Paladar o Tuberosidad, ¿Cuál es la Mejor Zona Donadora para un Injerto de Tejido Blando?: Una Revisión Sistemática / Palate or Tuberosity, Which is the Best Donor Site for a Soft tissue graft? A Systematic Review

RESUMEN: Comparar mediante una revisión sistemática los resultados clínicos de los procedimientos de cirugía plástica periodontal/periimplantar (CP) con injerto de tejido blando autógeno (ITB) obtenido del área lateral del paladar (ALP) versus del área de la tuberosidad (AT). Se realizó una búsqueda electrónica de ensayos clínicos en la base de datos Medline/Pubmed, Cochrane y las revistas de Periodoncia e Implantes de mayor impacto según la Web of Science, para hallar artículos publicados hasta abril del 2020. Se valoró el riesgo de sesgo de los artículos añadidos según el manual Cochrane Versión 5.1.0 para ensayos clínicos aleatorizados y la escala Newcastle-Ottawa para ensayos clínicos controlados. De una muestra inicial de 930 artículos, cuatro ensayos clínicos (tres aleatorizados) fueron incluidos en el presente estudio, donde se realizaron un total de 87 CP alrededor de piezas e implantes dentales, de las cuales 42 cirugías fueron realizadas con ITB del ALP y 45 cirugías con ITB del AT, se evaluó los resultados desde las 8 semanas hasta los 12 meses. No se hallaron diferencias estadísticamente significativas en los resultados clínicos entre ambos grupos, se mejoró el fenotipo gingival en la zona receptora para el grupo que obtuvo el ITB del AT y el nivel del dolor del sitio donador del AT fue menor en las dos primeras semanas que el sitio donante del ALP. Los estudios incluidos manifestaron un bajo riesgo de sesgo en promedio. Ambas áreas donantes de injerto de tejido blando proporcionan resultados clínicos similares, el injerto del área de la tuberosidad mejora el fenotipo gingival de la zona receptora y reduce el dolor post operatorio en las primeras semanas del sitio donador.

ABSTRACT: The objective of the study was to compare, through a systematic review, the clinical results of periodontal / peri-implant plastic surgery (CP) procedures with autogenous soft tissue graft (ITB) obtained from the lateral palate area (ALP) versus the tuberosity area (AT). We conducted an electronic search of clinical trials in the Medline/Pubmed, Cochrane database and the journals of Periodontics and Implants with the greatest impact according to the Web of Science, to find articles published until April 2020. The risk of bias of the articles added was assessed according to the Cochrane Manual Version 5.1.0 for randomized clinical trials and the Newcastle-Ottawa scale for controlled clinical trials. From the initial sample of 930 articles, four clinical trials were included (three randomized) in the present study, where a total of 87 PC were performed around dental pieces and implants, of which 42 surgeries were performed with ITB of the ALP and 45 surgeries with ITB of the AT, the results were evaluated from the 8 weeks to 12 months. No statistically significant differences were found in the clinical results between the two groups, the gingival phenotype in the receiving area was improved for the group that obtained the ITB of the AT and the level of pain at the donor site was lower in the first two weeks than the ALP donor site. The studies showed a lowrisk of bias on average. Both soft tissue graft donor areas provide similar clinical results, grafting the tuberosity area improves the gingival phenotype of the recipient area and reduces post-operative pain of the donor site in the first few weeks.

Risk factors associated with short dental implant success: a long-term retrospective evaluation of patients followed up for up to 9 years.

This multicenter study aimed to identify the different implant- and patient-related risk factors for long-term short dental implant success. Through a retrospective chart review of three centers, patient information regarding demographic variables, smoking habits, history of periodontitis, systemic diseases, and medications in addition to the parameters for short implant placement including implant manufacturer, design, anatomical location, diameter and length, and type of placement was collected. For statistical analysis, univariate regression models were used at the implant and patient levels. A total of 460 short implants placed in 199 patients followed up for up to 9 years were reviewed. Survival rates of the short implants were 95.86% and 92.96% and success rates were 90% and 83.41% for implant- and patient-based analysis, respectively. Peri-implantitis was reported as the primary cause of short dental implant failure (34/46, 73.91%). Univariate regression models revealed that female sex was strongly related to short implant success. In addition, smoking and history of periodontitis were found to have a significant negative influence on short implant success at the implant and patient levels. Taken together, these results support the use of short implants as a predictable longterm treatment option; however, smoking and history of periodontitis are suggested to be the potential risk factors for short implant success. Therefore, clinicians need to assess these potential risk factors and make treatment decisions accordingly.

