O condicionamento de tecido peri-implantar na reabilitação estética de próteses unitárias sobre implantes: relato de caso clínico / Peri-implant tissue conditioning in the esthetic rehabilitation of unitary prostheses on implants: Clinical case report / Acondicionamiento del tejido periimplantario en la rehabilitación estética de prótesis unitarias sobre implantes: Informe de caso clínico

Introdução:A reabilitação protética implantosuportada de espaços edêntulos na região do sorriso é um desafio para o cirurgião-dentista. Para obtenção da estética em próteses unitárias sobre implante é necessário considerar aspectos como o correto posicionamento do implante e sua harmonia com os tecidos moles e duros. Objetivo:relatar o resultado estético e funcional de um tratamento com auxílio de coroa provisória associada ao condicionamento gengival na reabilitação final com coroa unitária implantossuportada. Relato de caso clínico: Paciente MJFA, 36 anos, sexo feminino, compareceu à clínica de Prótese Dentária do Departamento de Odontologia/UFRN queixando-se de trauma dentário com perda do elemento dentário 15 e necessidade de "ficar com sorriso mais bonito". Após instalação de implante com conexão cônica e período de osseointegração, foi realizada a confecção da coroa provisória sobre implante e iniciada sessões de condicionamento gengival por meio de acréscimos com resina acrílica, utilizando a técnica de pressão gradual sob a margem gengival. Observou-se uma melhora no tecido periimplantar e um perfil de emergência adequado. O caso possui proservação de 3 anos. Conclusões:a realização de condicionamento gengival previamente a prótese final é uma etapa importante para alcançar umareabilitação com característicasestéticas e funcionais semelhantes à de dentes naturais (AU).

Introduction:Implant-supported prosthetic rehabilitation of edentulous spaces in the smile areais a challenge for dental surgeons. To achieve pleasing esthetics in single implant prostheses it is necessary to consider aspects such as the correct positioning of the implant and its harmony with the soft and hard tissues.Objective:to report the esthetic and functional results of a treatment with the aid of a provisional crown associated with gingival conditioning in the final rehabilitation with a single implant-supported crown.Clinical case report:Patient MJFA, 36 years old, female, attended the Prosthodonticsclinic of the Department of Dentistry/UFRN complaining of dental trauma with loss of tooth 15 and the need to "havea more beautiful smile". Afterinstalling an implant with a conical connection and a period of osseointegration, a temporary crown was made on the implant and gingival conditioning sessions were initiatedby means of acrylic resin augmentations, using the gradual pressure technique under the gingival margin. An improvement in the peri-implant tissue and an adequate emergenceprofile were observed. The case has a 3-year follow-up period.Conclusions:performing gingival conditioning prior to the final prosthesis is an important step in achieving rehabilitation with esthetic and functional characteristics similar to those of natural teeth (AU).

Introducción: La rehabilitación protésica implantosoportada de espacios edéntulos en el áreade la sonrisa es un desafío para el cirujano dentista. Para conseguir una buena estética en las prótesis unitarias sobre implanteses necesario tener en cuentaaspectos como el posicionamiento correctodel implante y su armonía con los tejidos blandos y duros.Objetivo: informar losresultadosestéticosy funcionalesde un tratamiento con ayuda de coronas provisionales asociado al acondicionamiento gingival en la rehabilitación final con corona única implantosoportada.Relato de caso clínico: Lapaciente MJFA, 36 años, sexo femenino, se dirigióa la clínica de Prostodonciadel Departamento de Odontología/UFRN quejándose de un traumatismodental con pérdida del diente 15 y de la necesidad de "tener una sonrisa más bonita". Después de la colocación de un implante con conexión cónica y de un período de osteointegración, se realizó una corona provisional sobre el implante y se iniciaron sesiones de acondicionamiento gingival con aumentos de resina acrílica, utilizando la técnica de presión gradual bajo el margen gingival. Se observó una mejora del tejido periimplantario y un perfil de emergencia adecuado. El caso tiene un seguimiento de 3 años. Conclusiones: el acondicionamiento gingival previo a la prótesis definitiva es una etapaimportante para conseguiruna rehabilitación con características estéticas y funcionales similares a las de los dientes naturales (AU).

Comportamento dos tecidos peri-implantares pós- reabilitação unitária em região estética comparando pilares protéticos pré-fabricados versus personalizados / Behavior of peri-implant tissues after unitary rehabilitation in the aesthetic region comparing prefabricated versus customized prosthetic abutments

