Morphometric Comparison of Two Implants with Different Macroscopy Placed Immediate in the Anterior Region of the Maxilla - A Randomized Clinical Trial with 6-Month of Follow Up.

Purpose - Compare the morphometric results of immediate implants (Type 1C) with a cylindrical (conventional) or triangular neck, in the anterior region of the maxilla, during 6 months of osseointegration. Materials and Methods - Prospective randomized clinical trial with a sample of 20 individuals randomly assigned to each group (10 triangular neck implants and 10 cylindrical neck implants). Consecutively direct measurements were performed: before (T-1) and after tooth extraction (T0), after implant placement (T1), after 1 month of the submerged implant healing (T2), when placing the healing abutment (T3), after placing the definitive crown (T3), and after 6 months of osseointegration (T4). Results - A significant difference between T1 and T3 in the buccal cortical thickness was identified (0.49Å}0.86mm). Although there was a significant increase in the buccal cortical thickness in both implants, this increase was greater for the triangular neck implants (cylindrical shape: 0.08Å}0.59 vs. triangular neck 0.90Å}0.91mm). It was also observed that implants placed below the buccal bone crest (í-1mm) promote less vertical buccal bone loss than implants placed Ñ-1mm at crest level (-0.65Å}0.52mm vs. -1.42Å}0.86mm). This observation needs to be further investigated in additional studies. Conclusions - The triangular neck implants present an increase in the cortical buccal thickness compared to the cylindrical implants. However, this increase does not fully compensate the remodulation after tooth loss.

Maxillary Sinus Augmentation with Xenogenic Collagen-Retained Heterologous Cortico-Cancellous Bone: A 3-Year Follow-Up Randomized Controlled Trial.

Sinus augmentation procedures have become a valuable solution for patients with posterior maxillary edentulism. The objective of this study was to explore the efficacy and safety of porcine xenograft with collagen supplementation as a potential alternative to autologous bone grafts in lateral sinus augmentation over a three-year follow-up period. Twelve patients, each with bilateral posterior maxillary edentulism, were enrolled and randomly allocated to receive either a porcine xenograft or an autologous graft. Comprehensive assessments, including clinical and radiographic evaluations, were conducted at specific intervals, including implant stability, marginal bone loss, prosthetic and biological complications, and patient preferences. The results demonstrated no significant differences between the two graft materials in terms of implant survival, marginal bone loss, and patient preferences after three years of follow-up. Only one implant was affected by peri-implantitis, and prosthesis-related complications were present in one patient possibly due to bruxism. In conclusion, these findings suggest that a porcine xenograft with collagen supplementation may be a viable alternative to an autograft in lateral sinus augmentation procedures. The high implant survival rate, minimal complications, and patient satisfaction indicate the potential clinical relevance of this graft material and should be further investigated to confirm these promising results.

Maxilla Reconstruction with Xenograft Blocks to Allow Implant Rehabilitation: A Case Report.

Reducing patient morbidity is one of the challenging goals of proper surgical techniques. The rehabilitation success begins with a good surgical plan. Scientifically proven biomaterials are excellent options to overcome the lack of autologous bone for maxillary reconstructions. This case report presents a clinical case of maxillary reconstruction combining guided bone regeneration with xenograft blocks and maxillary sinus elevation. This technique achieved maxillary rehabilitation with a fixed implant-supported prosthesis of a challenging case. The clinical case has an 18-month follow-up with no major complications and excellent clinical and radiographic results.

A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation.

The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.

A Pilot Randomized Controlled Clinical Trial Comparing Piezo Versus Conventional Rotary Surgery for Removal of Impacted Mandibular Third Molars.

