Evaluation of Temperature and Roughness Alteration of Diode Laser Irradiation of Zirconia and Titanium for Peri-Implantitis Treatment.

OBJECTIVE: This study investigated the effects of diode laser (gallium, aluminium, arsenide [GaAlAs]) irradiation with decontamination parameters on the temperature and roughness of yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP), titanium (TI), and sandblasted large grit acid-etched titanium (SLA). MATERIALS AND METHODS: Three groups (n = 10) of standardized disks with 5 mm diameter and 2 mm thickness were produced with Y-TZP obtained from computer-aided design and computer-aided manufacturing (CAD-CAM), machined TI and SLA. The diode laser single application (808 nm, 20 sec, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 28.29 J/cm(2)) was performed in contact mode, on each disk. The temperature was measured by a thermosensor attached to a digital thermometer fixed to the opposite irradiated surface. The temperature gradient (ΔT) was calculated (ΔT = final temperature - initial temperature) for each group. The parameters Ra (in µm) and Sa (in µm(2)) were measured by white light confocal laser microscopy to express the surface roughness. Data of ΔT was statistically analyzed by one way ANOVA at the 95% confidence level and compared by Tukey post-hoc test (α = 0.05). Roughness data was analyzed by t test. RESULTS: The diode laser irradiation presented the following results (ΔT value): Y-TZP = 10.3°C(B); TI = 38.6°C(A), and SLA = 26.7°C(A). The ΔT values ((°)C) of the titanium groups were higher than for the Y-TZP group. For both roughness parameters (Ra and Sa), data did not show statistical significant differences to "irradiation" factor (p > 0.05) to Y-TZP and SLA. The Ra results (in µm) were: Y-TZP (control) = 0.73 (0.55); Y-TZP (irradiated) = 0.45 (0.27); SLA (control) = 0.74 (0.23); and SLA (irradiated) = 0.99 (0.33). The Sa results (in µm(2)) were: Y-TZP (control) = 1.39 (1.05); Y-TZP (irradiated) = 0.73 (0.41); SLA (control) = 0.85 (0.08); and SLA (irradiated) = 1.27 (0.44). CONCLUSIONS: Diode laser irradiation for peri-implantitis treatment increased both zirconia and TI temperature without surface roughness alterations.

Medicação antirreabsortiva e antiangiogênica na Odontologia: fatores de risco, tratamento da MRONJ e informações recentes / Antiresorptive and antiangiogenic therapies in Dentistry: risk factors, MRONJ-medication and recent information

O objetivo desta revisão foi atualizar o conhecimento básico sobre medicações antiangioênicas e antirreabsortivas, além dos bifosfonatos, e discutir condutas clínicas, protocolos de tratamento e gerenciamento da osteonecrose que podem ser adotados para benefício dos pacientes na Implantodontia. Devido à ocorrência de novos casos de osteonecrose após o uso de medicações antiangiogênicas e antirreabsortivas, a American Association of Oral and Maxillofacial Surgeons (AAOMS) sugeriu a mudança de nomenclatura Bronj (Bisphosphonate-related osteonecrosis of the jaw) para MRONJ (Medication-related osteonecrosis of the jaw). O tipo de medicação e a indicação da mesma (câncer, mieloma múltiplo, osteoporose/osteopenia) devem ser levados em consideração no manejo dos pacientes. Há controvérsias sobre a suspensão das medicações (Drug Holiday) e testes que predigam o risco de MRONJ. Novas pesquisas realizadas em cobaias procuram determinar o efeito do alendronato ministrado sistemicamente, após a cirurgia, sobre a osteointegração de implantes, neoformação óssea e reabsorção de enxerto ósseo. Outra abordagem de pesquisa sobre bifosfonatos aplicados sobre a superfície dos implantes, com o objetivo de melhorar a osteointegração, está sendo realizada em humanos e em cobaias. A constante atualização dos profissionais de saúde se faz necessária para tratamentos mais eficientes e com menor risco aos pacientes.

The objective of this review is to update the basic knowledge about antiangiogenic and antiresorptive medications, in addition to bisphosphonates and discuss clinical procedures, treatment protocols and management of osteonecrosis, which can be adopted for the benefit of patients seeking dental implant treatment. Due to the occurrence of new cases of osteonecrosis after using antiangiogenic and antiresorptive medications, the American Association of Oral and Maxillofacial Surgeons (AAOMS) suggested changing Bronj nomenclature (Bisphosphonate-related osteonecrosis of the jaw) to MRONJ (Medication-related osteonecrosis of the jaw). The type of medication and treatment indications (cancer, multiple myeloma, osteoporosis/osteopenia), should be taken into consideration for patient management. There is controversy about the suspension of medications (Drug Holiday) and tests to predict the risk of MRONJ. New animal model studies try to determine the effects of alendronate as systemically administered, after implant surgery, on bone formation and bone graft resorption. Other studies at human and animal investigate the role of bisphosphonates as biological coatings at implant surfaces to improve osseointegration. Continuing dental education is mandatory to provide more efficient treatments with less risk to patients.