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Abstract This case report describes the clinical and therapeutic approach used in a 32-year-old female patient with a tooth fracture in tooth 22. The patient, with no history of systemic disease, presented with a chronic periapical lesion and a cervical fracture in the affected tooth. Treatment included atraumatic extraction of the tooth, followed by placement of a 3.75 x 10mm post-extraction implant with immediate loading and guided bone regeneration. The minimally invasive surgical technique was employed using the Dentoflex® drilling sequence. The primary stability of the implant, measured in 37 Newtons of torque, allowed the placement of a prefabricated metal abutment for the subsequent cemented crown. Bone regeneration of the interimplant space was successfully performed, supplemented by connective grafting due to the patient's thin gingival phenotype. Postoperative follow-up, including controls at 7, 14 days and four months, showed a satisfactory conformation of the gingival margin and papillary tissue, consolidating the success of the treatment.
Resumen Este reporte de caso describió el enfoque clínico y terapéutico utilizado en una paciente de 32 años de edad con una fractura dentaria en el diente 22. La paciente, sin antecedentes de enfermedad sistémica, presentaba una lesión periapical crónica y una fractura cervical en el diente afectado. El tratamiento incluyó la extracción atraumática del diente, seguida de la colocación de un implante postextracción de 3,75 x 10mm con carga inmediata y regeneración ósea guiada. Se empleó la técnica quirúrgica mínimamente invasiva utilizando la secuencia de fresado Dentoflex®. La estabilidad primaria del implante, medida en 37 Newtons de torque, permitió la colocación de un pilar metálico prefabricado para la posterior corona cementada. Se realizó con éxito la regeneración ósea del espacio interimplantario, complementada con injerto conectivo debido al fenotipo gingival delgado de la paciente. El seguimiento postoperatorio, incluyendo controles a los 7, 14 días y cuatro meses, mostró una conformación satisfactoria del margen gingival y del tejido papilar, consolidando el éxito del tratamiento.
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Abstract The purpose of this in vitro study was to develop a polymeric nanofiber mesh coating for titanium implant surfaces and assess its contribution to the cellular response. Two types of dental implants TiUltraTM and TiUniteTM (Nobel Biocare) were coated with poly (lactic acid) nanofibers fabricated using the air-jet spinning technique (AJS). The morphology of the polymeric nanofibers was characterized by scanning electron microscopy (SEM), and the biocompatibility was evaluated in terms of cell adhesion by using human fetal osteoblasts (hFOB). The cellular localization was observed under a fluorescent microscope, and the gene expression of Col 1, ALP, and OCN was evaluated by RT-PCR. The micrographs showed that the polymeric nanofiber coated the titaium (Ti) dental implant surfaces with a randomized deposition anchored between the depth of the threads, and well-interconnected pores were observed. Cell adhesion increased significantly (P<.05) more on the surfaces of Ti dental implants coated with the polymeric nanofiber mesh than on those not coated. After 21 days, the cell adhesion decreased significatively on the uncoated surfaces (P<.05). Col 1 and ALP genes showed a higher level of expression on dental implant surfaces coated with polymeric nanofibers mesh than on uncoated surfaces. Coating Ti dental implant surfaces with polymeric nanofiber mesh is a straightforward deposition technique for stimulating the cell response and improving the gene expression of osteogenic markers.
Resumen El objetivo de este estudio in vitro fue realizar un recubrimiento con nanofibras poliméricas para superficies de implantes de titanio y evaluar el comportamiento de la respuesta celular. Se recubrieron dos tipos de implantes dentales TiUltraTM y TiUniteTM (Nobel Biocare) con nanofibras de ácido poliláctico (PLA) fabricadas con la técnica de hilado por propulsión de aire (AJS). Se caracterizó la morfología de las nanofibras poliméricas por Microscopia Electronica de Barrido (MEB) y se evaluó la biocompatibilidad en términos de adhesión celular utilizando osteoblastos fetales humanos (hFOB). La localización celular se observó con el microscopio fluorescente y la expresión génica de Col 1, ALP y OCN se evaluó con RT-PCR. Las micrografías mostraron que las nanofibras poliméricas recubrieron las superficies de los implantes dentales de titanio (Ti) con una deposición aleatoria lo que generó poros interconectados fibrilares. La adhesión celular aumentó significativamente (P<.05) en las superficies de los implantes dentales de Ti recubiertas con las nanofibras poliméricas comparado con las no recubiertas. Después de 21 días, la adhesión celular disminuyó significativamente en las superficies no recubiertas (P<.05). Los genes Col 1 y ALP mostraron un mayor nivel de expresión en las superficies de los implantes dentales recubiertas con nanofibras poliméricas comparado con las no recubiertas. El recubrimiento de superficies de implantes dentales de Ti con nanofibras poliméricas es una técnica de deposición sencilla para estimular la respuesta celular y mejorar la expresión génica de marcadores osteogénicos.
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Aim: Cases of peri-implant diseases have increased, highlighting the need for preventive and therapeutic protocols. This study aimed to evaluate the effectiveness of ozonated water on In vitro decontamination of implant-abutment interfaces in external hexagon (EH) and morse cone (MC) connections. Study Design: In vitro study. Place and Duration of Study: Sample: Department of Periodontics and Implant Dentistry of Ingá University Center – UNINGÁ, between June 2020 and December 2021. Methodology: Twenty-four implant-abutments (IA) in EH (n=12) and MC (n=12) connections were divided into groups: negative control (NC) – sterile IA; positive control (PC) – IA contaminated with biofilm; and ozone (O) – IA contaminated with biofilm and decontaminated with ozonated water (60µg/mL,1min). The effectiveness of ozonated water was evaluated by counting colony-forming units (CFU/mL), and both connection types were compared. Results: There was a significant difference among groups in both connection types, outside and inside the implants (P=0.000). Group O showed a significant decrease in CFU/mL compared to group PC outside and inside the implants for EH and MC connections (P=0.000). Only group O in the EH connection presented a significative difference in CFU/mL compared to outside and inside the implants (2.475x103±0.320 and 1.775x103±0.125, respectively) (P=0.033). Comparison between connections was statistically different for groups PC and O, outside and inside the implants (P=0.000). Conclusion: Ozonated water showed effectiveness in vitro decontamination of implant-abutment interfaces in both connection types.
