Bone Substitutes Graft for Regeneration of the Anterior Maxillary Alveolar Process: A Systematic Review.

The objective of this systematic review was to identify the available scientific evidence on bone substitutes (BSs) compared with autogenous bone grafts (ABGs) for regeneration of horizontal bone resorption in the anterior maxillary alveolar process, aiming at rehabilitation with endosseous implants. This review was performed according to the PRISMA guidelines (2020) and registered in the database PROSPERO (CRD: 42017070574). The databases searched were PUBMED/MEDLINE, EMBASE, SCOPUS, SCIENCE DIRECT, WEB OF SCIENCE, and CENTRAL COCHRANE, in the English language. The Australian National Health and Medical Research Council (NHMRC) and Cochrane Risk of Bias Tool were used to assess the study's quality and risk of bias. A total of 524 papers were found. After the selection process, 6 studies were selected for review. A total of 182 patients were followed for a period of 6 to 48 months. The mean age of patients was 46.46 years, and 152 implants were installed in the anterior region. Two studies achieved a reduced graft and implant failure rate, whereas the remaining 4 studies had no losses. It may be concluded that the use of ABGs and some BSs is a viable alternative for the rehabilitation with implants in individuals with anterior horizontal bone loss. However, additional randomized controlled trials are warranted due to the limited number of papers.

Chronic consumption of alcohol increases alveolar bone loss.

This study evaluated the effects of the chronic consumption of different concentrations of alcohol on the experimental periodontitis (EP). 160 rats were divided into 4 groups: (EP-NT) rats with EP and no alcohol exposure; (EP-A14) rats with EP exposed to 14% alcohol; (EP-A25) rats with EP exposed to 25% alcohol; (EP-A36) rats with EP exposed to 36% alcohol. The animals from the EP-A14, EP-A25 and EP-A36 groups were subjected to different concentrations of alcohol 30 days before EP induction. The histological characteristics, percentage of bone in the furcation (PBF) and bone metabolism in the furcation region were evaluated. The PBF and tartrate-resistant acid phosphatase (TRAP) data were subjected to statistical analysis. The EP-A14, EP-A25 and EP-A36 groups had lower PBFs compared with the EP-NT group. A more severe inflammatory process and a greater number of TRAP+ cells were also observed. In the EP-A14, EP-A25 and EP-A36 groups, the inflammatory process became more severe as the ingested alcoholic concentration increased. An increase in RANKL immunolabeling and a significantly higher number of TRAP+ cells were also observed. We conclude that chronic alcohol consumption increases the severity of experimental periodontitis in a dose-dependent manner by increasing the magnitude of local inflammatory responses and stimulating alveolar bone resorption.

Platelet-Rich Fibrin in Coverage of Gingival Recession: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis sought to evaluate the efficacy of platelet-rich fibrin (PRF) membranes versus subepithelial connective tissue grafts (SCTGs) in the coverage of Miller class I and II gingival recessions. After the inclusion and exclusion criteria were applied, the quality of seven articles (Cohen's Kappa = 0.9) was evaluated using the Jadad scale. The MEDLINE/PubMed, Cochrane, and Web of Science databases were consulted, and manual searches were performed in the most popular periodontics journals. The studies included considered a total of 122 patients, 203 surgical fields on which SCTGs were used, and 205 surgical fields on which PRF was used. The parameters analyzed were probing depth, clinical attachment level, gingival recession, and keratinized mucosa. The minimum follow-up period accepted was 6 months. A statistically significant difference between the SCTG and PRF groups was found only in the case of keratinized mucosa. However, gingival recession, clinical attachment level, and probing depth parameters in the PRF group were found to be statistically equal to those of the SCTG group (the gold standard) (p ≥0.05). PRF membranes were determined to be a promising alternative to autogenous gingival grafts in the treatment of Miller class I and II gingival recessions.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment.

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Clinical Comparison of the Subepithelial Connective Tissue versus Platelet-Rich Fibrin for the Multiple Gingival Recession Coverage on Anterior Teeth Using the Tunneling Technique.

