Synergism between recombinant human bone morphogenetic protein 2/absorbable collagen sponge and bone substitutes favors vertical bone augmentation and the resorption rate of the biomaterials: Histomorphometric and 3D microcomputed tomography analysis.

BACKGROUND: Recombinant human bone morphogenetic protein 2 (rhBMP-2) is an osteoinductor frequently used for bone regeneration in oral and maxillofacial surgery. There is no consensus about the ideal carrier for this growth factor. The aim of this study was to compare the bone augmentation, bone microarchitecture, and biodegradation rate of additional carriers to rhBMP-2/absorbable collagen sponge (ACS) in a vertical guided bone regeneration model. METHODS: Four titanium cylinders were fixed onto the calvaria of rabbits (n = 20) that received (n = 10) or not (n = 10) rhBMP-2/ACS in conjunction with one of the carriers: beta-tricalcium phosphate (ß-TCP), biphasic calcium phosphate (BCP), bovine bone mineral (BBM) or blood clot. The samples were analyzed by means of microcomputed tomography and histomorphology after 14 weeks. RESULTS: All the materials with rhBMP-2/ACS exhibited improvement on bone augmentation, mainly BCP (P = 0.033) and ß-TCP (P = 0.038), in the upper portion of the cylinder. Although trabecular anisotropy was improved in all the materials groups, trabecular connectivity was diminished when the biomaterials received rhBMP-2/ACS. Resorption rate of the remaining biomaterial was improved by rhBMP-2/ACS, mainly in BBM (P <0.01) and ß-TCP (P <0.01). BBM exhibited the highest osteoclast density compared with the other materials groups. CONCLUSIONS: BCP and ß-TCP biomaterials exhibited a synergic effect with rhBMP-2/ACS, acting as suitable and viable carriers for vertical bone augmentation. The addition of rhBMP-2 significantly affected the biodegradation of ß-TCP and BBM, accelerating the resorption of these materials.

Growth Dynamic of Allogeneic and Autogenous Bone Grafts in a Vertical Model.

Several techniques have been proposed for vertical bone regeneration, and many of them use bone autogenous and allogeneic grafts. The purpose of this study was to compare demineralised freeze-dried bone allografts (DFDBA), fresh-frozen (FF) allografts, autogenous bone grafts to find differences between volumetric and histological quantity of bone formation and vertical bone growth dynamic. A vertical tissue regeneration bone model was performed in rabbit calvarias under general anaesthesia. Four hollow cylinders of pure titanium were screwed onto external cortical bone calvarias in eight rabbits. Each one of the cylinders was randomly filled with one intervention: DFDBA, FF, autogenous bone, or left to be filled with blood clot (BC) as control. Allogeneic grafts were obtained from a ninth animal following international standardised protocols for the harvesting, processing, and cryopreservation of allografts. Autogenous graft was obtained from the host femur scraping before adapting hollow cylinders. Animals were euthanized at 13 weeks. Vertical volume was calculated after probe device measurements of the new formed tissue inside the cylinders and after titanium cylinders were removed. Histomorphometry and fluorochrome staining were used to analyse quantity and dynamic of bone formation, respectively. Results showed that DFDBA and fresh-frozen bone improved the velocity and the quantity of bone deposition in distant portions of the basal plane of grafting. Remaining material in allograft groups was more intense than in autogenous group. Both allografts can be indicated as reliable alternatives for volume gain and vertical bone augmentation.

