Carga imediata não funcional associada à RTI-3 / Non-functional immediate loading associated with ITR-3

Os implantes imediatos têm sido utilizados com bastante frequência como uma forma de tratamento para a substituição de dentes condenados. Entretanto, quando a área a ser tratada pertence à zona estética, muito cuidado deve ser tomado. Nessa região, quando o objetivo é alcançar um peri-implante com estética satisfatória, o profissional deve utilizar técnicas que, associadas ao implante imediato, evitem a formação de um defeito decorrente da remodelação pós-exodontia, ou ainda, utilizar procedimentos de melhoria tecidual nos casos em que os dentes condenados já apresentem defeitos de tecido ósseo e/ou mole ao seu redor. O objetivo deste trabalho é, através da apresentação de um caso clínico de reposição do elemento 41 condenado, com perda óssea severa e defeito mucogengival, demonstrar e discutir uma modalidade de tratamento que utiliza o implante imediato de carga imediata não funcional associado ao enxerto de tecido conjuntivo e preenchimento com osso mineral bovino particulado.

Immediate implants have been used frequently as a treatment choice for the replacement of compromised teeth. However, when the area to be treated belongs to the aesthetic zone, great care must be exercised. In this region, when the objective is to reach a peri-implant with a satisfactory esthetics, the professional must use techniques that, associated to the immediate implant, prevent the formation of a defect due to the bone remodeling after tooth loss or to use procedures of tissue improvement for cases where the compromised teeth already have defects of bone and/or soft tissue around them. The objective of this study is to present a clinical case of replacement at tooth 41 with severe bone loss and mucogingival defect to demonstrate and discuss a treatment modality that uses the immediate implant with non-functional immediate loading associated with the connective tissue graft and particulate, deproteinized bovine bone filling.

Carga imediata em área estética utilizando um novo modelo de implante estreito / Immediate loading in the esthetic area using a new narrow dental implant model ­ case report

A utilização de implantes estreitos com carga imediata é um assunto relativamente pouco estudado. Entretanto, nos últimos anos, devido às melhorias tecnológicas, um maior interesse tem sido dado a estes implantes. Neste trabalho são apresentados e discutidos aspectos relativos a este assunto, utilizando como exemplo um caso clínico em que um novo modelo de implante estreito (Slim, Unitite ­ SIN), com 2,9 mm de diâmetro e conexão cônica, foi instalado em uma área com pouco espaço mesiodistal na região do elemento 23. Após o período de um ano de acompanhamento, a área apresentava boa estética peri-implantar e aspectos clínicos compatíveis com saúde e normalidade.

The use of narrow implants with immediate loading is a relatively little studied subject. However, in recent years, due to technological improvements greater interest has been given to these implants. In this work, aspects related to this subject are presented and discussed using as example a clinical case in which a new narrow implant model (Slim, Unitite ­ SIN) with 2.9 mm of diameter and a conical connection was installed in an area with narrow mesiodistal space in the region of element 23. One year later, excellent periimplant esthetic and clinical aspects were achieved compatible with a stable health condition.

Elevação de seio maxilar via crista utilizando a técnica hidrodinâmica / Maxilar transcrestal sinus lift with hidrodynamic technique

A elevação de seio via crista do rebordo maxilar é uma técnica bastante utilizada no aumento ósseo da maxila posterior, e a utilização de osteótomos de Summers com martelo é a modalidade mais conhecida. Esta técnica é denominada "técnica de elevação de seio atraumática", o que se trata de uma designação equivocada, uma vez que as marteladas utilizadas para elevar o assoalho do seio maxilar, dependendo do nível de densidade óssea, são bastante incômodas aos pacientes e não são raras as manifestações de desconforto pelos mesmos. Além do desconforto, devido às marteladas sobre os osteótomos, pode ocorrer a vertigem posicional paroxicística benigna (VPPB). Nos últimos anos, a Implantodontia vem buscando técnicas menos traumáticas para a elevação de seio maxilar, destacando-se aquelas que se utilizam de instrumentos rotatórios. Neste trabalho, foi apresentada uma técnica de elevação de seio via crista, que se caracteriza por ser minimamente invasiva e pouco traumática, utilizando instrumentos rotatórios (kit SCA ­ Neobiotech, Coreia), associada à técnica hidrodinâmica (Aqua Lift System, IM3 ­ Neobiotech, Coreia) para descolamento e elevação da membrana, enxertia com Cerasorb (Curasan, Alemanha) e instalação de implante concomitantemente (SW ­ SIN, Brasil).

