Rehabilitación implanto protésica en paciente con injerto mandibular de larga data / Implant-prosthetic rehabilitation in a patient with a longstanding mandibular graft / Reabilitação protética com implantes em pacientes com enxerto mandibular de longa data

En la actualidad es cada vez más frecuente la consulta de pacientes que siendo sometidos en edades tempranas a cirugías de extirpación tumoral y posterior reconstrucción con injertos presentan problemas tanto funcionales como estéticos, el uso de prótesis implantosoportadas mejora la calidad de vida, pero al mismo tiempo representan un desafío por la baja disponibilidad ósea. Se presenta un caso clínico de rehabilitación protésica implantosoportada en una paciente con gran déficit óseo mandibular como consecuencia de le extirpación de una neoplasia y posterior injerto de costilla. Se colocaron 2 implantes osteointegrados en hueso remanente y rehabilitación con prótesis removible sostenida a una barra colada. Por ser un tratamiento poco invasivo y conservador fue aceptado fácilmente por la paciente y la mejora tanto en la estética como en la función fue notoria.

Nowadays, it is becoming more and more frequent to see patients who underwent surgery for tumor removal and subsequent reconstruction with grafts at an early age, presenting both functional and esthetic problems. The use of implant-supported prostheses improves the quality of life, but at the same time represents a challenge due to the low availability of bone. A clinical case of implant-supported prosthetic rehabilitation is presented in a patient with a great mandibular bone deficit as a consequence of the removal of a neoplasm and subsequent rib graft. Two osseointegrated implants were placed in the remaining bone and rehabilitation with a removable prosthesis supported by a cast bar. Being a minimally invasive and conservative treatment, it was easily accepted by the patient and the improvement in both esthetics and function was notorious.

Atualmente, são cada vez mais frequentes os pacientes submetidos à cirurgia de remoção de tumores e posterior reconstrução com enxertos em idade precoce que apresentam problemas funcionais e estéticos. O uso de próteses implanto-suportadas melhora a qualidade de vida, mas, ao mesmo tempo, representa um desafio devido à baixa disponibilidade de osso. Apresentamos um caso clínico de reabilitação protética implanto-suportada em um paciente com grande déficit ósseo mandibular em consequência da remoção de uma neoplasia e posterior enxerto de costela. Dois implantes osseointegrados foram colocados no osso remanescente e a reabilitação foi feita com uma prótese removível suportada por uma barra de gesso. Por se tratar de um tratamento minimamente invasivo e conservador, foi facilmente aceito pelo paciente e a melhora na estética e na função foi perceptível.

Split crest con colocación simultánea de implantes en sector anterior: reporte de un caso / Split crest with simultaneous placement of implants in the anterior sector: a case report

La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)

Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)

The use of zygomatic implants in severe maxillary atrophy: a systematic and meta-analysis review of randomised clinical trials / El uso de implantes zigomáticos para atrofia maxilar severa: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

SUMMARY: Conventional implant treatment cannot always be used to rehabilitate edentulous patients with advanced maxillary atrophic. Zygomatic dental implants have been used over the past 20 years as an alternative treatment solution to bone grafting. The purpose of this meta-analysis is to evaluate the implant and prosthetic survival rate in non-oncologic patients with a severely atrophic maxilla. This review also aims to better understand the rate of peri-operative complications in this cohort of patients. A multi-database (PubMed, MEDLINE, EMBASE, and CINAHAL) focused systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Any randomised control trials studies involving human participants treated with zygomatic osseous implants were included. After eliminating duplicates, a total of 4 studies met the inclusion criteria for this meta-analysis review. With all the studies included there was a total of 174 patients treated with zygomatic osseous implants. The overall implant success rate was 98.03 %. The prosthetic success rate was 96.4 %. The most frequent peri-operative complication was sinusitis. Based on the limited data available in literature, zygomatic dental implants represent a valid alternative to bone augmenting procedure. However, they are not without risks and longer follow-ups are required to confirm the validity of the treatment in long term.

Los tratamientos convencionales con implantes no siempre pueden ser usados para rehabilitar pacientes edentulos con atrofia maxilar avanzada. Los implantes dentales zigomáticos son usados por los pasados 20 años como alternativa de tratamiento a las reconstrucciones óseas. El objetivo de este meta-análisis es evaluar la sobrevida de implantes y prótesis en pacientes no oncológicos con maxila severamente atrófica. Esta revisión también pretende entender al promedio de complicaciones peri operatorias en esta cohorte de pacientes. Una búsqueda sistemática en bases de datos múltiples (PubMed, MEDLINE, EMBASE y CINAHAL) fue desarrollada de acuerdo a recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Cualquier estudio clínico aleatorizado de participantes humanos donde se utilizaron los implantes zigomáticos fueron incluidos. Después de eliminar duplicados, un total de 4 estudios cumplieron los criterios de inclusión para esta meta análisis. Con todos los estudios incluidos se obtuvieron 174 pacientes tratados con implantes zigomáticos. El promedio de éxito fue de 98,03 %. El promedio de éxito de la rehabilitación fue de 96,4 %. La complicación mas frecuente fue la sinusitis. Basados en los datos limitados en la literatura, los implantes zigomáticos representan una alternativa valida a los procedimientos de aumento óseo. Sin embargo, estos no están libres de riesgos y seguimientos de mayores periodos son necesarios para confirmar la validez de los tratamientos en el largo plazo.