A estética e estabilidade dos tecidos moles e ósseo ao redor do implante é um componente crítico para o sucesso do implante em longo prazo e pode ser influenciado por fatores como os tipos de conexões protéticas. OBJETIVO: Comparar o comportamento do tecido peri-implantar em reabilitação com coroas implantossuportadas cimentadas na região estética usando um pilar protético pré-fabricado em titânio (GT) e um pilar protético personalizado em zircônia (GZ). METODOLOGIA: Neste estudo longitudinal do tipo ensaio clínico controlado, cego e não randomizado, 30 coroas cimentadas sobre implantes dentários unitários em região estética anterior foram alocados sequencialmente: 15 reabilitados sobre um sistema de implante com pilar protético pré-fabricado em titânio (GT) e 15 sobre um sistema de implantes com pilar protético personalizado em zircônia (GZ). O comportamento do tecido peri-implantar foi avaliado em T0 (início do condicionamento tecidual), T1 (fim do condicionamento tecidual), T2 (7 dias após cimentação final), T3 (6 meses após cimentação final). Índice de Placa Visível (IPV), Índice de Sangramento Gengival (ISG), Sangramento a sondagem (SS), Profundidade de Sondagem (PS), Relação Altura/Largura da papila interdental (AP/LP), Faixa de Mucosa Ceratinizada (MC), Espessura gengival (EG), Fenótipo periodontal (FP), Recessão Gengival (RG), distância radiográfica da crista óssea para o ponto de contato e Pink Esthetic Score (PES) foram avaliados. A análise dos dados foi realizada utilizando os seguintes testes estatísticos: Friedman, Mann-Whitney e Qui- quadrado/Exato de Fisher, com nível de significância de 5%. RESULTADOS: Não houve diferenças estatísticas significativas entre os grupos para nenhum dos parâmetros clínicos periodontais nos tempos avaliados (p>0,05). Entretanto, a análise intragrupo mostrou uma redução estatística no IPV e ISG entre T1 e T2 apenas para o GZ (p<0,05). Houve diminuição significativa entre os tempos T0 e T3 para o parâmetro de EG (1,67 mm - 1,47 mm no GT; 1,70 mm -1,47mm no GZ) e aumento da razão AP/LP (0,56 ­ 0,80 no GT; 0,70-0,83 no GZ) em ambos os grupos (p<;0.001). O PES também aumentou significativamente para ambos os grupos (9 ­ 12 no GT; 7 ­ 12 no GZ) de T0 para T1, mantendo-se elevado nos demais tempos analisados. CONLUSÃO: Os resultados mostraram que os pilares protéticos utilizados não impactaram em diferenças nas variáveis clínicas e estética relacionadas ao comportamento dos tecidos periimplantares ao longo do tempo. Sendo assim, a decisão pela seleção dos componentes para a reabilitação em região estética poderia se basear em aspectos como o custo, fluxo e tempo de trabalho (AU).

The esthetics and stability of the soft tissue and bone around the implant is a critical component to the long-term success of the implant and can be influenced by factors such as the type of prosthetic connections. OBJECTIVE: To compare the behavior of the periimplant tissue of single implant-supported crowns in the anterior aesthetic area using prefabricated titanium prosthetic abutments (GT) and customized zirconia prosthetic abutments (GZ). METHODOLOGY: In this controlled, blinded, non- randomized clinical trial, 30 single cemented crown over anterior implants were sequentially allocated: 15 implants rehabilitated on implant system with a prefabricated titanium prosthetic abutment (GT) and 15 on implant system with customized zirconia prosthetic abutment (GZ). The behavior of the peri- implant tissue was evaluated at T0 (beginning of tissue conditioning), T1 (end of tissue conditioning), T2 (7 days after final cementation), T3 (6 months after final cementation). Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), Bleeding on Probing (BoP), Probing Depth (PD), Interdental Papilla Height/Width Ratio (PH/PW), Keratinized Mucosa Width (KM), Gingival Thickness (PT), Periodontal Phenotype (PF), Gingival Recession (GR), radiographic distance from the bone crest to the contact point and Pink Esthetic Score (PES) were registered. The results were analyzed with the following statistical tests: Friedman, Mann-Whitney and Chi- square/Fisher; Exact test with a significance level of 5%. RESULTS: No statistically significant differences were observed between groups for any of the clinical parameters in any, (p>0.05). However, intragroup analysis showed a statistical reduction in VPI between T1 and T2 only for GZ (p< 0.05). There was a significant decrease between T0 and T3 for GT (1.67 mm - 1.47 mm in GT, and 1.70 mm -1.47 mm in GZ) and increase in the ratio PH/PW (0.56 - 0.80 in GT and 0.70- 0.83 in GZ) in both groups (p<0.0001). PES also increased significantly for both groups (9 ­ 12 in GT and 7 ­ 12 in GZ) from T0 to T1 and remained high in the other periods. CONCLUSION: The results showed that the prosthetic abutments used did not impact differences in clinical and aesthetic variables related to the behavior of peri-implant tissues during the study. Therefore, the decision to select components an aesthetic area should be based on aspects such as cost, workflow and timing (AU).

Lemongrass-Incorporated Tissue Conditioner with Adjustable Inhibitory Effect Against Candida albicans: An In Vitro Study.

