Interdisciplinary treatment to replace missing upper lateral incisors, 4.5 years follow up / Tratamiento interdisciplinario para reposición de incisivos laterales superiores faltantes, seguimiento de 4,5 años

Introduction: Multidisciplinary diagnosis and planning are essential to define the treatment option that will provide the best individual results for patients with congenitally missing upper lateral incisors. Objective: To determine the function and aesthetics after the therapeutic use of osseintegrated implants to replace congenitally missing upper lateral incisors in a young female at 4.5 years follow-up. Case report: The patient was a 13 years old female (at beginning of treatment) with congenitally missing upper lateral incisors condition. Five months after the orthodontic active treatment, the space for placing the implants was achieved. After 2 years of Orthodontic treatment and the evaluation of the craniomandibular growth term by hand radiography, two implants were placed with an expanded bone technique in the position of the upper lateral incisors. After 4 months, osseointegration was clinically confirmed and two screw retained temporary crowns were performed using temporary plastic abutments and acrylic teeth and recalled at 4.5 years to control. Conclusions: Our results showed predictable esthetics and functional results in a patient with congenitally missing upper lateral incisors. This was possible due to a multidisciplinary approach between the diagnosis and treatment performed (Orthodontics, Implantology and Prosthodontics(AU)

Introducción: El diagnóstico y la planificación multidisciplinarios son esenciales para definir la opción de tratamiento que proporcionará los mejores resultados individuales para los pacientes con incisivos laterales superiores que faltan congénitamente. Objetivo: Fue determinar la función y la estética después del uso terapéutico de implantes osteointegrados para reemplazar los incisivos laterales superiores ausentes congénitamente en una mujer joven a los 4,5 años de seguimiento. Presentación del caso: La paciente, mujer de 13 años (al inicio del tratamiento) con una condición congénita de incisivos laterales superiores ausentes. Cinco meses después del tratamiento activo de ortodoncia, se logró el espacio para la colocación de los implantes. Después de 2 años de tratamiento de Ortodoncia y la evaluación del término de crecimiento cráneo-mandibular corroborado mediante radiografía de mano, se colocaron dos implantes con técnica de hueso expandido en la posición de los incisivos laterales superiores. Después de 4 meses, se confirmó clínicamente la osteointegración y se realizaron dos coronas provisionales atornilladas utilizando pilares de plástico provisionales y dientes acrílicos y se controlaron a los 4,5 años de seguimiento. Conclusiones: Nuestros resultados mostraron resultados estéticos y funcionales predecibles en un paciente con incisivos laterales superiores ausentes congénitamente. Esto fue posible gracias a un abordaje multidisciplinar entre el diagnóstico y el tratamiento realizado (Ortodoncia, Implantología y Prostodoncia(AU)

Reabilitação oral utilizando prótese parcial removível associada a implantes osseointegrados: relato de caso / Oral rehabilitation using removable partial prosthesis associated with osseointegrated implants: case report

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)

Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)

Plataforma cone morse, o implate com resolução protética estética, com os tecidos peri-implantares / Morse cone platform, the implant with aesthetic proteic resolution, with the peri-implant tissues

Os problemas decorrentes de perdas dentárias em áreas estéticas têm sido motivo de intensa dedicação científica e empenho clínico a fim de alcançar estabilidade mecânica e estética favoráveis. O advento dos implantes dentários-osseointegráveis supriu quesitos de suporte mecânico; no entanto, a remodelação óssea cervical ao redor de implantes com plataforma convencional pode comprometer significativamente a manutenção dos tecidos peri-implantares, gerando sérios agravos estéticos. Atualmente, o objetivo da instalação de implantes Cone Morse vai além de atender a uma tendência evolutiva em Implantodontia, proporcionando a manutenção das características teciduais peri-implantares e o favorecimento da confecção de próteses estéticas, direcionando todo o processo terapêutico a possibilitar perfil de emergência ideal e relacionamento natural e harmonioso com os tecidos circunjacentes. Logo, essa revisão bibliográfica tem o intuito de apresentar tais características, que conferem um alto índice de sucesso e de longevidade das peças protéticas, garantindo maior previsibilidade de manutenção das condições em reabilitações protéticas.

