Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial.

OBJECTIVE: To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS: Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS: The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION: The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE: These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

Development of clinical criteria for the evaluation of indirect restorations.

OBJECTIVE: To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient. MATERIALS AND METHODS: The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria. RESULTS: Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%. CONCLUSION: The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations. CLINICAL SIGNIFICANCE: The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.

Peri-Implant Surgical Treatment Downregulates the Expression of sTREM-1 and MMP-8 in Patients with Peri-Implantitis: A Prospective Study.

sTREM-1 and its ligand PGLYRP1 play an essential role in the inflammatory process around teeth and implants. In this study, we aimed to evaluate the impact of peri-implant treatment on the salivary levels of the sTREM-1/PGLYRP-1/MMP-8 axis after 3 months. A total of 42 participants (with a mean age of 61 years old ± 7.3) were enrolled in this longitudinal study, 24 having peri-implant mucositis (MU) and 18 having peri-implantitis (PI). Clinical peri-implant parameters, such as probing pocket depth (PPD), % of plaque, and bleeding on probing (BOP), and the whole unstimulated saliva samples were evaluated at baseline and 3 months after treatment. The MU group received nonsurgical peri-implant treatment, while the PI group received open-flap procedures. The levels of sTREM-1, PGLYRP-1, MMP-8, and TIMP-1 were analyzed using enzyme-linked immunosorbent assays. BOP, plaque levels, and PPD significantly reduced after treatment in both groups. A significant decrease in the salivary levels of sTREM-1, MMP-8, and TIMP-1 in the PI group and PGLYRP1 and TIMP-1 in the MU group were observed. Salivary levels of sTREM-1 were significantly reduced in patients with PI but not with MU. Additionally, peri-implant treatment had a significantly higher impact on MMP-8 reduction in patients with PI than in those with MU.

Peri-implant treatment reduces the salivary levels of Colony stimulator factor-1 and S100A8/A9.

This study evaluated the impact of peri-implant treatment in the salivary levels of Colony stimulator factor -1 (CSF-1), S100A8/A9 and S100A12 in patients having mucositis or peri-implantitis. As a secondary aim, we analysed the correlation between the salivary and peri-implant crevicular fluid (PICF) levels. Forty-seven patient, 27 having mucositis (mean age 63.11 ± 7.78) and 20 having peri-implantitis (61.25 ± 7.01) participated in the study. Clinical parameters, probing pocket depth, clinical attachment level, % of plaque and bleeding on probing were evaluated. Unstimulated whole saliva was collected from all patients, while PICF was collected only from a patient's subgroup (n = 20). Samples were collected before and 3 months after peri-implant treatment. Enzyme-linked immunosorbent assays determined levels of CSF-1, S100A8/A9 and S100A12. Clinical parameters improved and salivary levels of CSF-1 and S100A8/A9, but not S100A12, reduced significantly after treatment in both groups. No significant correlation was found in the salivary and PICF levels of the same molecule. In conclusion, the treatment of peri-implant disease significantly improved the clinical parameters and reduced the salivary levels of CSF-1 and S100A8/A9. The salivary expressions of CSF-1, S100A8/A9 and S100A12 did not correlate with their own expression in PICF.

Bacterial Profile and Radiographic Analysis Around Osseointegrated Implants With Morse Taper and External Hexagon Connections: Split-Mouth Model.

The aim of this clinical study was to evaluate bacterial colonization, marginal bone loss, and optical alveolar density in implants with Morse taper (MT) and external hexagon (EH) connections. Thirty-five implants were installed in 7 patients (mean age: 65.8 ± 6.7 years). Implants were divided into 2 groups, according to platform design: G1 - MT, installed 2mm infra-osseous and G2 - EH, positioned according to Branemark protocol. Patients were evaluated at baseline (T0), 21 days (T1), 3 months (T2), 6 months (T3), and 12 months (T4) after installations. Bone loss and alveolar density were evaluated by standardized periapical radiographs and bacterial profile with checkerboard DNA-DNA hybridization. Statistical analyses were performed using SPSS 23.0. To present the results, boxplots and a line graph of mean were used. P-values ≤ .05 were statistically significant. After 3 months, alveolar bone loss was significantly higher in the G2 (T2-T0: P = .006; T3-T0: P = .003; and T4-T0: P = .005). No significant differences between G1 and G2 groups were observed for optical alveolar density. Microbiological analysis showed similar profiles between studied groups; however, there were significantly higher counts of Tannerella forsythia (P = .048), Campylobacter showae (P = .038), and Actinomyces naeslundii (P = .027) in G1 after 12 months. Based on the results of this study, it can be concluded that there was less peri-implant bone loss in MT compared to EH connections, but microbiological profile did not seem to influence bone changes.

