Association between periodontitis and Alzheimer's disease and its impact on the self-perceived oral health status: a case-control study.

PURPOSE: To test the hypothesis that periodontitis is associated with AD and search whether periodontal and other variables would negatively impact the oral health-related quality of life (OHRQoL) perception. MATERIALS AND METHODS: Oral examinations and interview on self-perceived oral health status (Geriatric Oral Health Assessment Index (GOHAI) questionnaire (higher score corresponds to better perceived oral status)) were carried out and socio-demographic data were collected from outpatients with mild to moderate AD (cases, n = 50) and from their age- and sex-matched family caregivers (controls, n = 52). Full-mouth periodontal examination was performed. Significance of differences between groups was sought by chi-square, Student's t, or the Mann-Whitney test. The association between the variables periodontitis, probing depth (PD) ≥ 5 mm, and clinical attachment loss (CAL) ≥ 5 mm with the variable group was tested in binary logistic regression models (LRMs). LRMs were used to test the association of oral findings, demographics, and group with GOHAI. RESULTS: Cases had fewer teeth and greater CAL than controls. Cases had a superior percentage of sites with plaque, calculus, and bleeding on probing than controls. Cases had greater GOHAI scores than controls. Periodontitis was a variable most likely associated with AD (OR = 11.08, p < 0.001). None of the oral findings or demographics, but group, was associated with GOHAI (OR = 14.45, p < 0.001). CONCLUSION: Periodontitis is associated with AD, but not with patients' OHRQoL. CLINICAL RELEVANCE: Health care professionals must be aware that AD patients should have a periodic thorough oral examination and preventive intervention aiming at their welfare and maintenance of a pain-free functional dentition.

Development of a calcified odontogenic hamartoma following avulsion of a permanent central incisor.

The avulsion of a permanent immature tooth is a serious condition and a real emergency in dentistry. The management of a traumatized avulsed tooth is always a challenge to the clinician. This case report concerns the development of a calcified odontogenic hamartoma after the avulsion of an immature central incisor in an eight-year-old female. The patient presented for the treatment four months after the avulsion. Her intraoral examination showed complete healing of the area but an atypical appearance of the alveolar area of the missing tooth was observed in the periapical radiograph. A new radiographic scan performed six months later revealed the formation of a radiopaque irregular structure at the cervical level of the alveolar ridge at the site of the missing tooth. Surgical removal was performed, and the histopathological examination revealed a hamartomatous proliferation of odontogenic tissue with calcification. After healing, the lateral incisor was orthodontically moved mesially and restored to resemble the central incisor. An orthodontic device was installed to improve function and aesthetics of the patient.

Effects of different pre-operative doses of dexamethasone on alveolar repair in rats.

Dexamethasone has been widly used in oral and maxillofacial surgery for controlling of postoperative surgical inflammation. Despite its clinical effectiveness, several studies have demonstrated the negative impact of this drug on the healing of soft and hard tissues. This study aimed to assess the effects of different pre-operative doses of dexamethasone on alveolar repair. Sixty rats were divided into four groups of 15 animals each. Single pre-operative doses of dexamethasone equivalent to human doses of 4 mg (Group 4 mg), 8 mg (Group 8 mg), and 12 mg (Group 12 mg), calculated by allometric dose extrapolation, were administered; and rats in the Control Group were injected with saline solution. The animals were anesthetized, and their left mandibular first molars (M1) were removed. After three, seven, and 40 days, 5 animals from each group were euthanized, and bone samples of M1 alveolus were collected for radipgraphic, histomorphological and histometric evaluation of the early and late phases of alveolar healing. At three days, Group 12 mg presented reduced radiographic density, percentage of collagen, and connective matrix compared with the Control Group. At 7 days, the percentage of bone was increased in the Control Group compared to Groups 8 mg and 12 mg (P < 0.05). It can be concluded that a single pre-operative dose of 12 mg of dexamethasone affected the early stages of alveolar repair in rats.

Experimental osteonecrosis: development of a model in rodents administered alendronate.

The main objective of this study was to cause bisphosphonate-related osteonecrosis of the jaws to develop in a rodent model. Adult male Holtzman rats were assigned to one of two experimental groups to receive alendronate (AL; 1 mg/kg/week; n = 6) or saline solution (CTL; n = 6). After 60 days of drug therapy, all animals were subjected to first lower molar extraction, and 28 days later, animals were euthanized. All rats treated with alendronate developed osteonecrosis, presenting as ulcers and necrotic bone, associated with a significant infection process, especially at the inter-alveolar septum area and crestal regions. The degree of vascularization, the levels of C-telopeptide cross-linked collagen type I and bone-specific alkaline phosphatase, as well as the bone volume were significantly reduced in these animals. Furthermore, on radiographic analysis, animals treated with alendronate presented evident sclerosis of the lamina dura of the lower first molar alveolar socket associated with decreased radiographic density in this area. These findings indicate that the protocol developed in the present study opens new perspectives and could be a good starting model for future property design.