Niveles bajos de vitamina D y su efecto en la oseointegración: revisión sistemática / Low levels of vitamin D and effect on osseointegration: a systematic review

Introducción: la vitamina D es una hormona que se sintetiza por células de la piel mediante la luz ultravioleta (UV) y se obtiene a través de la dieta. La relación que se establece entre la deficiencia de vitamina D y el fracaso en injertos óseos o implantes se basa en las alteraciones inmunológicas e inflamatorias debido al vínculo que existe con la inmunidad innata y adaptativa. Objetivo: identificar los factores que se presentan en el periodonto cuando existen niveles bajos de vitamina D y se realizan tratamientos periodontales como injertos óseos e implantes. Material y métodos: se realizó la búsqueda primaria de artículos en bases de datos PubMed y Google Académico (en español e inglés), de acuerdo con las palabras claves: deficiencia, vitamina D, implantología y oseointegración. Resultados: la vitamina D afecta y predispone al rechazo de injertos, ausencia de oseointegración en implantes debido a la inmunomodulación. Conclusión: el éxito del tratamiento se vuelve predecible cuando se encuentran niveles óptimos de vitamina D en conjunto con técnicas de abordaje quirúrgico correctas que permitan generar una integración ideal de los tejidos periodontales (AU)

Introduction: vitamin D is a hormone that is synthesized by skin cells using UV light and consumed through the diet. The relationship established between vitamin D deficiency and the failure of bone grafts or implants is based on immunological and inflammatory alterations due to the intimate link with innate and adaptive immunity. Objective: to identify the factors that occur in the periodontium when there are low levels of vitamin D and periodontal treatments such as bone grafts and implants are performed. Material and methods: a search for articles was carried out in PubMed and Google Scholar (Spanish and English). Results: vitamin D affects and predisposes to graft rejection, absence of osseointegration in implants due to immunomodulation. Conclusion: the success of the treatment becomes predictable when optimal levels of vitamin D are found together with the correct surgical approach techniques that allow the generation of an ideal integration of the periodontal tissues.(AU)

Colocación de implantes en paciente con antecedentes de toma de bifosfonatos / Placement of implants in a patient with a history of bisphosphonates taken

El uso de bifosfonatos es un excelente tratamiento para pacientes con artritis reumatoide y enfermedades óseas, por ejemplo, osteoporosis. Se realiza un reporte de caso de paciente femenino, quien estuvo bajo consumo de este fármaco por prescripción de su médico para la prevención de artritis reumatoide postmenopausia. La paciente acude a consulta para la colocación de implantes en zona desdentada y comenta haber terminado el tratamiento de bifosfonatos hace un año. Se tomaron pruebas de diagnóstico y se realizó la colocación de implantes sin ninguna complicación. Sus citas de control fueron más frecuentes en cuatro meses, sobre todo por el detalle de consumo de bifosfonatos, pero en ninguna cita hubo algún detalle alarmante, la cicatrización iba en forma. Se dio de alta a la paciente después de sus citas periódicas y de asegurar su buena cicatrización a un implante bien situado (AU))

The use of bisphosphonates is an excellent treatment for patients with rheumatoid arthritis and bone diseases such as osteoporosis. Here is a case report of a female patient, who was under consumption of this drug by prescription of her doctor for the prevention of post-menopausal rheumatoid arthritis. The patient went to the consultation for the placement of implants in the edentulous area and comments having finished the bisphosphonate treatment one year ago. The diagnostic tests were taken, and the implant placement was performed well without any complications. The control appointments were more frequent in four months, especially due to the detail of bisphosphonate consumption, but in no appointment, there were any alarming details, the healing was in good shape. The patient discharged after her regular appointments and to ensure that she was healing well and that implant was well placed (AU)

Clinical efficacy of simple taper retentive implants in immediate posterior dental implantation for 5-7 years / 华西口腔医学杂志

OBJECTIVES@#This study aimed to evaluate the long-term clinical efficacy of simple taper retentive implants in the posterior dental area after immediate implantation for 5-7 years.@*METHODS@#Selected from January 2015 to December 2017 in the Fourth Affiliated Hospital of Nanchang University dental clinic line tooth area immediately after the implant prosthesis, a total of 38 patients, 53 implants, were deep into (bone under 2 mm or higher) and the upper structure was repaired. In addition, after the completion of tracking observation of 60-90 months, the implant surrounding bone health was recorded and analyzed.@*RESULTS@#After 5-7 years of follow-up, 1 of the 53 implants failed to fall out, and the implant retention rate was 98.1%. The amount of bone resorption in the proximal and distal margins 5-7 years after implant restoration was (0.16±0.94) mm and (-0.01±1.29) mm, respectively, and the difference in bone height between the proximal and distal margins of the implant and the immediate post-restoration period was not statistically significant (P>0.05). No statistically significant differences were found in the effects of periodontitis, implant site inflammation, and smoking on peri-implant marginal bone resorption (P>0.05).@*CONCLUSIONS@#The single taper-retained implant broadens the indications for immediate implant placement in the posterior region, and its deep sub-osseous placement (≥2 mm below the bone) avoids to a certain extent the disturbance of the implant by external stimuli and the exposure of the cervical abutment of the implant, with the good long-term stability of the marginal bone around the implant.

Clinical decision making of implant guidance methods guided by new classification of surgical area mouth ope-ning / 华西口腔医学杂志

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.

