Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry.

Excessive sugar consumption is the main cause of dental caries. Dental caries is highly prevalent and negatively impacts the quality of life at all stages. Furthermore, sugar consumption is associated with other noncommunicable conditions and diseases, such as obesity, diabetes, and cardiovascular diseases. The aim of this paper is to propose recommendations at the individual and population levels for health professionals, families, educators, stakeholders, and public officials to reduce the burden of dental caries and other noncommunicable diseases that are caused by the excessive sugar intake. A systematic search was performed in PubMed and Cochrane databases to investigate the effectiveness of strategies and policies aiming to reduce sugar consumption as well as the impact of different patterns of sugar consumption on the occurrence of dental caries. Reference list of the identified papers and practice guidelines were manually reviewed as well. Based on the best evidence available, the Brazilian Academy of Dentistry recommends not to offer sugars to children younger than 2 years of age, and to limit total sugar consumption to <25 g per day after 2 years of age. Furthermore, families should be informed to limit sugar exposure, sugar-free areas should be available, content of food labels and advertisement should be regulated, taxation of products with sugar should be introduced, and reformulation of foods and drinks to reduce concentrations of sugars should be considered.

Prosthetically Driven Alveolar Reconstructions: A Retrospective Study.

This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Prosthetically driven alveolar reconstructions: a retrospective study

Abstract This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.

Evaluation of Pink and White Esthetic Scores for Immediately Placed and Provisionally Restored Implants in the Anterior Maxilla.

PURPOSE: To evaluate the esthetic result of immediately placed implants with immediate provisional restorations in the anterior maxilla using the pink esthetic score (PES) and white esthetic score (WES). MATERIALS AND METHODS: The records of patients were evaluated retrospectively. The evaluation was carried out by two examiners using 12 evaluation criteria. RESULTS: The average PES value from the evaluation of 53 images obtained from the 53 selected patients (22 men and 31 women) was 8.63 ± 2.4 (range, 1-14), whereas the average WES value was 6.92 ± 1.67 (range, 2-10). The mesial papilla had the highest average PES (1.39 ± 0.4) and the distal papilla had the lowest PES (0.87 ± 0.54). Texture had the highest average WES (1.54 ± 0.34) and tooth shape had the lowest average WES (1.25 ± 0.43). CONCLUSION: Treatment with immediate implants providing immediate provisional restoration in the anterior maxilla yields good clinical esthetic outcomes, as assessed by PES/WES values. The PES and WES values showed strong intraexaminer agreement, but weak interexaminer agreement.

Reconstrução estética com instalação imediata de implante / Aesthetic reconstruction with immediate implant installation ­ case report

A diminuição do tempo de tratamento com implantes osseointegrados, assim como a redução da complexidade do plano de tratamento e a otimização de protocolos minimamente invasivos, é um dos aspectos atuais em reabilitações com implantes. A instalação imediata de implantes em sítios pós-exodontia tem sido relatada na literatura como uma técnica previsível, permitindo a redução do tempo e do número de procedimentos para reabilitação protética. Este artigo relatou um caso clínico de reabilitação de um incisivo central superior perdido por reabsorção radicular, em que foi instalado um implante com confecção imediata de uma prótese temporária. No intuito de minimizar as alterações volumétricas inerentes ao processo de exodontia, além da utilização de um substituto ósseo entre a tábua óssea alveolar e o implante, foi utilizado enxerto de tecido conjuntivo removido do palato. A técnica possibilitou uma reabilitação estética e funcional adequada, e redução no tempo de tratamento com mínimo trauma ao paciente.

Decreasing treatment time with dental implants, as well as reducing the complexity of the treatment plan and optimize minimally invasive protocols, are current issues in rehabilitation with implants. Immediate implant placement in post-extraction sites have been reported in the literature as a predictable technique allowing to reduce the time and number of procedures for prosthetic rehabilitation. This is a case report of an upper central incisor lost due to root resorption, receiving an immediate implant and construction of a temporary prosthesis. In order to minimize volumetric changes inherent in the extraction process, besides the use of a bone substitute between alveolar bone plate and the implant, it was used connective tissue graft removed from the palate. The technique allowed an aesthetic and functional rehabilitation and appropriate reduction in treatment time with minimal tissue trauma.

