Publication trends of the Journal of Esthetic and Restorative Dentistry: A bibliometric analysis.

OBJECTIVE: The Journal of Esthetic and Restorative Dentistry (JERD) stands out as one of the most prominent international journals publishing research in esthetic dentistry. This study analyzed articles published by JERD since the year 2000 through bibliometric analysis. METHODOLOGY: The search was conducted in January 2024 using Scopus. The following data were extracted from the articles: citation count, year, language, access type, funding agency, study design, theme (general and specific), country, institution, authors, and keywords. The VOSviewer software was used to generate collaborative network maps among the data. Dimensions were consulted to measure altmetric data. Google Trends was used to investigate the global popularity of JERD research. RESULTS: A total of 1394 articles were included in this analysis. Citation count ranged from 0 to 625 (average: 16.9). Articles were published between 2000 and 2023. Laboratory studies were more prevalent (n = 850), with the most investigated general theme being restorative procedures (n = 882), and the highlighted specific theme being the use of composite resin (n = 327). The United States had the highest number of articles (n = 640), with the diverse distribution among other countries. The most common keyword was "cad/cam" (n = 63). VOSviewer demonstrated high collaboration among countries. Intense mentions were identified primarily on Facebook. According to Google Trends, Egypt was the country that searched for JERD the most. CONCLUSIONS: JERD exhibited significant growth in the number of published articles and their diversity by topics, types, origin (country), number of citations, and impact factor. CLINICAL SIGNIFICANCE: The JERD is a journal that publishes studies influencing clinical practice. Identifying the key characteristics of this journal is essential for charting future paths.

Pyroptosis-Mediated Periodontal Disease.

Pyroptosis is a caspase-dependent process relevant to the understanding of beneficial host responses and medical conditions for which inflammation is central to the pathophysiology of the disease. Pyroptosis has been recently suggested as one of the pathways of exacerbated inflammation of periodontal tissues. Hence, this focused review aims to discuss pyroptosis as a pathological mechanism in the cause of periodontitis. The included articles presented similarities regarding methods, type of cells applied, and cell stimulation, as the outcomes also point to the same direction considering the cellular events. The collected data indicate that virulence factors present in the diseased periodontal tissues initiate the inflammasome route of tissue destruction with caspase activation, cleavage of gasdermin D, and secretion of interleukins IL-1ß and IL-18. Consequently, removing periopathogens' virulence factors that trigger pyroptosis is a potential strategy to combat periodontal disease and regain tissue homeostasis.

Impact of laboratory treatment with coloring and fluorescent liquids on the optical properties of zirconia before and after accelerated aging.

STATEMENT OF PROBLEM: Laboratory procedures, such as dipping in coloring and fluorescent liquids, can be used to improve the optical properties of zirconia. However, information is lacking on the effect of these liquids. PURPOSE: The purpose of this in vitro study was to evaluate the color differences and degree of fluorescence of zirconia (3Y-TZP) treated with coloring and fluorescent liquids before and after an accelerated aging protocol. MATERIAL AND METHODS: Forty disk-shaped specimens of 3Y-TZP were fabricated by milling and separated according to the laboratory treatment performed: white zirconia (control group); zirconia treated with coloring liquid (A2 group); zirconia treated with fluorescent liquid (fluorescent group); and zirconia treated with both liquids (A2 fluorescent group). The L*a*b* coordinates before aging (T0) were obtained with a spectrophotometer, and the degree of fluorescence was measured. The disks were subjected to accelerated aging for 1 hour (T1) and 5 hours (T2). Measurements were made before and after each time interval. Color differences (ΔE00) were calculated using the CIEDE2000 formula and analyzed by 2-way ANOVA. Lightness (ΔL'), chroma (ΔC'), and hue differences (ΔH') were analyzed by multivariate ANOVA. Degrees of fluorescence were obtained as percentages and were analyzed by 2-way ANOVA. Multiple comparisons were performed by the Tukey HSD test (α=.05). RESULTS: Color differences were observed when 3Y-TZP disks were treated with coloring (7.91 ΔE00), with fluorescent liquid (5.81 ΔE00), and with both liquids (5.52 ΔE00). Accelerated aging resulted in color differences in the T2 A2 group (6.74 ΔE00) and at both times evaluated in the fluorescent group (T1=8.59 ΔE00 and T2=8.47 ΔE00) (P<.001). In the A2 fluorescent group, the degree of fluorescence was not influenced significantly (P>.05). The use of fluorescent liquid influenced the degree of fluorescence in the fluorescent group (T0=20%). CONCLUSIONS: Significant differences in color, lightness, chroma, and hue were achieved in all tested groups before and after aging. The degree of fluorescence was statistically different only in the fluorescent group and was not influenced by accelerated aging.

