One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations.

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

In-vitro polymicrobial oral biofilm model represents clinical microbial profile and disease progression during implant-related infections.

AIM: Clinically relevant in-vitro biofilm models are essential and valuable tools for mechanistically dissecting the etiopathogenesis of infectious diseases and test new antimicrobial therapies. Thus, the aim of this study was to develop and test a clinically relevant in-vitro oral polymicrobial biofilm model that mimics implant-related infections in terms of microbial profile. METHODS AND RESULTS: For this purpose, 24-well plate system was used to model oral biofilms, using three different microbial inoculums to grow in-vitro biofilms: (1) human saliva from periodontally healthy patients; (2) saliva as in inoculum 1 + Porphyromonas gingivalis strain; and (3) supra and subgingival biofilm collected from peri-implant sites of patients diagnosed with peri-implantitis. Biofilms were grown to represent the dynamic transition from an aerobic to anaerobic community profile. Subsequently, biofilms were collected after each phase and evaluated for microbiological composition, microbial counts, biofilm biomass, structure, and susceptibility to chlorhexidine (CHX). Results showed higher live cell count (P < .05) for biofilms developed from patients' biofilm inoculum, but biomass volume, dry weight, and microbiological composition were similar among groups (P > .05). Interestingly, according to the checkerboard DNA-DNA hybridization results, the biofilm developed from stimulated human saliva exhibited a microbial composition more similar to the clinical subgingival biofilm of patients with peri-implantitis, with proportions of the main pathogens closer to those found in the disease. In addition, biofilm developed using saliva as inoculum was shown to be susceptible to CHX with significant reduction in bacteria compared with biofilms without exposure to CHX (P < .05). CONCLUSION: The findings suggested that the in-vitro polymicrobial biofilm developed from human saliva as inoculum is a suitable model and clinically relevant tool for mimicking the microbial composition of implant-related infections.

Translating the determinant aspects on the study design in the dental implant field.

Objective: In this article, we analyzed the important categories capable of interfering with the determinants of scientific advancement in the type of study, considering seven leading journals over a 20-year. Methodology: A bibliometric review was performed at the website of well-established implant dentistry journals in five-time points defined to represent a 20-year period of observation. The measures associated with the type of study design were: the country of origin of the article, country income, continent of the corresponding author, inter-institutional collaboration, interdisciplinary collaboration, type of funding, and topic of research. Logistic regression was used in the multiple models to identify the exploratory factors associated with the type of study. Results: From a total of 1,944 articles, 50.6% comprised clinical studies. High-income countries and continents stood out for developing more clinical research than others. Since research funders request more collaborative research, overall clinical studies depended upon more inter-institutional collaboration than the others. Most clinical studies were partly supported by research institutes or universities and by industry. About the research topic, the majority of the clinical and animal studies disclosed surgical procedures. Conclusions: High-income countries and continents are more likely to develop clinical studies in the surgical procedures field. The highest collaborations in terms of the number of institutions and funding sources are more prevalent in clinical research designs. Indeed, most in vivo studies in dental implant fields are performed to evaluate new materials or even new surgical procedures.

Mapping the trends and impact of research collaboration between countries in oral implantology publications: A bibliometric analysis from 1999 to 2019.

STATEMENT OF PROBLEM: Scientific collaboration provides a suitable strategy for enhancing the exchange of knowledge and technological development. However, the impact of collaboration in oral implantology research between countries and how it has been influenced by the income status of the country has not been previously evaluated. PURPOSE: The purpose of this bibliometric analysis was to evaluate how collaboration between countries affected oral implant publications and whether patterns of collaboration differ depending on the country's income. MATERIAL AND METHODS: Articles were retrieved from 7 well-established journals whose scope included oral implantology at 5 time points (1999, 2004, 2009, 2014, and 2019). Data were extracted, and descriptive, bivariate, and multivariate logistic regression analyses were performed (α=.05). RESULTS: A total of 1944 articles were included; of which, 27.5% presented collaboration between countries. In 2009, 2014, and 2019, collaboration between countries was more likely to occur than at previous time points (P≤.005). Corresponding authors with a higher h-index (P<.05) and authors from Europe and North America (P<.001) were more likely to establish international connections. The possibility of collaboration between countries was higher for animal studies (P<.001) and for articles published by Clinical Oral Implants Research (P=.026). Collaborations between high-income and upper-middle- or lower-middle-income countries were more likely to happen in 2014 and 2019 (P<.05), as well as when the number of authors was higher (P=.015), compared with collaboration between high-income countries. With regard to the continent, European articles were less likely to have collaborations with upper-middle- or lower-middle-income countries (P<.001). CONCLUSIONS: The findings revealed that some parameters related to the study, authors, countries, and journals were statistically associated with the presence of collaboration between countries. However, the bibliometric parameters showed different trends when countries of different incomes established collaboration.

