Cisplatin chemotherapy impairs the peri-implant bone repair around titanium implants: An in vivo study in rats.

AIM: The purpose of this study in animals was to evaluate the peri-implant bone repair against systemic administration of the antineoplastic agent. MATERIAL AND METHODS: We used 84 male rats (Rattus norvegicus, albinus, Wistar), divided into two groups: cisplatin (CIS) and saline solution (SS). The titanium implants were inserted into the right tibia at day 0 in all animals from both groups. Group SS received SS intraperitoneally at 15 and 17 days postoperatively. Group CIS received 5 and 2.5 mg/kg of CIS intraperitoneally at 15 and 17 days postoperatively, respectively. Euthanasia was performed at 22, 30 and 60 days postoperatively. Twenty-four undecalcified specimens were prepared for histometric analysis of bone/implant contact (BIC). Sixty specimens were selected to bone area (BA) measurement, histological analysis and immunohistochemical analysis of RUNX-2, osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP). BIC and BA were considered to be the primary outcome parameters. RESULTS: Group CIS showed lower BIC (11.87 ± 0.97 mm; 19.19 ± 0.8 mm; 17.69 ± 1.05 mm; p ≤ .05) and BA (3.68 ± 1.29 mm2 ; 3.05 ± 0.88 mm2 ; 3.23 ± 0.67 mm2 ; p ≤ .05), as well as decreased number of RUNX-2 (102.8 ± 27.35 cells/mm2 ; 100.04 ± 8.61 cells/mm2 ; 118.82 ± 21.38 cells/mm2 ; p ≤ .05)- and OCN-positive cells (120 ± 24.5 cells/mm2 ; 102 ± 27.73 cells/mm2 ; 100 ± 14.23 cells/mm2 ; p ≤ .05) at 22, 30 and 60 days, respectively. The animals in group CIS also showed increased number of TRAP-positive cells (86.8 ± 6.37 cells/mm2 ; 71.5 ± 4.72 cells/mm2 ; 92.8 ± 9.52 cells/mm2 ; p ≤ .05) and a persistent and exacerbated inflammatory response in all experimental periods. CONCLUSION: Within the limits of this study, it was concluded that the chemotherapeutic CIS negatively affects the bone repair at peri-implant areas, jeopardizing the osseointegration of titanium implants.

Manipulação de tecido mole peri-implantar na região lingual posterior de mandíbula / Peri-implant soft tissue management in the posterior lingual region of the mandible ­ a case report

O objetivo deste artigo foi relatar um caso clínico no qual foi realizada uma modificação da técnica de estabilização do enxerto de tecido conjuntivo (ETC) concomitante à etapa de reabertura, com o intuito de melhorar a qualidade da mucosa peri-implantar na região lingual posterior de mandíbula. Após anamnese, foi constatada no exame clínico a necessidade de exodontia do dente 34 e reabilitação protética na região do 34-36. Após cinco meses, foram instalados três implantes na região dos dentes 34, 35 e 36. Decorridos quatro meses, foi realizada a reabertura desses implantes e, pela ausência de mucosa queratinizada na região dos implantes instalados, optou-se por realizar um ETC na região lingual do 35 e 36. Este foi removido do palato e, para melhor adaptação desse enxerto no leito receptor, foi utilizado um perfurador de lençol de borracha para perfurar o ETC no local que correspondia aos cicatrizadores dos implantes 35 e 36, estabilizando-se assim o ETC no leito receptor. O retalho foi reposicionado, cobrindo totalmente o ETC e suturado. Após três anos, o tecido mole adjacente ao implante apresentava-se clinicamente estável e saudável, e a paciente encontrava-se satisfeita com o resultado. De acordo com o caso clínico relatado, esta nova abordagem para utilização do ETC, para criar uma faixa de gengiva queratinizada ao redor de implantes, mostrou-se efi ciente quanto à sua utilização de região posterior de mandíbula. Entretanto, estudos clínicos adicionais são necessários para avaliar a precisão desta técnica em outras condições clínicas.

