Color change, tooth sensitivity, aesthetic self-perceptions and quality of life after at-home dental bleaching / Mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro

Objective: The aim of this study was to determine the color change, tooth sensitivity, aesthetic self-perception and quality of life after at-home dental bleaching. Material and Methods: Dental examination was performed and the initial color of the upper right incisor was recorded using a spectrophotometer (Easyshade Compact, Vita Zahnfabrik) and CIELab parameters. Individual vinyl trays were delivered to the patients (n=37) who were instructed to use the carbamide peroxide 16% (Total Blanc Home C16%, DFL) for 2 hours daily for 2 weeks. One-week after the end of treatment, measurements were repeated to calculate color (ΔEab,ΔE00) and whiteness index (ΔWID) variations. Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires were applied before and 30 days after treatment. Tooth sensitivity was by checked by visual analogue scale (VAS). Spearnan's correlation tests were used to verify the possible relation between color change parameters and sensitivity. The Wilcoxon test was applied for results obtained by OHIP and PIDAQ questionnaires. Results: Significant color change was observed after 14 days, regardless of the considered parameter. There was no significant correlation between sensitivity and color change. The dental self-confidence domain increased after bleaching (p = 0.029) and the psychological impact decreased (p = 0.001). Conclusion:At-home dental bleaching was effective on the overall whitening and the color change was not related to tooth sensitivity. The bleaching treatment had a positive impact on the quality of life, reducing psychological discomfort and improving dental self-confidence and aesthetic self-perception. (AU)

Objetivo: O objetivo deste estudo foi determinar a mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro. Material e Métodos: Uma consulta inicial foi realizada e a cor inicial do incisivo superior direito foi registrada usando um espectrofotômetro (Easyshade Compact, Vita Zahnfabrik) e parâmetros CIELab. Moldeiras individuais confeccionadas em vinil foram entregues aos pacientes participantes (n = 37), que foram instruídos a usar o gel à base de peróxido de carbamida 16% (Total Blanc Home C16%, DFL) durante 2 horas diárias durante 2 semanas. Uma semana após o término do tratamento, as medidas foram repetidas para calcular a variação de cor (ΔEab, ΔE00) e o índice de brancura (ΔWID). Os questionários OHIP (Oral Health Impact Profile) e PIDAQ (Psychosocial Impact of Dental Aesthetics Questionnaire) foram aplicados antes e 30 dias após o tratamento. A sensibilidade dental foi verificada por meio da escala visual análoga (VAS). Os testes de correlação de Spearnan foram utilizados para verificar a possível relação entre os parâmetros de mudança de cor e sensibilidade. O teste Wilcoxon foi aplicado para os resultados obtidos pelos questionários OHIP e PIDAQ. Resultados: Mudança de cor significativa foi observada após 14 dias, independentemente do parâmetro considerado. Não houve correlação significativa entre a sensibilidade e a mudança de cor. O domínio da autoconfiança dental aumentou após o branqueamento (p = 0,029) e o impacto psicológico diminuiu (p = 0,001). Conclusão: O clareamento dental caseiro foi eficaz no branqueamento geral e a mudança de cor não estava relacionada à sensibilidade dental. O tratamento clareador teve um impacto positivo na qualidade de vida, reduzindo o desconforto psicológico e melhorando a autoconfiança dental e a autopercepção estética.(AU)

Evaluation of the physical and antifungal effects of chlorhexidine diacetate incorporated into polymethyl methacrylate

Abstract This study aimed to evaluate the physical properties and antifungal activities of polymethyl methacrylate (PMMA) acrylic resins after the incorporation of chlorhexidine diacetate salt (CDA). Methodology: First, acrylic resin specimens were fabricated with Vipi Cor® and DuraLay® resins with and without the incorporation of 0.5%, 1.0% or 2.0% CDA. The residual monomer and CDA release were measured at intervals ranging from 2 hours to 28 days using ultraviolet spectrometry combined with high-performance liquid chromatography. The antifungal activity against C. albicans was evaluated with the agar diffusion method. Fourier transform infrared spectroscopy was used to analyze the degree of resin conversion. Finally, the water sorption values of the resins were also measured. Results: The incorporated CDA concentration significantly changed the rate of CDA release (p<0.0001); however, the brand of the material appeared to have no significant influence on drug release. Subsequently, the inhibition zones were compared between the tested groups and within the same brand, and only the comparisons between the CDA 2% and CDA 1% groups and between the CDA 1% and CDA 0.5% groups failed to yield significant differences. Regarding the degrees of conversion, the differences were not significant and were lower only in the CDA 2% groups. Water sorption was significantly increased at the 1.0% and 2.0% concentrations. Conclusions: We concluded that the incorporation of CDA into PMMA-based resins enabled the inhibition of C. albicans growth rate, did not alter the degrees of conversion of the tested resins and did not change the release of residual monomers.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses

Abstract This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

Edentulism in Brazil: trends, projections and expectations until 2040 / Edentulismo no Brasil: tendências, projeções e expectativas até 2040

Abstract The aim of this study was to examine the edentulism rates in Brazil and make projections for the next years. Data were collected from three national oral health surveys. The percentage of edentulous jaws was calculated. Projections were made for the years 2020, 2030 and 2040, assuming that edentulism follows a logistic function. Population projections were also performed. Annual change in proportion of edentulous jaws was -0.04% for teenagers, -0.96% for adults and 0.76% for the elderly. By 2040, edentulous jaws will be virtually zero among teenagers, 1.77% among adults and 85.96% among the elderly. Teenagers will slightly decrease in number; adults will increase and subsequently decrease; the elderly will continue to increase. In teenagers and adults, the number of edentulous jaws will decrease, being approximately 616,000 in 2040. In the elderly, it will increase alarmingly, reaching over 64 million in 2040. Edentulism is declining in Brazil among teenagers and middle-aged adults, but is still increasing and will continue to increase for the next decades among the elderly.

Resumo O objetivo deste estudo foi examinar as taxas de edentulismo no Brasil e fazer projeções para os próximos anos. Os dados foram coletados de três censos nacionais de saúde bucal. O percentual de arcadas edêntulas foi calculado. Foram feitas projeções para 2020, 2030 e 2040, assumindo que o edentulismo segue uma função logística. Também foram realizadas projeções populacionais. A variação anual da proporção de arcadas edêntulas foi de -0,04% para jovens, -0,96% para adultos e 0,76% para idosos. Até 2040, o percentual de arcadas edêntulas será virtualmente zero entre jovens, 1,77% entre adultos e 85,96% entre idosos. O número de jovens vai diminuir levemente; o de adultos vai aumentar e depois diminuir; e o de idosos vai continuar aumentando. Para jovens e adultos, o número de arcadas edêntulas vai diminuir, aproximando-se de 616.000 em 2040. Para os idosos, este número vai aumentar alarmantemente, alcançando mais de 64 milhões em 2040. O edentulismo está diminuindo no Brasil entre jovens e adultos, mas está aumentando e continuará a aumentar nas próximas décadas entre os idosos.

Expressão de citocinas na saliva de pacientes com peri-implantite / Cytokine expression in saliva from patients with peri-implantitis

O objetivo desse estudo foi avaliar os níveis de GM-CSF,IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IFN-γ e TNF-α na saliva de pacientes que apresentam peri-implantite comparados com indivíduos que apresentam mucosite peri-implantar; 22 pacientes foram divididos em dois grupos: mucosite (MU n = 12, média de idade de 65 ± 9,4, sendo dois homens e dez mulheres) totalizando 36 implantes de hexágono externo e plataforma regular em mandíbula e peri-implantite (PI n = 10, média de idade de 59,4 ± 11,8, sendo quatro homens e seis mulheres), totalizando 30 implantes de hexágono externo e plataforma regular em mandíbula. Os parâmetros clínicos avaliados foram: profundidade de bolsa, índice de placa e sangramento a sondagem. Foi realizada a coleta de saliva não estimulada e saliva do ducto da parótida. As amostras foram submetidas à análise imunológica e os níveis de GM-CSF,IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IFN-γ e TNF-α foram mensurados através da técnica de multianálise. Os resultados clínicos demonstraram que os pacientes com PI apresentaram maior índice de placa em relação aos com MU (100% e 80% respectivamente; p = 0,02). Os pacientes com MU apresentaram menor profundidade de bolsa em relação aos sítios rasos e profundos dos pacientes com PI (p = 0,001 e p ≤ 0,001, respectivamente). Na saliva do ducto da parótida, os níveis de IL-8 foram significativamente mais altos nos pacientes com PI em relação aos com MU (p = 0,04). A saliva do ducto da parótida apresentou um aumento significativo na expressão da IL-8 e IL-12, não detectado na saliva total.