Risk factors associated with short dental implant success: a long-term retrospective evaluation of patients followed up for up to 9 years

Abstract: This multicenter study aimed to identify the different implant- and patient-related risk factors for long-term short dental implant success. Through a retrospective chart review of three centers, patient information regarding demographic variables, smoking habits, history of periodontitis, systemic diseases, and medications in addition to the parameters for short implant placement including implant manufacturer, design, anatomical location, diameter and length, and type of placement was collected. For statistical analysis, univariate regression models were used at the implant and patient levels. A total of 460 short implants placed in 199 patients followed up for up to 9 years were reviewed. Survival rates of the short implants were 95.86% and 92.96% and success rates were 90% and 83.41% for implant- and patient-based analysis, respectively. Peri-implantitis was reported as the primary cause of short dental implant failure (34/46, 73.91%). Univariate regression models revealed that female sex was strongly related to short implant success. In addition, smoking and history of periodontitis were found to have a significant negative influence on short implant success at the implant and patient levels. Taken together, these results support the use of short implants as a predictable longterm treatment option; however, smoking and history of periodontitis are suggested to be the potential risk factors for short implant success. Therefore, clinicians need to assess these potential risk factors and make treatment decisions accordingly.

Knowledge, Awareness, and Attitude Regarding Dental Implants among Dental Interns.

INTRODUCTION: Implant therapy is an elective dental procedure of dental rehabilitative treatment. Objective of this study was to assess the knowledge, awareness, and attitude of dental interns of Nepal toward dental implants and to see associations of the responses with gender and geographic location of dental college. METHODS: It was conducted from June 2016 to June 2017 after taking ethical clearance and approval from the research committee. The sample included the interns who were present at the time of the survey. Data collection was done through a cross-sectional questionnaire survey, during clinical postings of the interns at all the dental colleges of Nepal, supervised and monitored by the investigators themselves; coded and entered in Microsoft Excel 2013 and statistical analysis was done by SPSS 20 version. RESULTS: A majority of the interns said they are moderately well informed about dental implants 141 (50.36%); main advantage of dental implants is they are conservative 164 (58.6%); most important factor for implant success is case selection 143 (51.07%); the longevity of dental implants is 10-20yrs, 162 (57.85%), 188 (67.14%) agreed that they were not provided with sufficient information and 191 (68.21%) stated that they need more information; 180 (64.3%) felt the difficulty encountered while placing implants is average and 229 (81.78%) stated that they need more hygiene care than natural teeth. There were major differences in the mindset to some other questions. Significant associations were seen with the location of college for some responses. CONCLUSIONS: A majority of interns have knowledge regarding dental implants, but the percentage of those who gave unsatisfactory answers is also large. They have a positive attitude towards gaining more information through various means.

Etiología de las Pérdidas Dentales en Pacientes Rehabilitados con Prótesis sobre Implantes / Etiology of Tooth Loss in Patients Rehabilitated with Dental Implants

RESUMEN: El objetivo de esta investigación fue analizar la etiología de las pérdidas dentales en pacientes rehabilitados con prótesis sobre implantes. Se realizó un estudio transversal con informaciones de 93 pacientes de una clínica privada que recibieron tratamiento con implantes en el período de 2000 a 2009. Los datos fueron recolectados a través de las fichas clínicas, documentaciones radiográficas y fotografías de los casos clínicos. Se levantaron datos sobre género, edad, nivel de escolaridad, hábito de fumar, tipo de diente extraído y razón de la extracción. Los resultados mostraron que la razón periodontal fue el principal motivo de las pérdidas dentales, representando el 24,7 %, seguida por las fracturas radiculares con pines metálicos (23,7 %) y caries secundarias (15,1 %). En los pacientes menores de 40 años, los traumatismos dentales y las fracturas radiculares con pino fueron responsables de la mayoría de las pérdidas. Las razones de las pérdidas dentales mostraron significancia estadística con la variable edad (p<0,05). El género, el hábito de fumar y el grado de escolaridad no mostraron asociación significativa (p>0,05) con las razones de las pérdidas dentales.

ABSTRACT: The aim of this study was to analyze the etiology of tooth loss in patients rehabilitated with dental implants. Was conducted a cross-sectional study with data from 93 patients from a private clinic who were treated with implants from the year 2000 until 2009. Data were collected through medical records, radiographic documentation and photographs of clinical cases. Data on sex, age, education level, smoking habits, teeth loss localization and extraction ratio were analyzed. The results showed that periodontal disease was the main reason for tooth loss, accounting for 24.7 %, followed by root fractures with posts (23.7 %) and secondary caries (15.1 %). In patients below 40 years, dental trauma and root fractures were responsible for most of the losses. The reasons for tooth loss showed statistical significance with the age (p<0.05). Sex, smoking habits and education showed no significant association (p>0.05) with the reasons of the tooth loss.

Morphological assessment of the mandibular canal trajectory in edentate subjects.

