Nanotopography and oral bacterial adhesion on titanium surfaces: in vitro and in vivo studies.

The present study aimed to evaluate the influence of titanium surface nanotopography on the initial bacterial adhesion process by in vivo and in vitro study models. Titanium disks were produced and characterized according to their surface topography: machined (Ti-M), microtopography (Ti-Micro), and nanotopography (Ti-Nano). For the in vivo study, 18 subjects wore oral acrylic splints containing 2 disks from each group for 24 h (n = 36). After this period, the disks were removed from the splints and evaluated by microbial culture method, scanning electron microscopy (SEM), and qPCR for quantification of Streptococcus oralis, Actinomyces naeslundii, Fusobacterium nucleatum, as well as total bacteria. For the in vitro study, adhesion tests were performed with the species S. oralis and A. naeslundii for 24 h. Data were compared by ANOVA, with Tukey's post-test. Regarding the in vivo study, both the total aerobic and total anaerobic bacteria counts were similar among groups (p > 0.05). In qPCR, there was no difference among groups of bacteria adhered to the disks (p > 0.05), except for A. naeslundii, which was found in lower proportions in the Ti-Nano group (p < 0.05). In the SEM analysis, the groups had a similar bacterial distribution, with a predominance of cocci and few bacilli. In the in vitro study, there was no difference in the adhesion profile for S. oralis and A. naeslundii after 24 h of biofilm formation (p > 0.05). Thus, we conclude that micro- and nanotopography do not affect bacterial adhesion, considering an initial period of biofilm formation.

Nanotopography and oral bacterial adhesion on titanium surfaces: in vitro and in vivo studies

Abstract The present study aimed to evaluate the influence of titanium surface nanotopography on the initial bacterial adhesion process by in vivo and in vitro study models. Titanium disks were produced and characterized according to their surface topography: machined (Ti-M), microtopography (Ti-Micro), and nanotopography (Ti-Nano). For the in vivo study, 18 subjects wore oral acrylic splints containing 2 disks from each group for 24 h (n = 36). After this period, the disks were removed from the splints and evaluated by microbial culture method, scanning electron microscopy (SEM), and qPCR for quantification of Streptococcus oralis, Actinomyces naeslundii, Fusobacterium nucleatum, as well as total bacteria. For the in vitro study, adhesion tests were performed with the species S. oralis and A. naeslundii for 24 h. Data were compared by ANOVA, with Tukey's post-test. Regarding the in vivo study, both the total aerobic and total anaerobic bacteria counts were similar among groups (p > 0.05). In qPCR, there was no difference among groups of bacteria adhered to the disks (p > 0.05), except for A. naeslundii, which was found in lower proportions in the Ti-Nano group (p < 0.05). In the SEM analysis, the groups had a similar bacterial distribution, with a predominance of cocci and few bacilli. In the in vitro study, there was no difference in the adhesion profile for S. oralis and A. naeslundii after 24 h of biofilm formation (p > 0.05). Thus, we conclude that micro- and nanotopography do not affect bacterial adhesion, considering an initial period of biofilm formation.

Demineralized human dentin matrix for alveolar ridge preservation using a volumetric and histologic analyses in rats

Abstract The aim of this study was to evaluate a Demineralized Human Dentine Matrix (DHDM) as viable biomaterial for alveolar ridge preservation in a rat model. Wistar rats were submitted to the extraction of maxillary first molars bilaterally. Sockets were filled with biomaterials and divided into 4 experimental groups (n=5): blood clot, autogenous bone, bovine-derived xenograft (BDX) and DHDM. Animals were sacrificed at 7, 14 e 28 days. Microtomography (uCT) volumetric evaluation and qualitative histological analyses were performed. Results obtained through the uCT showed similar values between the DHDM and the other experimental groups. The histological evaluation demonstrated DHDM with an unspecific inflammatory process and bone neoformation with slow reabsorption of the material. This result indicates that DHDM implanted in rat sockets is biocompatible and reduces the alveolar ridge volume loss after tooth extraction.

Resumo O objetivo deste estudo foi avaliar a Matriz Dentinária Humana Desmineralizada (MDHD) como biomaterial viável para preservação do rebordo alveolar, no modelo em rato. Ratos Wistar foram submetidos à exodontias dos primeiros molares superiores bilateralmente. Os alvéolos foram preenchidos com biomateriais e divididos em 4 grupos experimentais (n=5): coágulo sanguíneo, osso autógeno, osso xenógeno de origem bovina e MDHD. Os animais foram sacrificados aos 7, 14 e 28 dias. Foram realizadas avaliações volumétricas por microtomografia (uCT) e análises histológicas qualitativas. Os resultados obtidos por meio do uCT mostraram valores semelhantes entre o MDHD e os demais grupos experimentais. A avaliação histológica demonstrou MDHD com processo inflamatório inespecífico e neoformação óssea com lenta reabsorção do material. Esse resultado indica que a MDHD implantada em alvéolo de rato é biocompatível e reduz a perda de volume do rebordo alveolar após extração dentária.