The transcrestal maxillary sinus lift is a technique widely used in bone enhancement of the posterior maxilla and the use of Summers osteotomes with hammer is the best known modality. This technique is termed an atraumatic sinus elevation technique, which is probably a misnomer, since hammers used to raise the floor of the maxillary sinus, depending on the level of bone density, are very uncomfortable for patients and manifestations of discomfort are not uncommon. In addition to discomfort, due to the hammering of the osteotomes, benign paroxysmal positional vertigo (BPPV) can occur as a complication. In recent years, Implantology has been seeking less traumatic techniques for maxillary sinus elevation. Among them, stand out those that use rotary instruments. In this work, a technique of sinus elevation via crest is presented, which is characterized by being minimally invasive and not very traumatic, using rotary instruments (kit SCA ­ Neobiotech, Korea), associated to the hydrodynamic technique (Aqua Lift System, IM3 ­ Neobiotech, Korea) for membrane detachment and elevation, grafting with Cerasorb (Curasan, Germany) and concomitant implant installation (SW ­ SIN, Brazil).

Reconstrução tecidual imediata em área estética com substituto ósseo associado à técnica Vista / Immediate tissue reconstruction in the esthetic area with a bone substitute and the Vista technique

Este trabalho teve como objetivo demonstrar um caso clínico no qual foi obtida uma estética peri-implantar adequada, utilizando uma abordagem de reconstrução tecidual imediata (RTI), em um paciente com o dente 21 condenado com comprometimento dos tecidos ósseo e mole. Após a remoção do elemento condenado, um implante do tipo conexão cônica (Unitite, SIN) foi instalado. Para o tratamento do defeito de tecido mole, foi utilizado o enxerto de tecido conjuntivo inserido pela incisão do tipo Vista; para o tratamento do defeito ósseo vestibular, foi utilizado beta-tricálcio fosfato (Cerasorb, Curasan). Uma prótese fixa provisória foi instalada sobre o implante. Após oito meses, esta foi substituída por uma prótese cerâmica com infraestrutura em zircônia. Ao final do tratamento, um tecido peri-implantar harmônico foi obtido. Unitermos:

This case report demonstrates the achievement of adequate peri-implant esthetics using the immediate tissue reconstruction in a patient with compromised tooth (21), bone, and soft tissues. After tooth removal, a conical connection type implant (UniTite, SIN) was installed. After, the connective tissue graft was installed using the Vista technique; for the buccal bone defect, a beta- tricalcium material (Cerasorb, Curasan) was applied along with an immediate fixed provisional prosthesis. Eight months later, the definitive zirconia restoration was delivered. In this way, a harmonic peri-implant environment was obtained.

Assessment of the correlation between insertion torque and resonance frequency analysis of implants placed in bone tissue of different densities.