Effects on Bone Repair of Osteotomy With Drills or With Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet Laser: Histomorphometric and Immunohistochemical Study.

BACKGROUND: The erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser has been widely used in the dental clinic; however, few studies have demonstrated the advantages of the use of this laser for bone osteotomies. The purpose of this study is to evaluate and compare the bone repair process of defects generated by the Er,Cr:YSGG laser or conventional drills. METHODS: Ninety-six rats were divided into two groups of 48 animals (drill group and laser group). After surgical exposure of the right tibia, the animals were subjected to a 2-mm-diameter osteotomy created by conventional drills (drill group) or by the Er,Cr:YSGG laser (laser group). The animals were sacrificed 0, 3, 7, 14, 30, and 60 days after the creation of the defect, and histologic sections were obtained and used for histomorphometric and immunohistochemical analyses for the detection of osteocalcin, osteoprotegerin, receptor activator of nuclear factor κ-B ligand, vascular endothelial growth factor, and caspase-3. RESULTS: The osteotomy with the drill produced well-delimited and smooth walls, whereas the osteotomies in the laser group were irregular and presented an amorphous basophilic line and bone necrosis that was slowly resorbed during the repair process. Despite these characteristics, bone repair was similar between groups at various time points, and, at 60 days, the defects in both groups were completely repaired by newly formed bone. CONCLUSION: The repair process of osteotomies created by the Er,Cr:YSGG laser, despite producing thermal damage to bone tissue, is comparable to that with conventional drills.

Experimental osteonecrosis: development of a model in rodents administered alendronate

Abstract The main objective of this study was to cause bisphosphonate-related osteonecrosis of the jaws to develop in a rodent model. Adult male Holtzman rats were assigned to one of two experimental groups to receive alendronate (AL; 1 mg/kg/week; n = 6) or saline solution (CTL; n = 6). After 60 days of drug therapy, all animals were subjected to first lower molar extraction, and 28 days later, animals were euthanized. All rats treated with alendronate developed osteonecrosis, presenting as ulcers and necrotic bone, associated with a significant infection process, especially at the inter-alveolar septum area and crestal regions. The degree of vascularization, the levels of C-telopeptide cross-linked collagen type I and bone-specific alkaline phosphatase, as well as the bone volume were significantly reduced in these animals. Furthermore, on radiographic analysis, animals treated with alendronate presented evident sclerosis of the lamina dura of the lower first molar alveolar socket associated with decreased radiographic density in this area. These findings indicate that the protocol developed in the present study opens new perspectives and could be a good starting model for future property design.

Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats.

OBJECTIVE: The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA). DESIGN: Upper right incisors were extracted from 30 rats divided into three groups (n=10). The teeth were stored dry for 60min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis (P<0.05). RESULTS: Group I was the most affected by root resorption (mean=67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue (P<0.05). CONCLUSION: An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region.

Utilization of ethyl cyanoacrylate and 2-octyl cyanoacrylate adhesives for autogenous bone graft fixation: histomorphometric study in rats.

The present study analyzes the repair process of autogenous bone graft in a block fixed with ethyl cyanoacrylate and 2-octyl cyanoacrylate adhesives in rat calvaria. Forty-eight rats, divided into 3 groups, received round osteotomies at the right parietal bone for the attainment of autogenous bone graft fragment, which was fixed at the opposite side to the donor site with ethyl cyanoacrylate (ethyl group) and 2-octyl cyanoacrylate (octyl group) adhesives. In the control group, bone fragment was only juxtaposed at the parietal bone surface without any fixation material. The animals were euthanized after 10 and 60 postoperative days. The calvariae were processed in a laboratory for the attainment of slides stained through the hematoxylin and eosin technique for histological and histometric analysis. The qualitative analysis showed a discrete inflammatory infiltrate in the control group and moderate inflammatory infiltrate in the ethyl and octyl groups at the 10-day period, which remained at the 60-day period, mainly in the octyl group. The bone fragment remained bonded to the recipient site through the adhesive, but graft incorporation was not observed in any of the specimens. Resorption was higher in the octyl group followed by the ethyl and control groups, both at the 10- and 60-day periods, but with no statistical significance (P < .05). Although promoting graft fixation and its maintenance at the recipient site, both studied adhesives did not allow the graft incorporation, producing a localized and discrete inflammatory reaction, which persisted at 60 days, being more intense in the octyl cyanoacrylate group.