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)

Effects of restraint stress and high-fat diet on osseointegration of titanium implants: an experimental study

Abstract This study aimed to investigate the effects of chronic restraint stress (RS) and a high-fat diet (HFD) on the osseointegration of titanium implants in a rat model. After the surgical insertion of titanium implants into the metaphysis of the tibial bone, the rats were randomly divided into four equal groups (n = 8 each): control (CNT), restraint stress (RS), high-fat diet (HFD), and restraint stress plus high fat diet (RS-HFD). CNT: Rats received no further treatment during the 92-day experimental period. RS: Stress was applied to the rats beginning from two days after the implant surgery for one hour per day for the first 30 days, two hours per day for the next 30 days, and three hours per day for the last 30 days. HFD: Rats were fed a HFD for the following 90 days starting two days after surgery. RS-HFD: Rats were fed a HFD and RS was applied to rats for the following 90 days, starting two days after surgery. At the end of the experimental period, the rats were euthanized, and the implants and surrounding bone tissues were removed for histological analysis. Statistical analysis was performed by one way ANOVA and Bonferrroni tests. There were no significant differences in the bone-implant connection levels between the groups (p > 0.05), but in the HFD and RS-HFD groups, the bone filling ratios were found to be lower compared with the controls (p < 0.05) The data analyzed in this study suggest that an HFD with or without chronic RS adversely affected bone tissue in the rats during the 90-day osseointegration period.

Effects of restraint stress and high-fat diet on osseointegration of titanium implants: an experimental study

Abstract This study aimed to investigate the effects of chronic restraint stress (RS) and a high-fat diet (HFD) on the osseointegration of titanium implants in a rat model. After the surgical insertion of titanium implants into the metaphysis of the tibial bone, the rats were randomly divided into four equal groups (n = 8 each): control (CNT), restraint stress (RS), high-fat diet (HFD), and restraint stress plus high fat diet (RS-HFD). CNT: Rats received no further treatment during the 92-day experimental period. RS: Stress was applied to the rats beginning from two days after the implant surgery for one hour per day for the first 30 days, two hours per day for the next 30 days, and three hours per day for the last 30 days. HFD: Rats were fed a HFD for the following 90 days starting two days after surgery. RS-HFD: Rats were fed a HFD and RS was applied to rats for the following 90 days, starting two days after surgery. At the end of the experimental period, the rats were euthanized, and the implants and surrounding bone tissues were removed for histological analysis. Statistical analysis was performed by one way ANOVA and Bonferrroni tests. There were no significant differences in the bone-implant connection levels between the groups (p > 0.05), but in the HFD and RS-HFD groups, the bone filling ratios were found to be lower compared with the controls (p < 0.05) The data analyzed in this study suggest that an HFD with or without chronic RS adversely affected bone tissue in the rats during the 90-day osseointegration period.

Resultados audiológicos y de calidad de vida en pacientes con transición del sistema BAHA Connect® a BAHA Attract® / Audiological and quality of life outcomes in patients with transition from BAHA Connect® to BAHA Attract®

Introducción: los implantes auditivos de conducción ósea percutáneos han sido usados de forma exitosa; sin embargo, un número importante de pacientes reportan reacciones repetitivas en la piel. En esta medida, los implantes auditivos transcutáneos son una alternativa que puede solventar estas complicaciones. Con este estudio queremos describir los resultados audiológicos y de calidad de vida en los pacientes que requirieron una transición del sistema percutáneo al transcutáneo. Metodología: estudio observacional descriptivo de corte transversal, en el que se incluyeron pacientes con un implante auditivo percutáneo, quienes requirieron una transición al sistema transcutáneo. El desempeño auditivo se evaluó utilizando una prueba con fondo ruidoso, y se aplicó la escala de calidad de vida Glasgow Benefit Inventory (GBI). Resultados: se incluyeron 8 pacientes, 3 de ellos con cirugía bilateral, para 11 oídos. El implante percutáneo fue usado en promedio = 9,5 ± 5,0 años, y la razón de la transición fueron reacciones reiterativas en la piel. Los resultados auditivos muestran un buen desempeño, tanto en los umbrales en silencio = 37,1 ± 6,1 dB, como en el reconocimiento del habla en ambientes ruidosos = 71,2 % ± 19,8, medidas significativamente mejores que los resultados sin implante (p <0,05). La relación señal/ruido fue = -2,6 ± 2,7 dB. Los resultados de la escala GBI mostraron un cambio positivo tanto en el resultado global (mediana = +34,75) como en las tres subescalas (mediana; estado general = +35,4, relaciones sociales = +41,65, salud física = +33,3). Conclusión: la transición de un dispositivo de conducción ósea percutáneo a uno transcutáneo puede realizarse de forma segura y efectiva. Se encontró un desempeño auditivo satisfactorio con el uso del implante transcutáneo, así como un cambio positivo en la percepción de la calidad de vida.