Surface Engineering for Dental Implantology: Favoring Tissue Responses Along the Implant.

Dental implants represent an illustrative example of successful medical devices used in increasing numbers to aid (partly) edentulous patients. Particularly in spite of the percutaneous nature of dental implant systems, their clinical success is remarkable. This clinical success is at least partly related to the effective surface treatment of the artificial dental root, providing appropriate physicochemical properties to achieve osseointegration. The demographic changes in the world, however, with a rapidly increasing life expectancy and an increase in patients suffering from comorbidities that affect wound healing and bone metabolism, make that the performance of dental implants requires continuous improvement. An additional factor endangering the clinical success of dental implants is peri-implantitis, which affects both the soft and hard tissue interactions with dental implants. In this study, we shed light on the optimization of dental implant surfaces through surface engineering. Depending on the region along the artificial dental root, different properties of the surface are required to optimize prevailing tissue response to facilitate osseointegration, improve soft tissue attachment, and exert antibacterial efficacy. As such, surface engineering represents an important tool for assuring the continued future success of dental implants. Impact Statement Dental implants represent a common treatment modality nowadays for the replacement of lost teeth or fixation of prosthetic devices. This review provides a detailed overview of the role of surface engineering for dental implants and their components to optimize tissue responses at the different regions along the artificial dental root. The surface properties steering immunomodulatory processes, facilitating osseointegration, and rendering antibacterial efficacy (at both artificial root and abutment region) are described. The review finally concludes that surface engineering provides a tool to warrant that dental implants will remain future proof in more challenging applications, including an aging patient population and comorbidities that affect bone metabolism and wound healing.

Association between industry support and the reporting of study outcomes in randomized clinical trials of dental implant research from the past 20 years.

BACKGROUND: Industry support is a significant funding source in implant dentistry research, not only to provide regulatory processes, but also to validate and promote products through randomized clinical trials (RCTs). However, industry funding should not affect scientific outcomes. PURPOSE: The aim of this study was to investigate whether there is an association between industry support for RCTs in implant dentistry and a greater chance of the reporting of positive outcomes, and whether there are other funding tendencies. MATERIALS AND METHODS: Randomized clinical trials from five implant dentistry journals were reviewed. Data were extracted, and descriptive and inferential statistical analyses (α = 0.05), including bivariate and multivariable logistic regression, and Spearman's correlation were performed. RESULTS: Two hundred eleven RCTs were included. Industry-funded and -unfunded studies presented similar outcomes, in terms of positive and negative results (p ≥ 0.05). North American and European countries received more industry funding, as did high-income countries, which showed well-established collaboration with each other. Clinical Oral Implants Research and Clinical Implant Dentistry and Related Research published 83.6% of industry-funded articles. Industry-funded studies from middle-income countries established more international collaborations with high-income countries than did unfunded studies. Citation numbers were similar for funded and unfunded studies. The chance of RCTs being industry-funded was higher for high-income (odds ratio [OR] = 3.00; 95% confidence interval [CI], 0.99-9.32; p = 0.05) and North American articles (OR = 3.40; 95% CI, 1.37-8.42; p = 0.008) than in lower-middle-income and other continents, respectively. Higher industry funding was associated with specific topics such as "surgical procedures," "prosthodontics topics," and "implant macrodesign" (OR = 4.7; 95% CI, 1.45-15.20; p = 0.010) and with the increase in numbers of institutions (OR = 1.52; 95% CI, 1.16-2.0; p = 0.002). CONCLUSION: The available evidence suggests no association between industry funding and greater chances of the reporting of positive outcomes in implant dentistry RCTs. A strong association was identified in industry trends concerning geographic origins, higher numbers of institutions, and specific research topics.