Dental implant treatment in vascularized bone flaps after jaw reconstruction / 华西口腔医学杂志

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

Utilização de enxerto autógeno fixado por implantes / Use of autogenous graft fixed by implants / Uso de injerto autógeno fijado mediante implantes

OBJETIVO: Relatar um caso clínico em que foi utilizado enxerto autógeno na região anterior da maxila fixado com implantes. RELATO DE CASO: Paciente do gênero feminino, 46 anos, há 13 anos compareceu à Clínica de Implantodontia do Programa de Pós Graduação da UFPA tendo como queixa principal desconforto estético e dificuldade na mastigação, durante o exame clínico intraoral observou-se a ausência dos elementos 11,12, 21,22 e grande defeito ósseo em formato de U invertido. O tratamento foi dividido em duas etapas: na primeira foi realizada a correção do defeito ósseo em espessura com enxerto ósseo em bloco retirado da região mentoniana, e na segunda etapa foi realizada a correção em altura com enxerto ósseo em bloco retirado do ramo mandibular, na fixação do referido enxerto instalou-se simultaneamente os implantes. Após 13 anos, a paciente retornou para uma consulta de controle e durante a avaliação dos exames clínicos e radiológicos, observou-se que os implantes encontravam-se osseointegrados, sem sintomatologia e com ligeira perda óssea. CONCLUSÃO: Os implantes quando associados ao enxerto autógeno em bloco demonstraram-se eficazes em relação á estética e função no decorrer dos anos... (AU)

OBJECTIVE: To report a clinical case in which autogenous graft was used in the anterior region of the maxilla fixed with implants. CASE REPORT: 13years ago, a 46-year-old female patient, attended the Implantology Clinic of the UFPA Graduate Program with aesthetic discomfort and difficulty chewing as the main complaint, during the intraoral clinical examination, the absence of elements 11, 12, 21, 22 and large bone defect in inverted U format was observed. The treatment was divided into two stages: in the first one, the bone defect was correct in thickness with a block osseum graft removed from the mentionian region, and in the second stage, the correction was performed in height with block bone graft removed from the mandibular branch, and the implants were installed in the fixation of the said graft. After 13 years, the patient returned for a control consultation, and during the evaluation of clinical and radiological examinations, it was observed that the implants were Osseo integrated, without symptomatology and with slight bone loss. CONCLUSION: Implants when associated with autogenou block graft have been shown to be effective in relation to aesthetics and function over the years... (AU)

OBJETIVO: Relatar un caso clínico en que fue utilizado injerto autógeno en la región anterior de la maxila fijado con implantes. CASO CLÍNICO: Paciente del género femenino,46 años, compareció a Clínica de Implantología del Programa de Post-Graduación de la UFPA teniendo como queja principal, el malestar estético y la dificultad para masticar, durante el examen clínico intraoral, se observó la ausencia de elementos 11,12,21,22 y grande defecto óseo en formato U invertida. El tratamiento fue dividido en dos etapas: en la primera fue realizada la corrección de lo defecto óseo en espesor con material retirado de la región mentoniana, y en la segunda etapa fue realizada la corrección en altura con injerto óseo retirado de la rama mandibular, en la fijación de dicho injerto, se instalaron los implantes simultáneamente. Después de 13 años, el paciente retornó para una consulta de control, y durante la evaluación de los exámenes clínicos y radiológicos, se observó que los implantes estaban osteointegrados, sin sintomatología y con ligera pérdida ósea. CONCLUSIÓN: Los implantes cuando asociados el injerto de bloqueo autógeno se demostraron eficaces en relación con la estética y la función, en el trascurso de los años... (AU)

Fratura de implante dentário: relato de caso / Dental implant fracture: case report / Fractura de implante dental: informe de un caso

Com o aumento da população brasileira e consequentemente o número de edêntulos realizando tratamentos reabilitadores com implantes dentários, se tornou frequente aparições de complicações como, por exemplo, sua fratura. O presente trabalho tem por objetivo apresentar as causas prováveis relacionadas a fratura de implante dentário, através de um relato de caso clínico onde pode-se avaliar a condição da fratura apresentada e como foi solucionada. Após a analise do caso clínico, foi constatado que o principal fator que levou a sua fratura foram as sobrecargas oclusais associadas ao mal posicionamento e a qualidade do implante antigo. A partir disso, conclui-se que é de extrema importância o cirurgião dentista estar ciente de todas as possíveis complicações acerca do implante dentário, afim de realizar um bom planejamento cirúrgico diminuindo a taxa de insucesso levando a um bom prognóstico.

With the increase of the Brazilian population and, consequently, the number of edentulous individuals undergoing rehabilitation treatmentes with dental implants, the appearance of complications such as, for example, their fracture has become frequent. The present work aims to presente the probable causes related to dental implant fracture, trough a clinical case report where the condition of the fracture presented and how it was resolved can be evaluated. After analyzing the clinical case, it was found that de main factor that led to its fracture were the occlusal overloads associated with poor positioning and the quality of the old implant. From this , it is concluded that it is extremely important for the dental surgeon to be aware of all possible complications regarding the dental implant, in order to carry out a good surgical planning, reducing the failure rate, leading to a good prognosis.