Growth dynamic of allogeneic and autogenous bone grafts in a vertical model

Abstract Several techniques have been proposed for vertical bone regeneration, and many of them use bone autogenous and allogeneic grafts. The purpose of this study was to compare demineralised freeze-dried bone allografts (DFDBA), fresh-frozen (FF) allografts, autogenous bone grafts to find differences between volumetric and histological quantity of bone formation and vertical bone growth dynamic. A vertical tissue regeneration bone model was performed in rabbit calvarias under general anaesthesia. Four hollow cylinders of pure titanium were screwed onto external cortical bone calvarias in eight rabbits. Each one of the cylinders was randomly filled with one intervention: DFDBA, FF, autogenous bone, or left to be filled with blood clot (BC) as control. Allogeneic grafts were obtained from a ninth animal following international standardised protocols for the harvesting, processing, and cryopreservation of allografts. Autogenous graft was obtained from the host femur scraping before adapting hollow cylinders. Animals were euthanized at 13 weeks. Vertical volume was calculated after probe device measurements of the new formed tissue inside the cylinders and after titanium cylinders were removed. Histomorphometry and fluorochrome staining were used to analyse quantity and dynamic of bone formation, respectively. Results showed that DFDBA and fresh-frozen bone improved the velocity and the quantity of bone deposition in distant portions of the basal plane of grafting. Remaining material in allograft groups was more intense than in autogenous group. Both allografts can be indicated as reliable alternatives for volume gain and vertical bone augmentation.

Resumo Várias técnicas foram propostas para regeneração óssea vertical, e muitas delas usam enxertos ósseos e alogênicos ósseos. O objetivo deste estudo foi comparar os aloenxertos ósseos congelados desmineralizados (DFDBA), os aloenxertos congelados frescos (FF) com os enxertos ósseos autógenos para encontrar diferenças entre o volume, a histologia da formação óssea e a dinâmica do crescimento ósseo vertical. Um modelo ósseo de regeneração tecidual vertical foi realizado em calvarias de coelho sob anestesia geral. Quatro cilindros ocos de titânio puro foram parafusados nas calvarias de osso cortical externo em oito coelhos. Cada um dos cilindros foi preenchido aleatoriamente com uma intervenção: DFDBA, FF, osso autógeno ou com coágulo sanguíneo (BC) como controle. Os enxertos alogênicos foram obtidos a partir de um nono animal seguindo protocolos internacionais padronizados para a coleta, processamento e criopreservação de aloenxertos. O enxerto autógeno foi obtido da raspagem do fêmur do hospedeiro antes de adaptar os cilindros ocos. Os animais foram eutanasiados após 13 semanas. O volume vertical foi calculado após a medição, por meio de sonda milimetrada, do novo tecido formado dentro dos cilindros e após a remoção dos cilindros de titânio. Histomorfometria e coloração com fluorocromios foram utilizados para analisar a quantidade e a dinâmica da formação óssea. Os resultados mostraram que DFDBA e osso fresco congelado melhoraram a velocidade e a quantidade de deposição óssea em porções distantes do plano basal de enxerto. O material remanescente nos grupos de aloenxerto foi mais intenso do que em grupo autógeno. Ambos os aloenxertos podem ser indicados como alternativas confiáveis para ganho de volume e aumento ósseo vertical.

Photoelastic Analysis on Different Retention Methods of Implant-Supported Prosthesis.

The aim of this study was to evaluate the stress distribution of different retention systems (screwed, cemented, and mixed) in 5-unit implant-supported fixed partial dentures through the photoelasticity method. Twenty standardized titanium suprastructures were manufactured, of which 5 were screw retained, 5 were cement retained, and 10 were mixed (with an alternating sequence of abutments), each supported by 5 external hexagon (4.0 mm × 11.5 mm) implants. A circular polariscope was used, and an axial compressive load of 100 N was applied on a universal testing machine. The results were photographed and qualitatively analyzed. We observed the formation of isochromatic fringes as a result of the stresses generated around the implant after installation of the different suprastructures and after the application of a compressive axial load of 100 N. We conclude that a lack of passive adaptation was observed in all suprastructures with the formation of low-magnitude stress in some implants. When cemented and mixed suprastructures were subjected to a compressive load, they displayed lower levels of stress distribution and lower intensity fringes compared to the screwed prosthesis.