BACKGROUND: The extraction of impacted mandibular third molars is a frequent dental surgery, interfering with patients' quality of life. Ultrasonic surgery is an alternative to osteotomy with conventional rotary instruments. This study compares postoperative signals and symptoms after extracting impacted mandibular third molars using ultrasonic surgery or conventional rotary osteotomy. METHODS: A pilot randomized controlled clinical trial was conducted. Thirty patients were randomly divided into the test group (ultrasonic technique) and a control group (conventional rotatory technique). All surgeries were timed. Swelling parameters, trismus and paraesthesia were evaluated on the day of surgery and the third, fifth and seventh postoperative days. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a visual analogue scale and the number of ingested analgesics. RESULTS: Pain, swelling and trismus present beneficial results with the ultrasonic technique but without statistical significance. Intraoperative bleeding was significantly lower with ultrasonic surgery (t(28) = 3.258; p = 0.003). Operating time was significantly higher in extractions involving osteotomy and cutting crown and roots either with the conventional technique (p = 0.020) or ultrasonic technique (p = 0.039). Regardless of the surgical difficulty, no statistically significant results were detected between techniques regarding the procedure duration. CONCLUSIONS: The beneficial postoperative signs and symptoms make ultrasonic surgery a favourable therapeutic option, especially when the integrity of noble anatomical structures is the most important risk factor. Further studies with larger samples are needed to support the use of piezosurgery as a valid option for impacted mandibular third molar extraction.

Advantages of Porcine Xenograft over Autograft in Sinus Lift: A Randomised Clinical Trial.

This study aimed to compare the performance of intra-oral autologous bone grafts versus porcine xenografts in a two-step lateral window sinus lift. This split-mouth randomised controlled trial sequentially enrolled 12 patients with a 6-month follow-up. For each patient, a simultaneous randomised bilateral maxillary sinus lift was performed and filled with autologous bone from the mandible (control) or a porcine xenograft (test). A bone biopsy sample was collected during the implant placement for histological and histomorphometric analysis. CT scans were performed at the beginning and at the end of the trial to assess radiological evolution. A comparison of initial and six-month CT scans indicated statistically significant increases in bone level for both materials (7.8 ± 2.4 mm for autologous and 8.7 ± 2.2 mm for xenograft, p < 0.05), and there were no significant differences between the performance of the two materials over time (p = 0.26). The histological analysis showed various stages of the remodelling process and no cells or other signs of inflammation or infection were visible in both groups. The porcine xenografts presented similar results for the studied variables when compared to autologous bone, being a reasonable alternative for a sinus lift.

Analysis of the Buccal Bone Plate, Root Inclination and Alveolar Bone Dimensions in the Jawbone. A Descriptive Study Using Cone-Beam Computed Tomography.

OBJECTIVES: This study aims to determine if there are enough buccal alveolar bone thickness to perform an immediate dental implant placement in anterior and posterior maxillary teeth. MATERIAL AND METHODS: A total of 1463 teeth were examined, from 202 cone-beam computed tomography scans with voxel sizes of 0.15 mm. On each tooth, the following measures were determined: the alveolar bone thickness in two locations; the vertical distance between the buccal alveolar crest and cementoenamel junction; the angle between the tooth's long axis and the alveolar bone axial inclination in the sagittal plane. RESULTS: In the most coronal location of maxillary teeth, the thickness of alveolar bone was lower than 0.6 (SD 0.6) mm in 50% of the teeth, and in the middle of the root the bone thickness was, on average, 0.96 (SD 0.6) mm. For the same maxillary teeth, the vertical distance between the buccal alveolar crest and cementoenamel junction and the angulation measured were, on average, 3.6 (SD 1.2) mm and 12.1º (SD 1.4º), respectively. CONCLUSIONS: The present study revealed that in most cases the thickness of buccal alveolar bone was less than 1 mm. Consequently, in such cases, immediate dental implant placement operation is not recommended, or should be combined with bone regeneration techniques.

The applications of regenerative medicine in sinus lift procedures: A systematic review.

BACKGROUND: Findings in regenerative medicine applied to the sinus lift procedures. PURPOSE: Evaluate the effectiveness of regenerative medicine in sinus lift. MATERIALS AND METHODS: An extensive search for manuscripts were performed by using different combinations of keywords and MeSH terms (Pub-med; Embase; Scopus; Web of Science Core Collection; Medline; Current Contents Connect; Derwent Innovations Index; Scielo Citation Index; Cochrane library). The full text selected articles are written in English, Portuguese, Spanish, Italian, German, or French, and published until 28 of November 2016. Inclusion criteria were: implant osteointegration, radiographic, histologic, and/or histomorphometric analysis, clinical studies in humans using of regenerative medicine. This systematic review was performed by selecting only randomized controlled clinical trials and controlled clinical trials. RESULTS: Eighteen published studies (11 CT and 7 RCT) were considered eligible for inclusion in the present systematic review. These studies demonstrated considerable variation of biomaterial and cell technics used, study design, sinus lift technic, outcomes, follow-up, and results. CONCLUSION: Only few studies have demonstrated potential of regenerative medicine in sinus lift; further randomized clinical trials are needed to achieve more accurate results.