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Background: Bacterial contamination at the dental implant abutment interface through microgap may lead to peri-implant tissue infections resulting to marginal bone loss and affecting the long term success of implants. Aims: The purpose of this In vitro study in vitro was to evaluate the antimicrobial activity of oxygen active gel (BlueM®) against Porphyromonas gingivalis (Pg) at the implant-abutment interface (IAI) in three different types of implant-prosthetic connections. Methodology: A total of 45 dental implants with three different types of connections were divided into three groups (n=15/each) according to filling product at the interface: Control (C) - unfilled, BlueM (BM) - oxygen active gel, Chlorexidine (CX) - 2% chlorhexidine gel. They were incubated with a solution containing Pg for 5 days under an aerobic condition. Bacterial contamination at the interface were detected and quantificated by qPCR. Results: All 45 implants showed contamination at the IAI by Pg after 5 days of incubation, independent of prosthetic connection type. EH type connections showed greater contamination by Pg compared to MT type connections (p=0.0098). No differences were observed among different types of connections in BM and CX groups. Conclusion: The application of active oxygen gel promoted a reduction in P. gingivalis contamination in EH type connections at the IAI in vitro, but did not eliminate it completely.
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Dental implant placement for functional rehabilitation after oral cancer surgery could be done either before or after radiation therapy (RT). In both of the above scenarios, radiation exposure could affect implant osseointegration and survival. The present review aimed to evaluate the effect of post-implantation RT on osseointegration of dental implants placed in patients treated for oral cancer. A literature search was conducted to identify studies published in English between 2001 and November 2023. Articles reporting about the success of dental implant osseointegration after post-implantation radiotherapy were selected. Data about overall success of osseointegration and with respect to the anatomic site (maxilla, mandible or grafted bone), radiation dose and time-interval between implant placement and radiation exposure were collected and analyzed. Out of 189 articles identified through literature search, 12 studies fulfilling the inclusion criteria were systematically reviewed. In 403 patients, 1333 dental implants were placed prior to RT, out of which 1223 successfully osseointegrated (91.75%). The implant osseointegration rates in maxilla, mandible and grafted bone were 92.06% (255/277), 95.14% (313/329) and 80% (60/75), respectively. There was no relationship between radiation dose or time-interval and success of implant osseointegration. Based on the present review, it may be concluded that dental implants placed at least 1.5-3 months prior to RT, would successfully osseointegrate without major complications. The native maxilla and mandible are a favored choice for implant placement before radiotherapy, than grafted bone.
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Background: Dental implants are the most widely used treatment therapy for oral rehabilitation after tooth loss. Implant failures can be a result of many factors, with poor osseointegration being the main culprit and over the recent decades, there has been an important progress in the design and manufacturing of titanium implant surfaces with the goal of improving their osteointegration. Titanium implant surfaces are continuously modified to improve biocompatibility and promote osteointegration. The dental implant surfaces, subjected to specific treatments, perform better and allow for quicker healing times and better clinical performance. Stem cell therapy is a new age advancement which has led to quite promising results in the medical field. The implication of stem cells could lead to the unfolding of different dimensions of Biomimetic surface treatment leading to better results. Aim: This present review article aimed to assess the studies done on the effect of stem cells on the osseointegration, osteoinduction, viability, cytotoxic response, and biocompatibility of dental implants. This study assimilated various studies done using human dental pulp stem cells in combination with autologous plasma components, for in vitro bone generation on biomimetic titanium dental implant materials. Eleven studies that fulfilled the criteria were examined and included in the study. Results and Conclusion: All the included studies reported that the stem cells used with or without graft material acts as a great surface treatment on implant surface, and promoted osseointegration with higher levels of new bone formation. The mesenchymal stem attached to the implant surface facilitated cell proliferation which aided to boost bone formation and osseointegration at the bone–implant interfaces. A few selected studies showed a high risk of bias, indicating that caution must be exercised in their interpretation. These results highlight the significance of biomodified implant surfaces that in future can promote a better future for dental implants leading to reduced failures and better implant interface.
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Objective To assess the early dental failure rate and medication-related osteonecrosis of the jaw(MRONJ)incidence in patients treated with bisphosphonates(BPs),and provide evidence for evaluation of clinical risk.Methods Electronic databases,in-cluding Cochrane Library,Wiley Online Library,PubMed,CNKI and Wanfang Data were searched to collect clinical studies concerning early dental failure and medication-related osteonecrosis of the jaw in patients treated with bisphosphonates.The data were collected from inception until May 2022.The meta-analysis was conducted using Stata 15.Osoftware.Results A total of 13 clinical observational stud-ies involving 1261 implants,wherein 1182 implants were placed in patients who took bisphosphonate orally,and 79 implants were placed in patients treated with intravenous bisphosphonate.In patients who had orally administrated bisphosphonates,the pooled early dental fail-ure rate was 1.7%(95%CI:0.3%-3.9%),and the MRONJ incidence was 0.Among patients treated with intravenous bisphospho-nate,the pooled early dental failure rate was 0,and the MRONJ incidence was 5.6%.Conclusion The early dental failure rate and MRONJ incidence in patients who take bisphosphonates orally is as low as in a healthy population.On account of the relatively high risk of post-operative MRONJ in patients treated with intravenous bisphosphonates,clinical indications must be opted prudently.
