In vitro evaluation of membranes for regenerative procedures against oral bacteria.

The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.

In vitro evaluation of membranes for regenerative procedures against oral bacteria

Abstract The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.

Resumo O objetivo deste estudo foi avaliar, in vitro, a aderência do biofilme multiespécie e a passagem de bactérias através dos diferentes tipos de membranas disponíveis comercialmente para RTG/ROG. Quatro tipos de membranas foram testados (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; e LP) Lumina PTFE®. Papel alumínio (AL) simulou uma barreira impermeável e foi usado como controle negativo. As membranas foram adaptadas à um aparato específico e desafiadas com uma cultura bacteriana mista composta de A. actinomycetemcomitans b, S. mutans, S. mitis, e A. israelii. Após 2 h ou 7 dias, a aderência e passagem bacteriana foi avaliada através da contagem de UFCs. Duas membranas de cada grupo foram analisadas através da microscopia eletrônica de varredura (MEV). LC e LP apresentaram valores semelhantes de células bacterianas aderidas (p < 0.05), significativamente inferiores quando comparados aos outros grupos, em ambos os períodos experimentais (p < 0.05). Desde a análise inicial, todos os grupos testados foram permeáveis às células bacterianas, sem diferença significativa entre o período experimental de 2 h e 7 dias (p > 0.05). As análises em MEV demonstraram que o número de bactérias aderidas aumentou com o tempo (2 h < 7 days). Membranas biológicas comercialmente disponíveis demonstraram intensa aderência bacteriana e passagem de bactérias, que aumentou durante os períodos experimentais.

The impact of generic labels on the consumption of and adherence to medication: a randomized controlled trial.

Background: Although generic drugs are pharmacologically equivalent to their brand-name counterparts, prejudices against them remain strong. We assess the extent to which generic (versus brand-name) labels affect patients' consumption of and adherence to medication. Methods: One hundred one patients who received dental implants agreed to participate in a study. In a pre-surgery survey, most patients reported a positive view about generic drugs. After dental surgery, the patients were prescribed a once-daily analgesic regimen (50 mg tramadol hydrochloride) for up to 7 days. All the patients received at no cost the same brand-name medication with either a brand-name label (n = 51) or a generic label (n = 50) and were informed of the retail prices associated with both labels. Telephone follow-up was conducted 24 hours, four days, and seven days after surgery to assess the number of prescribed pills consumed and when their use was discontinued, the number of non-prescribed pills consumed, pain levels throughout the follow-up period, the perceived efficacy of the analgesic, and the willingness to recommend it to a friend. Results: The label manipulation impacted the participants' behaviour and subjective assessments. Discontinuation before the end of the 7-day period was more frequent under the generic (vs. brand-name) label condition. The patients in the generic label group were also more likely to consume non-prescribed pills (non-adherence). Additionally, the patients in the generic label group reported higher levels of pain. Conclusion: Generic labels may negatively affect adherence to treatment even if patients report ex ante positive evaluations of the quality of generics drugs.

Application of Immediate Dentoalveolar Restoration in Alveolus Compromised with Loss of Immediate Implant in Esthetic Area.

In the reported clinical case, the immediate dentoalveolar restoration (IDR) technique was applied to reconstruct the buccal bone wall, with autogenous graft of the maxillary tuberosity, which had been lost due to a root fracture, and to provide the necessary bone substrate for the installation of an implant and its provisioning. One of the greatest risks inherent in the survival of immediate implants is the maintenance of their stability during the healing period. In this case, due to a mechanical trauma in sports activity in the first postoperative month, there was a total failure in the osseointegration process, confirmed by tomographic examination of both the implant and the bone graft. The deleterious effects of this accident were compensated with a new approach and reapplication of IDR technique using a smaller-diameter implant and with conical macrogeometry in conjunction with the new bone reconstruction under the same compromised alveolus; associated, after the period of osseointegration, with the maneuvers of volume increase of the gingival tissue by subepithelial connective tissue graft. The tomographic result demonstrated the success of the surgical procedures, and the clinical/photographic analysis obtained showed the stability of the gingival margin without compromising the esthetic result of the prosthetic restoration.