BACKGROUND: The mandibular canal and its content represent the vital structure, which can complicate dentoalveolar surgical procedures in the posterior region of the mandible. The purpose of the present study was to determine the path the mandibular canal takes in relation to the horizontal and the vertical anatomical reference planes in edentate subjects, in order to minimize the risk of affecting its neurovascular content during various oral surgery procedures. MATERIALS AND METHODS: Morphometric evaluations were performed on 12 dried fully edentulous human mandibles and on cone-beam computed tomography (CBCT) cross-sectional images of the mandible, from 20 patients with either partial or complete edentulism. Both methods were utilized, in three target areas (corresponding to the second premolar, to the first molar and to the second molar regions), in order to measure the distance between the mandibular canal and the following reference points: (i) the lateral (buccal) surface of the mandible (MC-BS distance); (ii) the medial (lingual) surface of the mandible (MC-LS distance); (iii) the alveolar surface of the mandible (MC-AS distance). The results were statistically processed in Stata MP/13 software package using analysis of variance (ANOVA) test. RESULTS: The mandibular canal crossed the trabecular bone from the posterior towards the anterior, and from the lingual towards the buccal, reaching the premolar region, distal to the mental foramen, where it was located in the centre of the trabecular bone, main topographic pattern encountered in 27 (84.37%) of the cases. In five (15.63%) of the cases, in the premolar region, the mandibular canal was located near the buccal cortical plate. The mandibular canal descended from the second molar region towards the premolar region, main topographic pattern found in 28 (87.5%) of the cases. In four (12.5%) cases, the mandibular canal had a descending trajectory in the molar regions and it took a slightly ascending course in the premolar region. CONCLUSIONS: According to the results, the second molar region represents the highest risk area in the accidental injury to the content of the mandibular canal, during various oral surgery procedures.

Chronological Age as Factor Influencing the Dental Implant Osseointegration in the Jaw Bone.

The objectives of this study were to evaluate osseointegration of dental implant in the jaw bone in the young and elderly population and comparing the results to assess indicators and risk factors as age for the success or failure of dental implants. A retrospective study of 107 implants (Impladent, LASAK, Czech Republic) was prepared. The patients at implants surgery were divided in three groups. The patients were followed-up for a 7-year period. We evaluated osseointegration from long term point of view as a change of marginal bone levels close to dental implant. Marginal bone levels were recorded and analysed with regard to different patient- and implant-related factors. An influence of chronological age on change of marginal bone levels during 6-year retrospective study vas evaluated. The study examined 47 patient charts and 107 implants from the Second Faculty of Medicine, Charles University and University Hospital Motol. We proved that young healthy patients with long bridges or Branemarks have the same progression of marginal bone levels changes. The chronological age hasn't therefore direct influence on the osseointegration from long term point of view. But we found that the length of dental suprastrucure-prosthetic construction negatively influences marginal bone changes, though these results weren't statistically significant. More extensive dental implant suprastrucure undergoes smaller osseointegration. On the other hand the length of dental suprastrucure (prosthetic construction) negatively influences dental osseointegration in both groups of patient.

Implant and root canal treatment: Survival rates and factors associated with treatment outcome.

OBJECTIVES: To assess and compare the survival rates of implant and root canal treatment as well as to investigate the effect of patient and tooth related variables on the treatment outcome in a large-scale population-based study. METHODS: Dental records of patients who received root canal treatment and implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). RESULTS: A total of 13,434 records of patients who had implant (33.6%) or root canal therapy (66.4%) were included. The survival rate analysis and Kaplan-Meier table revealed the majority of the implants were removed within the first year (58.8%), while only 35.2% of the root canal treatments failed in the same time period. The overall survival rate was significantly (p < 0.001) higher for implant therapy (98.3%) compared to root canal treatment (72.7%). A statistically significant association was found between treatment (p 

A systematic review and meta-analysis of the survival rate of implants placed in previously failed sites

Abstract The aim of this study was to conduct a systematic review and meta-analysis to assess the clinical outcomes of dental implants placed in previously early and late implant failed sites. An electronic literature search was conducted in several databases for articles published up to February 2018. Human clinical trials that received at least one implant in a previously failed site were included. Hence, the PICO question that was aimed to be addressed was: Do patients undergoing implant replacement (second and third attempts) in previous failed sites have survival rates similar to implants placed at first attempts? A random effects model was used to calculate survival weighted means and corresponding 95% Confidence Intervals (CI) among studies. Eleven studies of low to moderate methodological quality were included in this review. Implants placed in sites with history of one and two implant failures had a weighted survival rate (SR) of 88.7% (95%CI 81.7-93.3) and 67.1% (95%CI 51.1-79.9), respectively. Implants placed in sites with a previous early failure revealed a weighted SR of 91.8% (95%CI 85.1-95.6). First implants presented higher SR than implants placed in sites with one or two previous implant failures. In contrast, implants placed in sites with one and two implant failures had similar SR. Within its limitations, this review suggests that replacement implants have moderate SR. Larger prospective studies with well-defined criteria for early and late implant failure are necessary to confirm and expand on these results.

The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature.