This study aimed to measure GM-CSF, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IFN-γ, and TNF-α levels in whole saliva from patients with Mucositis (MU) and periimlantitis (PI). Twenty-two completely edentulous patients (16 women, 6 men) participated in this study. They use a complete, mandibular supported prosthesis with five external hexagon regular platform fixtures for at least six months. Patients were divided into two groups: mucositis (MU = 2 men and 10 women; mean age 65.0 ± 9.4 years), and peri-implantitis (PI= 4 men and 6 women; mean age 59.4±11.8 years). The clinical parameters evaluated were probing pocket depth (PPD), bleeding on probing (BOP), and plaque score (PS). Samples were collected and cytokines were measured by a multiplexed bead immunoassay. PI patients had a higher percentage of PS when compared to those with MU (p = 0.02). The MU patients had lower PPD compared to shallow (p = 0.001) and deep sites (p ≤ 0.001) in PI patients. IL-8 and IL-12 levels were significantly higher in patients with PI (p = 0.04) than MU at parotid sites. The saliva from the parotid duct showed a significant increase in expression of IL-8 and IL-12 levels not detected in the whole salivary composition

A rationale method for evaluating unscrewing torque values of prosthetic screws in dental implants

OBJECTIVES: Previous studies that evaluated the torque needed for removing dental implant screws have not considered the manner of transfer of the occlusal loads in clinical settings. Instead, the torque used for removal was applied directly to the screw, and most of them omitted the possibility that the hexagon could limit the action of the occlusal load in the loosening of the screws. The present study proposes a method for evaluating the screw removal torque in an anti-rotational device independent way, creating an unscrewing load transfer to the entire assembly, not only to the screw. MATERIAL AND METHODS: Twenty hexagonal abutments without the hexagon in their bases were fixed with a screw to 20 dental implants. They were divided into two groups: Group 1 used titanium screws and Group 2 used titanium screws covered with a solid lubricant. A torque of 32 Ncm was applied to the screw and then a custom-made wrench was used for rotating the abutment counterclockwise, to loosen the screw. A digital torque meter recorded the torque required to loosen the abutment. RESULTS: There was a significant difference between the means of Group 1 (38.62±6.43 Ncm) and Group 2 (48.47±5.04 Ncm), with p=0.001. CONCLUSION: This methodology was effective in comparing unscrewing torque values of the implant-abutment junction even with a limited sample size. It confirmed a previously shown significant difference between two types of screws.

Influência das propriedades de superfícies dos implantes com as respostas dos tecidos moles e formação de biofilme / The influence of implant surface properties with soft tissue response and biofilm formation

Uma conexão estável entre a superfície de titânio do implante e os tecidos bucais a sua volta é um importante pré-requisito para o seu sucesso a longo prazo. Assim, tal superfície deve possuir propriedades que minimizem a colonização por microrganismos patogênicos da cavidade oral ao mesmo tempo em que permita boa adesão dos tecidos bucais. O objetivo deste estudo foi realizar uma revisão da literatura que buscasse relacionar as diferentes propriedades de superfícies dos implantes e suas características com as respostas dos tecidos moles peri-implantares, bem como com a formação de biofilme sobre sua superfície. Estudos in vitro e in vivo indicaram que a rugosidade e a textura de superfície do implante influenciam em adesão, orientação, proliferação, metabolismo das células epiteliais e células de tecido conjuntivo. Foi descrito também que a rugosidade superficial e a molhabilidade têm um impacto significativo na formação de biofilme, sendo que a influência da rugosidade foi dita como sendo mais significativa do que a molhabilidade. Sendo assim, nota-se que a otimização das superfícies dos implantes ainda é necessária. Tornando-se importante analisar o papel das propriedades de diferentes superfícies com relação à composição química e à microestrutura, avaliando o desempenho biológico dos diferentes tratamentos de superfícies e as propriedades químicas que eles promovem na superfície dos implantes dentários.

A stable connection between the titanium surface and the oral tissue around them is an important prerequisite for long-term dental implant success. Thus, this surface should minimize the bacterial colonization while allowing a good adhesion of the oral tissues. The aim of this study was to review the literature and to relate the properties of implant surfaces and their characteristics with the responses of oral soft tissues around implants, as well as the biofilm formation on its surface. In vitro and in vivo studies indicated that the roughness and texture of the implant surface influences the adhesion, orientation, proliferation, and metabolism of epithelial cells and connective tissue. It was also described that the surface roughness and wettability, have a significant impact on the biofilm formation, but the influence of roughness was said to be more significant than the wettability. In summary, it appears that an optimization of implant surfaces is still necessary. It is therefore important to systematically evaluate the role of different surface properties (chemical composition as well as microstructure) and to assess the biological performance of different implant materials.