Demineralized human dentin matrix for alveolar ridge preservation using a volumetric and histologic analyses in rats.

The aim of this study was to evaluate a Demineralized Human Dentine Matrix (DHDM) as viable biomaterial for alveolar ridge preservation in a rat model. Wistar rats were submitted to the extraction of maxillary first molars bilaterally. Sockets were filled with biomaterials and divided into 4 experimental groups (n=5): blood clot, autogenous bone, bovine-derived xenograft (BDX) and DHDM. Animals were sacrificed at 7, 14 e 28 days. Microtomography (uCT) volumetric evaluation and qualitative histological analyses were performed. Results obtained through the uCT showed similar values between the DHDM and the other experimental groups. The histological evaluation demonstrated DHDM with an unspecific inflammatory process and bone neoformation with slow reabsorption of the material. This result indicates that DHDM implanted in rat sockets is biocompatible and reduces the alveolar ridge volume loss after tooth extraction.

Postoperative Complications Following Free Gingival Graft: a Case Report / Complicações Pós-Operatórias Após Enxerto Gengival Livre: Relato de Caso

Among the available techniques for gingival recession treatment, the main surgical technique for gain of keratinized tissue is the free gingival graft. This procedure is also indicated for vestibule extension and frenulum removal. The technique consists of the epithelial and connective tissues removal from a donor site and its repositioning on to a recipient site, being an effective primary stability mandatory for the healing process. The aim of this study was to describe a case report of a 35-year-old male, who reported a postoperative complication in donor area, after a free gingival graft which occurred 07 days later. This situation occurred after patient reported having rinsed his mouth with hot water during shower. Due to that, a 1mm thick acetate tray was readymade for the donor site comfort and protection. Among the demands presented in this case, free gingival graft was the primary surgical choice to increase keratinized tissue. Despite the patient's morbidity, due to the two surgical sites, the use of the acetate tray showed great reduction in patient's discomfort and trauma. This approach proved to be successful since the patient described increase in self-esteem and oral hygiene facilitation which in combination contributed to satisfactory final results. (AU)

Entre as técnicas disponíveis para o tratamento da recessão gengival, a principal técnica cirúrgica para ganho de tecido queratinizado é o enxerto gengival livre. Este procedimento também é indicado para extensão do vestíbulo e remoção do frênulo. A técnica consiste na remoção de tecidos epiteliais e conectivos de um local doador e seu reposicionamento no local receptor, sendo necessária uma estabilidade primária eficaz para o processo de cicatrização. O objetivo deste estudo foi descrever um relato de caso de um homem de 35 anos, que relatou uma complicação pós-operatória na área doadora, 07 dias após a realização de um enxerto gengival livre. Essa situação ocorreu depois que o paciente relatou ter enxaguado a boca com água quente durante o banho. Devido a isso, uma placa de acetato de 1 mm de espessura foi preparada para conforto e proteção do local doador. Entre as demandas apresentadas neste caso, o enxerto gengival livre foi a principal opção cirúrgica para aumentar o tecido queratinizado. Apesar da morbidade do paciente, devido aos dois locais cirúrgicos, o uso da placa de acetato demonstrou grande redução no desconforto e trauma do paciente. Essa abordagem mostrou-se bem-sucedida, uma vez que o paciente descreveu aumento da autoestima e facilitação da higiene bucal, o que em conjunto contribuiu para resultados finais satisfatórios. (AU)

Periodontal Surgery for Correction of Gingival Smile: a Case Report Analysis of Periodontal Parameters After 2 Years / Cirurgia Periodontal para Correção de Sorriso Gengival: Relato de Caso e Análise dos Parâmetros Periodontais Após 2 Anos

Gingival smile is a term used to describe an aesthetic condition in which excessive gingival exposure at the jaw level occurs during smile. There are several factors related to its etiology, the most common is the altered passive eruption of anterior superior teeth. To correct this disharmony, a multidisciplinary approach is necessary, and the treatment plan depends on a correct diagnosis and assessment for a better prognosis. The present study aims to describe a clinical case where periodontal surgical techniques were used to correct this condition. Female patient, 25 years old, with aesthetic complaint of the amount of gum exposed when smiling and diagnosed with altered passive eruption. Clinical crown augmentation surgery was performed on the anterior superior teeth. After 1 and 2 years, periodontal clinical parameters (probing bleeding, probing depth, clinical attachment level, crown length, keratinized mucosa width and plaque index) were reassessed, through clinical examination, digital photographic monitoring and measurement tools. In two years, it was possible to note the stability of the results achieved, maintaining values similar to those of the immediate postoperative period. The case report confirmed the success of the clinical crown augmentation surgery and the periodontal parameters stability evaluated after 2 years. (AU)