Radiation therapy for the treatment of head and neck cancer can injure normal tissues and have devastating side effects. Hyperbaric oxygen (HBO) is known to reduce the severity of radiation-induced injury by promoting wound healing. While most of the research in literature has focused on its efficacy in osteonecrosis, HBO has other proven benefits as well. The aim of this review was to identify the various benefits of hyperbaric oxygen therapy in patients who have undergone radiation for head and neck cancer. An electronic database search was carried out to identify relevant articles and selected articles were reviewed in detail. The quality of evidence for each benefit, including preserving salivary gland function, preventing osteonecrosis, dental implant success, and overall quality of life, was evaluated. Evidence showed that HBO was effective in improving subjective symptoms of xerostomia, swallowing, speech and overall quality of life. There was no conclusive evidence to show that HBO improved implant survival, prevented osteonecrosis, or improved salivary gland function. The high costs and accessibility of HBO therapy must be weighed against the potential benefits to each patient.

Taxa de sobrevivência de implantes e biomateriais no levantamento do seio maxilar com pneumatização significativa: um estudo retrospectivo com 79 pacientes, durante seis meses a dez anos / Survival rate of immediate dental implants and biomaterials after large sinus lifting procedures: a retrospective study on 79 patients with a 6-month to 10-year follow-up

Objetivo: avaliar retrospectivamente a taxa de sucesso de implantes e biomateriais após o levantamento do seio maxilar. Material e métodos: foram utilizados prontuários de pacientes tratados entre 1998 e 2014, incluídos os que possuíam rebordo maxilar com altura menor do que 5 mm. Todos os procedimentos de enxertia foram realizados com instalação de implante de forma mediata e acesso ao seio maxilar pela janela óssea lateral, colocação do biomaterial, membrana e sutura. Resultados: foram analisados 79 pacientes, tendo sido utilizados dois biomateriais. O tempo de reavaliação variou de seis meses a dez anos. Nos dados de altura óssea radiográfica antes e depois do procedimento (70 implantes, 36 pacientes), houve um aumento médio de altura na região do seio maxilar com o Bio-Oss de 17,23 mm e com o Orthogen de 13,12 mm (p < 0,05), sendo a média geral de 15,17 mm. Na relação sobrevida do implante e enxerto utilizado (92 implantes, 43 pacientes), os valores foram de 96,8% (autógeno) e 98,3% (autógeno + biomaterial). Conclusão: os resultados permitiram concluir que tanto os enxertos autógenos como os biomateriais são alternativas viáveis para os seios maxilares com grande pneumatização.

Objective: to retrospectively evaluate the success rate of implants and biomaterials after maxillary sinus lift. Material and methods: records of patients treated between 1998 and 2014 were used, including those with maxillary ridge height less than 5 mm. All grafting procedures were performed with implant placement and access to the maxillary sinus through the lateral bony window, placement of the biomaterial, membrane and suture. Results: 79 patients were analyzed and two biomaterials were used. The follow-up period ranged from six months to ten years. In the radiographic bone height data before and after the procedure (70 implants, 36 patients), there was a mean increase in height in the maxillary sinus region with the Bio-Oss of 17.23 mm and with the Orthogen of 13.12 mm (p < 0.05), the overall mean being 15.17 mm. Regarding implant and graft survival (92 implants, 43 patients), the values were 96.8% (autogenous) and 98.3% (autogenous + biomaterial). Conclusion: both autogenous grafts and biomaterials are viable alternatives for the maxillary sinuses with great pneumatization.

Avaliação in vivo do torque de inserção do novo sistema de implantes Emfils / In vivo insertion torque assessment of the new dental implant system Emfi ls

Objetivo: avaliar o torque de inserção de um novo desenho de implante. Material e métodos: pacientes foram recrutados para instalação de implantes, no período de março a dezembro de 2015. Dados como o diâmetro, o comprimento do implante, a sequência de fresagem, a área de instalação e o torque atingido foram considerados. A avaliação do torque foi realizada com um torquímetro cirúrgico. Resultados: foram avaliados 82 implantes, com diâmetros entre 3,5 mm e 5 mm, e comprimentos entre 7 mm e 16 mm, sendo instalados 46 implantes na mandíbula e 36 implantes na maxila. Os torques (média ± desvio-padrão) alcançados foram de 53 ± 9,9 Ncm para maxila e 57 ± 11,3 Ncm para mandíbula. Conclusão: o sistema de implantes Novo Colosso promoveu torque de inserção adequado, com boa estabilidade primária nos implantes.

