An evaluation of peri-implant marginal bone loss according to implant type, surgical technique and prosthetic rehabilitation: a retrospective multicentre and cross-sectional cohort study.

To evaluate implant loss (IL) and marginal bone loss (MBL); follow-up period of up to 10 years after prosthetic loading. Retrospective multi-centre cross-sectional cohort study. Double analysis: (1) all the implants (n = 456) were analysed; (2) to allow for possible cluster error, one implant per patient (n = 143) was selected randomly. Statistical analysis: Spearman's correlation coefficient; Kruskal-Wallis (post-hoc U-Mann-Whitney); Chi-square (post-hoc Haberman). (1) Analysing all the implants (456): IL was observed in patients with past periodontitis (6 vs. 2.2%, p < 0.05), short implants (12 vs. 2.8%, p < 0.001) and when using regenerative surgery (11.3 vs. 2.9%, p < 0.001); greater MBL was observed among smokers (0.39 ± 0.52 vs. 0.2 ± 0.29, p < 0.01), maxillary implants (0.28 ± 0.37 vs. 0.1 ± 0.17, p < 0.0001), anterior region implants (0.32 ± 0.36 vs. 0.21 ± 0.33, p < 0.001), external connection implants (0.2 ± 0.29 vs. 0.63 ± 0.59, p < 0.0001), and 2-3 years after loading (p < 0.0001). (2) analysing the cluster (143): IL was observed in smokers (18.8 vs. 3.5%, p < 0.05), splinted fixed crowns (12.9%, p < 0.01), short implants (22.2 vs. 4.0%, p < 0.01) and when using regenerative surgery (19.2 vs. 3.4%, p < 0.01); greater MBL was observed in maxillary implants (0.25 ± 0.35 vs. 0.11 ± 0.18, p < 0.05), in the anterior region (p < 0.05), in the first 3 years (p < 0.01), in external connection implants (0.72 ± 0.71 vs. 0.19 ± 0.26, p < 0.01) and in short implants (0.38 ± 0.31 vs. 0.2 ± 0.32, p < 0.05). There is greater risk in smokers, patients with past periodontal disease, external connection implants, the use of short implants and when regenerative techniques are used. To prevent MBL and IL, implantologists should be very meticulous in indicating implants in patients affected by these host factors.

Clinical performance of titanium-zirconium implants with a hydrophilic surface in patients with controlled type 2 diabetes mellitus: 2-year results from a prospective case-control clinical study.

OBJECTIVE: Analyze the 2-year clinical performance of single-unit titanium-zirconium (TiZr) alloy narrow-diameter (3.3 mm) dental implants with a hydrophilic surface (Straumann® Roxolid®, SLActive®) in patients with controlled type 2 diabetes mellitus (T2DM), measured using the glycated hemoglobin A (HbA1c) concentration test, compared with results in individuals without T2DM. MATERIAL AND METHODS: The studied sample consisted of 28 patients, 14 with T2DM (study group) and 14 without (control group). The plaque index, bleeding on probing, probing depth, clinical attachment level, gingival biotype, and marginal bone loss (MBL) at the site of the implants were assessed. HbA1c levels were assessed in all patients during each checkup. RESULTS: Two years after implant placement and prosthetic restoration no implant failures were reported in either group, resulting in 100% survival and success rates in both groups. No statistically significant differences in MBL were found between the control and study groups (p > 0.05). CONCLUSIONS: Within the limitations of this study, it can be concluded that reduced-diameter TiZr alloy implants with a hydrophilic surface represent a safe and predictable treatment option for patients with well-controlled T2DM. The clinical performance was comparable with that observed in individuals without T2DM in the medium term. CLINICAL RELEVANCE: The narrow implants placed in patients with T2DM with well-controlled glycemia (HbA1c) showed a marginal bone loss and success and survival rates similar to those of the control group without DM2, in the medium term.

Radiolucent periapical lesions and bone mineral density in post-menopausal women.