Implante imediato na região anterior: aspectos cirúrgicos e protéticos / Immediate Implant in the Anterior Region: surgical and prosthetic aspects

O objetivo deste trabalho é relatar um caso clínico de implante imediato pós-exodontia na região anterior da maxila. O caso apresentado seguiu o seguinte protocolo de tratamento clínico: diagnóstico da necessidade de exodontia, sondagem óssea; cirurgia reversa em modelo de gesso para a confecção de um pilar de zircônia e uma restauração provisória, exodontia; instalação do implante; enxerto ósseo aloplástico; instalação do pilar de zircônia e da restauração provisória. Após seis meses foi realizada a moldagem do pilar preparado para a confecção da restauração definitiva. Os resultados obtidos preencheram os requisitos estéticos, funcionais e biológicos em função dos corretos diagnósticos, planejamento e execução do caso.

The aim of this work is to present a clinical case of immediate implant in a fresh extraction socket in the maxillary anterior region. The case was treated following the subsequent clinical treatment protocol: diagnosis of dental extraction necessity; reverse surgery in a cast model for the fabrication of a zirconia abutment and a temporary restoration; tooth extraction; alloplastic bone graft; implant placement; installation of the zirconia abutment and the temporary restoration. After a 6-month healing period, an impression of the prepared abutment was done for the production of the definitive restoration. The results met the aesthetic, functional and biological requirements due to the correct diagnosis, planning and execution of the case.

Pilares de zircônia na Implantodontia: biologia e técnicas / Zirconia abutments for implant dentistry: biology and technics

A busca pela excelência em estética vem se tornando cada vez mais necessária na Odontologia moderna. Com a evolução dos biomateriais, o surgimento dos pilares cerâmicos proporciona resultados satisfatórios em regiões críticas, onde a estética é fundamental. O presente estudo mostrou a aplicação de pilares em zircônia, suas propriedades físicas, biológicas e sua relação com os tecidos peri-implantares, através de uma revisão da literatura e do relato de dois casos clínicos.

The search for excellent on dental esthetics has become more necessary in contemporary implant dentistry. With advancements on biomaterials, the development of ceramic abutments provides satisfactory results in critical esthetic regions. The aim of this report is to discuss the use of zirconia abutments, their physical and biological properties, as well as relationship with peri-implant tissues through two clinical case reports and basic aspects on the literature.

Comparative analysis of microorganism species succession on three implant surfaces with different roughness: an in vivo study.

PURPOSE: Because almost all implant systems reveal marginal bone loss and some implants can be affected by periimplantitis, to realize an effective maintenance treatment it is important to understand the biofilm development over different implant surfaces. The objective of this human study is to comparatively analyze the kinetics of microorganism species succession on 3 surfaces. MATERIALS AND METHODS: Three commercially pure titanium sheets with different roughness were randomly fixed bilaterally on the lingual regions of Hawley-type plates of 6 volunteers. The participants used the apparatuses in the following experimental periods: 1, 3, 7, 14, and 21 days, and were instructed to remove the acrylic plates only during oral hygiene procedures. Samples of biofilm were harvested from the central areas of each sheet, and the presence of 24 bacterial species was identified using Checkerboard DNA-DNA Hybridization method. RESULTS: The results showed no statistically significant differences with regard to the kinetics of bacterial species succession on the different surfaces, in all periods of time. Rough surfaces were not more prone to colonization by pathogenic bacteria than the smooth surfaces. CONCLUSION: The surface roughness does not affect the bacterial species succession in the biofilm. The succession of species was similar during all periods of the study.