Survival Rate of Dental Implants in Patients with History of Periodontal Disease: A Retrospective Cohort Study.

PURPOSE: To evaluate the differences between the survival rates of implants placed in patients with no history of periodontal disease (NP) and in patients with a history of chronic periodontal disease (CP). MATERIALS AND METHODS: A retrospective cohort study was conducted in which all consenting patients treated with dental implants in a private clinic in Oporto, Portugal, from November 2, 2002 through February 11, 2011 were included. All patients were treated consecutively by the same experimental operator. This study aimed to analyze how the primary outcomes (presence of disease, time of placement, and time of loading) and the secondary outcomes (severity-generalized periodontitis, brand, implant length, prosthesis type, prosthesis metal-ceramic extension) influence the survival rate of dental implants. The survival analysis was performed through the Kaplan-Meier method, and the equality of survival distributions for all groups was tested with the log-rank test with a significance level of .05 for all comparisons. RESULTS: The sample consisted of 202 patients (47% NP and 53% CP) and 689 implants (31% NP and 69% CP). The survival rate in the NP and CP groups showed no statistically significant differences (95.8% versus 93.1%; P ≥ .05). Implants were lost before loading in 54.9% of the cases. The majority of the implants were lost in the first year and stabilized after the second year. Survival rates in the NP and CP patients showed no statistically significant differences when comparing the following factors: subclassification of the disease, implant brands, implant length (short/standard), type of prosthesis, extension of the prosthesis metal-ceramic, and time of placement and loading (P ≥ .05). CONCLUSION: This work disclosed no statistically significant differences in terms of survival rates when compared with the control group. Placing implants in patients with a history of periodontal disease appears to be viable and safe.

Implant Stability in the Posterior Maxilla: A Controlled Clinical Trial.

AIM: To evaluate the primary and secondary stability of implants in the posterior maxilla. METHODS: Patients were allocated into three groups: (A) native bone, (B) partially regenerated bone, and (C) nearly totally regenerated bone. Insertion torque (IT) and implant stability quotient (ISQ) were measured at placement, to evaluate whether satisfactory high primary stability (IT ≥ 45 N/cm; ISQ ≥ 60) was achieved; ISQ was measured 15, 30, 45, and 60 days after placement, to investigate the evolution to secondary stability. RESULTS: 133 implants (Anyridge®, Megagen) were installed in 59 patients: 55 fixtures were placed in Group A, 57 in Group B, and 21 in Group C. Fifty-two implants had satisfactory high primary stability (IT ≥ 45 N/cm; ISQ ≥ 60). A positive correlation was found between all variables (IT, ISQ at t = 0, t = 60), and statistically higher IT and ISQ values were found for implants with satisfactory high primary stability. Significant differences were found for IT and ISQ between the groups (A, B, and C); however, no drops were reported in the median ISQ values during the healing period. CONCLUSIONS: The evaluation of the primary and secondary implant stability may contribute to higher implant survival/success rates in critical areas, such as the regenerated posterior maxilla. The present study is registered in the ISRCTN registry with ID ISRCTN33469250.

Two-Dimensional Identification of Fetal Tooth Germs.