Efeito de três sistemas de osteotomia: ultrassom cirúrgico, laser Er, Cr: YSGG e sistema rotatório: sobre o processo de osseointegração e reparo de defeitos ósseos em tíbia de ratos. Estudo histomorfométrico, imuno-histoquímico e biomecânico / Effect of three osteotomy systems: Piezosurgery, ER, Cr: YSGG laser and rotary system: on osseointegration and repair of bone defects in tibia of rats. Histomorphometrical, immunohistochemical and biomechanical study

O objetivo deste trabalho foi avaliar o processo de reparo ósseo e a osseointegração de implantes inseridos em leitos cirúrgicos preparados por meio de Brocas Convencionais, Ultrassom Piezoelétrico e LASER Er,Cr:YSGG. Como objetivo secundário, foi testada a habilidade do ultrassom cirúrgico de estumilar a liberação de citocinas e fatores de crescimento ósseo durante o processo de reparo. Para tanto, dois estudos distintos foram conduzidos. No Estudo 1, 144 ratos foram divididos em 3 grupos (Grupos Broca, LASER e Piezo) com 48 animais cada. Mini implantes usinados foram instalados em ambas as tíbias de cada animal em alvéolos cirúrgicos preparados pelos 3 sistemas testados de acordo com o grupo ao qual o animal pertencia Após a intervenção cirúrgica, 8 animais por grupo foram sacrificados aos 0, 3, 7, 14, 30 e 60 dias pós-operatórios.. O implante da tíbia direita foi utilizado para o ensaio de torque de remoção e o da tíbia esquerda, para análise de ContatoOsso-Implante (COI) e Fração de Área Ocupada por Osso (FAOO). No Estudo 2, 174 animais foram divididos nos mesmos grupos experimentais ­ Broca, Piezo e Laser ­ com 63, 63 e 48 animais cada, respectivamente. Defeitos ósseos de 2mm de diâmetro foram produzidos na tíbia direita dos animais usando um dos três dispositivos testados de acordo com o grupo ao qual o animal foi designado. Oito animais de cada grupo foram sacrificados aos 0, 3, 7, 14 30 e 60 dias e a cicatrização óssea foi analisada por histomorfometria e detecção imunohistoquímica de Osteocalcina, Osteoprotegerina, Rankl, Vegf e Caspase-3. Cinco animais dos Grupos Broca e Piezo foram sacrificados aos 3, 7 e 14 dias e o espécimes coletados foram utilizados para análise de PCR quantitativo (Q-PCR). Os resultados do Estudo 1 demonstraram a osseointegração dos implantes no três grupos estudados. No Grupo Broca a formação óssea ocorreu mais precocemente, porém um aumento significativo no torque de remoção ocorreu somente aos 30 dias. Nos Grupos Laser e Piezo o torque de remoção aumentou precocemente e o reparo ósseo ao redor do implante foi progressivamente aumentado até os períodos tardios. Os resultados do Estudo 2 demonstraram diferenças no padrão de corte do dispositivos testados, onde Proca e Piezo produziram osteotomias regulares enquanto o LASER produziu osteotomias irregulares com carbonização das margens do defeito. A neoformação óssea foi maior nos Grupos Piezo e Laser ao longo dos períodos de reparo, porém essa diferença foi detectada estatisticamente somente aos 30 dias entre grupos Piezo e Broca (p<0.05). A expressão de caspase-3 foi significativamente menor aos 7 dias no Grupo Laser em comparação ao grupo broca. Os resultados do Q-PCR evidenciaram expressões elevadas de Runx2 e Caspase-3 nos grupos Broca e Piezo aos 7 dias, respectivamente (p<0,05). A análise dos resultados permite concluir que as osteotomias produzidas pelos três dispositivos testados são comparáveis, em termos de processo cicatricial e a formação óssea ao redor de implantes; e que o reparo ósseo produzido por ultrassom cirúrgico não possui o reparo ósseo acelerado pela liberação de fatores de crescimento

