2+ increased PKA activity and ERK1/2 phosphorylation. Ca2+-induced PKA activity decreased by pretreatment with PD98059. Conclusions: These findings indicate that elevated extracellular Ca2+ levels led to increased Fgf2 expression through ERK1/2 and PKA in mDP cells and that this mechanism may be useful for designing regenerative therapies for dentin.

Reconstrucción de la papila gingival alrededor del implante mediante técnica novedosa / Papilla reconstruction around the implant using novel technique

La reconstrucción de la estética gingival (rosada) es un tema importante en la odontología implanto-soportada moderna, y cualquier resultado estético comprometido se considera un fracaso. En la literatura se proponen variados enfoques quirúrgicos y no quirúrgicos para reconstruir la papila interdental perdida. En esta técnica modificada, el extremo distal del injerto pediculado fue dividido en dos partes creando una estructura bífida, que luego se colocó alrededor del pilar y suturó por vestibular. Esta técnica dio como resultado un aumento significativo de volumen de la papila en las direcciones coronaria y vestibular. El injerto de tejido conectivo pediculado subepitelial asociado con un colgajo coronalmente desplazado parece ser un abordaje viable para el tratamiento de la papila ausente, asociado con restauraciones implanto-soportadas.

Rebuilding the pink esthetic is an important issue in modern esthetic implant dentistry, and any compromised esthetic results following implant-supported restorations are considered failures. Several surgical and nonsurgical approaches are proposed in the literature to reconstruct the lost interdental papilla. In this modified technique the distal end of the pedicle graft was divided into two parts creating a bifid, which were then placed around the abutment and sutured on the facial aspect. This technique resulted in a significant gain of papillary volume in both coronal and facial directions. The subepithelial connective pedicle graft associated with a coronally advanced flap seems to be a viable approach for the treatment of missing papilla associated with implant-supported restorations.

Relationship between crown form of upper central incisors and papilla filling in Chinese Han-nationality youth / 北京大学学报(医学版)

Objective:To explore a crown form classification method for upper central incisor which is more objective and scientific than traditional classification method based on the standardized photography technique.To analyze the relationship between crown form of upper central incisors and papilla filling in periodontally healthy Chinese Han-nationality youth.Methods:In the study,180 periodontally healthy Chinese youth (75 males,and 105 females )aged 20 -30 (24.3 ±4.5)years were included.With the standardized upper central incisor photography technique,pictures of 360 upper central incisors were ob-tained.Each tooth was classified as triangular,ovoid or square by 13 experienced specialist majors in prothodontics independently and the final classification result was decided by most evaluators in order to ensure objectivity.The standardized digital photo was also used to evaluate the gingival papilla filling situation.The papilla filling result was recorded as present or absent according to naked eye observation. The papilla filling rates of different crown forms were analyzed.Statistical analyses were performed with SPSS 19.0.Results:The proportions of triangle,ovoid and square forms of upper central incisor in Chinese Han-nationality youth were 31.4% (113 /360),37.2% (134 /360)and 31.4% (113 /360 ), respectively ,and no statistical difference was found between the males and females.Average κvalue be-tween each two evaluators was 0.381.Average κvalue was raised up to 0.563 when compared with the final classification result.In the study,24 upper central incisors without contact were excluded,and the papilla filling rates of triangle,ovoid and square crown were 56.4% (62 /110),69.6% (87 /125 ), 76.2% (77 /101)separately.The papilla filling rate of square form was higher (P =0.007 ).Conclu-sion:The proportion of clinical crown form of upper central incisor in Chinese Han-nationality youth is obtained.Compared with triangle form,square form is found to favor a gingival papilla that fills the inter-proximal embrasure space.The consistency of the present classification method for upper central incisor is not satisfying,which indicates that a new classification method,more scientific and objective than the present one,is to be found.

Extrusão ortodôntica para restabelecer a arquitetura gengival / Orthodontic extrusion for restoring the gingival architecture: a clinical case report

Este artigo procurou enfatizar a importância de se realizar uma adequada avaliação tecidual antes de iniciar reabilitações estéticas, além de sugerir possíveis condutas para restabelecer a arquitetura gengival. No caso clínico apresentado, os incisivos centrais superiores foram tracionados lentamente por aparatologia ortodôntica, visando nivelar o arco gengival e devolver a papila interdental. Após a obtenção de um quadro gengival mais harmônico, a forma dental foi restaurada com facetas cerâmicas para alcançar um bom resultado estético.