OBJECTIVE: To demonstrate the efficiency and applicability of two-dimensional ultrasonography in the identification of tooth germs and in the assessment of potential pathology. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Prenatal Diagnosis Unit of Centro Hospitalar de Vila Nova de Gaia / Espinho-Empresa Pública in Portugal. PATIENTS: A total of 157 white pregnant women (median age, 32 years; range, 14 to 47 years) undergoing routine ultrasound exams. MAIN OUTCOME MEASURE(S): Description of the fetal tooth germs, as visualized by two-dimensional ultrasonography, including results from prior fetal biometry and detailed screening for malformations. RESULTS: In the first trimester group, ultrasonography identified 10 tooth germs in the maxilla and 10 tooth germs in the mandible in all fetuses except for one who presented eight maxillary tooth germs. This case was associated with a chromosomal abnormality (trisomy 13) with a bilateral cleft palate. In the second and third trimesters group, ultrasonography identified a larger range of tooth germs: 81.2% of fetuses showed 10 tooth germs in the maxilla and 85.0% of fetuses had 10 tooth germs in the mandible. Hypodontia was more prevalent in the maxilla than in the mandible, which led us to use qualitative two-dimensional ultrasonography to analyze the possible association between hypodontia and other variables such as fetal pathology, markers, head, nuchal, face, and spine. CONCLUSIONS: We recommend using this method as the first exam to evaluate fetal morphology and also to help establish accurate diagnosis of abnormalities in pregnancy.

The Influence of Crown-to-Implant Ratio on Short Implant Marginal Bone Loss.

PURPOSE: There is a need for more studies evaluating the marginal bone loss (MBL) of rehabilitations in the posterior regions of extremely resorbed maxillae and mandibles supported by short-length dental implants with a high crown/implant ratio (C/I-R). The aim of this study was to evaluate the influence of the C/I-R in implants on MBL considering dental implants with 4 mm of width and 7 mm of length. MATERIALS AND METHODS: This retrospective cohort study included 59 patients (mean age of 52.8 years) rehabilitated with at least one implant 4 mm in width and 7 mm in length, with an anodically oxidized surface and external connection on the premolar or molar positions, supporting a fixed prosthesis, and in function for a period of 36 months. Periapical radiographs at 36 months were used to calculate the C/I-R and MBL. The Spearman correlation coefficient was used to test the correlation between C/I-R and MBL. The level of significance was set at 5%. RESULTS: One hundred eighteen implants from 59 patients were evaluated. The mean ± SD MBL was 0.67 ± 0.63 mm. The C/I-R mean ± SD was 2.53 ± 0.79 mm. Thirty implants presented a C/I-R ≤ 2, while 88 implants had a C/I-R > 2. A weak nonsignificant inverse correlation (r = -0.081; P = .383, Spearman) was registered between C/I-R and MBL. CONCLUSION: Within the limitations of this study, it is possible to conclude that implant-supported fixed prostheses with C/I-R > 2 do not correlate positively with MBL.

Partial Rehabilitation with Distally Tilted and Straight Implants in the Posterior Maxilla with Immediate Loading Protocol: A Retrospective Cohort Study with 5-Year Follow-up.

PURPOSE: The purpose of this study was to compare the outcome of fixed partial prostheses in the posterior maxilla with two axially placed implants or one implant placed distally tilted and one axially placed implant following an immediate loading protocol. MATERIALS AND METHODS: A sample of 60 patients was divided into two groups-group 1: 30 patients rehabilitated with one axially placed implant and one implant placed distally tilted in the posterior maxilla; group 2: 30 patients rehabilitated with two axially placed implants in the posterior maxilla. Outcome measures were implant survival based on function, marginal bone resorption, and the incidence of mechanical and biologic complications at 5 years; inferential statistics were used to analyze the intergroup and intragroup differences. The level of significance was set at 5%. RESULTS: No significant differences were found between both groups in survival, complications, or marginal bone resorption. One axially placed implant was lost at 58 months in group 1, rendering a cumulative survival estimate at 5 years of 96.7% and 98.3% in group 1 and the total sample, respectively (P = .317). Mechanical complications occurred in 16 patients (26.7%; n = 8 patients in each group; [P > .999]), consisting of fractures in the provisional prosthesis (n = 8 patients), chipped ceramics of the definitive prosthesis (n = 2 patients), loosening of prosthetic components (n = 5 patients), and fracture of an attachment screw (n = 1 patient). Biologic complications occurred in 5 patients (8.3%; group 1 = 4 patients; group 2 = 1 patient; [P = .161]), consisting of peri-implant pathology. The mean ± SD marginal bone loss was 2.02 ± 0.36 mm and 1.90 ± 0.69 mm for groups 1 and 2, respectively (P = .235). In group 1, the mean ± SD marginal bone loss was 1.92 ± 0.48 mm and 2.11 ± 0.44 mm for the implant placed distally tilted and axially placed implant, respectively; the difference was significant (P < .001). CONCLUSION: Within the limitations of this study, the use of implants placed distally tilted together with axially placed implants or two axially placed implants in the fixed partial rehabilitation of the posterior maxilla are viable treatment alternatives.

