Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / dental implants

Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

Resultado de las sobredentaduras superiores según número de implantes dentales en pacientes edéntulos totales / Outcome of maxillary overdentures according to the number of dental implants in full edentulous patients

RESUMEN Objetivo: Realizar una revisión de la literatura sobre el resultado de las sobredentaduras maxilares según el número de implantes dentales en pacientes edéntulos totales. Materiales y Métodos: Se realizó una búsqueda bibliográfica sistematizada en los motores de búsqueda Pubmed, Scopus y Web of Science y luego de establecer los criterios y filtros de la misma, se utilizaron 6 artículos. De los 6 artículos analizados, 4 fueron estudios de tipo ensayo clínico aleatorizado, 1 estudio prospectivo y 1 estudio retrospectivo. Resultados: Los resultados clínicos de las sobredentaduras maxilares, basados en el número de implantes sobre los cuales fueron soportadas, y comparando los protocolos más difundidos e investigados como los de All-on-4 y All-on-6, fueron similares. Se consideran óptimos, confiables, exitosos y longevos, sin diferencia significativa según el número de implantes dentales colocados. Conclusiones: Las sobredentaduras maxilares soportadas por 4 o 6 implantes fueron técnicas de tratamiento confiables, y ofrecen resultados comparables. Las complicaciones fueron limitadas y los resultados óptimos y duraderos.

ABSTRACT Objective: To review the literature on the outcome of maxillary overdentures according to the number of dental implants in edentulous patients. Materials and Methods: A systematic bibliographic search was carried out in the Pubmed, Scopus and Web of Science search engines and, after appliying the criteria and filters, 6 articles were used. Of the 6 articles analyzed, 4 were randomized clinical trial type studies, 1 prospective study and 1 retrospective study. Results: The results of maxillary overdentures, according to the number of implants used to support them, and comparing the most widespread and researched protocols such as All-on-4 and All-on-6, were similar. They are considered optimal, reliable, successful and long-lived, with no significant difference within the number of dental implants placed. Conclusions: Maxillary overdentures supported by 4 or 6 implants were reliable, and exhibit comparable results. The complications were limited, and the results were optimal and enduring.

A feasible in vitro method to evaluate bacterial infiltration in three implant-abutment connection systems / Método in vitro factible para evaluar la infiltración bacteriana en tres sistemas de conexión implante-pilar

Introduction: Microorganism infiltration through the im-plant-abutment interface causes oral health problems such as periimplantitis, leading to implant loss. Materials and Methods: A feasible new method to quantify the Streptococcus mutans (S. mutans) infiltration through the implant-abutment interface gap is introduced in the present work. Internal hexagon (IH; n = 10), external hexagon (EH; n = 10), Morse taper (MT; n = 10), and a control for each group (n = 1) were tested. Bacteria suspension was prepared at 1.5x108 CFU/mL (CFU: colony forming units), and the implants were individually submerged up to the connection level, allowing the bacteria to contact it. The abutment was removed, and bacteria count was performed. Results: The implant sets were tested under normal bacterial growth and early and late biofilm growth conditions. Colony-forming units per mL were obtained, and the results were compared among groups. Differences in bacterial count between the MT and EH (p<0.001) and the MT and IH (p<0.001) groups were significantly higher in the MT-type implant. There was a significant increment of bacterial infiltration in the MTs submitted to late biofilm growth conditions. EH and IH connections are more effective in preventing bacterial infiltration independent of the growth condition. Conclusions: The proposed methodology is feasible to evaluate the infiltration of microorganisms through the implant-abutment interface.

Introducción: La infiltración de microorganismos a través de la interfaz implante-pilar provoca problemas de salud bucal como la periimplantitis, que conduce a la pérdida del implante. Materiales y Métodos: En el presente trabajo se presenta un nuevo método factible para cuantificar la infiltración de Streptococcus mutans (S. mutans) a través de la brecha de la interfaz implante-pilar. Se probaron el hexágono interno (IH; n = 10), el hexágono externo (EH; n = 10), el cono Morse (MT; n = 10) y un control para cada grupo (n = 1). Se preparó una suspensión de bacterias a 1,5x108 UFC/mL y los implantes se sumergieron individualmente hasta el nivel de conexión, permitiendo que las bacterias entraran en contacto con él. Resultados: Se retiró el pilar y se realizó recuento de bacterias. Los conjuntos de implantes se probaron en condiciones de crecimiento bacteriano normal y de crecimiento temprano y tardío de biopelículas. Se obtuvieron unidades formadoras de colonias por ml y los resultados se compararon entre grupos. Las diferencias en el recuento bacteriano entre los grupos MT y EH (p<0,001) y MT e IH (p<0,001) fueron significativamente mayores en el implante tipo MT. Hubo un incremento significativo de la infiltración bacteriana en los MT sometidos a condiciones tardías de crecimiento de biopelículas. Las conexiones EH e IH son más efectivas para prevenir la infiltración bacteriana independientemente de las condiciones de crecimiento. Conclusión: La metodología propuesta es factible para evaluar la infiltración de microorganismos a través de la interfaz implante-pilar.