Introduction: the percutaneous bone-anchored hearing aid, has been successfully used. However, a significant number of patients report repetitive skin reactions. The transcutaneous bone-anchored hearing aid is an alternative that can solve these complications. With this study we aim to describe the audiological results and changes in the quality of life in patients who required transition from the percutaneous to the transcutaneous system. Methods: cross-sectional, descriptive observational study, patients with percutaneous hearing implants who required transition to the transcutaneous system were included. Hearing performance was assessed using a noisy background test and the quality of life scale Glasgow Benefit Inventory (GBI) was applied. Results: 8 patients were included, 3 of them with bilateral surgery, for 11 ears. The percutaneous implant was used on average = 9.5 ± 5.0 years, the reason for the transition was repetitive skin reactions. The auditory results show good performance, both in thresholds in silence = 37.1 ± 6.1 dB, and in speech recognition in noisy environment = 71.2% ± 19.8. These measures are significantly better than the results without implant, p <0.05. The signal/noise ratio was = -2.6 ± 2.7 dB. The results of the GBI scale showed a positive change, both in the overall result (median = +34.75), and in the three subscales (median; general state = +35.4, social relations = +41.65, physical health = +33.3). Conclusion: the transition from a percutaneous to a transcutaneous bone-anchored hearing aid can be performed safely and effectively. Satisfactory hearing performance was found with the use of the transcutaneous implant; as well as a positive change in the perception of quality of life.

A influência do tratamento de superfície das fixações na osseointegração / The influence of surface treatment of fixtures in osseointegration

A evolução dos materiais e técnicas restauradoras culminou com o advento do fenômeno da osseointegração. A reabilitação oral, inicialmente de pacientes desdentados, posteriormente estendida aos casos estéticos unitários, tornou-se possível pelas múltiplas opções disponíveis. A produção em larga escala dos implantes modificou a forma, o tamanho, o diâmetro, a angulação e a textura das fixações. Busca-se uma melhor confiabilidade e menor dispêndio de tempo, acelerando-se e orientando-se a fisiologia para o uso da técnica da carga imediata. A exodontia seguida da colocação da prótese, mesmo que provisória, trouxe maior satisfação para os pacientes num mundo agitado em que as transformações se processam na velocidade dos computadores. Particularmente, a corrida comercial busca inovações técnicas que potencializem as fixações. Nesse contexto, a alteração superficial dos implantes procura orientar as células precursoras do osso a interagirem na interface osso/implante. A neoformação óssea ao redor dos implantes é responsável pela longevidade da reabilitação. Assim, a proposta foi a de verificar quais tratamentos de superfície dos implantes favorecem a osseointegração. O método utilizado foi uma revisão sistemática sobre artigos científicos em revistas e periódicos indexados e de fácil aquisição nas bases de dados PubMed, MEDLINE, Lilacs, BBO, SciELO e Google Acadêmico nos últimos 10 anos, acrescidos de referências clássicas e estudos considerados relevantes para essa publicação. O objetivo deste trabalho foi fazer uma revisão sistemática sobre os diferentes tratamentos de superfície dos implantes, ilustrando as reais possibilidades de aumento do contato osso/ implante com variadas texturas.