This article emphasizes the importance of adequate tissue assessment before starting aesthetic restorations, as well as to suggest possible guidelines to restore the gingival architecture. In the clinical case presented, the upper central incisors were orthodontically extruded, aiming to level the gingival arch and to retrieve the dental papillae. After obtaining a more harmonic gingival architecture, the dental form was restored with ceramic veneers to achieve good aesthetic result.

Avaliação de nova técnica não cirúrgica para tratamento de deficiência de papila em área estética: estudo clínico randomizado controlado / New evaluation technique non-surgical for papilla deficiency treatment in cosmetic area: randomized controlled trial

A ausência ou perda da papila interdental cria deficiência estética, problemas fonéticos, impactação alimentar e gera muita expectativa ao paciente. Até o momento, o tratamento da ausência ou perda da papila interdental tem sido mal sucedido e não há estudos que indiquem que a regeneração da papila é um resultado previsível. O objetivo deste estudo foi avaliar a efetividade da injeção de gel de ácido hialurônico de origem não animal na redução ou eliminação da deficiência de papila entre dentes naturais comparativamente ao tratamento por meio de enxerto de tecido conjuntivo subepitelial. Foram avaliados neste estudo 20 sítios de 6 pacientes de ambos os sexos, com idade variável de 29 a 62 anos, apresentando deficiência de papila entre dentes naturais, na região anterior superior, em pelo menos dois dentes. Os 20 sítios tratados foram aleatoriamente divididos em dois grupos, de acordo com o tratamento para correção da deficiência de papila por meio de enxerto de tecido conjuntivo subepitelial (grupo controle) ou por meio de injeção de gel de ácido hialurônico (grupo teste). Um examinador único, calibrado, avaliou a distância da ponta da papila ao ponto de contato com auxílio de sonda periodontal milimetrada antes e aos 1, 3 e 6 meses após o tratamento. Além disso, foram investigados, nos sítios tratados, as medidas de profundidade de sondagem, nível de inserção, índice de sangramento do sulco, índice de placa, distância do ponto de contato à crista óssea alveolar, distância da ponta da papila à crista óssea alveolar e largura da papila. Os resultados demonstraram que aos 6 meses de pósoperatório o percentual de mudança na altura da papila foi maior no grupo teste (14,94% ± 21,35%) do que no grupo controle (-1,39% ± 31,46%), entretanto sem diferenças significantes entre os grupos (p> 0.05). Não houve variação estatisticamente significante na largura da papila antes e aos 4 meses após o tratamento nos grupos teste (p= 0.09) e controle (p= 0.16), assim como não houve variação significativa na distância entre a ponta da papila e a crista óssea alveolar. Houve melhora significativa do Índice de Estética Rosa (IER) observado aos 6 meses de acompanhamento em comparação com a condição inicial no grupo teste (p= 0.0078; Wilcoxon), enquanto que não houve mudança significativa no IER observado no grupo controle aos 6 meses de acompanhamento (p= 0.35). Os resultados obtidos permitiram concluir que o tratamento da deficiência de papila por meio de injeção de gel de ácido hialurônico promove melhora da deficiência de papila, similar aos resultados obtidos com o tratamento por meio de enxerto de tecido conjuntivo subepitelial, porém com melhora estética significativa relacionada especialmente às características de cor e textura do tecido relativamente aos tecidos moles adjacentes.(AU)

The absence or loss of interdental papilla creates an esthetic deficiency, phonetic problems and food impaction and generates a lot of expectation for the patient. Until now, the treatment for absence or loss of interdental papilla is unsuccessful e and there are no researches that show that the papilla regeneration is a predictable outcome. The aim of this study was to evaluate the effectivity of a non-animal originated hyaluronic acid injection in the reduction or elimination of papilla deficiency between natural teeth in comparison to a sub epithelial connective tissue graft treatment. The analysis was made on 20 sites in 6 patients, both genders, 29 - 62 years, showing deficiency in the papilla between natural teeth in the upper anterior region in at least two teeth. The 20 sites treated were randomly divided into two groups, according to the treatment by subepithelial connective tissue graft (control group) or by hyaluronic acid injection (test group). A single calibrated examiner evaluated the distance between the tip of the papilla to the contact point using a graduated periodontal probe before the treatment and 1, 3 and 6 months after it. Besides, it were investigated probing pocket depth, clinical attachment level, gingival bleeding index, plaque index, distance from papilla to alveolar crest, distance from contact point to alveolar crest and width of the papilla. The results showed that 6 months after the procedure, the percentage of change in the papilla level was higher in the test group (14,94% ± 21,35%) than in the control group (-1,39% ± 31,46%), though not statistically significant (p>0.05). There was no significant difference variation in the width of the papilla before and 4 months after the treatment in test group (p=0.09) and control group (p=0.16), and there was no significant difference variation in the distance between the tip of the papilla and the alveolar bone crest. There was significant improvement of the Pink Esthetic Score (PES) after 6 months in comparison to the initial condition in test group (p=0.0078; Wilcoxon), while there was no significant difference in the PES in control group 6 months after treatment (p=0.35). The results allow to conclude that the treatment for of the papilla deficiency using hyaluronic acid injection promotes improvement, similar to the results of the sub epithelial connective tissue graft treatment, but with significant esthetic improvement related specially to the color and texture characteristics of the adjacent soft tissues.(AU)

