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1.
J Periodontal Res ; 54(5): 525-532, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31032961

RESUMO

OBJECTIVE: To determine whether circulating levels of two matrix metalloproteinases, MMP-2 and MMP-9, are associated with loss of alveolar bone density (ABD) or height (ABH), or with progression of periodontitis (relative clinical attachment level [RCAL]), among postmenopausal women with local and systemic bone loss. BACKGROUND: This study was planned as part of a 2-year randomized, double-blind, placebo-controlled, clinical trial examining efficacy/safety of subantimicrobial dose doxycycline (20 mg bid) in postmenopausal osteopenic women. This study examines whether serum levels of gelatinases are associated with local changes in the periodontium. METHODS: A sample of 113 women received periodontal maintenance for moderate to advanced chronic periodontitis and consented to analysis of stored serum biomarkers. Posterior vertical bitewings were taken, and serum collected, at baseline, one, and 2 years. ABD was determined by computer-assisted densitometric image analysis (CADIA), ABH by the Hausmann et al (1992, J Periodontol 63, 657) method, and RCAL by Florida Probe (every 6 months). MMPs were measured densitometrically on gelatin zymograms using denatured type I collagen as substrate and purified MMP-2 (72 kDa) and MMP-9 (92 kDa) as standards. Evidence of worsening in the periodontium at a tooth site was defined as a change from baseline of, for ABD, at least 14 densitometric units (for subcrestal locations) or 17 units (for crestal locations); of at least 0.4 mm for ABH; and of at least 1.5 mm for RCAL. Logistic regression models, while accounting for clustering, compared the odds of worsening in ABD, ABH, or RCAL, after 2 years of observation, between groups defined by baseline and concurrent levels of serum gelatinases. RESULTS: Changes in ABH and RCAL were not associated with circulating levels of MMP-2 or MMP-9. However, elevated odds of ABD loss over 24 months were associated, among smokers, with both baseline and concurrent levels of MMP-9 in the middle and highest tertile, and with concurrent levels of MMP-2 in the middle (but not the highest) tertile. Elevated odds of ABD loss were also associated, among women within 5 years of menopause, with baseline levels of MMP-2 in the highest tertile. CONCLUSION: Among postmenopausal osteopenic women, loss of ABD was associated, in smokers, with elevated circulating levels of MMP-9 and MMP-2. In those within 5 years of menopause, ABD loss was associated with elevated circulating levels of MMP-2.


Assuntos
Perda do Osso Alveolar , Densidade Óssea , Doenças Ósseas Metabólicas , Gelatinases , Pós-Menopausa , Método Duplo-Cego , Feminino , Gelatinases/sangue , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
J Periodontol ; 80(1): 48-55, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19228089

RESUMO

BACKGROUND: Intraoral radiographs (IRs) provide a two-dimensional view of osseous structures, whereas cone-beam volumetric tomography (CBVT) images are viewable in three dimensions. The aim of this investigation was to compare the measurements from digital IR and CBVT images to direct surgical measurements for the evaluation of regenerative treatment outcomes. METHODS: Digital IR and CBVT images were taken prior to initial bone grafting and at the 6-month reentry surgery for 35 intrabony defects. After defect debridement, direct bony defect measurements were made with a periodontal probe. These same measurements were made on the IR and CBVT images and then compared to the direct surgical values. RESULTS: CBVT correlated strongly with surgical measurements (r = 0.89 to 0.95), whereas IRs correlated less favorably (r = 0.53 to 0.67). IR measurements were significantly less accurate compared to CBVT for all parameters investigated and underestimated surgical measurements from 0.6 +/- 2.3 mm to 1.5 +/- 2.3 mm. No significant difference for the distance from the cemento-enamel junction (CEJ) to the alveolar crest (P = 0.66 for initial measurement and P = 0.92 for reentry), defect fill (P = 0.14), or defect resolution (P = 0.09) was seen between CBVT and surgical measurements; however, there was a significant difference for the distance from the CEJ to the base of the defect, with CBVT measurements underestimating the surgical measurements by 0.5 +/- 1.1 mm for reentry (P <0.01) and 0.9 +/- 0.8 mm for the initial measurement (P <0.01). CONCLUSIONS: Overall, compared to direct surgical measurements, CBVT was significantly more precise and accurate than IRs. If supported by further research, CBVT may obviate surgical reentry as a technique for assessing regenerative therapy outcomes.