Sorriso gengival é o termo utilizado para descrever uma condição estética em que ocorre uma exposição gengival excessiva ao nível da maxila, durante o sorriso. Há diversos fatores relacionados a sua etiologia, sendo a mais comum a erupção passiva alterada dos dentes ântero-superiores. Para correção dessa desarmonia é necessária uma abordagem multidisciplinar, sendo o plano de tratamento dependente de um correto diagnóstico e avaliação para um melhor prognóstico. O presente estudo tem objetivo de descrever um caso clínico onde técnicas cirúrgicas periodontais foram utilizadas para correção dessa condição. Paciente gênero feminino, 25 anos de idade, com queixa estética da quantidade de gengiva exposta ao sorrir e com diagnóstico de erupção passiva alterada. Foi submetida a cirurgia de aumento de coroa clínica nos dentes antero-superiores. Após 1 e 2 anos foram reavaliados os parâmetros clínicos periodontais (sangramento a sondagem, profundidade de sondagem, perda de inserção, comprimento da coroa, largura da mucosa queratinizada e índice de placa), através de exame clinico, acompanhamento digital fotográfico e ferramentas de medição de imagem. Em dois anos, foi possível constatar a estabilidade dos resultados alcançados, mantendo valores semelhantes aos do pós-operatório imediato. O relato de caso confirmou o sucesso da cirurgia de aumento de coroa clínica e a estabilidade dos parâmetros periodontais avaliados após 2 anos. (AU)

Análise físico-química da superfície de titânio após tratamento químico de descontaminação com clorexidina: estudo in vitro / Physical and chemical analysis of the titanium surface after chemical treatment of decontamination with chlorexidine: in vitro study

Introdução: Tratamentos têm sido propostos para a peri-implantite com o objetivo de descontaminar a superfície dos implantes, removendo microrganismos que podem estar associados à doença. Objetivo: O objetivo deste estudo foi avaliar a ação in vitro de diferentes métodos de aplicação de digluconato de clorexidina (CLX) na descontaminação de discos de titânio (Ti) com microtopografia e seu efeito físico-químico sobre a superfície. Material e método: Vinte discos de Ti foram expostos a inóculo de Escherichia coli por 24 horas. Foram distribuídos em quatro grupos de descontaminação (n=5): 1 - um minuto de exposição à solução de CLX 0,12%; 2 - dois minutos de exposição à solução de CLX 0,12%; 3 - esfregaço durante um minuto com gel de CLX 1%; 4 - esfregaço durante um minuto com gel de CLX 2%. O produto de cada disco foi diluído e plaqueado individualmente. Após 24 horas, realizou-se contagem das unidades de colônias formadas (UFC). Resultado: O grupo com o menor número de crescimento de UFC foi o grupo 4 (0,20±0,37), com apenas UFC em uma das amostras. Seguido do grupo 2 (0,40±0,73), grupo 1 (18,60±33,96). O grupo 3 apresentou as maiores quantidades de UFC (36,07±41,39). Em todas as amostras, foi possível observar uma diminuição estatisticamente significante da concentração superficial de Ti, assim como um aumento de oxigênio. Conclusão: Pode-se concluir que o uso de CLX gel a 2% em superfícies de Ti com microtopografia contaminadas com E. coli propicia a eliminação das UFC e que sua aplicação resulta em diminuição do percentual de Ti e aumento do teor de O.

Introduction: Treatments have been proposed for peri-implantitis aiming to decontaminate the implants` surface removing microorganisms associated with the disease. Objective: The objective of this study was to evaluate the in vitro action of application of chlorhexidine digluconate (CLX) in the decontamination of titanium (Ti) discs with microtopography and its chemical-physical effect on the surface. Material and method: Twenty Ti discs were exposed to the Escherichia coli inoculum for 24 hours. Distributed equally in 4 decontamination groups (n = 5): 1- one minute of exposure to the 0.12% CLX solution; 2- two minutes of exposure to the 0.12% CLX solution; 3- smear for 1 minute with 1% CLX gel; and 4- smearing for 1 minute with 2% CLX gel. The product was diluted and plated individually. After 24 hours, colony units formed (CFU) were counted. Result: The group with the lowest number of CFU growth was group 4 (0.20 ± 0.37) with only one CFU in one of the samples. Followed by group 2 (0.40 ± 0.73), group 1 (18.60 ± 33.96), and group 3, which presented the highest amounts of CFU (36.07 ± 41.39). In all samples it was possible to observe a statistically significant decrease in the surface concentration of Ti, as well as an increase in oxygen. Conclusion: It can be concluded that the use of 2% CLX gel on Ti surfaces with microtopography contaminated with E.coli allows the elimination of CFU, and that its application results in a decrease in the percentage of Ti and an increase in the content of O.