Objective: to evaluate the insertion torque of a new implant design. Material and methods: patients were recruited for implant placement from March to December 2015. Data such as diameter, implant length, drilling sequence, installation area, and torque reached were considered. Torque evaluation was performed with a surgical torque wrench. Results: 82 implants were evaluated, with diameters between 3.5 mm and 5.0 mm, and lengths between 7 mm and 16 mm, with 46 implants in the mandible and 36 implants in the maxilla. The torques (mean ± standard deviation) reached 53 ± 9.9 Ncm for maxilla and 57 ± 11.3 Ncm for mandible. Conclusion: the Novo Colosso implant system promotes adequate insertion torque with good primary implant stability.

What do sales data tell us about implant survival?

OBJECTIVE: The aim of this study was to evaluate the influence of implant diameter, length and shape on a surrogate parameter of implant survival; i.e. the implant return rate in a big data analysis. MATERIALS AND METHODS: A retrospective study was conducted and the factors influencing the success rates of 69,377 sold implants over a seven-year period were evaluated. The osseointegration program of a reseller provides reliable data of a single country. Implant loss rates were investigated using logistic regression models and regressed by implant type, diameter, and length. RESULTS: The return rate of 69,377 sold implants was 2.78% and comparable to implant loss rates in previous published prospective studies as its surrogate parameter. A total of 80% of implant returns had occurred within 157 days, and an additional 15% within 750.25 days. Diameters of 3.8 to 5.0mm showed the lowest return rates with its bottom in the 4.3mm implant whilst 6.0mm implants had significantly higher return rates. In comparison to the most sold implant length (13mm) shorter implants showed significantly higher early return rates. CONCLUSIONS: The study provides evidence that in cases of standard indications and sufficient bone, the use of screw typed dental implants with 3.8 or 4.3 diameter and 11 or 13 mm length shows the lowest implant return rates. Other implants may be selected only in specific indications.

Dental Implants in the Elderly Population: A Long-Term Follow-up.

PURPOSE: The objectives of this study were to evaluate implant survival and success in the elderly population and to assess indicators and risk factors for success or failure of dental implants in older adults (aged 60 years and older). MATERIALS AND METHODS: This historical prospective study was developed from a cohort of patients born prior to 1950 who received dental implants in a single private dental office. Implant survival and marginal bone levels were recorded and analyzed with regard to different patient- and implant-related factors. RESULTS: The study examined 245 patient charts and 1,256 implants from one dental clinic. The mean age at the time of implant placement was 62.18 ± 8.6 years. Smoking was reported by 9.4% of the cohort studied. The overall survival rate of the implants was 92.9%; 7.1% of the implants had failed. Marginal bone loss depicted by exposed threads was evident in 23.3% of the implants. Presenting with generalized periodontal disease and/or severe periodontal disease negatively influenced the survival probability of the implant. Implants placed in areas where bone augmentation was performed prior to or during implant surgery did not have the same longevity compared with those that did not have augmentation prior to implantation. CONCLUSION: The overall findings concluded that implants can be successfully placed in older adults. A variety of factors are involved in the long-term success of the implant, and special consideration should be taken prior to placing implants in older adults to limit the influence of those risk factors.

Análise in vivo da modulação óssea em implantes de titânio com superfície em nanoescala / Analysis in vivo of bone modulation in titanium implants with nanoscale surface

Nas últimas décadas houve um aumento considerável na utilização dos implantes metálicos para aplicações na área da ortopedia e odontologia, por isso as pesquisas têm como foco estudar os mecanismos biológicos de interação osso-implante. A nanotopografia de superfície de implantes osseointegráveis apresenta efeito direto sobre a resposta biológica óssea. No entanto a maneira como afeta a osseointegração in vivo ainda não está totalmente elucidada. O objetivo neste estudo foi comparar in vivo a influência da superfície em nanoescala (nano) confeccionada em implantes de titânio comercialmente puro (Ticp), comparado-a a superfície lisa (controle) em modelo experimental de camundongos osterix-mcherry (Osx-mcherry), os quais expressam proteína fluorescente concomitante com a expressão do gene osterix (Osx). Os animais receberam implantes de superfície lisa no fêmur direito e com nanoescala no fêmur esquerdo. Após diferentes períodos de eutanásia baseados na metodologia empregada foram realizados nas peças e nas células os seguintes testes biológicos: microscopia eletrônica de varredura (MEV) para avaliação da adesão celular e da superfície do implante; histologia e nanotomografia (nanoCT) para observação e quantificação de osso neoformado na interface osso/implante; citometria de fluxo para quantificação de células marcadas pelo gene osterix; PCR em tempo real (qPCR) para avaliação da expressão gênica; coloração fosfatase ácida resistente ao tartarato (TRAP) para contagem de osteoclastos. Nossos resultados mostraram que a maioria dos genes estudados estavam superexpressos nas amostras com superfície em nanoescala sendo que alguns deles apresentaram diferenças estatísticas (Teste t, p < 0.05), tais como: Osx (osterix), Alp (fosfatase alcalina), Prx1(homeobox relacionado emparelhado -1), Dmp1 (Dolicol-fosfatase mannosiltransferase subunidade 1), Bsp (sialoproteína óssea) e Ocn (osteocalcina). Os testes estatísticos ANOVA two way seguido do Teste de Tukey quando necessário, foram utilizados para os demais experimentos e o nível de significância foi estabelecido em p < 0.05. Diferenças estatísticas foram encontradas para o nanoCT e histologia entre as superfícies e períodos avaliados e os melhores resultados foram observados para a nanoescala. A coloração TRAP também mostrou diferenças estatísticas entre as superfícies e períodos estudados, com a superfície lisa mostrando melhores resultados aos 3 dias e a nano aos 5 e 7 dias. Não houve diferença estatística para a citometria de fluxo, porém a superfície em nanoescala mostrou melhores resultados que a lisa em todos os períodos analisados. Concluímos que a superfície em nanoescala possui propriedades osteocondutivas e favorece os eventos biológicos que ocorrem na superfície do implante melhorando o processo de osseointegração(AU)