The evolution of materials and restorative techniques culminated with the advent of the osseointegration phenomenon. Oral rehabilitation, initially of edentulous patients, later extended to the unitary aesthetic cases, was made possible by the multiple options available. The large-scale production of the implants modified the shape, size, diameter, angulation and texture of the fixtures. It is sought a better reliability and less expenditure of time, accelerating and orienting the physiology for the use of the technique of immediate loading. The exodontia followed by the prosthesis placement, even if provisional, brought greater satisfaction to the patients in a troubled world in which the transformations are processed in the speed of the computers. In particular, the commercial race looks for technical innovations that potentiate the fixtures. In this context, the superficial alteration of the implants seeks to guide the precursor cells of the bone to interact at the bone/implant interface. The bone neoformation around the implants is responsible for the longevity of the rehabilitation. Thus, the proposal was to verify which implant surface treatments favor osseointegration. The method used was a systematic review of scientific articles in indexed and easily retrieved journals and magazines in PubMed, MEDLINE, Lilacs, BBO, SciELO and Google Scholar databases in the last 10 years, together with classic references and studies considered relevant to this publication. The aim of this work was to systematically review the different surface treatments of implants, illustrating the real possibilities of increasing bone/implant contact with varied textures.

The Influence of Dietary Salt on the Osseointegration of Implants in Aging Rats

Introduction: The bone-implant interface has been studied extensively, but only few papers focused on the nutritional aspects that may affect bone quality, especially salt intake. Objective: To study the osseointegration of implants in salt-loaded rats with low mineral bone content. Methods: A total of 60 4-month-old male rats were divided in 2 groups ( n = 30), being these groups divided in 2 periods, (2 and 4 months). The control group received a normal diet, while the test group received a diet supplemented with 1% sodium chloride (NaCl). Implants were placed in the tibia of both groups. A total of 15 animals of each group were sacrificed at the 2 nd month of the experiment, while the remaining animals were sacrificed at the 4 th month. Results: No statistically significant difference was found in food intake between the groups on any experimental period, but a statistically significant difference was found in the liquid intake in the saline group in both periods. For all groups, osseointegration was observed in both groups. The mean percentage of osseointegration in the cortical bone, in the trabecular bone, and in the total osseointegrated surface between the control (46.38 ± 16.17%) and saline (49.13 ± 11.52%) groups at 2 months was not statistically different ( p = 0.61). The total osseointegration areas of the control (53.98 ± 12.06%) and saline (51.40 ± 13.01%) groups at the 4 th month of the study were not statistically ( p = 0.61). Conclusion: Ingestion of salt did not affect directly the osseointegration process during the period of the experiment. The results suggest that mineral losses may not affect the achievement of good osseointegration in aging rats. (AU)

Osseointegrated implant as an auxiliary of orthodontic leveling in case of asymmetric vertical skeletal discrepancy: case report / Implante osteointegrado como auxiliar do nivelamento ortodôntico em caso de discrepância esquelética vertical assimétrica: relato de caso

Objective: To present a case report that used an osseointegrated implant as skeletal anchorage unit in asso-ciation with fixed orthodontic appliance for the treatment of an adult patient with vertical asymmetric skeletal discrepancy. Case report: In this case, the pre-existing osseointegrated implant in the region of element 21 was used as an auxiliary of skeletal anchorage for leveling the upper occlusal plane. This was performed with the straight wire technique, Capelozza prescription pattern I, .022" slot, using the sequence of thermal--activated nickel-titanium arches of .014", .016", .017"X.025" and .019"X.025", followed by the steel arch of.019" X.025". Final considerations: The results presented in this report showed the osseointegrated implant asa good option when used as a resource of auxiliary anchorage in orthodontics, providing better comfort andaesthetic conditions to the treatment and simplifying the technique. (AU)

Objetivo: apresentar um relato de caso em que se utilizou um implante osteointegrado como uni-dade de ancoragem esquelética em associação com aparelho ortodôntico fixo, no tratamento de um paciente adulto com discrepância esquelética vertical assimétrica. Relato do caso: neste caso, foi utilizado o implante osteointegrado pré-existente na região do elemento 21 como auxílio de anco-ragem esquelética para o nivelamento do plano oclusal superior, por meio da técnica straight-wire, prescrição Capelozza padrão I, slot .022", utilizan-do a sequência de arcos de níquel-titânio termo-ativado .014", .016", .017"X.025" e .019X.025", seguido por arco de aço .019" X.025". Conside-rações finais: os resultados apresentados neste re-lato demonstraram ser o implante osteointegrado uma boa opção, quando utilizado como recurso de ancoragem auxiliar em ortodontia, conferindo melhores condições de conforto e estética ao trata-mento, bem como simplificação técnica. (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.