Assuntos
Perda do Osso Alveolar/cirurgia , Tomografia Computadorizada de Feixe Cônico , Regeneração Tecidual Guiada Periodontal/métodos , Radiografia Dentária Digital , Adulto , Idoso , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/patologia , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/patologia , Regeneração Óssea/fisiologia , Transplante Ósseo/diagnóstico por imagem , Transplante Ósseo/patologia , Periodontite Crônica/cirurgia , Desbridamento , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Periodontia/instrumentação , Colo do Dente/diagnóstico por imagem , Colo do Dente/patologia , Resultado do Tratamento
3.
J Periodontol ; 80(5): 725-33, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19405825

RESUMO

BACKGROUND: Dental implants have been used to replace missing teeth to provide function and esthetics. One goal of such restorations is to maintain host tissue around the implants. The purpose of this prospective multicenter human clinical trial was to evaluate radiographic marginal bone levels around non-submerged hollow cylindrical and solid-screw implants for 5 years after loading. METHODS: Patients older than 18 years of age with sufficient native bone to surround a dental implant without imposing on a vital structure were recruited at five sites. Solid-screw or hollow-cylinder implants with a titanium plasma-sprayed implant surface were placed in the anterior maxilla or anterior mandible and restored with fixed restorations. Baseline radiographs were taken at the time of implant placement. Subsequent radiographs were taken at the time of final prosthesis placement, at 6 months after prosthesis placement, and annually from prosthesis placement for 5 years. RESULTS: The results of 596 implants in 192 patients at five international sites revealed that clinically significant remodeling of the marginal bone occurred during the first 6 months after implant placement, with a mean (+/- SD) marginal bone loss of 2.44 +/- 1.20 mm. After that, clinically insignificant mean changes in the bone were observed. Overall, 0.22 +/- 0.42 mm of bone loss occurred between the time of prosthesis placement and 1-year postloading. Between 1-year postloading and the last 5-year recall, 0.18 +/- 0.88 mm bone loss occurred. Because 2.84 +/- 1.63 mm of bone loss occurred between implant placement and the 5-year postloading follow-up, 86% of the total mean bone loss over the course of 5 years was accounted for at the time of prosthesis placement. These same trends occurred if the data were analyzed with regard to implant design (solid screw and hollow cylinder), type of restoration (single and multiple), and length of implant (8 to 10, 12, and 14 to 16 mm). CONCLUSIONS: These data demonstrate that, in general, clinically significant marginal bone remodeling occurred between the time of implant placement and final prosthesis placement around one-stage non-submerged titanium implants with a titanium plasma-sprayed surface. Subsequent to that, bone loss observed around implants up to 5 years postloading was minimal. These results suggest that the factors that influence early healing around implants are significantly different from those that affect later marginal bone remodeling.


Assuntos
Perda do Osso Alveolar/diagnóstico por imagem , Implantação Dentária Endóssea , Implantes Dentários , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Adulto , Idoso , Remodelação Óssea , Implantação Dentária Endóssea/efeitos adversos , Análise do Estresse Dentário , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Adulto Jovem
4.
J Periodontol ; 79(2): 283-90, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18251642