Orientações de manutenção e higienização de prótese fixa total implantossuportada: revisão de literatura / Guidelines for maintenance and cleaning of implantssupported total fixed prosthesis: literature review

A evolução dos tratamentos em implantodontia possibilitou uma mudança nos tratamentos reabilitadores para pacientes edêntulos, tornando possível a colocação de próteses fixas, que proporcionam maior qualidade de vida para estes pacientes. Para que estas próteses tenham bom desempenho e longevidade satisfatórios é essencial que se mantenha um padrão adequado de higienização bucal e manutenção profissional. Assim, o objetivo deste trabalho foi realizar uma revisão de literatura a respeito dos principais recursos disponíveis para higienização e manutenção das próteses totais fixas sobre implante (protocolo de Branemark), tanto nos cuidados domiciliares dos pacientes quanto no atendimento profissional do cirurgião dentista. Foi realizada uma busca eletrônica, não sistemática, nas bases de dados Lilacs, Pubmed/Medline, Scielo e ScienceDirect, cruzando-se os seguintes descritores: "Higiene Oral"; "Implantes Dentários"; "Implantação Dentária"; "Manutenção"; "Prótese Dentária Fixada por Implante" e "Prótese Dentária". Foram consultados artigos de revisão de literatura, revisão sistemática, meta-análise, estudos clínicos randomizados, além de livros pertinentes ao assunto, publicados no período de 1995 a 2022.Verificou-se na literatura disponível que os principais instrumentos indicados para uso domiciliar são escova dental, fio dental, escova interdental, irrigador oral, dentifrício e enxaguatório. No atendimento profissional em consultório odontológico deve ser dispendida atenção especial às instruções passadas ao paciente e também fazer o possível para motivar e encorajar o seu engajamento na rotina de higienização, além do acompanhamento periodontal, possíveis substituições de parafusos e instalação de placa oclusal estabilizadora, quando necessário. Manter uma higiene oral adequada é essencial para o sucesso das próteses fixas sobre implantes e o cirurgião dentista desempenha um papel crucial não apenas ao realizar o acompanhamento periódico do paciente, mas também ao sugerir os instrumentos mais apropriados, instruir sobre a higiene oral adequada e motivar o paciente a manter a saúde bucal satisfatória(AU)

The evolution of treatments in implantology has enable a change in rehabilitation treatments for edentulous patients, making it possible to place fixed prostheses that provide a better quality of life for these patients. In order to ensure good performance and satisfactory longevity, it is essential to maintain an appropriate standard of oral hygiene and professional maintenance. Thus, the objective of this work was to conduct a literature review on the main resources available for cleaning and maintenance of complete fixed prostheses on implants (Branemark protocol), both in the patients' home care and in the professional care provided by the dentist. A nonsystematic electronic search was carried out in the Lilacs, Pubmed/Medline, Scielo, and ScienceDirect databases, crossing the following descriptors: "Oral Hygiene"; "Dental Implants"; "Dental Implantation"; "Maintenance"; "Dental Prosthesis, ImplantSupported"; and "Prosthodontics". Literature review articles, systematic reviews, meta-analyses, randomized clinical studies, and relevant books on the subject published from 1995 to 2022 were consulted. The literature available indicates that the main instruments recommended for home care are toothbrush, dental floss, interdental brush, oral irrigator, toothpaste, and mouthwash. In the professional dental office, special attention should be given to the instructions given to the patient, as well as to motivate and encourage their engagement in the hygiene routine, in addition to periodontal monitoring, possible screw replacements, and installation of an occlusal splint when necessary. Maintaining adequate oral hygiene is essential for the success of fixed prostheses on implants, and the dentist plays a crucial role, not only in providing periodic patient follow-up, but also in suggesting the most appropriate instruments, instructing on adequate oral hygiene, and motivating the patient to maintain satisfactory oral health(AU)

Tratamento da periimplantite por meio da descontaminação do implante: um relato de caso / Treatment of peri-implantitis through implant decontamination: a case report

Os implantes dentários osseointegrados representam uma parte da reabilitação oral, sendo uma alternativa cada vez mais utilizada na Odontologia a fim de substituir dentes perdidos. À semelhança das doenças periodontais, o fator etiológico das doenças periimplantares é o acúmulo de biofilme ao redor dos implantes dentários. Esta patologia também é classificada de acordo com os tecidos acometidos por ela, em mucosite e periimplantite. Para um correto tratamento e sucesso na terapia periimplantar, o diagnóstico deve ser baseado na sua etiologia e, seu tratamento segue variando de acordo com cada caso e estágio da doença. O presente trabalho tem como objetivo relatar o tratamento de um caso de periimplantite por meio da descontaminação da superfície do implante através de uma cirurgia de acesso. Paciente leucoderma, com 56 anos, sexo feminino, procurou atendimento no curso de graduação em Odontologia do centro Universitário da Serra Gaúcha ­ FSG, com queixa de sangramento/supuração, dor e edema na região dos dentes 15 e 16, reabilitados com implantes, e exposição de componentes protéticos. A paciente foi diagnosticada com periimplantite. O plano de tratamento proposto foi de promover a descontaminação da superfície do implante por meio de acesso cirúrgico. Com base no caso clínico apresentado, foi possível concluir que a técnica de tratamento utilizada foi eficaz para a resolução da periimplantite, no período de acompanhamento do estudo (90 dias), demonstrando melhora nos parâmetros clínicos e radiográficos(AU)