Peripheral ossifying fibroma in Pregnancy: A multifactorial consequence.

Pregnancy is the most remarkable time in every woman’s life. The upsurge in levels of estrogen and progesterone leads to the plethora of changes in various parts of human body, including the oral cavity. In the oral cavity, changes are commonly seen on the gingiva. These include pyogenic granuloma, peripheral giant cell granuloma and also peripheral ossifying fibroma. Not many cases have been reported in literature of the latter. Peripheral ossifying fibroma can interfere with normal tooth position, may become a plaque retentive factor and can be unaesthetic. The pathogenesis of such lesions still remains an enigma. Many believe that peripheral ossifying fibroma may be a progressive stage of pyogenic granuloma. Here, we present a rare case of a peripheral ossifying fibroma seen in a pregnant female in the lower left front tooth region and have discussed the possible etiopathogenesis of the same.

Type I Dentinal Dysplasia—Proposal of A New Classification System Combined with A Variant Case Presentation

Dentine dysplasia is an extremely rare autosomal dominant hereditary condition primarily characterized by defective dentine formation affecting both the deciduous and permanent dentitions. The aetiology of dentinal dysplasia remains imprecise to date, in spite of the numerous hypotheses put forward by various authors. Also, of late, new case reports of type I dentine dysplasias are emerging with clinical and radiographic findings which are unique and variant from the classical characteristic features of this anomaly, rendering it difficult to fit into the previously established classification systems. In this article, after a thorough review and understanding of the drawbacks of the previous classification systems and the cumulative findings from the published case reports in literature, we propose a new classification system for dentine dysplasia type I. We also present a case report which exhibited an absence of familial hereditary pattern, the absence of periradicular radiolucent lesions and osseous pathologies as well as atypical morphological defects of the molar roots which were diverse from the classical findings of the various sub types of dentine dysplasia type I reported to date. Early diagnosis and implementation of preventive and curative therapy is crucial for avoiding premature exfoliation of deciduous and permanent dentition and associated residual ridge resorption, thereby overcoming functional and aesthetic deficits. The new classification proposed in this article will help clinicians to diagnose and categorize the patients effectively, facilitating proper treatment and supportive care for all.

Neurogenic differentiation of human dental stem cells in vitro

OBJECTIVES: The purpose of this study was to investigate the neurogenic differentiation of human dental pulp stem cells (DPSCs), periodontal ligament stem cells (PDLSCs), and stem cells from apical papilla (SCAP). MATERIALS AND METHODS: After induction of neurogenic differentiation using commercial differentiation medium, expression levels of neural markers, microtubule-associated protein 2 (MAP2), class III beta-tubulin, and glial fibrillary acidic protein (GFAP) were identified using reverse transcriptase polymerase chain reaction (PCR), real-time PCR, and immunocytochemistry. RESULTS: The induced cells showed neuron-like morphologies, similar to axons, dendrites, and perikaryons, which are composed of neurons in DPSCs, PDLSCs, and SCAP. The mRNA levels of neuronal markers tended to increase in differentiated cells. The expression of MAP2 and beta-tubulin III also increased at the protein level in differentiation groups, even though GFAP was not detected via immunocytochemistry. CONCLUSION: Human dental stem cells including DPSCs, PDLSCs, and SCAP may have neurogenic differentiation capability in vitro. The presented data support the use of human dental stem cells as a possible alternative source of stem cells for therapeutic utility in the treatment of neurological diseases.