Deflexão mandibular medial relacionada às falhas biomecânicas da prótese fixa implantossuportada com conexão rígida distal ao forame mentual / Medial mandibular flexure related to biomechanical failures of implant-supported fixed prosthesis with distal rigid connection to the mental foramen

Introdução: algumas falhas mecânicas e possíveis problemas biológicos foram relacionados à deflexão mandibular medial em indivíduos que possuíam próteses fixas implantossuportadas extensas, com conexão rígida bilateral em implantes posteriores ao forame mentual. Métodos: a pesquisa literária pertinente ao tema foi realizada a partir da consulta à base de dados MEDLINE, compreendendo os anos de 1954 até 2010. A proposta dessa revisão de literatura foi relacionar as possíveis falhas biomecânicas das próteses implantossuportadas com extensão distal ao forame mentual, tais como fratura de implantes, afrouxamento ou fratura de parafuso da prótese, falta de assentamento passivo da estrutura metálica, saucerização e, em alguns casos, dor muscular e limitação de abertura de boca, e propor o desenho dessas próteses. Conclusão: quando o planejamento protético necessitar elementos de apoio na parte posterior ao forame mentual, a prótese deverá ser segmentada, principalmente em região de sínfise. Dessa forma, os efeitos deletérios causados pela deflexão mandibular medial na prótese e região peri-implantar serão minimizados.

Effect of recombinant human bone morphogenetic protein 2 associated with a variety of bone substitutes on vertical guided bone regeneration in rabbit calvarium.

BACKGROUND: A major challenge for dental implantology is to consistently obtain appropriate bone augmentation before implant placement. The aim of this study is to evaluate the effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) associated with bone substitute materials beta-tricalcium phosphate (ß-TCP), biphasic calcium phosphate (BCP), and bovine bone mineral on vertical guided bone regeneration (GBR) in rabbit calvarium. METHODS: Four titanium cylinders were fixed to the calvarium of 22 rabbits. In group 1 (n = 10), three cylinders were randomly filled with one of the test materials, and one cylinder was filled with a blood clot (CL). In group 2 (n = 12), the cylinders were randomly assigned to the same materials and CL but with the addition of rhBMP-2. Bone labels were injected over the course of 13 weeks, and euthanasia was performed 14 weeks after surgery in both groups. RESULTS: The mean volume and area of tissue growth was greater in group 2 (with rhBMP-2) than in group 1 (without rhBMP-2), irrespective of the material used (P <0.001). The mean volume of tissue growth in the CL cylinder was smaller than that observed with all other materials (P <0.001) in both groups. The mean area of regenerated bone in the CL cylinder was smaller than that observed in the ß-TCP cylinder (P = 0.028). The histologic study revealed more lamellar bone in the rhBMP-2 group, with a greater level of biodegradation of all the bone substitute materials tested. CONCLUSION: The use of rhBMP-2/absorbable collagen sponge (ACS) combined with all of the bone substitute materials tested resulted in a greater amount of bone formation than that produced with the bone substitute materials alone or rhBMP-2/(ACS) and CL using the rabbit calvarium GBR model.

A rhBMP-2 aumenta e acelera a formação óssea vertical quando associada a biomateriais em calvária de coelhos / rhBMP-2 increases and accelerates vertical bone formation when associated to biomaterials: the rabbit calvaria model

