Osteoimmunology drives dental implant osseointegration: A new paradigm for implant dentistry.

There is a complex interaction between titanium dental implants, bone, and the immune system. Among them, specific immune cells, macrophages play a crucial role in the osseointegration dynamics. Infiltrating macrophages and resident macrophages (osteomacs) contribute to achieving an early pro-regenerative peri-implant environment. Also, multinucleated giant cells (MNGCs) in the bone-implant interface and their polarization ability, maintain a peri-implant immunological balance to preserve osseointegration integrity. However, dental implants can display cumulative levels of antigens (ions, nano and microparticles and bacterial antigens) at the implant-tissue interface activating an immune-inflammatory response. If the inflammation is not resolved or reactivated due to the stress signals and the immunogenicity of elements present, this could lead implants to aseptic loosening, infections, and subsequent bone loss. Therefore, to maintain osseointegration and prevent bone loss of implants, a better understanding of the osteoimmunology of the peri-implant environment would lead to the development of new therapeutic approaches. In this line, depicting osteoimmunological mechanisms, we discuss immunomodulatory strategies to improve and preserve a long-term functional integration between dental implants and the human body. Scientific field of dental science: implant dentistry.

Coupling between Osseointegration and Mechanotransduction to Maintain Foreign Body Equilibrium in the Long-Term: A Comprehensive Overview.

The permanent interaction between bone tissue and the immune system shows us the complex biology of the tissue in which we insert oral implants. At the same time, new knowledge in relation to the interaction of materials and the host, reveals to us the true nature of osseointegration. So, to achieve clinical success or perhaps most importantly, to understand why we sometimes fail, the study of oral implantology should consider the following advice equally important: a correct clinical protocol, the study of the immunomodulatory capacity of the device and the osteoimmunobiology of the host. Although osseointegration may seem adequate from the clinical point of view, a deeper vision shows us that a Foreign Body Equilibrium could be susceptible to environmental conditions. This is why maintaining this cellular balance should become our therapeutic target and, more specifically, the understanding of the main cell involved, the macrophage. The advent of new information, the development of new implant surfaces and the introduction of new therapeutic proposals such as therapeutic mechanotransduction, will allow us to maintain a healthy host-implant relationship long-term.

Rehabilitación de rebordes severamente atróficos mediante prótesis híbridas confeccionadas con tecnología de sinterización láser cromo-cobalto: reporte de caso / Rehabilitation of severely atrophic full arches using hybrid prostheses made with chrome-cobalt laser sintering technology: A case report

Prótesis híbridas metal-acrílico implanto-retenidas han brindado solución funcional y estética para rehabilitar arcos completos severamente atróficos, constituyendo una alternativa a cirugías reconstructivas más complejas. La subestructura protésica debe ajustar pasivamente sobre los implantes. Con la tecnología CAD-CAM el diseño manual de las subestructuras, mediante cera perdida, se ha reemplazado por diseño digital mediado por software. La tecnología de sinterizado láser en la confección de subestructuras metálicas tiene como ventajas la disminución de acumulación de errores, rapidez y diseño de geometrías complejas según las necesidades del caso. Caso Paciente desdentada total. Se planifica prótesis híbrida maxilar (8 implantes) y mandibular (Revitalize®) con subestructuras en aleación Cr-Co mediante sinterizado láser, que presenta resultados a largo plazo similares a estructuras nobles, con menor costo y alta predictibilidad. Conclusiones Prótesis híbridas con subestructura Cr-Co mediante sinterizado láser podrían mejorar el pronóstico al incorporar CAD-CAM en su confección al obtener ajustes de precisión.

Abstract Implant-retained metal-acrylic hybrid prostheses provide a functional and aesthetic solution to rehabilitate severely atrophic complete arches, and are an alternative to more complex reconstructive surgeries. the prosthetic substructure must adjust passively on the implants. With the CAD-CAM technology, the manual design of the substructures, by lost wax, has been replaced by digital design. Laser sintering technology in the production of metal substructures has advantages, such as, decreased accumulation of errors, fabrication speed and design of complex geometry, according to the needs of the case. Case report Hybrid prostheses in the maxilla (8 implants) and jaw (Revitalize®) were planned in a patient with no teeth, using Co-Cr alloy substructures by laser sintering, which have similar long-term results as obtained with noble structures, but with lower cost and high predictability. Conclusions Hybrid prostheses with Co-Cr substructures using laser sintering could improve prognosis by incorporating CAD-CAM in their preparation to obtain fine adjustments.

Localización del Septo del Seno Maxilar a través de Abordaje Endoscópico: Reporte de Caso y Revisión de la Literatura / Location of Maxillary Sinus Septum through an Endoscopic Approach: Report of a Case and Review of the Literature

El abordaje quirúrgico del seno maxilar para maniobras como el levantamiento de la membrana sinusal y la colocación de injerto óseo con o sin implantes simultáneo en la zona subantral, es un procedimiento cada vez más habitual en implantología oral. Una de las mayores complicaciones en este tipo de procedimientos es el abordaje de la pared lateral del seno maxilar con presencia de septos intra-sinusales no diagnosticados, pudiendo producir perforación de la membrana durante el fresado óseo. La presencia de septos en el seno maxilar es muy variable, pudiendo presentarse única o múltiple y en diferentes localizaciones anatómicas en relación a la zona de las raíces de las piezas maxilares antrales en pacientes dentados o desdentados, desde la zona canina hasta el segundo molar. Diversos autores, han descrito diferentes valores de la prevalencia en relación a la presencia de septos intra-sinusales en base a imagenología tridimensional o in vivo en estudios cadavéricos. El objetivo del presente estudio, es realizar una revisión exhaustiva de la literatura desde 1997 hasta noviembre del 2010 en relación a la prevalencia de septos en el seno maxilar y su localización según método de visualización, y el reporte de un caso con una nueva técnica de abordaje quirúrgico que permite una visualización intra y extrasinusal para la localización del septo del seno maxilar in vivo.

Surgery of the maxillary sinus in procedures as elevation of the sinus membrane and bone graft, with or without simultaneous implants in the subantral area, is becoming a more standard procedure in oral implants each time. One of the most common complications in this type of procedure is the approach of the sinus lateral wall, with presence of undiagnosed intra-sinus septa with perforation of the membrane during sinus elevation. The presence of septa in the maxillary sinus is variable, presenting as single or multiple in different locations with relation to the rots in maxillary pieces in dentate or edentulous patients. Various authors have described different values in the prevalence of the intra sinus septum presence, based on three dimensional imaging studies, or the in vivo study of cadavers. The aim of this study is an exhaustive review of the literature since 1997 to November of 2010 in reference to the prevalence of maxillary sinus septa and their location according to observation methods, and the report of a case with innovative surgical approach technique, that allows intra and extra sinus visualization for in vivo maxillary sinus septum location.