In the last decades there has been a considerable increase in the use of metal implants for applications in the area of orthopedics and dentistry, so the researches are focused on studying the biological mechanisms of bone-implant interaction. Surface nanotopography of osseointegrated implants has a direct effect on the biological response of bone. However the way it affects osseointegration in vivo is not yet fully elucidated. The aim of this study was to compare the in vivo influence of the nanoscale surface (nano) made on implants of commercially pure titanium (Ticp) with the smooth surface (control), using an experimental model of osterix-mcherry mice (Osx-mcherry), which express fluorescent protein concomitant with osterix gene expression (Osx). The animals received implants with smooth surface in the right femur and nanoscale in the left femur. After different periods of euthanasia based on the methodology used, biological tests were performed in the femur and cells: scanning electron microscopy (SEM) for evaluation of cell adhesion and implant surface; histology and nanotomography (NanoCT) for observation and quantification of neoformed bone at implant interface; flow cytometry for quantification of cells marked by the osterix gene; Real-time PCR (qRT-PCR) for gene expression evaluation; tartrate resistant acid phosphatase staining (TRAP) for osteoclast counts. Our results showed that most genes studied were overexpressed in the nanoscale surface and some of which presented statistical differences(t Test, p <0.05), such as: Osx (osterix), Alp (alkaline phosphatase), Prx1 (related paired homeobox), Dmp1 (Dolicol-phosphatase mannosyltransferase subunit 1), Bsp (bone sialoprotein) and Ocn (osteocalcin). The two-way ANOVA statistical test followed by the Tukey test when necessary were used for the other experiments and the level of significance was set at p <0.05. Statistical differences were found for the nanoCT and histology between surface and periods evaluated and the best results were observed for the nanoscale. The TRAP staining also showed statistical differences between the surfaces and periods studied, with the smooth surface showing better results at 3 days and nano at 5 and 7 days. There was no statistical difference for flow cytometry, but the nanoscale surface showed better results than the smooth surface in all analyzed periods. We conclude that the nanoscale surface has osteoconductive properties and improves the biological events that occur on implants surface improving the osseointegration process(AU)

Lesiones del nervio dentario inferior en cirugías implantológicas del sector posterior mandibular / Inferior dental nerve injuries in implant surgeries on the posterior mandibular zone

Objetivo: se presenta este estudio para determinar el porcentaje de alteraciones nerviosas posteriores alas cirugías implantológicas del sector posterior mandibular. Pacientes y métodos: Se realizó un estudioretrospectivo de las cirugías implantológicas del sector posterior mandibular desde Enero de 2013 a Junio de 2015. Se incluyeron sólo las cirugías de rebordes cicatrizadosen brechas libres e intercalares. Resultados: Se colocaron 234 implantes en 106 pacientes en zonade premolares y molares inferiores. Se obtuvo un solo caso de alteración nerviosa post quirúrgica, determinandoun porcentaje de 0,43 por ciento (IC95: 0,08 por ciento a 2,38 por diento) por implante colocado, y un 0,94 por ciento (IC95: 0,17 por ciento a 5,15 por ciento) por paciente tratado. Esta alteración nerviosa revirtió a los 2 meses. No se registraron casos de alteraciones permanentes. Conclusión: El porcentaje de alteraciones nerviosas posteriores a cirugías implantológicasdifiere considerablemente en la literatura. Se han presentado valores en un rango de 0 a 40 por ciento.Indudablementeen una buena práctica quirúrgica, como se presenta en este estudio, los valores de alteracionesnerviosas deberían ser cercanos a cero.