A prospective case series on surgical treatment of circumferential and semi-circumferential defects due to peri-implantitis

Abstract Different surgical treatment strategies for peri-implantitis with the use of graft material and membranes have been suggested without any longitudinal remarkable success rate. The present preliminary study was aimed to analyze a new clinical approach based on the disinfection of the implant connection, the disinfection of the implant surface and GBR approach in the treatment of circumferential and semi-circumferential bony defect resulting from peri-implantitis. Six consecutive patients were selected for the present study. After removal of factors that could potentially influence peri-implant pathology, the prosthetic rehabilitation was always removed and a full thickness flap was elevated to allow access to the peri-implant defect and the exposed implant surface. Once the defect was degranulated and the implant surface cleaned, a mixture (50:50) of autogenous bone and allograft was used. Guided bone regeneration technique using membranes was adopted and the flaps were closed for a submerged healing. Six months thereafter, a new re-opening procedure was performed and cleaned superstructures and crowns were repositioned. Patients were followed for one year thereafter and recalled for a customized oral hygiene every three months. Radiological and periodontal analysis was performed before surgery and every six months. The studied procedure was associated with a pronounced increase in REC and CAL with stable peri-implant conditions at 6 and 12 months. PI, BOP and PD values were significantly reduced both at 6 and 12 months. At 12 months, a mean PD gain of 4.5 mm and a bone loss reduction of 5.1 mm was obtained. Within the limitation of the present preliminary study, the proposed technique might represent a promising result for treatment of circumferential and semi-circumferential bone defects around implants affected by 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.

Evaluación radiológica de los elementos de osteosíntesis en el miembro superior / Radiological evaluation of bone synthesis in the upper limb

El tratamiento de las fracturas óseas del miembro superior puede realizarse por métodos cerrados o abiertos. Los cerrados se basan en el principio de inmovilización y/o tracción con materiales externos, mientras que los abiertos utilizan elementos quirúrgicos de fijación interna o externa. Los rayos X(Rx) constituyen la primera y mejor metodología para la evaluación posquirúrgica de estos elementos. El conocimiento básico de los materiales utilizados es necesario para conseguir una buena evaluación e informe médico.

The treatment of bone fractures of the upper limb can be performed by closed or open methods. Closed methods are based on the principle of immobilisation and / or traction with external materials. Instead, open surgical methods use elements of internal or external fixation. The x-ray is the first method of choice in the post-operative evaluation of these elements. A basic knowledge of the materials used is necessary to make a good assessment and medical report.

Investigation on the biological effect of fluorine present on the surface of titanium implants: analysis of the reaction fluoride-titanium oxide / Investigación del efecto del fluoruro sobre la superficie de implantes de titanio: análisis de la reacción fluoruro-óxido de titanio

The aim of this work was to investigate the state of fluoride at the surface of fluoridemodified titanium implants, and to provide information to support or discard the hypothesis that fluoride ion participates in the osseointegration of implants. Titanium is coated with a 2-10 nm thick layer of stable and adherent TiO2, which reacts with fluoride as a function of the anion concentration. Under present experimental conditions, the half-life of the reaction is about 2 minutes at 17 °C. The stoichiometry of the reaction Ti:F is 0.46 ± 0.03, which do not differs significantly from 0.5, the ratio inferred from the reaction between sodium fluoride and TiO2: 3 TiO2 + 6 NaF Na2 TiF6 + 2 Na2 TiO3 . The reaction proceeds as a function of the fraction of anionic fluoride concentration, which increases from a minimum at pH 1 to a maximum close to pH 6. The number of fluoride mmoles that react with TiO2 grows exponentially as a function of fluoride concentration, towards a maximum at 0.24 M fluoride. According to literature reports, potassium hexafluorotitanate is insoluble in water and it decomposes by heating at 780 °C, indicating a high formation constant. It is concluded that the hexafluorotitanate would not ionize to provide fluoride ion to the implant-bone environment and to promote growth and differentiation of osteoblasts. The effect of fluoride on the surface of titanium sheet was investigated under SEM, showing that the titanium sheet surface is roughened and electron dispersive spectroscopic microanalysis indicated that fluorine is included in the TiO2 layer. (AU)