Con el aumento de la población brasileña y, en consecuencia, del número de personas edéntulas que se someten a tratamientos de rehabilitación con implantes dentales, las complicaciones, como las fracturas, se han vuelto comunes. El presente trabajo tiene como objetivo presentar las probables causas relacionadas con la fractura de implantes dentales, a través del reporte de un caso clínico, donde se puede evaluar la condición de la fractura presentada y la forma en que fue resuelta. Tras analizar el caso clínico, se comprobó que el principal factor que condujo a la fractura fue la sobrecarga oclusal asociada a una mala colocación y a la calidad del implante antiguo. Esto lleva a la conclusión de que es muy importante que el cirujano dental conozca todas las posibles complicaciones de los implantes dentales, para realizar una buena planificación quirúrgica, reduciendo así la tasa de fracasos y consiguiendo un buen pronóstico.

Implante transitório de corpo único com ativação imediata para retenção de prótese total provisória - relato de caso / Single body transient implants immediate activated for provisional prosthesis retention ­ case report

A reabilitação protética ganhou um componente que veio solucionar problemas de pessoas edentadas que até então pareciam sem solução. Trata-se dos implantes osseointegráveis, introduzidos pelo professor Per Ingvar Branemark entre os anos 70 e 80, e que, nos dias de hoje, se tornou na maioria dos casos, a primeira opção para a reabilitação oral. No caso de edentados totais na mandíbula, a prótese total fixa sobre implantes instalados entre os forames mentuais é um tipo de tratamento reabilitador com elevado grau de sucesso. Nos casos onde não é possível a colocação da prótese fixa com carga imediata após a instalação dos implantes, o paciente pode usar uma prótese total provisória, diretamente sobre os implantes permanentes instalados ou retida por implantes transitórios de corpo único, com encaixe tipo bola/o'ring. O presente artigo relata um caso clinico com utilização de implantes transitórios de corpo único para reter prótese total provisória, durante o tempo da osseointegração dos implantes permanentes.

Prosthetic rehabilitation gained a component that solved problems of edentulous people. These are the Osseo integrative implants, introduced by Professor Per Ingvar Branemark between the 1970s and 1980s, and which has become in most cases the first option for oral rehabilitation. In the case of mandible total edentulous, the total fixed prosthesis on implants installed between the mental foramina is a type of rehabilitation treatment with a high degree of success. In cases where it is not possible to place the fixed prosthesis with immediate loading after implant installation, the patient may use a provisional total prosthesis, directly on the permanent implants installed or retained by transient implants of single body, ball-type fitting 'ring. The present article reports a clinical case with the use of single body transient implants to retain temporary total prosthesis during the time of osseointegration of permanent implants.

Reabilitação oral utilizando prótese parcial removível associada a implantes osseointegrados: relato de caso / Oral rehabilitation using removable partial prosthesis associated with osseointegrated implants: case report

Introdução: As próteses parciais removíveis são alternativas amplamente utilizadas na reabilitação oral de pacientes parcialmente desdentados. Na atualidade os implantes dentais têm sido indicados para tratamento de pacientes edêntulos em associação com próteses parciais removíveis convencionais. Objetivo: Relatar um caso clínico utilizando uma prótese parcial removível convencional associada a implantes osseointegrados em paciente portador de Classe I de Kennedy. Relato de Caso: Paciente N.A.A.S., sexo feminino, 65 anos, procurou atendimento clínico no Instituto de Estudos da Saúde (IES) para reabilitação protética das arcadas dentais superior e inferior. A sua queixa principal era "dificuldade de mastigação". A paciente apresentava prótese total removível insatisfatória na maxila e não utilizava nenhum tipo de prótese dentária na mandíbula, que se apresentava parcialmente edêntula. O tratamento realizado foi a confecção de uma prótese total na arcada superior. Na arcada inferior foram inseridos dois implantes de hexágono externo nas regiões correspondentes às áreas dos dentes 34 e 44, após quatro meses a prótese parcial removível convencional foi confeccionada e incorporada aos implantes osseointegrados utilizando o sistema de retenção do tipo attachments Equator. Conclusão: Os resultados revelaram que a técnica de associação da prótese parcial removível convencional aos implantes osseointegrados demonstrou ser uma opção viável de tratamento com capacidade de devolver a função, a estética e manter a integridade dos dentes e tecidos periodontais(AU)

Introduction: Removable partial dentures are alternatives widely used in the oral rehabilitation of partially edentulous patients. Currently, dental implants have been indicated for the treatment of edentulous patients in association with conventional removable partial dentures. Objective: To report a clinical case using a conventional removable partial denture associated with osseointegrated implants in a patient with Kennedy Class I. Case Report: Patient N.A.A.S., female, 65 years old, sought clinical care at the Institute of Health Studies (HEI) for prosthetic rehabilitation of the upper and lower dental arches. His main complaint was "chewing difficulty". The patient had unsatisfactory removable total prosthesis in the maxilla and did not use any type of dental prosthesis in the mandible, which was partially edentulous. The treatment performed was the manufacture of a total prosthesis in the upper arch. In the lower arch, two external hexagon implants were inserted in the regions corresponding to the tooth areas 34 and 44, after four months the conventional removable partial denture was made and incorporated into the osseointegrated implants using the equator attachments retention system. Conclusion: The results revealed that the technique of associating conventional removable partial dentures with osseointegrated implants proved to be a viable treatment option with the ability to restore function, aesthetics and maintain the integrity of teeth and periodontal tissues(AU)

Avaliação da influência da Coenzima Q10 sobre o processo de reparo periimplantar de implantes instalados em tíbias de ratos expostos ou não à nicotina / Evaluation of the influence of Coenzyme Q10 on the periimplant repair processo of implants installed in the tíbias of rats exposed or not to nicotine