PURPOSE: To develop and assess lemongrass-incorporated tissue conditioners (LG-TCs) with a potent and long-lasting inhibitory effect against Candida albicans cultures to control the accumulation of fungi. MATERIALS AND METHODS: LG essential oil with concentrations of 7.17%, 3.56%, 1.77%, and 0.89% (w/w) or nystatin were mixed with the liquid part of the TC before being added to the powder part to form 486 TC samples of 6-mm diameter x 2-mm thickness (n = 81 samples for each group of LG-/nystatin-incorporated or unmodified TCs). After being immersed in 37°C water for 1, 2, 3, 5, 7, 9, 12, or 14 days, these TC samples were removed, blotted with sterile filter paper, and then exposed to fungal suspension (1 × 105 CFU/mL). The TC samples were evaluated for their capacity to inhibit fungal growth by 99.9%. RESULTS: The anti-Candida effect of the unmodified TCs was reduced significantly after the samples were immersed in water. Interestingly, a long-lasting anti-Candida effect was observed in the TCs incorporated with LG essential oil. After being immersed in water for at least 14 days, the TCs with 1.77% LG oil were still able to inhibit fungal growth substantially. In contrast, a shorter-lasting (5 days) anti-Candida effect was found in the TCs with 0.89% (w/w) LG oil. Additionally, the TCs incorporated with LG oil at concentrations of 3.56% (w/w) or more inhibited the growth of the fungus by 99.99%, and its anti-Candida effect lasted for 14 days. CONCLUSION: LG-TCs showed an impressive and long-lasting inhibitory effect against C. albicans.

Characterization and Physical and Biological Properties of Tissue Conditioner Incorporated with Carum copticum L.

AIM: One of the main problems in dentistry is the injury caused by the long-term application of an ill-fitting denture. The existence of multiple microorganisms along with the susceptibility of the tissue conditioners to colonize them can lead to denture stomatitis. This study is aimed at developing a tissue conditioner incorporated with Carum copticum L. (C. copticum L.) for the effective treatment of these injuries. MATERIALS AND METHODS: The Carum copticum L. essential oil composition was determined by gas chromatography-mass (GC-mass) spectrometry. The antimicrobial activity of the essential oil against the standard strains of bacterial and fungal species was determined by broth microdilution methods as suggested by the Clinical and Laboratory Standards Institute (CLSI). The physical and chemical properties of the prepared tissue conditioner were investigated by viscoelasticity, FTIR assays, and the release study performed. Furthermore, the antibiofilm activity of the Carum copticum L. essential oil-loaded tissue conditioner was evaluated by using the XTT reduction assay and scanning electron microscopy (SEM). RESULTS: The main component of the essential oil is thymol, which possesses high antimicrobial activity. The broth microdilution assay showed that the essential oil has broad activity as the minimum inhibitory concentration was in the range of 32-128 µg mL-1. The viscoelasticity test showed that the essential oil significantly diminished the viscoelastic modulus on the first day. The FTIR test showed that Carum copticum L. essential oil was preserved as an independent component in the tissue conditioner. The release study showed that the essential oil was released in 3 days following a sustained release and with an ultimate cumulative release of 81%. Finally, the Carum copticum L. essential oil exhibited significant activity in the inhibition of microbial biofilm formation in a dose-dependent manner. Indeed, the lowest and highest amounts of biofilm formation on the tissue conditioner disks are exhibited in the Streptococcus salivarius and Candida albicans by up to 22.4% and 71.4% at the 64 µg mL-1 concentration of C. copticum L. with a statistically significant difference (P < 0.05). CONCLUSION: The obtained results showed that the Carum copticum L. essential oil-loaded tissue conditioner possessed suitable physical, biological, and release properties for use as a novel treatment for denture stomatitis.

Influência do intermediário protético sobre a estética e a satisfação de pacientes reabilitados com próteses unitárias provisórias sobre implantes: um ensaio clínico / Influence of the prosthetic intermediary on the aesthetics and satisfaction of patients rehabilitated with temporary single prostheses on implants: a clinical trial

Objetivos: Avaliar a influência do tipo de intermediário protético e do condicionamento tecidual sobre a estética de coroas unitárias provisórias sobre implantes instalados na região do sorriso. Material e Métodos: Trinta implantes foram alocados sequencialmente: 15 foram reabilitados provisoriamente sobre um intermediário protético pré-fabricado em titânio (GT) e 15 sobre um intermediário protético preparável provisório (GP). Em ambos os grupos foi realizado condicionamento tecidual (CT) pela técnica não-cirúrgica de pressão gradual e a estética periimplantar foi avaliada antes e após esse processo, por meio do Pink Esthetic Score (PES). O PES também foi aplicado no dente homólogo à reabilitação. A satisfação estética foi analisada pela escala visual analógica (EVA) após o procedimento de CT. Dados clínicos da mucosa gengival também foram coletados. Resultados: 22 pacientes, totalizando 24 implantes, concluíram o estudo, sendo 14 implantes do GT e 10 do GP. A estética periimplantar antes e após o CT, bem como a satisfação dos pacientes foi semelhante entre os grupos, p>0,05. Diferenças significativas foram encontradas para os valores de PES antes e após o CT, e para a comparação com o dente homólogo em ambos os grupos, p<0,05. O processo de condicionamento tecidual não foi influenciado pelo tempo de implantação, tempo de carga e fenótipo periimplantar, p>0,05. Conclusão: O intermediário protético não influenciou nem no processo de condicionamento tecidual e nem na satisfação dos pacientes. A etapa de condicionamento tecidual foi capaz de melhorar os resultados estéticos periimplantares, entretanto, a estética gengival dos dentes naturais homólogos apresenta resultados significativamente superior (AU).