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Objective:To find out factors influencing the compliance of supportive treatment of patients with periodontitis who have received implant restoration therapy.Methods:Patients who had completed periodontal and implant restoration treatment for more than 5 years in Department of Periodontology,Pe-king University Hospital of Stomatology were subjected to inclusion between March 2022 and August 2023.A questionnaire was compiled to gather the information including patients'basic information(gen-der,age,and educational background etc.),smoking habits,general health conditions,oral hygiene habits,willingness to undertake periodontal and dental implant supportive treatment,actual fact on sup-portive treatment recorded in medical records,whether medical advices were correctly remembered,and reasons affected them to implement supportive therapy.The questionnaires were handed out to the above patients and filled during the process of follow-up treatment.Chi-square test,univariate and multivariate analysis of Logistic regression were employed to explore the correlations of these factors and the patients'compliance.Results:In the study,92 patients and questionnaires were collected and analyzed.The re-sults indicated that oral hygiene habits and whether medical advices were correctly remembered had sig-nificant correlation with compliance(P<0.05).Time constraint(47.0%)and difficulty in appointment registration(24.8%)were the top 2 reasons obstructed them to undertake supportive treatment.Al-though the vast majority of the patients indicated willingness to perform follow-ups,55.4%of them wouldn't come back until the dentist called them back.The results of our study also indicated that the patients placed significantly less importance on the health of natural teeth than implants.Conclusion:In order to improve the compliance of supportive treatment,we suggest that dentists should put more empha-sis on oral hygiene instruction,and knowledge regarding periodontitis should also be added as part of pa-tient education contents.In the early stages of treatment,the patient should develop the habit of regular follow-up checks,More attention and patience should be given to elderly patients and those with lower level of education;use language that is easy to understand and printed medical instructions to help them remember.Patients can memorize better from refined doctors'advice,reinforcing care knowledge and refining medical advices can promote better follow-up treatment results.Motivating patients based on their characteristics is critical to improving compliance.
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Objective:To compare the trueness of incisal guidance of implant-supported single crowns designed by patient-specific motion(PSM)with that designed by average-value virtual articulator(AVA).Methods:The study had recruited 12 participants with complete dentition and stable incisal guidance.An intraoral scanner was used to scan digital casts and record two types of patient-specific mo-tion(data only including protrusive movement,and data including protrusive movement and lateral pro-trusive movement).The lingual surfaces of the maxillary incisors which guided the protrusive movement was selected and elevated to create a reference cast.A maxillary central incisor of original casts was vir-tually extracted and implanted to generate a working cast.The Dental system software program was used to design implant-supported single crowns with the anatomical coping design method.The incisal guidance was designed by different methods.The incisal guidance in control group was designed by the average-value virtual articulator.The incisal guidance in experiment groups was designed by the patient-specific motion only including protrusive movement(PSM1)and with the patient-specific motion including protru-sive movement and lateral protrusive movement(PSM2).The incisal guidance of prosthesis designed by these 3 methods were compared with the original incisal guidance in Geomagic Control 2015(3DSystem,America).The measurements included:Average of positive values,ratio of positive area and maximum value reflecting supra-occlusion;average of negative values,ratio of negative area and minimum value re-flecting over-correction;and root mean square reflecting overall deviation.Results:Statistical data were collected using the median(interquartile range)method.The average of positive values,ratio of positive area and average of negative values of the PSM2 group were smaller than those of the control group[8.0(18.8)μm vs.37.5(47.5)μm;0vs.7.2%(38.1%);-109.0(63.8)μm vs.-66.5(64.5)μm],and the ratio of negative area of PSM2 group was larger than those of the control group[52.9%(47.8%)vs.17.3%(45.3%)],with significant differences(P all<0.05).The ratio of positive area[0.1%(7.0%)]and average of negative values[-97.0(61.5)μm]of PSM1 group,were smaller than those of the control group,and the ratio of negative area[40.7%(39.2%)]of the PSM1 group was larger than that of the control group,with significant differences(P<0.05).The average of positive values[20.0(42.0)μm]and ratio of positive area of PSM1 group was larger than that of the PSM2 group with significant differences(P<0.05).Conclusion:To establish the incisor guidance of implant-supported single crowns,compared with the average-value virtual articulator and the patient-specific motion only including protrusive movement,the patient-specific motion including protrusive movement and lateral protrusive movement is more conducive to reducing the protrusive interference of prosthesis and improving the occlusal fit.
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Objective:To retrospectively evaluate the clinical outcomes of autonomous dental implant robot(ADIR)assisted implant surgery in 1-year follow-up.Methods:20 patients with tooth missing underwent implantation surgery by ADIR were incuded.The plat-form deviation,apex deviation and angular deviation of the implants were analyzed.The marginal bone height and peri-implant soft tis-sue health were measured and observed immediately,6 months and 12 months after the restoration.Results:The platform deviation,apex deviation and angular deviation of 20 implants at the 3 follow-up examinations were(0.34±0.11)mm,(0.34±0.15)mm and(0.82°±0.38°),respectively.There was no significant difference in the accuracy of different implant diameter and length(P>0.05).During the follow-up period,all implants had successful osseointegration,stable marginal bone height,and acceptable peri-implant soft tissue condition.Conclusion:The 1-year follow-up indicates that ADIR can achieve promising clinical performance.Long-term follow-up studies are still necessary for verification.