The aim of this article is to report a clinical case where a modification of the technique of stabilization of the connective tissue graft concomitant to the reopening stage was performed in order to improve the quality of the periimplantar mucosa in the posterior lingual region of the mandible. After anamnesis, and clinical examination, the need to perform tooth 34 extraction and prosthetic rehabilitation in the region 34-36 was verifi ed. After 5 months, 3 implants were installed in the region of teeth 34, 35 and 36. After 4 months, the reopening of these implants was performed and because of the absence of keratinized mucosa in the region of the implants it was chosen to perform a connective tissue graft (CTG) in the lingual region of 35 and 36. The graft removed from the palate and for better adaptation bed, a rubber sheet punch was used to puncture it at the site corresponding to the implants 35 and 36 being stabilized in the recipient bed. The flap was repositioned, completely covering the CTG and sutured. After 3 years, the soft tissue adjacent to the implant was clinically stable, healthy and the patient was satisfied with the result. According to the reported clinical case, this new approach for the use of CTG to create a keratinized gingival band around implants proved to be efficient in its use of the posterior mandible region. However, additional clinical studies are needed to assess the accuracy of this technique in other clinical conditions.

Influence of low-level laser therapy on the healing process of autogenous bone block grafts in the jaws of systemically nicotine-modified rats: A histomorphometric study.

OBJECTIVE: To analyze the influence of low-level laser therapy (LLLT) on the bone healing process of autogenous bone block grafts installed in nicotine systemically modified rats. METHODS: Seventy-two rats (Wistar) were randomly assigned into 4 groups (n=18). SS-BG: saline application+bone graft. SS-BG/LLLT: saline application+bone graft+LLLT. NIC-BG: nicotine application+bone graft. NIC-BG/LLLT: nicotine application+bone graft+LLLT. After 30days of application of solutions, all animals received autogenous bone block graft in the jaw, with the donation from the parietal bone's calvarial area. Treatment with LLLT was in bed-graft interface, after accommodation of the graft. The animals in each group were sacrificed at 7, 14, and 28days after graft surgery. RESULTS: The histologic analyses of NIC-BG group depicted a delay of osteogenic activity in the recipient bed-graft interface and the irradiation of tissue with LLLT provided better bone healing. The histometric analysis revealed that SS-BG/LLLT and NIC-BG/LLLT groups showed increased bone formation compared to BG-SS and NIC-BG groups, after 14days (SS-BG 24.94%±13.06% versus SS-BG/LLLT 27.53%±19.07% and NIC-BG 14.27%±2.22% versus NIC-BG/LLLT 24.37%±11.93%) and 28days (SS-BG 50.31%±2.69% versus SS-BG/LLLT 58 19%±12.32% and NIC-BG 36.89%±8.40% versus NIC-BG/LLLT 45.81%±6.03%). CONCLUSION: Nicotine harms bone formation in the bed-graft interface and LLLT action can mitigate this.

Strength training prior to muscle injury potentiates low-level laser therapy (LLLT)-induced muscle regeneration.

We evaluated whether strength training (ST) performed prior to skeletal muscle cryolesion would act as a preconditioning, improving skeletal muscle regeneration and responsiveness to low-level laser therapy (LLLT). Wistar rats were randomly assigned into non-exercised (NE), NE plus muscle lesion (NE + LE), NE + LE plus LLLT (NE + LE + LLLT), strength training (ST), ST + LE, and ST + LE + LLLT. The animals performed 10 weeks of ST (climbing ladder; 3× week; 80% overload). Forty-eight hours after the last ST session, tibialis anterior (TA) cryolesion was induced and LLLT (InGaAlP, 660 nm, 0.035 W, 4.9 J/cm2/point, 3 points, spot light 0.028 cm2, 14 J/cm2) initiated and conducted daily for 14 consecutive days. The difference between intergroups was assessed using Student's t test and intragroups by two-way analysis of variance. Cryolesion induced massive muscle degeneration associated with inflammatory infiltrate. Prior ST improved skeletal regeneration 14-days after cryolesion and potentiated the regenerative response to LLLT. Cryolesion induced increased TNF-α levels in both NE + LE and ST + LE groups. Both isolated ST and LLLT reduced TNF-α to control group levels; however, prior ST potentiated LLLT response. Both isolated ST and LLLT increased IL-10 levels with no additional effect. In contrast, increased TA IL-6 levels were restricted to ST and ST + LE + LLLT groups. TA myogenin mRNA levels were not changed by neither prior ST or ST + LLLT. Both prior ST and LLLT therapies increased MyoD mRNA levels and, interestingly, combined therapies potentiated this response. Myf5 mRNA levels were increased only in ST groups. Taken together, our data provides evidences for prior ST potentiating LLLT efficacy in promoting skeletal muscle regeneration.

Effectiveness of Mechanical Debridement Combined With Adjunctive Therapies for Nonsurgical Treatment of Periimplantitis: A Systematic Review.