Objective: To evaluate the influence of prosthetic abutment and tissue conditioning on the esthetics of single implants' temporary crowns. Materials and Methods: Thirty implants were allocated sequentially: fifteen implants were provisionally rehabilitated with a titanium prefabricated prosthetic abutment (GT) and 15 with a provisional preparable prosthetic abutment (GP). In both groups, tissue conditioning (TC) was performed by the non-surgical gradual pressure technique and peri-implant aesthetics were assessed before and after this process, using the Pink Esthetic Score (PES). PES was also applied on homologous tooth. Aesthetic satisfaction was assessed using the visual analog scale (EVA) after the conditioning process. Clinical data on the gingival mucosa were also collected. Results: 22 patients (24 implants) completed this study, 14 implants from GT and 10 from GP. Peri-implant aesthetics before and after TC, as well as patient satisfaction was similar between groups, p> 0.05. Significant differences were found for PES values before and after TC, and for comparison with the homologous tooth in both groups, p <0.05. The TC process seems not be influenced by the implantation time, loading time and peri-implant biotype, p> 0.05. Conclusion: The prosthetic abutment seems not influence neither the TC process nor patient satisfaction. The TC step is able to improve the peri-implant aesthetic results, however, the gingival aesthetics of the natural teeth is still significantly greater (AU).

Effect of Different Immediate Implant Loading Protocols on Peri-implant Soft Tissue Health / Efeito de diferentes protocolos de implante com carga imediata no tecido mole peri-implantar

Objectives: This clinical study was conducted to evaluate the effect of immediate loading on peri-implant soft tissue health using three protocols: I) Immediate functional loading using polymer infiltrated ceramic (PIC) material (IFLV). II) Immediate functional loading using polymethyl methacrylate (PMMA) followed by delayed functional loading using PIC material (IFLP). III) Immediate non-functional loading using PMMA followed by delayed functional loading using PIC material (INFLP). Material & Methods: 30 Implants were placed in the upper premolar area and divided randomly according to the immediate loading protocol. In the control group (INFLP), CAD/CAM PMMA crowns were placed out of occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns in functional occlusion. For (IFLV) group, CAD/CAM VITA ENAMIC crowns were immediately loaded in functional occlusion; while in (IFLP) group, CAD/CAM PMMA crowns were placed in functional occlusion for 3 months, and then replaced by CAD/CAM VITA ENAMIC crowns. Modified pink esthetic score (MPES) and probing depth were used for evaluation of peri-implant soft tissue at base line and follow up periods. Results: INFLP showed higher MPES results compared to IFLV and IFLP. Moreover, the INFLP probing depth at 3 months showed higher results compared to the other groups. Conclusions: Immediate non-functional loading showed the best outcomes. However, peri-implant soft tissue health of the immediate functional loading using the PIC crown material was clinically acceptable (AU)

Objetivo: Este estudo clínico foi realizado para avaliar o efeito da carga imediata na saúde do tecido mole peri-implantar usando três protocolos: I) Carga imediata funcional usando material de cerâmica infiltrada com polímero (PIC) (IFLV). II) Carga imediata funcional usando polimetilmetacrilato(PMMA) seguida por carga funcional retardada usando material PIC (IFLP). III) Carga imediata não funcional usando PMMA seguida por carga funcional retardada usando material PIC (INFLP). Material e Métodos: 30 implantes foram colocados na área dos pré-molares superiores e divididos aleatoriamente de acordo com o protocolo de carga imediata. No grupo controle (INFLP), as coroas CAD / CAM PMMA foram colocadas sem oclusão por 3 meses, e então substituídas pelas coroas CAD / CAM VITA ENAMIC na oclusão funcional. Para o grupo (IFLV), as coroas CAD / CAM VITA ENAMIC foram carregadas imediatamente em oclusão funcional; enquanto no grupo (IFLP), as coroas CAD / CAM PMMA foram colocadas em oclusão funcional por 3 meses, e então substituídas por coroas CAD / CAM VITA ENAMIC. O escore da estética rosa modificado (PESM) e a profundidade de sondagem foram realizados para avaliação do tecido mole peri-implantar no início e nos períodos de acompanhamento. Resultados: INFLP apresentou resultados de PESM superiores em comparação com IFLV e IFLP. Além disso, a profundidade de sondagem INFLP em 3 meses apresentou resultados superiores em comparação com os outros grupos. Conclusões: A carga imediata não funcional apresentou os melhores resultados. No entanto, a integridade do tecido mole peri-implantar da carga imediata funcional usando o material da coroa PIC foi clinicamente aceitável. (AU)

Biomimetic Conditioning of Human Dentin Using Citric Acid.

