PURPOSE: The purpose of this systematic review was to assess histological and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, comparing different types of grafts. MATERIALS AND METHODS: Systematic Review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA), and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, Medline/PubMed, Cochrane Library and Embase databases, including gray literature and manual investigation, were searched to identify clinical trials reporting human histological and imaging data of bone formation around implants, inserted into the maxillary sinus at the same moment of the elevation and augmentation procedure, using several materials. Study selection, risk of bias (Rob 2.0 or ROBINS I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. RESULTS: Of the 1101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility and 5 were included in this systematic review (4 randomized and one controlled clinical trials). As a result, 130 grafted sinuses with 179 installed implants in 103 patients, aged between 24 and 79 years and followed up from 6 to 15 months, were analyzed. The heterogeneity between studies did not allow the data to be combined for meta-analyses. All graft materials proved to be viable options for the intervention. The use of BCP was related to higher bone-to-implant contact. CONCLUSION: All the assessed grafts are viable options for the intervention addressed. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical site of implants under the sinus membrane. Longer chair time and the morbidity of the donor site should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior values of %BIC when compared to DBB.
ABSTRACT Objective: development of an application for mobile computer devices, mobile phones and tablets, which contains educational material for patients and professionals in the area of Implantology. The use of ImplantoPUC at PUC Minas implant dentistry clinics aims at a more effective communication between professionals and patients, with better visualization of the proposed treatments, improving the understanding of patients. Methods: for the development of ImplantoPUC, a responsive technology was used, and the application windows can adapt to different screen formats, consequently, the application can be made available on different platforms such as: Web, Android and Apple. The application size is 13.4 MB and was developed using the OutSystems platform using Apache Cordova. The prototype of the ImplantoPUC application can already be accessed through the link https://includesistemas.outsystemcloud.com/implantpuc/homescreen. Results: the application is still under test at PUC Minas implant dentistry clinics, but due to the pandemic its use is still below expectations. In the Play Store your rating has a maximum rating of 5.0, with more than 50 downloads so far. Conclusion: Implanto PUC makes the task of informing more interactive and easy to understand for patients, also assisting professionals in the area in obtaining updated information and at the reach of hands, and can also be used in other Dentistry Educational Institutions, becoming a reference in the area of implant dentistry.
RESUMO Objetivo: desenvolvimento de um aplicativo para dispositivos móveis de informática, celulares e tablets, que contém material educacional para os pacientes e profissionais da área da Implantodontia. A utilização do ImplantoPUC nas clínicas de Implantodontia da PUC Minas visa uma comunicação mais efetiva entre profissionais e pacientes, com melhor visualização dos tratamentos propostos, melhorando o entendimento dos pacientes. Métodos: Para o desenvolvimento do ImplantoPUC foi utilizado uma tecnologia responsiva, podendo as janelas do aplicativo se adaptarem a diferentes formatos de telas, consequentemente, o aplicativo pode ser disponibilizado em diferentes plataformas como: Web, Android e Apple. O tamanho do aplicativo é de 13,4 MB e foi desenvolvido utilizando a plataforma OutSystems, utilizando a Apache Cordova. O protótipo do aplicativo ImplantoPUC já pode ser acessado através do link https://includesistemas.outsystemcloud.com/implantpuc/homescreen Resultados: O aplicativo ainda continua em teste nas clínicas da PUC Minas, mas em virtude da pandemia o seu uso está abaixo do esperado. Na Play Store a sua avaliação tem nota máxima 5,0, com mais de 50 downloads até o momento. Conclusão: O ImplantoPUC torna a tarefa de informar mais interativa e de fácil compreensão para os pacientes, auxiliando também os profissionais da área na obtenção de informações atualizadas e ao alcance das mãos, podendo também ser utilizado em outras instituições de ensino da Odontologia, tornando-se uma referência na área da Implantodontia.