O objetivo deste estudo foi avaliar a formação óssea vertical aposicional obtida com a associação da proteína morfogenética óssea recombinante humana 2 (rhBMP-2) com os materiais beta fosfato tricálcico (CE), fosfato de cálcio bifásico (BC) e osso mineral bovino (BO) em um modelo de regeneração óssea guiada (ROG) em calvária de coelhos; 22 coelhos albinos da raça Nova Zelândia receberam quatro cilindros de titânio fixados na calvária. No grupo 1 (n = 10), os cilindros foram aleatoriamente preenchidos com um dos referidos materiais e coágulo sanguíneo (CO). No grupo 2 (n = 12), foi repetida a mesma distribuição aleatória dos materiais e coágulo, acrescidos da rhBMP-2. Corantes ósseos foram aplicados durante 13 semanas, e a eutanásia foi realizada na 14a semana nos dois grupos. Os resultados clínicos mostraram que o volume ósseo e a sua área média no grupo 2 (com rhBMP-2) foram maiores do que no grupo 1 (sem rhBMP-2), independente dos materiais utilizados (p < 0,001). Não houve diferença estatisticamente significante entre os volumes médios de BC e BO (p = 0,625), BC e CE (p = 0,876), BO e CE (p = 0,968). O volume médio do CO foi menor do que todos os materiais (p < 0,001) nos dois grupos. Não houve diferença significativa entre as médias das áreas em BC e BO (p = 0,965), BC e CE (p = 0,866), BO e CE (p = 0,990), BC e CO (p = 0,190), BO e CO (p = 0,060). A área média do CO foi menor em CE (p = 0,028). O estudo histológico revelou quantidades significativas de tecido ósseo neoformado nos dois grupos. No entanto, no grupo com rhBMP-2, foi observado osso mais maduro e lamelar, e com maior taxa de biodegradação em todos os materiais. A análise de fluorescência mostrou que a adição de rhBMP-2 é mais significativa na porção superior do cilindro e que a formação óssea é tempo-dependente. Pôde-se concluir que a utilização da rhBMP-2 associada a qualquer um dos biomateriais gerou maior formação óssea neste modelo de regeneração óssea guiada (ROG) em coelhos.

The aim of this study was to evaluate the appositional vertical bone formation obtained with the association of recombinant human bone morphogenetic protein 2 (rhBMP-2) with the materials Beta Tricalcium Phosphate (CE), Biphasic Calcium Phosphate (BC), and Mineral Bovine Bone (BO) in a guided bone regeneration model (GBR) in rabbit calvaria. Twenty-two New Zealand white rabbits received four titanium cylinders fixed in the calvaria. In group 1 (n = 10), each cylinder was randomly filled with one of these materials and one with a blood clot (CO). In group 2 (n = 12) cylinders were randomly assigned the same materials and blood clot with the addition of rhBMP-2. Bone labels were injected during 13 weeks, and the euthanasia was performed in the 14th week in both groups. The results showed that the average volume and area in group 2 (with rhBMP-2) was higher than that in group 1 (without rhBMP-2), regardless the materials used (p < 0.001). There was no statistically significant difference between the average volumes of BO and BC (p = 0.625), BC and CE (p = 0.876) and BO and CE (p = 0.968). The average volume of CO was lower than all materials (P < 0.001) in both groups. There was no statistically significant difference between the average areas of BC and BO (p = 0,965), BC and CE (p = 0,866), BO and CE (p = 0,990), BC and CO (p = 0,190) and BO and CO (p = 0,060). The average area of CO was lower than CE (p = 0,028). The histological study revealed significant amounts of newly formed bone in both groups. Nevertheless, in the group with rhBMP-2 a more mature and lamellar bone with a greater level of biodegradation in all materials was observed...

A utilização da proteína morgogenética óssea recombinante humana 2 com carreadores adicionais: análise histomorfométrica e por microtomografia computadorizada 3D / The use of the human recombinant bone morphogenetic protein 2 with additional carriers: Histomorphometric and 3D Micro-computed tomography analysis