The aim of this study was to evaluate the bone healing process and osseointegration of implants placed in sockets prepared by conventional Drills, Piezosurgery and Er,Cr:YSGG laser. As a secondary objective we tested the hability of Piezosurgery of enhancing the bone repair by releasing of citokynes and growth factor. Therefore, two different studies were conducted. In study 1, 144 rats were assigned to 3 groups: Groups Drill, Laser and Piezo, with 48 animals in each group. Machined mini-implants were placed in both tibiae of each animal in sockets prepared by the three tested systems, according to the group in which it was assigned. After the surgical procedures, 8 animals were sacrificed postoperatively at 0, 3, 7, 14, 30 and 60 days in each group. The implant of the right tibia was used for removal torque test and the left tibia implant was used for Bone-to-Implant Contact (BIC) and Bone Area Fraction Occupancy (BAFO) analysis. In Study 2, 174 animals were ssigned to the same experimental Goups - Drill, Piezo and Laser ­ with 63, 63 and 48 animals in each group. Bone defects with 2mm in diameter were created in the righ tibia of each animal using one of the three tested devices according to the group in which it was assigned. Eight animals of each group was sacrificed at 0, 3, 7, 14 , 30 and 60 days and bone healing were analyzed by means of histomorphometry and immunohistochemical detection of Osteocalcin, Osteoprotegerin, Rankl, Vegf and Caspase-3. Also, 5 animals form Gorups Drill and Piezo were sacrificed at 3, 7 and 14 days and the bone samples were used for quantitative PCR (QPCR) analysis. Results of Study 1 demonstrated implant osseointegration in all experimental groups. The Group Drill presented early bone formation, however, significant increasing in torque removal values occurred only at 30 days. In Groups Laser and Piezo, removal torque increased early and bone healing around the implant was progressively increased until later time-points. Results gotten from Study 2 showed differences on the cut characteristics among the tested devices, where Drill and Piezo produced regular osteotomies whilst Laser produced irregular osteotomies with carbonization at the defect margins. Bone neoformation was higher in Groups Piezo and Laser along the time-points, however, this difference was statistically significant only at 30 days between Groups Piezo and Drill (p<0.05). Expression of Caspase-3 was significantly lower at 7 days in Group Laser in comparison to Group Drill. Results of QPCR analysis demonstrated higher expression of Runx2 and Caspase-3 in Groups Drill and Piezo at 7 days respectively (p<0.05). According to the results it can be concluded that osteotomies produced by the three tested devices are comparable in terms of healing and bone formation around the implants; and piezosurgery has not the ability of accelerate the bone healing by an increased releasing of growth factors

Tratamento cirúrgico de sialolitíase em glândula submandibular - relato de caso / Surgical treatment of sialolithiasis in the submandibular gland - case report

A sialolitíase é responsável por metade das patologias que acometem as glândulas salivares e, em função disso, vem sendo tratada e estudada há décadas. Nos últimos anos, com o advento de novos recursos de diagnóstico e métodos de tratamento, propostas terapêuticas vêm sendo continuamente sugeridas para abordagem dos cálculos salivares. Este trabalho apresenta o caso clínico de um paciente de gênero masculino, de trinta e sete anos que procurou atendimento profissional devido aumento volumétrico e dor em região submandibular esquerda com seis meses de evolução. A avaliação clínica associada aos exames de imagem levaram à confirmação diagnóstica de sialolitíase, com o cálculo salivar localizado no ducto da glândula submandibular esquerda. Foi planejada e realizada a remoção cirúrgica por acesso intrabucal do sialolito, de forma que num pós-operatório imediato já se observa funcionamento normal da glândula e de seu sistema secretor. Com base no caso apresentado, este trabalho ainda discute os mais recentes métodos de diagnóstico e tratamento de sialolitíase.

Considering that sialolithiasis is responsible for half of disorders that affect the salivary glands, and therefore it has been studied and treated during decades. Therapeutic alternatives have been suggested to treat salivary calculi over the last years due to development of diagnostic and treatment resources. The aim of this study is to report the case of a male patient, 37 years old, who reported pain and volume expansion in left submandibular region during 6 months. Clinical evaluation combined with radiographic exams confirmed the diagnosis of sialolithiasis with salivary calculus in the duct of left submandibular gland. After definitive diagnostic of sialolithiasis, surgical removal of calculus was planned and performed through intraoral approach of calculus in left submandibular duct. Normal function and drainage recovery was achieved in an immediate postoperative period. According to the present report, this study still discusses the current methods for diagnosis and treatment of sialolithiasis.

Dynamics of bone healing after osteotomy with piezosurgery or conventional drilling - histomorphometrical, immunohistochemical, and molecular analysis.

BACKGROUND: Piezosurgery is an osteotomy system used in medical and dental surgery. Many studies have proven clinical advantages of piezosurgery in terms of quality of cut, maneuverability, ease of use, and safety. However, few investigations have tested its superiority over the traditional osteotomy systems in terms of dynamics of bone healing. Therefore, the aim of this study was to evaluate the dynamics of bone healing after osteotomies with piezosurgery and to compare them with those associated to traditional bone drilling. METHODS: One hundred and ten rats were divided into two groups with 55 animals each. The animals were anesthetized and the tibiae were surgically exposed to create defects 2 mm in diameter by using piezosurgery (Piezo group) and conventional drilling (Drill group). Animals were sacrificed at 3, 7, 14, 30 and 60 days post-surgery. Bone samples were collected and processed for histological, histomorphometrical, immunohistochemical, and molecular analysis. The histological analysis was performed at all time points (n = 8) whereas the histomorphometrical analysis was performed at 7, 14, 30 and 60 days post-surgery (n = 8). The immunolabeling was performed to detect Vascular Endothelial Growth Factor (VEGF), Caspase-3 (CAS-3), Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL), and Osteocalcin (OC) at 3, 7, and 14 days (n = 3). For the molecular analysis, animals were sacrificed at 3, 7 and 14 days, total RNA was collected, and quantification of the expression of 21 genes related to BMP signaling, Wnt signaling, inflammation, osteogenenic and apoptotic pathways was performed by qRT-PCR (n = 5). RESULTS: Histologically and histomorphometrically, bone healing was similar in both groups with the exception of a slightly higher amount of newly formed bone observed at 30 days after piezosurgery (p < 0.05). Immunohistochemical and qRT-PCR analyses didn't detect significant differences in expression of all the proteins and most of the genes tested. CONCLUSIONS: Based on the results of our study we conclude that in a rat tibial bone defect model the bone healing dynamics after piezosurgery are comparable to those observed with conventional drilling.