Implante imediato com provisionalização imediata através de cicatrizador multifuncional de PEEK / Immediate implant placement and provisionalization using a multifunctional PEEK healing abutment

Este artigo teve por objetivo apresentar um caso clínico cuja prótese provisória utilizou um componente protético multifuncional de PEEK. Este é um polímero biocompatível personalizável e de boa aderência às resinas. O caso descrito é um implante imediato com carga imediata na região do 21. Foi realizado um approach palatino do implante, preenchimento do gap vestibular com um enxerto aloplástico (Nanosynt), um provisório imediato utilizando um componente provisório multifuncional de PEEK e um dente de estoque. O caso foi acompanhado até a fase de confecção da prótese defi nitiva, na qual foi verifi cada a arquitetura dos tecidos peri-implantares quanto à saúde e manutenção. Na Implantodontia contemporânea, o PEEK é a opção biológico-funcional com melhor custo-benefício nos casos de implantes colocados e carregados imediatamente.

The aim of this article was to present a clinical case where the provisional restoration was fabricated over a multifunctional PEEK healing abutment. This biocompatible polymer can be customized and has excellent bond strength to resin composites. A dental implant was loaded at the region of tooth 21. After a palatal approach for implant placement, the buccal gap was fi lled with an alloplastic graft (Nanosynt). Then, the immediate restoration was fabricated with the multifunctional PEEK and an acrylic tooth form. At the delivery of the defi nitive restoration, the peri-implant soft tissue health and architecture were preserved. In the contemporary implant dentistry, PEEK abutments provide the best biological and functional option with a signifi cant cost-benefi t ratio for cases of immediate implant loading

Biofilm Analysis of Retrieved Dental Implants after Different Peri-Implantitis Treatments.

The aim of the current study was to analyse the planktonic growth of Streptococcus mutans on the surfaces of three implants retrieved after three different peri-implantitis treatments. Three implants from a male patient with high levels of bone loss were treated by mechanical debridement, chemical decontamination, and implantoplasty. After 4 months of follow-up, the implants were removed. The growth and biofilm formation were measured by spectrophotometry (OD630 nm) and scanning electron microscopy (SEM), after 48 hours of incubation. Results showed an average of Streptococcus mutans planktonic growth over the implants of 0.21 nm (mechanical debridement), 0.16 nm (chemical decontamination), and 0.15 nm (implantoplasty). Data were analysed by ANOVA and Tukey's test (p < 0.05 for chemical decontamination and implantoplasty). Implantoplasty and chemical decontamination showed the lowest levels of planktonic growth, indicating a possible influence of the modification procedures on the titanium surface on the initial biofilm attachment.

Risk indicators for Peri-implantitis. A cross-sectional study with 916 implants.

OBJECTIVES: The aim of this study was to identify systemic and local risk indicators associated with peri-implantitis. MATERIAL AND METHODS: One hundred eighty-three patients treated with 916 osseointegrated titanium implants, in function for at least 1 year, were included in the present study. The implants were installed at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) - University of Sao Paulo (USP) - from 1998 to 2012. Factors related to patient's systemic conditions (heart disorders, hypertension, smoking habits, alcoholism, liver disorders, hepatitis, gastrointestinal disease, diabetes mellitus I and II, hyperthyroidism or hypothyroidism, radiation therapy, chemotherapy, menopause, osteoporosis, active periodontal disease, history of periodontal disease and bruxism), implant's characteristics (location, diameter, length, connection, shape, and antagonist), and clinical parameters (wear facets, periodontal status on the adjacent tooth, plaque accumulation on the adjacent tooth, modified plaque index, sulcus bleeding index, probing depth, bleeding on probing, width of keratinized tissue and marginal recession). RESULTS: An increased risk of 2.2 times for history of periodontal disease (PD), 3.6 times for cemented restorations compared to screw-retained prostheses, 2.4 times when wear facets were displayed on the prosthetic crown and 16.1 times for total rehabilitations when compared to single rehabilitations were found. Logistic regression analysis did not show any association between the implant's characteristics and peri-implantitis. CONCLUSIONS: A history of periodontal disease, cemented prostheses, presences of wear facets on the prosthetic crown and full mouth rehabilitations were identified as risk indicators for peri-implantitis. Implants' characteristics were not related to the presence of peri-implantitis.