Expressão de proteínas relacionadas às células mieloides de pacientes com doença peri-implantar / Expression of myeloid cell-related proteins from patients having peri-implant diseases

O objetivo geral do presente estudo foi avaliar a expressão das proteínas relacionadas às células mieloides em pacientes com mucosite peri-implantar e peri-implantite; bem como a correlação desses biomarcadores com os parâmetros clínicos da doença peri-implantar. Os objetivos específicos foram avaliar os níveis de CSF-1, IL-34, IL-1ß, na saliva e no fluido peri-implantar de pacientes com doença peri-implantar e as correlações clínicas (estudo 1) e avaliar os níveis de sTREM-1, PGLYRP1, MMP-8, TIMP-1 e a razão MMP-8/TIMP-1 na saliva de pacientes com mucosite peri-implantar, peri-implantite, gengivite e periodontite e as correlações clínicas; bem como analisar a influência da existência concomitante da periodontite na expressão desses biomarcadores em pacientes com doença peri-implantar (estudo 2). No estudo 1, quarenta e três pacientes foram divididos em dois grupos: (1) Mucosite peri-implantar e (2) Peri-implantite; para o estudo 2, além dos pacientes do estudo 1, foram acrescidos pacientes com gengivite e com periodontite. Os parâmetros clínicos avaliados foram: profundidade de bolsa (PB), nível de inserção clínico (NIC), índice de placa e sangramento à sondagem. A saliva não estimulada foi coletada nos pacientes do estudo 1 e 2 e o fluido peri-implantar foi coletado no estudo 1. Os níveis dos biomarcadores foram mensurados através do ELISA. No estudo 1, os resultados das características clínicas de boca toda demonstraram que a PB dos pacientes com peri-implantite foi significativamente maior quando comparada aos pacientes com mucosite (p = 0,036). No estudo 2, a PB (p <0,001) e o NIC (p <0,001) dos pacientes com periodontite foi significativamente maior quando comparada aos demais pacientes. Tanto no estudo 1 quanto no estudo 2, a análise dos parâmetros peri-implantares mostrou que os pacientes com peri-implantite apresentaram maior PB nos implantes (p = 0,003) em comparação aos pacientes com mucosite. A análise dos níveis salivares de CSF-1, IL-34, IL-1ß, sTREM-1, PGLYRP1 e MMP-8 não apresentaram diferença significativa entre os grupos e também não foi encontrada correlação significativa desses biomarcadores com os parâmetros clínicos. No estudo 1, níveis de CSF-1 no fluido peri-implantar foram significativamente maiores nos pacientes com peri-implantite (p = 0,028), mostrando potencial para discriminar entre peri-implantite e mucosite (AUC = 0,695, IC 95% 0,53-0,85; p = 0,029). No estudo 2, os níveis salivares de MMP-8 foram significativamente maiores nos pacientes com doença peri-implantar e presença da periodontite concomitante (p = 0,03). Assim, pôde-se concluir que os níveis salivares das proteínas relacionadas às células mieloides não apresentaram diferença estatística entre os pacientes com mucosite e peri-implantite, sem correlação com os parâmetros clínicos. Os níveis de CSF-1 estavam elevados no fluido peri-implantar de pacientes com peri-implantite, sugerindo assim, um potencial osteoclastogênico alterado. Não observamos diferenças significativas nos níveis de sTREM-1, PGLYRP1 e MMP-8 entre pacientes com doenças periodontais e peri-implantares. Além disso, a presença da periodontite concomitante em pacientes com doença peri-implantar pode afetar os níveis salivares de MMP-8.(AU)