Dipirona versus paracetamol no controle da dor pós-operatória / Dipyrone versus acetaminophen in the control of postoperative pain

Introdução: A dor é definida como uma experiência desagradável, sendo o controle da dor pós-operatória um grande desafio na área da saúde. Objetivo: Comparar a eficácia da dipirona e do paracetamol no controle da dor pós-operatória após exodontia de terceiros molares inclusos. Material e Método: Foram selecionados 30 pacientes da Disciplina de Cirurgia da Faculdade de Odontologia de Araçatuba - UNESP, que necessitavam extrair os terceiros molares inclusos. Desses, 15 receberam dipirona (Grupo I) e outros 15 receberam paracetamol (Grupo II) no pós-operatório. Todos os pacientes foram tratados, no pré-operatório, uma hora antes do procedimento cirúrgico, com dexametasona 4 mg e amoxicilina 1 grama. A intensidade da dor foi avaliada pelos pacientes por meio de escala visual analógica, em um período pós-operatório de 48 horas, em intervalos de 6 horas. Os critérios de exclusão foram: presença de desordens sistêmicas, hipersensibilidade medicamentosa, gestação, lactação e contraindicações locais. Os escores obtidos foram submetidos ao teste de Mann-Whitney (α = 0,05) para comparação das intensidades de dor em intervalos de 6 horas, nas 24 horas iniciais, nas 24 horas finais e no período total de 48 horas. Resultado: Não houve diferença estatística entre os analgésicos estudados nos intervalos de 6 horas; entretanto, nas 24 horas finais e nas 48 horas totais de observação, o Grupo I apresentou valores médios menores, estatisticamente significantes, quando comparado ao Grupo II. Conclusão: A eficácia analgésica da dipirona foi superior à do paracetamol.

Introduction: The pain is defined as an unpleasant experience, and control of postoperative pain a great challenge in healthcare. Objective: To compare the efficacy of Dipyrone and acetaminophen in postoperative pain after third molar surgery. Material and Method: Thirty patients of the Discipline of Surgery of School of Dentistry of Araçatuba - UNESP, that needed to extract their third included molars, were selected. Among these, 15 received Dipyrone (group I) and the other received acetaminophen (group II) in the postoperative. All patients were treated pre-operatively with dexamethasone 4 mg and amoxycillin 1 g, one hour before surgery. Pain intensity was evaluated by a visual analogue scale by forty eight hours postoperative period and in intervals of six hours. The exclusion criteria were: presence of systemic disorders, drugs hypersensitivity, pregnant, lactic and local contraindications. The scores obtained were submitted to the Mann-Whitney test (p < 0,05) for comparison of the pain intensity in the 6 hours intervals, in the initial 24 hours, in the last 24 hours and in the total period of 48 hours. Result: There was no statistical difference among the analgesics in the 6 hours intervals, however, in the last 24 hours and in the total period of 48 hours, the group I presented smaller medium values, significant statistically, when compared to group II. Conclusion: The analgesic efficacy of dipyrone was superior to paracetamol.

Evaluation of the bone healing process utilizing platelet-rich plasma activated by thrombin and calcium chloride: a histologic study in rabbit calvaria.

To evaluate the bone healing of defects filled with particulate bone graft in combination with platelet-rich plasma (PRP), added with a mixture of calcium chloride and thrombin or just calcium chloride. Two 5-mm bone defects were created in the calvaria of 24 rabbits. Each defect was filled with particulate bone graft and PRP. In one defect the PRP was activated by a mixture of calcium chloride and thrombin; in the other, PRP was activated by calcium chloride only. The animals were euthanized 1, 2, 4, and 8 weeks after the surgeries, and the calvaria was submitted to histologic processing for histomorphometric analysis. The qualitative analysis has shown that both defects presented the same histologic characteristics so that a better organized, more mature, and well-vascularized bone tissue was noticed in the eighth week. A good bone repair was achieved using either the mixture of calcium chloride and thrombin or the calcium chloride alone as a restarting agent of the coagulation process.