Avaliação contínua da aprendizagem por meio da aplicação de quiz semanal no ensino da Periodontia / Continuous learning evaluation through the application of weekly quiz in Periodontics

A avaliação contínua e rotineira mantém o estudante sob constante estudo, leitura e aprendizado, além de suavizar o impacto das avaliações teóricas formais sobre os critérios tradicionais de aprovação. O objetivo deste estudo foi avaliar o impacto da aplicação de quiz semanal sobre a nota da avaliação teórica formal no componente curricular Periodontia I do Curso de Odontologia da Universidade Federal do Paraná. Para este estudo observacional retrospectivo, avaliaram-se os campos "nota quiz" e "nota avaliação" dos diários de classe das turmas do primeiro e segundo semestres de 2016, respectivamente "sem quiz" (n=53) e "com a realização de quiz semanal" (n=55). As avaliações teóricas formais foram idênticas para as duas turmas. Os dados referentes ao número de quizzes realizados e média das notas de quiz foram tabulados. As análises estatísticas utilizadas foram teste t de Student e coeficiente de correlação de Spearman. A aplicação de quiz semanal deslocou a curva referente às notas de avaliação teórica à direita, sendo que as notas foram significativamente maiores neste grupo (p<0.01). Além disso, houve correlação significativa entre a nota da avaliação teórica e o número de quizzes realizados por cada estudante (r=0,39; p<0,01), bem como com a média da nota do quiz (r=0,47; p<0,01). Concluiu-se que a utilização de quiz semanal como instrumento de avaliação da aprendizagem influi positivamente no grau de conhecimento adquirido, provavelmente devido a um maior estímulo à leitura e estudo constante (AU).

Continuous and routine evaluation keeps the student studying, reading and learning permanently, as well as lightens the impact of formal theoretical exams on the traditional criteria for passing a course. The aim of this study was to evaluate the impact of weekly quiz application on the formal theoretical exam score in the course of Periodontics I ­ a theoreticalpractical course ­ at the School of Dentistry at Federal University of Paraná, Brazil. For this retrospective observational study, the fields "quiz score" and "exam score" of the register book from students of the first and second term of 2016, "no quiz" (n=53) and "weekly quiz application" (n=55), respectively, were analyzed. Formal theoretical exams were identical for both students groups. Data related to the number of quizzes taken by each student and quiz scores were tabulated. Student's t-test and Spearman correlation coefficient test were used for statistical analyses. Weekly quiz application moved the theoretical exam scores curve to the right and scores were significantly greater in this group (p<0.01). Besides, there was a significant correlation between theoretical exam score and the number of quizzes taken by each student (r=0.39; p<0.01), as well as with mean quiz score (r=0.47; p<0.01). We concluded that weekly application of quiz as an evaluation instrument in Periodontics positively influences acquired knowledge, probably due to stimulating permanent studying (AU).

Changes in alveolar bone support induced by the Herbst appliance: a tomographic evaluation.

OBJECTIVE: This study evaluated alveolar bone loss around mandibular incisors, induced by the Herbst appliance. METHODS: The sample consisted of 23 patients (11 men, 12 women; mean age of 15.76 ± 1.75 years), Class II, Division 1 malocclusion, treated with the Herbst appliance. CBCT scans were obtained before treatment (T0) and after Herbst treatment (T1). Vertical alveolar bone level and alveolar bone thickness of mandibular incisors were assessed. Buccal (B), lingual (L) and total (T) bone thicknesses were assessed at crestal (1), midroot (2) and apical (3) levels of mandibular incisors. Student's t-test and Wilcoxon t-test were used to compare dependent samples in parametric and nonparametric cases, respectively. Pearson's and Spearman's rank correlation analyses were performed to determine the relationship of changes in alveolar bone thickness. Results were considered at a significance level of 5%. RESULTS: Mandibular incisors showed no statistical significance for vertical alveolar bone level. Alveolar bone thickness of mandibular incisors significantly reduced after treatment at B1, B2, B3, T1 and significantly increased at L2. The magnitude of the statistically significant changes was less than 0.2 mm. The changes in alveolar bone thickness showed no statistical significance with incisor inclination degree. CONCLUSIONS: CBCT scans showed an association between the Herbst appliance and alveolar bone loss on the buccal surface of mandibular incisors; however, without clinical significance.