O propósito do presente estudo foi avaliar a influência da Coenzima Q10 (CoQ10) no reparo periimplantar em implantes instalados em tíbias de ratos modificados sistemicamente ou não pela nicotina. Oitenta ratos machos (Wistar), foram divididos em quatro grupos (n=20). No dia 0 os animais receberam um implante (4 x 2,2mm ­ SLA) na metáfise proximal das tíbias direita e esquerda. Nos 30 dias que antecedem o procedimento cirúrgico e nos 28 que o sucedem, os animais receberam duas injeções subcutâneas diárias de 3mg/kg de hemissulfato de nicotina ou solução salina na região dorsal, com 12 horas de intervalo entre elas. Logo após à cirurgia, o protocolo se constituiu na administração via gavagem gástrica de 1 ml de glicerina vegetal, ou suplementação diária com 120 mg de CoQ10, ambos até o final do experimento. SS (SHAM): o protocolo de aplicação utilizado foi o de solução salina subcutânea, e os animais receberam gavagem gástrica diária de 1 ml de glicerina vegetal. SS-CoQ10: o protocolo de aplicação utilizado foi o de solução salina subcutânea e, como suplementação, receberam 120 mg de Coenzima Q10 via gavagem gástrica. NIC: o protocolo de aplicação utilizado foi o de nicotina, e os animais receberam gavagem gástrica diária de 1 ml de glicerina vegetal. NIC-CoQ10: o protocolo de aplicação utilizado foi o de nicotina e, como suplementação, os animais receberam 120 mg de CoQ10 via gavagem gástrica. As eutanásias foram aos 7 e 28 dias pós-operatórios. As peças coletadas foram processadas com desmineralização para as análises histológica, histométrica (PTON) e imunoistoquímica para detecção de BMP/2, OCN e TRAP; e sem desmineralização para análise da área do contato direto osso/implante (BIC). Após análise de normalidade e homocedasticidade, os dados foram submetidos aos testes mais adequados com significância de 5% (p≤0,05). Com relação ao contato osso implante, o grupo SS, SS-Q10 e NIC- Q10, apresentaram maior BIC em todos os períodos experimentais quando comparado com o grupo NIC. Os grupos SS, SS-Q10 e NIC-Q10 apresentaram também maior PTON em todos os períodos experimentais quando comparado com o grupo NIC. A análise histológica dos tecidos periimplantares mostrou que o grupo NIC-Q10 apresentou características histológicas que se mostraram similares ao grupo controle, no entanto, com maior quantidade de tecido ósseo periimplantar e menor quantidade de tecido conjuntivo. Nos padrões de marcação imunoistoquímica, quando comparado ao grupo SS, o grupo NIC-Q10 apresentou menor imunomarcação para e OCN, menor marcação para TRAP e não houve diferenças quanto a marcação de BMP2. Dentro dos limites do presente estudo, pode-se concluir que a Coenzima Q10 exerceu uma influência positiva na remodelação óssea periimplantar em implantes osseointegrados(AU)

The purpose of the presente study was to evaluate the influence of Coenzyme Q10 (CoQ10) on periimplant repair in implants installed in the tíbia of rats modificated sistemically or not by nicotine. Eighty male rats (Wistar) were divided into four groups(n=20). On day 0 the animals received na implant (4x2,2mm-SLA) in the proximal metaphasys of the right and left tíbias. In the 30 days preceding the surgical procedure and the 28 days following it, the animals received two daily subcutaneous injections of 3 mg/kg of nicotine hemissulfate or saline solution in the dorsal region, with a 12-hour interval between them. Soon after surgery, the protocol consisted of the administration via gastric gavage of 1ml of vegetable glycerin, or daily supplementation with 120 mg of CoQ10, both until the endo f of the experiment. SS (SHAM): the application protocol used was subcutaneous saline solution, and the animals received daily gastric gavage of 1 ml of vegetal glycerin. SS-CoQ10: the application protocol used was subcutaneous saline solution and, as a supplement, they received 120 mg of Coenzyme Q10 via gastric gavage. NIC: the application protocol used was nicotine, and the animals received daily gastric gavage of 1 ml of vegetable glycerin. NIC-CoQ10: the application protocol used was nicotine and, as a supplement, the animals received 120 mg of CoQ10 via gastric gavage. Euthanasias were performed at 7 and 28 days after surgery. The colleted pieces were processed with desmineralization for histological analysis, área of neofomad bone tissue, histomorfometric analysis (PTON) and immunohistochemistry for the detection of BMP2, OCN and TRAP; and without desmineralization for direct bone/implant contat (BIC) analysis. Regarding bonéimplant contact, the SS, SS-Q10 and NIC-Q10 groups showed higher BIC in all experimental periods When compared to the NIC group. The histological analysis of the periimplant tissues showed that the NIC-Q10 group presented histological characteristics that were similar to the control group, however, with a greater amount of periimplant bone tissue and less connective tissue. In immunohistochemical staining patterns, when compared to the SS group, the NICQ10 group showed lower immunostaining for and OCN, lower staining for TRAP and there were no diferences regarding BMP2 staining. Within the limits of the presente study, it can be concluded that Coenzyme Q10 exerted a positive influence on periimplant bone remodeling in osseointegrated implants(AU)

Elevación unilateral de piso de seno maxilar con ventana lateral utilizando xenoinjerto: reporte de caso / Unilateral elevation of maxillary sinus floor with lateral window using xenografts: report of a case