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Objective:To explore the differences of microenviroment between peri-implant tissue and oral mucosal tissue.Methods:The gene chip data GSE43744 was downloaded from the GEO database,bioinformatics tools were used to analyze the differentially ex-pressed genes between the peri-implant tissue and normal oral mucosal tissue in rat.Results:1315 differentially expressed important genes,including 797 upregulated genes and 518 downregulated genes,were screened out.Gene enrichment analysis showed that com-pared with normal oral mucosal tissue,the gene expression of innate immune activity,cell activation,inflammatory response,and func-tional expression related to external and bacterial stimuli in peri-implant tissue were significantly upregulated,while that of extracellular matrix tissue,adhesion,extracellular matrix polysaccharides,response to mechanical stimuli and response to toxic substances was sig-nificantly downregulated.Meanwhile,multiple molecular functions and biological pathways related to T cells were highly expressed,which may play an important role in the peri-implant microenvironment.In addition,PPI network was constructed,and screened 7 core genes including FCER1G,TYROBP,PTPRC,ITGB2,AIF1,EMR1 and RAC2,which may be target genes for studying peri-implant microenvironment.Conclusion:There is a significant difference of microenvironment characteristics between peri-implant tissue and o-ral mucosa.The target genes screened using PPI network may be the key to future research on the peri-implant microenvironment.
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BACKGROUND:Cerium(Ce)is the most abundant element among lanthanides,which is mostly in the form of ceria.The reversible transformation between Ce3+and Ce4+ ions contributes to the high redox activity of cerium.Because of its antibacterial,anti-inflammatory,osteogenic,angiogenic and anti-tumor properties,cerium has been widely used in stomatology. OBJECTIVE:To summarize the antibacterial,anti-inflammatory,osteogenic,angiogenic and anti-tumor mechanism of cerium,and to review the research status and application prospects of cerium and cerium-based materials in the modification of oral materials and the diagnosis and treatment of oral diseases in recent years. METHODS:The articles published from database inception to 2023 were retrieved from Web of Science,PubMed,CNKI and WanFang databases with the search terms"cerium,ceria,prosthodontics,prosthesis,restorative dentistry,denture,dental implant,caries,endodontics,pulpitis,periodontitis,periodontal diseases,oral cancer"in English and"cerium,ceria,prosthodontics,implant,dental caries,dental pulp,periodontitis,periodontal disease,oral cancer"in Chinese.By analyzing and reading literature for screening,according to the inclusion and exclusion criteria,73 articles were finally included in this review. RESULTS AND CONCLUSION:(1)Cerium exerts an antibacterial effect through direct contact with bacteria,oxidative stress and destroying bacterial biofilm,and exerts an anti-inflammatory function based on mimetic enzyme activity.The osteogenic and angiogenic activities of cerium involve a series of signaling pathways including ERK and Wnt signaling pathways.(2)Antibacterial,anti-inflammatory,osteogenic,and angiogenic activities allow cerium significant potential in the treatment of oral infectious diseases and regeneration of oral soft and hard tissues.However,there is still a certain gap in the application of cerium's anti-tumor properties in the oral field.(3)Due to excellent mechanical properties and a low light-transmitting property,ceria-stabilized zirconia as a dental ceramic material can be used for core ceramics,the frameworks of dental prostheses and dental implants.(4)Benefited from its biological properties,cerium-based materials have the ability to promote osseointegration and soft tissue integration,inhibit demineralization and cariogenic bacteria,facilitate regeneration of the dentin-pulp complex,lessen inflammatory response and enhance periodontal tissue regeneration.There are wide applications of cerium in surface modifications of implants and treatments of caries,pulpitis,periodontitis and oral cancers.(5)Cerium shows certain toxicity under conditions of high concentration and long-term administration.To further expand clinical applications of cerium in dentistry,biosafety and optimization of cerium-based materials need to be further explored in the future.
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Objective: This study aimed to evaluate the effect of coating titanium (Ti) dental implant with polyether ketone ketone (PEKK) polymer using magnetron sputtering on osseointegration, trying to overcome some of the problems associated with Ti alloys. Material and Methods: Implants were prepared from grade (II) commercially pure titanium (CP Ti), then laser was used to induce roughness on the surface of Ti. PEKK was deposited on the surface of Ti implants by radiofrequency (RF) magnetron sputtering technique. The implants were divided in to three groups: without coating (Ls), with PEKK coating using argon (Ar) as sputtering gas (Ls-PEKK-Ar), and with PEKK coating using nitrogen (N) as sputtering gas (Ls-PEKK-N). All the implants were implanted in the femoral bones of rabbits. After three different healing periods (2, 6, and 12 weeks) the rabbits were sacrificed for a mechanical examination (removal torque) and for histological examination. Results: The results revealed a significant increase in the removal torque mean values when using PEKK coating on Ti implants, with the highest value recorded by Ls-PEKK-N group. Histologically, the study demonstrated the progression of osteogenesis during all the research periods. It was observed that the Ls-PEKK-N group had the highest percentage of new bone formation in all healing periods. Conclusion: The use of PEKK as coating material on the surface of Ti implants by RF- magnetron sputtering results in an increase in the torque required to remove implants and enhance bony tissue formation around the implants especially when using nitrogen as a sputtering gas (AU)
