Injeção de agregados plaquetários no rejuvenescimento facial: uma revisão sistemática / Injection of platelet aggregates in facial rejuvenation: a systematic review

Introdução: Essa revisão sistemática foi conduzida para avaliar se a associação da aplicação da injeção de agregados plaquetários quando comparada a outras terapias faciais favorece no rejuvenescimento facial em pacientes adultos. Métodos: A pesquisa buscou ensaios clínicos randomizados que compararam uso de técnicas de rejuvenescimento facial isoladas com as mesmas técnicas aliadas à injeção de agregados plaquetários. A busca foi realizada em bases de dados indexadas e literatura cinzenta. A ferramenta de risco de viés da "Cochrane Collaboration" foi aplicada para a avaliação da qualidade dos estudos. Resultados: Foram identificados 7137 artigos. Apenas quatro estudos permaneceram na síntese qualitativa, e os demais foram considerados com risco indefinido de viés nos domínios chaves. Conclusão: Existem poucos estudos na literatura que comparam o uso de agregados plaquetários em rejuvenescimento facial e os que estão disponíveis têm risco de viés "indefinido" ou "alto". Há necessidade de realizar mais estudos clínicos bem delineados que comparem o uso de injeção de agregados plaquetários associados ou não às técnicas de rejuvenescimento facial.

Introduction: This systematic review was conducted to assess whether the use of a platelet aggregate injection with or without associated facial rejuvenation techniques favors facial rejuvenation in adult patients. Methods: Randomized clinical trials that compared the use of techniques for facial rejuvenation alone with the same techniques coupled with the injection of platelet aggregates were searched. The search was performed in indexed databases and in the gray literature. The Cochrane Collaboration bias risk tool was applied to assess the quality of the studies. Results: In total, 7137 articles were identified. Only four studies remained in the qualitative synthesis, and the others were considered as having undefined bias risk in the key domains. Conclusion: There are few studies in the literature that compare the use of platelet aggregates in facial rejuvenation and those that are available have a risk of "undefined" or "high" bias. There is a need for more well-designed clinical studies comparing the use of platelet aggregate injection with or without associated facial rejuvenation techniques.

Does the implant-abutment interface interfere on marginal bone loss? A systematic review and meta-analysis

Abstract The objective of this systematic review was to compare the conical internal connection (IC) with the external hexagonal connection (EH) on the occurrence of marginal bone loss (ΔMBL). Different databases were used to carry out the selection of the elected studies. The studies were judged according to the risk of bias as "high", "low" and "unclear" risk. For the meta-analysis we included only studies that could extract the data of ΔMBL, survival rate (SR) and probing depth (PD). No statistically significant differences were found for ΔMBL data at one, three- and five-year survival rates between implant connections (p <0.05), however statistically significant differences were found for PD between EH and IC implants (1-year follow-up) -0.53 [95%CI -0.82 to -0.24, p = 0.0004]. This present systematic review demonstrated that there are no significant differences between IC and EH implants for both ΔMBL and SR at 1, 3 e 5 years after functional loading, although better PD values were observed for implants pertaining to the IC connections. Considering the high heterogeneity, more well-delineated, randomized clinical trials should be conducted.

Recontorno gengival e reposicionamento labial cirúrgico para tratamento do sorriso gengival: resultados após um ano / Gummy smile treatment with gingival recontouring and surgical lip repositioning: 1-year follow-up results

O presente artigo teve como objetivo esclarecer as diferentes alternativas utilizadas para o reposicionamento labial e melhora da estética do sorriso, propondo uma nova classificação para o diagnóstico e tratamento do sorriso gengival. A técnica cirúrgica descrita no relato de caso associa o recontorno gengival e o reposicionamento labial com tratamento estético restaurador. A cirurgia realizada proporcionou a correção da erupção passiva alterada dos dentes anterossuperiores, combinada com o alongamento do feixe lateral do músculo levantador do lábio superior e da asa do nariz, e a contenção do mesmo com sutura mononylon, diminuindo o sorriso gengival. Notou-se, após a cirurgia, que a linha alta do sorriso foi corrigida sem comprometer a harmonia labial. A paciente manifestou alto grau de satisfação com o tratamento. O diagnóstico e a técnica cirúrgica proposta neste estudo podem ser uma opção terapêutica para o reposicionamento labial e harmonia do sorriso.