As características protéticas das reabilitações implantossuportadas podem influenciar no sangramento a sondagem? Um estudo retrospectivo em 916 implantes / Does the prosthesis type over implant-supported rehabilitations can infl uence on bleeding on probing? A retrospective study with 916 dental implants

Objetivos: avaliar se a união entre implantes e/ou a presença de gengiva artifi cial infl uencia no sangramento a sondagem dos tecidos peri-implantares. Material e métodos: foram incluídos pacientes tratados com implantes de titânio (Implacil De Bortoli, São Paulo, Brasil), instalados no período de 1998 a 2012, na Universidade de São Paulo (USP). Os implantes foram examinados para avaliação do sangramento a sondagem, sendo divididos de acordo com o tipo de prótese: unitárias (n=167), parciais (n=522) e totais (n=227); e de acordo com a ausência (n=674) ou presença (n=242) de gengiva artifi cial. O teste estatístico com equação de estimativa generalizada foi usado para testar possíveis associações. Resultados: foram examinados 183 pacientes reabilitados com 916 implantes em função, pelo menos por um ano. Ao menos um ponto de sangramento a sondagem foi detectado em 85 (50,9%), 304 (58,2%) e 129 (56,8%) implantes das próteses unitárias, parciais e totais, respectivamente. Em relação à gengiva artificial, 378 (56,1%) dos implantes sem e 140 (57,9%) dos implantes com esta característica apresentaram sangramento a sondagem. Não foram verificadas diferenças significativas entre os grupos. Conclusão: a união dos implantes ou a presença de gengiva artificial não foram associadas com os resultados de sangramento a sondagem nos implantes em função.

Objective: to evaluate whether the prosthesis type (single, partial, complete) and/or the presence of artifi cial gingiva can influence on bleeding on probing of peri-implant tissues. Material and methods: patients treated with titanium dental implants (Implacil De Bortoli, São Paulo, Brazil) between 1998 to 2012 at the University of Sao Paulo (USP) were included in this study. The implants were divided according the following prosthodontic types: single (n=167), partial (n=522), and complete (n=277), and also regarding the presence (n=674) or absence (n=242) or artificial gingiva. The generalized estimating equation test was used to verify possible associations. Results: 183 patients and 916 implants at least 1 year in function were screened. At least one bleeding point was detected in 85 (50.9%), 304 (58.2%), and 129 (56.8%) implants for single, partial, and complete prostheses, respectively. 378 (56.1%) and 140 (57.9%) implant from groups without and with artificial gingiva presented bleeding on probing. No significant differences were identified among groups. Conclusion: the prosthesis design and/or artifi cial gingiva were not associated to bleeding on probing for dental implants in function.

Conditioned medium from fresh and demineralized bone enhances osteoclastogenesis in murine bone marrow cultures.

OBJECTIVES: Osteoclasts rapidly form on the surface of bone chips at augmentation sites. The underlying molecular mechanism, however, is unclear. Soluble factors released from bone chips in vitro have a robust impact on mesenchymal cell differentiation. Whether these soluble factors change the differentiation of hematopoietic cells into osteoclasts remains unknown. METHODS: Osteoclastogenesis, the formation of tartrate-resistant acid phosphatase-positive multinucleated cells, was studied with murine bone marrow cultures exposed to RANKL and M-CSF, and conditioned medium from fresh (BCM) and demineralized bone matrix (DCM). Histochemical staining, gene and protein expression, as well as viability assays were performed. RESULTS: This study shows that BCM had no impact on osteoclastogenesis. However, when BCM was heated to 85°C (BCMh), the number of tartrate-resistant acid phosphatase-positive multinucleated cells that developed in the presence of RANKL and M-CSF approximately doubled. In line with the histochemical observations, there was a trend that BCMh increased expression of osteoclast marker genes, in particular the transcription factor c-fos. The expression of c-fos was significantly reduced by the TGF-ß receptor I antagonist SB431542. DCM significantly stimulated osteoclastogenesis, independent of thermal processing. CONCLUSIONS: These data demonstrate that activated BCM by heat and DBM are able to stimulate osteoclastogenesis in vitro. These in vitro results support the notion that the resorption of autografts may be supported by as yet less defined paracrine mechanisms.