INTRODUCTION: In carious teeth, transforming growth factor beta 1 (TGF-ß1) is released from the dentin matrix and possibly activated in an acidic environment. Conversely, EDTA solutions with a neutral to slightly alkaline pH are used in clinics to promote cell homing in regenerative endodontic procedures. We hypothesized that citric acid (CA) might be more beneficial. METHODS: TGF-ß1 release from human dentin disks conditioned with either 10% CA (pH = 2) or 17% EDTA (pH = 8) and the behavior of human stem cells toward such pretreated dentin were studied. The protein concentration in conditioning solutions after 10 minutes of dentin exposure was determined using a pH-independent slot blot technique. RESULTS: There was a 5-fold higher concentration of the target protein in CA (382 ± 30 ng/disk) compared with EDTA (66 ± 3 ng/disk, P < .005). Using confocal laser scanning microscopy on immunofluorescent-labeled disks, we identified a high density of TGF-ß1 in peritubular dentin after CA treatment. A migration assay showed that CA conditioning attracted significantly more stem cells toward the dentin after 24 hours compared with EDTA (P < .05) or phosphate-buffered saline (P < .005). To investigate whether the cell response to these dentin surfaces could be affected by different pretreatments, we cultured stem cells on conditioned dentin disks and found that CA had a significantly (P < .05) better effect than EDTA on cell attachment and cell survival. CONCLUSIONS: CA conditioning could be useful and may have significant benefits over current treatments.

Changes in deciduous and permanent dentinal tubules diameter after several conditioning protocols: In vitro study.

Innovators conditioning protocols are emerged in permanent dentin, however for deciduous dentin the information is limited; the aim of this study was to evaluate in vitro diameter of deciduous and permanent dentinal tubules after several conditioning protocols. Eighty dentin samples were distributed in sixteen groups (n = 5 p/g) and dentin surface was conditioned as follow: G1D/G1P acid etching; G2D/G2P, self-etch adhesive; G3D/G3P, G4D/G4P, Er: YAG laser irradiation at 200 mJ-25.5 J/cm2 and 300 mJ-38.2 J/cm2 , at 10 Hz under water spray respectively; G5D/G5P, G6D/G6P, G7D/G7P, and G8D/G8P were irradiated under the same energy densities followed phosphoric acid or self-etch adhesive conditioning. The sample dentin of deciduous and permanent teeth was analyzed with scanning electron microscopy and tubule diameter was evaluated by Image Tools Scandium program. Data were subjected to one-way analysis ANOVA to compare among groups with a level of significance at p ≤ .05. For deciduous dentin, diameters were from 1.52 ± 0.32 µm in G3D to 3.88 ± 0.37 µm in G1D; narrowest and widest diameter, respectively (p < .000). While permanent dentin tubules exhibited diameters from 1.16 ± 0.16/1.19 ± 0.12 µm in G7P/G8P to 2.76 ± 0.28 µm in G6P; narrowest and widest diameter, respectively (p < .000). All dentin conditioning protocols produced more open dentin tubules (diameter size) in deciduous dentin than permanent, specific conditioning protocols are required for each tissue (deciduous or permanent dentin), since same protocol produced stronger effects on primary dentin, which is important for dental clinical success in children and adolescents.

Antifungal Effect of a Dental Tissue Conditioner Containing Nystatin-Loaded Alginate Microparticles.

In this in vitro study, nystatin-alginate microparticles were successfully fabricated to control the release of nystatin from a commercial dental tissue conditioner. These nystatin-alginate microparticles were spherical and had a slightly rough surface. The microparticles incorporated into the tissue conditioner were distributed homogeneously throughout the tissue conditioner matrix. The incorporation of the microparticles did not deteriorate the mechanical properties of the original material. The agar diffusion test results showed that the tissue conditioner containing the microparticles had a good antifungal effect against Candida albicans. The nystatin-alginate microparticles efficiently controlled the release of nystatin from the tissue conditioner matrix over the experimental period of 14 days. Moreover, the nystatin-alginate microparticles incorporated in the tissue conditioner showed effective antifungal function even at lower concentrations of nystatin. The current study suggests that the tissue conditioner containing the nystatin-alginate microparticle carrier system has potential as an effective antifungal material.

Effect of incorporation of surface pre-reacted glass ionomer filler in tissue conditioner on the inhibition of Candida albicans adhesion.

We investigated the effects of incorporation of surface pre-reacted glass ionomer (S-PRG) filler in tissue conditioner (TC) on Candida albicans adhesion. We prepared specimens containing 0, 5, 10, or 20 wt% of S-PRG filler, and measured the amount of C. albicans on the surface using a colony forming unit (CFU) assay and scanning electron microscopic images. In addition, we measured the consistency, penetration depth, and surface roughness (Ra). CFU values for 10 and 20 wt% were significantly lower than that for the control (p<0.05). Hyphal density on the surface was greater in the control. The 10 and 20 wt% specimens showed significantly higher consistency and Ra, lower penetration depth ratio than control (p<0.05). These results suggest that incorporation of S-PRG filler may reduce C. albicans adhesion onto TC surface; however, the optimal amount of filler is dictated by the influence of filler incorporation on mechanical and surface characters of TC.

Antifungal and Mechanical Properties of Tissue Conditioner Containing Plant-Derived Component: An In Vitro Study.