PURPOSE: To investigate the relationship between radiolucent periapical lesions and bone mineral density in post-menopausal women. MATERIAL AND METHODS: Seventy-five post-menopausal women were recruited for the study. Bone mineral density was measured using dual-energy X-ray absorptiometry. Three groups were established: healthy bone group, osteopenic group and osteoporotic group. Periapical radiolucencies were diagnosed on the basis of examination of digital panoramic radiographs. Statistical analysis was carried out using anova and chi-squared tests, and logistic regression analysis. RESULTS: In both the osteopenic and osteoporotic groups, 25% of women showed at least one periapical radiolucency, whereas this was only 7.4% in the healthy bone group (odds ratio = 4.2; p = 0.061). After multivariate logistic regression analysis adjusting for covariates (age, number of teeth, number of root-filled teeth and number of teeth with coronal restorations), a marginally significant association was evident between bone mineral density and the presence of periapical radiolucencies (odds ratio = 1.9; CI 95% = 1.0-3.8; p = 0.050). CONCLUSIONS: After adjusting for covariates, low bone mineral density is marginally associated with a higher frequency of radiolucent periapical lesions.

Protocol for oral implant rehabilitation in a hemophilic HIV-positive patient with type C hepatitis.

CASE REPORT: A 46-year-old man with severe hemophilia A, stage A2 HIV infection and chronic hepatitis C genotype 1A, for whom the treatment plan included implant-supported prostheses in 2 mandibular edentulous sections. The protocol followed included factor VIII replacement concentrate and oral antifibrinolytic therapy. The right mandibular section was fitted with 3 Straumann implants (Ø 4.1 mm, length 10 mm), and the left mandibular section received 2 implants of the same characteristics. The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. After a 3-month period of osseointegration, the prosthesis was fitted. CONCLUSIONS: Although, in this case, the treatment proved successful 2 years postrehabilitation and the protocol used seems safe and effective, long-term prospective studies are needed to evaluate the implant success rate in these patients.

The bacteremia of dental origin and its implications in the appearance of bacterial endocarditis.

Numerous systemic diseases may affect the oral cavity and vice versa,in particular severe diseases that involve the heart valve. In these cases, additional measures or a modification to our dental treatment need to be taken. We are aware of various diseases that can cause the emergence of bacterial endocarditis (BE), such as; rheumatic fever, valve lesions due to intravenous drug use, Kawasaki disease and valve surgery, among others. Due to its severity when it is not taken into account in dental treatment, we intend to show the evolution of the antimicrobial prophylaxis towards this condition. Furthermore, we intend to publish the current guidelines of institutions and societies which increasingly encourage rational antimicrobial use. In addition, we intend to examine the evidence of the possible origins of this disease during dental treatment and at the same time describe the necessary considerations that need to be taken during dental treatment.

Confocal microscopy: a valid approach to evaluate the three-dimensional characteristics of root-end cavities.

OBJECTIVE: To analyze, using confocal microscope, the three-dimensional characteristics of the root-end cavity preparations completed in root apices of extracted teeth determining their area, perimeter, circularity and cavo-surface angle. STUDY DESIGN: Thirty-two single-rooted extracted teeth underwent endodontic treatment and apical resection. Root-end cavities were prepared according to 4 protocols, as follows: Group 1, stainless steel ultrasonic tips (SST) at 33 KHz power; Group 2, SST at 30 KHz power; Group 3, diamond-coated ultrasonic tips (DCT) at 30 KHz power; and Group 4, DCT at 33 KHz power. Finally, root-end cavity was evaluated using a confocal microscope, recording its area, perimeter, circularity and cavo-surface angle. RESULTS: The largest cavity perimeter was found in the Group 2 (4.8 ± 1.6 mm) (p > 0.05). Root-end cavities performed using SST showed larger areas than those performed with DCT (p = 0.03). The power of vibration or the tip type did not show correlation with the perimeter, circularity and cavo-surface angle of the root-end cavity (p > 0.05). CONCLUSIONS: Confocal microscopy is a useful approach to study the three-dimensional characteristics of the root-end cavity.

Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates.

AIM: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects. MATERIAL AND METHODS: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression. RESULTS: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). CONCLUSIONS: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects.

Multicentre Prospective Study Analysing Relevant Factors Related to Marginal Bone Loss: A Two-Year Evolution.