Tratamento cirúrgico de peri-implantite û relato de caso com 3 anos de acompanhamento / Surgical treatment for peri-implantitis û case report with 3-years follow-up

A peri-implantite (PI), doença peri-implantar causada pelo desequilíbrio entre a colonização bacteriana ao redor dos implantes e a resposta do hospedeiro, é caracterizada pela perda óssea e profundidade de sondagem aumentada com sangramento e/ou supuração. Este artigo relata um caso clínico de tratamento cirúrgico de peri-implantite em área estética da maxila e descreve o acompanhamento longitudinal da paciente, num período de 3 anos após cirurgia. A paciente compareceu ao Centro de Ensino e Pesquisa em Implantes Dentários (CEPID), no Departamento de Odontologia da Universidade Federal de Santa Catarina (UFSC) (Florianópolis/Brasil) para tratamento de doença peri-implantar na região do dente 11. Após diagnóstico de PI e tratamento não cirúrgico local, a terapia cirúrgica foi indicada. A coroa parafusada foi removida e o osso foi exposto através de uma incisão de espessura total. O tecido de granulação foi removido através de raspagem manual e a osteoplastia foi realizada ao redor do implante com cinzéis, de forma manual, buscando preservar ao máximo o osso próximo aos dentes vizinhos à região. Ácido cítrico a 3% foi aplicado com o intuito de promover a descontaminação química e, também, o condicionamento do osso para reinserção dos tecidos. O manejo da PI permanece sem um protocolo de tratamento definido, porém, as opções terapêuticas adotadas foram suficientes para limitar os danos da doença e restabelecer a saúde dos tecidos peri-implantares no caso apresentado...

Peri-implantitis (PI), a peri-implant disease caused by an imbalance between bacterial colonization around the implant and host response, is characterized by bone loss and increased probing depths with bleeding and/or suppuration. This paper reports a clinical case of surgical treatment of PI in aesthetic area of the maxilla and describes the longitudinal follow-up of the patient over a period of 3 years after surgery. The patient searched the Center of Education and Research on Dental Implants (CEPID), Department of Dentistry of the Federal University of Santa Catarina (UFSC) (Florianopolis/Brazil), for peri-implant disease treatment in the 11 tooth region. After diagnosis of PI and local non-surgical treatment, surgical therapy was indicated. The screwed crown was removed and the bone exposed through a full thickness incision. Granulation tissue was removed by manual curettage and osteoplasty was performed manually around the implant with chisels, as an attempt to preserve bone near the adjacent teeth. In order to promote chemical decontamination and bone conditioning for tissue reinsertion, citric acid at 3% was applied. PI management remains without a defined treatment protocol, however in the present case the adopted therapeutic options were sufficient to limit the damage of the disease and restore health of peri-implant tissues...

Bone Conditioned Medium: Preparation and Bioassay.

Autologous bone grafts are widely used in oral and maxillofacial surgery, orthopedics, and traumatology. Autologous bone grafts not only replace missing bone, they also support the complex process of bone regeneration. This favorable behavior of autografts is attributed to the three characteristics: osteoconductivity, osteogenicity, and osteoinductivity. However, there is another aspect: Bone grafts release a myriad of molecules, including growth factors, which can target mesenchymal cells involved in bone regeneration. The paracrine properties of bone grafts can be studied in vitro by the use of bone-conditioned medium (BCM). Here we present a protocol on how to prepare bone-conditioned medium from native pig cortical bone, and bone that underwent thermal processing or demineralization. Cells can be directly exposed to BCM or seeded onto biomaterials, such as collagen membranes, previously soaked with BCM. We give examples for in vitro bioassays with mesenchymal cells on the expression of TGF-ß regulated genes. The presented protocols should encourage to further reveal the paracrine effects of bone grafts during bone regeneration and open a path for translational research in the broad field of reconstructive surgery.