Aim: this study was designed to determine the percentage of altered sensation in patients undergoing posterior mandibular endoseous implant placement. Patients and Methods: One hounded and six patients who underwent posterior mandibular implant placement, from January 2013 to June 2015, constituted thestudy group. Only surgeries performed in edentulou salveolar bone sites were included. Results: 234 implants were placed in premolar and molar areas. There was only one case of nerve injury that recovered two months after the surgery. The percentage of temporary altered sensation was 0.43% (IC95: 0.08% a 2.38%) per implant placed, and 0.94% (IC95: 0.17%a 5.15%) per patient treated. No cases of permanent altered sensation were observed. Conclusion: Thepercentage of altered nerve sensation after posterior mandibular implant placement varies considerably in the international literature. Studies have presented values ranging from 0 to 40%. By using proper treatment planning, as shown in this study, nerve injuries values should be close to zero.

Regeneração óssea na região posterior da maxila para instalação de implantes dentários / Regeneración del hueso en la región posterior del maxilar para la instalación de implantes dentales / Bone regeneration in the posterior maxillary region for installation of dental implants

Introdução: regeneração óssea da região posterior da maxila, é um recurso importante para possibilitar a localização correta dos implantes e assim permitir uma adequada reabilitação protética. Várias técnicas cirúrgicas são relatadas, desde a forma de acesso ao seio, elevação da membrana de Schneider e preenchimento da cavidade. Objetivo: abordar os recursos que vem sendo utilizados na cirurgia de regeneração óssea da região posterior da maxila bem como a efetividade dos métodos aplicados. Métodos: foi realizada uma busca eletrônica da literatura, nas bases de dados LILACS, MEDLINE e BBO de estudos publicados na língua inglesa e portuguesa. Como critérios de inclusão foram considerados artigos entre o ano 2000 e 2014, sendo que as palavras chaves que orientaram a busca foram: maxillary bone regeneration, Schneiderian membrane, maxillary sinus lift. Foram obtidos 1 529 artigos, dos quais selecionados 27 artigos relevantes para o estudo em questão. Como critérios de exclusão foram eliminados artigos no qual se encontravam no ano abaixo de 2008 e que fugiam do assunto em questão. Análises e integração da informação : encontrou-se que a técnica tradicional de acesso ao seio maxilar com uso de brocas, elevação da membrana, por meio de curetas, e a regeneração propriamente dita com enxerto ósseo autógeno e/ou heterógeno continuam como as mais utilizadas, no entanto alternativas menos invasivas como tecnologia ultrassônica para fazer acesso, hidrodissecção para elevar a membrana Schneider e biomateriais para preencher a cavidade surgem como opções viáveis e com resultados favoráveis. Conclusões: existe um direcionamento na busca por métodos e materiais que diminuam a morbidade da técnica tradicional e que ofereçam resultados satisfatórios a curto e a longo prazo. A utilização de técnicas cirúrgicas menos invasivas e uso de biomateriais estão entre os avanços para a regeneração da região posterior da maxila(AU)

Introducción: la regeneración ósea de la región posterior del maxilar es un procedimiento importante que permite la correcta colocación de los implantes dentales y una adecuada rehabilitación protésica. Se describen varias técnicas quirúrgicas que van desde la forma de acceder al seno maxilar, el levantamiento de la membrana de Schneider hasta el relleno de la cavidad. Objetivo: abordar los recursos utilizados en la cirugía de regeneración ósea de la zona posterior del maxilar y la efectividad de los métodos aplicados. Métodos: se realizó una revisión bibliográfica en las bases de datos LILACS, MEDLINE y BBO en busca de estudios publicados en inglés y portugués. El criterio de inclusion abarcó los artículos publicados entre los años 2000 y 2014 y las palabras claves que orientaron la búsqueda fueron: regeneración del hueso maxilar, membrana de Schnneider y elevación del seno maxilar. Se encontraron 1 529 artículos de los cuales se seleccionaron 27 con contenido relevante para el estudio en cuestión. En cuanto a los criterios de exclusion, se eliminaron los artículos publicados antes del 2008 y que no se asociaban mucho con el tema referido. Análisis e integración de la información: se halló que la técnica tradicional de acceso al seno maxilar con el uso de brocas, el levantamaiento de la membrana de Schnneider por medio de curetas y la regeneración como tal mediante injertos óseos autógenos y/o heterógenos siguen siendo los procedimientos más utilizados. Por otra parte, alternativas menos invasivas como la tecnología del ultrasonido para lograr acceso, la hidrodisección para levantar la membrana de Schneider y el empleo de biomaterials para rellenar la cavidad emergen como opciones viables con resultados alentadores. Conclusiones: existe una orientación hacia la búsqueda de métodos y materials que disminuyan la morbilidad de las técnicas tradicionales y ofrezcan resultados satisfactorios a corto y a largo plazos. Las técnicas quirúrgicas menos invasivas y el uso de los biomateriales se encuentran entre los avances de hoy día para la regeneración de la zona posterior del maxilar(AU)