PURPOSE: To evaluate the antifungal activity and mechanical properties of a novel antifungal tissue conditioner containing Juncus powder. MATERIALS AND METHODS: Juncus powder was mixed with GC tissue conditioner at concentrations of 2.5%, 5.0%, and 10.0% by mass. The cylindrical specimens of Juncus-mixed tissue conditioner (dimensions: 10 mm in diameter and 2 and 6 mm in height for antimicrobial and mechanical tests, respectively) were prepared. The specimens placed on the bottom of the 24-well tissue culture plate were cultured with Candida albicans CAD1 for 2 and 4 days. The proliferation of the C. albicans in the wells was determined by measuring the optical density of fungal culture, and the surface of the specimens were also observed by scanning electron microscopy (SEM). To assess the mechanical properties of the specimens, the fluidity and hardness of Juncus-mixed tissue conditioner were measured using the methods certified according to ISO 10139-1. RESULTS: Juncus-mixed tissue conditioner significantly exhibited growth inhibitory effect in a Juncus concentration-dependent manner after both 2- and 4- day cultures. SEM observation showed that the amount of C. albicans on Juncus-mixed specimens drastically decreased, and biofilm formation was markedly inhibited. Moreover, both mechanical properties were found to be within the ranges regulated and specified by ISO. CONCLUSION: These findings demonstrated that the tissue conditioner including Juncus powder has a significant growth inhibitory effect against C. albicans, and it is suggested that the application of Juncus-mixed tissue conditioner may prevent denture stomatitis and oral candidiasis in denture wearers.

Ultramorphology of pre-treated adhesive interfaces between self-adhesive resin cement and tooth structures / Ultramorfologia de interfaces adesivas entre cimento resinoso auto-adesivo e estruturas dentárias pré-tratadas

Introduction: Convencional resin cements can be used in combination with a total-etch system in a conventional mode or as self-adhesive resin cements. The latter are less technique sensitive and able to bond to dental tissues without previous treatment or adhesive layer and requires only a single step to be applied to dental structures. Objective: To compare qualitatively the adhesive interfaces of two self-adhesive resin cements and one conventional resin cement after different tooth surface treatments under scanning electron microscopy. Material and method: 42 crowns of bovine incisors were sectioned and flattened exposing enamel (E) or dentine (D) substrate. Subgroups were defined according to conditioning type and time: E1—no treatment, E2—37% phosphoric acid for 15 seconds, E3—37% phosphoric acid for 30 seconds; D1—no treatment, D2—37% phosphoric acid for 5 seconds; D3—11.5% polyacrylic acid for 15 seconds. A resin block was bonded to each substrate using the self-adhesive resin cements RelyX U100 (3M ESPE) and RelyX U200 (3M ESPE). As a reference hybrid layer, six resin blocks were luted with RelyX ARC and Scotchbond Multi-Purpose adhesive system (3M ESPE) (enamel—EA; dentine—DA). After aging for 7 days in a moist environment at 37±1°C, samples were prepared for microscopy analysis. Result and Discussion: In the ARC specimens, there was hybrid layer formation in both EA and DA. U100 E1 showed gaps at the adhesive interface, while E2 and E3 showed interaction for both self-adhesive cements. There was superficial interaction with bothU100 and U200 in D1, while in D2 and D3, resin tags were only observed in the case of U100. Conclusion: It was concluded that substrate conditioning may enhance the interaction between self-adhesive resin cements and dental tissues, although this is not the case for RelyX U200 and dentine.

Introdução: Restaurações estéticas indiretas são preferencialmente cimentadas utilizando-se cimentos resinosos convencionais e sistema adesivo de condicionamento total ou cimentos resinosos autoadesivos. Estes últimos são tecnicamente menos sensíveis e aderem aos tecidos dentários sem tratamento prévio ou aplicação de adesivo, com um único passo para sua aplicação aos tecidos dentários. Objetivo: Comparar qualitativamente as interfaces adesivas de dois cimentos resinosos autoadesivos e um cimento resinoso convencional, sob microscopia eletrônica de varredura. Material e método: 42 coroas de incisivos bovinos foram seccionadas e as faces vestibulares planificadas expondo esmalte (E) ou dentina (D). Os subgrupos foram definidos de acordo com o tipo e tempo de condicionamento: E1-sem tratamento, E2-37% de ácido fosfórico por 15 segundos, E3-37% de ácido fosfórico por 30 segundos; D1-sem tratamento, D2-37% de ácido fosfórico durante 5 segundos; D3-11,5% de ácido poliacrílico durante 15 segundos. Um bloco de resina foi unido a cada substrato usando os cimentos resinosos autoadesivos RelyX U100 e RelyX U200 (3M ESPE) (n=3). Como referência de camada híbrida, foram cimentados seis blocos de resina com RelyX ARC e o sistema adesivo Scotchbond Multi-Purpose(esmalte-EA, dentina-DA). Após armazenamento (7 dias, umidade, 37±1°C), as amostras foram preparadas para análise microscópica. Resultado: Nos espécimes ARC, houve formação de camada híbrida em EA e DA. U100 E1 mostrou lacunas na interface adesiva, enquanto E2 e E3 apresentaram boa interação para ambos os cimentos autoadesivos. Houve interação superficial com U100 e U200 em D1, enquanto em D2 e ​​D3, foram observadas tags de resina apenas para U100. Conclusão: Concluiu-se que o condicionamento do substrato pode aumentar a interação entre cimentos resinosos autoadesivos e os tecidos dentários, embora este não seja o caso do RelyX U200 e da dentina.

