In vitro assessment of PEEK and titanium implant abutments: Screw loosening and microleakage evaluations under dynamic mechanical testing.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) has been advocated to replace metal components in dentistry. Although PEEK is a high-performance polymer with a white color, adequate biological response, and resistance to fracture, data to support PEEK as an alternative material for implant abutments are lacking. PURPOSE: The purpose of this in vitro study was to assess the mechanical and functional properties of PEEK implant abutments as a nonmetallic alternative to titanium abutments, which presents esthetic limitations and greater difficulty to customize clinically. MATERIAL AND METHODS: Implant abutments manufactured by using PEEK (n=24) or titanium grade 5 (n=24) were attached to MIS Implants type M4 3.75×16 mm with an internal screw tightened to 25 Ncm. Screw loosening and microleakage was assessed by submersion in a 2% methylene blue solution for 48 hours at 37 °C. Both groups were compared with and without applying dynamic loading; fatigue testing was performed following the International Organization for Standardization (ISO) 14801:2016 standard. All specimens were observed under a stereomicroscope at ×8 magnification. Statistically significant differences among the PEEK and titanium implant abutments were tested with 2-factor ANOVA and the chi-square analysis for nonpaired and paired data, respectively (α=.05). RESULTS: The implant abutments made of titanium were better in all mechanical tests. The torque loss of titanium abutments was approximately 10%, while PEEK showed a significantly higher (P<.05) torque loss of up to 50%. Moreover, 91.6% of the titanium abutments did not present microleakage, while there was no specimen of PEEK abutments without microleakage, once subjected to dynamic loading (P<.05). CONCLUSIONS: Titanium implant abutments (Ti6Al4V) were better in all tests performed. However, PEEK abutments may be suitable for long-term interim restorations, especially in the anterior area, in patients without parafunction.

Dental anxiety, cardiovascular changes and patient preconceptions toward implants and root canal treatments: An observational study.

Background: There is little information about dental anxiety and the patient's vital signs during dental procedures. This study evaluates and compare patient anxiety levels and cardiovascular changes before and during root canal treatment (RCT) and single-tooth implant procedures. Material and Methods: Preoperative data and pre-treatment considerations were recorded. HR and SpO2 were monitored during treatment procedures at five points. Data were analyzed accordingly using Mann Whitney or X2 tests. 80 patients met the inclusion criteria. Results: Anxiety and fear scores were strongly correlated (p< 0.001). Both treatments resulted in low levels of dental anxiety and fear. Patients with a prior dental bad experience presented higher anxiety scores in the implant treatment group (p< 0.05). Implant treatment was considered a more time-consuming and more painful procedure than root canal treatment (p< 0.05). No significant relation was found between the level of anxiety with HR and SpO2. Conclusions: No significant relation was found between the level of dental anxiety with HR and SpO2. Single-implant treatment was pre-considered to be a more time-consuming and more painful procedure when compared with a RCT. HR was higher at the initial stages and decreased as both procedures finished. Key words:Dental anxiety, endodontics, dental implants, oximetry, heart rate.

General Anxiety in Dental Staff and Hemodynamic Changes over Endodontists' Workday during the Coronavirus Disease 2019 Pandemic: A Prospective Longitudinal Study.

INTRODUCTION: The aim of this study was to assess general anxiety levels in endodontists and dental assistants related to different conditions during the pandemic and lockdown and to evaluate hemodynamic changes in endodontists' heart rate (HR), blood pressure, and blood oxygenation during their workday. METHODS: Anxiety levels in endodontists and dental assistants were recorded weekly during the state of alarm declared because of the coronavirus disease 2019 pandemic. Hemodynamic parameters were monitored using a sphygmomanometer for HR and blood pressure and a pulse oximeter for oxygen saturation. Measurements were taken before and after each root canal treatment as well as on arrival at the clinic and at the end of the working day. Rest data, recorded every Saturday, served as a control. Data analysis was performed using chi-square, paired t, Mann-Whitney, and analysis of variance tests (P < .05). RESULTS: General anxiety decreased over the weeks, with significant differences between weeks 1 and 4 (P < .05). Endodontists perceived higher anxiety levels of anxiety during anesthesia inoculation and dental assistants during the dental unit's disinfection and equipment material (P < .05). There was a significant increase in the cardiovascular response in all endodontists in the clinic registrations compared with rest data (P < .05). Values were higher in the strict confinement period and significant for HR when arriving at the clinic (P < .05). CONCLUSIONS: Levels of general anxiety were higher during the first weeks. The chief perceived factors related to anxiety in endodontists and dental assistants were the risk of contagion and protection measures. Higher HR and blood pressure levels were registered during the workday, especially when arriving at the clinic.