Effect of Carbonated Drinks on Primary and Permanent Teeth Replacement in Children / 天津医药

Objective To study the effect of carbonated drinks on primary and permanent teeth replacement in Chil-dren. Method Dog tooth enamel samples were soaked in coca-cola, sprite and pure soda, and the calcium, phosphorus lev-el were analysed. Dental papilla stem cells were separated and cultured in the conditioned medium by adding three drinks. PCR and western blot were used to detect mRNA and protein levels of activator of nuclear factor-k B receptor ligand (RANKL), osteoprotegerin (OPG) and vitamin D receptor (VDR) , then the possible role of each gene and interactions rela-tionship were analyzed. Results Compared with saline, coca-cola and sprite showed their significantly decalcification and dephosphorization role, while plain soda water showed calcium and phosphorus protective effect. These three drinks had no effect on mRNA and protein levels of RANKL gene (P>0.05). Coca-cola and sprite can reduce OPG mRNA and protein lev-els, and at the same time increase transcription and expression of the VDR gene. Plain soda water has no effect on the OPG gene manifestation, but can significantly reduce the transcription and translation level of the VDR gene. Conclusion Car-bonated drinks may affect the dental health of the children's primary and permanent teeth replacement by regulating bone re-lated gene expression and vitamin D receptor family.

Functional Roles of 1,25(OH)2D3 in Osteogenic Differentiation of the Dental Papilla Stem Cells / 天津医药

Objective To study the functional roles of 1,25(OH)2D3 in osteogenic differentiation of the dental papilla stem cells. Methods The dental papilla stem cells were isolated and cultured in medium supplemented with different con-centrations of 1,25(OH)2D3 (1, 10 and 100 nmol/L). MTT assay was used to detect the cell growth, and flow cytometry was used to detect the cell cycle. Western blot assay was used to detect protein expression levels of receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG) and vitamin D receptor (VDR). After siRNA silencing VDR expression, protein levels of RANKL and OPG were detected. Results MTT and flow cytometry results showed that there were no sig-nificant differences in the cell proliferation between different concentrations of 1,25(OH)2D3 (1, 10 and 100 nmol/L) and con-trol groups (P>0.05). Western blot results showed that there were protein expressions of VDR, RANKL and OPG in control group. The protein expressions of VDR, RANKL and OPG were increased after adding 1,25(OH)2D3, in which the upward trend was the most significant in VDR. After VDR expression was silenced by siRNA, the protein expression levels of VDR, RANKL and OPG were decreased. Conclusion 1,25(OH) 2D3 affects the osteoblast differentiation process of the dental pa-pilla stem cells by adjusting the VDR expression.

Constructing a tissue-engineered dental root by seeding dental papilla cells into poly(lactic-co-glycolic acid)/sodium alginate hydrogel / 中国组织工程研究

BACKGROUND:Studies addressing reconstruction of tooth tissue engineering have shown that tooth structure can be constructed using tissue engineering technology. Tooth root and its periodontal attachment are critical for tooth survival and functions, based on which, whether we can target root tissues with simple structure for tissue engineering construction by bypassing a complex dental tissue engineering concept with the structural integrity? OBJECTIVE:To construct a tissue-engineered dental root by seeding dental papil a cells, as seed cells, into poly(lactic-co-glycolic acid)/sodium alginate hydrogel. METHODS:Rabbit dental papil a cells were isolated and cultured. The cells were then mixed with 1%sodium alginate hydrogel at a final density of 6×109/L. The cellsuspension was seeded into a poly(lactic-co-glycolic acid) scaffold with predetermined shape of human tooth and solidified with calcium chloride. Final y, the cel-scaffold composites were subcutaneously implanted into the back of nude mice. The specimens were harvested after 4 and 8 weeks respectively and processed for gross inspection, X-ray and CT examination and histological observation. RESULTS AND CONCLUSION:The newly formed tissue kept the original shape of human dental root 4 and 8 weeks post-implantation. After 4 weeks of implantation, the specimen density was low;the root implants appeared to be incompletely mineralized, alginate hydrogels were degraded, but the copolymer scaffold was not degraded;a number of dentin-like structure appeared, and a fibrous membrane structure was visible on the surface of specimens paral el to the root surface, but the structure was not continuous, and no pulp cavity formed. After 8 weeks, the newly formed tissue was highly mineralized close to root tissue of the nature tooth;the copolymer scaffold was mostly degraded;specimens appeared to have a large number of mature dentin-like structure, and form continuous fibers membrane on the surface paral el to the root surface, below which, cementum-like structure formed. Artificial dental root with biological y similar structures of human dental roots can be constructed using the method of tissue engineering.