INTRODUCTION: The aim of this prospective descriptive study was to analyse the possible variables associated with marginal bone loss in rehabilitated implants (Proclinic S.A.U, Zaragoza, Spain) two years after their prosthetic loading. MATERIALS AND METHODS: Three clinical centres collaborated for a period of two years after the prosthetic rehabilitation of the implants (Proclinic S.A.U, Zaragoza, Spain), in which marginal bone loss and the possible associated variables were evaluated. The collection form comprised different variables throughout different stages of the implant procedure, from implant insertion to the subsequent prosthetic rehabilitation, over a two-year period. Data of the patients and implant characteristics were studied. Statistical analysis was performed with SPSS for qualitative (univariate logistic regressions, Chi2 test, and Haberman's corrected standardised residuals) and quantitative variables (Kolmogorov-Smirnov test). RESULTS: The total study sample consisted of 218 implants (Proclinic S.A.U, Zaragoza, Spain). The sample presented a frequency of 99 men (45.4%) and 119 women (54.6%). The mean age of the patients among the reported cases was 58.56 ± 10.12 years. A statistically significant association was found between marginal bone loss 2 years after prosthetic rehabilitation placement and several variables, including age (under 55 years, 0.25 mm ± 0.56; 55-64 years, 0.74 mm ± 0.57; over 65 years, 0.63 mm ± 0.55; p < 0.0001), gender (female, 0.74 mm ± 0.61; male, 0.34 mm ± 0.51; p < 0.0001), bone quality (D1, 0.75 mm ± 0.62; D2, 0.43 mm ± 0.57; D3, 0.65 mm ± 0.60; p < 0.01), implant diameter (up to 4 mm, 0.49 mm ± 0.58; more than 4 mm, 1.21 mm ± 0.30; p < 0.0001), prosthetic connection type (direct to implant, 0.11 mm ± 0.58; transepithelial straight, 0.67 mm ± 0.57; transepithelial angled, 0.33 mm ± 0.25; p < 0001), implant model (internal conical, 0.17 mm ± 0.24; external conical, 0.48 mm ± 0.61; external cylindrical, 1.12 mm ± 0.32; p < 0.0001), prosthetic restoration type (full denture, 0.59 mm ± 0.59; partial denture, 0.50 mm ± 0.85; unitary crown, 0.08 mm ± 0.19; p < 0.05), and insertion torque (>35 N/cm, 0.53 mm ± 0.58; <35 N/cm, 1.04 mm ± 0.63; p < 0.01). CONCLUSIONS: At 2 years, marginal bone loss following prosthetic rehabilitation was shown to be influenced by multiple factors. Correct implantological planning is of vital importance for successful rehabilitation.

Frequency and distribution of root-filled teeth and apical periodontitis in an adult population of Barcelona, Spain.

AIM: To determine the prevalence of apical periodontitis (AP) and the frequency of root canal treatment in a sample of Spanish adults. DESIGN: A descriptive cross-sectional study. SETTING: Barcelona, Spain. PARTICIPANTS: A total of 397 adult subjects, 49% males and 51% females. METHODS: Digital panoramic radiographs were used. Periapical status was scored according to the periapical index. Results were analysed statistically using the chi-squared test and logistic regression. RESULTS: Radiographic signs of AP in one or more teeth were found in 135 patients (34%). The prevalence of AP was significantly higher in males (42.3%) than females (26.1%) [odds ratio (OR)=2.1; 95% confidence interval (95% CI)= 1.4-3.2; P= 0.0007]. At least one root-filled tooth (RFT) was found in 233 patients (59%). Twenty-six per cent of subjects with RFT had at least one RFT with AP. The prevalence of AP increased with age (P < 0.05). Patients with RFT showed a higher prevalence of AP (42%) relative to patients without RFT (23%) (OR = 2.4; 95% CI = 1.5-3.7; P = 0.00013). Adjusting for age, gender and teeth number, endodontic status remained significantly associated with periapical status (OR = 2.3; 95% CI = 1.4-3.6; P = 0.0005). CONCLUSIONS: Both the prevalence of AP and the frequency of root canal treatment are high among Spanish adults. AP affects more frequently RFT relative to untreated teeth. Patients with one or more RFT have a greater likelihood of having AP than patients without RFT.

External apical root resorption in maxillary root-filled incisors after orthodontic treatment: a split-mouth design study.