RESUMO

BACKGROUND: Because of bone resorption following tooth extraction, preservation of adequate bony dimension is performed often for subsequent treatment with dental implants. This study evaluated a novel, non-invasive treatment using ultrasound to accelerate healing following extraction to minimize alveolar bone loss. The objective of this study was to evaluate the effect of ultrasound on the dimensional healing changes of alveolar bone following tooth extraction using cone-beam volumetric tomography (CBVT). METHODS: This randomized, split-mouth trial involved 12 subjects requiring extraction of two contralateral erupted permanent teeth. Baseline CBVT scans were captured 7 to 10 days following extraction, after which time ultrasound therapy commenced in test sites. Ultrasound therapy was delivered for 20 minutes using a piezoelectric transducer for 10 sessions over the subsequent 4 weeks. Follow-up radiographic scans were obtained at 4 weeks and 3 months postextraction. Analyses of variance and covariance were performed to assess dimensional changes over the 3-month healing period. RESULTS: Analysis of dimensional changes in all measures of vertical height and horizontal width demonstrated no statistically significant differences between the ultrasound and control groups from baseline to 3 months postextraction. Evaluation of correlations between dimensional changes demonstrated a moderately strong correlation (r = 0.67; P = 0.023) in the ultrasound group between the change in buccal vertical height and the baseline crestal ridge width. Analysis of the change in buccal vertical height relative to baseline crestal width demonstrated a statistically significant benefit to ultrasound compared to control (P = 0.016). This benefit was more pronounced in wider sockets compared to narrow sockets. CONCLUSIONS: In this pilot study, there was no significant benefit to ultrasound in absolute bony dimensional changes following tooth extraction. There was a significant interaction between the treatment rendered (ultrasound versus control) and the change in buccal ridge height relative to baseline ridge width at the crest and 3 mm apical to the crest. This benefit was apparent in wide sockets compared to narrow sockets; however, the clinical importance of these relative dimensional changes in the ultrasound group are difficult to determine given the inclusion of all tooth types in a pilot study with a small sample size.


Assuntos
Perda do Osso Alveolar/prevenção & controle , Extração Dentária/efeitos adversos , Terapia por Ultrassom , Adulto , Idoso , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/etiologia , Análise de Variância , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
5.
J Periodontol ; 79(8): 1409-18, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18672990

RESUMO

BACKGROUND: We recently demonstrated that a 2-year subantimicrobial-dose doxycycline (SDD) regimen (double-masked, placebo-controlled clinical trial) in postmenopausal (PM) women exhibiting mild systemic bone loss (osteopenia) and local bone loss (periodontitis) reduced the progression of periodontal attachment loss (intent-to-treat analysis) and the severity of gingival inflammation and alveolar bone loss (subgroups) without producing antibiotic side effects. We now describe SDD effects on biomarkers of collagen degradation and bone resorption in the gingival crevicular fluid (GCF) of the same vulnerable subjects. METHODS: GCF was collected from SDD- and placebo-treated PM subjects (n=64 each) at the baseline and 1- and 2-year appointments; the volume was determined; and the samples were analyzed for collagenase activity (using a synthetic peptide as substrate), relative levels of three genetically distinct collagenases (Western blot), a type-1 collagen breakdown product/bone resorption marker (a carboxyterminal telopeptide cross-link fragment of type I collagen [ICTP]; radioimmunoassay), and interleukin-1beta (enzyme-linked immunosorbent assay). Statistical analyses were performed using generalized estimating equations; primary analyses were intent-to-treat. RESULTS: Collagenase activity was significantly reduced by SDD treatment relative to placebo based on intent-to-treat (P=0.01). ICTP showed a similar pattern of change during SDD treatment, and GCF collagenase activity and ICTP were positively correlated at all time periods (P<0.001). Matrix metalloproteinase (MMP)-8 accounted for approximately 80% of total collagenase in GCF, with much less MMP-1 and -13, and SDD reduced the odds of elevated MMP-8 by 60% compared to placebo (P=0.006). CONCLUSION: These observations support the therapeutic potential of long-term SDD therapy to reduce periodontal collagen breakdown and alveolar bone resorption in PM women; effects on serum biomarkers of systemic bone loss in these subjects are being analyzed.