The aim of this study was to evaluate and compare, clinically, the efficiency of the subepithelial connective tissue graft (SCTG) and platelet-rich fibrin (L-PRF) using the tunnel technique to cover the multiple gingival recessions on anterior teeth, in the same patient. Within the limits of this study, we conclude that both SCTG and L-PRF proved to be reliable options for the treatment of gingival recessions, efficiently supporting the biological and aesthetic demand, stimulating the periodontal tissues' health, and bringing reliable and highly predictable results.

Aumento da mucasa queratinizada em área peri-implantar com enxerto gengival livre / Keratinized tissue augmentation in peri-implantar area with free gingival graft

Geralmente, a mucosa queratinizada em pacientes edêntulos totais apresenta-se reduzida, o que poderia afetar a função mastigatória, estética e funcional nas reabilitações com implantes dentais. A saúde do tecido peri-implantar é importante para preservar os princípios biológicos da Osseointegração. O relato deste caso teve por objetivo descrever o aumento da mucosa queratinizada em área peri-implantar, em um segundo tempo cirúrgico, com enxerto gengival livre. Uma paciente do sexo feminino, com 74 anos de idade, desdentada total foi encaminhada para a equipe de Implantodontia e Periodontia da Faculdade de Odontologia Araçatuba, Universidade Estadual Paulista (Unesp) com a queixa principal de falta de estabilidade de sua prótese inferior. Para resolução do caso, foi indicada uma sobredentadura suportada por dois implantes 4 mm x 11,5 mm Master Easy Grip (Conexão Sistema de Prótese, Arujá/SP). Durante a segunda fase da cirurgia, foi realizado um enxerto gengival livre e posicionado na face vestibular de cada implante. Após três meses de acompanhamento, o enxerto apresentou-se com boa aparência, excelente cor e ótima qualidade clínica do enxerto. Diante do exposto, pôde-se concluir que o enxerto gengival livre é uma opção de tratamento confiável para aumento da mucosa queratinizada, ajudando a manter a saúde do tecido peri-implantar, diminuindo o acúmulo de placa e evitando o trauma mecânico da escovação e mastigação.

Effects of oestrogen deficiency and 17ß-estradiol therapy on bone healing in calvarial critical size defects treated with bovine bone graft.

OBJECTIVE: To histomorphometrically analyze the effect of ovariectomy-induced oestrogen deficiency and 17ß-estradiol therapy on bone healing of surgically created critical-size defects (CSDs) treated with bovine bone graft (BBG). METHODS: Forty-eight female rats were randomly assigned to the following 3 experimental groups (n=16): sham-operated animals (SHAM), ovariectomized animals (OVX) and ovariectomized animals treated with oestrogen (OVX+E2). OVX+E2 animals received daily subcutaneous injections of 17ß-estradiol (20µg/kg) from 8 days after ovariectomy until euthanasia. Thirty days after the surgery, an 8mm CSD was surgically created in each calvaria of all animals and filled with BBG. Animals were euthanized at either 30 or 60 days postoperative. A histological analysis, percentage of Newly Formed Bone Area (NFBA), osteoblast and osteoclast number was histomorphometrically performed (p≤0.05). RESULTS: At 30 days, SHAM group (8.82%±2.93) had significantly greater NFBA than OVX (4.66%±1.35) and OVX+E2 groups (5.85%±4.08) (p≤0.05). At 60 days, SHAM group (11.51%±3.08) and OVX+E2 group (9.84%±1.87) had significantly greater NFBA than OVX animals (5.12%±0.68) (p≤0.05). Fewer osteoblasts were observed in the OVX group at 30 (763.40±121.60) and 60 (696.60±80.92) days than in the SHAM group at 30 days (1356.00±95.38). Fewer osteoclasts were observed in the OVX+E2 group (3.25±2.16) than in the SHAM (9.75±1.82) and OVX (12.75±1.47) groups at 30 days (p≤0.05). CONCLUSIONS: Oestrogen deficiency compromises bone healing in calvarial CSDs treated with BBG in ovariectomized rats. After 60 days post-surgery, 17ß-estradiol therapy improved bone healing in calvarial CSDs treated with BBG in ovariectomized rats.