Otimização a estética em restaurações sobre implantes: revisão da literatura / Optimizing esthetics for implant restorations: literature review

Considerações estéticas em Implantodontia têm sido motivo de diversos estudos e publicações nos últimos 15 anos, atentando-se para a existência de diversos parâmetros que devem ser criteriosamente analisados durante a etapa de planejamento para a instalação de implantes osseointegrados. Alguns fatores se destacam na busca do resultado estético ideal, como o posicionamento tridimensional adequado do implante, anatomia do rebordo alveolar, fenótipo periodontal, tipo de material restaurador, perfil emergente da prótese, dimensões do espaço edêntulo disponíveis e o momento de instalação do implante.

Osseointegration of titanium alloy and HA-coated implants in healthy and ovariectomized animals: a histomorphometric study.

OBJECTIVES: The objective of the present study is to evaluate the response to dental implants in healthy and osteoporotic bone. MATERIALS AND METHODS: Ten ovariectomized (OVX) New Zealand rabbits submitted to a hypocalcic diet and 10 sham-aged rabbits were used. All animals were submitted to bone mineral density (BMD) measurements before ovariectomy, and also 4 months afterwards, using dual energy X-ray absorptiometry. The BMD measurements showed a significant loss of bone mass, between the first and second examinations, only in the experimental group (P<0.05). After the bone mass loss induction period, three different implants were installed in the proximal tibia metaphisis of each animal: a titanium alloy implant (Ti), a plasma-spray hydroxyapatite-coated implant (HA-PS), and another implant coated with hydroxyapatite with the biomimetic process (HA-B). RESULTS: After 3 months, histomorphometry showed a bone-to-implant contact (BIC) for Ti implants of 73.09+/-13.74% in healthy and 66.09+/-30.01% in OVX animals. The BIC for the HA-PS was 64.83+/-15.65% and 90.17+/-8.14% for healthy and OVX animals, respectively, and 88.66+/-5.30% and 87.96+/-10.71% for the HA-B implants placed in the same conditions. The differences between the implants in healthy and OVX conditions were not statistically significant (P>0.05). The only significant difference within groups was observed in the healthy animals between HA-B and Ti implants (P<0.06). CONCLUSION: Within the parameters used in this animal model it was not possible to observe BIC differences between osteoporotic and healthy animals.

Surface characterization of dental implants coated with hydroxyapatite by plasma spray and biomimetic process.

PURPOSE: The aim of this study was to characterize implants coated with hydroxyapatite (HA) using 2 different processes. MATERIALS AND METHODS: Commercially pure titanium implants were coated with HA using a modified biomimetic process and the plasma spray process. These implants were characterized by scanning electron microscopy, Fourier-transformed infrared spectroscopy, and x-ray photoelectron spectroscopy. RESULTS: The plasma spray process generates a typical rough topography mainly consisting of HA. The HA coating produced by biomimetic process was partially dissolved in water and only a very thin layer of calcium titanate plus calcium phosphate and probably beta-tricalcium phosphate remained. In vitro test showed that both coatings can be considered bioactive. CONCLUSION: The modified biomimetic process seems to be a simple and low-cost alternative to coat titanium with a high potential of In vitro application.

Análise estrutural e do desempenho in vitro das lâminas dos raspadores ósseos / Structural and in vitro analysis of commercially available bone scrapers

Existem diversos raspadores ósseos comercialmente disponíveis, apresentando diferentes características e resultados clínicos. Na literatura atual, existem poucos trabalhos que analisem as características estruturais e do projeto dos diferentes raspadores e que as relacionem à eficácia dos mesmos. O objetivo deste trabalho foi analisar os projetos de nove diferentes raspadores ósseos e as características estruturais do aço das lâminas de corte, correlacionando com o desempenho in vitro. O presente trabalho avaliou o ângulo de corte da ponta ativa; a distância do acesso por onde o osso é coletado; a dimensão do contorno de grãos, o grau de dureza e a composição química do metal da lâmina do raspador; além da eficácia do raspador num teste in vitro. Com cada um dos raspadores ósseos, um cirurgião-dentista realizou 20 golpes de raspagem ao longo de um segmento de fêmur bovino de 6 cm. As partículas de osso coletadas foram pesadas em uma balança de precisão. Os resultados demonstraram que tanto a abertura da ponta ativa, quanto o ângulo de corte da ponta ativa, que são características dos projetos dos raspadores ósseos, não influenciaram na quantidade de osso raspado. Entretanto, as características estruturais das lâminas dos raspadores ósseos (diâmetro médio de grão, dureza Vickers e composição química) influenciaram na quantidade de osso raspado. A análise estrutural dos raspadores ósseos é uma importante ferramenta para validar seu uso e oferecer maior conforto e segurança aos pacientes e cirurgiões.

