Alveolar ridge bone changes in patients treated with the split-crest technique with simultaneous implant placement: A retrospective longitudinal observational study.

OBJECTIVES: To investigate long-term alveolar ridge bone changes in patients treated with the split-crest technique (SCT) with simultaneous implant placement. MATERIALS AND METHODS: Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL-BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05). RESULTS: Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow-up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL-BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL-BBC = 0 mm. CONCLUSION: Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL.

Tooth resorptions are not hereditary.

Root resorptions caused by orthodontic movement are not supported by consistent scientific evidence that correlate them with heredity, individual predisposition and genetic or familial susceptibility. Current studies are undermined by methodological and interpretative errors, especially regarding the diagnosis and measurements of root resorption from orthopantomographs and cephalograms. Samples are heterogeneous insofar as they comprise different clinical operators, varied types of planning, and in insufficient number, in view of the prevalence of tooth resorptions in the population. Nearly all biological events are coded and managed through genes, but this does not mean tooth resorptions are inherited, which can be demonstrated in heredograms and other methods of family studies. In orthodontic root resorption, one cannot possibly determine percentages of how much would be due to heredity or genetics, environmental factors and unknown factors. There is no need to lay the blame of tooth resorptions on events taking place outside the orthodontic realm since in the vast majority of cases, resorptions are not iatrogenic. In orthodontic practice, when all teeth are analyzed and planned using periapical radiography or computerized tomography, and when considering all predictive factors, tooth resorptions are not iatrogenic in nature and should be considered as one of the clinical events inherent in the treatment applied.

Tooth resorptions are not hereditary

ABSTRACT Root resorptions caused by orthodontic movement are not supported by consistent scientific evidence that correlate them with heredity, individual predisposition and genetic or familial susceptibility. Current studies are undermined by methodological and interpretative errors, especially regarding the diagnosis and measurements of root resorption from orthopantomographs and cephalograms. Samples are heterogeneous insofar as they comprise different clinical operators, varied types of planning, and in insufficient number, in view of the prevalence of tooth resorptions in the population. Nearly all biological events are coded and managed through genes, but this does not mean tooth resorptions are inherited, which can be demonstrated in heredograms and other methods of family studies. In orthodontic root resorption, one cannot possibly determine percentages of how much would be due to heredity or genetics, environmental factors and unknown factors. There is no need to lay the blame of tooth resorptions on events taking place outside the orthodontic realm since in the vast majority of cases, resorptions are not iatrogenic. In orthodontic practice, when all teeth are analyzed and planned using periapical radiography or computerized tomography, and when considering all predictive factors, tooth resorptions are not iatrogenic in nature and should be considered as one of the clinical events inherent in the treatment applied.

RESUMO As reabsorções radiculares decorrentes da movimentação ortodôntica não têm evidência científica consistente que as correlacione com a hereditariedade, predisposição e suscetibilidade genética ou familiar. Os trabalhos sobre esse tema apresentam erros metodológicos e interpretativos, em especial quanto ao diagnóstico e à mensuração das reabsorções radiculares a partir de ortopantomografias e cefalogramas. As amostras são heterogêneas - quanto aos operadores clínicos e tipos de planejamentos aplicados - e em número muito pequeno, considerando-se a prevalência das reabsorções dentárias na população. Quase todos os eventos biológicos são codificados e gerenciados a partir dos genes, mas não por isso as reabsorções dentárias são hereditárias, o que seria demonstrado em heredogramas e outras formas de estudos familiares. Nas reabsorções radiculares em Ortodontia, não é possível determinar percentuais de quanto seria decorrente da hereditariedade ou da genética, de fatores ambientais e de fatores desconhecidos. Não se faz necessário transferir a "culpa" das reabsorções dentárias para eventos externos à Ortodontia pois, na grande maioria dos casos, elas não são iatrogênicas. Na prática ortodôntica, quando se faz a análise de todos os dentes e o planejamento, via radiografia periapical ou tomografia computadorizada, e quando se leva em consideração os fatores preditivos, as reabsorções dentárias não serão de natureza iatrogênica, e devem ser encaradas como uma das intercorrências clínicas do tratamento aplicado.

Cisto gengival do adulto: diagnóstico diferencial com fístulas, abscessos, mucoceles e neoplasias / Gingival cyst of the adult: differential diagnosis with fístulas, abscesses, mucoceles and neoplasias

O cisto gengival do adulto nem sempre é notado, devido ao seu crescimento limitado e ausência de sintomatologia. Em quase todos os casos, está localizado na face vestibular. O diagnóstico diferencial inclui mucocele, abscesso gengival, fístulas e algumas neoplasias benignas. Os adenomas, neuromas e neoplasias ou cistos odontogênicos periféricos podem se localizar nos tecidos gengivais e, quando ainda são pequenos e detectáveis, podem simular o cisto gengival do adulto. Esse apresenta-se como uma tumefação arredondada, em forma de domo, bem delimitada e firme à palpação, localizada nos tecidos gengivais, especialmente na gengiva aderida. Localiza- -se quase sempre na região dos pré-molares e caninos inferiores ou em suas áreas imediatamente vizinhas; em uma minoria de casos, pode ocorrer na mesma região da maxila. A maioria dos pacientes tem mais de 40 anos de idade, independentemente do sexo, mas qualquer idade pode ser afetada; eventualmente é bilateral. O cisto gengival do adulto deve ser incluído no diagnóstico diferencial de casos em que a nodulação ou tumefação localizada na gengiva aderida não se relaciona com nenhum dente com necrose pulpar, e depois que a possibilidade de abscesso gengival ou periodontal tiver sido descartada, pela presença de saúde plena dos tecidos periodontais. A conduta frente ao cisto gengival do adulto deve ser sua remoção cirúrgica completa e posterior análise microscópica. O prognóstico tende a ser muito bom e não há casos de transformação agressiva ou malignização.