A utilização de osteoindutores como a proteína morfogenética óssea recombinante humana tipo 2 (rhBMP-2) em cirurgia oral e maxilofacial para reparação e regeneração óssea tem aumentado progressivamente. Porém, suas indicações ainda estão limitadas a preenchimento de cavidades e pequenas reconstruções. Este estudo teve como objetivo analisar e comparar, por meio da microtomografia computadorizada tridimensional (Micro-TC 3D) e histomorfometria, a arquitetura óssea, a taxa de osso neoformado e a taxa de biodegradação do -Tricálcio Fostato (-TCP), Fosfato de Cálcio Bifásico (BCP) e Osso Mineral Bovino (BBM), utilizados como carreadores adicionais à rhBMP-2/esponja de colágeno (ACS) em um modelo de regeneração óssea guiada (ROG) vertical em calvária de coelhos. Quatro cilindros de titânio foram fixados à calvária de 20 coelhos da raça Nova Zelândia. No Grupo 1 (n = 10), 3 cilindros foram aleatoriamente preenchidos com um dos materiais teste utilizados como carreadores e um cilindro foi preenchido com coágulo sanguíneo (CO). No Grupo 2 (n = 10), os cilindros foram aleatoriamente designados para os mesmos materiais e coágulo sanguíneo, com a adição da rhBMP-2/ACS. Após 14 semanas de reparação, as amostras foram coletadas e enviadas para a aquisição de imagens da Micro-TC e processamento histológico. De acordo com a análise histomorfométrica, a área óssea média para o Grupo 2 (com rhBMP-2) foi maior do que no Grupo 1 (sem rhBMP-2) para os materiais BCP e -TCP (p <0,001). Não houve diferença entre os grupos para BBM e CO (p> 0,05). Em relação às taxas de reabsorção, a área média dos materiais remanescentes no Grupo 2 foi menor do que no Grupo 1 para todos os materiais (p <0,001) e BBM e -TCP obtiveram a maior taxa de reabsorção nos dois grupos (BBM = -TCP > BCP). A análise da micro-TC revelou que no Grupo 2, BCP e -TCP apresentaram maior volume ósseo médio (BV) do que no Grupo 1 (p <0,05). Não houve diferença entre os grupos para os materiais BBM e CO (p> 0,05). O volume médio de materiais restantes (MV) para o Grupo 2 foi menor do que no Grupo 1 para BBM e -TCP (p <0,05), sem diferença significante entre os grupos para BCP (p = 0,848). A análise dos parâmetros Fator Padrão Trabecular (Tb.Pf) e Índice de Modelo Estrutural (SMI) mostrou no Grupo 2 valores negativos para BCP e -TCP, indicando melhor interconectividade e presença de arquitetura trabecular mais achatada e côncava, indicadores de melhor qualidade e resistência óssea. Pelos resultados apresentados concluiu-se que a utilização da rhBMP-2/ACS associada aos materiais carreadores BCP (Fosfato de Cálcio Bifásico) e -TCP (-Fosfato Tricálcio) aumentou significativamente a formação óssea neste modelo de ROG em calvária de coelhos além de acelerar a biodegradação dos materiais BBM (Osso Mineral Bovino) e -TCP (-Fosfato Tricálcio) neste modelo de ROG.

The use of osteoinductors as the human recombinant bone morphogenetic protein 2 type 2 (rhBMP-2) in oral and maxillofacial surgery for bone regeneration and repair has progressively increased. However, indications are still limited to filling of cavities and small reconstructions. However, its indications are still limited to filling of cavities and small reconstructions. This study aimed to analyze and compare, by means of three-dimensional microtomography (Micro-CT 3D) and histomorphometry, the bone architecture, the rate of newly formed bone and the biodegradation rate of beta tricalcium phosphate (-TCP), biphasic calcium phosphate (BCP), and mineral bovine bone mineral (BBM) used as additional carriers to rhBMP-2/absorbable collagen sponge (ACS) in a vertical guided bone regeneration model (GBR) in rabbit calvarium. Four titanium cylinders were fixed to the calvarium of 22 New Zealand rabbits. In Group 1 (n = 10), 3 cylinders were randomly filled with one of the test materials and 1 cylinder was filled with a blood clot (CL). In Group 2 (n = 10), the cylinders were randomly assigned to the same materials and blood clot, with the addition of rhBMP-2. After 14 weeks of healing the samples were collected and sent to 3D Micro-CT image acquisition and histological processing. According to histomorphometric analysis, the mean bone area in Group 2 (with rhBMP-2) was greater than in Group 1 (without rhBMP-2) to materials BCP and -TCP (p<0.001). There was no difference between groups to BBM and CL (p>0.05). Regarding the resorption rates, the mean area of remaining materials in Group 2 was lower than in Group 1 to all materials (p<0.001) and BBM and -TCP had the greater resorption rate in both groups (BBM= -TCP >BCP). The Micro-CT analysis revealed that in Group 2, BCP and -TCP had greater mean bone volume (BV) than in Group 1 (p<0.05). There was no difference between groups to materials BBM and CL (p>0.05). The mean volume of remaining materials (MV) in Group 2 was lower than in Group 1 to BBM and -TCP (p<0.05). There was no difference between groups to BC (p=0.848). The analysis of the parameters Trabecular Pattern Factor (Tb.Pf) and Structure Model Índex (SMI), in Group 2 showed negative values for BCP and -TCP, indicating better interconnectivity and presence of more plate-like and trabecular architecture more flattened and concave, indicators of better quality and bone strength. By presented results it was concluded that the use of rhBMP-2/ACS associated with the carriers materials biphasic calcium phosphate (BCP) and beta tricalcium phosphate (-TCP) used as additional carriers, significantly increased bone formation in addition to accelerate the resorption of the materials BO (bovine bone mineral) and -TCP in this guided bone regeneration model in rabbit calvaria.