El objetivo de este trabajo fue investigar el estado del flúor en la superficie de implantes de titanio tratados con fluoruro de sodio y obtener información para descartar o apoyar la hipótesis de su participación en el proceso de osteo-integración. El titanio está recubierto con una capa estable y adherente de TiO2, de 2-10 nm de espesor, que reacciona con el fluoruro en función de la concentración del anión. En las condiciones experimentales utilizadas el tiempo de vida media de la reacción es de 2 minutos at 17 ºC, pH 5,5. La reacción procede en función de la fracción de fluoruro iónico de la concentración total de fluoruro, que aumenta de un mínimo a pH 1 a un máximo a pH 6. El número de µmoles de fluoruro que reaccionan con TiO2 crece exponencialmente en función de la concentración del anión, hacia un máximo a 0,244 M. La relación estequiométrica de la reacción Ti:F es 0.46 ± 0.03 no difiere significativamente de 0.5; relación inferida de la reacción: 3 TiO2 + 6 NaF Na2 TiF6 + 2 Na2 TiO3. Como el hexafluorurotitanato de potasio es insoluble en agua y tiene una elevada constante de formación (se descompone por calentamiento a 780 ºC), se concluye que no se disociará para proveer fluoruro a las células óseas en contacto con el implante. La observación al microscopio electrónico de barrido y el análisis por espectroscopía de dispersión de rayos X de la superficie de un trozo de hoja de titanio tratado con solución de NaF a pH 3.5, indicaron aumento de la rugosidad y presencia de flúor en la capa de TiO2. (AU)

Osseointegration of titanium implants anodized with and without fluoride in the electrolyte: a study in rats / Osteo-integración de implantes de titanio anodizado con y sin agregado de fluoruro en el electrolito: estudio en la rata

Based on the hypothesis that fluoride acts as a bone anabolic agent, the aim of this study was to measure in rats the osseointegration of implants (grade II titanium wire, 1 mm diameter, 4 mm long) submitted to anodic oxidation in 2 M phosphoric acid solution (control implants) or b) in 2 M phosphoric acid solution plus 0.2 M NaF (F-modified implants). Chemical composition of the implants surface was assessed by energy-dispersive X-ray spectroscopy. The surface of F-modified implants contained a 2.57% fluorine in weight. Adult male Sprague Dawley rats (300-350 g body weight) received two implants (in the femur and in the tibia, close to the knee) in each hind limb. Control and F-modified implants were inserted in the left and right hind limbs, respectively. Three weeks after surgery, the animals were sacrificed. The undecalcified bones were embedded in methylmetacrylate. Sections were obtained to measure two histomorphometric magnitudes: bone-toimplant contact (BIC) and bone volume in a defined volume of tissue around the implant (BV/TV). BIC was significantly increased on F-modified implants with respect to their controls (57.2%±3.3%, vs. 47.9±3.4, p<0.05). BV/TV did not differ significantly between F-modified and control implants (24.5±2.2% vs. 22.9±1.4, p=0.30). Profiles of the average gray pixel levels of pseudo3D images showed a greater roughness of F-modified implants respect to their controls (p<0.05). The relative contributions of surface roughness and its fluorine content to the osseointegration process requires further research. (AU)

Con la hipótesis de que el ión fluoruro actúa como anabólico sobre las células óseas, el objetivo de este trabajo fue determinar el grado de osteo-integración (en la rata) de implantes (alambre de titanio II, 1 mm de diámetro, 4 mm de largo) anodizados en solución de ácido fosfórico 2 M + NaF 0,2 M (implantes-F) comparados con implantes controles, anodizados en solución de ácido fosfórico 2 M. La composición química de la superficie de los implantes fue evaluada mediante el espectro de dispersión de rayos X producidos durante la observación en el microscopio electrónico de barrido. La superficie de los implantes-F contiene 2.57% de flúor. Ratas macho Sprague-Dawley recibieron dos implantes (en el fémur y en tibia, próximos a la rodilla). Los implantes-F y controles se insertaron en las patas izquierda y derecha respectivamente. En los cortes de hueso sin decalcificación previa se midió el contacto hueso-implante (BIC) y volumen óseo en un volumen definido de tejido (BV/TV). BIC fue significativamente mayor con los Implantes-F respecto de los controles (57,2±3,3% vs. 47,9±3,4, p<0,05). BV/TV no exhibió diferencias significativas entre implantes-F y controles (24,5±2,2% vs. 22,9±1,4, p=0,30). Los perfiles de los niveles de grises de los imágenes pseudo3D de las superficies de los implantes pusieron en evidencia la mayor rugosidad de los implantes-F respecto de los controles (p<0,05). Las contribuciones relativas de la rugosidad y del flúor en el proceso de osteo-integración requieren investigación adicional. (AU)