The present article aims to address the different alternatives used for lip repositioning and improved smile aesthetics, proposing a new classification for the diagnosis and treatment of the gummy smile. The surgical technique described this a case report associates gingival recontouring and lip repositioning with restorative aesthetic treatment. The surgery provided the correction of altered passive eruption of the anterior superior teeth combined with lengthening of the lateral bundle levator muscle of the upper lip and the ala of the nose, containing them with mononylon sutures, decreasing the gummy smile. It was noted that after surgery, the high smile line was corrected without compromising the labial harmony. The patient expressed high satisfaction with the treatment. The diagnosis and surgical technique proposed in the present study may be a therapeutic option for lip repositioning and smile harmony.

Effect of the use of different periodontal curettes on the topography and roughness of root surface

Introduction: Periodontal scaling is the treatment approach most used to remove dental calculus, plaque, and altered cementum from root surface. During root decontamination, the instruments used leave the root rougher and more irregular. Objective: To verify the root surface after mechanical scaling with different Gracey curettes steel through SEM and superficial roughness analyses. Material and methods: Twelve teeth were embedded in acrylic resin. The teeth were instrumented with new Gracey curettes Gracey 5/6 from different brands. The groups (n=2) were divided into: control, no instrumentation (GC); carbon steel (CSN); stainless steel Neumar (SSN); stainless steel Millenium (SSM); premium steel Neumar (PSN); Hu-Friedy (HF). An area measuring 3 x 3 mm2 was marked on the distal surface of the root to guide the Reading of the root topography on SEM and rugosimeter. The data were analyzed by a single examiner previously calibrated. SEM analysis was based on scores of the root surface smoothness after scaling. We analyzed the parameters of mean roughness (Ra) and mean roughness deepness (Rz). SEM data were submitted to statistical analysis through Fisher's exact test (p < 0.002) and roughness data by Anova followed by Student t test. Results: The quality of the active surface of the curette demonstrated by SEM and roughness analyses that it can exert difference in the result regarding to the homogeneity produced after the scaling of root surface. Group SSM demonstrated a homogenous root surface (score 0) in SEM and better smoothness in rugosimeter analysis. Conclusion: According to com the methodology used, the group of curettes that provided better smoothness of root surface after scaling was SSM.

Investigation of the influence of design details on short implant biomechanics using colorimetric photoelastic analysis: a pilot study

Introduction : The clinical survival of a dental implant is directly related to its biomechanical behavior. Since short implants present lower bone/implant contact area, their design may be more critical to stress distribution to surrounding tissues. Photoelastic analysis is a biomechanical method that uses either simple qualitative results or complex calculations for the acquisition of quantitative data. In order to simplify data acquisition, we performed a pilot study to demonstrate the investigation of biomechanics via correlation of the findings of colorimetric photoelastic analysis (stress transition areas; STAs) of design details between two types of short dental implants under axial loads. Methods Implants were embedded in a soft photoelastic resin and axially loaded with 10 and 20 N of force. Implant design features were correlated with the STAs (mm2) of the colored fringes of colorimetric photoelastic analysis. Results Under a 10 N load, the surface area of the implants was directly related to STA, whereas under a 20 N load, the surface area and thread height were inversely related to STA. Conclusion A smaller external thread height seemed to improve the biomechanical performance of the short implants investigated.