A Prosthetic and Surgical Approach for Full-Arch Rehabilitation in Atrophic Maxilla Previously Affected by Peri-Implantitis.

Rehabilitation of atrophic maxilla with dental implants is still a challenge in clinical practice especially in cases of alveolar bone resorption due to peri-implantitis and pneumatization of the maxillary sinuses. Several surgical approaches have been employed to reconstruct the lost tissues allowing the proper tridimensional position of the implants. In this context, the aim of this case report is to describe a surgical and prosthetic approach to fully rehabilitate the atrophic maxilla with dental implants. The patient presented with unsatisfactory functional and esthetical implant-supported prosthesis with some of the implants already lost by peri-implantitis. The remaining three implants were also affected by peri-implantitis. Reversal prosthetic planning was performed, and a provisional prosthesis was fabricated and anchored in two short implants. Sinus floor augmentation procedure and onlay bone graft were then accomplished. After a healing period of 8 months, digital-guided surgery approach was performed to place the implants. Finally, a definitive prosthesis was installed. One-year follow-up has revealed stabilization of the bone tissue level, successful osseointegration, and a pleasant esthetic and functional result. A proper diagnosis and careful planning play an important role to enhance precision and to achieve patient esthetic and functional outcomes.

Antifungal activity and biocompatibility of α-AgVO3 microcrystals: A promising material against oral Candida disease.

The number of studies on microcrystals containing silver has increased in recent decades. Among the silver-containing microcrystals, α-AgVO3 has gained prominence owing to its polymorphism that allows it to exert interesting antimicrobial activity against pathogenic microorganisms. The aim of this study was to evaluate the antifungal activity and cytotoxicity of three different α-AgVO3 microcrystals when in solution. α-AgVO3 microcrystals were synthesized using the co-precipitation method at three different temperatures (10 °C, 20 °C, and 30 °C), and then characterized by X-ray diffraction and scanning electron microscopy. The antifungal activity of α-AgVO3 microcrystals against Candida albicans was determined by estimating the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). Fluorescence images were obtained to confirm antifungal concentrations. To assess the biocompatibility of microcrystals applied at MIC and MFC on keratinocytes cells (NOK-si), an Alamar Blue assay, scanning electron microscopy, and a DNA gel integrity test were carried out. The quantitative and qualitative results showed that, regardless of the co-precipitation method used to synthetize α-AgVO3 microcrystals, C. albicans growth was visibly inhibited at 3.9 µg/mL (MIC) and completely inhibited at 15.62 µg/mL (MFC). The cytotoxic and genotoxic outcomes revealed that the MIC and MFC concentrations did not affect NOK-si cell morphology, proliferation, or DNA integrity. The search for new antimicrobial materials has been the focus of the research community recently because of increases in microbial resistance. The findings reported herein demonstrate a novel antifungal and non-cytotoxic material that could be used in biomedical and dental applications.

Ultraviolet Light Treatment of Titanium Suppresses Human Oral Bacterial Attachment and Biofilm Formation: A Short-Term In Vitro Study.