Provisionalização em implantes imediatos / Immediate implants provisionalization

A provisionalização imediata, em que o provisório é adaptado diretamente no implante recém-instalado, é uma ótima alternativa para temporização. A indicação depende do posicionamento tridimensional correto, estabilidade primária do implante e o perfil oclusal do paciente. O manejo da prótese é essencial para a estética e o desenho do pilar protético (provisório ou definitivo) pode influenciar favorável ou negativamente os resultados.

Immediate provisionalization, in which the provisional is adapted directly into the newly installed implant, is a great alternative for temporization. Its indication depends on correct three-dimensional positioning, implant primary stability and patient's occlusal profile. Prosthesis handling is essential for prosthetic abutment (provisional or definitive) aesthetics and design and can favorably or negatively influence the results.

Estudio comparativo in vitro de diferentes métodos de profilaxis y acondicionamiento del esmalte en la capacidad de adhesión de un sellador de fosas y fisuras / In vitro comparative study of different methods of prophylaxis and conditioning of enamel in the adhesiveness of a pit and fissure sealant

El objetivo de este estudio comparativo in vitro fue evaluar y comparar el efecto de diferentes métodos de profilaxis y acondicionamiento del esmalte, en la capacidad de adhesión de un sellador de fosas y fisuras fotopolimerizable. La porción coronaria de 50 premolares extraídos se seccionaron en dos mitades (vestibular y lingual) y se incluyeron en bloques de acrílico. Las muestras se dividieron en cinco grupos de acuerdo con los métodos de profilaxis: sin profilaxis, piedra pómez, gluconato de clorhexidina, pasta fluorada y limpiador por bicarbonato (air prophy); y técnicas de acondicionamiento del esmalte: grabado ácido con ácido fosfórico al 37% y adhesivo de autograbado. La fuerza de adhesión del sellador se midió en una máquina Instron® mediante una prueba de tracción. Los resultados no demostraron diferencias significativas en la resistencia a la tracción de acuerdo a las técnicas de acondicionamiento del esmalte utilizadas. En relación con los métodos de profilaxis estudiados, se observó que existieron diferencias significativas en los grupos tratados con pasta fluorada y limpiador por bicarbonato.

The aim of this in vitro comparative study was to evaluate and compare the effect of different methods of prophylaxis and conditioning of enamel, in the adhesiveness of a light-curing pit and fissure sealant. The coronal portion of 50 extracted premolars were sectioned into two halves (buccal and lingual) and embedded in acrylic blocks. The samples were divided into five groups according to the methods of prophylaxis: no prophylaxis, pumice powder, chlorhexidine gluconate, fluoridated paste and air prophy; and enamel conditioning techniques: etching acid with 37% phosphoric acid and self-etching adhesive. The sealant adhesion strength was measured using an Instron® machine for a tensile test. The results showed no significant differences in tensile strength according to the enamel conditioning techniques used. Regarding the methods of prophylaxis under study, a significant difference in groups treated with fluoridated paste and air prophy was observed.

Condicionamento peri-implantar com restaurações provisórias em área estética: técnica de compressão dinâmica e otimização de moldagem na reprodução do perfil de emergência / Peri-implant conditioning with provisional restorations in the aesthetic area: dynamic compression technology and impression optimization to reproduce the emergence profile

A otimização estética de restaurações implantossuportadas é uma combinação da concordância visual entre prótese e arquitetura do tecido mole peri-implantar. A proposta deste artigo consiste na aplicação do método clínico de compressão dinâmica, de condicionamento tecidual ao redor do nível ósseo peri-implantar, utilizando resina flow para reprodução deste condicionamento no processo de moldagem. A técnica tem sido bastante eficaz e difundida em virtude da estabilização do adequado perfil de emergência, a fim de estabelecer a harmonia do contorno gengival com os dentes adjacentes, incluindo altura e largura dos zênites gengivais, tornando o perfil gengival mais triangular e mantendo a estabilidade das áreas de contatos proximais com dentes adjacentes aos implantes.

The esthetic enhancement for implant-supported restorations is a visual combination between prosthesis and its gingival architecture. The aim of this case report is to demonstrate the use of the clinical dynamic compression technique for peri-implant tissues with a flow composite resin during the impression procedures. This technique has proven its efficacy and been well established because it allows for an adequate emergence profile, generating harmony at the gingival contour of the adjacent teeth, including the position of the gingival zeniths, making the gingival profile more tapered while keeping the proximal contact areas between tooth and implants.

Growth Factor Liberation and DPSC Response Following Dentine Conditioning.