OBJECTIVE: This study aimed to perform a systematic review of the effectiveness of nonsurgical treatment associated with different adjuvant therapies on periimplantitis. MATERIALS AND METHODS: Different individuals, following a research process, performed a network research of controlled and randomized controlled clinical trials on PubMed, Embase/MEDLINE, with 20 years' time constraint and the last search in January 2016. RESULTS: From 108 articles found by the first search, they analyzed 10 full texts, and in none did they find a standard control group. When compared, mechanical therapies combined with adjuvant therapy decreased prevalence of periimplant ratios; however, some groups showed unsatisfactory results, mainly related to the probing depth and bleeding index. When comparing debridement with other nonsurgical therapies (Er:YAG, Vector, air abrasive with amino acid glycine powder), increased periimplant levels were noticed in the test and control groups, although in different periods. CONCLUSION: Despite the improvement in the periimplant indices, there is no sufficient evidence to score the best results or even to choose the best association for nonsurgical treatment of periimplantitis; hence, more trials are necessary to answer this question.

Effects of low-level laser therapy on bone healing of critical-size defects treated with bovine bone graft.

OBJECTIVE: To histomorphometrically analyze the effect of low-level laser therapy (LLLT) on bone formation process in surgically created critical-size defects (CSDs) treated with bovine bone graft (BBG) and its influence over particles' resorption of BBG. METHODS: A 10-mm diameter CSD was surgically created in the calvaria of 64 male rats, which were distributed into 4 experimental groups: the C group (control), only blood clot; the LLLT group, LLLT (GaAlAs, 660nm) and blood clot; the BBG group, CSD filled with BBG; the BBG/LLLT group, LLLT and CSD filled with BBG. Animals were euthanized at either 30 or 60days post-operation. A histological analysis was performed. Additionally, the percentage of newly formed bone area (NFBA) and remaining particles areas (RPA) of BBG were histometrically evaluated and data statistically analyzed. RESULTS: The LLLT (5.82±2.05; 7.34±1.01) group presented significantly greater NFBA when compared to the C group (1.61±0.30; 5.59±0.94) at 30 and 60days post-operation (p<0.05). The BBG/LLLT group (7.39±1.45; 9.44±2.36) presented significantly greater NFBA than the BBG group (3.85±1.56; 8.02±0.63) at 30 and 60days postoperation (p<0.05). There was no significant difference in the mean percentage of implanted material RPA between the BBG and the BBG/LLLT groups. CONCLUSIONS: LLLT can improve bone formation process in CSD filled or not with BBG in rat calvaria, but it is not able to accelerate particles resorption of this material in the interior of bone defect.

Influência da nicotina na osseointegração de implantes instalados em tíbias de ratos: avaliação biomecânica, histológica, histométrica e imunoistoquímica / Influence of nicotine on osseointegration of implants installed in the tibia of rats: biomechanical, histological, histometric and immunohistochemical evaluation