PURPOSE: Antibacterial dental implants and related prosthetic components could help to reduce infection and prevent peri-implantitis. The purpose of this study was to determine the effect of ultraviolet (UV) light treatment of titanium on biofilm formation of human oral bacteria. MATERIALS AND METHODS: Machine-prepared commercially pure titanium disks were treated with UV light for 12 minutes. Human oral bacteria were seeded onto untreated and UV-treated disks. Early bacterial attachment to titanium was assessed at 12 hours. Surface topography of initial biofilms was evaluated by 3D scanning electron microscopy at 24 hours. The quantity and morphology of subsequent colony development and biofilm formation were examined by confocal laser scanning microscopy for up to 7 days. RESULTS: Throughout the time course, significantly fewer bacterial cells attached to UV-treated titanium surfaces compared to untreated ones. While biofilm developed rapidly to a final thickness of about 16 µm by day 3 on untreated titanium, on UV-treated surfaces it remained below 8 µm, even at day 7. Similarly, UV treatment resulted in 70% less exopolysaccharides (EPS) volume than on untreated surfaces at day 7. This is consistent with the finding that EPS production per cell was significantly lower on UV-treated surfaces. Untreated titanium surfaces covered with biofilm were 5-fold rougher than the original machined surface, while UV-treated surfaces remained 2-fold rougher due to a significantly less biofilm formation. CONCLUSION: UV treatment of titanium surfaces significantly reduces attachment of human oral bacteria and subsequent biofilm formation as well as EPS production for at least 7 days. UV treatment prevented the escalation of surface colonization, mitigating an unfavorable bacteriophilic cascade and environmental trigger for biofilm formation.

Promising effects of silver tungstate microcrystals on fibroblast human cells and three dimensional collagen matrix models: A novel non-cytotoxic material to fight oral disease.

Silver tungstate (α-Ag2WO4) microcrystals have shown encouraging results regarding their antimicrobial activity. However, in addition to the promising outcomes in fighting oral disease, cytotoxic tests are mandatory for screening new materials for biological applications. Here, we developed a better understanding of the effects of microcrystals on the behavior of both human gingival fibroblast (HGF) cells and three-dimensional (3D) collagen matrices. To perform these experiments, the lowest concentration of α-Ag2WO4 capable of preventing the visible growth of Candida albicans (C. albicans) planktonic cells was defined as the test concentration, and it ranged from 0.781 (C1) to 7.81 (C2) to 78.1 (C3) µg/mL. Complete medium and lysis buffer (LB) served as negative (C-) and positive (C+) controls, respectively. The effect of the microcrystal concentration on the morphology, remodeling and proliferation of HGF cells was evaluated by different approaches. Quantitative and qualitative assessments demonstrated that α-Ag2WO4 did not affect the mitochondrial enzymatic activity of HGF cells cultured in a monolayer or the cell viability within 3D collagen matrices. These experiments showed that α-Ag2WO4 at the C2 concentration did not damage the genomic DNA. The development of new materials is attractive for the possible treatment of diseases and for avoiding indiscriminate prescribing of antibiotics. These findings provide information on the effect of α-Ag2WO4 on cell behavior and reveal that these microcrystals are non-cytotoxic against human gingival cells over a sufficient period to measure the hazard potential.

Qualitative, quantitative and genotypic evaluation of Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum isolated from individuals with different periodontal clinical conditions.

Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum are strongly associated with periodontitis, and their evaluations are relevant to understand their role in the etiology and progression of periodontal diseases. In this study, the qualitative and quantitative detection of A. actinomycetemcomitans and F. nucleatum, as well as their genetic diversity, were evaluated in individuals with gingivitis, chronic periodontitis and periodontally healthy. In addition, the biotyping, serotyping, and prevalence of the ltx and cdt genes in A. actinomycetemcomitans were also determined. Subgingival biofilms obtained from gingivitis (70), periodontitis (75) and healthy (95) individuals were analyzed by cultures and PCR. Bacterial typing and presence of ltx and cdt genes in A. actinomycetemcomitans were also verified. DNA from A. actinomycetemcomitans and F. nucleatum was detected respectively, in 65.7% and 57.1% of gingivitis, 80% and 68% of periodontitis, and 57.8% and 37.8% of healthy. A. actinomycetemcomitans from gingivitis were biotypes I, II, IV, V, and X, and serotypes a, c, and e. In periodontitis, biotypes II, VI, and X, and serotypes a, b, and c were found. In healthy subjects, biotypes II and X, and serotypes b and c were found. The LTX and ltxA were observed in strains from gingivitis and periodontitis pockets. Subsequently, our data also showed no direct relationship between ltxA gene expression and leukotoxin gene 530-bp presence. On the other hand, cdt gene predominated during the inflammatory disease process. Our results strongly support a role of A. actinomycetemcomitans and F. nucleatum in advanced stage of periodontal disease.

