Photobiomodulation Therapy in the Proliferation and Differentiation of Human Umbilical Cord Mesenchymal Stem Cells: An In Vitro Study.

Introduction: Since photobiomodulation therapy (PBMT) favors in vitro mesenchymal stem cell (MSC) preconditioning before MSC transplantation, increasing the proliferation of these cells without molecular injuries by conserving their characteristics, in the present in vitro study we analyzed the effect of PBMT on the proliferation and osteogenic differentiation of human umbilical cord mesenchymal stem cells (hUCMSCs). Methods: Irradiation with an InGaAIP Laser (660 nm, 10 mW, 2.5 J/cm2 , 0.08 cm2 spot size, and 10 s) was carried out. The cells were divided into four groups: CONTROL [cells grown in Dulbecco's Modified Eagle Medium (DMEM)], OSTEO (cells grown in an osteogenic medium); PBMT (cells grown in DMEM+PBMT), and OSTEO+PBMT (cells grown in an osteogenic medium plus PBMT). The cell proliferation curve was obtained over periods of 24, 48 and 72 hours using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Osteogenic differentiation was analyzed by the formation of calcium nodules over periods of 7, 14 and 21 days. Morphometric analysis was performed to quantify the total area of nodular calcification. Results: The highest cell proliferation and cell differentiation occurred in the OSTEO+PBMT group, followed by the PBMT, OSTEO and CONTROL groups respectively, at the observed times (P <0.05). Conclusion: PBMT enhanced the osteogenic proliferation and the differentiation of hUCMSCs during the periods tested, without causing damage to the cells and preserving their specific characteristics, a fact that may represent an innovative pretreatment in the application of stem cells.

Photobiomodulation Therapy in Bone Repair Associated with Bone Morphogenetic Proteins and Guided Bone Regeneration: A Histomorphometric Study.

OBJECTIVE: To evaluate the efficacy of photobiomodulation for bone repair of critical surgical wounds with implants of bone morphogenetic proteins (BMPs) and bovine biological membranes, using histological and histomorphometric analysis. BACKGROUND: Tissue engineering has been developing rapidly through the use of various biomaterials for the treatment of bone defects, such as mechanical barriers consisting of biological membranes and implants of biomaterials for bone supply. MATERIALS AND METHODS: Thirty-two male rats were divided into four groups (n = 8): group I-C: control; group II-PT: photobiomodulation therapy; group III-PM: Gen-Pro® BMPs+Gen-Derm® membrane; and group IV-PMPT: Gen-Pro® BMPs+Gen-Derm® membrane+photobiomodulation therapy. A 3 mm bone cavity was performed in the upper third of the lateral surface of the right rat femur to obtain a bone defect considered to be critical. The irradiated groups received seven applications of AlGaAs diode laser 830 nm, P = 40 mW, continuous wave (CW) emission mode, f ∼ 0.6 mm, 4 J/cm2 per point (north, south, east, and west) at 48 h intervals, for a total of 16 J/cm2 per session (final dose: 112 J/cm2). Bone repair was evaluated at sacrifice 15 and 30 days after the procedure. The specimens were embedded in paraffin and stained with hematoxylin and eosin and Picrosirius for analysis by light microscopy and by the Leica interactive measurement module software. Statistical analysis was performed (p < 0.05%). RESULTS: Histological analysis confirmed the histomorphometric results, with the experimental groups showing bone neoformation of significantly higher quality and quantity at the end of 30 days compared with the control group. CONCLUSIONS: Photobiomodulation therapy was effective for bone repair mainly when associated with BMPs and a biological membrane. The results of this study are promising and stimulate further scientific and clinical research.