Avaliação das taxas de sucesso e sobrevivência de 497 implantes há cinco anos ou mais em função – estudo retrospectivo com 139 pacientes / Success and survival rates of 497 implants with at least 5 years of function – a retrospective study with 139 patients

Objetivo: avaliar as taxas de sucesso e sobrevivência de implantes há cinco anos ou mais em função. Material e métodos: pacientes tratados com implantes de titânio (Implacil De Bortoli, São Paulo, Brasil) na Fundecto (USP), no período de 1998 a 2008 foram incluídos neste estudo. Os implantes foram classificados individualmente, de acordo com um rigoroso critério de sucesso. Também foram levados em consideração o formato e o tipo de plataforma dos implantes. Resultados: a taxa de sobrevivência dos implantes tipo hexágono externo (n=357) e interno (n=140) foi de 99,4% e 99,3%, respectivamente. Já com relação aos implantes cônicos (n=88) e cilíndricos (n=409), a taxa de sobrevivência foi de 100% e 99,3%, respectivamente. A taxa de sucesso para implantes tipo hexágono externo e interno foi de 90,8% e 93,6%, respectivamente. Implantes cônicos obtiveram 90,9%, enquanto que implantes cilíndricos apresentaram 91,7% de taxa de sucesso. Conclusão: de acordo com o presente estudo, a taxa geral de sobrevivência dos implantes foi de 99,4%, enquanto a taxa de sucesso foi de 91,5%.

Objective: to assess success and survival rates from implants in function for five or more years. Material and methods: patients treated with osseointegrated implants (Implacil De Bortoli, Sao Paulo, Brazil) at Fundecto (USP), from 1998 to 2008, were included in this study. Implants were individually classified using strict success criteria. For further analysis, data were obtained regarding implant’s platform and implant’s macro design. Results: survival rates for external (n=357) and internal hexagon implants (n=140) were 99,4% and 99,3%, respectively. Regarding tapered (n=88) and cylindrical implants (n=409), survival rates were 100% and 99,3%, respectively. Success rates for external and internal hexagon implants were 90,8% and 93,6%. Tapered implants had 90,9% and cylindrical implants presented 91,7% of success rates. Conclusion: according to this retrospective study, the overall survival rate was 99,4% and the overall success rate was 91,5%.

Extensão da reabilitação protética implantossuportada e a relação com o índice de placa modificado / The relationship between the extent of implant-supported posthetic rehabilitation with the modified plaque index

Objetivo: avaliar retrospectivamente a relação da extensão da reabilitação protética com o índice de placa modificado. Material e métodos: pacientes tratados com implantes (Implacil De Bortoli, São Paulo, Brasil) na Fundecto (USP), no período de 1998 a 2012, foram incluídos neste estudo. Três grupos foram formados, de acordo com a extensão da reabilitação protética (unitária, parcial ou total). O parâmetro clínico índice de placa modificado foi utilizado para comparação entre os grupos. Para análise estatística, a equação de estimativa generalizada (GEE) foi utilizada. Resultados: foram examinados 183 pacientes, reabilitados com 916 implantes em função por pelo menos um ano. A taxa de sobrevivência dos implantes foi de 98,28%. Observou-se que havia placa bacteriana abundante (escore 3) ao redor de 30% (n=68) dos componentes protéticos de implantes pilares de reabilitações totais fixas sobre implantes. Já para os grupos de reabilitações parciais e unitárias, os valores foram de 3,6% (n=19) e 0,6% (n=1), respectivamente. Conclusão: componentes protéticos de implantes pilares de próteses totais fixas implantossuportadas apresentaram maior acúmulo de placa bacteriana abundante em sua superfície.

Objective: to retrospectively evaluate the relationship between the extent of prosthetic rehabilitation with modified plaque index. Material and methods: patients treated with osseointegrated implants (Implacil De Bortoli, Sao Paulo, Brazil) at Fundecto (USP) from 1998 to 2012 were included in this study. Three groups were formed according to the extent of prosthetic rehabilitation (single, partial or total). The modified plaque index was used for comparison among groups. Generalized estimating (GEE) equation was used for statistical evaluation. Results: 183 patients with 916 implants with at least 1 year in function were examined. The implant survival rate was 98.28%. Abundant soft matter (score 3) around 30% (n=68) of the prosthetic abutments from implants supporting total rehabilitations was seen. For the groups that comprised partial and single rehabilitations, the values were 3.6% (n=19) and 0.6% (n=1), respectively. Conclusion: prosthetic abutments from implants supporting total rehabilitations presented the greatest values for abundant bacterial plaque accumulation.

Does the number of implants have any relation with peri-implant disease?

OBJECTIVE: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. MATERIAL AND METHODS: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. RESULTS: Clinical parameters were compared between groups using Student's t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 - 19 (20.43%)--compared with G2 - 26 (38.24%)--showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). CONCLUSION: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis.