Gengivite descamativa por corpo estranho - um caso clínico atípico / Desquamative gingivitis by foreign-body - an atypical clinical case

A gengivite descamativa caracteriza-se por eritema doloroso, perda da camada superficial de queratina, com ou sem ulceração, na gengiva aderida. Não cede às medidas profiláticas convencionais. Paciente do sexo feminino, 55 anos, caucasiana, compareceu na FMDUP, com “dor e ardência nas gengivas”. Após diagnóstico clínico de gengivite descamativa iniciámos tratamento convencional. Foi realizada biópsia incisional para despiste: líquen plano, pênfigo, penfigóide e lúpus eritematoso. O resultado da biópsia revelou lesão liquenóide com infiltrado linfoplasmocitário e presença de corpo estranho. A histologia, e o facto de a doente não apresentar melhoras com a aplicação de corticóide tópico, à excepção da zona biopsada, favoreceu a hipótese de gengivite descamativa por corpo estranho. Paciente foi aconselhada a fazer controlos trimestrais. Pacientes com estas manifestações deverão proceder a um bom controlo de placa bacteriana e descartar outras fontes de inflamação. A remissão da doença, só se consegue totalmente com a eliminação cirúrgica da gengiva afectada.

Desquamative gingivitis is a descriptive term that refers to an erythematous appearance of the gingiva, characterized by loss of keratin, with or without ulceration, and painprophylactic measures won´t restrain symptoms. 55 year-old woman, caucasian, came to FMDUP with pain and burn on the gingiva. Clinical diagnosis of desquamative gingivitis was followed by convencional treatment. Incisional biopsy was performed after verifying the insuccess of convencional measures: lichen planus, pemphigus, pemphigoid, lupus erythematosus were considered. The biopsy unfolded a lichenoid lesion with lymphocytic infiltrate and presence of foreign body. This diagnosis in association with the lack of improvement after topic application of corticosterois, favored the hypothesis of desquamative gingivitis associated with foreign body. The patient was advised to attend to quarterly appointments. Patients with these clinical manifestations, must have a perfect plaque control, allowing to discard other sources of inflammation. Cure is only complete with surgical removal of the affected gingiva.

Prenatal ultrasound and postmortem histologic evaluation of tooth germs: an observational, transversal study.

INTRODUCTION: Hypodontia is the most frequent developmental anomaly of the orofacial complex, and its detection in prenatal ultrasound may indicate the presence of congenital malformations, genetic syndromes and chromosomal abnormalities. To date, only a few studies have evaluated the histological relationship of human tooth germs identified by two-dimensional (2D) ultrasonography. In order to analyze whether two-dimensional ultrasonography of tooth germs may be successfully used for identifying genetic syndromes, prenatal ultrasound images of fetal tooth germs obtained from a Portuguese population sample were compared with histological images obtained from fetal autopsies. METHODS: Observational, descriptive, transversal study. The study protocol followed the ethical principles outlined by the Helsinki Declaration and was approved by the Ethics Committee of the School of Dental Medicine, University of Porto (FMDUP, Porto, Portugal) and of the Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/EPE, Porto, Portugal) as well as by the CGC Genetics Embryofetal Pathology Laboratory. Eighty-five fetuses examined by prenatal ultrasound screening from May 2011 to August 2012 had an indication for autopsy following spontaneous fetal death or medical termination of pregnancy. Of the 85 fetuses, 37 (43.5%) were randomly selected for tooth germ evaluation by routine histopathological analysis. Fetuses who were up to 30 weeks of gestation, and whose histological pieces were not representative of all maxillary tooth germs was excluded. Twenty four fetus between the 13(th) and 30(th) weeks of gestation fulfilled the parameters to autopsy. RESULTS: Twenty four fetuses were submitted to histological evaluation and were determined the exact number, morphology, and mineralization of their tooth germs. All tooth germs were identifiable with ultrasonography as early as the 13(th) week of gestation. Of the fetuses autopsied, 41.7% had hypodontia (29.1% maxillary hypodontia and 20.9% mandibular hypodontia). CONCLUSIONS: This results indicate that prenatal ultrasound is a reliable method for detecting of hypodontia an early gestational ages. Further studies with larger samples are needed to confirm these results.