Osseointegrated dental implants represent a part of oral rehabilitation, being an increasingly used alternative in Dentistry in order to replace lost teeth. Similar to periodontal diseases, the etiological factor of peri-implant diseases is the accumulation of biofilm around dental implants. This pathology is also classified according to the tissues affected by it, in mucositis and peri-implantitis. For a correct treatment and success in peri-implant therapy, the diagnosis must be based on its etiology, and its treatment continues to vary according to each case and stage of the disease. The present work aims to report the treatment of a case of peri-implantitis through the decontamination of the implant surface through an access surgery. Caucasian female patient, 56 years old, sought care at the graduation course in Dentistry at Centro Universitário da Serra Gaúcha ­ FSG, complaining of bleeding/suppuration, pain and edema in the region of teeth 15 and 16, rehabilitated with implants, and exposure of prosthetic components. The patient was diagnosed with peri-implantitis. The proposed treatment plan was to promote decontamination of the implant surface through surgical access. Based on the presented clinical case, it was possible to conclude that the treatment technique used was effective for the resolution of periimplantitis, in the follow-up period of the study (90 days), demonstrating improvement in clinical and radiographic parameters(AU)

Osteomielitis, perimplantitis y fractura vertical radicular mandibular en un paciente con fibromialgia: presentación de caso / Osteomyelitis, Peri-implantitis and Mandibular Root Vertical Fracture in a Patient with Fibromyalgia: Case Report / Osteomielite, peri-implantite e fratura vertical da raiz mandibular em um paciente com fibromialgia: relato de caso

Introducción: se considera la osteomielitis mandibular un proceso patológico poco frecuente. La mayor parte de los casos presentados involucran pacientes con osteorradionecrosis y aquellos pacientes con ingesta de algunos medicamentos antirresortivos. El objetivo es informar un caso inusual de una paciente con osteomielitis, perimplantitis y fractura vertical radicular con antecedentes de fibromialgia. Presentación del caso: mujer de 70 años de edad, no fumadora ni consumidora de alcohol, que acudió con un dolor posteroinferior izquierdo de un año de evolución. Presentaba una profundidad de son-deo mayor de 12 mm en el órgano dental (od) 37, sangrado a la palpación, dolor y movilidad grado ii. En el od 36 fue notoria la exposición clínica del tercio superior del implante dental, sin movilidad, con una profundidad de 4 mm. El tratamiento consistió en una exodoncia atraumática del od 37, donde se identificó una fractura radicular vertical. Discusión: actualmente, los implantes dentales permiten restablecer la salud bucodental. Sin embargo, ellos también pueden inducir una osteomielitis en los maxilares. La terapia instaurada redujo ostensiblemente la morbilidad del implante dental implicado y regeneró la zona intervenida.

Introduction: Mandibular osteomyelitis is considered a rare pathological process. Most of the cases pre-sented involve patients with osteoradionecrosis and those patients with intake of some antiresorptive drugs. The objective of this report is to report an unusual case of a patient with osteomyelitis, peri-im-plantitis and vertical root fracture with a history of fibromyalgia. Case presentation: A 70-year-old female patient, non-smoker or alcohol consumer, who presented with lower left postero-pain of one year's evolution. She presented a probing depth greater than 12 mm in dental organ (od) 37, bleeding on palpation, pain and grade II mobility. At the level of do 36, the clinical exposure of the upper third of the dental implant was notorious, without mobility, with a depth of 4 mm. The treatment consisted of an atraumatic extraction of do 37, where a vertical root fracture was identified. Discussion: Currently, dental implants make it possible to restore oral health. However, they can also induce osteomyelitis in the jaws. The established therapy ostensibly reduced the morbidity of the involved dental implant and regeneration of the intervened area

Introdução: a osteomielite mandibular é considerada um processo patológico raro. A maioria dos casos apresentados envolve pacientes com osteorradionecrose e aqueles pacientes com uso de alguns medi-camentos antirreabsortivos. O objetivo deste relato é relatar um caso incomum de um paciente com osteomielite, periimplantite e fratura radicular vertical com histórico de fibromialgia. Apresentação do caso: paciente do sexo feminino, 70 anos, não fumante ou etilista, que apresentou dor póstero-infe-rior esquerda com um ano de evolução. Apresentava profundidade de sondagem maior que 12 mm no órgão dentário (od) 37, sangramento à palpação, dor e mobilidade grau ii. Ao nível de do 36, foi notória a exposição clínica do terço superior do implante dentário, sem mobilidade, com profundidade de 4 mm. O tratamento consistiu em uma extração atraumática de do 37, onde foi identificada uma fratura vertical da raiz. Discussão: atualmente, os implantes dentários possibilitam o restabelecimento da saúde bucal. No entanto, eles também podem induzir osteomielite nos maxilares. A terapia instituída reduziu ostensivamente a morbidade do implante dentário envolvido e a regeneração da área intervencionada

Expert consensus on strategies to correct proximal contact loss between implant prostheses and the adjacent natural teeth / 口腔疾病防治