Introduction: bone regeneration of the posterior maxilla is an important feature to enable correct placement of implants and thus allow an adequate prosthetic rehabilitation. Several surgical techniques are reported, since the form of access to the sinus, elevation of Schneider membrane and fill the cavity. Objective: to address the resources used in bone regeneration surgery of the posterior maxilla and the effectiveness of the methods applied. Methods: an electronic search of the literature was performed in the databases LILACS, MEDLINE and BBO studies published in English and Portuguese. The inclusion criteria were considered articles between 2000 and 2014, with the key words that guided the search were: maxillary bone regeneration, Schneiderian membrane, maxillary sinus lift. 1 529 articles were obtained, of which 27 selected articles relevant to the study. Exclusion criteria were eliminated in the articles which were in the year below 2008 and fleeing the matter at hand. Data analysis and integration: it was found that the traditional technique of access to the maxillary sinus with the use of drills, lifting the membrane through curettes, and the regeneration itself with autogenous bone graft and/or heterogeneous continue as the most commonly used, however alternative as less invasive ultrasonic technology to access, hydrodissection to raise the Schneider membrane and biomaterials to fill the cavity emerge as viable, with favorable results options. Conclusions: there is a direction in the search for methods and materials that reduce the morbidity of traditional techniques and which offer satisfactory results in the short and long term. The use of surgical techniques less invasive and use of biomaterials are among the advances for the regeneration of the posterior maxilla(AU)

Avaliação retrospectiva das características dos implantes instalados na faculdade Ingá entre 2005 e 2014 / Retrospective evaluation of the characteristics of dental implants installed in the University Inga between 2005 and 2014

Objetivo: avaliar retrospectivamente as características dos implantes colocados no curso de especialização do Centro Universitário Ingá (Uningá). Material e métodos: os prontuários dos pacientes que realizaram tratamento entre 2005 e 2014 na Uningá foram analisados quanto à saúde sistêmica, sexo, idade, local de colocação, uso de enxertos, diâmetro e comprimento dos implantes, e complicações. Resultados: neste centro, 108 pacientes receberam 307 implantes de quatro marcas comerciais diferentes (154 na maxila e 160 na mandíbula). Os implantes foram instalados mais em mulheres (67,6%), principalmente na região posterior (76,7%), tanto de maxila (49%) quanto de mandíbula (51%), com o uso de enxertos ósseos em cerca de 20% dos casos da maxila e somente 1% dos casos de mandíbula. Além disso, ainda são realizados muitos implantes longos (38,6% > 13 mm), de diâmetro regular (83,6% entre 3,75 mm e 4 mm) e com plataforma do tipo hexágono externo (97,7%). Conclusão: no local pesquisado, ainda são instalados muitos implantes na região posterior, longos e de diâmetro regular, com plataforma do tipo hexágono externo. Além disso, os enxertos ósseos são usados em um em cada dez casos de implantes, principalmente na maxila.

Objective: to retrospectively evaluate the characteristics of implants placed in the specialization course of the Inga University Center (Uningá). Material and methods: the medical records of patients who underwent treatment between 2005 and 2014 at Uningá were analyzed for systemic health, gender, age, area of installation, use of grafts, diameter and length of the implants and complications. Results: in this center, 108 patients received 307 implants (four different brands, 154 in maxilla and 160 in mandible). The implants were installed more frequently in women (67.6%), mainly in the posterior region (76.7%), in both maxilla (49%) and mandible (51%), with the use of bone grafts in 20% of maxillary cases and only 1% of cases in mandible. The prevalence of long (38.6%, 13 mm), regular diameter (83.6% between 3.75 mm and 4 mm), and external hex implants (97.7%) was great. Conclusion: at the Uningá, many implants in the posterior region, long and of regular diameter with external hexagonal platform are still installed. Moreover, bone grafts are used in 1 of each 10 cases of implants, mainly in th e maxilla.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Implant survival and patient satisfaction of reduced diameter implants made from a titanium-zirconium alloy: A retrospective cohort study with 550 implants in 311 patients.

The aim of the study was to evaluate implant survival of reduced-diameter implants compared to regular-diameter implants. A retrospective evaluation of 154 Straumann Bone Level Roxolid® implants (diameter 3.3 mm) with SLActive®-surface in 107 patients, which were inserted between 2009 and 2010 in private practice, was performed. The mean observation period was 22.4 ± 8.2 months. 396 Straumann SLActive® implants (4.1 mm and 4.8 mm) in 204 patients, with an observation period of 28.4 ± 10.1 months served as control group. Implant survival rate, resonance frequency analysis and patient satisfaction were evaluated. The implant survival rate was 97.4% in the test vs. 98.5% in the control group. Resonance frequency analysis showed statistically significant lower values for the reduced-diameter implants. Patient satisfaction showed no significant difference between the test and the control group. Reduced-diameter implants displayed high survival rates during the period investigated and represent a convincing treatment alternative. Long-term follow-up investigations confirmed the high implant survival rates of 96.8% (after 69.7 ± 12.3 months) in the test group and 98.5% (after 76.0 ± 13.6 months) in the control group.