Clinical aspects in the treatment planning for rehabilitation with overdenture and protocol-type prosthesis / Aspectos clínicos utilizados no planejamento de prótese overdenture e protocolo

Objective: The aim of this study was to criticaly review the published literature regarding the clinical aspects involved in the rehabilitation of edentulous patients using Branemark protocol and overdenture prostheses.Methods: An active search was conducted in the LILACS, MEDLINE, PubMed, and SciELO databases using the descriptors: "Coating for dentures" (Overlay Prosthesis and Overdenture) and "Implant-supported fixed dental prosthesis" (Protesis dental de suporte implantado, Dental prosthesis, and Implant Supported Prosthesis) in Portuguese, English, and Spanish between January 2000 and October 2014.Results: The following parameters should be considered when selecting between Branemark protocol and overdenture prostheses: bone support, lip support, lip-line, upper lip length, oral mucosa conditions and size, alveolar ridge contour, crown-bone ratio, interarch space, and speaking space. Overdenture rehabilitation can provide many benefits to patients, such as prosthetic retention, stability, comfort, and improved aesthetics.Conclusions: This study highlights the need for a thorough individualized treatment planning to ensure that fixed prostheses and overdentures have an excellent prognosis when used appropriately in suitable patients at the appropriate time.

Objetivo: Verificar por meio de revisão crítica da literatura os aspectos clínicos durante o planejamento de pacientes edêntulos frente à utilização de próteses tipo protocolo de Branemark e overdenture.Métodos: Busca ativa nas bases de dados LILACS, MEDLINE, PubMed e SciELO por meio dos descritores: "Revestimento de dentadura" (Prótese de Recobrimento e Overdenture) e "Prótese dentária fixada por implante" (Protesis dental de suporte implantado e Dental prosthesis, implant supported) entre janeiro de 2000 até outubro de 2014 nas línguas Portuguesa, Inglesa e Espanhola.Resultados: Deve-se levar em consideração para indicar as próteses overdentures e protocolo o suporte ósseo, suporte labial, linha do sorriso, comprimento do lábio superior, qualidade e quantidade da mucosa, contorno do rebordo alveolar, relação coroa/osso, espaço interarcos e zona fonética. A reabilitação com overdenture pode trazer muitos benefícios ao paciente, tais como retenção, estabilidade, conforto, e a estética.Conclusões: Evidencia-se a necessidade de um planejamento individualizado, para que se chegue a um correto plano de tratamento, no qual as próteses fixas e overdentures possam ter um excelente prognóstico, desde que utilizadas no momento apropriado e no paciente indicado.

Oroantral fistulas closure using Bichat's fat pad / Fechamento de fístulas bucossinusais através do uso da bola de Bichat

The oroantral fistula is one of the complications most common after dental extractions in posterior maxillary, mainly in the region of second and third molar. The diagnosis is based on clinical signs and symptoms, which may be present in pain, fever, hyposmia and drainage of purulent discharge; additional examinations such as computed tomography and sinus nasal endoscopy improve diagnostic precision. It is therefore of paramount importance to correct early diagnosis and treatment avoiding in this way, the symptons of sinusitis, infections and dysphonia. Several surgical techniques have been proposed for the closure of the bucosinusal fistula; the use of Bichat´s fat pad has become a successful alternative among them. Many surgical treatments have been to propose for closure of bucosinusal fistula; Bichat fat pad has been a good alternative. The propose for this article is report two cases with closure of bucosinusal fistulas through Bichat's fat pad, as well as to discuss the surgical techniques, characteristics, indications and peculiarities.

A fístula bucosinusal ou oro-antral é uma das complicações mais comuns, após extrações dentárias na região posterior de maxila, principalmente em região de segundo e terceiro molares permanentes. O diagnóstico se baseia em sinais e sintomas clínicos, nos quais pode-se destacar: dor, febre, hiposmia e drenagem de secreção purulenta. Os exames complementares como a endoscopia sinonasal e a tomografia computadorizada melhoram a precisão diagnóstica. Assim, é de suma importância, o correto diagnóstico e tratamento precoce, evitando dessa maneira a instalação de sinusites, infecções e disfonia. Diversas técnicas cirúrgicas têm sido propostas na literatura, para o fechamento da fístula bucossinusal, dentre elas, a utilização do corpo adiposo de Bichat tem se tornado uma alternativa bem sucedida. O objetivo deste trabalho é relatar dois casos clínicos de fechamento de fístulas bucossinusais através do retalho da bola de Bichat, realizados pelo Departamento de Cirurgia e Traumatologia Bucomaxilofacial do Hospital da Face e Hospital da Restauração em Recife, Pernambuco. Ainda, descrever acerca de sua técnica cirúrgica, características, indicações e peculiaridades.