Liberation of the sequestrated bioactive molecules from dentine by the action of applied dental materials has been proposed as an important mechanism in inducing a dentinogenic response in teeth with viable pulps. Although adhesive restorations and dentine-bonding procedures are routinely practiced, clinical protocols to improve pulp protection and dentine regeneration are not currently driven by biological knowledge. This study investigated the effect of dentine (powder and slice) conditioning by etchants/conditioners relevant to adhesive restorative systems on growth factor solubilization and odontoblast-like cell differentiation of human dental pulp progenitor cells (DPSCs). The agents included ethylenediaminetetraacetic acid (EDTA; 10%, pH 7.2), phosphoric acid (37%, pH <1), citric acid (10%, pH 1.5), and polyacrylic acid (25%, pH 3.9). Growth factors were detected in dentine matrix extracts drawn by EDTA, phosphoric acid, and citric acid from powdered dentine. The dentine matrix extracts were shown to be bioactive, capable of stimulating odontogenic/osteogenic differentiation as observed by gene expression and phenotypic changes in DPSCs cultured in monolayer on plastic. Polyacrylic acid failed to solubilize proteins from powdered dentine and was therefore considered ineffective in triggering a growth factor-mediated response in cells. The study went on to investigate the effect of conditioning dentine slices on growth factor liberation and DPSC behavior. Conditioning by EDTA, phosphoric acid, and citric acid exposed growth factors on dentine and triggered an upregulation in genes associated with mineralized differentiation, osteopontin, and alkaline phosphatase in DPSCs cultured on dentine. The cells demonstrated odontoblast-like appearances with elongated bodies and long extracellular processes extending on dentine surface. However, phosphoric acid-treated dentine appeared strikingly less populated with cells, suggesting a detrimental impact on cell attachment and growth when conditioning by this agent. These findings take crucial steps in informing clinical practice on dentine-conditioning protocols as far as treatment of operatively exposed dentine in teeth with vital pulps is concerned.

Role of antifungal medicaments added to tissue conditioners: A systematic review.

PURPOSE: The aim of this review is to investigate the current state of knowledge on the incorporation of antifungal agents into the tissue conditioners for the treatment of denture induced stomatitis. STUDY SELECTION: Studies reporting the incorporation of antifungal/antimicrobial agents in to tissue conditioners were included in the review. In order to search the studies on the topic "incorporation of antifungal agents in tissue conditioners for the treatment of denture induced stomatitis" ISI web of science, PubMed/MEDLINE, and Google-Scholar databases were searched from 1970 up to and including July 2015 using various keywords such as antifungal agents, tissue conditioners, Candida albicans, denture stomatitis, etc. RESULTS: Various studies reported the efficacy and effectiveness of adding conventional organic antifungal medicines (nystatin, azole group derivatives and chlorhexidine, antimicrobials/antifungals other than organic (silver zeolite, silver nano-particles, photo-catalysts and metallic oxides) and natural and herbal antimicrobials (tea tree oil, lemongrass essential oil and origanum oil) into various tissue conditioners. The review literature reported that incorporation of antifungal agents into tissue conditioners is effective with minimal or no effects on physical and mechanical properties of tissue conditioners. CONCLUSIONS: Incorporation of different antifungal medicaments to commercially available tissue conditioners can be recommended for the management of denture induced stomatitis.

Esthetic Outcome of Implant Supported Crowns With and Without Peri-Implant Conditioning Using Provisional Fixed Prosthesis: A Randomized Controlled Clinical Trial.

BACKGROUND: Achieving an optimal esthetic result using dental implants is challenging. Fixed implant-supported provisional crowns are often used to customize the emergence profile and to individualize the surrounding peri-implant soft tissue. PURPOSE: The objective of this study is to evaluate whether the use of a provisional implant-supported crown leads to an esthetic benefit on implants that are placed in the esthetic zone. The null hypothesis is that there is no-difference between the two study groups. MATERIAL AND METHODS: Twenty single implants (Bone Level, Straumann AG, Basel, Switzerland) were inserted in consecutive patients. After reopening, a randomization process assigned them to either cohort group 1: a provisional phase with soft tissue conditioning using the "dynamic compression technique" or cohort group 2: without a provisional. Implants were finally restored with an all-ceramic crown. Follow-up examinations were performed at 3 and 12 months including implant success and survival, clinical, and radiographic parameters. RESULTS: After 1 year all implants successfully integrated, mean values of combined modPES and WES were 16.7 for group 1 and 10.5 for Group 2. This was statistically significant. Mean bone loss after 1 year was -0.09 and -0.08 for groups 1 and 2, respectively, without being statistically significant. CONCLUSION: A provisional phase with soft tissue conditioning does improve the final esthetic result.

Hardness Changes of Tissue Conditioners in Various Storage Media: An in Vitro Study.

The aim of the present study was to evaluate the effects of storage media on the longitudinal hardness changes of tissue conditioning materials. Four tissue-conditioning materials were used for fabrication of 80 disc-shaped specimens and divided in four groups, stored in four storage media. The specimens underwent artificial ageing corresponding to 30 nights of extra-oral storage. Hardness measurements were obtained at nine intervals between 8 and 240 hours after specimen fabrication. To test the effects of storage media on hardness we employed multivariate modelling (Bonferroni correction; α = 0.05). The materials exhibited varying hardness changes, most pronounced when stored in ambient air.