BACKGROUND: Regardless of the kind of biomaterial used for the graft, it is clear that, over time, the graft undergoes dimensional changes that could influence the final bone volume obtained, which could alter the stability of the installed implants. The aim of the present study was to compared and correlated the graft behavior with the amount (in grams) of xenogeneic and alloplastic biomaterials used in grafts for maxillary sinus lift. MATERIAL AND METHODS: This retrospective cohort study used 148 CBCT images of 74 grafts from 68 maxillary sinuses lift patients in a university, post-graduate clinic. The weights of biomaterials, categorized in intervals according to amount used, were correlated with the graft volumes at V1 (10 days) and V2 (180 days). Kruskal-Wallis test was used to evaluate the possible bias effect of weight on graft maintenance. RESULTS: Mean weights of biomaterials used were: Bio-Oss Small® (1.58g); Bio-Oss Large® (1.35g); Endobon® (0.72g); BoneCeramic®+Emdogaim® (0.96g); Cerasorb® (1.13g) and Osteogen® (2.70g). No significant differences (p>0.05). Were found for the influence of these mean amounts in graft maintenance: Bio-Oss Small® (18); Bio-Oss Large® (10); Endobon® (17); BoneCeramic®+Emdogaim® (10); Cerasorb® (11); and Osteogen® (08) at V1 and V2. However, when biomaterials were categorized by intervals, all Cerasorb® interval groups showed statistically significant differences (p<0.001) in graft volume at V2. CONCLUSIONS: The amounts of the biomaterials used could influence the final volume; depending on the biomaterial characteristics. Implant installation was possible with all studied grafts, although graft volume shrinkage should be considered when selecting biomaterial for sinus lift. Key words:Biocompatible materials; cone beam computed tomography; maxillary sinus; hydroxyapatites.
Rehabilitation of patients through implants in areas with severe bone resorption in the posterior mandible is a challenge in implant dentistry. In this context, extra short implants configure a treatment option for this type of patient, as they can avoid increased financial cost, treatment time and patient morbidity. The present study evaluated the marginal bone stability in individualized extra-short implants for masticatory function in the posterior mandible. Using digitized periapical radiographs of 13 extra-short implants performed on 7 patients. The mesial and distal regions of each implant were selected, from the bone crest to the region parallel to the apex, and the bone stability of this crest was measured using the Image J software immediate T1 and 1 year after rehabilitation (T2). The height of the bone crest remained stable, showing no statistically significant difference between T1 and T2 (p> 0.005) for both the mesial bone crest and the distal bone crest in individual or united crowns rehabilitation. Marginal bone stability was observed in extra short implants, corroborating the biological and biomechanical stability of these implants presented in the literature. Despite the limited sample size and proservation time, extra-short implants are predictive treatment options for patients with severe bone atrophy in the posterior mandible. Key words:Extra-short implants, marginal bone loss, mandibular bone atrophy.
OBJECTIVE: The present controlled clinical pilot study proposed to assess blood clot contraction and bone neo-formation following maxillary sinus lift (MSL) with immediate implant placement without using grafts using cone beam tomography exams. MATERIALS AND METHODS: Ten implants were placed in ten patients with a residual bone crest height ≥4 and ≤ 7 mm, in maxillary premolars or 1st or 2nd molars regions, using MSL and immediate implant placement without grafts, by means of the lateral window approach. A resorbable membrane (Bio-Gide®, Geistlich, USA) was used to close the window. Computed tomography images were taken after 15 (T1) and 180 (T2) days to assess the rate of blood clot contraction and bone neo-formation. The images were analysed by OsirixMD software. The Shapiro Wilk test was used to verify the normality hypothesis and the data were submitted to Student's paired t-test. RESULTS: The mean of bone clot height in mesial, apical and distal area referred to implant, presented 4.77 mm, 0.77 mm and 5.30 mm respectively. The mean measurements of new bone formation presented 2.95 mm, 0.44 mm and 3.45 mm. The height contraction (coagulum/new bone formation), between T1 and T2, presented 38%, 43% and 35% respectively, with a significant statistical value p < 0.05. The volume measurements at T1 presented a mean volume of 0.90 cm3 sd ± 0.60 cm3 and at T2 a mean volume of 0.75 cm3 sd ± 0.62 cm3, with a significant volume contraction between T1 and T2, p < 0.005. The mean blood clot contraction was 16.52% ± 8.60%. CONCLUSION: The present study demonstrates consistent bone formation around all assessed implants, although with significant contraction of the blood clot. The need for longitudinal studies to establish a long-term prognosis in different modalities of prosthetic rehabilitation of those implants is strongly suggested.