Avaliação clínica em curto prazo do sistema de Cone Morse e plataforma reduzida em prótese sobre implantes do tipo protocolo: estudo piloto randomizado controlado / Short-term clinical evaluation of morse taper and platform switching in implant-supported protocol-type prosthesis: pilot randomized controlled study

Introdução: Implantes dentários com conexões do tipo Cone Morse combinados a plataforma reduzida podem minimizar a reabsorção da crista óssea perimplantar. Entretanto, ainda não está claro se seu uso resultaria também em uma melhor manutenção da altura dos tecidos moles, o que poderia interferir no resultado estético final. Objetivo: Este estudo teve o objetivo de avaliar os tecidos moles ao redor de implantes dentários com Cone Morse, comparativamente àqueles com hexágono interno, em pacientes com edentulismo total, submetidos a carregamento imediato com prótese total fixa inferior. Material e método: Dez pacientes tiveram quatro implantes instalados na mandíbula, dois com Cone Morse e dois com hexágono interno, sendo a prótese instalada 72 horas após esse procedimento. Três meses depois, o índice de placa, o índice de sangramento à sondagem, a profundidade de sondagem, a posição do tecido marginal e o nível de inserção relativo foram avaliados pelos testes t e Wilcoxon (α = 5%). Resultado: Nos implantes com Cone Morse, a profundidade de sondagem foi significantemente menor do que naqueles com hexágono interno (p = 0,02). Nos implantes com Cone Morse, o tecido marginal estava em média 0,6 mm coronal à junção prótese-conector protético, enquanto que, nos implantes com hexágono interno, o tecido marginal esteve em média 0,4 mm apical à junção prótese-componente protético (p = 0,001). Adicionalmente, a inserção clínica nos implantes com Cone Morse estava em um nível mais coronal do que naqueles com hexágono interno (p = 0,02). Conclusão: Nas condições estudadas, os implantes do sistema Cone Morse se mostraram mais eficientes em manter a altura dos tecidos moles perimplantares do que os implantes do sistema hexágono interno.

Introduction: Dental implants with Morse taper connection combined with platform switching may minimize peri-implant crestal bone resorption. However, it remains unclear whether its use would better maintain soft tissue height, which could interfere with the esthetic outcome. Objective: The aim of this study was to evaluate the soft tissue around dental implants with Morse taper, compared to implants with internal hexagon connection, in patients with total edentulism who were submitted to immediate loading with lower fixed complete dentures. Material and method: Ten patients had four implants installed in the mandible, two with Morse taper and two with internal hexagon; and a provisional prosthesis was installed 72 hours afterward. Three months later, plaque index, bleeding on probing index, probing depth, position of soft tissue margin, and relative attachment level. Result: In implants with Morse taper, probing depth was significantly lower than in those with internal hexagon (p = 0.02). In Morse taper implants, the soft tissue margin was positioned 0.6 mm coronal to the prosthesis-abutment junction; in internal hexagon implants, marginal tissue was 0.4 mm apical to the prosthesis-abutment junction (p = 0.001). Additionally, in the Morse taper implants, the attachment level was at a more coronal level than in the internal hexagon implants (p = 0.02). Conclusion: Under the conditions studied, implants with the Morse taper connection were more effective in maintaining the height of peri-implant soft tissue than implants with internal hexagon.

Prevalência de alterações sistêmicas em pacientes atendidos na disciplina de Cirurgia e Traumatologia Bucomaxilofacial do curso de Odontologia da UNIARA / Prevalence of systemic diseases in patients evaluated in the discipline of Oral and Maxillo Facial Surgery of Araraquara University Center - UNIARA

Introdução: A avaliação pré-operatória é de fundamental importância para a prevenção de intercorrências transoperatórias e de complicações pós-operatórias. Objetivo: Identificar a prevalência de enfermidades e condições sistêmicas em pacientes submetidos a tratamento cirúrgico na área de Cirurgia e Traumatologia Bucomaxilofacial do Curso de Odontologia, do Centro Universitário de Araraquara - UNIARA, no período de 2004 a 2009. Material e método: Para o desenvolvimento deste trabalho, foi realizado um levantamento nos prontuários desses pacientes, sendo analisados os seguintes fatores: idade, gênero, presença de vícios, principais enfermidades e condições sistêmicas que afetam a população mundial. Os dados obtidos foram analisados quantitativamente e registrados em uma tabela. Resultado: No total de prontuários analisados (693), foram detectadas 340 respostas afirmativas (49,06%) a uma ou mais enfermidades. As doenças cardiovasculares foram as mais prevalentes (22,34%). Considerando-se a prevalência de doenças relacionadas à idade, a faixa etária de menos de 20 anos representou 16,32%; 20-29 anos, 43,06%; 30-39 anos, 45,16%; 40-44 anos, 48,64%; 45-49 anos, 56,25%; 50-54 anos, 58,33%; 55-59 anos, 57,74%; 60-64 anos, 70,37%; 65-69 anos, 66,66%; 70 anos ou mais, 68,75%. Conclusão: As doenças e alterações sistêmicas com maior prevalência foram doenças cardiovasculares, anemia, sinusite e diabetes. A frequência das respostas afirmativas a quadros sistêmicos foi idade-dependente e houve predominância do gênero feminino. Já o vício mais frequente foi o tabaco. Assim, pôde-se observar ser de fundamental importância a realização de avaliação pré-operatória da saúde dos pacientes que irão se submeter a tratamento odontológico/cirúrgico.

