Impact of micronutrients supplementation on bone repair around implants: microCT and counter-torque analysis in rats.

UNLABELLED: The use of natural substances and micronutritional approaches has been suggested as a therapeutic alternative to benefit the bone healing associated with no side effects. Nevertheless, the influence of micronutritional interventions with therapeutic proprieties on the bone repair has yet to be intensely evaluated, and no evidence is available exploring the impact of micronutrient supplementation on the peri-implant bone healing. OBJECTIVE: This study investigated the effect of micronutrients supplementation on the bone repair around implants. MATERIAL AND METHODS: One screw-shaped titanium implant was inserted in each tibia of each rat, which were assigned to: daily administration, for 30 d, of the placebo solution (Placebo group-n:18) or micronutrients supplementation (Micronutrients group-n:18), based on calcium, magnesium, zinc, and vitamin D3 intake. After, the animals were sacrificed. One of the implants was removed by applying a counter-torque force to evaluate the force to rupture the bone-implant interface. The other implant was evaluated by microcomputed tomography (CT) examination to determine the bone-to-implant contact (BIC) and the bone volume (BV/TV). RESULTS: No statistically significant differences were observed between the groups for both counter-torque values and microCT parameters (p>0.05). CONCLUSION: Within the limits of this study, micronutrients supplementation did not provide additional benefits to the bone healing around dental implants.

Impact of micronutrients supplementation on bone repair around implants: microCT and counter-torque analysis in rats

ABSTRACT The use of natural substances and micronutritional approaches has been suggested as a therapeutic alternative to benefit the bone healing associated with no side effects. Nevertheless, the influence of micronutritional interventions with therapeutic proprieties on the bone repair has yet to be intensely evaluated, and no evidence is available exploring the impact of micronutrient supplementation on the peri-implant bone healing. Objective This study investigated the effect of micronutrients supplementation on the bone repair around implants. Material and Methods One screw-shaped titanium implant was inserted in each tibia of each rat, which were assigned to: daily administration, for 30 d, of the placebo solution (Placebo group-n:18) or micronutrients supplementation (Micronutrients group-n:18), based on calcium, magnesium, zinc, and vitamin D3 intake. After, the animals were sacrificed. One of the implants was removed by applying a counter-torque force to evaluate the force to rupture the bone-implant interface. The other implant was evaluated by microcomputed tomography (CT) examination to determine the bone-to-implant contact (BIC) and the bone volume (BV/TV). Results No statistically significant differences were observed between the groups for both counter-torque values and microCT parameters (p>0.05). Conclusion Within the limits of this study, micronutrients supplementation did not provide additional benefits to the bone healing around dental implants.

Paradigmas associados às doenças peri-implantares: O que se sabe e o que ainda precisa ser pesquisado / Paradigms associated with peri-implant diseases: what is known and what still needs to be researched

A doença peri-implantar é um processo inflamatório de etiologia bacteriana que pode acometer os tecidos ao redor dos implantes. Quando a inflamação atinge exclusivamente os tecidos moles circundantes é denominada mucosite peri-implantar, e quando há também a perda do osso de suporte é denominada peri-implantite. Má higiene oral, tabagismo e histórico prévio de doença periodontal são fatores de risco para a doença peri-implantar. Os parâmetros básicos de diagnóstico e tratamento das doenças peri-implantares são delineados pelos utilizados nas doenças periodontais, principalmente devido às similaridades etiológicas encontradas entre elas. Porém, algumas características dos implantes, como a sua morfologia, rugosidade de superfície e desenho protético, criam condições específicas que desafiam os profissionais a ter protocolos ideais de identificação e tratamento das doenças peri-implantares. O objetivo deste trabalho foi realizar uma revisão da literatura sobre o diagnóstico, os fatores de risco e os tratamentos atualmente pesquisados.

Protective effect of topical Cordia verbenacea in a rat periodontitis model: immune-inflammatory, antibacterial and morphometric assays.

BACKGROUND: This study evaluated the effects of C. verbenacea essential oil topically administered in a rat periodontitis model. METHODS: Periodontitis was induced on rats in one of the mandibular first molars assigned to receive a ligature. Animals were randomly divided into two groups: a) non-treatment group (NT) (n = 18): animals received 1mL of vehicle; b) C. verbenacea group (C.v.) (n = 18): animals received 5mg/Kg of essential oils isolated from C. verbenacea. The therapies were administered topically 3 times daily for 11 days. Then, the specimens were processed for morphometric analysis of bone loss. The ligatures were used for microbiological assessment of the presence of Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Porphyromonas gingivalis using PCR. The gingival tissue was collected to Elisa assay of interleukin (IL)-1α and IL-10 levels. RESULTS: Bone loss was inhibited by C. verbenacea when compared to the NT group (p < 0.05). A decrease in the levels of IL-1α and increase in the IL-10 amounts was observed in the C.v. group as compared to NT group (p < 0.05). A lower frequency of P. gingivalis was found in C.v. group (p < 0.05). CONCLUSION: C. verbenacea essential oil topically administered diminished alveolar bone resorption, promoting a positive local imbalance in the pro/anti-inflammatory system and reducing the frequency of detection of P. gingivalis.

Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the response of proximal furcations treated with enamel matrix derivative proteins (EMD) in a 24-month follow-up. MATERIALS AND METHODS: Twelve patients presenting bilateral class II proximal furcation with vertical probing depth (PD) ≥5 mm and bleeding on probing were selected. The furcations were assigned to: a control group (n=12), open flap debridement (OFD)+EDTA and a test group (n=12) - OFD+EDTA+EMD. The gingival margin position, PD, relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated before treatment and after 6, 12 and 24 months. RESULTS: After follow-up, no statistical difference could be seen between groups. At 24 months, the test group showed 1.9 ± 1.6 mm PD reduction whereas the control group showed 1.0 ± 1.3 mm PD reduction. RHCAL gains of the control and the test group were 0.7 ± 1.3 and 1.4 ± 0.9 mm, respectively. However, at 24 months, the test group only presented five remaining class II furcations versus 10 furcations in the control group (p<0.05). CONCLUSION: It could be concluded that EMD therapy promoted a reduction in the number of proximal furcations presenting a diagnosis of class II after 24 months of treatment compared with OFD therapy.

Influence of anatomic features on the effectiveness of enamel matrix derivative proteins in the treatment of proximal Class II furcation involvements.

OBJECTIVES: To evaluate the influence of furcation anatomy and bone defect morphology on the treatment of Class II proximal furcations treated with enamel matrix derivative (EMD) proteins. METHOD AND MATERIALS: Eighteen Class II proximal furcations were treated with open-flap debridement + 24% EDTA conditioning + EMD proteins. Probing depth, gingival margin position, relative vertical and horizontal clinical attachment level, and vertical and horizontal bone levels were evaluated immediately before and 6 months after the surgeries. The changes in these parameters were correlated with vertical defect depth, number of walls, depth defect, interdental distance, root divergence, furcation distance, horizontal measure, root trunk, and furcation height, using the Pearson and Spearman rank correlation tests (a = 5%). RESULTS: The depth defect correlated with gingival margin position (r = 0.52; P = .03), probing depth (r = 0.63; P = .005), and horizontal bone level (r = -0.46; P = .05). The furcation height also correlated with gingival margin position (r = 0.53; P = .02) and horizontal bone level (r = -0.57; P = .01). Moreover, the number of walls of vertical defect positively influenced relative vertical clinical attachment level (r = 0.47; P = .05). CONCLUSIONS: Within the limits of this study, furcation anatomy and defect morphology influence the clinical response of EMD protein therapy in Class II proximal furcation involvements.

Effect of aluminum oxide-blasted implant surface on the bone healing around implants in rats submitted to continuous administration of selective cyclooxygenase-2 inhibitors.

PURPOSE: The continual use of selective cyclooxygenase-2 (COX-2) inhibitors may have a negative impact on bone repair around titanium implants. Because modified implant surfaces could be considered an important strategy to increase success rates in some conditions that interfere in bone healing, the aim of this study was to investigate whether an aluminum oxide (Al2O3)-blasted implant surface could reduce the negative action promoted by the continuous administration of selective COX-2 inhibitors on bone healing around implants. MATERIALS AND METHODS: Thirty Wistar rats received one titanium implant (machined or Al2O3-blasted surface) in each tibia and were randomly assigned to one of the following groups: saline (n = 14) or meloxicam (n = 16); each was administered daily for 60 days. Bone-to-implant contact (BIC), bone area (BA) within the limits of threads, and bone density (BD) in a zone lateral to the implant were examined in undecalcified sections. RESULTS: The Al2O3-blasted surface resulted in significantly increased BIC in both groups, and meloxicam significantly reduced bone healing around implants (P < .05). For the machined surface, significant differences were observed for BIC (39.48 +/- 10.18; 25.23 +/- 9.29), BA (60.62 +/- 4.09; 42.94 +/- 8.12), and BD (56.31 +/- 3.64; 49.30 +/- 3.15) in the saline and meloxicam groups, respectively. For the Al2O3-blasted surface, data analysis also demonstrated significant differences for BIC (45.92 +/- 11.34; 33.30 +/- 7.56), BA (61.04 +/- 4.39; 44.89 +/- 7.11), and BD (58.77 +/- 2.93; 50.04 +/- 3.94) for the saline and meloxicam groups, respectively. CONCLUSIONS: The Al2O3-blasted surface may increase BIC; however, it does not reverse the negative effects promoted by a selective COX-2 inhibitor on bone healing around implants.