Dental Implants , Sinus Floor Augmentation , Space Maintenance, Orthodontic/methods , Thrombosis , Cone-Beam Computed Tomography , Dental Implantation, Endosseous , Humans , Maxillary Sinus , Osteogenesis , Pilot Projects , Thrombosis/diagnostic imaging
This study aimed to compare the primary and secondary stability, measured by resonance frequency analysis (RFA), in implants of different lengths installed in areas submitted to maxillary sinus lift. Correlation between RFA and implant insertion torque was also assessed. Twenty implants of 9 and 11 mm were inserted in areas submitted to maxillary sinus lift. The insertion torque was measured by the Bien Air motor. Osstell, through RFA, determined the implant stability quotient (ISQ) 2 times: the day of implant installation (T1) and 90 days after implant installation (T2). No differences were observed in the ISQ between T1 and T2 when the 20 implants were grouped, nor when the 9 mm implants were evaluated separately. In contrast, when the 11 mm values were evaluated separately, the ISQ was significantly higher in T2 than in T1 ( P < .05). In T1, 9 mm implants had a higher ISQ than 11 mm ones ( P < .05), whereas in T2, the implants of 11 mm showed a higher ISQ than did the 9 mm implants ( P < .05). There was no difference in insertion torque between 9 and 11 mm implants ( P > .05), nor was there a correlation between ISQ and insertion torque ( P > .05). In conclusion, longer implants (11 mm) presented a significant increase in ISQ values during the healing period when installed in areas previously submitted to maxillary sinus lift. This phenomenon was not observed for shorter implants (9 mm). Finally, no correlation was observed between ISQ and insertion torque.
Dental Implantation, Endosseous , Dental Implants , Maxillary Sinus/surgery , Sinus Floor Augmentation , Dental Prosthesis Design , Dental Prosthesis Retention , Dental Prosthesis, Implant-Supported , Humans , Maxilla/surgery , Osseointegration , Torque , Wound Healing
OBJECTIVE: Using computed tomography, to compare vertical and volumetric bone augmentation after interposition grafting with bovine bone mineral matrix (GEISTLICH BIO-OSS® ) or hydroxyapatite/tricalcium phosphate (STRAUMANN® BONECERAMIC) for atrophic posterior mandible reconstruction through segmental osteotomy. MATERIAL AND METHODS: Seven patients received interposition grafts in the posterior mandible for implant rehabilitation. The computed tomography cone beam images were analysed with OsiriX Imaging Software 6.5 (Pixmeo Geneva, Switzerland) in the pre-surgical period (T0), at 15 days post-surgery (T1) and at 180 days post-surgery (T2). The tomographic analysis was performed by a single trained and calibrated radiologist. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS: There was a significant difference in vertical and volume augmentation with both biomaterials using the technique (P < 0.05). There were no significant differences (P > 0.05) in volume change of the graft, bone volume augmentation, or augmentation of the maximum linear vertical distance between the two analysed biomaterials. CONCLUSIONS: The GEISTLICH BIO-OSS® and STRAUMANN® BONECERAMIC interposition grafts exhibited similar and sufficient dimensional stability and volume gain for short implants in the atrophic posterior mandible.
Alveolar Ridge Augmentation/methods , Bone Substitutes , Hydroxyapatites , Mandible/surgery , Minerals , Atrophy , Cone-Beam Computed Tomography , Female , Humans , Male , Mandible/diagnostic imaging , Mandible/pathology , Pilot Projects
BACKGROUND: Several studies have demonstrated the application of mini-implants in the orthodontic treatment as anchorage during the retraction movement of the anterior teeth. PURPOSE: This study was designed to evaluate the mass retraction movement of the anterior upper teeth using orthodontic mini-implants as anchorage. MATERIALS AND METHODS: Nine patients with class I malocclusion and Angle's class II, needing extractions of the upper first premolars, were enrolled in this case series. The retraction was performed using sliding mechanics and orthodontic anchorage on mini-implants. Measures were taken by initial and final cephalometric X-rays of the retraction movement to evaluate whether the mini-implants remained stationary and displacements of the incisors and the upper first premolars. RESULTS: Out of 18 mini-implants, 8 mesialized (0.45 mm, average) and 3 extruded (0.14 mm, average). The upper incisors were retracted on the average of 4.21 mm, extruded 0.33 mm, and tipped 10.3°. There were no statistical significant modifications in the placement of the posterior teeth. CONCLUSIONS: Although there was a very small displacement of the mini-implants, they still provided an adequate anchorage for the retraction of the anterior teeth, and there was no loss in the anchorage of the posterior teeth.