Non-Pedicled Buccal Fat Pad Grafts to Treatment for Class I and II Gingival Recessions: A Clinical Trial

The aim of this study was to analyze the transplant efficiency of non-pedicled buccal fat pad graft (BFPG) for the treatment of Miller Class I or II gingival recessions (GRs) and to compare these results with those of subepithelial connective tissue graft (SCTG), which is considered the gold standard. Twelve patients with Miller Class I or II (≥2 mm) bilateral recessions in maxillary premolars or canines were selected. Recessions were randomly assigned to receive SCTG or BFPG. The clinical parameters evaluated at baseline and at 1, 3, and 6 months postoperatively included gingival index, plaque index, probing depth, GR, clinical attachment level, width of keratinized tissue, thickness of keratinized tissue and gingival margin to the acrylic guide. None of the evaluated clinical parameters differed significantly between the groups. At all evaluated postoperative time-points, both groups exhibited statistically significant differences in GR and gingival margin to the acrylic guide compared to baseline. Six months after surgery, the mean percentages of root coverage were 67.5% and 87.5% in the BFPG and SCTG groups respectively. In both groups, complete root coverage was observed in 50% of cases 6 months after surgery. The results presented herein indicate that the use of BFPG transplant has clinical similarities with SCTG and both may be considered as clinically successful methods for treating Miller Class I and II GRs.

Resumo O objetivo deste estudo foi analisar a eficiência do transplante do enxerto de tecido adiposo bucal não pediculado (ETAB) para o tratamento de recessões gengivais Classe I e II de Miller e comparar seus resultados com o enxerto de tecido conjuntivo (ETC), que é considerado o enxerto padrão ouro. Foram selecionados 12 pacientes com recessões gengivais bilaterais Classe I e II de Miller presentes em canino ou pré-molares maxilares. As recessões foram randomizadas para receber um dos dois tratamentos ETAB ou ETC. Os parâmetros clínicos avaliados no baseline e com 1, 3 e 6 meses de pós-operatório foram o índice gengival, índice de placa, profundidade de sondagem, recessão gengival (RG), nível clinico de inserção, espessura e largura de tecido queratinizado e a medida da margem gengival ao guia de acrílico (MG-GA). Os resultados mostraram que não houve diferença estatisticamente significativa entre os grupos em nenhum dos parâmetros clínicos avaliados. Os parâmetros clínicos de RG e MG-GA, em ambos os grupos, apresentaram diferença estatisticamente significativa nos 3 períodos pós-operatórios em relação ao baseline. Aos 6 meses de pós-operatório, a média percentual de recobrimento radicular foi de 67,5% e 87,5% para o grupo ETAB e ETC respectivamente. Em ambos os grupos o recobrimento radicular completo foi em 50% dos casos após 6 meses de pós-operatório. Pode-se concluir que o transplante do ETAB apresentou similaridades clínicas com o ETC e ambos os tratamentos podem ser considerados de sucesso clínico para o tratamento de RGs Classe I e II de Miller.

Immunoexpression of BMP-2 protein on bone repair of critical size defects treated with autogenous macerated adipose tissue

Introduction: The adipose tissue is an important reservoir of adult stem cells which have capacity of differentiating in osteoblasts with potential implication in reaching bone regeneration. The evaluation of the osteoblastic differentiation can be verified through immunohistochemical markers such as bone morphogenetic protein- 2 (BMP-2). Objective: To evaluate the immunoexpression of BMP-2 protein on the bone repairing of critical size defects (CSD) surgically created in rat calvaria and treated by autogenous macerated adipose tissue. Material and methods: Forty male rats had a CSD measuring 5 mm created on their calvaria. The animals were randomly divided into two groups: group C (control) and group AT (macerated adipose tissue grafting). In group C, the defect was filled with only blood clot. In group AT, the defect was filled with autogenous macerated adipose tissue. The groups were subdivided into two subgroups (n = 10) for euthanasia at 7 and 90 post-operative days. Histological and immunohistochemical analyses were carried out. Data were submitted to descriptive statistics (mode). Results: In group AT, both at 7 and 90 post-operative days, the main healing type was the presence of dense conjunctive tissue exhibiting bundles of collagen fibers disposed in beams permeating the remaining adipose tissue with rare heterotopic bone formation associated to fibrosis and different types of tissue necrosis. In group C, the repair was achieved by the formation of bundles of collagen fibers oriented parallelly to the surface of the wound at the two post-surgical periods. The immune-staining of BMP-2 was present only in group C (7 and 90 post-operative days). Conclusion: Within the limits of this present study, it can be concluded that the adipose tissue grafting did not favor bone neoformation in critical size defects and BMP-2 signaling was not observed.