Avaliação da experiência e do grau de satisfação de pacientes tratados com próteses totais fixas sobre implantes / Assessing the degree of experience and satisfaction of patients treated with implant-supported complete dentures

Introdução: com os implantes dentários consegue-se resolver a falta de estabilidade de próteses totais convencionais, mas pouco se conhece quanto à satisfação dos pacientes tratados com próteses totais implantos suportadas. Objetivo: identificar a experiência e o grau de satisfação de pacientes tratados com próteses totais fixas sobre implantes. Métodos: sessenta e seis pacientes foram entrevistados por um único pesquisador. Questionou-se os pacientes sobre a experiência de algo desagradável durante o tratamento e a recomendação do tratamento para outras pessoas. Também foi utilizada uma Escala Visual Analógica, para medir o grau de satisfação dos pacientes em relação à estabilidade, estética, conforto, fonética, mastigação e facilidade de higienizar suas próteses. Os dados obtidos foram analisados por meio da correlação de Spearman (P < 0,05) e submetidos a uma regressão múltipla. Resultados: dos pacientes entrevistados, 22,7% relataram ter experimentado algo desconfortável ou desagradável durante o tratamento e todos afirmaram que recomendariam o tratamento. O grau de satisfação dos pacientes foi alto, alcançando uma média de 97,7%. Os itens que obtiveram significância estatística foram a estabilidade, a fonética e o conforto, juntamente com a recomendação do tratamento. Conclusão: identificou-se que o grau de satisfação dos pacientes tratados com próteses totais fixas sobre implantes é alto, devido, principalmente, à estabilidade, seguida da fonética e do conforto dessas próteses.

Introduction: Dental implants can solve the issue of lack of stability of conventional dentures, but little is known about patients’ satisfaction regarding implant-supported completedenture. Objective: Identify the experience and the degree of satisfaction of patients treated with implant-supported complete denture. Material and Methods: Sixty-six patients were interviewed by one single investigator. Patients were questioned about potential unpleasant experiences during treatment and whether treatment should be recommended to others. A Visual Analogue Scale was also used to assess the degree of patients’ satisfaction in terms of stability, esthetics, comfort, speech, and ease of sanitization. Data were analyzed by Spearman correlation (P < 0.05) and submitted to multiple regression. Results: Of the patients interviewed, 22.7% reported experiencingsomething unpleasant or uncomfortable during treatment, and all of them stated that they would recommend it. The degree of patients’ satisfaction was high, reaching an average of 97.7%. Thefollowing items were statistically relevant: stability, speech and comfort, as well as treatment recommendation.Conclusion: The degree of patients’ satisfaction proves high, mainly due to stability, followed by speech and comfort provided by implant-supported complete denture.

Does the number of implants have any relation with peri-implant disease?

Objective: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. Material and Methods: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. Results: Clinical parameters were compared between groups using Student’s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 – 19 (20.43%) – compared with G2 – 26 (38.24%) – showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). Conclusion: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis. .

Prevalence of peri-implantitis in patients with implant-supported fixed prostheses.

OBJECTIVE: The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care. METHOD AND MATERIALS: A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants. RESULTS: From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses. CONCLUSION: It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm.

Relação entre o índice de placa modificado e a prevalência das doenças peri-implantares ao redor de implantes osseointegrados / Relationship between modified plaque index and the prevalence of peri-implants diseases around osseointegrated implants

O objetivo deste artigo é avaliar a relação entre o índice de placa modificado (IPM) e a prevalência das doenças peri-implantares ao redor de implantes osseointegrados. Foram examinados 172 pacientes (627 implantes) reabilitados com próteses implantossuportadas. Os pacientes foram divididos em dois grupos de acordo com o índice de placa modificado: G1) presença de biofilme bacteriano (escore 1, 2 ou 3) e G2) ausência de biofilme bacteriano (escore 0). O índice de placa modificado foi classificado como presente (escore 1, 2 ou 3) ou ausente (escore 0). A presença de placa bacteriana teve relação direta com a prevalência da mucosite (p< 0.05). Já com relação à peri-implantite, os resultados obtidos não apresentaram relevância estatística (p>0.05). Conclui-se que implantes com índice de placa modificado (IPM) 0 possuem menor propensão ao desenvolvimento da mucosite peri-implantar.