Ridge Preservation After Maxillary Third Molar Extraction Using 30% Porosity PLGA/HA/ß-TCP Scaffolds With and Without Simvastatin: A Pilot Randomized Controlled Clinical Trial.

OBJECTIVE: To evaluate clinically and radiographically, in humans, the healing of maxillary third molars postextraction sockets after application of different ridge preservation techniques 3 months after tooth extraction. MATERIALS AND METHODS: Twenty-six sockets (13 patients) were randomly assigned to 4 treatment modalities: deproteinized bovine bone mineral with 10% collagen (DBBM-C), poly(D,L-lactide-co-glycolide) with hydroxyapatite/ß-TCP scaffold (PLGA/HA), PLGA/HA/ß-TCP with 2.0% simvastatin scaffold (PLGA/HA/S), and spontaneous healing (control). Clinical complications were assessed, and cone-beam computed tomographies were taken in 5 patients 3 months after surgeries. For statistical purposes, the Fisher exact test was used (P < 0.05). RESULTS: After 3 months, 6 of 9 grafts from the PLGA/HA group were lost (P < 0.05). PLGA/HA/S' loss was only 2 of 8 (P > 0.05), but no loss was observed in the DBBM-C group. Pain was present in 3 of 8 sites that lost the graft (37.5%) (P > 0.05) and infection in 1 of 8 (12.5%) (P > 0.05), with these only occurring in the PLGA/HA group. CONCLUSIONS: Poly (D, L-lactide-co-glycolide) with hydroxyapatite/ß-TCP (PLGA/HA/ß-TCP) scaffolds, with and without simvastatin, failed to obtain the initial expected results and presented more complications. Scaffolds with simvastatin showed to be superior, with less clinical complications than scaffolds without simvastatin.

Clinical Performance of 170 Frictional Morse Taper Implants: 2 Years Follow-Up.

This study evaluated the clinical survival rates of 170 Morse taper implants through clinical and mechanical parameters in different therapeutic approaches such as single crowns, fixed partial prostheses, and fixed full-arch prostheses. Patients referred to the Center on Education and Research on Dental Implants from May 2017 to July 2018 with the indication for dental implant therapy, aged >18 years, without periodontal disease, recent evidence of inflammatory activity or other oral disorders, current pregnancy, uncontrolled diabetes mellitus or heavy smoking habit were included in this study. After 12 weeks of healing since the implants were placed in the mandible and after 16 weeks following implants placed in the maxilla, patients returned to the Center for prosthetic rehabilitation. After implant therapy, all patients underwent periodical, clinical, and prosthetic examinations every 6 months. Prosthetic restorations involved 109 fixed reconstructions in function. Few prosthetic complications were reported (6.55%). Twenty implants were rehabilitated with cemented prostheses; from those, 1 crown suffered a loss in retention/decementation. Of the 148 implants rehabilitated with screwed-retained prostheses, 6.76% suffered prosthetic screw loosening. The cumulative implant survival rate was 98.2%. When peri-implant tissue health was evaluated, the keratinized mucosa band appeared related to peri-implant tissue stability. Thus, Morse taper implants represented a successful procedure for implant rehabilitation, with a high cumulative implant survival rate, low prevalence of biological and prosthetic complications, and good stability of peri-implant tissues over the assessed period.

Tomographic and Histologic Analysis of Different Socket Sealing Approaches for Alveolar Ridge Preservation: A Randomized Controlled Pilot Clinical Trial.