@#The problems caused by proximal contact loss (PCL) of dental implants have been a mainstream research topic in recent years, and scholars are unanimously committed to analyzing their causes and related factors, aiming to identify solutions to the problems related to PCL. The effects of the anterior component of force (ACF), the lifelong remolding of the adult craniofacial jaw and alveolar socket, and the osseointegration characteristics of dental implants are the main causes of PCL. On the one hand, the closing movement of the mandible causes the ACF of the tooth to move through the posterior molar cusp. Moreover, drifting between the upper and lower posterior teeth and mandibular anterior teeth can cause the anterior teeth of the upper and lower jaws to be displaced labially. On the other hand, reconstruction of the jaw, alveolar socket and tooth root, the forward horizontal force of the masticatory muscles, the dynamic component of the jaw and the forward force generated by the oblique plane of the tooth cusp can cause the natural tooth to experience near-middle drift. Additionally, natural teeth can shift horizontally and vertically and rotate to accommodate remodeling of the stomatognathic system and maintain oral function. Nevertheless, the lack of a natural periodontal membrane during implant osseointegration, the lack of a physiological basis for near-medium drift, the small average degree of vertical motion and the integrated silence of dental implants without the overall drift characteristics of natural teeth increases the probability of PCL. The high incidence of PCL is clearly associated with the duration of prosthesis delivery and the mesial position; but it is also affected by the magnitude of the bite force, occlusion, the adjacent teeth, restoration design, implant location, jaw, and patient age and sex. PCL has shown a significant correlation with food impaction, but not a one-to-one correspondence, and did not meet the necessary and sufficient conditions. PCL is also associated with peri-implant lesions as well as dental caries. PCL prevention included informed consent, regular examinations, selection of retention options, point of contact enhancement, occlusal splints, and the application of multipurpose digital crowns. Management of the PCL includes adjacent contact point additions, orthodontic traction, and occlusal adjustment. Existing methods can solve the problem of food impaction in the short term with comprehensive intervention to seek stable, long-term effects. Symmetric and balanced considerations will expand the treatment of issues caused by PCL.

Clinical analysis of denture rehabilitation after mandibular fibula free-flap recon-struction / 北京大学学报(医学版)

Objective:To evaluate the postoperative denture restoration and denture function in pa-tients with mandibular defect reconstructed with vascularized free fibula flap.Methods:In the study,154 patients who underwent mandibular segment resection and used vascularized free fibula flap to repair mandibular defects due to inflammation,trauma and tumor from January 2015 to December 2020 were collected.These patients had common inclusion criteria which were stable occlusal relationship before operation,segmental defects of mandibular bone caused by lesions of mandible and adjacent parts(such as floor of mouth,tongue,cheek),free fibula flap used for repair and surviving after operation.Relevant data were reviewed and situation of denture restoration was followed up.A questionnaire related to den-ture functional evaluation had been proposed for those who had completed the denture rehabilitation.The evaluation index of denture restoration function was assigned by expert authority to obtain the denture function score.SPSS 18.0 software was used for statistical analysis of the basic information of the patients included in the study and the denture restoration of the patients.Results:The rate of postoperative den-ture restoration in the patients with mandibular defects repaired by free fibula flap was 17.5％,and the rate of postoperative denture restoration in the patients with benign mandibular tumors was 25.0％(18/72),which was significantly greater than that in the patients with malignant tumors 11.0％(9/82,P＜0.05).There was no significant difference in denture function score between the patients with condylar defect and those without condylar defect in denture repair rate and denture function score(P＞0.05).The functional score of implant denture was significantly greater than that of removable denture(P＜0.05).According to Brown classification,the denture function score of the patients with the defect invo-lving the anterior mandibular region was significantly greater than that of the patients without the anterior mandibular region involved(P＜0.05).The poor oral conditions,such as less amount of remaining teeth,insufficient retention strength,large mobility of soft tissue in the surgical area,poor oral vestibular groove condition became the main reason of not receiving denture restoration(37.86％).Conclusion:The denture rehabilitation of mandibular defect reconstructed with vascularized free fibula flap is closely rela-ted to pathological properties and oral conditions.The clinical outcome of implant denture has been con-firmed effectively and it is a better choice for future denture restoration after mandibular reconstruction.

Aesthetic effect evaluation of the xenogeneic collagen matrix in keratinized mucosa augmentation around dental implants / 口腔疾病防治

Objective@#To evaluate the stability and aesthetic effect of a xenogeneic collagen matrix (mucograft) on achieving an adequate keratinized mucosa width (KMW) around implants and to provide a reference basis for the clinical application of xenogeneic collagen matrix materials.@*Methods@#The hospital ethics committee approved the study protocol, and the patients provided informed consent. Twenty patients with a KMW<2 mm at the buccal implant site who were treated in Binzhou Medical University Affiliated Yantai Stomatological Hospital from July 2020 to September 2022 were included, and a total of 36 implants were included. The mean age of the patients was (52.0±10.4) years, of which 18 were females and 2 were males. They were divided into a free gingival graft group (FGG, control group) and a xenogeneic collagen matrix group (test group) according to different graft materials. The incremental effect of the KMW on the buccal side of the implant and the mucosal shrinkage rate was measured at 1 month and 3 months after the operation. The mucosal scar index (MSI) was evaluated after the operation.@*Results@#At 3 months postoperatively, the KMW was (3.67 ± 1.06) mm in the control group and (2.96 ± 0.98) mm in the test group, and the difference was statistically significant (t = 2.076, P<0.05). The KMW shrinkage rate was (33.34 ± 16.30) % in the test group and (22.05 ± 15.47) % in the control group at 1 month postoperatively and (51.95 ± 12.60) % in the test group and (37.44 ± 16.30) % in the control group at 3 months postoperatively, with statistically significant differences between the two groups at the same time points (P<0.05). Three months after surgery, the test group showed significantly better outcomes than the control group in terms of the five scar indicators (scar width, scar convexity, scar color, scar trace, and overall appearance), and the difference was statistically significant (P<0.05).@*Conclusion@#Xenogeneic collagen matrix can increase the peri-implant KMW and achieve a more natural and coordinated soft tissue aesthetic effect but with a higher shrinkage rate.