Utilização das proteínas derivadas da matriz do esmalte em lesões de bifurcação Classe II proximais / Enamel matrix derivative proteins in the treatment of proximal class II furcation involvements - case report

O tratamento das lesões de bifurcação proximais de molares superiores ainda representa um desafio clínico, visto que estas lesões apresentam uma resposta inferior aos tratamentos não cirúrgico e regenerativo quando comparadas a furcas livres. A baixa previsibilidade do tratamento dessas lesões se deve a características específicas da região que dificultam o acesso para higienização pelo paciente, acesso para raspagem e também adaptação das membranas para regeneração. Nesse contexto, o presente relato de caso pretende mostrar uma alternativa para o tratamento dessas lesões, com a utilização das proteínas derivadas da matriz do esmalte. Foi selecionado um paciente de 49 anos, apresentando uma lesão de furca Classe II distal no elemento 26. Após o descolamento e debridamento ultrassônico, foram aplicados um gel de Edta 24% e, após lavagem, as proteínas derivadas da matriz do esmalte. Após 12 meses, pôde-se observar uma redução na profundidade de sondagem, ausência de sangramento e ganho no nível clínico de inserção horizontal, mostrando que essas proteínas podem ser uma alternativa no tratamento dessas lesões.

A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements.

OBJECTIVE: The aim of the present randomized, double-blind study was to evaluate the clinical response of proximal furcations treated with enamel matrix derivative proteins (EMD). MATERIAL AND METHODS: Fifteen patients, each with a pair of contralateral class-II proximal furcation involvements, presenting probing depths (PDs) >/=5 mm and bleeding on probing (BOP) were selected. The patients were randomly assigned to: control group (n=15) - open flap debridement (OFD)+24% ethylenediaminetetraacetic acid (EDTA) conditioning; test group (n=15) - OFD+24% EDTA conditioning+EMD application. Plaque index (PI), BOP, PD, gingival margin position (GMP), relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated immediately before and 2, 4 and 6 months after the surgeries. RESULTS: At 6 months, the RVCAL gains of the control and test group were 0.39 +/- 1.00 and 0.54 +/- 0.95 mm, while the RHCAL gains were 1.21 +/- 2.28 and 1.36 +/- 1.26 mm (p>0.05). The VBL and HBL gains of the control group were 1.04 +/- 1.12 and 1.00 +/- 1.79 mm, and 0.82 +/- 1.82 and 1.17 +/- 1.38 mm for the test group (p>0.05). In addition, a statistical difference was observed in the number of the remaining class-II furcations between the test and control groups (p<0.05) in this period. CONCLUSION: It may be concluded that the use of EMD in proximal furcations did not promote a superior reduction in PD or a gain in clinical and osseous attachment levels, but resulted in a higher rate of class-II to class-I furcation conversion.

Root surface biomodification with EDTA for the treatment of gingival recession with a semilunar coronally repositioned flap.

BACKGROUND: The purpose of this randomized clinical trial was to evaluate the outcome of gingival recession therapy using the semilunar coronally repositioned flap (SCRF) with or without EDTA application for root surface biomodification. METHODS: Fifteen patients with bilateral Miller Class I buccal gingival recessions (< or =4.0 mm) were selected. Thirty teeth with recessions were assigned randomly to receive the semilunar coronally repositioned flap with (SCRF-E group) or without (SCRF group) the application of an EDTA gel. Recession height (RH), recession width (RW), width (WKT) and thickness of keratinized tissue, probing depth, and clinical attachment level (CAL) were measured at baseline and 6 months post-surgery. Patient perception of root sensitivity and postoperative pain also was evaluated. RESULTS: Both treatments yielded significant improvements in terms of RH and RW decrease and CAL gain compared to baseline values. For SCRF-E and SCRF, the average root coverage was 70.2% and 90.1%, respectively (P = 0.01), and the complete root coverage was 40.0% and 66.7%, respectively. Only the SCRF group had a significant (P <0.05) increase in WKT. The SCRF group showed a greater reduction (P <0.05) in RW and RH compared to the SCRF-E group. No patient in either group reported any pain during the postoperative course; however, 6 months later, patients in the SCRF-E group complained more of residual or new root sensitivity compared to patients in the SCRF group. CONCLUSION: The use of EDTA gel as a root surface biomodifier agent negatively affected the outcome of root coverage with the SCRF.