Dental Anxiety, Fear, and Root Canal Treatment Monitoring of Heart Rate and Oxygen Saturation in Patients Treated during the Coronavirus Disease 2019 Pandemic: An Observational Clinical Study.

INTRODUCTION: The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO2) before, during, and after a root canal treatment (RCT) during the state of alarm in 2 different periods of strict and partial confinement. METHODS: The patients who required a primary RCT were selected. Demographic, preoperative, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO2. Spearman correlation, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests were used to compare HR and SpO2 between groups and different treatment points. RESULTS: Ninety-six patients were included. The median Modified Dental Anxiety Scale scores were 8 (interquartile range [IQR], 6-9.25) and 6 (IQR, 5.5-8) in patients treated during the strict and partial confinement periods. The median fear scores were 2 (IQR, 0-5) and 3 (IQR, 1-5), respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (P < .05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (P < .05). In treatment time points T6 (x-ray taking), and T7 (post-treatment), HR decreased compared with the other evaluated treatment time points (P < .05). No clinical differences were found regarding SpO2. CONCLUSIONS: Self-perception on dental anxiety and fear was similar to other studies in a nonpandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

Current state of dynamic surgery. A literature review / Estado actual de la cirugía dinámica. Una revisión de la literatura

Background: Recently, dental implant technology has been widely used for oral reconstruction. Dental implantsare the treatment of choice for those patients with dental absences. An optimal implant placement is based on theprosthetic driven concept in order to achieve an aesthetic and functional restoration with a long-term prognosis.There are two types of guided implant surgery that are described in the literature: Static Guided Surgery (SGS)and Dynamic Guided Surgery (DGS). The aim of this study is to be aware of the current state of dynamic surgeryand compare in the literature the discrepancies between planning and placement of dental implants.Material and Methods: The study consists of a bibliographic review on the topic. The research has been performedin the Medline/Pubmed of articles published by different professional associations and societies in the interna-tional context.Results: Twenty two studies out of 100 articles from the initial search were finally included. Our results have beencompared with other current available papers in the literature reviewed that obtained similar outcomes.Conclusions: Dynamic navigation shows a better accuracy and precision of implant placement. To corroborate theresults of this review as well as to evaluate the different variables that could influence the accuracy of this tech-nique, future randomized control trials will be needed.(AU)

Alzheimer’s disease: oral manifestations, treatment and preventive measures / Enfermedad de Alzheimer: manifestaciones orales, tratamiento y medidas preventivas

In the treatment of patients with dementia Alzheimer's type non-current and are facing tough situations. Treatment should be tailored to each stage of the disease and for each patient. In this type of disease is very important to involve families and caregivers to improve the quality of life of patients. The main goal with these patients is prevention. Patients should be all oral manifestations caused by the lack of inadequate oral hygiene, xerostomia and manifestations derived by taking drugs. The aim of this review is to describe the main oral manifestations that can result from this disease and the best treatment options taking into account the clinical stages in which patients are found.

En el tratamiento a pacientes con demencias tipo Alzheimer se afrontan situaciones infrecuentes y comprometidas. El tratamiento debe personalizarse para cada estadio de la enfermedad y para cada paciente. En este tipo de enfermedades es muy importante involucrar a los familiares y cuidadores para mejorar la calidad de vida del enfermo. El principal objetivo con estos pacientes es la prevención. Se deben controlar todas las manifestaciones orales provocadas por la falta de una inadecuada higiene oral, la xerostomía y las manifestaciones derivadas por los fármacos que consumen. El objetivo de esta revisión es describir cuáles son las principales manifestaciones orales que pueden derivar de esta enfermedad y las mejores opciones de tratamiento teniendo en cuenta las etapas clínicas en las que se encuentran los pacientes.

Immediate implants following tooth extraction. A systematic review

Objectives: The aim of this article is to review the current state of immediate implants, with their pros and contras, and the clinical indications and contraindications. Material and Methods: An exhaustive literature search has been carried out in the COCHRANE library and MEDLINE electronic databases from 2004 to November 2009. Randomized clinical trials and clinical trials focused on single implants placed in fresh extraction sockets were included and compared. A meta-analysis could not be performed due to heterogeneity of the data. Results: Twenty studies out of 135 articles from the initial search were finally included, which summed up a total of 1139 immediate implants with at least a 12-month follow-up. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Discussion: Immediate implants have predictable results with several advantages over delayed implant placement. However, technical complications have been described regarding this technique. Also, biomaterials may be needed when the jumping distance is greater than 1mm or any bone defect is present. Conclusions: Few studies report on success rates rather than survival rates in the literature reviewed. Short-term clinical results were described and results were comparable to those obtained with delayed implant placement. Further long-term, randomized clinical trials are needed to give scientific evidence on the benefits of immediate implants over delayed implant placement (AU)