Assuntos
Antibacterianos/administração & dosagem , Doenças Ósseas Metabólicas/complicações , Colagenases/efeitos dos fármacos , Doxiciclina/administração & dosagem , Líquido do Sulco Gengival/efeitos dos fármacos , Periodontite/tratamento farmacológico , Pós-Menopausa , Idoso , Perda do Osso Alveolar/enzimologia , Perda do Osso Alveolar/prevenção & controle , Biomarcadores/análise , Doenças Ósseas Metabólicas/enzimologia , Colágeno/análise , Colágeno/efeitos dos fármacos , Colágeno Tipo I , Colagenases/análise , Método Duplo-Cego , Feminino , Seguimentos , Líquido do Sulco Gengival/química , Gengivite/prevenção & controle , Humanos , Interleucina-1beta/análise , Interleucina-1beta/efeitos dos fármacos , Metaloproteinase 1 da Matriz/análise , Metaloproteinase 1 da Matriz/efeitos dos fármacos , Metaloproteinase 13 da Matriz/análise , Metaloproteinase 13 da Matriz/efeitos dos fármacos , Metaloproteinase 8 da Matriz/análise , Metaloproteinase 8 da Matriz/efeitos dos fármacos , Pessoa de Meia-Idade , Fragmentos de Peptídeos/análise , Fragmentos de Peptídeos/efeitos dos fármacos , Peptídeos , Perda da Inserção Periodontal/prevenção & controle , Periodontite/enzimologia , Placebos , Pró-Colágeno/análise , Pró-Colágeno/efeitos dos fármacos
6.
J Periodontol ; 84(10): 1382-90, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23205917

RESUMO

BACKGROUND: The purpose of the present study is to examine the association between clinical and radiographic periodontitis measurements during 2 years of periodontal maintenance. METHODS: Secondary analyses were performed from a 2-year, double-masked, placebo-controlled, randomized clinical trial evaluating the efficacy and safety of subantimicrobial dose doxycycline (SDD) in 128 postmenopausal osteopenic females with moderate-to-severe chronic periodontitis. Relative clinical attachment level (relative CAL) and probing depth (PD) measurements were made. Posterior vertical bitewings were taken for alveolar bone density (ABD) and alveolar bone height (ABH) measurements. Generalized estimating equations were used to model associations. RESULTS: One-year ABD changes and 1-year relative CAL/PD changes did not predict 2-year ABH changes and ABH/ABD changes, respectively. Baseline relative CAL and PD were positively associated with baseline ABH loss (P <0.0001), and baseline PDs were associated with subsequent ABD and ABH loss (P <0.05 for each). Among placebo (but not SDD) participants, relative CAL changes were associated with concurrent ABD loss (P = 0.027) when considering 1- and 2-year changes combined. The odds of ABH loss were higher among sites with concurrent 1-year ABD loss versus no change (odds ratio [OR] = 3.15, P <0.0001) or concurrent PD increases versus no change (OR = 1.88, P = 0.0025) when considering 1- and 2-year changes combined. CONCLUSIONS: In postmenopausal osteopenic females undergoing periodontal maintenance, baseline PD was associated with subsequent ABD and ABH loss. Although no longitudinal change preceded another measurement change, changes in PDs and relative CALs appeared to reflect changes in the underlying alveolar bone over time.


Assuntos
Antibacterianos/administração & dosagem , Periodontite Crônica/prevenção & controle , Doxiciclina/administração & dosagem , Idoso , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/prevenção & controle , Processo Alveolar/diagnóstico por imagem , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/complicações , Periodontite Crônica/classificação , Periodontite Crônica/diagnóstico por imagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Perda da Inserção Periodontal/classificação , Perda da Inserção Periodontal/prevenção & controle , Índice Periodontal , Bolsa Periodontal/classificação , Bolsa Periodontal/prevenção & controle , Placebos , Pós-Menopausa/fisiologia , Radiografia Interproximal , Segurança , Resultado do Tratamento
7.
J Periodontol ; 81(2): 251-9, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20151804