INTRODUCTION: The purpose of this study was to compare, in a split mouth design, the external apical root resorption (EARR) associated with orthodontic treatment in root-filled maxillary incisors and their contralateral teeth with vital pulps. METHODOLOGY: The study sample consisted of 38 patients (14 males and 24 females), who had one root-filled incisor before completion of multiband/bracket orthodontic therapy for at least 1 year. For each patient, digital panoramic radiographs taken before and after orthodontic treatment were used to determine the root resortion and the proportion of external root resorption (PRR), defined as the ratio between the root resorption in the endodontically treated incisor and that in its contralateral incisor with a vital pulp. The student's t-test, chi-square test and logistic regression analysis were used to determine statistical significance. RESULTS: There was no statistically significant difference (p > 0.05) between EARR in vital teeth (1.1 ± 1.0 mm) and endodontically treated incisors (1.1 ± 0.8 mm). Twenty-six patients (68.4%) showed greater resorption of the endodontically treated incisor than its homolog vital tooth (p > 0.05). The mean and standard deviation of PPR were 1.0 ± 0.2. Multivariate logistic regression suggested that PRR does not correlate with any of the variables analyzed. CONCLUSIONS: There was no significant difference in the amount or severity of external root resorption during orthodontic movement between root-filled incisors and their contralateral teeth with vital pulps.

Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques.

OBJECTIVES: To investigate and compare postoperative pain after one-visit root canal treatment (RCT) on teeth with vital pulps using three different obturation techniques. STUDY DESIGN: Two hundred and four patients (105 men and 99 women) aged 12 to 77 years were randomly assigned into three treatments groups: cold lateral compaction of gutta-percha (LC), Thermafil technique (TT), and Backfill - Thermafil obturation technique (BT). Postoperative pain was recorded on a visual analogue scale (VAS) of 0 - 10 after 2 and 6 hours, and 1, 2, 3, 4, 5, 6 and 7 days. Data were statistically analyzed using multivariate logistic regression analysis. RESULTS: In the total sample, 87% of patients experienced discomfort or pain in some moment between RCT and the seventh day. The discomfort experienced was weak, light, moderate and intense in 6%, 44%, 20% and 6% of the cases, respectively. Mean pain levels were 0.4 ± 0.4, 0.4 ± 0.3, and 1.4 ± 0.7 in LC, BT, and TT groups, respectively. Patients of TT group experienced a significantly higher mean pain level compared to other two groups (p < 0.0001). In TT group, all patients felt some level of pain at six hours after RCT. CONCLUSIONS: Postoperative pain was significantly associated with the obturation technique used during root canal treatment. Patients whose teeth were filled with Thermafil obturators (TT technique) showed significantly higher levels of discomfort than patients whose teeth were filled using any of the other two techniques.

Evaluation of apical preparations performed with ultrasonic diamond and stainless steel tips at different intensities using a scanning electron microscope in endodontic surgery.

OBJECTIVE: The objective of our study is to analyse (with the help of scanning electron microscopes) the quality of the dental root surface and the appearance of dental cracks after performing apical preparations using two different types of ultrasonic tips. STUDY DESIGN: We used 32 single-rooted teeth that underwent a root canal and apical resection. Afterwards, the teeth were divided into 4 groups of 8 teeth each, with preparations of the apical cavities in the following manner: Group 1: stainless steel ultrasonic tip at 33 KHz. Group 2: stainless steel ultrasonic tip at 30 KHz. Group 3: diamond ultrasonic tip at 30 KHz. Group 4: diamond ultrasonic tip at 33 KHz. The quality of the root surface and the presence of cracks were evaluated by one single observer using a scanning electron microscope. RESULTS: All of the teeth in our study had cracks after the apical preparations. The mean number of cracks per tooth ranged between 6. ± 1.9 (group 1) and 3.5 ± 2.4 (group 4), with a significantly higher number found in the groups that used stainless steel tips (P=.03). The types of cracks produced involved: 8 complete cracks (4.5%), 167 incomplete cracks (94.4%), and 2 intradentinal cracks (1.1%), with no significant differences observed between the different frequencies used for each group. CONCLUSIONS: Stainless steel ultrasonic tips provoked a larger number of cracks than diamond tips. The frequency of vibration used did not have any effect on the number of cracks found.

Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy.

OBJECTIVE: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. METHOD AND MATERIALS: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. RESULTS: The mean pain level during root canal treatment was 2.9±3.0 (median=2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p>0.05). Pain during root canal treatment was significantly greater in molar teeth (OR=10.1; 95% C.I.=1.6-63.5; p=0.013). Root canal instrumentation and obturation techniques did not affect significantly patients' pain during root canal treatment (p>0.05). CONCLUSION: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients' pain during RCT.

Bone loss around narrow implants versus standard diameter implants: Retrospective 2-years case-control study.

BACKGROUND: The objectives were to evaluate the bone loss (BL) around narrow diameter implants (3.3 mm) 2 years after implant loading and compare with the bone loss around conventional-diameter implants (4.1 mm), as well as with clinical and anatomical variables. 2-years follow-up. MATERIAL AND METHODS: Cases: 20 patients either gender-age, narrow implants (Straumann TM-SLA, diameter 3.3 mm); Control: 20 patients matching for gender-age, conventional implants (Straumann TM-SLA, diameter 4.1). Total 82 implants (31 narrow implants and 51 conventional implants) in 40 patients. To avoid statistical bias, a cluster of one implant per patient was randomly selected (20 narrow implants and 20 conventional implants). To evaluate changes resulting from bone loss around the implants, a total of 80 panoramic radiographs were taken of all 40 patients; the first panoramic image was taken at the time of implant loading and the second one 2 years later. Clinical and demographic variables were obtained from the patients' medical records. Statistical method: Spearman's correlation coefficient, chi-squared (Haberman's post hoc), Mann-Whitney U and Kruskal-Wallis tests. Statistical significance p< 0.05. RESULTS: No significant differences in bone loss around were found around narrow implants versus conventional implants. Differences linked to tobacco use were found after studying one implant per patient (p< 0.05). CONCLUSIONS: With the limitations of the present study, no significant differences in BL were found when comparing narrow implants with conventional implants after 2 years of implant loading. There were also no differences found when accounting for other demographic and clinical variables, with the exception of tobacco use. Key words:Lagervall & Jansson's index, bone loss, narrow implants, panoramic radiographs.

Influence of marginal bone loss on peri-implantitis: Systematic review of literature.

BACKGROUND: The marginal bone of dental implants is subjected to slight load modifications over time, conditioning implant survival. Objective: Perform a systematic review of the literature analyzing the factors that contribute to marginal bone loss (MBL) and the subsequent development of peri-implantitis. MATERIAL AND METHODS: Bibliographic research in the databases PubMed, Medline and Scopus between 2010 and 2018 was performed. The inclusion criteria were articles published in the last 10 years and that were in English or Spanish, that were carried out on humans, that were cohort studies, that included cases and controls or that used randomized clinical trials. Exclusion criteria removed articles that contained clinical cases, case series or systematic reviews. RESULTS: A total of 90 articles were analyzed that examined all the factors reported in the literature, such as idiosyncratic factors, toxic habits, systemic drugs and implant characteristics (diameter, length, type surface, implant connection, implant design and type of platform at the moment of the prosthetic load). Discussion: Patient characteristics and associated pathologies must be taken into account when assessing MBL. MBL in all dental implants can be considered independent of the type of prosthetic rehabilitation and the moment of load; this was emphasized. The MBL is smaller in dental implants with rough surfaces, switch platforms and infracrestal localization, as they are of multifactorial origin. CONCLUSIONS: All the reviewed articles maintain a common criterion regarding the concept and measurement of the MBL and highlighting the importance of radiodiagnosis for quantification. Longterm prospective studies with unified criteria are needed to reduce bias by identifying the most relevant factors in MBL. Key words:Marginal bone loss, dental implant, peri-implantitis.

Implant survival in patients with oral cancer: A 5-year follow-up.