Oral Focal Mucinosis: Clinical Case Presentation With a Focus on Esthetic and Functional Surgical Resolution.

INTRODUCTION: When planning excisional surgery, alterations in the oral mucosa, particularly in esthetically important areas, represent a challenge. For cases involving an exophytic lesion with a vegetative tumoral aspect, a clinician may prioritize obtaining a definitive diagnosis by histopathologic and histochemical examinations over the preservation of esthetics or maintenance of the involved tooth. CASE PRESENTATION: A painless, hard lesion with normal coloration was present in the maxillary left central incisor of a patient for at least 6 years. A biopsy was performed to preserve oral mucosa and a treatment plan was established that included endodontic retreatment and prosthetic restoration. The histopathologic diagnosis was oral focal mucinosis, an uncommon and poorly characterized type of lesion. CONCLUSION: A conservative biopsy of the lesion facilitated an accurate diagnosis, promoted the patient's comfort, and achieved satisfactory esthetic results.

O efeito do consumo abusivo de álcool no torque de remoção de implantes de titânio / The effect of alcohol abuse consumption on the removal torque of titanium implants

Estudos relatam que o álcool pode levar ao desequilíbrio na formação e na reabsorção óssea, porém, seus efeitos sobre a osseointegração de implantes de titânio ainda se apresentam como um tópico inconclusivo. Neste contexto, o propósito do presente estudo foi avaliar biomecanicamente o efeito do consumo abusivo de álcool no torque de remoção de implantes de titânio osseointegrados. Para tanto, 30 ratos (Wistar) machos foram divididos em dois grupos experimentais (n=15), os quais receberam apenas água (controle) ou solução alcoólica (36%) por via oral (álcool). Após 30 dias do início das administrações, todos os animais foram submetidos à instalação de implante de titânio (2,2 mm x 4 mm) na tíbia direita e esquerda. Os alvéolos cirúrgicos foram preparados com fresa (2 mm) montada em contra-ângulo (20:1) e motor para implante (com torque de 45 Ncm e velocidade de 1.200 rpm) sob irrigação constante do alvéolo cirúrgico com solução salina. Cinco animais de cada grupo foram eutanasiados aos 15, 30 e 60 dias pós-operatórios. As tíbias foram submetidas à análise de torque reverso. Os dados obtidos foram submetidos à análise estatística pelos testes não paramétricos de Kruskal-Wallis e Dunn (p<0,05). Os animais do grupo álcool apresentaram menor torque de remoção, quando comparados aos animais do grupo controle, aos 15, 30 e 60 dias pós-operatórios (p < 0,05). Concluiu-se que o consumo abusivo de álcool reduz o torque de remoção de implantes de titânio instalados em tíbia de ratos, sugerindo que o álcool pode interferir no processo de osseointegração de implantes de titânio...

Studies have reported that alcohol may lead to imbalance in bone formation and resorption, however, its effects on osseointegration of titanium implants continues to be an inconclusive subject. In this context, the aim of this study was to make a biomechanical evaluation of the effect of abusive alcohol consumption on the removal torque of osseointegrated titanium implants. Male Wistar rats (n=30) were divided into two experimental groups (15 each) receiving only water (Control) or 36% alcohol solution oral administration. Thirty days later, all animals were submitted to titanium implant (2.2 mm x 4 mm) placement in the right and left tibiae. The surgical alveoli were prepared with a 2 mm drill mounted in a counter-angle hand-piece (20:1 ratio, 35 Ncm torque at 1200 rpm) under abundant cooling. Five animals from each group were euthanized at 15, 30, and 60 days. Tibiae were submitted to reverse torque analysis. Data obtained were submitted to statistical analysis by the non-parametric Kruskal-Wallis and Dunn Tests (p < 0.05). Animals in the alcohol group presented lower removal torque values when compared with control group animals for all periods tested (p < 0.05). It can be concluded that abusive alcohol consumption can reduce the removal torque of titanium implants placed in rat tibiae, suggesting that alcohol may interfere in the osseointegration process of titanium implants...