Purpose: To compare different socket sealing approaches for alveolar ridge preservation and assess the dimensional changes and histologic characteristics of soft and hard tissues in a 4- to 6-month period. Material and Methods: A total of 22 patients with indicated single-tooth extraction in the maxillary nonmolar region were eligible for this study. After CBCT scanning and minimally traumatic tooth extraction, the alveolar sockets were filled with demineralized bovine bone mineral with collagen (DBBM-C) in patients from all groups except for those in the control group. Patients were divided into groups for socket sealing as follows: unsealed/spontaneous healing (control; n = 6), collagen matrix (n = 5), collagen membrane (n = 5), and autogenous graft (n = 6). A second CBCT scan was taken 4 to 6 months after extraction, and a trephine biopsy of soft and hard tissues was collected during implant placement. Tomographic dimensional changes were compared between groups. Intragroup tomographic evaluation and histological analysis were also performed. Results: Analysis of dimensional changes did not detect differences between the socket sealing groups (P > .05). In an intragroup evaluation, the height of the buccal bone and cross-sectional area of the alveolar ridge were significantly lower 4 to 6 months after extraction for the control group (P = .031). Histological analysis revealed that the socket sealing approach had no impact on hard and soft tissue formation. Conclusion: The data from the present study suggest that socket sealing with a collagen matrix, a collagen membrane exposed to the oral cavity, or an autogenous punch graft had no difference in the effects on volumetric maintenance and tissue formation in a period of 4 to 6 months.

Histologic and Histomorphometric Analyses of Free Gingival Grafts After Mechanical Expansion: A Study in Dogs.

This study assessed the histologic and histomorphometric changes of free gingival grafts in a canine model after mechanical expansion. A total of eight epithelialized tissue samples were obtained from the palate of eight Beagle dogs. Samples were cut in half and separated into two groups: the test group, in which a device was used to expand the grafts, and the control group, without expansion. After histologic processing, samples were evaluated by qualitative histology and histomorphometry. Histologic analysis revealed some differences in epithelial cell morphology and keratin layer integrity in the test group compared to the control group. Differences in histomorphometric parameters for the expanded and nonexpanded groups, including the thickness of the keratin layer (15.4 ± 13.4 µm and 32.3 ± 18.1 µm, respectively), thickness of the epithelium (398.0 ± 168.0 µm and 368.4 ± 142.8 µm, respectively), and the area occupied by collagen fibers in the connective tissue (62.0% ± 11.0% and 55.8% ± 7.6%, respectively), were not statistically significant (P < .05). Despite some changes in qualitative histology, free gingival grafts maintained their histomorphometric characteristics after mechanical expansion. These data provide a scientific basis for the use of mechanical expansion as a possible procedure to reduce the morbidity of autogenous grafts because a single soft tissue sample can be expanded before grafting. Int J Periodontics Restorative Dent 2023;43:e89-e97. doi: 10.11607/prd.5752.

Allogeneic Bone Application in Association with Platelet-Rich Plasma for Alveolar Bone Grafting of Cleft Palate Defects.

AIM: The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP). MATERIALS AND METHODS: The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil). PATIENTS: Thirty out of 46 patients with 8-12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP. INTERVENTIONS: Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved. RESULTS: There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%). CONCLUSION: ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.

Retinoic acid increases the effect of bone morphogenetic protein type 2 on osteogenic differentiation of human adipose-derived stem cells.

BACKGROUND: Bone morphogenetic protein type 2 (BMP-2) and retinoic acid (RA) are osteoinductive factors that stimulate endogenous mechanisms of bone repair which can be applied on management of osseous defects in oral and maxillofacial fields. OBJECTIVE: Considering the different results of RA on osteogenesis and its possible use to substitute/potency BMP-2 effects, this study evaluated the outcomes of BMP-2, RA, and BMP-2+RA treatments on in vitro osteogenic differentiation of human adipose-derived stem cells (ASCs) and the signaling pathway(s) involved. MATERIAL AND METHODS: ASCs were treated every other day with basic osteogenic medium (OM) alone or supplemented with BMP-2, RA, or BMP-2+RA. Alkaline phosphatase (ALP) activity was determined using the r-nitrophenol method. Extracellular matrix mineralization was evaluated using von Kossa staining and calcium quantification. Expression of osteonectin and osteocalcin mRNA were determined using qPCR. Smad1, Smad4, phosphorylated Smad1/5/8, BMP-4, and BMP-7 proteins expressions were analyzed using western blotting. Signaling pathway was evaluated using the IPA® software. RESULTS: RA promoted the highest ALP activity at days 7, 14, 21, and 28, in comparison to BMP-2 and BMP-2+RA. BMP-2+RA best stimulated phosphorylated Smad1/5/8 protein expression at day 7 and Smad4 expression at days 7, 14, 21, and 28. Osteocalcin and osteonectin mRNA expressions were best stimulated by BMP-2+RA at day 7. Matrix mineralization was most improved by BMP-2+RA at days 12 and 32. Additionally, BMP-2+RA promoted the highest BMP signaling pathway activation at days 7 and 14, and demonstrated more activation of differentiation of bone-forming cells than OM alone. CONCLUSIONS: In summary, RA increased the effect of BMP-2 on osteogenic differentiation of human ASCs.