Objetivo: Avaliar do ponto de vista biomecânico, histomorfométrico, histoquímico e através de marcadores imunoistoquímicos a influência da terapia com laser em baixa intensidade (LLLT) na osseointegração de implantes instalados em tíbias de ratos modificados ou não sistemicamente pela nicotina. Materiais e métodos: Um total de 120 ratos (Wistar) foi distribuído em dois grandes grupos experimentais (n = 60) submetidos a duas aplicações diárias de solução salina (Veh) ou nicotina (Nic). Após 30 dias, implantes de titânio (2.2 mm x 4 mm) foram instalados na metáfise proximal de ambas as tíbias de todos os animais. Grupos experimentais de diferentes tratamentos locais do alvéolo cirúrgico previamente a instalação do implante (n = 30) foram criados no momento da cirurgia: Veh - nenhum tratamento; Veh/LLLT - irradiação do alvéolo cirúrgico com laser em baixa intensidade; Nic - nenhum tratamento; Nic/LLLT - irradiação do alvéolo cirúrgico com laser em baixa intensidade. O laser utilizado foi o Thera Lase (InGaAlP 660 nm, modo de aplicação contínuo, em contato com a área, 35 mW, 0,14 J, 4,9 J/cm2 , por 4 segundos). Dez animais de cada grupo foram eutanasiados aos 15, 30 e 60 dias pós-operatórios. As tíbias direitas foram submetidas à análise de torque reverso e posteriormente processadas para confecção de cortes histológicos descalcificados, corados por hematoxilina e eosina, vermelho picrosirius ou submetidos a reações imunoistoquímicas com os anticorpos primários policlonais: HIF-1 α, VEGF, BMP-2, RUNX-2, OCN, ALP, RANKL, OPG e TRAP. A partir das tíbias esquerdas foram preparados cortes histológicos calcificados para análise das porcentagens de contato osso-implante (BIC) e área óssea (BA), dentro dos limites das roscas do implante. A análise foi realizada através da microscopia de luz polarizada para análise histoquímica e da microscopia óptica de campo claro para a análise histológica, histométrica e imunoistoquímicas. As imunomarcações foram submetidas à análise qualitativa para os anticorpos HIF-1 α, VEGF, BMP-2, OCN, ALP, RANKL e OPG e análise quantitativa para os anticorpos RUNX-2 e TRAP. Os dados quantitativos foram analisados estatisticamente (p≤0,05). Resultados: A nicotina atrasou a produção de elementos da matriz óssea, diminuiu o padrão de imunomarcação de HIF-1α, VEGF, BMP-2, OCN, ALP e OPG, aumentou o padrão de imunomarcação de RANKL e aumentou a quantidade de células imunorreativas a RUNX-2 e TRAP, diminuindo a BA, embora não tenha sido capaz de influenciar o torque de remoção e o BIC. O laser aumentou o padrão de imunomarcação de HIF-1α, VEGF, BMP-2, OCN e ALP, aumentou a quantidade de células imunorreativas a RUNX-2 e TRAP, aumentou a BA, mas também não foi capaz de influenciar o torque de remoção e o BIC. Adicionalmente, o laser influenciou positivamente a BA e o torque de remoção dos implantes, aumentou a angiogênese e a diferenciação osteoblástica, promovendo a formação óssea, biomineralização e maturação óssea peri-implantar nos animais modificados sistemicamente pela nicotina. Conclusão: A LLLT é capaz de promover o processo de reparo ósseo periimplantar em condições normais e compensar os efeitos negativos da nicotina na osseointegração(AU)

Objective: To evaluate, from biomechanical, histomorphometric, histochemical stand point and through of immunohistochemical markers, the influence of low level laser therapy (LLLT) on the osseointegration of implants placed in the tibias of nicotine systemically modified (or not) rats. Materials and methods: A total of 120 rats (Wistar) was assigned into two major experimental groups (n = 60) underwent two-daily-applications of saline (Veh) or nicotine (Nic). After thirty days, titanium implants (2.2 mm x 4 mm) were placed in the proximal metaphysis of both tibiae from all animals. Experimental groups of different surgical alveolus local treatments prior to implant placement (n = 30) were created at the moment of the surgery: Veh - no local treatment; Veh/LLLT - irradiation of surgical alveoli with low level laser; Nic - no local treatment; Nic/LLLT - irradiation of surgical alveoli with low level laser. The laser used was Thera Lase® (InGaAIP 660 nm, in continuous mode, in contact with the area, 35 mW, 0.14 J, 4.9 J/cm2 , for 4 seconds). Ten animals from each group were euthanized at 15, 30 and 60 days postoperative. The right tibiae were submitted to reverse-torque analysis and, then processing in order to prepare decalcified histological sections, stained either by hematoxylin and eosin or picrosirius red or subjected to immunohistochemical reactions with the primary polyclonal antibodies: HIF-1 α, VEGF, BMP-2, RUNX-2, OCN, ALP, RANKL, OPG and TRAP. From left tibias were prepared undecalcified histological sections to evaluate the percentages of bone-to-implant contact (BIC) and bone area (BA) within the limits of the implant threads. The histochemical analysis was performed by a polarized light microscopy and the histological, histometric and immunohistochemical analysis were performed by a bright field optical microscopy. The HIF1α, VEGF, BMP-2, OCN, ALP, RANKL and OPG immunostaining were submitted to qualitative analysis and the RUNX-2 and TRAP immunostaining were submitted to quantitative analysis. Quantitative data were analyzed statistically (p≤0.05). Results: The nicotine delayed the production of bone matrix components, decreased the imunolabeling pattern of HIF-1α, VEGF, BMP-2, OCN, ALP and OPG, increased the imunolabeling pattern of RANKL, increased the amount of RUNX-2 and TRAP-immunoreactive cells, reduced the BA, but did not influence the BIC and the force required to break the osseointegration. The laser increased the imunolabeling pattern of HIF-1α, VEGF, BMP-2, OCN and ALP, increased the amount of RUNX-2 and TRAP-immunoreactive cells, increased the BA, but also was not be able to influence the BIC and the force required to break the osseointegration. In addition, the laser positively influenced the BA and the implant removal torque, increased the angiogenesis and osteoblast differentiation, promoted bone formation, biomineralization and peri-implant bone maturation in the nicotine systemically modified rats. Conclusions: LLLT is able to promote the peri-implant bone repair process in normal conditions and is able to compensate the negative effects of nicotine on osseointegration(AU)

Adjuvant Therapy With Sodium Alendronate for the Treatment of Experimental Periodontitis in Rats.