The aim of this paper is to evaluate the relationship between modified plaque index (MPI) and the prevalence of peri-implants diseases around osseointegrated implants. There were examined 172 patients (627 implants) rehabilitated with implant-supported prostheses. Patients were divided into two groups regarding modified plaque index: G1) presence of bacterial plaque (score 1, 2 or 3) and G2) absence of bacterial plaque (score 0). Modified plaque index (mPI) was classified as present (score 1, 2 or 3) or absent (score 0). The presence of bacterial plaque had direct relation with the prevalence of mucositis (p< 0.05). Considering peri-implantitis, the obtained results have not shown statistical relevance (p>0.05). It can be concluded that implants with MPI zero have less susceptibility to the development of periimplant mucositis.

Relação entre extensão do cantilever e complicações biológicas em implantes distais de próteses totais fixas / Relation between cantilever extension and biological complication of distal implants in full fixed prostheses

Este estudo tem como objetivo avaliar a relação entre a extensão do cantilever em próteses totais fixas e a presença de peri-implantite e perda óssea peri-implantar em implantes distais. A amostra consistiu em 32 pacientes portadores de prótese total fixa implantossuportada instalada há, pelo menos, 1 ano. Os implantes foram divididos em dois grupos conforme a extensão do cantilever: G1) ≤10 mm (43 implantes) e G2) ≤10 mm (21 implantes). Os dados coletados inclu¡ram parâmetros clínicos, tais como profundidade de sondagem (PS), sangramento … sondagem (SS) e perda óssea (PO). Esses dados foram agrupados para cada implante a fim de conduzir o diagnóstico de peri-implantite e perda óssea. Não houve diferença estatística (p<0,05) para os parâmetros clínicos avaliados ou para a presença da doença entre G1 – 8 (18,60%) com peri-implantite e 32 (74,42%) implantes com perda óssea e G2 – 3 (14,29%) implantes com peri-implantite e 19 (90,48%) implantes com perda óssea. Conclui-se que a extensão do cantilever não foi relacionada com peri-implantite e perda óssea nos implantes distais

This study aimed to evaluate the relationship between cantilever extension and the prevalence of peri-implantitis and peri-implant bone loss around the distal implants of full fixed prostheses. The sample consisted of 32 patients using full fixed prostheses for at least 1 year. Implants were divided into two groups regarding cantilever extension: G1 ≤ 10 mm (43 implants) and G2 >10 mm (21 implants). Data collection included clinical parameters, like probing depth (PD), bleeding on probing (BOP), and bone loss (BL). All the data were pooled for each group in order to conduct to diagnosis of peri-implantitis and bone loss. As a result, there was no statistical relevance (p<0.05) for the clinical parameters previously evaluated nor for the presence of the disease between G1 – 8 subjects (18.60%) with peri-implantitis and 32 implants (74.42%) with bone loss, and G2 – 3 subjects (14.29%) with peri-implantitis and 19 implants (90.48%) with bone loss. It was concluded that the cantilever extension in full fixed prostheses was not related with peri-implantitis nor with bone loss in the distal implants

Existe associação entre pilares angulados e doenças peri-implantares? Estudo clínico transversal / Is there association between angulated abutments and peri-implant diseases? A clinical cross-sectional study

Objetivos: avaliar a prevalência de mucosite e peri-implantite em implantes restaurados compilares retos ou angulados. Material e métodos: foram avaliados 291 implantes, em função por pelo menos um ano, instalados em 56 pacientes. Dois grupos foram formados de acordo com o pilar instalado na reabilitação protética: reto (G1) e angulado (G2). A coleta de dados incluiu profundidade de sondagem (PS), sangramento ou supuração (SS) a sondagem e perda radiográfica (PO). Os dados clínicos e radiográficos foram agrupados para conduzir ao diagnóstico de saudável, mucosite ou peri-implantite. Resultados: G1 apresentou 141 implantes saudáveis (56,18%), 89 implantes com mucosite (35,46%) e 21 implantes com peri-implantite (8,37%). G2 apresentou 12 implantes saudáveis (30%), 23 implantes com mucosite (57,5%) e cinco com peri-implantite (12,5%). Não houve diferença estatística entre os grupos. Conclusão: os achados clínicos não mostraram associação da prevalência das doenças peri-implantares com pilares retos ou angulados.