Patient-, implant- and prosthetic-related factors on peri-implant mucositis and bone loss

Abstract Peri-implant diseases, including peri-implant mucositis (PIM) and peri-implantitis, are a chronic inflammatory disorder triggered by bacterial biofilm in susceptible hosts. Potential risk factors for peri-implant diseases include smoking, dental plaque accumulation, poor oral hygiene, genetics, and absence of peri-implant keratinized mucosa. This cohort study aimed to evaluate the influence of patient-, implant-, and prosthetic-related factors on PIM and peri-implant bone loss (PBL) around dental implants after 1 year of loading. A total of 54 subjects (22 males and 32 females) were included in the study. Peri-implant clinical parameters were assessed and standardized periapical radiographs of each dental implant were obtained 15 days after the definitive prosthesis installation (baseline) and at 3, 6, and 12 months of follow-up. A total of 173 implants were evaluated. PIM affected 44.8% of the implants and no significant association was found between the investigated parameters and PIM incidence, except for type of implant connection. A significantly higher incidence of PIM (80.0%) was observed for implants with internal hexagon connection type after 1 year of follow-up (p = 0.015). Moreover, a mean PBL of 0.35 ± 1.89 mm was observed and no dental implant was affected by peri-implantitis after 1 year of function. No specific influence of patient, implant, or prosthetic factors on PBL was observed. No association was found between the occurrence of PIM/PBL and the patient-, implant-, and prosthetic-related factors investigated in this cohort study, except for the type of dental-implant connection.

Total removal of the buccal flange in maxillary prosthetic preparation: a necessity?: case report / Remoção total do flange vestibular no preparo protético de maxila: uma necessidade?: relato de caso

ABSTRACT Fixed implant-supported complete maxillary dentures aim to rehabilitate aesthetic, phonetic, and functional aspects of edentulous arches. A previous prosthetic preparation without a flange in the anterior sector makes it possible to evaluate the labial support and the existing space for the future prosthesis. Thus, it allows the most appropriate choice of the type of rehabilitation and surgical technique. However, follow-up studies have shown that when proceeding this way, problems in the posterior sector are still occurring, such as the lack of vertical space for an adequate bar design and concave internal designs, which make access to hygiene difficult. Faced with the problem, the aim of this study is to report a clinical case in which the previous prosthetic preparation included the removal of the flange also from the posterior sector during the teeth try-in and the duplication of this assembly in a transparent multifunctional guide that allowed the visualization of the amount of bone removal needed. The osteotomy, performed before the installation of the implants, provided enough space for the bar, acrylic, and prefabricated denture teeth in the prosthesis that was installed, an important fact considering that this is an area with greater chewing efforts. It also allowed for correct internal design in the prosthesis, which will ensure access to correct hygiene. Based on the analysis of the rehabilitated case, it seems fair to conclude that the total removal of the buccal flange at the time of testing the wax try-in of the teeth and its duplication is a differential in the approach of cases and should always be adopted to ensure a lower margin of error and greater longevity in the proposed rehabilitative treatment.

RESUMO Próteses totais fixas implantossuportadas objetivam reabilitar arcos edêntulos nos aspectos estético, fonético e funcional. Um preparo protético prévio sem flange no setor anterior permite avaliar o suporte labial e o espaço presente para a futura prótese, auxilinado na escolha do tipo de reabilitação e da técnica cirúrgica mais adequada. No entanto, estudos de acompanhamento tem mostrado que ao proceder dessa maneira ainda estão ocorrendo problemas no setor posterior, como falta de espaço vertical para um desenho adequado da barra e desenhos internos côncavos, que dificultam o acesso à higienização. Frente ao problema, o objetivo do presente trabalho é relatar um caso clínico no qual o preparo protético prévio incluiu a remoção do flange também do setor posterior durante a prova dos dentes e a duplicação dessa montagem em um guia multifuncional transparente permitindo a visualização da quantidade de remoção óssea necessária. A osteotomia, realizada antes da instalação dos implantes, proporcionou espaço suficiente para a barra, acrílico e dentes de estoque na prótese que foi instalada, fato importante considerando ser essa uma zona com maiores esforços mastigatórios. Também permitiu a confecção de desenho interno correto na prótese, que garantirá o acesso para correta higiene. Com base na análise do caso reabilitado, parece lícito concluir que a remoção total do flange vestibular no momento da prova dos dentes em cera e sua duplicação é um diferencial na abordagem dos casos e que deveria sempre ser adotada para garantir menor margem de erros e maior longevidade no tratamento reabilitador proposto.