BACKGROUND: This study assesses the effects of topical sodium alendronate (SA) as an adjuvant to the mechanical treatment of ligature-induced periodontitis in rats. METHODS: Ninety animals were subjected to the induction of periodontitis via the installation of a ligature around the mandibular left first molar. After 7 days, the ligature was removed, and the animals were distributed into the following groups: 1) NT group (n = 30), no treatment; 2) SRP group (n = 30), scaling and root planing (SRP) and local irrigation with physiologic saline solution; and 3) SRP/SA group (n = 30), SRP and local irrigation with SA (10(-5) M). Ten animals from each group were euthanized at 7, 15, and 30 days after treatment. Histologic and histometric analyses were performed in the furcation region. The percentage of bone in the furcation (PBF) was measured. Immunohistochemical analyses for detecting the receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), tartrate-resistant acid phosphatase (TRAP), and activated caspase-3 were performed at the furcation region. RESULTS: Compared with the other groups, the SRP/SA group showed less local inflammation and better tissue reparation during the entire experiment. There was more PBF in the SRP/SA group than in the other groups at days 7 and 15. Stronger OPG immunolabeling and weaker RANKL immunolabeling were observed in the SRP/SA group at 15 and 30 days. There were fewer TRAP-positive cells in the SRP/SA group than in the NT group at all of the time points. There was no difference in the number of activated caspase-3-positive osteocytes among groups and time points. CONCLUSION: It can be concluded that topical use of SA as an adjuvant to SRP is effective in the treatment of experimental periodontitis.

Root coverage of adjacent gingival recessions with a combination of two surgical techniques

Introduction: The dentin hypersensitivity associated with gingival recession is an occurrence of high prevalence in the clinical routine of dentists. Coverage of exposed root surfaces represents a challenge for periodontal treatment. Objective: The purpose of the present study is to describe an approach for adjacent gingival recession treatment using a combination of two surgical techniques: the subepithelial connective tissue graft (SCTG) with a laterally positioned double flap. Case report: This surgical treatment was conducted in a 45-yearold female patient who complained of sensitivity when brushing the lower right teeth. Clinical and radiographic examinations showed gingival recessions (Miller Class III) with traumatic origin promoted for tooth brushing and the presence of thin periodontium in the region. In addition, interproximal bone loss was noted on vestibular face of the right mandibular second premolar and mesial root of the right mandibular first molar. At 12 postoperative months, it was observed that the association of the two surgical techniques promoted an almost complete coverage of the gingival recessions, an increased keratinized gingival band and the elimination of initial dentin hypersensitivity. Conclusion: The appropriate choice of techniques and patient compliance to the periodontal support therapy led to treatment success and periodontal health maintenance in the region during the whole follow-up period.

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.

Abordagens periodontais na promoção da harmonia do sorriso / Periodontal approaches in promotion of harmony smile

Várias abordagens terapêuticas têm sido propostas com o objetivo de alcançar uma estética favorável e harmônica do sorriso. O presente estudo relata um caso clínico em que foi realizada gengivoplastia na região dos dentes anteriores superiores associada à osteotomia na região dos dentes posteriores superiores e remoção do freio labial superior, para promoção da harmonia do sorriso, por meio da diminuição do sorriso gengival e adequação do corredor bucal. Os procedimentos de osteoplastia, gengivoplastia e frenectomia foram planejados e realizados em uma única sessão. Também foi realizada a remoção cirúrgica do freio labial superior que se apresentava fibroso e com baixa inserção, e dos terceiros molares superiores direito e esquerdo, que se apresentavam semi-inclusos, para evitar complicações pós-operatórias. Consultas de acompanhamento foram realizadas aos sete, 15, 30 e 180 dias do pós- operatório. Aos sete dias, o tecido gengival encontrava-se em processo inicial de cicatrização. Aos 15 dias, o tecido gengival encontrava-se nos períodos finais da cicatrização, já apresentando as características normais. Aos 30 dias, foi observada completa cicatrização dos tecidos gengivais, sem exposição clínica das superfícies radiculares. Após 180 dias, os tecidos permaneceram saudáveis, demonstrando o sucesso do tratamento realizado. A paciente demonstrou completa satisfação com os resultados obtidos. Pôde-se concluir que, quando bem indicadas, a gengivoplastia e a osteotomia são abordagens terapêuticas promissoras para promoção da harmonia do sorriso.