Enclavado Endomedular Trocantérico versus DHS por técnica mínimamente invasiva en el tratamiento de fracturas extracapsulares de fémur proximal / Intermediate Endomedullary Trochanteric versus DHS by minimally invasive technique in the treatment of extracapsular proximal femoral fractures

Las fracturas extracapsulares de cadera están asociadas a traumatismos de baja energía en ancianos y a traumatismos de alta energía, como los arrollamientos o heridas por arma de fuego, en pacientes jóvenes. El objetivo de este estudio fue comparar los resultados del tratamiento de las fracturas extracapsulares de cadera con dos métodos quirúrgicos. Se realizó un estudio experimental de tipo ensayo clínico controlado, conducido en un centro de IV nivel, diseñado para comparar la efectividad del enclavado endomedular trocantérico y el tornillo deslizante de cadera por técnica MIO en el tratamiento de fracturas extracapsulares de cadera. Se incluyeron pacientes de ambos géneros, mayores de 16 años. El tiempo promedio de seguimiento fue de 8,2 meses. Se incluyeron 120 pacientes, 60 para cada grupo. 65% de sexo femenino y 35% masculino. La edad promedio fue de 79,39 años. El tipo de fractura más frecuente fue la 31A2.1 en 34,16% y la 31A1.2 con 21,66%. El mecanismo de trauma más frecuente fue la caída simple en 85%. El enclavado endomedular trocantérico mostró mejores resultados en cuanto a sangrado operatorio, tiempo exposición al fluoroscopio, duración de la cirugía, y resultados en la escala de Harris y Montoya al final de la valoración (p<0,05). La tasa de complicaciones fue de 24,16%. El enclavado endomedular trocantérico demostró ser superior al tornillo deslizante de cadera por técnica MIO en el tratamiento de estas fracturas(AU)

Extracapsular hip fractures are associated with low-energy trauma in elderly and high-energy trauma, such as coils or gunshot wounds in young patients. The aim of this study was to compare the results of treatment of extracapsular hip fractures with two surgical methods. A controlled clinical trialexperimental study, conducted at a level IV center was made. Designed to compare the effectiveness of proximal femoral nail and sliding hip screw for MIO technique in the treatment of extracapsular hip fractures. Patients of both genders, aged 16 years, were included. The average follow-up time was 8.2 months. We study 120 patients, 60 for each group. 65% were female and 35% male. The average age was 79.39 years. The 31A2.1 and 31A1.2 type of fracture was the most common in 34.16% and 21.66% respectively. The most common mechanism of trauma was simply falling by 85%. The proximal femoral nail showed better results in terms of operative bleeding, fluoroscopy exposure time, duration of surgery, and results on the scale of Harris and Montoya at the end of following (p <0.05). The complication rate was 24.16%. The trochanteric nailing proved superior to the sliding hip screw for MIO technique in the treatment of these fractures(AU)

Evaluation of tensile strength resistance of different biomaterials in calvarial rats

AIM: The aim of this study was to determine the effect of different grafting materials on bone tensile strength after 6-month wound healing. MATERIAL AND METHODS: Non-critical size defects (3-mm diameter) were created in calvarium of 30 three-month-old Wistar rats. Animals were divided into 3 groups (n=10) treated with different grafting materials: GenOx® (Group 1A); GenMix® (Group 1B); no treatment (blood clot, Group 3). Six months after the surgery, rats were sacrificed; bone specimens were harvested and submitted to tensile strength test using a universal testing machine. The bone fracture surface morphology was evaluated using scanning electron microscopy (SEM) at 200X magnification. Data were compared by One-Way ANOVA at 5% significance. RESULTS: No significant difference was found among the groups although tensile strength decreased in the following order: Group 3 (9.56±3.74MPa), Group 1B (8.58±3.60MPa), Group 1A (7.70±2.41MPa). All tested materials showed similar effects on bone tensile strength, no matter the source (xenogenic or blood clot). CONCLUSION: After six months of bone healing, the type of grafting material is irrelevant to the final outcome and bone tensile strength.