Assessing peri-implant bone microarchitecture: conventional vs. osseodensification drilling - ex vivo analysis.

The aim was to evaluate primary implant stability and bone microarchitecture in two drilling situations, by comparing the conventional technique (CT) and osseodensification (OD) (Versah Burs - Jackson - Mississippi - USA). The implant insertion torque (IT), implant stability quotient (ISQ), and the peri-implant trabecular microstructure were assessed on bone fragments obtained from pig's tibia (n=12), divided between CT (n=6) and OD (n=6). After the drilling procedure, the implants were installed (3.5x8.5 mm, Epikut - SIN - São Paulo - Brazil). The IT and ISQ were measured using a digital torque wrench and resonance frequency analysis. Then, the bone fragments containing the implants were removed with a trephine and analyzed by Microtomography (µCT, 8.0 µm). The comparison between groups was performed using the unpaired t-test (α=0.05). The results revealed that OD promotes a higher insertion torque (CT: 7.67±2.44 Ncm; OD: 19.78±5.26 Ncm) (p=0.0005), although ISQ was not different (CT: 61.33±4.66; OD: 63.25±4.58) (p=0.48). There was a significant increase in peri-implant bone volume (CT: 23.17±3.39 mm3; OD: 32.01±5.75 mm3) (p=0.008), and trabecular parameters: separation (CT: 0.4357±0.03 mm; OD: 0.3865±0.04 mm) (p=0.0449), number (CT: 1.626±0.18 1/mm; OD: 1.946±0.13 1/mm) (p=0.007), and thickness (CT: 0.1130±0.009 mm; OD: 0.1328±0.015 mm) (p=0.02). Structure model index (SMI) data demonstrate no significant differences between groups (CT: 1.7±0.2; OD: 1.4±0.4) (p=0.12). In conclusion, OD increases the insertion torque values and promotes beneficial changes regarding bone microarchitecture compared with CT, revealing more peri-implant bone volume with consequent higher primary stability.

Assessing peri-implant bone microarchitecture: conventional vs. osseodensification drilling - ex vivo analysis

Abstract: The aim was to evaluate primary implant stability and bone microarchitecture in two drilling situations, by comparing the conventional technique (CT) and osseodensification (OD) (Versah Burs - Jackson - Mississippi - USA). The implant insertion torque (IT), implant stability quotient (ISQ), and the peri-implant trabecular microstructure were assessed on bone fragments obtained from pig's tibia (n=12), divided between CT (n=6) and OD (n=6). After the drilling procedure, the implants were installed (3.5x8.5 mm, Epikut - SIN - São Paulo - Brazil). The IT and ISQ were measured using a digital torque wrench and resonance frequency analysis. Then, the bone fragments containing the implants were removed with a trephine and analyzed by Microtomography (µCT, 8.0 µm). The comparison between groups was performed using the unpaired t-test (α=0.05). The results revealed that OD promotes a higher insertion torque (CT: 7.67±2.44 Ncm; OD: 19.78±5.26 Ncm) (p=0.0005), although ISQ was not different (CT: 61.33±4.66; OD: 63.25±4.58) (p=0.48). There was a significant increase in peri-implant bone volume (CT: 23.17±3.39 mm3; OD: 32.01±5.75 mm3) (p=0.008), and trabecular parameters: separation (CT: 0.4357±0.03 mm; OD: 0.3865±0.04 mm) (p=0.0449), number (CT: 1.626±0.18 1/mm; OD: 1.946±0.13 1/mm) (p=0.007), and thickness (CT: 0.1130±0.009 mm; OD: 0.1328±0.015 mm) (p=0.02). Structure model index (SMI) data demonstrate no significant differences between groups (CT: 1.7±0.2; OD: 1.4±0.4) (p=0.12). In conclusion, OD increases the insertion torque values and promotes beneficial changes regarding bone microarchitecture compared with CT, revealing more peri-implant bone volume with consequent higher primary stability.

Resumo O objetivo deste estudo foi avaliar a estabilidade de implante e a microarquitetura óssea em duas técnicas de fresagem, comparando a técnica convencional (CT) e a osseodensificação (OD) (Versah Burs - Jackson - Mississippi - EUA). O torque de inserção do implante (IT), quociente de estabilidade primária (ISQ) e a estrutura trabecular peri-implantar foram avaliados em fragmentos ósseos obtidos de tíbia de porco (n=12), divididos entre CT (n=6) e OD (n=6). Após o procedimento de fresagem, foram instalados implantes (3,5x8,5 mm, Epikut - SIN - São Paulo - Brasil). O IT e o ISQ foram aferidos por meio de um torquimetro digital e análise de frequência de ressonância. Em seguida, os fragmentos ósseos contendo os implantes foram removidos com trefina e analisados ​​por microtomografia computadorizada (µCT, 8,0 µm). A comparação entre os grupos foi realizada por meio do teste-t não-pareado (α=0.05). Os resultados revelaram que a OD promove maior torque de inserção (CT: 7,67 ± 2,44º Ncm; OD: 19,78 ± 5,26 Ncm) (p=0,0005), embora a estabilidade primária não tenha sido diferente (CT: 61.33 ± 4.66; OD:63.25 ± 4.58) (p=0,48). Houve um aumento significativo no volume ósseo peri-implantar (CT: 23,17±3,39 mm3; OD: 32,01±5,75 mm3) (p=0,0089) e parâmetros trabeculares: separação (CT: 0,4357 ± 0,03 mm; OD: 0,3865 ± 0,04 mm) (p=0,0449), número (CT: 1,626 ± 0,18 1/mm; OD: 1,946 ± 0,13 1/mm) (p=0,007) e espessura (CT: 0,1130 ± 0,009 mm; OD: 0,1328 ± 0,015 mm) (p=0,02) O índice de modelo estrutural (SMI) não demostrou diferença estatisticamente significativa (p=0.1228). Concluindo, OD apresenta maiores valores de torque de inserção e promove mudanças benéficas na microarquitetura óssea em comparação com a TC, revelando maior volume ósseo peri-implantar.