En maxilares atróficos la elevación de piso de seno es una práctica de alta predictibilidad. El adve- nimiento de materiales osteoconductores que generan andamiaje para la formación ósea propor- cionaron un aumento en la tasa de éxito de los implantes endoóseos. El presente artículo reporta un caso clínico en el cual se llevo a cabo un aumento del nivel de altura del piso de seno unila- teralmente por medio de la técnica de Cadwell- Luck modificada por Tatum, técnica con ventana lateral, donde se utilizó xenoinjerto óseo (OstiumMAX, implante de matriz ósea bovina, Laboratorio Bioxen) y membrana reabsorbible de colágeno( Laboratorio Bioxen) en el primer tiempo quirúrgi- co y seis meses después, en el segundo acto quirúrgico se colocaron tres implantes endoóseos (Sistema de implante dental TRP, Laboratorio Tormicron S.R.L.). Los resultados obtenidos fueron controlados en forma mediata y a distancia a través de radiografías panorámicas y tomografías computadas tipo Cone Beam, donde se midió la altura ósea generada post injerto. Pudo consta- tarse el éxito del procedimiento, basándonos en criterios clínico radiograficos de oseointegración (AU)

Avaliação das respostas de biomineralização pelo Rubus coreanus frente à deficiência de estrógeno: um estudo translacional / Evaluation of biomineralization responses by Rubus coreanus to estrogen deficiency: a translational study

Caracterização da ação local do Rubus coreanus através da funcionalização da superfície dos implantes a serem instalados. Realizado em 2 etapas. Na primeira etapa, foi realizada a caracterização da superfície de implantes funcionalizadas pelos fármacos, a partir de teste físico químico e testes biológicos em culturas de células. Para a cultura de células foram utilizadas células mesenquimais indiferenciadas, isoladas de fêmures de ratas. Foram avaliadas a atividade e a diferenciação celular. Posteriormente, foi realizada a segunda etapa onde foram executados os experimentos in vivo. Para tanto, foram utilizadas 80 ratas Wistar adultas jovens, fêmeas, sendo 32 ratas para o primeiro período de eutanásia (14 dias), e 48 ratas para o segundo período de eutanásia (28 dias). Os grupos experimentais são: SHAM CONV, SHAM DMSO, SHAM RC 200, SHAM RC 400, OVX CONV, OVX DMSO, OVX RC 200 e OVX RC 400, sendo que os animais OVX foram submetidos a ovariectomia bilateral, enquanto que os animais SHAM foram submetidos à cirurgia fictícia de ovariectomia bilateral. Passados 30 dias, todos animais foram submetidos à cirurgia de instalação dos implantes nas metáfises tibiais. Os implantes tiveram as superfícies tratadas com DMSO ou RC 200 ou RC 400, e houve o controle negativo realizado através dos implantes convencionais. A eutanásia dos animais do primeiro período de eutanásia aconteceu aos 14 dias após a instalação dos implantes e as tíbias foram destinadas para a análise biomecânica (contra-torque). Para os animais do segundo período de eutanásia, aos 28 dias após a instalação dos implantes foi realizada a eutanásia dos animais, e as tíbias foram destinadas para as seguintes análises: biomecânica (contra-torque), enquanto do lado contralateral foi realizada a microtomografia computadorizada para avaliação morfométrica do osso formado ao redor dos implantes instalados. Os dados quantitativos foram submetidos ao teste de homocedasticidade para a seleção do teste estatístico apropriado (paramétrico ou não paramétrico), com nível de significância de 5%. Através das análises biomecânica e microtomográfica foi possível verificar resultados semelhantes entre os grupos experimentais. Contudo, o rubus coreanus não foi capaz de atuar de forma positiva no processo de reparo ósseo perimplantar(AU)

Characterization of the local action of Rubus coreanus through the functionalization of the surface of the implants to be installed. Carried out in 2 steps. In the first stage, the characterization of the surface of implants functionalized by drugs was carried out, based on physical-chemical tests and biological tests on cell cultures. For cell culture, undifferentiated mesenchymal cells, isolated from femurs of rats, were used. Cell activity and differentiation were evaluated. Subsequently, the second stage was carried out, where the in vivo experiments were performed. For that, 80 young adult female Wistar rats were used, 32 rats for the first period of euthanasia (14 days), and 48 rats for the second period of euthanasia (28 days). The experimental groups are: SHAM CONV, SHAM DMSO, SHAM RC 200, SHAM RC 400, OVX CONV, OVX DMSO, OVX RC 200 and OVX RC 400, with the OVX animals undergoing bilateral ovariectomy, while the SHAM animals underwent submitted to sham surgery of bilateral ovariectomy. After 30 days, all animals underwent surgery to install the implants in the tibial metaphysis. The implants had their surfaces treated with DMSO or RC 200 or RC 400, and there was a negative control performed using conventional implants. The animals from the first period of euthanasia were euthanized 14 days after implant placement and the tibiae were destined for biomechanical analysis (counter-torque). For animals in the second period of euthanasia, 28 days after implant placement, the animals were euthanized, and the tibiae were destined for the following analyses: biomechanics (counter-torque), while on the contralateral side, computerized microtomography was performed for morphometric evaluation of the bone formed around the installed implants. Quantitative data were submitted to the homoscedasticity test to select the appropriate statistical test (parametric or non-parametric), with a significance level of 5%. Through biomechanical and microtomographic analyzes it was possible to verify similar results between the experimental groups. However, rubus coreanus was not able to act positively in the peri-implant bone repair process(AU)