RESUMO

BACKGROUND: The analysis of biomarkers in gingival crevicular fluid (GCF) may be helpful in forecasting patient vulnerability to future attachment loss. The purpose of this study is to correlate GCF biomarkers of inflammation and bone resorption with subsequent periodontal attachment and bone loss in a longitudinal trial of a matrix metalloproteinase (MMP) inhibitor. METHODS: GCF was collected from two periodontal pockets (mean +/- SD: 5.1 +/- 1.0 mm) at baseline and annually in postmenopausal females with moderate to advanced periodontitis undergoing periodontal maintenance every 3 to 4 months during a 2-year double-masked, placebo-controlled, randomized clinical trial of subantimicrobial dose doxycycline (SDD; 20 mg two times a day). Subjects were randomized to SDD (n = 64) or a placebo (n = 64). GCF was analyzed for the inflammation markers interleukin (IL)-1beta (using enzyme-linked immunosorbent assay), total collagenase activity (using hydrolysis of a synthetic octapeptide), and MMP-8 (using a Western blot) and the bone-resorption marker carboxyterminal telopeptide cross-link fragment of type I collagen (ICTP) (using a radioimmunoassay). Generalized estimating equations were used to associate these biomarkers, categorized into tertiles, with subsequent clinical attachment (using an automated disk probe) or interproximal bone loss (using radiography). Odds ratio (OR) values compared highest to lowest tertile groups. RESULTS: Increases in GCF IL-1beta and MMP-8 during the first year of periodontal maintenance were associated with increased odds of subsequent (year 2) periodontal attachment loss (OR = 1.67; P = 0.01 and OR = 1.50; P = 0.02, respectively) driven by the placebo group. Elevated baseline ICTP was also associated with increased odds of 1- and 2-year loss of alveolar bone density (OR = 1.98; P = 0.0001) in the placebo group, not the SDD group, and a loss of bone height (OR = 1.38; P = 0.06), again driven by the placebo group. CONCLUSION: These data support the hypothesis that elevated GCF biomarkers of inflammation and bone resorption from a small number of moderate/deep sites have the potential to identify patients who are vulnerable to progressive periodontitis, and SDD may modify that risk.


Assuntos
Antibacterianos/uso terapêutico , Doenças Ósseas Metabólicas/imunologia , Doxiciclina/uso terapêutico , Líquido do Sulco Gengival/imunologia , Atrofia Periodontal/imunologia , Bolsa Periodontal/imunologia , Idoso , Biomarcadores/metabolismo , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/metabolismo , Reabsorção Óssea , Progressão da Doença , Feminino , Líquido do Sulco Gengival/metabolismo , Humanos , Interleucina-1beta/efeitos dos fármacos , Interleucina-1beta/imunologia , Interleucina-1beta/metabolismo , Metaloproteinase 8 da Matriz/efeitos dos fármacos , Metaloproteinase 8 da Matriz/imunologia , Metaloproteinase 8 da Matriz/metabolismo , Pessoa de Meia-Idade , Razão de Chances , Atrofia Periodontal/complicações , Atrofia Periodontal/metabolismo , Bolsa Periodontal/complicações , Bolsa Periodontal/tratamento farmacológico , Bolsa Periodontal/metabolismo , Pós-Menopausa/imunologia , Pós-Menopausa/metabolismo , Medição de Risco , Índice de Gravidade de Doença
9.
J Clin Periodontol ; 34(9): 776-87, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17716313