Effect of infrared laser in the prevention and treatment of paresthesia in orthognathic surgery.

Orthognathic surgery is the surgical procedure that makes correcting deformities of the bones in the region of the maxilla and mandible a reality in the Brazilian dentistry. However, this type of surgery usually involves paresthesia in the postoperative period, concerning the surgeons who perform them and generating discomfort to patients. This study aimed at evaluating the effect of infrared laser (830 nm) in the prevention and treatment of paresthesias after orthognathic surgery. Six patients underwent orthognathic surgery: the experimental group composed of 4 patients and the control group that did not receive laser therapy composed of 2 patients. The experimental group received laser applications during the transoperative and 12 postoperative sessions. Tests for mechanical (deep and shallow) and thermal (cold) sensitivity were performed in the preoperative and postoperative period (during 12 sessions) in the lip and chin areas by the same operator. The paresthesia was classified into 1, strong; 2, moderate; 3, mild; and 4, absent, through the patient's response to stimuli. The results showed that all patients had no disturbance of sensitivity in the preoperative period, but paresthesia was presented at various levels in the postoperative period. Both groups showed recovery of deep mechanical sensitivity within a shorter time interval compared with the superficial mechanical and thermal sensitivity. However, at the 12th assessment, patients who underwent the laser therapy showed better reduction in the level of paresthesia or even complete regression of this. The laser, therefore, brought benefits to the treatment of paresthesia, accelerating the return of neurosensorial sensitivity.

Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥ 6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

Critérios de escolha no planejamento das próteses overdentures e totais fixas parafusadas / Selection criteria on prosthetic planning for implant-supported overdenture and total fixed prostheses: literature review

A perda dos dentes naturais é avassaladora para os pacientes e sua reposição com elementos artificiais torna-se essencial para a reabilitação estética, fonética e mastigatória. Porém, a reabilitação protética muitas vezes torna-se insatisfatória em função da falta de tecido de suporte para utilização de prótese, culminando em perda de qualidade de vida. A utilização de próteses sobreimplantes tipo protocolo e overdenture estabeleceu uma opção terapêutica satisfatória e eficiente para a reabilitação oral. O objetivo deste trabalho foi expor e discutir duas situações clínicas distintas de reabilitação onde são comparados os fatores biomecânicos e outros fatores relevantes, como idade, sexo, densidade óssea e dentição antagonista que permitem a reabilitação através de próteses protocolo e overdenture

The loss of natural teeth is overwhelming for patients and their replacement with artificial elements is essential for the rehabilitation, aesthetics, phonetics, and mastication. However, the prosthetic rehabilitation often becomes unsatisfactory due to the lack of supporting tissue for use of prosthesis, resulting in loss of quality of life. The use of implant-supported, total fixed, and overdenture modalities established a satisfactory and efficient treatment for oral rehabilitation options. The objective of this work is to describe and discuss two distinct clinical situations of rehabilitation where biomechanical and other relevant factors are compared, such as age, gender, bone density, and the opposing dentition allowing rehabilitation in both modalities

Implantes dentários imediatos e em carga imediata / Immediate placed and immediate loaded implants. A literature review