Bone Screws , Incisor , Malocclusion, Angle Class II/surgery , Malocclusion, Angle Class I/surgery , Orthodontic Anchorage Procedures , Prostheses and Implants , Tooth Movement Techniques , Adolescent , Bicuspid/surgery , Cephalometry , Child , Female , Humans , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Male , Orthodontic Appliance Design , Tooth Extraction , Young Adult
A utilização de implantes para reabilitação bucal em indivíduos submetidos à radioterapia na região de cabeça e pescoço ainda permanece um tema controverso na literatura. Estudos apontam para a ocorrência de osseointegração e taxas de sucesso de 80% em implantes dentais colocados em sítios ósseos irradiados. No entanto, outros trabalhos demonstram não haver previsibilidade de resultados. A osteoradionecrose pode se desenvolver em sítios previamente irradiados onde implantes são instalados apresentando uma porcentagem na literatura que varia entre 4% a 22%. A introdução da terapia com oxigênio hiperbárico diminuiu a incidência de ORN e aumentou a sobrevida de implantes dentais em indivíduos submetidos à radioterapia. Diante disso, esta revisão da literatura tem como objetivo abordar os principais aspectos da radioterapia e sua relação com a Implantodontia.
The use of implants for oral rehabilitation in irradiated head-neck subjects still remains a controversy in the literature. Studies indicate that osseointegration occurs in irradiated sites, and success rates of 80% for dental implants installed in irradiated bony sites are shown. Jaw osteonecrosis can occur in sites previously irradiated where implants are installed, with a range between 4% to 22%. The introduction of hyperbaric oxygen therapy decreased the incidence of osteonecrosis and increased dental implant survival in previously irradiated subjects. The aim of this literature review was to investigate the main aspects of radiotherapy and its implication on implant dental practice.
Dental Implants , Osteoradionecrosis , Radiotherapy
Estudos sugerem que a doença peri-implantar e as falhas de implante apresentam maior incidência em pacientes com histórico de periodontite. Neste contexto, esta revisão da literatura discute os fatores de risco, associados atualmente, e procura também determinar suas relações com a doença peri-implantar e/ou a falha do implante. Os estudos avaliados permitem concluir-se que há um maior índice de falhas e presença de peri-implantite em pacientes portadores de doença periodontal prévia, no entanto, estudos longitudinais e mesmo retrospectivos, com avaliação dos diferentes fatores de risco e seu peso de forma individualizada ou associada, devem ser realizados.
Studies suggest that peri-implant disease and implant failures have a higher incidence in patients with a history of periodontitis. In this context, this literature review discusses the risk factors associated with current topics and also seeks to determine their relationship with peri-implant disease and/or implant failure. The studies reviewed support the conclusion that there is a higher failure rate and presence of peri-implantitis in patients with previous periodontal disease, however, longitudinal and even retrospective studies evaluating different risk factors and their weight, whether individually or associated, should be performed.
Dental Restoration Failure , Peri-Implantitis , Periodontal Diseases
A grande dificuldade enfrentada em tratamentos ortodônticos com extrações de pré-molares é o controle da ancoragem, principalmente durante o movimento de retração dos dentes anteriores. O controle da ancoragem é fundamental para o sucesso do tratamento ortodôntico. A introdução dos mini-implantes ortodônticos tem como objetivo proporcionar uma ancoragem esquelética adequada para retração tanto de um dente ou de um bloco de dentes anteriores e um dos aspectos de maior importância é a redução na necessidade de cooperação do paciente. Este artigo tem por finalidade demonstrar toda a sequência de um protocolo cirúrgico para a instalação dos mini-implantes que serão utilizados na ancoragem do movimento de retração em massa dos dentes ânterossuperiores.
Dental Implants , Orthodontic Anchorage Procedures , Orthodontics
A aplicação do plasma rico em plaquetas (PRP) em procedimentos regenerativos em Implantodontia gerou grande expectativa quando se imaginou a possibilidade de se evitar enxertos ósseos autógenos em muitas situações. No entanto, atualmente, o real papel do PRP tem sido questionado. Este estudo de boca dividida avaliou histologicamente o grau de formação óssea após a utilização do PRP em alvéolos dentais humanos. Cinco pacientes, de ambos os sexos, com média de idade de 42,8 anos, com indicação para exodontia de dentes análogos bilaterais em maxila previamente à instalação de implantes, foram selecionados. Vinte e quatro alvéolos foram divididos aleatoriamente em grupo teste (n=12) e grupo controle (n=12). Após a realização das exodontias, os alvéolos testes foram preenchidos com PRP, enquanto os alvéolos controles foram preenchidos apenas com o coágulo formado após a exodontia. Decorridos 50 dias de cicatrização pós-cirúrgica, os pacientes foram submetidos à biópsia dos alvéolos durante a instalação de implantes. Os espécimes trefinados foram analisados histologicamente, dividindo-os em área superficial, mediana e apical. Os resultados mostraram, em ambos os grupos, a presença de tecido conjuntivo frouxo com fibras colágenas finas e desorganizadas na região mais superficial e mediana do alvéolo. O osso neoformado foi encontrado na periferia do alvéolo com grande número de células aprisionadas na matriz e osteoblastos. Na região mais apical dos alvéolos, observou-se osso neoformado ao redor de trabéculas pré-existentes com áreas de condensação de matriz orgânica. Concluiu-se que não houve diferença entre os aspectos histológicos encontrados nos alvéolos testados com PRP comparando-os aos alvéolos controle.