Efeito do alendronato na progressão da periodicidade induzida pela porphyromonas gingivalis estudo em ratos / Effect of alendronate treatment on the progression of experimental periodontitis

O objetivo deste estudo foi investigar na literatura o efeito do Alendronato (ALN) na inibição da perda óssea alveolar numa periodontite experimental ratos. A periodontite foi induzida pela inoculação oral do P. gingivalis associado ao F. nucleatum durante 4 semanas em ratos Wistar (N=80). Os grupos foram divididos em CN (N=10): Controle negativo. CP (N=10): Controle Positivo (infectado), TB (N=10): ALN por 8 semanas T12 (N=10): ALN por 12 semanas T16 (N=10): ALN por 16 semanas, C8 (N=10): placebo por 8 semanas, C12 (N=10): placebo por 12 semanas e C16 (N=10): ALN por 16 semanas. Depois da periodontite estabelecida, 2mg/kg de ALN ou placebo foi administrado a cada 2 dias na semana. A perda óssea foi determinada pela análise morfo e histológica. Um examinador independente, cegado e previamente, calibrado (CIC:0,91) realizou as medidas. Morfométrica: a distância da junção esmalte cemento até a crista óssea alveolar (JEC-COA) do segundo molar inferior esquerdo foi realizada com auxílio de uma lupa (20x) em diferentes superfícies do dente. Disto-vestibular (d), furca (f), mésio vestibular (h) e área. A histometria foi realizada no segundo molar contra-lateral. foram realizados cortes (6um) para medida da área óssea (MAQ) na furca (ex. 1195um região abaixo da furca e entre as raízes). Após análise estatística (teste de mam-Whitney and Kruskal-Wallis), o grupo CP desenvolveu periodontite após inoculação do Pg e Fn (p<0,0001). A análise morfométrica mostrou que o tratamento com o ALN foi estatisticamente efetivo no grupo de 8 semanas nas medidas d. f e h (p<0,05). Não houve diferença estatística entre os grupos T8xT12xT16 nas medidas lineares. Na análise da MAO não houve diferença estatística entre os grupos do ALN e placebo em 8 e 16 semanas p>0,05). ALN foi efetivo contra perda óssea na MAO em 12 semanas de tratamento (p<0,0001). Segundo a metodologia utilizada os resultados deste estudo sugerem que a administração via oral do alendronato pode inibir a perda óssea alveolar em ratos submetidos a periodontite experimental.

The aim of this study was to investigate the inhibition effect of alveolar bone loss caused by the use of Alendronate in rats with periodontitis. Periodontitis was induced in 80 Wistar rats by inoculating P. gingivalis associated with F. nucleatum into the oral cavity for 4 weeks. After periodontitis induction, 2mg/kg of Alendronate (ALN) or placebo was administered 2 days per week for 8, 12 or 16 weeks. Bone loss was determined by mopho and histometric analysis using image-analysis software. One independent and blind examiner, previously calibrated (ICC: 0,91), performed the measurements on each sample. Morphometric the distance from cemento-enamel juntion to alveolar bone crest (CEJ-ABC) of second left mandible molar was measured under magnification (x20) with light and position standardized in a stereoscope loupe at different sites: bucal-distal (d), buccal-furcation region (f), buccal-mesial (h) and area region. Histometric analyses were on the contralateral mandible molar. Mesio-sistal serial sections (6um) were obtained and stained with hematoxylin and eosin. The measurements of the furcation bone area (A-FB) (i.e) 1195um zone under the furcation and between the roots were performed. After statistical analysis (Miann-Whitney and Kruskal-Wallis tests, (p<0,05), morphometric measurements showed that ALN treatment were statistical effective at 8 weeks. The maximum (0,970mm) and minimum (0,060mm) values of alveolar bone loss were seen at d site in the 12-week placebo and 16-week ALN groups respectively. In the A-FB, no statistically significant differences were found between ALN and placebo groups at 8 and 16 weeks (p>0,05). ALN therapy was effective against bone loss in the A-FB at 12 weeks of treatment (0,337±0,106mm) when compared to its control group (0.148±0,109). The oral adminstration of ALN is effective in inhbiting bone loss in experimental periodontitis in rats.