The need for complete dentures in Brazil: an epidemiological approach for the next 10 years

The only two censuses on oral health (Levantamento Epidemiológico em Saúde Bucal em 1986 e Projeto em Saúde Bucal de 2003) show a tendency in the reduction of edentulous patients in Brazil. The aim of this article was to estimate the variation in rates of the need for dentures in Brazil in 2010 and 2020. The projection was obtained from a linear variation carried out between the 1986 and 2003 censuses. A formula was used to calculate the result, which showed a strong trend in the decline of the number of edentulous patients until 2020. After the result analyses, it was found that by 2020 the need for complete denture for people between 15 and 74 years old will be none. Unfortunately, the only two censuses on oral health do not give us sufficient data to show a reliable projection of edentulous patients in Brazil

Reabilitação de paciente vítima de projétil de arma de fogo com dois implantes zigomáticos / Rehabilitation of a patient victim of gunshot wound through the use of two zygomatic fixtures

Os implantes zigomáticos (IZs) têm sido utilizados desde os anos de 1990 para reabilitação de maxilas severamente atróficas. Neste artigo pretendemos relatar um caso de reabilitação de maxila com perda óssea provocada por projétil de arma de fogo (PAF) através destes implantes.

Avaliaçäo da osteogênese com proteínas ósseas morfogenéticas (BMPs): análise em defeitos na calvária e ao redor de implantes de titânio em coelhos / Osseointegration enhancement around titanium implants and calvarial reconstruction induced by bone morphogenetic proteins in rabbits

Objetivos. Avaliar a formaçäo óssea em defeitos ósseos criados em calvárias de coelhos, aplicando proteínas ósseas morfogenéticas (BMPs) carreadas pelo compósito carbonato de cálcio-colágeno. Analisar o percentual linear de contato osso-implante e o volume ósseo percentual no interior das roscas de implantes de titânio, inseridos em alvéolos cirúrgicos, preparados em tíbias de coelho e preenchidos pelo compósito carbonato de cálcio-colágeno combinado à BMPs. Material e métodos. Experimento I: Defeitos criados cirurgicamente em calvária de 45 coelhos (Oryctolagus cuniculus) brancos, raça Nova Zelândia, gênero masculino. Nos sítios teste, preencheu-se estes defeitos com rBMPs extraídas de ossos longos de renas (Rangifer tarandus) combinadas ao compósito carbonato de cálcio-colágeno, tanto em forma granular quanto em forma de bloco. Nos sítios controle, preencheu-se os defeitos com osso autógeno (controle positivo), com as duas formas do compósito. O controle negativo näo recebeu nenhum tipo de tratamento. Experimento II: Confeccionou-se alvéolos cirúrgicos nas tíbias de 30 coelhos. Previamente a inserçäo de implantes rosqueáveis de titânio, apresentando 3,75mm de diâmetro e 11,5mm de comprimento, preencheu-se os alvéolos dos sítios teste com compósito carbonato de cálcio-colágeno combinado a rBMP. Preencheram-se os sítios controle com carbonato de cálcio-colágeno, colágeno e; no controle negativo nenhum tipo de material foi inserido. Resultados. Experimento I: Após os períodos de quatro, seis e dez semanas os animais foram submetidos à eutanásia. A BMP extraída de rena e combinada ao compósito carbonato de cálcio-colágeno promoveu osteogênese semelhante à obtida quando utilizado osso autógeno e superior aos controles de compósito e coágulo sangüíneo. A análise tomográfica apresentou um quadro de resultados semelhantes aos obtidos com a histomorfometria, entretanto, superestimados para os períodos iniciais de observaçäo, nos grupos que receberam enxerto do compósito. O compósito carbonato de cálcio-colágeno isoladamente ou combinado a BMP näo induziu reaçöes inflamatórias desfavoráveis. Experimento II: A BMP extraída de rena e combinada ao compósito carbonato de cálcio-colágeno promoveu osteogênese superior aos controles do compósito, do colágeno e do coágulo sangüíneo, provendo à superfície do implante de titânio maior percentual de contato linear e maior volume percentual de osso no interior de suas roscas...