Effect of γ-lactones and γ-lactams compounds on Streptococcus mutans biofilms.

Considering oral diseases, antibiofilm compounds can decrease the accumulation of pathogenic species such as Streptococcus mutans at micro-areas of teeth, dental restorations or implant-supported prostheses. OBJECTIVE: To assess the effect of thirteen different novel lactam-based compounds on the inhibition of S. mutans biofilm formation. MATERIAL AND METHODS: We synthesized compounds based on γ-lactones analogues from rubrolides by a mucochloric acid process and converted them into their corresponding γ-hydroxy-γ-lactams by a reaction with isobutylamine and propylamine. Compounds concentrations ranging from 0.17 up to 87.5 µg mL-1 were tested against S. mutans. We diluted the exponential cultures in TSB and incubated them (37°C) in the presence of different γ-lactones or γ-lactams dilutions. Afterwards, we measured the planktonic growth by optical density at 630 nm and therefore assessed the biofilm density by the crystal violet staining method. RESULTS: Twelve compounds were active against biofilm formation, showing no effect on bacterial viability. Only one compound was inactive against both planktonic and biofilm growth. The highest biofilm inhibition (inhibition rate above 60%) was obtained for two compounds while three other compounds revealed an inhibition rate above 40%. CONCLUSIONS: Twelve of the thirteen compounds revealed effective inhibition of S. mutans biofilm formation, with eight of them showing a specific antibiofilm effect.

Modified Double-Papillae Flap Technique With Subepithelial Connective Tissue Graft for Root Coverage in the Esthetic Zone: Case Report.

Gingival recession can compromise the esthetic appearance, leading to functional problems, hypersensitivity, and root caries. Several techniques have been implicated for root coverage, which includes pedicle grafts, free gingival grafts, connective tissue grafts, and guided-tissue regeneration. The double-papillae flap associated with subepithelial connective tissue is a predictable technique to cover isolated areas with insufficient attached gingiva apical to a recession. This case report demonstrates a surgical alternative to the technique using a sling periosteal suture to stabilize the connective tissue and pedicle flap during the initial phase of healing, increasing the potential of this periodontal procedure for gingival recession coverage.

Biofilm Analysis of Retrieved Dental Implants after Different Peri-Implantitis Treatments.

The aim of the current study was to analyse the planktonic growth of Streptococcus mutans on the surfaces of three implants retrieved after three different peri-implantitis treatments. Three implants from a male patient with high levels of bone loss were treated by mechanical debridement, chemical decontamination, and implantoplasty. After 4 months of follow-up, the implants were removed. The growth and biofilm formation were measured by spectrophotometry (OD630 nm) and scanning electron microscopy (SEM), after 48 hours of incubation. Results showed an average of Streptococcus mutans planktonic growth over the implants of 0.21 nm (mechanical debridement), 0.16 nm (chemical decontamination), and 0.15 nm (implantoplasty). Data were analysed by ANOVA and Tukey's test (p < 0.05 for chemical decontamination and implantoplasty). Implantoplasty and chemical decontamination showed the lowest levels of planktonic growth, indicating a possible influence of the modification procedures on the titanium surface on the initial biofilm attachment.

Lip Repositioning Technique With Smile Elevator Muscle Containment - A Novel Cosmetic Approach for Gummy Smile: Case Report.

Excessive gingival display (EGD) is a challenge for dentists attempting to provide their patients a pleasant smile. EGD associated with hyperactivity of the smile elevator muscles can be treated with various surgical techniques; regardless of which technique is used, to achieve a predictable result with long-term stability limiting upper lip movement when the patient smiles, a firm muscle containment is imperative. This report describes an innovative suture procedure associated with a lip repositioning technique aimed at maintaining the traction and containment of the smile elevator muscles. This case demonstrates a successful and stable result for excessive gingival exposure, addressing and satisfying a patient's esthetic concerns.