Objetivo: Este estudo teve como objetivo avaliar o efeito do revestimento de implante dentário de titânio (Ti) com polímero de poliéter cetona cetona (PEKK) usando pulverização catódica por magnetron na osseointegração, tentando superar alguns dos problemas associados às ligas de Ti. Material e Métodos: Os implantes foram preparados a partir de titânio comercialmente puro grau (II) (CP Ti), em seguida o laser foi utilizado para induzir rugosidade na superfície do Ti. PEKK foi depositado na superfície de implantes de Ti pela técnica de pulverização catódica por radiofrequência (RF). Os implantes foram divididos em três grupos: sem revestimento (Ls), com revestimento de PEKK utilizando argônio (Ar) como gás de pulverização catódica (Ls-PEKK-Ar) e com revestimento de PEKK utilizando nitrogênio (N) como gás de pulverização catódica (Ls-PEKK -N). Todos os implantes foram implantados em ossos femorais de coelhos. Após três períodos de cicatrização diferentes (2, 6 e 12 semanas), os coelhos foram sacrificados para exame mecânico (torque de remoção) e exame histológico. Resultados: Os resultados revelaram um aumento significativo nos valores médios do torque de remoção quando se utilizou o revestimento de PEKK em implantes de Ti, sendo o maior valor registrado pelo grupo Ls-PEKK-N. Histologicamente, o estudo demonstrou a progressão da osteogênese durante todos os períodos da pesquisa Observou-se que o grupo Ls-PEKK-N apresentou maior percentual de neoformação óssea em todos os períodos de cicatrização. Conclusão: O uso de PEKK como material de revestimento na superfície de implantes de Ti por pulverização catódica RF-magnetron resulta em um aumento no torque necessário para remover os implantes e melhorar a formação de tecido ósseo ao redor dos implantes, especialmente quando se utiliza nitrogênio como gás de pulverização catódica(AU)
Subject(s)
Titanium , Dental Implants , OsseointegrationABSTRACT
Objective: To report a clinical case of a female patient rehabilitated with Cemented Metal-Ceramic Multiple Prostheses on Implants in the upper arch. Materials and Methods: A multidisciplinary approach was employed, utilizing various clinical skills to achieve satisfactory outcomes in the rehabilitation of a fully edentulous patient. The treatment plan involved the use of cemented metal-ceramic prostheses, with a focus on optimizing the positioning of the crown margins to ensure periodontal health. Results: The use of cemented metal-ceramic multiple prostheses effectively addressed the patient's aesthetic concerns by eliminating screw access holes and ensuring the continuity of the ceramic material. The supragingival positioning of the crown margins prevented excess cement in the peri-implant sulcus, promoting periodontal health. The final prostheses provided excellent aesthetics and functionality, leading to enhanced patient satisfaction. Conclusion: The choice of cemented implant-supported prostheses represents a highly effective approach for treating edentulism. This method offers clinical benefits, such as increased retention and improved esthetic outcomes, while also positively impacting the patient's quality of life (AU)
Objetivo: Relatar um caso clínico de uma paciente feminina reabilitada com Próteses Metálicas-Cerâmicas Cimentadas em Implantes na arcada superior. Materiais e Métodos: Foi empregada uma abordagem multidisciplinar, utilizando várias habilidades clínicas para alcançar resultados satisfatórios na reabilitação de um paciente totalmente edêntulo. O plano de tratamento envolveu o uso de próteses metálicas-cerâmicas cimentadas, com foco na otimização do posicionamento das margens das coroas para garantir a saúde periodontal. Resultados: O uso de próteses metálicas-cerâmicas cimentadas abordou efetivamente as preocupações estéticas da paciente ao eliminar os orifícios de acesso para parafusos e garantir a continuidade do material cerâmico. O posicionamento supragengival das margens das coroas preveniu o excesso de cimento no sulco peri-implantar, promovendo a saúde periodontal. As próteses finais proporcionaram excelente estética e funcionalidade, resultando em maior satisfação do paciente. Conclusão: A escolha de próteses suportadas por implantes cimentadas representa uma abordagem altamente eficaz para o tratamento da edentulismo. Este método oferece benefícios clínicos, como maior retenção e melhores resultados estéticos, além de impactar positivamente a qualidade de vida do paciente(AU)
Subject(s)
Humans , Female , Prostheses and Implants , Dental Implants , Dental Prosthesis, Implant-Supported , Denture, Partial, Fixed , Mouth RehabilitationABSTRACT
A interface implante pilar (IAI) por se constituir de duas peças inevitavelmente apresentam micro lacuna (GAP), na qual pode ocorrer infiltração bacteriana, permitindo a penetração de microorganismos que colonizam na parte interna do implante levando ao acúmulo de biofilme e, podendo levar ao desenvolvimento da periimplantite. O desgaste da conexão interna do implante é algo que ocorre com frequência, muitas vezes pela fratura do parafuso e/ou, pela perda da rosca interna do implante. A ausência de informações prévias também pode gerar a necessidade da remoção do implante, devido a estas intercorrências, surge a possibilidade da criação de um novo componente para implantes para possibilitar a reabilitação protética, sem ter que passar por uma nova cirurgia de remoção e instalação do implante. O objetivo do trabalho foi mensurar o nível de afrouxamento do parafuso do pilar protético e do minipilar comparando com novo componente protéticos, na tentativa de simular o comportamento do conjunto implante/pilar/prótese. Foram utilizados vinte implantes de plataforma cone morse (CM) da DSP® com seus respectivos mini pilares, na qual foram distribuídos em 2 grupos(n=10): Grupo 1 - implante CM + mini pilar FlexCone® DSP + coroa simplificada pirâmide invertida carga aplicada 3 mm do centro da coroa. E Grupo 2 - implante CM + mini pilar novo + coroa simplificada pirâmide invertida carga aplicada 3 mm do centro da coroa. Foram realizados ciclagem mecânica com carga 133 N, durante 2x106 ciclos, com frequência 2 Hz e temperatura de 37ºC em ambos grupos. Um torquímetro digital foi usado para medir os valores