There are many commercially available bone scrapers presenting different characteristics and different clinical results. In the current literature, there are few articles analyzing the structural and design characteristics related to the effectiveness of bone scrapers. The aim of the present study was to analyze the design of nine different commercially available bone scrapers, as well as the structural characteristics of their stainless steel blades, as well as the in vitro performance of these instruments. With each bone scraper, one dentist performed 20 strokes in a 6cm bovine femur block. The bone particles harvested were weighted using a precision weight. The results of the different scrapers show that both the opening and the cutting angles of the cutting end, which are characteristics of the bone scrapers projects, did not influence the quantity of bone harvested. On the other hand, structural characteristics of these blades (average diameter of the grain, Vickers hardness, and chemical composition) influenced in the quantity of the harvested bone. The structural analyses of scrapers are an important tool in the validation of its use and also provide more comfort and safety for patients and surgeons.

Histomorphometric analysis of HA-coated implants interface with irradiated and nonirradiated bone.

PURPOSE: The purpose of the present study was to investigate whether osseointegration of HA-coated implants can be affected by irradiation. MATERIALS AND METHODS: A single dose of 15 Gy was applied to the right tibia of 5 rabbits and the left tibia was not irradiated and used as control. After 3 months, the animals were killed and the quantification of the implant-bone contact surfaces was performed using scanning electron micrographs of the resin sections containing the implants in the irradiated and nonirradiated bones. After the healing period, all implants were stable. RESULTS: The results show a mean percentage of bone-implant contact of 45.52% in the irradiated tissue and 47.56% in the nonirradiated tissue, with no statistic significant difference (P > 0.05). CONCLUSION: In conclusion, radiotherapy may not interfere with osseointegration process around HA-coated implants in rabbit cortical bone.

Extrusão ortodôntica como auxiliar na obtenção da excelência estética de prótese sobre implante / Orthodontic extrusion as an assistant on obtaining esthetic excellence of prosthesis over implant

Este artigo relata a seqüência de extrusão forçada de um incisivo central superior, através de aparotologia ortodôntica, previamente à colocação de implante osseointegrado e à realização de prótese sobre implante. Havia indicação de exodontia e a extrusão ortodôntica foi realizada com objetivo de fornecer área adequada para inserção do implante. A conjugação dos tratamentos ortodôntico, periodontal e protético é apresentada nesse relato de caso, que obteve resultado estéticos satisfatórios.

A relação implante-pilar protético na saúde perimplantar: uma revisão de literatura / Interrelation between implant and prosthetic abutment concerning perimplant health: a literature review

A perda óssea marginal ao redor de implantes osseointegráveis é um constante desafio. Estudos da interface entre a base dos pilares protéticos e o topo da plataforma dos implantes têm revelado a presença de uma fenda (microgap) vertical existente, que permite a colonização bacteriana e a presença de um infiltrado reacional inflamatório, podendo levar a reabsorção óssea marginal ao redor dos implantes osseointegrados. O objetivo desta revisão de literatura é correlacionar a desadaptação vertical existente entre o implante e o seu respectivo pilar protético, com o espaço biológico ao redor deste implante

The marginal bone loss around osseointegrated implants is a constant challenge. Studies focusing the interfaces between the prosthetics abutments bases and the implant platform top have been showing the presence of an important vertical gap (“microgap”) that allows bacterial colonization and a consequent reactionary inflammatory infiltrate that can promote marginal bone loss around osseointegrated implants. As so, the aim of this literature review is to correlate the existent vertical microgap between implant/prosthetic abutment and it’s biological space

Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure.