Avaliação dos tecidos ao redor de implantes osseointegrados com e sem peri-implantite induzida e a relação com a ocorrência de osteonecrose dos maxilares associada à terapia medicamentosa / Tissue evaluation around osseointegrated implants with and without induced peri-implantitis and the relation with the occurrence of medication-related osteonecrosis of the jaw

Objetivo: O objetivo deste trabalho foi avaliar a resposta dos tecidos periimplantares em condições de normalidade e com peri-implantite induzida por ligadura, em implantes osseointegrados na maxila de ratas senescentes submetidas ao tratamento posterior com dosagem oncológica de zoledronato. Material e métodos: Foram utilizadas 28 ratas Wistar (Rattus novergicus) iniciando o experimento com aproximandamente 14 meses de idade e pesando entre 350 e 450g. Os animais foram submetidos à exodontia do incisivo superior direito e instalação imediata de um implante de titânio com 2,5 mm de diâmetro por 5,7 mm de comprimento, onde após quase 2 meses, foi realizada a cirurgia de reabertura dos implantes e instalação de um cicatrizador. Após uma semana, os animais foram divididos de acordo com os seguintes tratamentos: veículo, administração de solução salina estéril 0,9% intraperitoneal (Grupo VEI); zoledronato, com administração de 100 µg/Kg de zoledronato (Grupo ZOL); veículo com peri-implantite experimental (Grupo VEI-PIE) e; zoledronato com peri-implantite experimental (Grupo ZOL-PIE), com a indução da peri-implantite experimental (PIE) por meio de uma ligadura de algodão 5 semanas após o início do tratamento medicamentoso. A porcentagem de tecido ósseo total (PTO-T) e porcentagem de tecido ósseo não vital (PTO-NV) foram analisadas histometricamente, e foram realizadas imunomarcações para fosfatase ácida resistente ao tartarato (TRAP), fator de necrose tumoral alfa (TNFα), interleucina 1 beta (IL1-ß), fator de crescimento endotelial vascular (VEGF) e osteocalcina (OCN). Os dados foram submetidos à análise estatística. Resultados: O grupo ZOL mostrou persistência de inflamação no tecido conjuntivo peri-implantar e uma quantidade considerável de PTO-NV ao redor do implante quando comparado com VEI. A inflamação peri-implantar foi mais exacerbada em ZOL-PIE, assim como, o comprometimento da vitalidade do tecido ósseo ao redor dos implantes quando comparado com VEI-PIE. Conclusão: Conclui-se que o tratamento com altas doses de zoledronato ocasiona alterações ao nível periimplantar, dentre elas, um aumento da inflamação local, e da PTO-NV ao redor do implante osseointegrado, o que pode representar um possível fator de risco para o surgimento da osteonecrose dos maxilares associada à terapia medicamentosa relacionada ao implante odontológico (ONMM-IO). Na presença da PIE há uma exacerbação da inflamação e um aumento ainda maior da PTO-NV, o que implica em um importante fator de risco agravante para o surgimento da ONMM-IO no modelo experimental estudado(AU)

Aim: The aim of this study was to evaluate the response of peri-implant tissues under normal conditions and with ligature-induced peri-implantitis, in osseointegrated implants in the maxilla of senescent rats submitted to subsequent treatment with oncological dosage of zoledronate. Material and methods: Twenty-eight female Wistar rats (Rattus novergicus) were used, starting the experiment at approximately 14 months of age and weighing between 350 and 450g. The animals underwent extraction of the upper right incisor and immediate installation of a titanium implant 2.5 mm wide by 5.7 mm long, where after almost 2 months, surgery to reopen the implants and installation of a healer was performed. After one week, the animals were divided according to the following treatments: vehicle, administration of 0.9% sterile saline intraperitoneally (VEI Group); zoledronate, with administration of 100 µg/Kg of zoledronate (ZOL Group); vehicle with experimental peri-implantitis (VEIPIE Group) and; zoledronate with experimental peri-implantitis (ZOL-PIE Group), with the induction of experimental peri-implantitis (PIE) by means of a cotton suture 5 weeks after the start of drug treatment. The percentage of total bone tissue (PBT-T) and percentage of non-vital bone tissue (PBT-NV) were analyzed histometrically, and immunostaining for tartrate-resistant acid phosphatase (TRAP), tumor necrosis factor alpha (TNFα), interleukin 1 beta (IL1-ß), vascular endothelial growth factor (VEGF) and osteocalcin (OCN). Data were subjected to statistical analysis. Results: The ZOL group showed persistence of inflammation in the peri-implant connective tissue and a considerable amount of PBT-NV around the implant when compared to VEI. Peri-implant inflammation was more exacerbated in ZOL-PIE, as well as compromised bone tissue vitality around the implants when compared to VEI-PIE. Conclusion: It is concluded that treatment with high doses of zoledronate causes changes at the peri-implant level, among them, an increase in local inflammation, and in PBT-NV around the osseointegrated implant, which may represent a possible risk factor for the emergence of medication-related osteonecrosis of the jaws implant- associated (MRONJ-IA). In the presence of PIE, there is an exacerbation of inflammation and an even greater increase in PBT-NV, which implies an important aggravating risk factor for the emergence of MRONJ-IA in the experimental model studied(AU)