A evolução da Implantodontia vem trazendo o desenvolvimento de novas técnicas, que levam cada vez mais conforto ao paciente, seja pelo fato de menos intervenções cirúrgicas com o implante imediato, seja pelo menor tempo que ele passe desdentado, pela técnica da carga imediata. O implante imediato é utilizado, geralmente, logo após a realização de exodontia, para que futuramente seja colocada a prótese. Sua principal vantagem é de redução das etapas cirúrgicas e de evitar a reabsorção óssea, principalmente em áreas estéticas. O uso da carga imediata em implantes tem a finalidade de reduzir o tempo de tratamento, possibilitando que o procedimento protético seja realizado logo após a colocação do implante, porém, o cirurgião-dentista deve saber indicar adequadamente a sua aplicação, seguindo todos os critérios necessários para evitar que ocorram insucessos do tratamento. Este trabalho teve por objetivo revisar a literatura acerca de dois métodos de instalação de implantes, de carga imediata e imediatos, que visem reduzir o tempo de espera pela prótese por parte dos pacientes e apontar suas principais indicações e contraindicações.

he evolution of dental implants has led to the development of new techniques that bring more comfort to the patient, either by the need for fewer surgical interventions with the immediate implant or by the short time period patients spent toothless on immediate loading. The immediate implant is used soon after tooth extraction for prosthesis delivery. Its advantages include reduction of surgical steps and bone resorption, particularly in esthetics areas. The use of immediate loading is intended to reduce overall treatment time, allowing prosthetic installation immediately after implant placement; however, proper indications are necessary as well as the correct protocol for preventing the incidence of treatment failures. This paper aims to review the literature on these two methods for implant placement (immediate implants and immediate loading) which reduce time until prosthesis delivery, highlightening their main indications and drawbacks.

Avaliação histológica da eficácia do laser de λ 830 nm no reparo ósseo de feridas cirúrgicas com implante de proteínas morfogenéticas ósseas (BMPs) e membrana biológica / Evaluation histologic of eficacy on the repair of sugical defects with implant bone morphogenetic proteins (BMPs) and biological menbrane

Um dos maiores problemas na odontologia moderna é a recuperação de perdas ósseas que podem ser ocasionados por trauma, procedimentos cirúrgicos ou por processos patológicos. Diversos tipos de biomateriais tem sido usados na tentativa de melhorar o reparo das mesmas, estes muitas vezes são associados a RTG. Estudos têm evidenciado efeitos positivos da Laserterapia sobre o processo de reparo de feridas de tecidos moles, porém os seus efeitos sobre tecidos ósseo ainda são poucos conhecidos. O objetivo deste trabalho foi avaliar macroscópica e histologicamente, através de microscopia de luz a eficácia da Laserterapia (AsAIGa, λ830nm, P=40mW, CW, Φ ~0,6mm, 16J/cm² por sessão) no reparo ósseo de feridas cirúrgicas em fêmur de ratos da raça Wistar albinos g~enero – macho), submetidas a implante de proteínas morfogenéticas ósseas (BMps – Gen-pro®), associadas ou não a membrana biológica de osso bovino liofilizado desmineralizado (gen-derm®). Feridas ósseas padronizadas (2mm²) foram criadas no fêmur de 96 animais, divididos em oito grupos: Grupo I (controle - 12 animais); Grupo II (Experimental Laser – 12 animais); Grupo III (Experimental Membrana – Gen-derm® - 12 animais); Grupo IV (Experimental Membrana – gen-derm® + Laser – 12 animais); Grupo V (Experimental BMPs – Gen-pro® - 12 animais); Grupo VI (Experimental BMPs – Gen-pro® + Laser – 12 animais); Grupo VII (Experimental BMPs – Gen-pro® + Membrana – Gen-derm® + 12 animais); Grupo VIII (Experimental BMPs – Gen-pro® + Membrana – Gen-derm® + laser – 12 animais). Os grupos experimentais Laser, receberam sete irradiações com intervalos de 48h, sendo a primeira imediatamente após o ato cirúrgico. A dosimetria utilizada foi de 16J/cm² por sessão, divididos em quatro pontos de 4J/cm², perfazendo uma dose total de tratamento de 112J/cm². Os períodos de sacrifício foram de 15, 21 e 30 dias. Os resultados obtidos no presente estudo demonstraram que nas feridas cirúrgicas irradiadas, foi evidenciado histologicame.