RESUMO

AIM: Determine the efficacy of 2-year continuous subantimicrobial dose doxycycline (SDD; 20 mg bid) on alveolar bone in post-menopausal osteopenic, oestrogen-deficient women undergoing periodontal maintenance in a 2-year double-blind, placebo-controlled, randomized clinical trial. MATERIAL AND METHODS: One-hundred and twenty-eight subjects randomized to SDD or placebo (n=64 each). Posterior vertical bite wings taken at baseline, 1 and 2 years for alveolar bone density (ABD), using radiographic absorptiometry (RA) and computer-assisted densitometric image analysis (CADIA), and alveolar bone height (ABH). Statistical analyses utilized generalized estimating equations; primary analyses were intent to treat (ITT). Results are presented as SDD versus placebo. RESULTS: Under ITT, there was no statistically significant effect of SDD on ABD loss (RA: p=0.8; CADIA: p=0.2) or ABH loss (p=0.2). Most sites (81-95%) were inactive. For subgroup analyses, mean CADIA was higher with SDD for non-smokers (p=0.05) and baseline probing depths > or =5 mm (p=0.003). SDD was associated with 29% lower odds of more progressive ABH loss in women >5 years post-menopausal (p=0.05) and 36% lower among protocol-adherent subjects (p=0.03). CONCLUSIONS: In post-menopausal osteopenic women with periodontitis, SDD did not differ overall from placebo. Based on exploratory subgroup analyses, additional research is needed to determine the usefulness of SDD in non-smokers, subjects >5 years post-menopausal and in deeper pockets. Protocol registered at (ClinicalTrials.gov). Identifier: NCT00066027.


Assuntos
Perda do Osso Alveolar/prevenção & controle , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Pós-Menopausa , Absorciometria de Fóton , Idoso , Processo Alveolar/efeitos dos fármacos , Densidade Óssea , Doenças Ósseas Metabólicas/complicações , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Bolsa Periodontal/prevenção & controle , Periodontite/prevenção & controle , Placebos , Radiografia Interproximal , Fumar , Resultado do Tratamento
10.
Clin Oral Implants Res ; 16(2): 161-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15777325

RESUMO

OBJECTIVES: The aim of this clinical study was to determine the effectiveness of progressive loading procedures on preserving crestal bone height and improving peri-implant bone density around maxillary implants restored with single premolar crowns by an accurate longitudinal radiographic assessment technique. MATERIALS AND METHODS: Twenty-three HA-coated, endosseous dental implants were placed in 20 subjects and permitted to heal for 5 months before surgical uncovering. The implants were randomly assigned to either an experimental or control group. Following a conventional healing period, the control group implants were restored with a metal ceramic crown and the experimental group implants underwent a progressive loading protocol. The experimental group was progressively loaded by increasing the height of the occlusal table in increments from a state of infraocclusion to full occlusion by adding acrylic resin to a heat-processed acrylic crown. The progressively loaded crowns were placed in infraocclusion for the first 2 months, light occlusion for the second 2 months, and full occlusion for the third 2 months. At this point, a metal ceramic crown replaced the acrylic crown. Standardized radiographs of each implant were made at the time of restoration, then after 2, 4, 6, 9, and 12 months of function. Digital image analysis and digital subtraction radiography were used to measure changes in crestal bone height and peri-implant bone density. RESULTS: The mean values of crestal bone height loss at 12 months were 0.2+/-0.27 mm for the progressively loaded implants and 0.59+/-0.27 for the conventionally loaded implants, and when tested with repeated-measure ANOVA across the time periods, the differences were statistically significant (P< or =0.05). The progressively loaded group showed a trend for higher bone density gain in the crestal area than the conventionally loaded group, but the conventionally loaded group showed a trend for higher bone density gain at the apex of the implants. CONCLUSION: The peri-implant bone around progressively loaded implants demonstrates less crestal bone loss than the bone around implants placed conventionally into full function. The peri-implant density measurements of the progressively loaded implants show continuous increase in peri-implant bone density by time.


Assuntos
Densidade Óssea , Implantação Dentária Endóssea/métodos , Implantes Dentários para Um Único Dente , Maxila/fisiologia , Processo Alveolar/anatomia & histologia , Análise de Variância , Humanos , Maxila/diagnóstico por imagem , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Fatores de Tempo , Suporte de Carga
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