The primary stability of dental implants is fundamental for osseointegration. Therefore, this study aimed to assess the correlation between insertion torque (IT) and resonance frequency analysis (RFA) of implants placed in mandibles and maxillas of different bone densities. Eighty dental implants were placed in maxillas and mandibles, and IT and the implant stability quotient (ISQ) were measured at the time of implant insertion. Bone density was assessed subjectively by the Lekholm and Zarb index. The type I and II densities were grouped together (group A)as were the type III and IV densities (group B). The IT in group A was higher (Student t test, P = .0013) than in group B (46.27 ± 18.51 Ncm, 33.62 ± 14.74 Ncm, respectively). The implants placed in group A showed higher ISQ (Student t test, P = .0004) than those placed in group B (70.09 ± 7.50, 63.66 ± 8.00, respectively). A significant correlation between IT and the ISQ value was observed for group A (Pearson correlation test; r = 0.35; P = .0213) and for group B (r = 0.37; P = .0224). Within the limitations of this study, it was possible to conclude that there is a correlation between IT and RFA of implants placed in mandibles and maxillas of different bone densities.

Two-stage bone expansion technique using spear-shaped implants associated with overlapped flap: a case report.

The conventional method of ridge expansion uses a mucoperiosteal flap elevation to allow bone corticotomy, which is followed by bone expansion performed with chisels and bone expanders. To facilitate corticotomy and avoid flap elevation, bone expansion can be performed in 2 stages. This case report presents a modified 2-stage bone expansion technique to achieve better implant stabilization and wound closure. This modified approach may be an efficient procedure for minimizing complications.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial.

AIM: To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS: Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS: There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION: The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

[Diffuse plane idiopathic normolipemic xanthoma with hypersplenism]. / Xantoma plano difuso normolipêmico idiopático com hiperesplenismo.

Diffuse plane normolipemic xanthoma is a rare disease, of a group of clinical syndromes called histiocytoses, characterized by the presence of yellowish or yellow-orange plaques, distributed symmetrically on the cutaneous surface and usually accompanied by xanthelasma. It affects mainly adults and it may cause discrete changes in serum lipids. The case of an 85-year-old female patient who has been showing extensive asymptomatic yellow-orange plaques in the trunk and abdomen for a year is reported. Laboratory tests did not show an increase in serum lipids or the occurrence of reticuloendothelial disorders.

Xantoma plano difuso normolipêmico idiopático com hiperesplenismo / Diffuse plane idiopathic normolipemic xanthoma with hiperesplenism

O xantoma plano difuso normolipêmico é doença rara, do grupo das histiocitoses, caracterizada pelo aparecimento de placas amareladas ou amarelo-alaranjadas, distribuídas simetricamente na pele e geralmente acompanhadas por xantelasma. Acomete principalmente adultos, podendo ou não apresentar alterações discretas dos lípides séricos. Relata-se o caso de uma paciente do sexo feminino, de 85 anos, há um ano com extensas placas amarelo-alaranjadas no tronco e abdome, assintomáticas. Os exames laboratoriais não demonstraram aumento dos lípides séricos, nem ocorrência de desordens retículo-endoteliais.

Diffuse plane normolipemic xanthoma is a rare disease, of a group of clinical syndromes called histiocytoses, characterized by the presence of yellowish or yellow-orange plaques, distributed symmetrically on the cutaneous surface and usually accompanied by xanthelasma. It affects mainly adults and it may cause discrete changes in serum lipids. The case of an 85-year-old female patient who has been showing extensive asymptomatic yellow-orange plaques in the trunk and abdomen for a year is reported. Laboratory tests did not show an increase in serum lipids or the occurrence of reticuloendothelial disorders.

Avaliação imunohistoquímica de proteínas da matriz extracelular na reparação de defeitos agudos de furca classe II em cães / Immunohistochemical evaluation of extracellular matrix proteins in the repair of acute class II furcation defects in dogs