Introduction: pre-operative assessment is of fundamental importance for the prevention of transoperative and of postoperative complications. Objective: to identify the prevalence of diseases and systemic conditions in patients undergoing surgical treatment in the discipline of surgery and Traumatology of University Center of Araraquara, in the period of 2004 to 2009. Material and method: for the development of this study, a survey in medical records of patients was performed and the factors considered included: age, sex, presence of vices, and systemic conditions that affect the world?s population. The data obtained were analyzed quantitatively and recorded in atable. Result:  Considering all patient records analyzed (693), 340 affirmative responses were detected (49,06%) to one or more diseases. Cardiovascular diseases were the most prevalent (22,34%). Considering the prevalence of diseases related to age, the age of less than 20 years represented 16,32%; of 20-29 years, 43,06%; 30-39 years, 45,16%; 40-44 years, 48,64%; 45-49 years, 56,25%; 50-54 years, 58,33%; 55-59 years, 57,74%; 60-64 years, 70,37%; 65-69 years, 66,66%; and 70 years or more, 68,75%. Conclusion: diseases and systemic alterations with higher prevalence were cardiovascular diseases, anemia, sinusitis and diabetes. The frequency of affirmative answers to systemic conditions was age-dependent and there was a predominance of females. The tobacco addiction was the most frequent. Thus, it was found that the preoperative assessment of the health of patients who will undergo surgical dental treatment is of fundamental importance.

Qual a importância da Odontologia Hospitalar? / What is the importance of Hospital Dentistryn

Odontologia Hospitalar pode ser compreendida por cuidados das alterações bucais que exigem intervenções de equipes multidisciplinares nos atendimentos de alta complexidade. A Odontologia integrada ao hospital permite melhor desempenho no compromisso de assistência ao paciente e expandiu o atendimento de saúde bucal à população. No entanto, mesmo entre os dentistas, as opiniões divergem sobre o assunto. A participação do cirurgião-dentista em nível ambulatorial ou baixa hospitalar tem o objetivo de colaborar, oferecer e agregar mais força ao que caracteriza a nova identidade do hospital. O objetivo deste trabalho foi realizar uma revisão da literatura quanto à importância de se ministrar conceitos sobre a Odontologia Hospitalar para o exercício da profissão odontológica e como se encontra a situação a respeito atualmente.

Hospital Dentistry can be understood by the care of the oral abnormalities that require intervention of multidisciplinary team for highly complex treatment. Dentistry integrated into the hospital, allows a better performance in the commitment to patient care and also expanded oral health care to the population. However, even among dentists, opinions differ on the subject. The participation of the dentist in an outpatient or in hospital, aims to collaborate, deliver and add more strength to what characterizes the new identity of the hospital. The aim of this study was to review the literature about the importance of ministering concepts of Hospital Dentistry for the exercise of this profession and how the situation is nowadays.

Levantamento de seio maxilar com enxerto de coágulo sanguíneo / Sinus lifting associated to blood clot grafting. A report of two clinical cases

Após a perda dentária, a região posterior da maxila sofre um processo de atrofia óssea e pneumatização do seio maxilar, o que dificulta a instalação de implantes dentários pela redução do volume ósseo disponível. Dentre as opções terapêuticas, o levantamento do seio maxilar com enxerto sinusal é um procedimento que possibilita a recuperação da altura óssea para a instalação de implantes. O uso de osso autógeno associado ou não a biomateriais tem sido o padrão para enxertia após o levantamento do seio. Porém, recentemente, a importância de se utilizar materiais de enxerto neste tipo de cirurgia tem sido questionada. Este trabalho apresenta o relato de dois casos clínicos de levantamento do seio maxilar com instalação imediata de implante utilizando-se apenas o coágulo sanguíneo como veículo de neoformação óssea

After tooth loss, the posterior maxillary region undergoes a bone atrophy process and maxillary sinus pneumatization, which hinders the placement of dental implants due to the reduction of the available bone volume. Among the therapeutic options, the sinus lift with grafting is a procedure which enables the regeneration of bone height for dental implant placement. The use of autogenous bone associated or not with biomaterials has been the standard after sinus membrane elevation; however, the importance of grafting materials in this kind of surgery has been questioned. This paper presents the report of two clinical cases of sinus lifting with immediate implant placement using only the blood clot as a bone neoformation carrier

Lateralização de nervo alveolar inferior: compreendendo e desmistificando a técnica cirúrgica / Inferior alveolar nerve lateralization: understanding and demystifying the surgical technique

A lateralização do nervo alveolar inferior (LAI) é um procedimento cirúrgico que consiste na criação de uma janela óssea e no deslocamento do nervo para a inserção de implantes através do canal mandibular. Este procedimento oferece a possibilidade de reabilitação com implantes na área edêntula posterior da mandíbula, nos casos onde a perda em altura do rebordo alveolar impossibilitaria a instalação de implantes de comprimento regular sem cirurgias reconstrutivas prévias. Apesar das vantagens oferecidas por esta cirurgia, o alto índice de complicações pós-operatórias especialmente relacionadas a distúrbios neurológicos sensitivos, a LAI é um recurso pouco explorado na prática clínica. Detalhes e abordagens alternativas que aumentam a previsibilidade desta técnica são discutidos em conjunto com o relato de um caso clínico.