CT maxillary sinus evaluation--A retrospective cohort study.

BACKGROUND: Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. MATERIAL AND METHODS: Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. RESULTS: 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. CONCLUSIONS: Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis.

IRAK4 gene polymorphism and odontogenic maxillary sinusitis.

OBJECTIVES: This study aimed to evaluate whether a specific interleukin-1 receptor-associated kinase-4 (IRAK4) gene polymorphism had any influence on the development of changes in maxillary sinus, particularly in the presence of etiological factors of dental origin. MATERIALS AND METHODS: The study population included 153 Portuguese Caucasians that were selected from a database of 504 retrospectively analysed computed tomography (CT) scans. A genetic test was performed, and a model was created through logistic analysis and regression coefficients. The statistical methodologies included were the independent Chi test, Fisher's exact test, binary logistic regression and the receiver operating characteristic (ROC) curve. RESULTS: The estimated prevalence of IRAK4 gene polymorphism found in a Portuguese Caucasian population was 26.8 % (CI 95%) [20.1, 34.7 %]. A model to predict the inflammatory response in the maxillary sinus in the presence etiological factors of dental origin was constructed. This model had the following as variables: previously diagnosed sinusitis, sinus pressure symptoms, cortical bone loss observed on CT, positive genetic test result and radiographic examination that revealed the roots of the teeth communication with the maxillary sinus, which are interpreted as risk factors. CONCLUSIONS: The constructed model should be considered an initial clinical tool. The area under the ROC curve found, AUC = 0.91, revealed that the model correctly predicts the outcome in 91.1% of cases. CLINICAL RELEVANCE: The clinical relevance of this study lies in trying to achieve a potential tool (a model) that may assist the clinician in the implementation of suitable dental treatment plans in complex cases, with probable involvement of the maxillary sinus.

Relationship between invasion of the periodontium by periodontal pathogens and periodontal disease: a systematic review.

Bacterial invasion of the periodontal tissues has been suggested as a relevant step in the etiopathogenesis of periodontal disease. However, its exact importance remains to be defined. The present systematic review assessed the scientific evidence concerning the relationship between the quality or quantity of periodontal microbiota in periodontal tissues and development of periodontal disease. The databases Medline-PubMed, Cochrane-CENTRAL, ISI Web of Knowledge and SCOPUS were searched, up to January 2014. Studies that reported evaluation of periodontal pathogens invasion on human tissues were selected. The screening of 440 title/abstracts elected 26 papers for full-text reading. Twenty three papers were subsequently excluded because of insufficient data or a study protocol not related to the objectives of this systematic review. All included studies were case-control studies that evaluated intracellular or adherent bacteria to epithelial cells from periodontal pockets versus healthy sulci. Study protocols presented heterogeneity regarding case and control definitions and methodological approaches for microbial identification. No consistent significant differences were found related to the presence/absence or proportion of specific periopathogens across the studies, as only one study found statistically significant differences regarding the presence of A. actinomycetemcomitans (p = 0.043), T. forsythia (P < 0.001), P. intermedia (P < 0.001), C. ochracea (P < 0.001) and C. rectus (P = 0.003) in epithelial cells from periodontal pockets vs. healthy sulci. All studies reported a larger unspecific bacterial load in or on the epithelial cells taken from a diseased site compared to a healthy sulcus. The current available data is of low to moderate quality and inconsistent mainly due to study design, poor reporting and methodological diversity. As so, there is insufficient evidence to support or exclude the invasion by periodontal pathogens as a key step in the etiopathogenesis of periodontal disease. Further research is needed.