Effect of extrinsic pigmentation and surface treatments on biaxial flexure strength after cyclic loading of a translucent ZrO2 ceramic.

OBJECTIVE: To evaluate the influence of extrinsic pigmentation on the biaxial flexural strength and surface topographic of translucent Y-TZP (InCoris TZI - Sirona - USA) subjected to several surface treatments. METHODS: Sintered zirconia discs-shaped specimens (n=120) (ø:12mm; thickness:1.2mm; ISO 6872) were prepared and divided (n=15) according to various factors: "extrinsic pigmentation" (n: without; p: with) and "surface treatments" (C: control - as sintered; A: abraded with silica-coated alumina particles (30µm); G: glazed with a thin film of low-fusing porcelain glaze; GH: glazed and etched with 10% hydrofluoridric acid for 60s. Mechanical cycling (1.2×106 cycles, 200N, 3.8Hz) and flexural strength test (1mm/min - 1000kg cell) were performed. Two-way ANOVA and Tukey's were used for statistical test (α=0.05). Weibull analysis was used to evaluate the strength reliability. Samples were analyzed via (1) an optical profilometer to determine the surface roughness (Ra); (2) an X-ray diffraction (XRD) to evaluate phase transformations; and (3) a SEM equipped with an energy dispersive X-ray spectroscopy (EDX) to elucidate morphological properties and chemical compositions. RESULTS: Regardless of the surface treatment (p=0.5459) (Cn: 560.16MPa; Gn: 573.36MPa; An: 643.51MPa; GHn: 542.94MPa; Cp: 628.04MPa; Gp: 641.90MPa; Ap: 554.47MPa; GHp :602.84MPa) and extrinsic pigmentation (p=0.1280) there was no difference in the flexural strength among the experimental groups. According to the XRD analysis, phase transformations occurred in the An group (t→m) and in Ap group (t→c). Surface roughness was affected by surface treatments (An - p=0.001) and extrinsic pigmentation (Gp - p=0.001). SIGNIFICANCE: The biaxial flexural strength of the tested samples was not affected neither by surface treatments nor by pigmentation, although it can cause phase transformation and promote surface roughness.

Factors associated with multimorbidity in the elderly: an integrative literature review / Fatores associados à multimorbidade em idosos: uma revisão integrativa da literatura

Abstract Objective: The objective of the present study was to identify factors associated with multimorbidity in the elderly through an integrative literature review. Method: The "Cochrane Library", "MEDLINE", "Web of Science", "Scopus" and "LILACS" databases were used, as well as the "SciELO" virtual library and the electronic search engine "Google Academic". The following search terms were applied: "multimorbidity"; "multi-morbidity"; "comorbidity; "multiple diseases"; "elderly"; "major adults", "older people", "older persons", "aged", "associated factors", "correlated factors", "socioeconomic factors" and "demographic factors." The inclusion criterion was that the object of the study was the elderly population with multimorbidity. Studies in which multimorbidity was not the dependent variable were excluded. Results: a total of seven articles were included in this review. A prevalence of multimorbidity in the elderly ranging from 30.7% to 57% was found. The associated factors were smoking, alcohol consumption, lived in rural areas, low levels of schooling, the female gender, older elderly persons and not living with children. In the majority of articles a low level of family income was also associated with multimorbidity. Conclusion: The results suggest that multimorbidity in the elderly is a common condition and that it is influenced by socioeconomic and demographic factors, lifestyle and family structure.

Resumo Objetivo: Objetivou-se identificar os fatores associados à multimorbidade em idosos por meio de uma revisão integrativa da literatura. Método: Foram utilizadas as bases de dados "Cochrane Library", "MEDLINE", "Web of Science", "Scopus" e "LILACS". Também foram utilizados a biblioteca virtual "Scielo" e o buscador eletrônico "Google Acadêmico". Empregaram--se os seguintes termos para as buscas: "multimorbidity"; "multi-morbidity"; "comorbidity"; "multiple diseases"; "elderly"; "major adults", "older people", "older persons", "aged", "associated factors", "correlated factors", "socioeconomic factors" e "demographic factors". Os critérios de inclusão consistiram em: estudos transversais ou longitudinais que tinham como objeto de estudo a população idosa com multimorbidade. Foram excluídos os estudos em que a multimorbidade não foi a variável dependente. Resultados: Um total de sete artigos foi incluído nesta revisão. Observou-se uma prevalência variando de 30,7% a 57,0% de multimorbidade em idosos. Os fatores associados foram o ato de fumar, consumo de álcool, morar em áreas rurais, baixa escolaridade, sexo feminino, idosos mais envelhecidos e não morar com crianças. Para a maioria dos artigos, uma renda familiar baixa também se mostrou associada à multimorbidade. Conclusão: Os resultados sugerem que a multimorbidade em idosos é uma condição comum e que ela tem sido influenciada por fatores socioeconômicos, demográficos, estilo de vida e estrutura familiar.