Changes in alveolar bone support induced by the Herbst appliance: a tomographic evaluation

ABSTRACT Objective: This study evaluated alveolar bone loss around mandibular incisors, induced by the Herbst appliance. Methods: The sample consisted of 23 patients (11 men, 12 women; mean age of 15.76 ± 1.75 years), Class II, Division 1 malocclusion, treated with the Herbst appliance. CBCT scans were obtained before treatment (T0) and after Herbst treatment (T1). Vertical alveolar bone level and alveolar bone thickness of mandibular incisors were assessed. Buccal (B), lingual (L) and total (T) bone thicknesses were assessed at crestal (1), midroot (2) and apical (3) levels of mandibular incisors. Student's t-test and Wilcoxon t-test were used to compare dependent samples in parametric and nonparametric cases, respectively. Pearson's and Spearman's rank correlation analyses were performed to determine the relationship of changes in alveolar bone thickness. Results were considered at a significance level of 5%. Results: Mandibular incisors showed no statistical significance for vertical alveolar bone level. Alveolar bone thickness of mandibular incisors significantly reduced after treatment at B1, B2, B3, T1 and significantly increased at L2. The magnitude of the statistically significant changes was less than 0.2 mm. The changes in alveolar bone thickness showed no statistical significance with incisor inclination degree. Conclusions: CBCT scans showed an association between the Herbst appliance and alveolar bone loss on the buccal surface of mandibular incisors; however, without clinical significance.

RESUMO Introdução: este estudo avaliou a perda óssea alveolar ao redor dos incisivos inferiores induzida pelo aparelho de Herbst. Métodos: a amostra foi composta por 23 pacientes (11 homens e 12 mulheres; média de idade 15,76 ± 1,75 anos), má oclusão de Classe II, divisão 1, tratados com aparelho de Herbst. TCFCs foram realizadas antes do tratamento (T0) e após o tratamento (T1) com o Herbst. A altura e a espessura óssea alveolar dos incisivos inferiores foram avaliadas. As espessuras ósseas vestibular (V), lingual (L) e total (T) foram mensuradas nos terços cervical (1), médio (2) e apical (3) dos incisivos inferiores. O teste t de Student e o teste t de Wilcoxon compararam as amostras dependentes nos casos paramétricos e não paramétricos, respectivamente. As análises de Pearson e Spearman determinaram a correlação entre as alterações na espessura do osso alveolar. Os resultados foram considerados para um nível de significância de 5%. Resultados: os incisivos inferiores não apresentaram significância estatística para a altura óssea alveolar. Após o tratamento, a espessura óssea alveolar dos incisivos inferiores reduziu-se significativamente em V1, V2, V3 e T1 e aumentou significativamente em L2. A quantidade da alteração óssea significativa foi menor que 0,2mm. As alterações na espessura óssea alveolar não apresentam correlação estatisticamente significativa com o grau de inclinação do incisivo. Conclusões: as imagens de TCFC demonstram associação entre o uso do aparelho de Herbst e a perda óssea alveolar no lado vestibular dos incisivos inferiores; entretanto, sem significância clínica.

Cone beam computed tomography study of apical root resorption induced by Herbst appliance.

OBJECTIVE: This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT). MATERIAL AND METHODS: The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates' correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%. RESULTS: Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders. CONCLUSION: CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Cone beam computed tomography study of apical root resorption induced by Herbst appliance

Objective This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT).Material and Methods The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates’ correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%.Results Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders.Conclusion CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Statins and Antimicrobial Effects: Simvastatin as a Potential Drug against Staphylococcus aureus Biofilm.

Statins are important lipid-lowering agents with other pleiotropic effects. Several studies have explored a possible protective effect of statins to reduce the morbidity and mortality of many infectious diseases. Staphylococcus aureus is one of the main pathogens implicated in nosocomial infections; its ability to form biofilms makes treatment difficult. The present study observed the MIC of atorvastatin, pravastatin and simvastatin against S. aureus, Pseudomonas aeruginosa, Escherichia coli and Enterococcus faecalis. Simvastatin was the only agent with activity against clinical isolates and reference strains of methicilin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). Thus, the effects of simvastatin on the growth, viability and biofilm formation of S. aureus were tested. In addition, a possible synergistic effect between simvastatin and vancomycin was evaluated. Simvastatin's MIC was 15.65 µg/mL for S. aureus 29213 and 31.25 µg/mL for the other strains of S. aureus. The effect of simvastatin was bactericidal at 4xMIC and bacteriostatic at the MIC concentration. No synergistic effect was found between simvastatin and vancomycin. However, the results obtained against S. aureus biofilms showed that, in addition to inhibiting adhesion and biofilm formation at concentrations from 1/16xMIC to 4xMIC, simvastatin was also able to act against mature biofilms, reducing cell viability and extra-polysaccharide production. In conclusion, simvastatin showed pronounced antimicrobial activity against S. aureus biofilms, reducing their formation and viability.