A Step-by-Step Management of Extraction Sites in Areas of Maxillary Sinus Pneumatization: A Literature Review and a Case Presentation of a New Surgical Technique.

INTRODUCTION: The rehabilitation of the posterior maxilla with implant-supported prosthesis is often complicated by pneumatization of the maxillary sinus. Bone grafting is commonly required in these cases. Over the years, a number of techniques have been developed for this type of reconstruction. AIM: Present and discuss the possibility of alveolar bone regeneration for subsequent placement of oral implants using Fugazzotto's technique in combination with particulate autograft harvested from the mandibular ramus and a connective tissue pedicle flap to cover the graft. METHODS: A case of a 37-year-old woman with a molar perforated during endodontic treatment and indicated for extraction and implant placement is reported. RESULT AND CONCLUSION: The clinical case showed the possibility of grafting of extraction sites combined with atraumatic elevation of the maxillary sinus floor can be achieved using non-conventional techniques such as Fugazzotto's technique associated with alveolar bone regeneration.

Does the number of implants have any relation with peri-implant disease?

OBJECTIVE: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. MATERIAL AND METHODS: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. RESULTS: Clinical parameters were compared between groups using Student's t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 - 19 (20.43%)--compared with G2 - 26 (38.24%)--showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). CONCLUSION: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis.

Retinoic acid increases the effect of bone morphogenetic protein type 2 on osteogenic differentiation of human adipose-derived stem cells

Abstract Bone morphogenetic protein type 2 (BMP-2) and retinoic acid (RA) are osteoinductive factors that stimulate endogenous mechanisms of bone repair which can be applied on management of osseous defects in oral and maxillofacial fields. Objective Considering the different results of RA on osteogenesis and its possible use to substitute/potency BMP-2 effects, this study evaluated the outcomes of BMP-2, RA, and BMP-2+RA treatments on in vitro osteogenic differentiation of human adipose-derived stem cells (ASCs) and the signaling pathway(s) involved. Material and Methods ASCs were treated every other day with basic osteogenic medium (OM) alone or supplemented with BMP-2, RA, or BMP-2+RA. Alkaline phosphatase (ALP) activity was determined using the r-nitrophenol method. Extracellular matrix mineralization was evaluated using von Kossa staining and calcium quantification. Expression of osteonectin and osteocalcin mRNA were determined using qPCR. Smad1, Smad4, phosphorylated Smad1/5/8, BMP-4, and BMP-7 proteins expressions were analyzed using western blotting. Signaling pathway was evaluated using the IPA® software. Results RA promoted the highest ALP activity at days 7, 14, 21, and 28, in comparison to BMP-2 and BMP-2+RA. BMP-2+RA best stimulated phosphorylated Smad1/5/8 protein expression at day 7 and Smad4 expression at days 7, 14, 21, and 28. Osteocalcin and osteonectin mRNA expressions were best stimulated by BMP-2+RA at day 7. Matrix mineralization was most improved by BMP-2+RA at days 12 and 32. Additionally, BMP-2+RA promoted the highest BMP signaling pathway activation at days 7 and 14, and demonstrated more activation of differentiation of bone-forming cells than OM alone. Conclusions In summary, RA increased the effect of BMP-2 on osteogenic differentiation of human ASCs.

Creeping attachment involving dental implants: two case reports with a two-year follow-up from an ongoing clinical study.

Introduction. This paper describes case reports where coronal growth of soft tissue on implant threads was observed after surgery for soft tissue graft. This phenomenon is known as "creeping attachment." Methods. Two patients were submitted to gingival graft procedure including subepithelial connective tissue graft and masticatory mucosal graft. A two-year follow-up appointment was performed. Results. After a two-year follow-up gingival growth over titanium surfaces characterizing the "creeping attachment" phenomenon was observed. This gingival growth happened over abutment and threads surfaces. Conclusion. The creeping attachment phenomenon is possible over titanium surfaces and has not yet been reported in the relevant literature over this kind of structure.