BACKGROUND: To evaluate the evolution of patients rehabilitated with endosseous implants after oral cancer treatment. MATERIAL AND METHODS: An observational retrospective study was carried out between 1991 and 2011 with a sample consisting of patients with oral cancer who had been referred for rehabilitation to the Prosthetics Rehabilitation Unit from the Oral and Maxillofacial Surgery Unit of the Virgen del Rocío University Hospital. All these patients have overcome oral cancer, and have a five-year follow-up after their oral rehabilitation. Age, sex, smoking habits, oral pathology, type of treatment of oral pathology, edentulism, receptor bone, prosthetic rehabilitation, timeouts, working time and evolution were studied. SPSS Statistics was used for statistical analysis of the variables studied. A chi-square test centered on the survival rate of implants placed in relation to the other recorded variables was performed. RESULTS: 17 patients were treated for cancer and rehabilitated with implant prosthetics, with a total of 106 implants placed. 32% were partially edentulous patients (4 patients), and 68.2% were completely edentulous patients (13 patients). An implant survival rate of 87.7% was observed at 5 years. In the upper maxilla, the survival rate was 79.2%, and in the mandible 93.7% (p = 0.03). 91 implants were placed in native receptor bones (85.8%), with only 15 implants placed in grafted receptor bone (14.2%). According to the type of receptor bone, in native receptor bones, 9 implants failed (90.1% of implant survival), while in grafted receptor bones, 4 implants failed (overall 73.3% implant survival rate) (p = 0.08). CONCLUSIONS: Although a high survival rate was obtained in this study (with lower survival rates seen in mandible and grafted bone), prospective long-term studies are needed to assess the relationship between radiotherapy doses and the time required for implant placement, prosthetic protocol used, and type of implants used in patients selected for prosthetic rehabilitation. Key words:Dental implant, oral cancer, survival.

In Vitro Comparative Study of Oxygen Plasma Treated Poly(Lactic⁻Co⁻Glycolic) (PLGA) Membranes and Supported Nanostructured Oxides for Guided Bone Regeneration Processes.

(1) Background: The use of physical barriers to prevent the invasion of gingival and connective tissue cells into bone cavities during the healing process is called guided bone regeneration. The objective of this in-vitro study was to compare the growth of human osteoblasts on Poly(Lactic⁻co⁻Glycolic) (PLGA) membranes modified with oxygen plasma and Hydroxyapatite (HA), silicon dioxide (SiO2), and titanium dioxide (TiO2) composite nanoparticles, respectively. (2) Methods: All the membranes received a common treatment with oxygen plasma and were subsequently treated with HA nanostructured coatings (n = 10), SiO2 (n = 10) and TiO2 (n = 10), respectively and a PLGA control membrane (n = 10). The assays were performed using the human osteoblast line MG-63 acquired from the Center for Scientific Instrumentation (CIC) from the University of Granada. The cell adhesion and the viability of the osteoblasts were analyzed by means of light-field microphotographs of each condition with the inverted microscope Axio Observer A1 (Carl Zeiss). For the determination of the mitochondrial energy balance, the MitoProbe™ JC-1 Assay Kit was employed. For the determination of cell growth and the morphology of adherent osteoblasts, two techniques were employed: staining with phalloidin-TRITC and staining with DAPI. (3) Results: The modified membranes that show osteoblasts with a morphology more similar to the control osteoblasts follow the order: PLGA/PO2/HA > PLGA/PO2/SiO2 > PLGA/PO2/TiO2 > PLGA (p < 0.05). When analysing the cell viability, a higher percentage of viable cells bound to the membranes was observed as follows: PLGA/PO2/SiO2 > PLGA/PO2/HA > PLGA/PO2/TiO2 > PLGA (p < 0.05), with a better energy balance of the cells adhered to the membranes PLGA/PO2/HA and PLGA/PO2/SiO2. (4) Conclusion: The membrane in which osteoblasts show characteristics more similar to the control osteoblasts is the PLGA/PO2/HA, followed by the PLGA/PO2/SiO2.

A Prospective Case-Control Clinical Study of Titanium-Zirconium Alloy Implants with a Hydrophilic Surface in Patients with Type 2 Diabetes Mellitus.