Procedimentos Cirúrgicos Minimamente Traumáticos em Periodontia: Revisão de Literatura / Minimally Traumatic Surgical Procedures in Periodontics: a Review

O conceito de procedimentos minimamente invasivos pode ser estendido a todas as áreas da odontologia, mas a periodontia, em especial, temresultados benéficos quando da utilização desta modalidade terapêutica. Dessa forma, esta revisão de literatura teve como objetivo descrevera utilização dos procedimentos minimamente invasivos em cirurgias periodontais, seus conceitos, aplicações e possiveis beneficios. Para estarevisão de literatura, foram avaliados 682 artigos publicados entre 1950 e 2012 que abordaram o tema cirurgia periodontal minimamenteinvasiva. Destes 682 artigos, 668 não descreveram claramente os procedimentos realizados não atendendo aos critérios de inclusão e portantoforam descartados. Cuidados como iluminação adequada promovem um aumento da acuidade visual durante os procedimentos cirurgicos,assim favorecendo a precisão associada aos instrumentos microcirúrgicos especificamente concebidos e permitindo uma manipulação maisprecisa e minimamente traumática dos tecidos moles e duros. Além disso, auxilia na melhora do acesso cirúrgico, evita a remoção desnecessáriade tecidos, a optimização do desbridamento, melhora a vascularização e, por conseguinte, a possibilidade de obtenção de cicatrizaçãoprimária de feridas cirúrgicas. A abordagem microcirúrgica pode melhorar a previsibilidade dos diferentes procedimentos periodontais,proporcionar melhores resultados estéticos e causar menor desconforto pós-operatório. No entanto, poucos estudos foram realizados commetodologias estabelecidas sobre o uso de instrumentos que promovam procedimentos minimamente invasivos em periodontia. Portanto, sãonecessários estudos para determinar se as técnicas microcirúrgicas podem levar a uma diferença significativa no prognóstico da terapeuticaproposta. A maioria dos estudos encontrados na literatura são baseados em observações e experiências dos autores, que mostram claramenteque há vantagens em uma melhor iluminação, melhor visão e técnica mais controlada e menos traumática.

The concept of minimally invasive procedures can be extended to all s of dentistry. Periodontics, in particular, has been reported as oneof the areas with great benefits. This review aims to describe the use of minimally invasive procedures in periodontal surgery, its concepts,applications, and possible benefits from its use. For that, 682 articles published between 1950 and 2012 focused on minimally invasiveperiodontal surgery were evaluated. Of them, 669 studies did not describe clearly the procedures, and did not attend the inclusion criteria.The results showed that proper lighting promotes increased visual acuity during surgical procedures, favoring the precision associated withmicrosurgical instruments specifically designed, allowing a more accurate manipulation of the soft and hard tissues. Surgical access avoidsunnecessary tissues removal, optimizing the debridement, improving vascularisation, and therefore the possibility of obtaining primary healingof surgical wounds. The microsurgical approach can improve the predictability of different periodontal procedures, providing better resultsand cause less postoperative discomfort. However, few controlled methodologies on the use of instruments to promote minimally invasiveprocedures in periodontics have been found in literature. Therefore, studies are needed to determine whether microsurgical techniques can leadto a significant difference in the successful outcome. Most of the studies are based on observations and experiences of the authors, which clearlyshow that there are advantages in having better lighting, better vision, and a more controlled and less traumatic technique.

Vertical root fracture: preservation of the alveolar ridge using immediate implants.

Teeth with vertical root fracture (VRF) have complete or incomplete fractures that begin in the root and extend toward the occlusal surface. The most frequent causes of VRF originate from physical trauma, occlusal prematurity, inadequate endodontic treatment, and iatrogenic causes. Diagnose is difficult and delay can cause stomatognathic system problem. The purpose of this case report was to evaluate immediate implant placement after extraction of teeth with vertical root fracture. For the 1st case, the VRF in 1st left lower molar was confirmed during surgical flap and at the same time, the tooth was removed and immediate implant was placed. For the 2nd case, the VRF 1st left lower molar was confirmed during endodontic access and at the same appointment, the tooth was removed and the immediate implant is placed. Several studies have shown that immediate implants have similar success rates when compared with late implants. Consider that this approach is a safe procedure with favorable prognosis. In cases of VRF, the main factor to be considered is the presence of adequate bone support and immediate implants can preserve the vertical bone height, adding the fact that good patient compliance reduces the number of surgical interventions and promotes the functionality of stomatognathic system.