Papillary regeneration: anatomical aspects and treatment approaches

Introduction and objective: This paper aims to report a literature review on the anatomy and morphology of the interproximal papilla and present the options of both surgical and nonsurgical treatment for the recovery of interdental papilla. Literature review: The loss of the interdental papilla because of the interproximal bone loss accounts for aesthetic, phonetic and functional problems of patients with periodontal disease. The interproximal tissue reconstruction has been reported in literature through both surgical procedures with the use of subepithelial connective tissue graft, restorative and orthodontic treatment. Conclusion: The etiology of gingival black space is multifactorial, therefore, it is important to diagnose properly the etiological factor to establish an appropriate treatment planing. However, the treatment approaches are not predictable and further studies are necessary to recommend the clinical practices available to date.

The effect of peri-implant bone exposure on soft tissue healing and bone loss in two adjacent implants

PURPOSE: The purpose of this study was to evaluate the soft tissue and bone change around two adjacent implants in one-stage implant surgery. METHODS: Eleven subjects (7 males, 4 females) who were needed placement of 2 adjacent implants in the molar area were included. The two implants were placed with the platform at the level of the alveolar crest. The interproximal bone between the 2 implants was not covered with gingiva. After surgery, an alginate impression was taken to record the gingival shape and radiographs were taken to evaluate implant placement. Using a master cast, the gingival height was measured at baseline, 4 weeks, and 12 weeks. In the radiograph, the alveolar bone level was measured at the mesial and distal side of both implants at baseline and 12 weeks. RESULTS: The exposed bone was covered with gingiva at both 4 and 12 weeks. Loss of alveolar bone around implants was found in all areas. The alveolar bone level in the exposed bone area did not differ from that in the non-exposed area. CONCLUSIONS: This study showed that the alveolar bone level and gingival height around 2 adjacent implants in the exposed bone area did not differ from that in unexposed bone area.

Importância dos tecidos dentais e periodontais como fontes de células-tronco / Importance of dental and periodontal tissues as sources of stem cells

Objetivo: o presente estudo consiste de uma revisãosistemática sobre os estudos com células-tronco dentais eperiodontais, relatando os resultados obtidos nosexperimentos, bem como seu potencial de aplicação naOdontologia. Material e Métodos: a pesquisa bibliográficadeste trabalho foi realizada nos bancos de dados eletrônicos(Pubmed, Science Direct e Scielo), complementada pelabusca manual de artigos referenciados. Resultados: aliteratura consultada mostrou que os tecidos dentais eperiodontais podem ser uma fonte autógena fácil e eficientede células-tronco, com capacidade de expansão e dediferenciação em fibroblastos, cementoblastos eosteoblastos. Entre as células-tronco dentais e periodontais,as células-tronco da polpa de dentes decíduos (SHED) sãoas que apresentam maior potencial de diferenciação celular.Conclusão: existe um grande avanço nos experimentos comcélulas-tronco adultas provenientes de tecidos bucais; o seufácil acesso e o fato de não serem órgãos vitais constituemum atrativo para uso em técnicas da bioengenharia, além dopotencial clínico na regeneração tecidual.

Objective: This study consists on a systematic review ofliterature on dental and periodontal stem cells. Resultsobtained from the experiments are reported as well as thepotential application of stem cells in Dentistry. Material andMethods: literature search was performed in electronicdatabases (Pubmed, Science Direct and Scielo), togetherwith manual search of references from retrieved articles.Results: literature shows that dental and periodontal tissuesmay be easy and efficient autologous sources of stem cells,which are capable of expansion and differentiation intofibroblasts, cementoblasts and osteoblasts. Among the dentaland periodontal stem cells, the ones from deciduous teethpulp (SHED) are considered to have the highest potential fordifferentiation. Conclusion: there is a great progress inexperiments with adult stem cells derived from oral tissues;their easy access and the fact that those are not vital organsare attractive for using them in bioengineering techniques, inaddition to their clinical potential for tissue regeneration.

Cierre de diastema con restauraciones directas: reporte de caso / Diastema closure with direct restorations: report of a case

La sonrisa y específicamente los dientes hacen parte de un rostro atractivo. La presencia de diastemas es una de las quejas estéticas más comunes entre los pacientes. Es responsabilidad del odontólogo ofrecer la técnica más apropiada para resolver esos espacios indeseados. La prioridad para el tratamiento de diastemas es la creación del punto de contacto sin perjudicar la anatomía armónica de los dientes involucrados para conseguir la formación de la papila interdental. La utilización de resinas compuestas directas es una opción estética y funcional para tratar tejido sano de forma mínimamente invasiva. El objetivo de este reporte de caso clínico es describir detalladamente el cierre de diastema utilizando restauraciones directas adhesivas.