Tratamento da periimplantite: revisão da literatura / Periimplantitis treatment: literature review

Introdução e objetivo: Este estudo teve como objetivo revisar na literatura as principais modalidades de tratamento de periimplantite. Foi relatado o uso de antissépticos bucais, antibioticoterapia, raspagem cirúrgica, raspagem não-cirúrgica, enxerto ósseo, uso de membranas, tratamento combinado com uso de enxertos ósseos e membranas e laserterapia. Revisão de literatura: A maioria dos estudos mostrou casos sobre os tipos de tratamento, porém apenas um protocolo específico da doença foi relatado. Todos os outros demonstraram associações de tratamentos com sucesso na maioria absoluta dos casos, independentemente do tratamento realizado. Conclusão: A associação de técnicas de tratamento é válida e, muitas vezes, necessária. Contudo, para chegarmos a uma conclusão mais específica, devem ser feitos mais estudos em humanos a respeito de cada tipo de tratamento.

Introduction and objective: The aim of this study was to review in the literature the aim modalities of periimplantitis treatment. They were study the use of buccal antiseptics, antimicrobial treatment, open debridment, close debridment, osseous grafts, the use of membranes, combination with osseous grafts and membrane technique and laserteraphy. Literature review: The most of studies showed cases about these treatment types but only one related a specific protocol of peri-implantar disease. All of other demonstrated treatment associations had success on the most absolute cases, independent of treatment. Conclusion: The techniques association of treatment is valid and necessary, but to have a more specific conclusion should be done more studies in humans.

O uso do vidro bioativo na terapia regenerativa periodontal: revisão da literatura / The use of the bioactive glass in the regenerative periodontal therapy: a literature review

Introdução e objetivo: A correção dos defeitos ósseos causados pela doença periodontal é realizada por intermédio de procedimentos cirúrgicos que podem ser divididos como ressectivos, reparativos ou regenerativos. O objetivo deste trabalho é revisar e discutir a literatura relativa ao uso do vidro bioativo nos procedimentos periodontais regenerativos. Revisão de literatura e conclusão: Os procedimentos regenerativos correspondem a formas de tratamento que visam reproduzir ou reconstituir a parte perdida ou injuriada dos tecidos periodontais. A regeneração periodontal pode ser definida como o procedimento que busca regenerar os tecidos de suporte do dente, formados por osso alveolar, cemento e ligamento periodontal. Numerosas modalidades cirúrgicas têm sido testadas para alcançar a regeneração dos defeitos ósseos periodontais. Os métodos mais comumente utilizados são os enxertos ósseos autógenos, alógenos e xenógenos, a regeneração tecidual guiada (RTG) e o uso de materiais aloplásticos (substitutos ósseos). Entre os materiais aloplásticos está o vidro bioativo (VB), o qual é definido como uma cerâmica bioativa que se caracteriza por ser osteocondutora e osteoestimulatória e por ter a propriedade de adesão óssea. Alguns estudos histológicos mostram que o uso dos vidros bioativos pode induzir a neoformação de cemento e a formação de uma nova inserção.

Introduction and objective: The correction of the osseous defects caused by periodontal disease is performed through surgical procedures that are divided as resective, reparative or regenerative. The purpose of this paper is to review and discuss the literature dealing with the use of bioactive glasses in the regenerative periodontal procedures. Literature review and conclusion: The regenerative procedures correspond to therapy forms of reproducing or reconstituting the lost or injured parts of the periodontal tissues. A periodontal regeneration may be defined as the regeneration of the teeth supporting tissues including alveolar bone, cementum and ligament. Numerous surgical means have been tested in an effort to achieve the regeneration of the periodontal osseous defects. The most common methods are the autogenous bone grafts, allografts, xenografts, Guided Tissue Regeneration (GTR) and the use of alloplastic materials (bone substitutes). Among these alloplastic materials there is the Bioactive Glass (BG). This material is defined as a bioactive ceramic, known as an osteoconductive and osteostimulatory material and by having the property of osseous adhesion. Some recent histological studies have shown that the use of bioactive glasses can induce the cementum neoformation and the formation of a new attachment.