The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography

Abstract Objectives: This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR). Study design: VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm. Results: The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the interrater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm. Conclusions: Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs. German Clinical Trials Register ID:DRKS00007589, www.germanctr.de

Evaluation of the Implant Success Rate of Titanium-based Implant Materials: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To investigate the success of implants, the increase of bone integration, and the effect of nanostructure/nanoparticles as Titanium-based implant materials on the success of implants. The present study evaluated the implant success rate of Titanium-based implant materials. Material and Methods: PICO: Population (dental implant), intervention (coated titanium implant surface), comparison (uncoated titanium implant surface), and outcome (bone-implant contact) were considered as a search strategy tool and study inclusion criteria. Searches for systematic literature were conducted on databases from Scopus, Science Direct, PubMed, ISI, Web of Knowledge, and Embase until 12 December 2022. Modified CONSORT Criteria (Reporting guidelines for preclinical in vitro studies on dental materials) were used to evaluate the quality of studies. The fixed effect model and inverse-variance method were used to calculate the 95% confidence interval for mean differences. Stata/MP V. 17 software was used to conduct the meta-analysis. Results: After reviewing the abstracts of 97 articles, studies not related to the inclusion criteria were excluded, and ten studies were selected from the remaining 39 studies after reviewing the full text. The mean difference in boneimplant contact between coated and uncoated dental implants was 0.25 (MD, 0.25 95% CI 0.01, 0.49;p=0.04). Conclusion: The titanium implant surface with nano coating can increase bone-implant contact and cause bone integration.

Influence of torque and bone type on stability quotient of two implant platforms: a clinical trial

Abstract The objective of this study was to analyze the influence of insertion torque, bone type, and peri-implant bone loss on implant stability quotient (ISQ) of cylindrical external hexagon (EH) and Morse Taper (MT) implants. Forty-four single implants were placed in the edentulous areas of 20 patients who met the inclusion and exclusion criteria. Immediately after implant placement (t1) and after osseointegration (four and six months for mandible and maxilla, respectively) (t2), insertion torque, resonance frequency, and peri-implant bone loss were measured using probing depths and digital periapical radiography. A significant difference was noted in the ISQ values between t1 and t2 in type III bone for EH and MT implants. No significant difference in bone loss values was observed when comparing bone types for EH or MT in all evaluated sites. Based on marginal bone loss assessed using radiography, there was no significant difference between the MT and EH groups. A positive correlation between torque and ISQ t1 value was observed for MT (correlation: 0.439; p = 0.041) and EH (correlation: 0.461; p = 0.031) implants. For EH and MT implants, the greater the insertion torque, the greater was the ISQ value (moderately positive correlation). A weak negative correlation was found between bone type and ISQ t1 for MT implants. Contrarily, no correlation was observed between bone type and ISQ t1 for EH implants. In all cases, bone loss around the implants was clinically normal.

Modulation of osteoclastogenesis by macrogeometrically designed hydrophilic dual acid-etched titanium surfaces

Abstract The aim of this study was to evaluate the influence of implant macrodesign and surface hydrophilicity on osteoclast (OC) differentiation, activation, and survival in vitro. Titanium disks were produced with a sandblasted, dual acid-etched surface, with or without additional chemical modification for increasing hydrophilicity (SAE-HD and SAE, respectively) and different macrodesign comprising trapezoidal (HLX) or triangular threads (TMX). This study evaluated 7 groups in total, 4 of which were experimental: HLX/SAE-HD, HLX-SAE, TMX/SAE-HD, and TMX/SAE; and 3 control groups comprising OC differentiated on polystyrene plates (CCPC): a positive CCPC (+), a negative CCPC (-), and a lipopolysaccharide-stimulated assay positive control group, CCPC-LPS. Murine macrophage RAW264.7 cells were seeded on the disks, differentiated to OC (RAW-OC) by receptor activator of nuclear factor-κB ligand (RANKL) treatment and cultured for 5 days. Osteoclast differentiation and cell viability were respectively assessed by specific enzymatic Tartrate-Resistant Acid Phosphatase (TRAP) activity and MTT assays. Expression levels of various OC-related genes were measured at the mRNA level by quantitative polymerase chain reaction (qPCR). HLX/SAE-HD, TMX/SAE-HD, and HLX/SAE significantly suppressed OC differentiation when compared to CCPC (+). Cell viability was significantly increased in TMX/SAE and reduced in HLX/SAE-HD. In addition, the expression of Interleukin (IL)-6 and Tumour Necrosis Factor (TNF)-α was upregulated in TMX/SAE-HD compared to CCPC (+). Hydrophilic surfaces negatively modulate macrophage/osteoclast viability. Specifically, SAE-HD with double triangular threads increases the cellular pro-inflammatory status, while surface hydrophilicity and macrodesign do not seem to have a distinct impact on osteoclast differentiation, activation, or survival.