The smile and specially the teeth are important for an attractive face. The presence of diastema is the most common esthetic complain among patients. It is responsibility of the dentist to offer the best treatment to solve these undesirable spaces. The priority for the diastema treatment is to create a contact point without interfering in the harmonic shape of the teeth involved to achieve the formation of the dental papilla. The use of direct composite resins is an esthetic and functional option to treat intact tissue with a minimum intervention. The purpose of this case report is to describe in details the diastema closure using direct resin composite restoration.

I-shaped incisions for papilla reconstruction in second stage implant surgery

PURPOSE: Pink gingival esthetic especially on the anterior teeth has been an important success criterion in implant-supported restoration. Inter-implant papillae are a critical factor for implant esthetics, and various techniques for inter-implant papilla reconstruction have been introduced. The aim of this study is to suggest and evaluate a surgical technique for reconstructing inter-implant papillae. METHODS: A 28-year-old man had an implant placed on the #13 and #14 area. Four months after implant placement, a second stage surgery was planned for inter-implant papilla reconstruction. At the time of the abutment connection, I-type incisions were performed on the #13i & #14i area followed by full-thickness flap elevation and connection of a healing abutment on underlying fixtures without suture. RESULTS: Two weeks after the second stage implant surgery, soft tissue augmentation between the two implants was achieved. CONCLUSIONS: I-shaped incisions for papilla reconstruction performed during the second stage implant surgery were useful for inter-implant papilla reconstruction and showed a good esthetic result.

Mensuração e classificação dos tecidos moles: revisão de literatura e aplicação clínica / Measurement and classification of soft tissues: literature review and clinical application

A papila interdental e o comportamento dos tecidos moles peri-implantares são considerados um ponto crítico para o sucesso estético em osseointegração e geralmente apresenta-se como um desafio clínico. O presente artigo tem o objetivo de revisar as classificações propostas na literatura em relação ao comportamento do tecido gengival e perimplantar. Foi realizada uma pesquisa no banco de dados Medline entre 1985 a 2005, tendo sido selecionados 8 artigos. Os métodos foram aplicados e comparados destacando suas vantagens e desvantagens no uso clínico. Os métodos descritos são específicos e com finalidades distintas. Os métodos são eficazes, visto que todos possibilitam uma medida fácil e prática dos tecidos, podendo comparar o início e o fim do tratamento, além de uma melhor comunicação entre os clínicos.

The interdental papilla and the behavior of soft peri-implant tissues are considered a critical point for the aesthetic success in osseointegration and generally it is presented as a clinical challenge. The present article has the objective to revise the classifications proposals in literature in relation to the behavior of the gingival and to peri-implant tissues. A Medline research was made between 1985 and 2005, and 8 articles were selected. All the methods had been evaluated through a comparative analysis detaching its advantages and disadvantages in the clinical use. The methods described are specific with different purposes. All the methods are efficient (for distinct ends) when are carried through correctly, since all make possible an easy and practical measure of papilla, being able to compare the beginning and end of the treatment beyond one better communication between the clinical.

Evaluation of osteogenic activity and mineralization of cultured human dental papilla-derived cells

Mineralization and related differential phenotype of cultured human dental papilla cells / 实用口腔医学杂志

砄bjective: To study the mineralization and related differential phenotype of human dental papilla cells in vitro . Methods: Human dental papilla cells were primarily cultured with explant technique, the cells of third passage were incubated for a long term in the presence of 10 mmol/L ? glycerophosphate(? GP)and 50 ?g/ml of ascorbic acid (L AA) in DMEM containing 5% FBS. Alkaline phosphatase (ALP) and osteocalcin(OC) were measured at different culture time. Cell growth was observed under inverted microscope and mineralization was tested with Von Kossa stainning. Results: Cultured papilla cells were growing in multilayer. Cells exposed to ? GP and L AA exhibited higher ALP activity in 14 days and increased OC in 21 days with certain amount of secreted matrix. After 35 days of culture, mineralized tubercles were formed. ALP activity and synthesized OC began to decrease after 42 days of culture. Conclusion: Human dental papilla cells may show odontoblast phenotype in vitro .