de torque reverso do parafuso protético da coroa e também do pilar protético, antes e após o carregamento. Os resultados do modelo de regressão demonstraram diferenças estatisticamente significativas em função do envelhecimento comparando os grupos da coroa sobre o pilar protético (p = 0.020) e entre os grupos do pilar sobre o implante (p = 0.048), indicando que após o envelhecimento de 2.000.000 de ciclos ao longo do tempo está associado de maneira significativa a essas variáveis no contexto deste estudo. O segundo objetivo deste estudo foi avaliar in vitro a taxa de infiltração bacteriana através da IAI, entre o novo componente protético e a superfície interna do implante, juntamente foi analisado a permeabilidade do IAI para colonização bacteriana. Um total de oitenta implantes foram testados. As estruturas montadas para grupo 1 foi torqueado com 20 N/cm e do G2 foram torqueados com 45 N, ambos imersos em microtubos contendo 200 µl de saliva humana. Após 14 dias de incubação da amostra de bactéria nos implantes, foi realizada uma análise qPCR (reação da cadeia da polimerase em tempo real). O teste revelou que não houve diferenças estatisticamente significativas no crescimento bacteriana entre os grupos em qualquer um dos pontos temporais analisados. Conclui-se que o novo componente testado apresentou um destoque menor do que comparado ao mini pilar FlexCone DSP® e apresentou infiltração bacteriana no GAP da conexão implante-pilar semelhante comparado ao mini pilar original da empresa (AU)
The abutment implant interface (IAI), as it consists of two pieces, inevitably presents a micro gap (GAP), in which bacterial infiltration can occur, allowing the penetration of microorganisms that colonize in the internal part of the implant, leading to the accumulation of biofilm and, which can lead to development of peri-implantitis. Wear of the implant's internal connection is something that occurs frequently, often due to screw fracture and/or loss of the implant's internal thread. The lack of prior information can also generate the need to remove the implant, due to these complications, the possibility arises of creating a new component for implants to enable prosthetic rehabilitation, without having to undergo a new surgery to remove and install the implant. implant. The objective of the work was to measure the level of screw loosening of the prosthetic abutment and the mini-abutment compared with the new prosthetic component, in an attempt to simulate the behavior of the implant/ abutment/prosthesis set. Twenty DSP® morse cone (CM) platform implants were used with their respective mini pillars, which were distributed into 2 groups (n=10): Group 1 - CM implant + FlexCone® DSP mini pillar + simplified crown inverted pyramid load applied 3 mm from the center of the crown. And Group 2 - CM implant + new mini abutment + simplified crown inverted pyramid load applied 3 mm from the center of the crown. Mechanical cycling was carried out with a load of 133 N, for 2x106 cycles, with a frequency of 2 Hz and a temperature of 37ºC in both groups. A digital torque wrench was used to measure the reverse torque values of the prosthetic crown screw and also the prosthetic abutment, before and after loading. The results of the regression model demonstrated statistically significant differences as a function of aging comparing the crown-on-prosthetic abutment groups (p =0.020) and between the abutment-on-implant groups (p = 0.048), indicating that after aging 2,000 ,000 cycles over time is significantly associated with these variables in the context of this study. The second objective of this study was to evaluate in vitro the rate of bacterial infiltration through the IAI, between the new prosthetic component and the internal surface of the implant, together with the permeability of the IAI for bacterial colonization. A total of eighty implants were tested. The assembled structures for group 1 were torqued with 20 N/cm and G2 were torqued with 45 N, both immersed in microtubes containing 200 µl of human saliva. After 14 days of incubation of the bacteria sample in the implants, a qPCR (real-time polymerase chain reaction) analysis was performed. The test revealed that there were no statistically significant differences in bacterial growth between groups at any of the time points analyzed. It is concluded that the new component tested presented a lower impact compared to the FlexCone DSP® mini abutment and presented bacterial infiltration in the GAP of the implant-abutment connection similar to the company's original mini abutment.(AU)
Subject(s)
Streptococcus mutans , Dental Implants , Peri-ImplantitisABSTRACT
A eficácia dos implantes osseointegrados é amplamente reconhecida na literatura científica. Contudo, infiltrações bacterianas na junção implante-pilar podem desencadear inflamação nos tecidos circundantes, contribuindo para a evolução de condições mais sérias, como a peri-implantite. O objetivo desse estudo foi produzir complexos polieletrólitos (PECs) de quitosana (Q) e xantana (X) em forma de membranas, carregá-las com ativos naturais e sintéticos antimicrobianos, caracterizálas estruturalmente e avaliá-las frente a degradação enzimática, cinética de liberação e ações antimicrobianas com finalidade de aplicação para drug delivery. Membranas de QX a 1% (m/v) foram produzidas em três proporções, totalizando doze grupos experimentais: QX (1:1); QX (1:2), QX (2:1), QX-P (com própolis) (1:1); QX-P (1:2); QX-P (2:1); QX-C (com canela) (1:1); QX-C (1:2); QX-C (2:1) e CLX (com clorexidina 0,2%) (1:1); CLX (1:2); CLX (2:1). Para os estudos de caracterização foram feitas análises da espessura em estado seco; análises morfológicas superficial e transversal em Microscopia Eletrônica de Varredura (MEV); análise estrutural de espectroscopia de infravermelho por transformada de Fourier (FTIR); análise de degradação por perda de massa sob ação da enzima lisozima; e análise da cinética de liberação dos ativos em saliva artificial. Para os testes microbiológicos, análises de verificação de halo de inibição e ação antibiofilme foram feitas contra cepas de Staphylococcus aureus (S. aureus) e Escherichia coli (E. coli). Os resultados