A rhBMP-2 aumenta e acelera a formação óssea vertical quando associada a biomateriais em calvária de coelhos / rhBMP-2 increases and accelerates vertical bone formation when associated to biomaterials: the rabbit calvaria model

O objetivo deste estudo foi avaliar a formação óssea vertical aposicional obtida com a associação da proteína morfogenética óssea recombinante humana 2 (rhBMP-2) com os materiais beta fosfato tricálcico (CE), fosfato de cálcio bifásico (BC) e osso mineral bovino (BO) em um modelo de regeneração óssea guiada (ROG) em calvária de coelhos; 22 coelhos albinos da raça Nova Zelândia receberam quatro cilindros de titânio fixados na calvária. No grupo 1 (n = 10), os cilindros foram aleatoriamente preenchidos com um dos referidos materiais e coágulo sanguíneo (CO). No grupo 2 (n = 12), foi repetida a mesma distribuição aleatória dos materiais e coágulo, acrescidos da rhBMP-2. Corantes ósseos foram aplicados durante 13 semanas e a eutanásia foi realizada na 14a semana nos dois grupos. Os resultados clínicos mostraram que o volume ósseo e a sua área média no grupo 2 (com rhBMP-2) foram maiores do que no grupo 1 (sem rhBMP-2), independente dos materiais utilizados (p < 0,001). Não houve diferença estatisticamente significante entre os volumes médios de BC e BO (p = 0,625), BC e CE (p = 0,876), BO e CE (p = 0,968). O volume médio do CO foi menor do que todos os materiais (p < 0,001) nos dois grupos. Não houve diferença significativa entre as médias das áreas em BC e BO (p = 0,965), BC e CE (p = 0,866), BO e CE (p = 0,990), BC e CO (p = 0,190), BO e CO (p = 0,060). A área média do CO foi menor em CE (p = 0,028). O estudo histológico revelou quantidades significativas de tecido ósseo neoformado nos dois grupos. No entanto, no grupo com rhBMP-2, foi observado osso mais maduro e lamelar, e com maior taxa de biodegradação em todos os materiais. A análise de fluorescência mostrou que a adição de rhBMP-2 é mais significativa na porção superior do cilindro e que a formação óssea é tempo-dependente. Pôde-se concluir que a utilização da rhBMP-2 associada a qualquer um dos biomateriais gerou maior formação óssea neste modelo de regeneração óssea guiada (ROG) em coelhos.