Analysis of peri-implant bone tissue between hydrophilic and rough implant surfaces in spontaneously hypertensive rats treated with losartan

Abstract Hypertensive individuals present alterations in their calcium metabolism that consequently decrease the concentration of this mineral in the bone tissue. Objectives to evaluate the morphological and functional characteristics of the peri-implant bone tissue that was formed during the healing process by the placement implants using two different surface treatments: hydrophilic Acqua™ (ACQ) and rough NeoPoros™ (NEO), in spontaneously hypertensive (SHR) and normotensive rats (Wistar) whether or not treated with losartan. Methodology In total, 96 male rats (48 Wistar and 48 SHR) were divided into eight subgroups: absolute control rough (COA NEO), absolute control hydrophilic (COA ACQ), losartan control rough (COL NEO), losartan control hydrophilic (COL ACQ), SHR absolute rough (SHR NEO), SHR absolute hydrophilic (SHR ACQ), SHR losartan rough (SHRL NEO), and SHR losartan hydrophilic (SHRL ACQ). The rats medicated with losartan received daily doses of the medication. NeoPoros™ and Acqua™ implants were installed in the tibiae of the rats. After 14 and 42 days of the surgery, the fluorochromes calcein and alizarin were injected in the rats. The animals were euthanized 67 days after treatment. The collected samples were analyzed by immunohistochemistry, biomechanics, microcomputerized tomography, and laser confocal scanning microscopy analysis. Results The osteocalcin (OC) and vascular endothelium growth factor (VEGF) proteins had moderate expression in the SHRL ACQ subgroup. The same subgroup also had the highest implant removal torque. Regarding microarchitectural characteristics, a greater number of trabeculae was noted in the control animals that were treated with losartan. In the bone mineralization activity, it was observed that the Acqua™ surface triggered higher values of MAR (mineral apposition rate) in the COA, COL, and SHRL groups (p<0.05). Conclusion the two implant surface types showed similar responses regarding the characteristics of the peri-implant bone tissue, even though the ACQ surface seems to improve the early stages of osseointegration.

Rendimiento y fuerza masticatoria máxima funcional en pacientes con prótesis parcial removible dentomucosoportadas y dentoimplantosoportadas

Introducción: Debido al desdentamiento, el rendimiento y la fuerza masticatoria disminuyen, lo que implica una desorganización y descompensación del sistema estomatognático con fuerzas provocadas por la masticación, que se distribuyen en el hueso a través de dientes y mucosas y provocan la reabsorción ósea en zonas edéntulas. Objetivo: Comparar el rendimiento masticatorio y la fuerza masticatoria máxima funcional en pacientes desdentados parciales portadores de prótesis parcial removible dentomucosoportadas, antes y después de la instalación quirúrgica de implantes oseointegrados como pilares protésicos auxiliares. Métodos: Se seleccionaron 10 pacientes rehabilitados mediante prótesis parcial removibles. Se les realizaron el test biomecánico de medición de fuerza masticatoria y test de Manly para la evaluación del rendimiento masticatorio antes de la instalación del implante y a los tres y seis meses poscirugía. Resultados: Se obtuvo un valor promedio de rendimiento masticatorio de 24,2 ( 9,73 % antes de la cirugía de implantes, de 44,1 ( 13,28 % a los tres meses y de 45,6 ( 14,33 % a los seis meses posterior a esta (p = 0,001). Antes de la cirugía implantaria se obtuvo como promedio una fuerza masticatoria de 10,6 ( 4,34 kg, de 12,5 ( 4,28 kg a los tres meses y de 15,1 ( 5,12 kg a los seis meses posterior a esta (p = 0,008). Conclusiones: La utilización de implantes oseointegrados como pilares auxiliares en prótesis removibles dentomucosoportadas se asocian a un mayor rendimiento masticatorio y a un aumento de la fuerza masticatoria máxima funcional, asociado al alivio de la carga directa sobre los rebordes maxilares edéntulos.

Introduction: Due to edentulousness, masticatory performance and masticatory force decrease, which implies a disorganization and decompensation of the stomatognathic system with forces provoked by mastication, which are distributed in the bone through teeth and mucous membranes and cause bone resorption in edentulous areas. Objective: To compare masticatory performance and maximum functional masticatory force in partially edentulous patients with dentomucosally supported removable partial dentures before and after surgical installation of osseointegrated implants as auxiliary prosthetic abutments. Methods: Ten patients rehabilitated with removable partial dentures were selected. The biomechanical test of masticatory force measurement and the Manly test were performed to evaluate masticatory performance before implant installation and at three- and six-months post-surgery. Results: An average masticatory performance value of 24.2 ( 9.73 % was obtained before implant surgery, 44.1 ( 13.28 % at three months and 45.6 ( 14.33 % at six months after implant surgery (p = 0.001). Before implant surgery, an average masticatory force of 10.6 ( 4.34 kg, 12.5  4.28 kg at three months and 15.1 ( 5.12 kg at six months after implant surgery was obtained (p = 0.008). Conclusions: The use of osseointegrated implants as auxiliary abutments in dentomucosally supported removable prostheses are associated with increased masticatory performance and increased maximum functional masticatory force, associated with relief of direct load on edentulous maxillary ridges.