Several therapeutic approaches have been proposed in order to achieve an esthetically pleasing and harmony smile. The present study reports a case in which gingivectomy was performed in the region of the upper anterior teeth combined with osteotomy in the region of the upper posterior teeth and removal of the superior labial frenum to promote harmony smile by decreasing the gummy smile and adequacy of buccal corridor. Osteoplasty gingivoplasty, and frenectomy procedures were planned and performed in a single session. The extraction of the maxillary third molars was also performed in order to avoid postoperative complications. Follow-up visits were performed at 7, 15, 30 and 180 days postoperatively. At 7 days, the gingival tissue was in the initial process of healing, demonstrating inflammation still in evidence. At 15 days, the gingival tissue was found in the final healing process, showing characteristics of normal health gum. At 30 days, there was complete healing of gingival tissues without clinical exposure of the root surfaces. After 180 days, tissues remained in healthy, demonstrating the success of the treatment. Patient showed complete satisfaction with the results. It can be concluded that, when properly indicated, the combination of gingivectomy, osteotomy and frenectomy procedures are promising therapeutic approaches for promoting harmony smile.

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...

Enxerto de tecido conjuntivo para correção da margem peri-implantar / Subepithelial tissue graft for peri-implantar margin correction. Case report

A recessão de tecido mole frequentemente provoca insatisfação e desarmonia estética. O recobrimento de regiões peri-implantares é menos previsível quando comparado ao recobrimento dos elementos dentários. Este relato de caso clínico descreve a correção de um problema estético de um implante unitário com o uso de enxerto de tecido conjuntivo (ETC) associado com o reestabelecimento de um novo limite da margem gengival e do perfil de emergência da coroa. Após anamnese e exame clínico do paciente, foi constatado um implante instalado na região do dente 22 em posição vestibularizada no rebordo alveolar, com uma recessão de 5 mm em sua face vestibular. Em um primeiro procedimento cirúrgico, a coroa e o componente metálico foram removidos e um ETC, associado a um retalho posicionado coronalmente, foi realizado com o objetivo de reestabelecer o limite da margem gengival. Após 90 dias, foi constatado que o tecido na região do implante não apresentava espessura e volume adequados. Por isso, foi realizado um novo ETC. O procedimento de reabertura para instalação do cicatrizador foi realizado após quatro semanas e seguiu-se a instalação da prótese. Nos pós-operatórios de 180 e 360 dias, o tecido adjacente ao implante apresentou-se com contorno regular, cor compatível com saúde e ausência de sangramento. O paciente apresentava-se satisfeito com o resultado estético. Diante do resultado clínico e estético favorável, pôde-se concluir que o uso do ETC para corrigir deficiências estéticas parece ser favorável para reestabelecer um novo e estável contorno de tecido mole peri-implantar.

Aumento de gengiva queratinizada em mucosa peri-implantar / Increased keratinized gigiva in peri-implant mucosa

Introdução: Estudos recentes são direcionados a explorar a relação da faixa da mucosa queratinizada com a saúde dos tecidos peri-implantares. Quando esta faixa não é suficiente, uma cirurgia para o aumento de mucosa queratinizada pode ser indicada, pois tem sido relatado que a presença ou a reconstrução de tecido queratinizado ao redor de implantes pode facilitar os procedimentos restauradores, promover a estética e ainda permitir a manutenção de uma higienização oral rotineira sem irritação ou desconforto ao paciente. Dentre os procedimentos cirúrgicos disponíveis, a técnica do enxerto gengival livre é consagrada na literatura periodontal para aumento da faixa de mucosa queratinizada. Objetivo: Este estudo relata um caso clínico em que foi realizada cirurgia de enxerto gengival livre com objetivo de aumentar a faixa da mucosa queratinizada na região de implantes previamente instalados na maxila, para suporte de prótese tipo protocolo. Relato de caso: Foi realizada a cirurgia de enxerto gengival livre na região anterior da maxila, obtido do palato, na qual haviam sido instalados implantes osseointegrados para suporte de prótese tipo protocolo e a mucosa peri-implantar apresentava-se sem tecido queratinizado e inflamada. Após dois meses de reparação da cirurgia mucogengival, foi possível observar que o enxerto gengival livre favoreceu a saúde peri-implantar e os procedimentos protéticos de moldagem. Conclusão: Diante dos resultados clínicos, pode-se concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para aumento da faixa de mucosa queratinizada em mucosa peri-implantar de prótese protocolo.

Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case Report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation.

Influência do hidrocloreto de tetraciclina associado à terapia fotodinâmica no tratamento da doença periodontal induzida: estudo histomorfométrico e imunoistoquímico em ratos / Influence of tetracycline hydrochloride associated with photodynamic therapy in the treatment of experimental periodontal disease: histomorphometric and immunohistochemical study in rats

Objetivo: O propósito do presente estudo foi realizar uma avaliação histomorfométrica e imunoistoquímica do efeito do hidrocloreto de tetraciclina (TTC) e da terapia fotodinâmica antimicrobiana (aPDT), usados isoladamente ou em associação, como adjuvantes à raspagem e alisamento radicular (SRP) no tratamento da doença periodontal (DP) experimental induzida. Materiais e métodos: Foram utilizados 168 ratos, nos quais a DP foi induzida através da adaptação de fio de algodão ao redor do primeiro molar inferior esquerdo. Após 7 dias, a ligadura de todos os animais foi removida e o primeiro molar inferior esquerdo foi submetido à SRP. Os animais foram então divididos randomicamente em 7 grupos experimentais de diferentes tratamentos adjuvantes à SRP: SRP-SS - irrigação com solução salina (SS); SRP-MB - irrigação com azul de metileno (MB); SRP-TTC - irrigação com TTC; SRP-MB/TTC - irrigação com solução de MB e TTC; SRP-aPDT - irrigação com MB e, após 60 s, irradiação com Laser em baixa intensidade (LLLT) (660 nm); SRP-TTC/LLLT – irrigação com TTC e, após 60 s, irradiação com LLLT (660 nm); SRP-TTC/aPDT - irrigação com solução de MB e TTC e, após 60 s, irradiação com LLLT (660 nm). Os animais foram eutanasiados aos 7, 15 e 30 dias após o tratamento da DP. Foi realizada uma análise histométrica da área de perda óssea (PO) e das características histopatológicas e imunoistoquímicas da região de furca. Resultados: Aos 7 dias pós-tratamento, os grupos SRP-TTC, SRP-MB/TTC, SRP-aPDT, SRP-TTC/LLLT e SRP-TTC/aPDT exibiram menor área de PO que os grupos SRP-SS e SRP-MB (p<0,05). Aos 15 dias pós-tratamento, os grupos SRP-TTC, SRP-aPDT, SRP-TTC/LLLT e SRP-TTC/aPDT exibiram menor área de PO que o Grupo SRP-SS (p<0,05). Os grupos SRP-TTC e SRP-TTC/aPDT exibiram menor área de PO que o Grupo SRP-aPDT (p<0,05). Aos 30 dias pós-tratamento, os todos os grupos tratados exibiram menor área de PO que o Grupo SRP-SS (p<0,05). Aos 15 e 30 dias pós-tratamento houve diminuição gradual na...

Aim: The purpose of the present study was to perform a histomorphometric and immunohistochemical assessment of the effect of tetracycline hydrochloride (TTC) and antimicrobial photodynamic therapy (aPDT), used alone or in combination, as adjunct to scaling and root planing (SRP) in the treatment of experimentally induced periodontal disease (PD). Materials and methods: One-hundred-and-sixty-eight rats were used, in which PD was induced by tying cotton thread around the left mandibular first molar. After 7 days, ligatures were removed from all animals, and left first molar was subjected to SRP. The animals were then randomly divided into 7 experimental groups receiving different treatments adjuvant to SRP: SRP-SS - irrigation with saline solution (SS); SRP-MB - irrigation with methylene blue (MB), SRP-TTC - irrigation with TTC; SRP-MB/TTC - irrigation with TTC and MB solution; SRP-aPDT - irrigation with MB and afterwards 60 s irradiation with low-level laser therapy (LLLT) (660 nm); SRP -TTC/LLLT - irrigation with TTC, and afterwards 60 s, LLLT irradiation (660 nm); SRP-TTC/aPDT - irrigation with TTC and MB solution and afterwards 60 s, irradiation with LLLT (660 nm). Animals were euthanized at 7, 15 and 30 days after treatment of PD. Histometric evaluation of bone loss (BL), and of histopathological and immunohistochemical characteristics of the furcation region, was performed. Results: At 7 days postoperatively, SRP-TTC, SRP-MB/TTC, SRP-aPDT, SRP-TTC/LLLT and SRP-TTC/aPDT groups exhibited less BL than SRP-SS and SRP-MB groups. At 15 days postoperatively, SRP-TTC, SRP-aPDT, SRP-TTC/LLLT and SRP-TTC/aPDT groups exhibited smaller area of BL than SRP-SS Group. SRP-TTC and SRP-TTC/aPDT groups exhibited smaller area of BL than SRP-aPDT Group. At 30 days post-treatment, all treated groups showed smaller area of BL than SRP-SS Group. At 15 and 30 days post-treatment, a gradual decrease in the amount of TRAP-positive cells was observed, except in SRP-SS. In SRP-SS…