Effect of different implant abutment surfaces on OBA-09 epithelial cell adhesion.

For the long-term success of implants, it is necessary to achieve a direct contact between the implant and the subjacent bone. To avoid bacterial penetration that could adversely affect the initial wound healing as well as the long-term behavior of the implants, an early tissue barrier must form that is able to protect the biological peri-implant structures. Given the need of an effective tissue early barrier around dental implants, the present study evaluated, in vitro, the influence of physical and chemical characteristics of two implant abutment surfaces on gingival epithelial cells (OBA-9) adhesion. To this end, titanium (Ti) and zirconia (ZrO2 ) disk-shaped specimens were used mimicking the abutment components surfaces, while bovine enamel (BE) and glass cover slips (GCS) disks served as positive and negative controls, respectively. Roughness and surface free energy (SFE) of all materials were evaluated previously to cellular adhesion step. In sequence, the effect of each material on cells morphology and viability was analyzed after 1 and 24 hr. The results showed that roughness and SFE had no effect on the cell viability data or on their interaction (p = .559), independent of a post-contact analysis of 1 or 24 hr. However, cells attachment and spreading increased after 24 hr on Ti and ZrO2 than BE, corresponding to the highest SFE values. SFE appears to be an important property interfering on the quality of the soft tissue surrounding dental implants. These data can be considered a trigger point for developing new material surfaces.

Pathogenicity and genetic profile of oral Porphyromonas species from canine periodontitis.

OBJECTIVE: In this study, the presence of the prtC and fimA genes involved in the pathogenicity of oral Porphyromonas spp. isolated from dogs with periodontitis and healthy, as well as their genetic diversity was investigated. DESIGN: Thirty-two Beagle dogs, 24 with periodontitis and 8 healthy were evaluated. Subgingival samples from only one gingival site of both groups were collected. Bacteria grown in anaerobiosis were identified by RAPID ID 32A kits. From each strain the respective DNA was obtained and used to genotyping by conventional PCR and AP-PCR. RESULTS: Dogs with periodontitis harbored 28 P. gulae, 2 P. creviocaricanis, 1 P. cangingivalis and 7 P. macacae; and from healthy dogs, 11 P. gulae and 5 P. circumdentaria. In P. gulae isolated from periodontal dogs the gene prtC was observed in 19 (67.85%) and in 7 (63.63%) from healthy dogs. P. gulae strains from periodontal dogs harbored either the gene fimA I or fimA II; while strains from healthy dogs harbored the gene fimA I, fimA II, fimA III or fimA IV, as well as 1 P. circumdentaria the gene fimA II. By AP-PCR strains were grouped in different clusters suggesting heterogeneity of these microorganisms. CONCLUSIONS: The results presented herein inform that Porphyromonas spp. isolated from dogs with and without periodontitis harbored the prtC and fimA genes and it could be a role in the establishment of the infectious process.

The impact of antimicrobial photodynamic therapy on peri-implant disease: What mechanisms are involved in this novel treatment?

According to the American Academy of Implant Dentistry, 3 million Americans have dental implants, and this number is growing by 500,000 each year. Proportionally, the number of biological complications is also increasing. Among them, peri-implant disease is considered the most common cause of implant loss after osseointegration. In this context, microorganisms residing on the surfaces of implants and their prosthetic components are considered to be the primary etiologic factor for peri-implantitis. Some research groups have proposed combining surgical and non-surgical therapies with systemic antibiotics. The major problem associated with the use of antibiotics to treat peri-implantitis is that microorganisms replicate very quickly. Moreover, inappropriate prescription of antibiotics is not only associated with potential resistance but also and most importantly with the development of superinfections that are difficult to eradicate. Although antimicrobial photodynamic therapy (aPDT) was discovered several years ago, aPDT has only recently emerged as a possible alternative therapy against different oral pathogens causing peri-implantitis. The mechanism of action of aPDT is based on a combination of a photosensitizer drug and light of a specific wavelength in the presence of oxygen. The reaction between light and oxygen produces toxic forms of oxygen species that can kill microbial cells. This mechanism is crucial to the efficacy of aPDT. To help us understand conflicting data, it is necessary to know all the particularities of the etiology of peri-implantitis and the aPDT compounds. We believe that this review will draw attention to new insights regarding the impact of aPDT on peri-implant disease.