O estudo da reparação periodontal deve se basear em modelos que forneçam os dados necessários para a análise deste fenômeno. O modelo proposto, de defeitos agudos de furca classe II, parece ser o mais indicado, pois possui um grau previsível de regeneração espontânea, fornecendo um ambiente em que é possível o estudo dos fatores que favorecem a regeneração dos tecidos periodontais. O objetivo deste trabalho foi avaliar a qualidade da reparação de defeitos agudos de furca classe II por meio da imunoexpressão de proteínas da matriz extracelular (MEC). Após a elevação de retalhos de espessura total, em quatro cães, foram criados defeitos agudos de furca classe II nos segundos, terceiros e quartos pré-molares de um dos lados da mandíbula. Os retalhos foram posicionados coronariamente e suturados. Após 45 dias, os espécimes foram coletados, descalcificados e analisados, em um plano vestíbulo- lingual, por meio de técnica imunohistoquímica para osteopontina (OPN), sialoproteína óssea (BSP) e osteonectina (BON). Nos tecidos periodontais originais, a marcação para os anticorpos testados foi fracamente positiva na MEC, caracterizando a presença de tecidos maduros. Já no interior dos defeitos, houve diferença na marcação, com marcação mais pronunciada para BSP, OPN e BON. Conclui-se que os resultados evidenciam maior atividade metabólica nos tecidos reparativos.

The study of periodontal repair should be based on models that provide the data required for analysis of thisphenomenon. The proposed model of acute class II furcation defects seems to be the most appropriate, as it provides apredictable degree of spontaneous regeneration, creating an environment where the factors that promote the regeneration of periodontal tissues can be studied. The objective of this study was to evaluate the quality of repair ofacute class II furcation defects, by means of immunoexpression of extracellular matrix (ECM) proteins.After lifting full thickness flaps in 4 dogs, acute class II furcation defects were created in the second, third and fourth premolar in one side of the mandible. The flaps were coronallypositioned and sutured. After 45 days, the specimens were collected, decalcified and analyzed in a buccal-lingual plane, by immunohistochemistry technique for osteopontin (OPN), bone sialoprotein (BSP) and osteonectin (BON). In original periodontal tissues, the marking for the tested antibodieswas weakly positive in the ECM, characterizing the presence of mature tissues. Inside the defects, there was a difference in the marking, with markings more pronounced for BSP, OPN and BON. It was concluded that the results showed greater metabolic activity in the reparative tissues.

Repair of Class II furcation defects after a reparative tissue graft obtained from extraction sockets treated with growth factors: a histologic and histometric study in dogs.

BACKGROUND: Reparative tissue of extraction sockets was proposed as grafting material in the treatment of periodontal defects. Our hypothesis was that the addition of growth factors to extraction sockets improves the regenerative potential of this tissue when used as a graft. The objective of the present study was to analyze qualitatively and quantitatively the repair of acute Class II furcation defects after they receive this grafting material. METHODS: The second and third upper premolars were extracted from four dogs. Platelet-derived growth factor (PDGF)-BB and insulin-like growth factor (IGF)-I, at concentrations of 6 microg/ml each, were applied to the resulting sockets. After 5 days, 24 acute defects (12 control and 12 test defects) were created in the second, third, and fourth lower premolars. Only the test sites received the graft. The flaps were positioned coronally on both sides and sutured. After 45 days, the specimens were collected, decalcified, and processed histologically in a buccal-lingual plane. The parameters were measured horizontally in the buccal-lingual direction. RESULTS: Repair was histologically and histometrically similar in the two groups. No significant difference was observed between the test and control groups in the parameters connective tissue, new cementum, new bone, and junctional epithelium. CONCLUSION: The use of this graft did not show beneficial effects on the repair of acute Class II furcation defects in dogs.

Associação do PDGF e IGF na regeneração periodontal: revisão da literatura / Association of PDGF and IGF on periodontal regeneration: literature review

Os fatores de crescimento são polipeptídeos que podem estimular evento como a proliferação celular. migração e síntese de matriz extracelular que são, sem dúvida, fundamentais para a obtenção da regeneração periodontal. A associação entre dois fatores de crescimento, PDGF (fator de crescimento derivado de plaquetas) e IGF (fator de crescimento semelhante à insulina), tem sido pesquisa da em estudos que visam a regeneração periodontal. apresentado resultados promissores.O objetivo desta revista de literatura foi verificar os efeitos da aplicação da associação PDGF/IGF na regeneração periodontal.