A proporção plasma rico em plaquetas/enxerto ósseo autógeno pode influenciar o reparo ósseo de defeitos de tamanho crítico: um estudo radiográfico em calvária de ratos / The proportion platelet-rich plasma/particulate autogenous bone graft may influencebone healing in criticalsize defects: a radiographic study in rat calvaria

Introdução: Tem sido sugerido que enxertos ósseos associados ao Plasma Rico em Plaquetas (PRP) cicatrizam com maior densidade que os enxertos sem PRP. Contudo, esse resultado parece depender da proporção PRP/enxerto ósseo utilizada. Objetivo: O propósito deste estudo foi avaliar, radiograficamente, a influência da proporção PRP/enxerto de Osso Autógeno (OA) no reparo ósseo de defeitos de tamanho crítico (DTCs) criados cirurgicamente em calvárias de ratos. Material e método: Cinquenta ratos foram divididos em cinco grupos: C, OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito cirúrgico foi preenchido somente com coágulo sanguíneo. No Grupo OA, o defeito foi preenchido com enxerto de OA particulado. Nos grupos OA/PRP-50, OA/PRP-100 e OA/PRP-150, o defeito foi preenchido com enxerto de OA particulado associado a 50, 100 ou 150 µL de PRP, respectivamente. Os animais foram eutanasiados aos 30 dias pós-operatórios. Imagens radiográficas padronizadas das calvárias foram obtidas com o sistema Digora (Soredex, Finlândia). As imagens foram avaliadas por três examinadores por meio de escores, que indicaram o percentual de radiopacidade dos defeitos. Os escores obtidos foram submetidos ao Teste de Kruskal-Wallis (p < 0,05). Resultado: O Grupo C apresentou radiopacidade significativamente menor que os grupos OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150 (p < 0,05). O Grupo OA/PRP-50 apresentou radiopacidade significativamente maior que os grupos OA/PRP-100 e OA (p < 0,05). Conclusão: Dentro dos limites deste estudo, pode-se concluir que a proporção PRP/enxerto de OA influencia a cicatrização de DTCs criados em calvárias de ratos.

Introduction: It has been suggested that bone grafts combined with platelet rich plasma (PRP) present greater density than bone grafts without PRP after healing process. However, this result may depend on proportion PRP/autogenous bone (AB) graft used. Objective: The purpose of this study was to analyze radiographically the influence of the proportion PRP/particulate autogenous bone (AB) graft on bone healing in surgically created criticalsize defects (CSD) in rat calvaria. Material and method: 50 rats were divided into 5 groups: C, AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C the defect was filled by blood clot only. In Group AB the defect was filled with 0.01 mL of AB graft. In groups AB/ RP-50, AB/PRP-100 and AB/PRP-150 the defects were filled with 0.01 mL of AB graft combined with 50, 100 and 150 µL of PRP, respectively. All animals were euthanized at 30 days post-operative. Standardized radiographic images of the rat calvaria were obtained using Digora System (Soredex, Finland). The images were evaluated by three examiners using scores that indicated the percentage of radiopacity of the defect. The obtained data were subjected to statistical analysis (Kruskal-Wallis test, p <0.05). Result: Group C presented radiopacity significantly lower than groups AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. Group AB/PRP-50 showed radiopacity significantly greater than groups AB/PRP-100 and AB. Conclusion: It can be concluded that the proportion PRP/AB graft influences bone healing in CSD in rat calvaria.