Facial and occlusal esthetic improvements of an adult skeletal Class III malocclusion using surgical, orthodontic, and implant treatment.

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.

Structural and quantitative analysis of a mature anaerobic biofilm on different implant abutment surfaces.

STATEMENT OF PROBLEM: The longevity of dental implants depends on the absence of inflammation in the periimplant tissue. Similar to teeth, pathogenic bacteria can adhere on implant abutment surfaces and cause periimplant disease and consequently implant loss. PURPOSE: The purpose of this in vitro study was to evaluate the influence of physical and chemical properties of 2 common materials used as implant abutments, titanium (Ti) and zirconia (ZrO2), and the use of bovine enamel (BE) as a positive control on biofilm formation. MATERIAL AND METHODS: Biofilm formation was analyzed by growing Porphyromonas gingivalis and Fusobacterium nucleatum as monospecies and mixed species biofilms on the surfaces. The mean roughness (Ra) and surface free energy were evaluated for each material. Mature biofilm, formed after 7 days of incubation, was analyzed quantitatively and qualitatively by colony-forming unit and confocal laser scanning microscopy. RESULTS: The mean roughness in all disks was ≤0.21 µm and did not affect the bacterial adhesion. Titanium showed a greater degree of hydrophilicity compared with BE after 90 minutes of immersion in saliva. The surface free energy did not show differences, with the highest values for BE. Monospecies biofilms formed by P. gingivalis on Ti, and mixed species biofilm on ZrO2 exhibited small numbers of cells on disk surfaces. By confocal imaging, the mixed species biofilm appeared as a thin layer on ZrO2 surfaces. CONCLUSIONS: Material surfaces could have a significant impact on biofilm formation. ZrO2 implant abutment surfaces showed a decrease in anaerobic biofilm compared with Ti and BE.

Aesthetic Implant Rehabilitation in Periodontally Compromised Patients: A Surgical and Prosthetic Rationale.

Two cases of aesthetic implant abutment rehabilitation in the maxillary anterior area in periodontally compromised patients following conventional periodontal therapy and tooth extractions are presented. For the two cases of anterior tooth loss due to advanced periodontal disease progression, atraumatic flapless extractions were performed followed by the placement of immediate implants and provisional restorations. For the first case, lithium disilicate cemented over the abutment was used to achieve excellent aesthetic results. In the second case, custom zirconia abutments were used as prosthetic components. The results at the 3-year follow-up showed absence of inflammation and/or infection on the peri-implantar tissue with satisfactory aesthetic and excellent biological and clinical results achieved with reduced treatment time and morbidity for both patients. Total absence of infection and frequent plaque control after implant placement are mandatory before selection of the abutment material. The planning of the final treatment as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed in relation to the literature.

Long-term evaluation of oral gavage with periodontopathogens or ligature induction of experimental periodontal disease in mice.