PURPOSE: To evaluate prospectively the behavior of narrow-diameter (3.3-mm) titanium-zirconium alloy implants with a hydrophilic surface (Straumann Roxolid SLActive) in patients with type 2 diabetes mellitus in single-unit restorations, compared with a healthy control group (assessed using the glycosylated hemoglobin HbA1c test). MATERIALS AND METHODS: The patients evaluated in this study required single-unit implant treatment; 15 patients had type 2 diabetes mellitus, and 14 patients were healthy (control group [CG]). Marginal bone level (MBL) change around the implants was evaluated using conventional, sequential periapical digital radiographs. Patient HbA1c was assessed in each check-up. Normality test (Kolmogorov-Smirnov), univariate and multivariate logistic regression, analysis of variance (ANOVA), and Mann-Whitney U test were used for statistical analysis. RESULTS: No differences in MBL change and implant survival and success rates were found between the diabetes mellitus group (DMG) versus the control group, either during the initial recording (DMG, 0.99 ± 0.56 vs CG, 0.68 ± 0.54; P > .05) or 6 months after restoration (DMG, 1.28 ± 0.38 vs CG, 1.11 ± 0.59; P > .05). No significant correlation between HbA1c levels and MBL change was detected in these patients (P > .05). CONCLUSION: Patients with glycemic control exhibit similar outcomes to healthy individuals with regard to the investigated parameters. In light of these findings, the titanium-zirconium alloy small-diameter implants can be used in the anterior region of the mouth in type 2 diabetic patients.

Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder: A case report.

BACKGROUND: Paranoid schizophrenia is a mental illness that involves no observable anatomical alteration. Main characteristic affects the personality of the individual, as well as areas of his own psychology. CASE REPORT: A 33-year-old man with paranoid schizophrenia and obsessive-compulsive disorder in treatment with Haloperidol, Oxcarbazepine, Olanzapine and Seroquel is presented. Dental exploration showed widespread decay mostly cervical with numerous root fragments, agenesis of lateral incisors, impacted wisdom teeth, missing teeth and malocclusion. Treatment plan included restoration of teeth decay, extractions of root fragments and implant-supported prostheses in bilateral upper lateral incisors for aesthetics reason. A previous consultation with a psychiatric specialist was performed and no contraindication were observed. A preliminary radiological examination was performed previous dental treatment and implant placement. Due to patient refusal to replace dental abscenses with implants, inform consent was signed up from his parents. After local anesthesia, first implant was placed at upper right lateral positions (Straumann Bone Level Ø 3.3 mm, length 10 mm). Two weeks later a second implant was placed at upper left lateral position (Straumann Bone Level Ø 3.3 mm, length 12 mm). The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. The prosthesis was placed after a 3-month period of osseointegration. CONCLUSIONS: Implant placement can be considered a suitable option for people with mental disorders. A previous consultation with psychiatric specialists for conducting a good patient management is necessaire. Key words:Paranoid schizophrenia, obsessive-compulsive disorder, dental implants.

In Vitro and in Vivo Study of Poly(Lactic⁻co⁻Glycolic) (PLGA) Membranes Treated with Oxygen Plasma and Coated with Nanostructured Hydroxyapatite Ultrathin Films for Guided Bone Regeneration Processes.

The novelty of this study is the addition of an ultrathin layer of nanostructured hydroxyapatite (HA) on oxygen plasma modified poly(lactic⁻co⁻glycolic) (PLGA) membranes (PO2) in order to evaluate the efficiency of this novel material in bone regeneration. METHODS: Two groups of regenerative membranes were prepared: PLGA (control) and PLGA/PO2/HA (experimental). These membranes were subjected to cell cultures and then used to cover bone defects prepared on the skulls of eight experimental rabbits. RESULTS: Cell morphology and adhesion of the osteoblasts to the membranes showed that the osteoblasts bound to PLGA were smaller and with a lower number of adhered cells than the osteoblasts bound to the PLGA/PO2/HA membrane (p < 0.05). The PLGA/PO2/HA membrane had a higher percentage of viable cells bound than the control membrane (p < 0.05). Both micro-CT and histological evaluation confirmed that PLGA/PO2/HA membranes enhance bone regeneration. A statistically significant difference in the percentage of osteoid area in relation to the total area between both groups was found. CONCLUSIONS: The incorporation of nanometric layers of nanostructured HA into PLGA membranes modified with PO2 might be considered for the regeneration of bone defects. PLGA/PO2/HA membranes promote higher osteosynthetic activity, new bone formation, and mineralisation than the PLGA control group.