The general aim of present study was to evaluate the expression of myeloid cell-related proteins from patients having peri-implant mucositis and peri-implantitis; as well as their correlation to clinical parameters of peri-implant disease. The specific aims were to evaluate levels of CSF-1, IL-34, IL-1ß, in saliva and peri-implant crevicular fluid from patients having peri-implant disease and their correlation to clinical parameters (study 1) and to evaluate levels of sTREM- 1, PGIMRP1, MMP-8, TIMP-1 and MMP-8/TIMP-1 ratio in saliva from patients having peri-implant mucositis, peri-implantitis, gingivitis and periodontitis, and their correlation to clinical parameters; as well as to analyze the influence of the concomitant existence of periodontitis in the expression of these biomarkers in patients having peri-implant disease (study 2). In study 1, forty-three patients were divided into two groups: (1) peri-implant mucositis and (2) Peri-implantitis; for study 2, in addition to the patients in study 1, patients with gingivitis and periodontitis were added. The following clinical parameters were evaluated: probing depth (PD), clinical attachment level (CAL), visible plaque index and bleeding on probing. Unstimulated whole saliva was collected in the patients in study 1 and 2, and peri-implant crevicular fluid was collected in study 1. Biomarker levels were measured by ELISA. In study 1, regarding full-mouth periodontal parameters, PD from patients having peri-implantitis was significantly higher when compared to patients with mucositis (p = 0.036). In study 2, PD (p <0.001) and CAL (p <0.001) from patients with periodontitis were significantly higher when compared to the other patients. In both study 1 and study 2, regarding the peri-implant clinical characteristics showed that peri-implantitis patients presented higher PD in implants (p = 0.003) compared to the mucositis patients. When comparing the salivary levels of CSF-1, IL-34, IL-1ß, sTREM-1, PGLYRP1 and MMP-8, there was no significant difference between groups and no significant correlation of these biomarkers with clinical parameters was found. In study 1, CSF-1 levels were higher in peri-implant crevicular fluid from peri-implantitis compared with mucositis patients (p=0.028), showing potential to discriminate between peri-implantitis and mucositis (AUC = 0.695, 95% CI 0.53 -0.85, p = 0.029). In study 2, concomitant periodontitis resulted in higher significant levels of MMP-8 in patients with peri-implant disease (p = 0.03). Thus, based on these results, we can conclude that the salivary levels of myeloid cell-related proteins showed no difference between patients with peri-implant mucositis and peri-implantitis. There was also no significant correlation between biomarkers salivary levels and clinical parameters. Increased levels of CSF-1 in peri-implant crevicular fluid were found in peri-implantitis patients, thus suggesting an altered osteoclastogenic potential. We did not observe significant differences in levels of sTREM-1, PGLYRP1 and MMP-8 among patients with periodontal and peri-implant diseases. In addition, concomitant periodontitis in patients with peri-implant disease may affect salivary levels of MMP-8(AU)

Th17-related cytokines in mucositis: is there any difference between peri-implantitis and periodontitis patients?

OBJECTIVE: This study aimed to compare Th17-related cytokines named IL-1ß, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L and TNF-α in peri-implant fluid (PIF) from mucositis sites in patients having either peri-implantitis, periodontitis or without interproximal alveolar bone loss. MATERIAL AND METHODS: Thirty-three patients diagnosed with peri-implant mucositis were divided into three groups: individuals with peri-implant mucositis but without any signs of interproximal alveolar bone loss (group 1, n = 10), individuals with peri-implantitis (group 2, n = 14) and individuals with periodontitis (group 3, n = 9). Probing depth (PD), clinical attachment level (CAL), visible plaque index and bleeding on probing were measured. PIF was collected from mucositis sites in patients from the three groups and from peri-implantitis (group 2) and periodontitis sites (group 3). Cytokines were measured by a bead-based multiplex assay. RESULTS: Probing depth was significantly lower in group 1 when compared to both groups 2 and 3 (P < 0.001 and P = 0.01, respectively). There was no significant difference in cytokine levels in mucositis sites among the three groups. In group 2, IL-21 level was significantly higher in mucositis compared to peri-implantitis sites (P = 0.04). CONCLUSION: The expression of Th17-related cytokines in PIF from mucositis sites seems to be similar regardless the presence or not of alveolar bone loss around implants or teeth.