OBJECTIVE: To evaluate in long-term periods the destruction of periodontal tissues and bacterial colonization induced by oral gavage with periodontopathogens or ligature experimental periodontal disease models. MATERIAL AND METHODS: Forty-eight C57BL/6 J mice were divided into four groups: group C: negative control; group L: ligature; group G-Pg: oral gavage with Porphyromonas gingivalis; and group G-PgFn: oral gavage with Porphyromonas gingivalis associated with Fusobacterium nucleatum. Mice were infected by oral gavage five times in 2-day intervals. After 45 and 60 days, animals were sacrificed and the immune-inflammatory response in the periodontal tissue was assessed by stereometric analysis. The alveolar bone loss was evaluated by live microcomputed tomography and histometric analysis. qPCR was used to confirm the bacterial colonization in all the groups. Data were analyzed using the Kruskal-Wallis, Wilcoxon, and ANOVA tests, at 5 % of significance level. RESULTS: Ligature model induced inflammation and bone resorption characterized by increased number of inflammatory cells and decreased number of fibroblasts, followed by advanced alveolar bone loss at 45 and 60 days (p < 0.05). Bacterial colonization in groups G-Pg and G-PgFn was confirmed by qPCR but inflammation and bone resorption were not observed (p < 0.05). CONCLUSIONS: The ligature model but not the oral gavage models were effective to induce inflammation and bone loss in long-term periods. Pg colonization was observed in all models of experimental periodontal disease induction, independent of tissue alterations. These mice models of periodontitis validates, compliments, and enhances published PD models that utilize ligature or oral gavage and supports the importance of a successful colonization of a susceptible host, a bacterial invasion into vulnerable tissue, and host-bacterial interactions that lead to tissue destruction. CLINICAL RELEVANCE: The ligature model was an effective approach to induce inflammation and bone loss similar to human periodontitis, but the oral gavage models were not efficient in inducing periodontal inflammation and tissue destruction in the conditions studied. Ligature models can provide a basis for future interventional studies that contribute to the understanding of the disease pathogenesis and the complex host response to microbial challenge.

Impact of Physical Chemical Characteristics of Abutment Implant Surfaces on Bacteria Adhesion.

Surface attachment is the first step in biofilm formation, and the ability of bacteria to adhere to surfaces and develop a biofilm is directly influenced by electrostatic interactions between the bacteria and the chemical composition of material surfaces. Here, we investigated the influence of physical and chemical characteristics of titanium (Ti) and zirconia (ZrO2) as implant abutment surfaces on the bacterial adhesion phase and compared the results to bovine enamel (BE) simulating a human tooth. To achieve this goal, we used 2 common pathogens of the oral cavity, Streptococcus mutans UA140 and Porphyromonas gingivalis 33277. To investigate the influence of material surfaces on bacterial adhesion, we studied the surface free energy as well as the topography by atomic force microscopy, and the chemical elements composition by scanning electron microscopy equipped with an energy dispersive X-ray spectroscope. Our results indicated a hydrophobic characteristic for all of the materials; however, the presence of polar and nonpolar components could aid in understanding why greater numbers of bacteria had adhered to BE compared to the other surfaces. Our confocal microscopy data support the proposition that electrostatic interactions, indeed, affected the initial adhesion phase. Within the limitations of a laboratory study, the results revealed bacterial adhered on BE and no bacteria could be observed by confocal images on Ti and ZrO2 implant abutment surfaces.

Effect of UV-photofunctionalization on oral bacterial attachment and biofilm formation to titanium implant material.

Bacterial biofilm infections remain prevalent reasons for implant failure. Dental implant placement occurs in the oral environment, which harbors a plethora of biofilm-forming bacteria. Due to its trans-mucosal placement, part of the implant structure is exposed to oral cavity and there is no effective measure to prevent bacterial attachment to implant materials. Here, we demonstrated that UV treatment of titanium immediately prior to use (photofunctionalization) affects the ability of human polymicrobial oral biofilm communities to colonize in the presence of salivary and blood components. UV-treatment of machined titanium transformed the surface from hydrophobic to superhydrophilic. UV-treated surfaces exhibited a significant reduction in bacterial attachment as well as subsequent biofilm formation compared to untreated ones, even though overall bacterial viability was not affected. The function of reducing bacterial colonization was maintained on UV-treated titanium that had been stored in a liquid environment before use. Denaturing gradient gel-electrophoresis (DGGE) and DNA sequencing analyses revealed that while bacterial community profiles appeared different between UV-treated and untreated titanium in the initial attachment phase, this difference vanished as biofilm formation progressed. Our findings confirm that UV-photofunctionalization of titanium has a strong potential to improve outcome of implant placement by creating and maintaining antimicrobial surfaces.