Impacto de cesación de tabaquismo en la calidad de vida relacionada a la salud bucal de fumadores con implantes oseointegrados / The impact of tobacco cesation on life quality related to oral health

El tabaquismo es un importante factor de riesgo para las enfermedades periodontales y periimplantares. Los fumadores tienen más posibilidades de presentar pérdida de dientes e implantes y puede promover un impacto negativo en la calidad de vida relacionada a la salud bucal (QVRSB). Este estudio prospectivo tiene como objetivo verificar el impacto de la cesación de tabaquismo sobre la QVRSB de pacientes fumadores que recibieron implantes oseointegrados. Todos los participantes recibieron terapia antitabáquica y rehabilitación protética implantosoportada. Fue aplicado un cuestionario OHIP-14 para evaluar la calidad de vida relacionada a la salud bucal. La exposición a tabaco fue evaluada por dedio de un cuestionario estructurado y validado por medición de los niveles de monóxido de carbono expirado. Pacientes que consiguieron dejar de fumar (NF) fueron comparados con pacientes fumadores que no consiguieron dejar de fumar(F) en relación al OHIP-14. Durante el período de estudio, fueron incluídos 83 pacientes, de los cuales 77 permanecieron hasta el final del estudio. La media de cigarros fumados por día fue de 14,3 y un número medio de años de tabaquismo fue de 29,8 años. Hubo reducción significativa de los escores medios de OHIP-14 en los dos grupos: que dejaron de fumar que no consiguieron de dejar de fumar. Por otro lado, no hubo diferencia entre los grupos en relación a la media de OHIP-14. Dentro de los límites del estudio, concluímos que dejar de fumar no tiene impacto significativo en la calidad de vida relacionada a la salud bucal (AU)

Risk analysis and preventive strategies of implant placement in patients with hypertension / 中华口腔医学杂志

Recently, among the edentulous patients who undergo dental implants, the proportion of hypertensive patients remains high, which poses a greater challenge for clinicians to operate and to maintain the therapeutic effect. The present review comprehensively summarized clinical researches about the adverse effects on dental implants, outlined molecular mechanisms of the positive effects of various antihypertensive drugs on bone metabolism, and proposed that clinicians should select preventive strategies during preoperative and intraoperative procedures according to the blood pressure of patients with hypertension.

Diagnosis, etiology, prevention and treatment in retrograde peri-implantitis / 中华口腔医学杂志

Retrograde peri-implantitis (RPI), a kind of rare biological complication in implant-supported prosthetic rehabilitation, has been reported more frequently in recent years. RPI is defined as the periapical lesion that occurs following implant placement while the coronal part of the implant achieves normal osseointegration. Due to the possibilities of asymptomatic clinical scenarios, RPI can easily be ignored if routine radiographic examination is absent postoperatively, which may postpone treatment and affect long-term outcome. The common cause is infection originating from the periapical lesion of the neighboring teeth, the residual bacteria at the implant site, the contaminated implant apex and etc. Treatment methods rely on the infection source and severity of defect. This article discusses the diagnosis, classification, etiology, and pathology as well as prevention and treatment of RPI in order to provide evidence for clinical decisions in the future.

Feasibility analysis of immediate implant placement in the maxillary molar region / 中华口腔医学杂志

Objective: To study the clinical outcomes and feasibility of immediate implantation after flap surgery and minimally invasive extraction in the maxillary molar area and to provide a reference for it. Methods: Forty-one patients (41 molars in total) with maxillary molars that could not be preserved, treated from June 2018 to June 2020 at the Department of Oral and Maxillofacial Surgery at the Affiliated Hospital of Qingdao University, were selected. There are 24 males and 17 females with the age of (49.7±1.8) years (range 18-66 years). Pre-operative cone-beam CT (CBCT) was taken for measurement and analysis. After flap surgery and minimally invasive tooth extraction, the inflammatory granulation tissues attached to the soft and hard tissues were completely scraped and clipped, followed by the preparation of the implants in the correct three-dimensional position. Torque value and implant stability quotient (ISQ) were recorded after implant placement and with non-submerged healing. CBCT examination was taken 6 months after surgery and ISQ value was checked before crown restoration. CBCT examination was also taken 1 year after the permanent restoration. The survival rate of 6 months after surgery, the success rate of 1 year after permanent restoration, and the size of jump gaps immediately after surgery, 6 months after surgery, 1 year after permanent restoration respectively, were performed. The ISQ values were compared immediately and 6 months after surgery. Results: A total of 41 implants were placed in 41 patients. Six months after surgery, the survival rate was 100% (41/41). Twelve months after permanent restoration, the success rate of the implant restoration was 100% (41/41). The torque value after implant implantation was (42.77±0.79) N·cm. The buccal and palatal jump gaps were (3.15±0.16) mm and (2.86±0.18) mm immediately after surgery, respectively. The mesial and distal jump gaps were (2.94±0.19) mm and (3.77±0.21) mm, respectively. CBCT showed that no jump gap around the implants at 6 months after surgery and 1 year after permanent restoration. The ISQ values at immediately and 6 months after surgery were (74.78±0.59) and (80.20±0.49) respectively, and the difference was statistically significant (t=-9.03, P<0.001). Conclusions: Immediate dental implantation in the correct three-dimensional position could achieve good osseointegration by means of flap surgery, minimally invasive extraction and thorough removal of inflammatory tissue on the surface of soft and hard tissues. The clinical outcomes were satisfactory.