Expressão de citocinas relacionadas à resposta Th17 no fluido peri-implantar de mucosites em pacientes com e sem perda óssea alveolar / Expression of cytokines related to Th17 response in peri-implant fluid of mucositis in patients having or not alveolar bone loss

O objetivo do presente estudo foi analisar os níveis de IL-1ß, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L e TNF-α no fluido peri-implantar de mucosite em pacientes sem perda óssea alveolar e compará-los com os níveis na mucosite de pacientes com peri-implantite e de pacientes com periodontite. Trinta e três pacientes foram divididos em três grupos: (1) Mucosite peri-implantar (idade média 59,8±7,5, seis mulheres e quatro homens), (2) Peri-implantite (idade média 59,9±3,8, nove mulheres e cinco homens) e (3) Periodontite (idade média 66,7±8,8, cinco mulheres e quatro homens). Os parâmetros clínicos avaliados foram: profundidade de bolsa (PB), nível de inserção clínica (NIC), índice de placa e sangramento à sondagem. Em cada paciente foi realizada a coleta do fluido peri-implantar com pontas de papel absorvente pré-fabricadas. No grupo 1, foram coletados de sítios com mucosite (perda óssea ao redor dos implantes não atingindo a primeira rosca); no grupo 2, foram coletados sítios de mucosite e de peri-implantite (perda óssea de duas ou mais roscas do implante); no grupo 3, foram coletados de sítios com mucosite e com periodontite (PB ≥ 5mm e NIC ≥ 3mm). As amostras foram submetidas à análise imunológica e os níveis de citocinas foram mensurados através do ensaio multiplex com microesferas. Os resultados das características clínicas de boca toda demonstraram que a PB média do grupo 1 (2,0mm±0,1) foi significativamente menor quando comparado com o grupo 2 (2,6mm±0,4) e ao grupo 3 (2,5mm±0,3), com p<0,001 e p=0,01 respectivamente. Quanto ao NIC e a presença de placa, não houve diferença significativa entre os grupos. Avaliando as características clínicas peri-implantares dos sítios com mucosite peri-implantar dos três grupos, estes foram semelhantes, exceto pelo fato do percentual de sangramento no grupo 1 ser significativamente menor do que no grupo 3 (p=0,05). Ao comparar os níveis de citocinas nos sítios com mucosite dos três grupos, não houve diferença significativa. No grupo 2, ao comparar os níveis de citocinas nos sítios inflamados com mucosite e peri-implantite, a única citocina que apresentou diferença significativa foi a IL-21, sendo maior nos sítios com mucosite (p=0,04). No grupo 3, não foram observadas diferenças significativas entre os sítios com mucosite e sítios com periodontite. Assim, com base nos resultados obtidos, pôde-se concluir que os níveis de citocinas relacionadas à resposta Th17 no fluido peri-implantar de mucosite em pacientes sem perda óssea alveolar não apresentaram diferenças significantes daqueles na mucosite de pacientes com peri-implantite e de pacientes com periodontite.

