Instalación de implante y reparación de tabla ósea vestibular / Implant Setting and Vestibular Bone Board Repair

ABSTRACT Background: The occurrence of a vestibular bone lamina dehiscence of a fresh alveolus becomes a challenge for rehabilitation treatment of dental implants. Objective: To evaluate prosthetic treatment and stability of periimplant soft tissues in an alveolus with advanced oral bone resorption immediately after extraction, by using single fixed prostheses on a dental implant. Case presentation: A 29-year-old female patient, without systemic disease, completely toothed, with a thick-scalloped gingival biotype, attended the clinic and her main reason for consultation was not being aesthetically satisfied with her right upper central incisor. Radiographic examination showed advanced oral bone loss, secondary to an infection of the root of the right upper central incisor. In a first surgical phase, the right central incisor was extracted using a traumatic technique with periotomes, and a dental implant was placed. A resorbable membrane was adapted to the vestibular defect and the particulate cortical bone allograft was then compacted into the site in order to fill the space between the collagen membrane and the dental implant. A screw-retained provisional restoration was performed using the extracted natural tooth. The emergence profile was established simply by adding fluid composite resin, until the desired contours were achieved. Radiological and clinical follow-up at six months showed favorable implant evolution. No mechanical or biological complications were observed during this observation period. The oral gingival margin was in a correct position. Conclusion: This technique allowed predictable aesthetic-functional outcomes and soft tissue stability in a thick-scalloped gingival biotype with a single fixed prosthesis.

RESUMEN Antecedentes: La presencia de una dehiscencia de la lámina ósea vestibular de un alveolo fresco se convierte en un desafío en el tratamiento de la rehabilitación con implantes dentales. Objetivo: Evaluar el tratamiento protésico y la estabilidad de los tejidos blandos periimplantarios en un alveolo con reabsorción ósea bucal avanzada inmediatamente posterior a una extracción, mediante el uso de prótesis fijas unitaria sobre implante dental. Presentación del caso: Una paciente de 29 años de edad, sin enfermedad sistémica, completamente dentada, con un biotipo gingival festoneado grueso, asiste a la clínica y su principal motivo de consulta fue no estar conforme estéticamente en su incisivo central superior derecho. El examen radiográfico mostró la presencia de una pérdida ósea bucal avanzada, secundaria a una infección de la raíz del incisivo central superior derecho. En una primera fase quirúrgica, se extrajo el incisivo central derecho utilizando una técnica atraumática usando periótomos y se colocó un implante dental. Se adaptó una membrana reabsorbible al defecto vestibular y después se compactó el aloinjerto de hueso cortical particulado en el sitio para llenar el espacio entre la membrana de colágeno y el implante dental. Se realizó una restauración provisional atornillada utilizando el diente natural extraído. El perfil de emergencia se estableció simplemente agregando resina compuesta fluida, hasta que se lograron los contornos deseados. El seguimiento radiológico y clínico a los 6 meses mostró una evolución favorable del implante. No se observaron complicaciones mecánicas ni biológicas durante este periodo de observación. El margen gingival bucal estaba en una posición correcta. Conclusión: Esta técnica permitió resultados estéticos-funcionales predecibles y estabilidad de los tejidos blandos en un biotipo gingival festoneado grueso con una única prótesis fija.

Avaliação de diferentes protocolos de campo eletromagnético pulsado na osseointegração de implantes: estudo in vivo e in vitro / Evaluation of differents protocols of pulsed electromagnetic fields in implants osseointegration: in vivo and in vitro study

A utilização de estimulação biofísica através da modalidade de campo eletromagnético pulsado (CEMP) para o tratamento de diversas condições no tecido ósseo tem despertado o interesse científico há décadas. Entretanto, a grande variedade nos parâmetros e protocolos utilizados e a divergência de resultados na literatura dificultam o estabelecimento de uma metodologia que seja eficaz no contexto da terapia com implantes osseointegrados. Dessa forma, torna-se importante avaliar o efeito de diferentes tempos de aplicação do CEMP padronizado em diferentes momentos no processo de osseointegração de implantes de titânio inseridos em tíbias de ratos. Para isso, foram utilizados 60 animais (Rattus norvegicus, variação albinus, Wistar), randomizados em três grupos experimentais: controle, teste A (GTA) submetidos por 3 horas de CEMP, e teste B (GTB) com 1 hora de CEMP, sendo que, a exposição ocorreu em 5 dias semanalmente durante o período experimental. Todos os animais receberam implantes em ambas as tíbias, e a aplicação do CEMP ocorreu apenas nos grupos teste com parâmetros fixos de ± 1 mT, 15 Hz, com 25 ciclos repetidos por 200 microssegundos. Após a eutanásia as peças foram separadas e preparadas para o teste mecânico, análises histomorfométricas, microtomografia computadorizada (µCT) e ensaios biológicos in vitro. Os dados foram tabulados e a análise de variância ANOVA foi aplicada, com nível de significância de 5%. Os resultados obtidos revelaram que, GTB apresentou melhores resultados em comparação ao GTA nos testes de torque de remoção em 07 dias; no volume ósseo e densidade mineral óssea, ambos em 07, 21 e 45 dias; na proliferação celular em 21 dias, na viabilidade celular em 07 e 45 dias, no conteúdo de proteína total em 07 dias e nódulos de mineralização em 03 e 07 dias. O GTA apresentou melhor desempenho na avaliação da espessura do osso trabecular em 03 dias e na proliferação celular em 03 e 45 dias comparado ao GTB. Os grupos teste apresentaram resultados superiores ao controle nas avaliações de contato osso-implante, espessura do osso trabecular, na viabilidade celular, conteúdo de proteína total e fosfatase alcalina. Na análise histomorfométrica e no número de trabéculas não houve diferenças entre os grupos teste. Com os resultados pode-se concluir que, a aplicação do campo eletromagnético pulsado como um bioestimulador foi efetivo na otimização dos eventos no tecido ósseo que acarretam na osseointegração, especialmente quando aplicado por menor tempo e nos períodos iniciais do reparo ósseo(AU)