Effect of γ-lactones and γ-lactams compounds on Streptococcus mutans biofilms

Abstract Considering oral diseases, antibiofilm compounds can decrease the accumulation of pathogenic species such as Streptococcus mutans at micro-areas of teeth, dental restorations or implant-supported prostheses. Objective To assess the effect of thirteen different novel lactam-based compounds on the inhibition of S. mutans biofilm formation. Material and methods We synthesized compounds based on γ-lactones analogues from rubrolides by a mucochloric acid process and converted them into their corresponding γ-hydroxy-γ-lactams by a reaction with isobutylamine and propylamine. Compounds concentrations ranging from 0.17 up to 87.5 μg mL-1 were tested against S. mutans. We diluted the exponential cultures in TSB and incubated them (37°C) in the presence of different γ-lactones or γ-lactams dilutions. Afterwards, we measured the planktonic growth by optical density at 630 nm and therefore assessed the biofilm density by the crystal violet staining method. Results Twelve compounds were active against biofilm formation, showing no effect on bacterial viability. Only one compound was inactive against both planktonic and biofilm growth. The highest biofilm inhibition (inhibition rate above 60%) was obtained for two compounds while three other compounds revealed an inhibition rate above 40%. Conclusions Twelve of the thirteen compounds revealed effective inhibition of S. mutans biofilm formation, with eight of them showing a specific antibiofilm effect.

Análise tridimensional de elementos finitos da distribuição de tensões em implantes inclinados: uma revisão de literatura / Three-dimensional finite element analysis of stress distribution in tilted implants: a review of literature

Implantes inclinados atualmente são utilizados como uma alternativa cirúrgica e protética. Por tanto, estudos in vitro demonstram que o seu uso aumenta a concentração de tensão no osso cortical peri-implantar e questionasse se esse fator pode levar ao insucesso da reabilitação oral estética. O objetivo do presente artigo foi avaliar a informação relacionada com a influência de forças funcionais sobre a biomecânica de implantes inclinados nas reabilitações orais implantossuportadas. No intuito de investigar essa hipótese, foi realizada uma revisão da literatura e busca de informações existentes em artigos científicos indexados ao PubMed, que avaliassem o efeito da distribuição das tensões na interface osso-implante de implantes inclinados, através do método de análise dos elementos finitos. Os resultados mostraram que o uso de implantes inclinados aumenta a concentração de tensões no osso cortical peri-implantar sob simulação de cargas parafuncionais. No entanto, análises in-vitro não podem prever de forma precisa o comportamento dos tecidos biológicos. Apesar dessa limitação dos estudos, pode-se concluir que elevados picos de tensões poderiam comprometer os limites de resistência do osso cortical, podendo levar a falhas do conjunto osso-implante. Todavia, quando associados a reabilitações de próteses múltiplas, os implantes inclinados mudam sua biomecânica, favorecendo a distribuição e redução das tensões e o aumento da estabilidade das reabilitações como um todo.

Tilted implants are currently used as a surgical and prosthetic's alternative. Therefore, in-vitro studies demonstrate that their use increases the stress concentration in the peri-implant cortical bone and it wonders whether this can lead to the failure of an aesthetic oral rehabilitation. The aim of this paper was to assess information related to the influence of functional forces on the biomechanics of tilted implants in implant oral rehabilitation. In order to investigate this hypothesis, a literature review was made in scientific articles indexed to PubMed, to assess the effect of the stress distribution in the bone-implant interface of tilted implants, through the analysis of the finite element method. The results showed that the use of tilted implants increases the concentration of stresses in the peri-implant cortical bone under the simulation of parafunctional loads. However, in-vitro tests may not accurately predict the behavior of biological tissues. Despite this limitation of the study, it can be concluded that high peaks of tension could compromise the strength limits of cortical bone, leading to failure of the bone-implant joint. However, when associated with multiple rehabilitations, the titled implants change their biomechanics, favoring the distribution and reduction of tension and the increase of the stability of restorations as a whole.

Viability analysis of subepithelial connective tissue grafts subjected to a mechanical expansion process: a histologic study in dogs.

The aim of this study was to histologically evaluate the viability of mechanically expanded subepithelial connective tissue grafts. Sixteen samples of palatal connective tissue were collected from eight beagle dogs. Half of the samples were subjected to the expansion procedure and used as subepithelial grafts in the canine region, and the samples not subjected to expansion were grafted at the contralateral side. After 60 days, biopsies were collected and examined histologically by light and confocal laser microscopy and immunohistochemically with anti-CD31 antibody for endothelial cells. There were no significant differences between the control and test groups. It was concluded that this new method to expand the area of connective tissue grafts was not only viable biologically, but also decreased surgical risks without increasing processing time.