Influência da Irrigação na Osseointegração: Revisão da Literatura / Osseointegration Influenced by the Irrigation System: a Literature Review

O uso de implantes para a reabilitação oral é pratica comum na odontologia. Entretanto, falhas são relatadas na literatura. Para evitar o insucesso, cuidados na preparação do leito receptor dos implantes são importantes e, entre esses cuidados, o não aquecimento do osso adjacente é fundamental. A elevação da temperatura durante a osteotomia é um fator importante para o fracasso da técnica cirúrgica. O objetivo do trabalho foi revisar a literatura sobre a influência da irrigação na osseointegração. Foram realizadas buscas em bases de dados no portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), National Center for Biotechnology Information (NCBI)/U.S., National Library of Medicine (PubMed) e Google Acadêmico, no perído de 1964 a 2012. Foram selecionados 333 estudos relacionados à busca, sendo que 203 foram descartados por não abordarem de forma clara a relação entre o controle do calor gerado e o procedimento de instalação de implantes orais. Os 130 artigos remanescentes foram selecionados e 50 estudos foram incluídos. Foram identificados os fatores relacionados aos diferentes sistemas de irrigação do tipo externo e do tipo interno usados para o controle da temperatura, tanto das brocas como do tecido ósseo adjacente, durante a osteotomia para a inserção de implantes. Baseado na literatura, é imprescindível a utilização da irrigação durante a confecção dos alvéolos cirúrgicos para a inserção de implantes dentários, independentemente de serem interno ou externo, já que os estudos mostram que o desempenho de ambos é semelhante, salvo em casos específicos, como no caso de cirurgias guiadas, em que a irrigação interna parece ser mais eficiente.

The use of implants for oral rehabilitation is a common practice in dentistry, though failures are reported in literature. To avoid failure, careful preparation of the recipient site of the implants is important, and among these cares, not heating the adjacent bone is essential. Increasing temperature during osteotomy is an important factor in failure of the surgical technique. This study aimed to review the literature about the influence of irrigation on osseointegration. Searches were conducted in databases on the portal of periodicals from Coordination of Improvement of Higher Education Personnel (CAPES), National Center for Biotechnology Information (NCBI) / U.S., National Library of Medicine (PubMed) and Google Scholar, in the period from 1964 to 2012. Then, 333 studies were selected, but 203 were discarded for not clearly addressing the subject. One hundred and thirty remaining articles were selected, and 50 studies were included. The study identified the factors related to the external and internal irrigation systems used to control the temperature of drills and adjacent bone tissue during the osteotomy for the insertion of implants. Based on the literature the irrigation during the surgical preparation for the insertion of dental implants is fundamental, independently from being internal or external systems, once the performance of both is similar, except in specific cases, including guided surgery in which the internal irrigation appears to be more efficient.

Osteogenesis-inducing calcium phosphate nanoparticle precursors applied to titanium surfaces.

This study investigated the effects of the morphology and physicochemical properties of calcium phosphate (CaP) nanoparticles on osteogenesis. Two types of CaP nanoparticles were compared, namely amorphous calcium phosphate (ACP) nano-spheres (diameter: 9-13 nm) and poorly crystalline apatite (PCA) nano-needles (30-50 nm × 2-4 nm) that closely resemble bone apatite. CaP particles were spin-coated onto titanium discs and implants; they were evaluated in cultured mouse calvarial osteoblasts, as well as after implantation in rabbit femurs. A significant dependence of CaP coatings was observed in osteoblast-related gene expression (Runx2, Col1a1 and Spp1). Specifically, the PCA group presented an up-regulation of the osteospecific genes, while the ACP group suppressed the Runx2 and Col1a1 expression when compared to blank titanium substrates. Both the ACP and PCA groups presented a more than three-fold increase of calcium deposition, as suggested by Alizarin red staining. The removal torque results implied a slight tendency in favour of the PCA group. Different forms of CaP nanostructures presented different biologic differences; the obtained information can be used to optimize surface coatings on biomaterials.

The influence of surface treatment on the implant roughness pattern.