The use of biophysical stimulation through the pulsed electromagnetic field modality (PEMF) for the treatment of various conditions in bone tissue has aroused scientific interest for decades. However, the wide variety of parameters and protocols used and the divergence of results in the literature make it difficult to establish a methodology that is effective in the context of therapy with osseointegrated implants. Thus, it is important to evaluate the effect of different application times of the standardized PEMF at different times in the osseointegration process of titanium implants inserted in tibiae of rats. For this, 60 animals (Rattus norvegicus, variation albinus, Wistar) were used, randomized in three experimental groups: control, test A (GTA) submitted for 3 hours of CEMP, and test B (GTB) with 1 hour of PEMF, and the exposure occurred in 5 days weekly during the trial period. All animals received implants in both tibiae, and the application of PEMF only occurred in the test groups with fixed parameters ± 1 mT, 15 Hz, with 25 cycles repeated for 200 microseconds. After euthanasia, the pieces were separated and prepared for mechanical testing, histomorphometric analysis, computed microtomography (µCT) and in vitro biological tests. Data were tabulated and ANOVA analysis of variance was applied, with a significance level of 5%. The results obtained revealed that, GTB presented better results in comparison to GTA in the removal torque tests in 07 days; in bone volume and bone mineral density, both at 07, 21 and 45 days; cell proliferation in 21 days, cell viability in 07 and 45 days, total protein content in 07 days and mineralization nodules in 03 and 07 days. GTA performed better in assessing trabecular bone thickness in 03 days and in cell proliferation in 03 and 45 days compared to GTB. The test groups showed results superior to the control in assessments of boneimplant contact, trabecular bone thickness , in cell viability, total protein content and alkaline phosphatase. In the histomorphometric analysis and in the number of trabeculae, there were no differences between the test groups. With the results it can be concluded that the application of the pulsed electromagnetic field as a biostimulator was effective in the optimization of the events in the bone tissue that result in osseointegration, especially when applied for a shorter time and in the initial periods of bone repair(AU)

Implant-based factor as possible risk for peri-implantitis

Abstract Peri-implantitis is currently a topic of major interest in implantology. Considered one of the main reasons of late implant failure, there is an emerged concern whether implant characteristics could trigger inflammatory lesion and loss of supporting bone. The purpose of this narrative review is to provide an evidence based overview on the influence of implant-based factors in the occurrence of peri-implantitis. A literature review was conducted addressing the following topics: implant surface topography; implant location; occlusal overload; time in function; prosthesis-associated factors (rehabilitation extension, excess of cement and implant-abutment connection); and metal particle release. Although existing data suggests that some implant-based factors may increase the risk of peri-implantitis, the evidence is still limited to consider them a true risk factor for peri-implantitis. In conclusion, further evidences are required to a better understanding of the influence of implant-based factors in the occurrence of peri-implantitis. Large population-based studies including concomitant analyses of implant- and patient-based factors are required to provide strong evidence of a possible association with peri-implantitis in a higher probability. The identification of these factors is essential for the establishment of strategies to prevent peri-implantitis.

New strategies and developments for peri-implant disease

Abstract The aim of this illustrated review is to present the new strategies and developments to treatment and diagnosis of periimplant diseases. Periimplant disease is a subject of great concern for modern dentistry. The numbers of implant exhibiting biological complications grows as implant dentistry expands thought-out the world. Diagnosis and treatment of those diseases are still controversial and difficult. We present novel treatment for infection control and biological rationale of additional use of guided bone regeneration, with an illustrative explanation of the treatments presented with two cases.

Treatment of peri-implant soft tissue defects: a narrative review

Abstract Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Sobredentadura total superior implantosoportada / Superior total overdenture on implants

Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica Pedro Ortiz del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional(AU)

This is the case of a total maxilla edentulous patient seen in consultation of the Pedro Ortíz Clinic Implant of Habana del Este municipality in 2009 and con rehabilitation by prosthesis over osteointegration implants added to stomatology practice in Cuba as an alternative to conventional treatment in patients totally edentulous. We follow a protocol including a surgery or surgical phase, technique without or with flap creation and early or immediate load. This is a male patient aged 56 came to our multidisciplinary consultation worried because he had three prostheses in last two years and any fulfilled the requirements of retention to feel safe and comfortable with prostheses. The final result was the total satisfaction of rehabilitated patient improving its aesthetic and functional quality(AU)