Assessing peri-implant bone microarchitecture: conventional vs. osseodensification drilling - ex vivo analysis

Abstract: The aim was to evaluate primary implant stability and bone microarchitecture in two drilling situations, by comparing the conventional technique (CT) and osseodensification (OD) (Versah Burs - Jackson - Mississippi - USA). The implant insertion torque (IT), implant stability quotient (ISQ), and the peri-implant trabecular microstructure were assessed on bone fragments obtained from pig's tibia (n=12), divided between CT (n=6) and OD (n=6). After the drilling procedure, the implants were installed (3.5x8.5 mm, Epikut - SIN - São Paulo - Brazil). The IT and ISQ were measured using a digital torque wrench and resonance frequency analysis. Then, the bone fragments containing the implants were removed with a trephine and analyzed by Microtomography (µCT, 8.0 µm). The comparison between groups was performed using the unpaired t-test (α=0.05). The results revealed that OD promotes a higher insertion torque (CT: 7.67±2.44 Ncm; OD: 19.78±5.26 Ncm) (p=0.0005), although ISQ was not different (CT: 61.33±4.66; OD: 63.25±4.58) (p=0.48). There was a significant increase in peri-implant bone volume (CT: 23.17±3.39 mm3; OD: 32.01±5.75 mm3) (p=0.008), and trabecular parameters: separation (CT: 0.4357±0.03 mm; OD: 0.3865±0.04 mm) (p=0.0449), number (CT: 1.626±0.18 1/mm; OD: 1.946±0.13 1/mm) (p=0.007), and thickness (CT: 0.1130±0.009 mm; OD: 0.1328±0.015 mm) (p=0.02). Structure model index (SMI) data demonstrate no significant differences between groups (CT: 1.7±0.2; OD: 1.4±0.4) (p=0.12). In conclusion, OD increases the insertion torque values and promotes beneficial changes regarding bone microarchitecture compared with CT, revealing more peri-implant bone volume with consequent higher primary stability.

Resumo O objetivo deste estudo foi avaliar a estabilidade de implante e a microarquitetura óssea em duas técnicas de fresagem, comparando a técnica convencional (CT) e a osseodensificação (OD) (Versah Burs - Jackson - Mississippi - EUA). O torque de inserção do implante (IT), quociente de estabilidade primária (ISQ) e a estrutura trabecular peri-implantar foram avaliados em fragmentos ósseos obtidos de tíbia de porco (n=12), divididos entre CT (n=6) e OD (n=6). Após o procedimento de fresagem, foram instalados implantes (3,5x8,5 mm, Epikut - SIN - São Paulo - Brasil). O IT e o ISQ foram aferidos por meio de um torquimetro digital e análise de frequência de ressonância. Em seguida, os fragmentos ósseos contendo os implantes foram removidos com trefina e analisados ​​por microtomografia computadorizada (µCT, 8,0 µm). A comparação entre os grupos foi realizada por meio do teste-t não-pareado (α=0.05). Os resultados revelaram que a OD promove maior torque de inserção (CT: 7,67 ± 2,44º Ncm; OD: 19,78 ± 5,26 Ncm) (p=0,0005), embora a estabilidade primária não tenha sido diferente (CT: 61.33 ± 4.66; OD:63.25 ± 4.58) (p=0,48). Houve um aumento significativo no volume ósseo peri-implantar (CT: 23,17±3,39 mm3; OD: 32,01±5,75 mm3) (p=0,0089) e parâmetros trabeculares: separação (CT: 0,4357 ± 0,03 mm; OD: 0,3865 ± 0,04 mm) (p=0,0449), número (CT: 1,626 ± 0,18 1/mm; OD: 1,946 ± 0,13 1/mm) (p=0,007) e espessura (CT: 0,1130 ± 0,009 mm; OD: 0,1328 ± 0,015 mm) (p=0,02) O índice de modelo estrutural (SMI) não demostrou diferença estatisticamente significativa (p=0.1228). Concluindo, OD apresenta maiores valores de torque de inserção e promove mudanças benéficas na microarquitetura óssea em comparação com a TC, revelando maior volume ósseo peri-implantar.

Nanotopography and oral bacterial adhesion on titanium surfaces: in vitro and in vivo studies

Abstract The present study aimed to evaluate the influence of titanium surface nanotopography on the initial bacterial adhesion process by in vivo and in vitro study models. Titanium disks were produced and characterized according to their surface topography: machined (Ti-M), microtopography (Ti-Micro), and nanotopography (Ti-Nano). For the in vivo study, 18 subjects wore oral acrylic splints containing 2 disks from each group for 24 h (n = 36). After this period, the disks were removed from the splints and evaluated by microbial culture method, scanning electron microscopy (SEM), and qPCR for quantification of Streptococcus oralis, Actinomyces naeslundii, Fusobacterium nucleatum, as well as total bacteria. For the in vitro study, adhesion tests were performed with the species S. oralis and A. naeslundii for 24 h. Data were compared by ANOVA, with Tukey's post-test. Regarding the in vivo study, both the total aerobic and total anaerobic bacteria counts were similar among groups (p > 0.05). In qPCR, there was no difference among groups of bacteria adhered to the disks (p > 0.05), except for A. naeslundii, which was found in lower proportions in the Ti-Nano group (p < 0.05). In the SEM analysis, the groups had a similar bacterial distribution, with a predominance of cocci and few bacilli. In the in vitro study, there was no difference in the adhesion profile for S. oralis and A. naeslundii after 24 h of biofilm formation (p > 0.05). Thus, we conclude that micro- and nanotopography do not affect bacterial adhesion, considering an initial period of biofilm formation.

Ozone therapy improves early stages of osseointegration in ovariectomized rats

Abstract Objective the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats. Methodology ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg — OZ Group (n=15) — and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05). Results our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32). Conclusion it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.