The Alveolar Inferior nerve Transposition (AIT) is a surgical procedure which consists in creating a bony window and nerve displacement for implant insertion through the inferior alveolar canal. This procedure offers the possibility to rehabilitate the posterior mandibular area in cases where the loss of alveolar ridge height would prevent placement of regular length implants without previous reconstructive surgeries. Despite the advantages offered by this surgery, the high level of post-operative complications, especially related to sensory neurological disorders, the AIT is an underutilized recourse in clinical practice. This study presents a case report, reviews and discusses the technical details and the different approaches and strategies in the literature that help make the technique more practical and predictable.

Biomateriais em cirurgia de levantamento de seio maxilar: uma revisão crítica / Biomaterials in sinus lifting procedures - a critical review

O levantamento do seio maxilar é um procedimento que visa aumentar o volume ósseo e permitir a instalação de implantes na maxila posterior atrófica. Embora o osso autógeno seja o principal material de enxerto empregado nesta cirurgia, vários biomateriais têm sido propostos para substituí-lo, evitando-se, assim, os riscos e a morbidade cirúrgica que resultam da abordagem a uma área doadora. Embora haja uma grande quantidade de estudos testando a eficácia de vários biomateriais no levantamento de seio maxilar, ainda existem controvérsias quanto ao real desempenho de cada um deles na formação óssea e na manutenção do volume enxertado. Este artigo, por meio de uma revisão dos principais estudos sobre o assunto, propôs uma revisão crítica da literatura sobre a real eficácia dos biomateriais mais utilizados no levantamento do seio maxilar

Sinus augmentation is a common procedure which aims to increase the bone volume for dental implant placement in the atrophic posterior maxilla. Although autogenous bone is the main grafting material used for this surgery, many other biomaterials have been proposed as an alternative, avoiding the risks and surgical morbidity at the donor site. Although there are many experimental papers testing the effectiveness of several biomaterials for sinus augmentation, there is still controversy about their real performance. This paper provides a critical review on the real effectiveness of most used biomaterials in this surgical procedure

A cirurgia guiada como auxílio na Implantodontia / Implant guided surgery - an aid in Implantolog

O propósito do estudo foi realizar uma revisão da literatura sobre a cirurgia guiada na Implantodontia, a fim de destacar indicações, planejamento, vantagens, limitações, técnica propriamente dita, carga imediata de implantes bem como as possíveis complicações, o protocolo de fabricação e o funcionamento do software de planejamento virtual. Para isto realizou-se um levantamento blibliográfico por meio das bases de dados Medline (Pubmed) e Bireme desde o ano de 1990 até 2010, utilizando como descritores: “Implante dentário”, “Dental Implant”, “Cirurgia Assistida por Computador”, “Computer Aided Surgery”, “Cirurgia Guiada”, “Guided Surgery”, “Prótese Implantossuportada” e “Implant-Supported Prosthesis”. Quarenta estudos sobre esse tema, nas línguas Inglesa e Portuguesa, foram selecionados e analisados. Baseado na revisão de literatura foi possível concluir que a técnica de cirurgia guiada na implantodontia representa uma excelente modalidade terapêutica para a inserção dos implantes em pacientes com quantidade óssea satisfatória. O sucesso de uma prótese de carga imediata fabricada anteriormente à cirurgia depende da precisão de todas as etapas clínicas e do planejamento laboratorial virtual

The purpose of the study was to review the literature on Implant Guided Surgery in order to highlight some aspects such as: information, planning, advantages, limitations, proper technique, immediate loading of implants and possible complications, protocol and operation of manufacturing planning software virtual. This literature review was based on OLDMEDLINE and MEDLINE databases from 1990 to 2010 using as descriptors: “Dental Implant”, “Computer Aided Surgery”, “Guided Surgery” and “Implant-Supported Prosthesis”. Forty studies on this topic were selected both in English and Portuguese, and then analyzed. Based on this literature review it was concluded that the technique of guide surgery represents an excellent therapeutic modality for the insertion of implants in patients with satisfactory bone quantity. The success of an immediately loaded prosthesis manufactured prior to the surgery depends on the accuracy of all clinical stages and the virtual laboratory planning