demonstraram que a espessura das membranas variou conforme a proporção, sendo que o grupo QX (1:2) apresentou a maior média de 1,022 mm ± 0,2, seguida respectivamente do QX (1:1) com 0,641 mm ± 0,1 e QX (2:1) com 0,249 mm ± 0,1. Nas imagens de MEV é possível observar uma maior presença de fibras, rugosidade e porosidade nos grupos QX (1:2) e QX (1:1) respectivamente, e, no QX (2:1) uma superfície mais lisa, uniforme e fina. No FTIR foram confirmados os picos característicos dos materiais isoladamente, além de observar as ligações iônicas que ocorreram para formação dos PECs. Na análise de degradação, os grupos com ativos naturais adicionados tiveram melhores taxas de sobrevida do que os grupos QX. No teste de liberação, os grupos QX-P tiveram uma cinética mais lenta que os QX-C, cuja liberação acumulada de 100% foi feita em 24 h. Já nos testes do halo inibitório, somente os grupos CLX tiveram ação sobre as duas cepas, e os QX-P tiveram sobre S. aureus. Nas análises antibiofilme, os grupos CLX apresentaram as maiores taxas de redução metabólica nas duas cepas (± 79%); os grupos QX-P apresentaram taxas de redução similares em ambas as cepas, porém com percentual um pouco maior para E. coli (60- 80%) e os grupos QX-C tiveram grande discrepância entre as duas cepas: de 35 a 70% para S. aureus e 14 a 19% para E. coli. Pode-se concluir que, frente as análises feitas, o comportamento do material foi afetado diretamente pelos ativos adicionados a matriz polimérica. As proporções de Q ou X afetaram somente a espessura final. Quanto a aplicação proposta de drug delivery, os dispositivos apresentaram grande potencial, principalmente os grupos CLX e QX-P. (AU)
The effectiveness of osseointegrated implants is widely recognized in scientific literature. However, bacterial infiltrations at the implant-abutment interface may trigger inflammation in surrounding tissues, contributing to the development of more serious conditions, such as peri-implantitis. The aim of this study was to produce chitosan (Q) and xanthan (X) polyelectrolyte complexes (PECs) in the form of membranes, load and evaluate them for enzymatic degradation, release kinetics, and antimicrobial actions for drug delivery applications. QX membranes at 1% (w/v) were produced in three proportions, totaling twelve experimental groups: QX (1:1), QX (1:2), QX (2:1), QX-P (with propolis) (1:1), QX-P (1:2), QX-P (2:1), QX-C (with cinnamon) (1:1), QX-C (1:2), QX-C (2:1), and CLX (with 0.2% chlorhexidine) (1:1), CLX (1:2), CLX (2:1). Characterization studies included analyses of dry state thickness, surface and crosssectional morphology using Scanning Electron Microscopy (SEM), structural analysis by Fourier Transform Infrared (FTIR) spectroscopy, mass loss degradation analysis under lysozyme action, and active release kinetics analysis in artificial saliva. Microbiological tests included verification analyses of inhibition halos and antibiofilm action against strains of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Results showed that membrane thickness varied according to proportion, with group QX (1:2) presenting the highest average of 1.022 mm ± 0.2, followed by QX (1:1) with 0.641 mm ± 0.1, and QX (2:1) with 0.249 mm ± 0.1. SEM images showed greater presence of fibers, roughness, and porosity in groups QX (1:2) and QX (1:1) respectively, while QX (2:1) exhibited a smoother, more uniform, and thinner surface. FTIR confirmed characteristic peaks of the materials individually, besides showing ionic bonds formed for PECs. Degradation analysis revealed that groups with added natural actives had better survival rates than QX groups. In release tests, QX-P groups exhibited slower kinetics than QX-C, with 100% cumulative release achieved in 24 h. inhibitory halo tests, only CLX groups exhibited action against both strains, while QX-P acted against S. aureus. Antibiofilm analyses showed CLX groups with the highest metabolic reduction rates in both strains (± 79%); QX-P groups showed similar reduction rates in both strains, slightly higher for E. coli (60-80%), and QX-C groups had a significant discrepancy between strains: 35-70% for S. aureus and 14-19% for E. coli. In conclusion, material behavior was directly affected by added actives to the polymeric matrix. Proportions of Q or X only affected final thickness. Regarding proposed drug delivery applications, the devices showed great potential, especially CLX and QX-P groups.(AU)
Subject(s)
Drug Delivery Systems , Chitosan , Dental Implant-Abutment Design , Phytochemicals , PolyelectrolytesABSTRACT
Objective: In response to the demand for dental implants, extensive research has been conducted on methods for transferring load to the surrounding bone. This study aimed to evaluate the stresses on the peripheral bone, implants, and prostheses under scenarios involving of the following variables: prosthesis designs, vertical bone heights, load angles, and restorative materials. Material and Methods: Three implants were inserted in the premolar and molar regions (5-6-7) of the two mandibular models. Model 1 represented 0 mm marginal bone loss and Model 2 simulated 3 mm bone loss. CAD/CAM-supported materials, hybrid ceramic (HC), resin-nano ceramic (RNC), lithium disilicate (LiSi), zirconia (Zr), and two prosthesis designs (splinted and non-splinted) were used for the implant-supported crowns. Forces were applied vertically (90°) to the central fossa and buccal cusps and obliquely (30°) to the buccal cusps only. The stresses were evaluated using a three-dimensional Finite Element Analysis. Results: Oblique loading resulted in the highest stress values. Of the four materials, RNC showed the low stress in the restoration, particularly in the marginal area. The use of different restorative materials did not affect stress distribution in the surrounding bone. The splinted prostheses generated lower stress magnitude on the bone, and while more stress on the implants were observed. Conclusion: In terms of the stress distribution on the peri-implant bone and implants, the use of different restorative materials is not important. Oblique loading resulted in higher stress values, and the splinted prosthesis design resulted in lower stress (AU)