This study aimed to analyse the levels of IL-1ß, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L, and TNF-α in peri-implant fluid from mucositis in patients without alveolar bone loss and to compare with the levels of mucositis from in peri-implantitis patients and with mucositis from periodontitis patients. Thirty three patients were divided in three groups: (1) Peri-implant Mucositis (average age 59.8 ± 7.5, six women and four men), (2) Peri-implantitis (average age 59.9 ± 3.8, nine women and five men) and (3) Periodontitis (average age 66.7 ± 8.8, five women and four men). The following clinical parameters were evaluated: probing depth (PD), clinical attachment level (CAL), visible plaque index and bleeding on probing. Peri-implant fluid was collected in each patient using pre-fabricated absorbent paper. In group 1, fluid was collected from mucositis sites (bone loss around the implant did not reach the first thread); in group 2, it was collected from mucositis sites and from peri-implantitis sites (bone loss involving two or more threads of the implant); in group 3, is was collected from mucositis sites and also from periodontitis sites (PD ≥ 5mm and CAL ≥ 3mm). Cytokines level were measured by a bead-based multiplex assay. Regarding full-mouth periodontal parameters, the mean PD of group 1 (2.0 mm ± 0.1) was significantly decreases when compared to group 2 (2.6 mm ± 0.4) and to group 3 (2.5 mm ± 0.3), with p<0.001 and p=0.01 respectively. CAL and visible plaque index did present no significant difference among the groups. Regarding the peri-implant clinical characteristics, it was found that peri-implant mucositis were similar, except for the significantly decreased bleeding on probing in group 1 in comparison with that in group 3 (p=0.05). When comparing the levels of cytokines in sites with peri-implant mucositis, there was no significant difference among them. In group 2, the levels of cytokines IL-21 was higher in sites with peri-implant mucositis when compared with peri-impantitis (p=0.04). In group 3, there were no significant differences between sites with mucositis sites and sites with periodontitis. Thus, based on these results, we can conclude that the levels of cytokines related to Th17 response in the peri-implant fluid from mucositis in patients without alveolar bone loss showed no significant differences in comparison to those from mucositis in patients with peri-implantitis and patients with periodontitis.

Implante dentário em incisivo central versus faceta dentária: trabalhando com diferentes substratos: passo a passo clínico / Dental implant in a central incisor versus ceramic veneers: working with different substrates: clinical step by step

No tratamento odontológico que almeje a estética é fundamental a realização de um planejamento clínico minucioso. Nesse contexto os implantes dentários unitários têm sido comumente empregados para a substituição de dentes perdidos. No entanto, a reabilitação de um dente/implante anterossuperior ainda é um desafio para os profissionais de odontologia. Este artigo tem por objetivo demonstrar o passo a passo de um caso clínico com implante dentário em um incisivo central, prótese sobre implante e facetas, com ênfase em uma solução clínica para igualar o substrato de uma coroa sobre implante com a cor de dentina de um dente preparado para faceta dentária, ressaltando a importância de restaurações estéticas em diferentes substratos...

A rigorous clinical planning is fundamental towards aesthetic treatments. In this context, single-unit dental implants has been commonly used to replace missing teeth. However, the rehabilitation of an anterior maxillary tooth/implant is still a challenge for dental professionals. This article aims to demonstrate the step by step of a clinical case with dental implant in a central incisor, implant-supported restorations and ceramic veneers, with emphasis on a clinical solution for matching the shade of an implant-supported crown and dentin shade of a tooth prepared for ceramic laminate, emphasizing the importance of aesthetic restorations on different substrates...

“Lentes de contato”: tratamento multidisciplinar no uso de laminados cerâmicos ultrafinos / Dental “contact lenses”: multidisciplinary treatment for the use of ultrathin ceramic laminate veneers

Em um tratamento odontológico que vise à obtenção de resultados estéticos satisfatórios é necessário um planejamento integrado de anatomia dentária, proporções dentárias e faciais. Com a evolução de materiais e técnicas, o uso de restaurações minimamente invasivas tem-se intensificado. As lentes de contato dental são facetas ou lâminas muito delgadas, cimentadas ao dente, sem preparo prévio ou com um mínimo de desgaste. Este artigo tem por objetivo demonstrar o passo a passo de um caso clínico, desde seu plano de tratamento até a fase de cimentação e acompanhamento, e destaca que é possível realizar restaurações estéticas ultraconservadoras combinando planejamento e técnica...

In a dental treatment that aims to achieve satisfactory aesthetic results, a comprehensive treatment planning, comprising dental anatomy, dental and facial proportions is necessary. With the evolving materials and techniques, the use of minimally invasive restorations has increased significantly. Tooth contact lenses are extremely thin veneers or shelfs without preparation or with minimal tooth reduction. The aim of this article is to demonstrate a step by step clinical case, from treatment planning to the cementation phase and follow-up, emphasizing that it is possible to fabricate ultraconservative restorations, associating thoughtful technic and planning...