The aim of this study was to evaluate the appositional vertical bone formation obtained with the association of recombinant human bone morphogenetic protein 2 (rhBMP-2) with the materials Beta Tricalcium Phosphate (CE), Biphasic Calcium Phosphate (BC), and Mineral Bovine Bone (BO) in a guided bone regeneration model (GBR) in rabbit calvaria. Twenty-two New Zealand white rabbits received four titanium cylinders fixed in the calvaria. In group 1 (n = 10), each cylinder was randomly filled with one of these materials and one with a blood clot (CO). In group 2 (n = 12) cylinders were randomly assigned the same materials and blood clot with the addition of rhBMP-2. Bone labels were injected during 13 weeks, and the euthanasia was performed in the 14th week in both groups. The results showed that the average volume and area in group 2 (with rhBMP-2) was higher than that in group 1 (without rhBMP-2), regardless the materials used (p < 0.001). There was no statistically significant difference between the average volumes of BO and BC (p = 0.625), BC and CE (p = 0.876) and BO and CE (p = 0.968). The average volume of CO was lower than all materials (P < 0.001) in both groups. There was no statistically significant difference between the average areas of BC and BO (p = 0,965), BC and CE (p = 0,866), BO and CE (p = 0,990), BC and CO (p = 0,190) and BO and CO (p = 0,060). The average area of CO was lower than CE (p = 0,028). The histological study revealed significant amounts of newly formed bone in both groups. Nevertheless, in the group with rhBMP-2 a more mature and lamellar bone with a greater level of biodegradation in all materials was observed. The fluorescence analysis showed that the addition of rhBMP-2 is more significant in the upper portion of the cylinder and that bone formation is time-dependent...

Sugestão de protocolo para o tratamento da peri-implantite / Suggestion of a protocol for treatment of peri-implantitis

Embora inúmeros estudos longitudinais comprovem o alto índice de sucesso dos implantes, a incidência de doenças peri-implantares vem crescendo proporcionalmente ao número de implantes instalados. O objetivo deste trabalho foi avaliar um protocolo para tratamento de peri-implantite que foi elaborado com base em recente revisão da literatura sobre o tema.

Reosseointegração: é um objetivo viável? / Re-osseointegration: is it a viable goal?

A peri-implantitte é uma doença de origem bacteriana que atinge tardiamente um implante após uma osseointegração bem-sucedida. Suas conseqüências são a destruição óssea, perda de inserção, sangramento e alterações dos tecidos moles adjacentes ao implante afetado, podendo, em casos avançados, gerar a perda parcial ou total da osseointegração. Sendo assim, a reosseointegração é o objetivo final de todo e qualquer tratamento de peri-implantite. A proposta deste trabalho foi revisar, na literatura, estudos com opções de tratamento que possibilitem a sua obtenção, estabelecida clinicamente e comprovada por evidências científicas. O levantamento da literatura foi realizado manualmente e através da base de dados Medline, compreendendo o período de 1990 a 2009. O tratamento ideal poderia ser dividido em três etapas: eliminação das causas, restauração das condições anatômicas perdidas e manutenção da saúde dos tecidos peri-implantares, permitindo a longevidade do implante em função. Analisando os estudos in vitro e em animais, concluiu-se que é possível a obtenção da reosseointegração em implantes previamente contaminados. Quanto aos estudos em humanos, embora alguns mostrassem remissão dos sinais clínicos e aumento ósseo observado clínica e radiograficamente, o processo de reosseointegração não pôde ser comprovado, devido à impossibilidade de realização de estudos histológicos.

Peri-implantitis is a bacterial disease that lately affects an implant after a successful osseointegration, which promotes bone destruction, attachment loss, bleeding and changes in soft tissues adjacent to the implant affected and can, in advanced cases, generate partial or complete loss of osseointegration.Thus, the re-osseointegration is the ultimate goal of any peri-implantitis treatment. The aim of this study was to review the literature on studies with treatment options that would enable its attainment, clinically established and corroborated by scientific evidence. The review of the literature was performed manually and through Medline database from 1990 to 2009. Basically, the ideal treatment could be divided into three stages; elimination of the causes, restoration of anatomical and biological conditions that had been lost and maintenance of healthy peri-implantar tissues, allowing the longevity of the implant in function. Analyzing in vitro and animal studies, we conclude that it is possible to obtain the re-osseointegration in previously contaminated implants: in relation to humans, some studies slowed remission of clinical signs and increased bone formation observed clinically and by x-rays, nevertheless the re-osseointegration process could not be proven due to the impossibility of histological studies.