UNLABELLED: An important parameter for the clinical success of dental implants is the formation of direct contact between the implant and surrounding bone, whose quality is directly influenced by the implant surface roughness. A screw-shaped design and a surface with an average roughness of Sa of 1-2 µm showed a better result. The combination of blasting and etching has been a commonly used surface treatment technique. The versatility of this type of treatment allows for a wide variation in the procedures in order to obtain the desired roughness. OBJECTIVES: To compare the roughness values and morphological characteristics of 04 brands of implants, using the same type of surface treatment. In addition, to compare the results among brands, in order to assess whether the type of treatment determines the values and the characteristics of implant surface roughness. MATERIAL AND METHODS: Three implants were purchased directly from each selected company in the market, i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01 Korean company (Oneplant). The quantitative or numerical characterization of the roughness was performed using an interferometer. The qualitative analysis of the surface topography obtained with the treatment was analyzed using scanning electron microscopy images. RESULTS: The evaluated implants showed a significant variation in roughness values: Sa for Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for the surfaces examined. CONCCLUSIONS: The surface treatment alone is not able to determine the roughness values and characteristics.

The influence of surface treatment on the implant roughness pattern

An important parameter for the clinical success of dental implants is the formation of direct contact between the implant and surrounding bone, whose quality is directly influenced by the implant surface roughness. A screw-shaped design and a surface with an average roughness of Sa of 1-2 µm showed a better result. The combination of blasting and etching has been a commonly used surface treatment technique. The versatility of this type of treatment allows for a wide variation in the procedures in order to obtain the desired roughness. OBJECTIVES: To compare the roughness values and morphological characteristics of 04 brands of implants, using the same type of surface treatment. In addition, to compare the results among brands, in order to assess whether the type of treatment determines the values and the characteristics of implant surface roughness. MATERIAL AND METHODS: Three implants were purchased directly from each selected company in the market, i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01 Korean company (Oneplant). The quantitative or numerical characterization of the roughness was performed using an interferometer. The qualitative analysis of the surface topography obtained with the treatment was analyzed using scanning electron microscopy images. RESULTS: The evaluated implants showed a significant variation in roughness values: Sa for Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for the surfaces examined. CONCCLUSIONS: The surface treatment alone is not able to determine the roughness values and characteristics.

Caracterização micrométrica das superfícies dos implantes das cinco maiores companhias do mercado brasileiro. Parte III: implantes SIN / Characterization of implants surface of the five largest companies in the Brazilian market, on micrometric level. Part III: SIN implants

Introdução: a qualidade da interface osso-implante é influenciada diretamente pela rugosidade da superfície do implante; e uma rugosidade média, com Sa entre 1 e 2µm, tem demonstrado melhores resultados clínicos e laboratoriais. No Brasil, são instalados mais de dois milhões de implantes por ano, sendo que 79% são fabricados por empresas nacionais. Porém, muito pouco é divulgado ou se conhece sobre a caracterização das superfícies desses implantes, a nível micrométrico. Esse estudo visa avaliar e caracterizar, numericamente, a superfície dos implantes da SIN (Sistema de Implante Nacional), uma das cinco maiores empresas do mercado brasileiro. Métodos: foram avaliados 6 implantes, comprados diretamente no mercado, de 2 desenhos da companhia (Tryon-HE e Strong-SW) e de diferentes lotes, através de um interferômetro de luz. Foram realizados 9 medições, escolhidas aleatoriamente, para cada unidade, sendo 3 nos topos, 3 nos vales e 3 nos flancos das roscas. O mesmo padrão foi seguido para avaliação através microscópio eletrônico de varredura. Resultados: os implantes analisados dessa companhia, apresentaram valores de Sa de 0,84µm para o Tryon-HE e de 1,01µm para o Strong SW. Na comparação entre os lotes, somente o desenho SW apresentou diferença estatisticamente significativa entre si. Conclusões: os valores de rugosidade encontrados classificam as superfície, dos implantes Tryon-HE como minimamente rugosas e dos implantes Strong-SW como moderadamente rugosas.

Introduction: The quality of the bone-implant interface is directly influenced by implant surface roughness and a roughness average, with the Sa between 1 to 2µm, has demonstrated better clinical and laboratory results. In Brazil, more than two million implants per year are installed, where 79% are manufactured by domestic companies. However, very little is known or published about the characterization of surfaces of these implants, on the micrometer level. The aims of this study are to evaluate and characterize numerically the surface of the implants of SIN (Sistema de Implante Nacional) company, one of the five largest companies in the Brazilian market. Methods: Were evaluated a total of 6 implants, purchased directly on the market, of two different designs (Tryon-HE and Strong-SW) and different batches, using light interferometry. Were performed 9 measurements randomly chosen for each unit,3 on the tops, 3 on the valleys and 3 on the flanks of the threads. The same pattern was followed for evaluation by scanning electron microscope. Results: the analyzed implants from this company showed Sa values of 0.84µm for Tryon-HE and 1.01µm for Strong SW. Comparing the batches, only the SW design showed statistically significant differences between them. Conclusions: the roughness values found herein categorize the surfaces of Tryon-HE as minimally rough, and Strong-SW implants as moderately rough.