The use of platelet-rich plasma (PRP) in implant dentistry raised the possibility to avoid bone augmentation in some clinical situations. However, PRP's actual role has been questioned. This split-mouth histological study evaluated the degree of bone formation after the use of PRP in human dental alveolar sockets. Five patients of both sexes, mean age of 42.8 years, presenting indications for extraction of bilateral maxillary teeth, were included in the study. Twenty-four alveolar sockets were randomly distributed in test (n=12) and control (n=12) groups. After tooth extractions, the test sockets were filled with PRP, while the control sockets were filled just with clot. After 50 days of postsurgical repair, patients were submitted to a socket biopsy during implant surgery. The retrieved samples were prepared for histological analysis. In both groups, results showed the presence of loose connective tissue with thin and sparsely collagens fibers in the most superficial and median socket's region. Neoformed bone was also found at the perialveolar socket region with a large number of entrapped cells in the matrix and osteoblasts as well. In the most apical socket region, there was neoformed bone around the pre-existing trabeculae with condensation areas of organized matrix. It was concluded that there was no difference between histological aspects found in the tested sockets (PRP) and control sockets.
Humans , Male , Female , Adult , Bone Substitutes , Wound Healing , Dental Implants , Platelet-Rich Plasma
Este estudo teve como objetivo avaliar a associação da condição periodontal materna na ocorrência de parto pré-termo e baixo peso ao nascimento (PTBPN). Participaram do estudo 236 mulheres, com a média de 25 anos de idade e características socioeconômicas semelhantes, que deram à luz em uma instituição de saúde pública de Belo Horizonte (MG - Brasil). Os dados maternos, obstétricos e pediátricos foram obtidos nos prontuários médicos. O exame periodontal foi realizado no período de internação pós-parto, em seis sítios ao redor de todos os dentes presentes e incluiu a avaliação dos parâmetros clínicos profundidade de sondagem (PS), nível clínico de inserção (NIC) e sangramento à sondagem (SS). Para a análise considerou-se como caso de doença periodontal a presença de um sítio com PS e NIC e" 4 mm. Não houve diferenças significantes quando da análise das variáveis raça, escolaridade, prematuridade prévia, diabetes, infecção geniturinária, consumo de álcool, hábito de fumar e doença periodontal. O teste Qui-quadrado mostrou significância estatística para os fatores de risco hipertensão (p=0,016) e consumo de drogas ilícitas (p=0,017). Já o teste t Student mostrou significância estatística para a variável idade (p=0,010). Na análise multivariada somente o consumo de drogas ilícitas mostrou-se significativo: elevou de 25% para 66,7% a ocorrência de PTBPN. Esses resultados demonstraram que a condição periodontal materna não apresentou associação estatisticamente significativa com a ocorrência de PTBPN (p= 0,364).
Humans , Female , Pregnancy , Adolescent , Adult , Periodontal Diseases/complications , Periodontal Diseases/epidemiology , Infant, Low Birth Weight , Obstetric Labor, Premature/etiology , Risk Factors
A reabilitação de pacientes totalmente edêntulos, através da carga imediata sobre implantes osseointegrados esplintados, aparece como alternativa de tratamento viável, apresentando alta previsibilidade de sucesso. Entretanto, a utilização da carga ou restauração imediata visando à solução das perdas unitárias é recente. Esse estudo aborda as possibilidades de se restaurar imediatamente um implante unitário, analisando os critérios para indicação, além das vantagens, limitações e contra-indicações da técnica.
Dental Prosthesis, Implant-Supported , Esthetics, Dental , Dental Implants, Single-Tooth/trends , Alveolar Bone Loss , Dental Materials , Osseointegration , Patient Selection