Objetivo: Em resposta à demanda por implantes dentários, extensa pesquisa foi realizada sobre métodos para transferir carga ao osso circundante. Este estudo buscou avaliar os estresses no osso periférico, implantes e próteses em cenários que envolvem as seguintes variáveis: designs de próteses, alturas ósseas verticais, ângulos de carga e materiais restauradores. Material e Métodos: Três implantes foram inseridos nas regiões dos pré-molares e molares (5-6-7) de dois modelos de mandíbula. O Modelo 1 representou perda óssea marginal de 0 mm e o Modelo 2 simulou perda óssea de 3 mm. Materiais suportados por CAD/CAM, cerâmica híbrida (HC), cerâmica nano-resina (RNC), dissilicato de lítio (LiSi), zircônia (Zr) e dois designs de próteses (sintetizadas e não-sintetizadas) foram utilizados para as coroas suportadas por implantes. Forças foram aplicadas verticalmente (90°) à fossa central e cúspides bucais e obliquamente (30°) apenas às cúspides bucais. Os estresses foram avaliados usando Análise de Elementos Finitos tridimensional. Resultados: Cargas oblíquas resultaram nos valores mais altos de estresse. Entre os quatro materiais, RNC mostrou baixo estresse na restauração, especialmente na área marginal. O uso de diferentes materiais restauradores não afetou a distribuição de estresse no osso circundante. Próteses sintetizadas geraram menor magnitude de estresse no osso, enquanto mais estresse nos implantes foi observado. Conclusão: Em termos de distribuição de estresse no osso peri-implantar e implantes, o uso de diferentes materiais restauradores não é crucial. Cargas oblíquas resultaram em valores mais altos de estresse, e o design de prótese sintetizada resultou em menor estresse. (AU)
Subject(s)
Dental Implants , Dental Prosthesis , Finite Element Analysis , Biomechanical PhenomenaABSTRACT
Abstract Objectives This study aimed to investigate the osseointegration of titanium (Ti) implants with micro-nano textured surfaces functionalized with strontium additions (Sr) in a pre-clinical rat tibia model. Methodology Ti commercially pure (cp-Ti) implants were installed bilaterally in the tibia of 64 Holtzman rats, divided into four experimental groups (n=16/group): (1) Machined surface - control (C); (2) Micro-nano textured surface treatment (MN); (3) Micro-nano textured surface with Sr2+ addition (MNSr); and (4) Micro-nano textured surface with a higher complementary addition of Sr2+ (MNSr+). In total, two experimental euthanasia periods were assessed at 15 and 45 days (n=8/period). The tibia was subjected to micro-computed tomography (μ-CT), histomorphometry with the EXAKT system, removal torque (TR) testing, and gene expression analysis by PCR-Array of 84 osteogenic markers. Gene expression and protein production of bone markers were performed in an in vitro model with MC3T3-E1 cells. The surface characteristics of the implants were evaluated by scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), and laser scanning confocal microscopy. Results SEM, confocal, and EDS analyses demonstrated the formation of uniform micro-nano textured surfaces in the MN group and Sr addition in the MNSr and MNSr+ groups. TR test indicated greater osseointegration in the 45-day period for treated surfaces. Histological analysis highlighted the benefits of the treatments, especially in cortical bone, in which an increase in bone-implant contact was found in groups MN (15 days) and MNSr (45 days) compared to the control group. Gene expression analysis of osteogenic activity markers showed modulation of various osteogenesis-related genes. According to the in vitro model, RT-qPCR and ELISA demonstrated that the treatments favored gene expression and production of osteoblastic differentiation markers. Conclusions Micro-nano textured surface and Sr addition can effectively improve and accelerate implant osseointegration and is, therefore, an attractive approach to modifying titanium implant surfaces with significant potential in clinical practice.
ABSTRACT
Aim: The present study was conducted to assess the role of vitamin C in wound healing following dental implant surgery. Materials and Methods: 60 patients receiving dental implants were divided into two groups of 30 each. group A and group B. Group A included 30 patients who underwent dental implant surgery along with vitamin C supplementation, 500 mg twice a day post-surgery for 5 days and group B included 30 patients who underwent dental implant surgery alone. The Wound Healing Index, Wound Evaluation score and Visual Analog Scale were the following indices evaluated. Results: The results of the present study showed that there was a significant improvement in all indices in both group A and group B, but results in group A were statistically more significant than group B and indicating that maximum healing was seen in the first 7 days post-operative, thereafter, remaining more or less the same. In reference to vitamin C for pain relief, there was no statistically difference between the study groups. Conclusion: Using vitamin C supplementation post-operative healing following dental implant surgery in patients given vitamin C. However, vitamin C supplementation does not decrease the post operative pain associated with dental pain and anxiety.
ABSTRACT
This clinical case aims to report a minimally invasive approach for maxillary sinus augmentation for first-molar replacement with a dental implant. A 61-year-old male presented to dental clinic with missing upper right first molar. Panoramic x-ray (OPG) showed insufficient posterior maxillary bone with a residual alveolar bone height<4 mm. The patient underwent a minimally invasive sinus floor elevation and augmentation. Three months postoperatively, and a dental implant (? 4.1×12 mm, bone level, straumann) was placed successfully. Thereafter, at 3-months post-implantation, the final restoration was accomplished. A 12-months follow-up demonstrated satisfactory clinical outcome. In conclusion, the present case-report demonstrates the advantages of the presented technique for sinus augmentation and dental implant restoration with high precision and promising result, in similar cases with a residual alveolar bone height <5 mm.