Profilaxia antibiótica na prevenção da infeção associada aos terceiros molares / Antibiotic prophylaxis on prevention of third molars infection

Existe controvérsia acerca da eficácia da profilaxia antibiótica na prevenção de complicações após a remoção dos terceiros molares. Esta revisão bibliográfica baseada em meta-análises, 5 ensaios clínicos, ensaios clínicos randomizados e artigos de revisão tem por objetivo comparar a profilaxia versus o efeito placebo. Sendo a infeção o principal variável resposta "outcome". Efetuou-se uma pesquisa eletrônica na base de dados da PubMed, utilizando as palavras-chave "Third Molar" e " Antibiotic prophylaxis". Foram incluídos trabalhos de meta-análise, ensaios clínicos, ensaios clínicos randomizados, revisões sistemáticas e artigos de revisão. Foram pré-selecionados 35 artigos, dos quais 14 foram descartados por não atenderem aos critérios de inclusão. A amostra final foi composta por uma meta-análise, quatro ensaios clínicos, 11 ensaios clínicos randomizados e cinco artigos de revisão. Observou-se evidência científica limitada acerca das vantagens e desvantagens da profilaxia antibiótica associada à remoção dos terceiros molares. Novos estudos são necessários a fim de se obter um consenso sobre a efetividade da profilaxia antibiótica.

There is controversy regarding the efficacy of antibiotic prophylaxis in preventing complications after the third molar removal. Based on meta-analysis, randomized and clinical trials and reviews the main goal of this review is to report the use of antibiotic prophylaxis when compared to the use of placebo, being "infection" as an outcome. Research on PubMed database was performed with the following key-words: "Third Molar" and "Antibiotic prophylaxis". Meta-analysis, clinical trials, randomized clinical trials and review articles were selected.Initially 35 articles were selected. After consider inclusion criteria, 14 articles were eliminated. Our final sample was composed of 21 articles (1 metaanalyses, 4 clinical trials, 11 randomized clinical trials and 5 reviews). There is limited evidence about the advantages and disadvantages using antibiotics in preventing complications after the third molar removal. Well designed and well reported randomized trials are needed in order to reach a final consensus on the efficacy of antibiotic prophylaxis.

Taxa de sobrevivência dos implantes dentários em pacientes com história de doença periodontal / Survival rate of dental implants in patients with a history of periodontal disease

Objetivo: O objetivo principal desta revisão bibliográfica foi determinar quais as taxas de sobrevivência dos implantes dentários em pacientes com história de doença periodontal. Materiais e Métodos: A pesquisa foi realizada na base de dados Pubmed e Cochrane Library, utilizando-se um total de 17 artigos, datados dos anos 1998 a 2011 com as palavras chaves: Dental Implants"[MeSH] AND "Periodontal Diseases" [MeSH] AND "Survival Rate" [MeSH]; "periodontal disease AND oral implants survival"; "implant survival AND periodontal patients"; "short implants AND periodontal patients"; "narrow implants AND periodontal patient". Conclusão: A colocação de implantes dentários em pacientes periodontais parece ser uma opção viável e segura. O tratamento da doença periodontal deverá ser anterior à colocação do implante e um controle posterior desse implante deverá ser mantido. Mais estudos são necessários, com avaliações de pelo menos 10 anos, para se definir as reais taxas de sobrevivências e de sucesso dos implantes em pacientes com história de doença periodontal.(AU)

Aim: The main aim of this literature review was to determine the survival rates of dental implants in patients with a history of periodontal disease. Materials and Methods: The present research was conducted based on data from the Pubmed database and the Cochrane Library, using a total of 17 articles published from 1998 to 2011 and searching for the keywords "Dental Implants" [Mesh] AND "Periodontal Diseases" [Mesh] AND "Survival Rate" [Mesh]; "periodontal disease and oral implants survival "; "implant survival in periodontal patients"; "short implants and periodontal patients"; "narrow implants and periodontal patient". Conclusion: Dental implants in periodontal patients appears to be a viable and safe procedure. The treatment of the disease should be performed prior to implant placement, and a subsequent control of the implant should be maintained. More studies with follow-up periods of no less than 10 years are needed to determine the true survival and success rates of dental implants in patients with a history of periodontal disease.(AU)