PURPOSE: To evaluate the angulation of the maxillary sinus walls at the apical sinus region. MATERIALS AND METHODS: Using preoperative computerized tomographies of 15 patients selected for sinus lift procedures, the angulation of the maxillary sinus floor was measured drawing straight lines tangential to the mesial and lateral walls. The measurements were taken from sagittal images at specific areas (i.e., second bicuspid, first molar, and second molar). RESULTS: The results showed that the second bicuspid sites have a sharper angulation than the second molar sites, and these second molar sites have a sharper angle than the first molar sites. CONCLUSION: The sharper angle observed in the second bicuspid area can influence the feasibility of schneiderian membrane evaluation when compared to the molar areas.

Espaço biológico e outros fatores que influenciam na estética periimplantar: relato de um caso / Biological width and some factors that influence peri-implant esthetic: a case report

O espaço biológico em dentes é definido como uma barreira biológica formada por tecido epitelial e conjuntivo que veda o segmento tecidual do meio bucal. Em implantes, esse espaço biológico apresenta características semelhantes em tamanho e composição tecidual. Fatores tais como biocompatibilidade dos componentes transmucosos; contaminação deste componentes e número de retiradas e recolocações, podem interferir na integridade e saúde do espaço biológico como barreira. O objetivo deste artigo é apresentar um caso clínico de instalação de implante e provisionalização imediata, pós-exodontia na região estética, e discutir os fatores que podem influenciar a formação e a posição dessa barreira biológica

Achieving aesthetic success with an immediate-function implant and customized abutment and coping.

UNLABELLED: The absence of teeth in the anterior region often results in a number of negative consequences compromising appearance and facial anatomy, as well as patients' self-esteem and social behavior. Dental implants have increasingly become a viable option for achieving natural-looking restorations. The success of anterior restorations, however, depends upon several factors. The following case presentation discusses these factors as well as the implementation of clinical and laboratory procedures for the restoration of a missing anterior tooth. LEARNING OBJECTIVES: This article demonstrates an implant surgical procedure and restorative sequence used to replace a fractured single anterior tooth. Upon reading this article, the reader should: Understand how dental implants can be a viable solution based upon factors within the proximity of the region being restored. Realize that optimal aesthetics can be achieved when the final abutment is installed at the time of implant placement.

O conceito de espaço biológico determinando um novo desenho de implantes. Parte I: aspectos cirúrgicos / The concept of biological space in determining a new implant sedign. Part I: surgical aspects

O objetivo deste artigo foi descrever aspectos cirúrgicos da instalação de um implante com o topo parabólico indicado para regiões de necessidade estética periimplantar, e apresentar um caso clínico onde esse novo desenho de implantes foi empregado. Nesta situação clínica, a distância entre a futura margem gengival e o topo do implante é constante. Pode-se concluir que o uso do implante com o topo parabólico vem a ser uma excelente alternativa terapêutica para pacientes com edentulismo unitário na região anterior superior que necessite de reconstrução tridimensional dos tecidos perdidos

Relato de caso / NobelDirectTM como solução estética para espaço reduzido / NobelDirectTM as aesthetic solution for small spaces. A clinical case

Uma vez em que as pesquisas em Implantologia Oral buscam otimização do resultado estético, assim como técnicas alternativas para transpor limitações no sítio cirurgico, novos desenhos de implantes associados à novas terapias de reabilitação têm sido bastante discutidos. este trabalho apresenta um caso clínico, com espaço ósseo reduzido em região anterior de maxila, que foi solucionado coma instalação de um novo desenho de implante de 3,0 mm de diâmetro. Os aspectos pós-cirúrgicos mostram preservação de tecidos moles e duros periimplantes, otimização dos resultados estéticos, além de proporcionar um conforto pós-operatório superior ao paciente