Noncarious cervical lesions: Response from a 25-year clinical follow-up study.

STATEMENT OF PROBLEM: The etiology and diagnosis of noncarious cervical lesions (NCCLs) remain poorly understood. PURPOSE: The purpose of this clinical study was to examine NCCL progression in an existing group of participants, establish the incidence of new NCCLs in a 25-year follow-up study, and relate them to possible risk factors, including occlusal factors. MATERIAL AND METHODS: Thirty-three participants who had completed a questionnaire about their habits, diet, and personal information were evaluated in this observational retrospective study. Impressions were made, and casts from 3 time periods (Phase I in 1996, Phase II in 1999, and Phase III in 2021) were scanned to obtain digital casts. The casts were then evaluated in a 3-dimensional analysis software program (Geomagic Control; 3D Systems) to establish digital comparisons between NCCLs and occlusal wear. Furthermore, data from an occlusal analysis device (T-Scan; Tekscan) collected in Phase I was used to analyze occlusal interferences relating to the progression of NCCLs. The statistical analysis applied nonparametric tests, followed by the assessment of the association between NCCLs and risk factors, including occlusal wear, through binary logistic regression (α=.05). RESULTS: At the end of Phase III, 7 new individuals with NCCLs were detected compared with Phase II. The median percentage progression of NCCLs per participant was 0.0% in Phase I, 7.1% in Phase II, and 35.7% in Phase III (P<.005). Occlusal wear in Phase I was associated with 5.02 times the occurrence of NCCLs in Phase III; occlusal wear in Phase II was associated with 4.73 times the occurrence of NCCLs in Phase III; and occlusal wear in Phase III was associated with 1.94 times the occurrence of NCCLs in Phase III (P<.001). Occlusal interference in border movements of the mandible was associated with a 3.55 times greater chance of presenting NCCLs in Phase III (P<.001). Additionally, statistically significant risk factors for the presence of NCCLs in Phase III were an acidic diet (P=.043) and alcohol consumption (P=.021). CONCLUSIONS: The 25-year data showed an association between NCCLs and specific risk factors, including occlusal wear and occlusal interferences.

Development of clinical criteria for the evaluation of indirect restorations.

OBJECTIVE: To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient. MATERIALS AND METHODS: The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria. RESULTS: Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%. CONCLUSION: The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations. CLINICAL SIGNIFICANCE: The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.

Effectiveness of Supportive Care in the Prevention of Peri-implant Diseases in Brånemark Protocol Rehabilitations: A Retrospective Cohort Study.

This retrospective cohort study aimed to evaluate the efficiency of supportive periodontal treatment (SPT) on peri-implant disease prevention. A total of 63 rehabilitated patients with 504 implants were selected with both maxillary and mandibular Brånemark-type protocols (all-on-four system) placed between 2004 and 2014 in a private practice with 5 to 15 years of follow-up. Study participants were divided into those who adhered to SPT with regular intervals of two or more times a year (Group 1) and those with irregular intervals with more than 1 year without attending SPT (Group 2). The implants placed were evaluated clinically and radiographically to assess peri-implant diseases. The prevalence of mucositis and peri-implantitis in the total population was 64.7% (326 implants) and 3.7% (19 implants), respectively. Group 2 had higher rates of mucositis (181 implants) and peri-implantitis (16 implants) than Group 1 (145 and 3 implants, respectively) (P < .05). The odds ratio for peri-implantitis in Group 2 was 7.1. The results suggest that patients who regularly received SPT had lower chances of developing peri-implant diseases.

Filling Materials Efficacy on Preventing Biofilm Formation Inside Screw Access Channels of Implant Abutments.

The choice of the material used to fill screw access channels in implant-supported prostheses depends, in most cases, on operator's preference, without considering the susceptibility of biofilm colonization. Therefore, the aim of this study was to determine and compare the total amount of biofilm formed on different materials used to fill screw access channels in implant abutments. For this propose, titanium implant analogs were attached on abutments and divided into 5 groups: positive control (no filling material); negative control (closed with resin); and filled with cotton, gutta-percha, or polytetrafluoroethylene (PTFE). The analogs with attached abutments were then immersed in a brain heart infusion medium containing Candida albicans (strain 10231 from American Type Culture Collection [ATCC]) and incubated aerobically at 37°C with gentle agitation. After 15 days, materials were removed, and total viable biofilm on each material was quantified by methyl tetrazolium reduction assay at 490 nm. All experiments were performed in triplicate. Data were processed by IBM SPSS Statistic software using 1-way analysis of variance and Bonferroni post hoc tests to analyze differences between groups, with an overall significance level of P < .001. A significant difference was observed between cotton and gutta-percha (P < .017) and between cotton and PTFE (P < .025). However, there was no statistical difference between gutta-percha and PTFE (P > .050). Thus, this in vitro experiment showed that gutta-percha and PTFE presented lower biofilm formation compared with cotton when used to fill screw access channels. These results can provide a basis for future clinical studies that can be a guide to decreasing the occurrence of gaps and bacterial growth inside the implant/abutment attachment site. In addition, controlled in vivo studies are necessary to confirm the clinical viability of findings of this study.

Peri-Implant Surgical Treatment Downregulates the Expression of sTREM-1 and MMP-8 in Patients with Peri-Implantitis: A Prospective Study.

sTREM-1 and its ligand PGLYRP1 play an essential role in the inflammatory process around teeth and implants. In this study, we aimed to evaluate the impact of peri-implant treatment on the salivary levels of the sTREM-1/PGLYRP-1/MMP-8 axis after 3 months. A total of 42 participants (with a mean age of 61 years old ± 7.3) were enrolled in this longitudinal study, 24 having peri-implant mucositis (MU) and 18 having peri-implantitis (PI). Clinical peri-implant parameters, such as probing pocket depth (PPD), % of plaque, and bleeding on probing (BOP), and the whole unstimulated saliva samples were evaluated at baseline and 3 months after treatment. The MU group received nonsurgical peri-implant treatment, while the PI group received open-flap procedures. The levels of sTREM-1, PGLYRP-1, MMP-8, and TIMP-1 were analyzed using enzyme-linked immunosorbent assays. BOP, plaque levels, and PPD significantly reduced after treatment in both groups. A significant decrease in the salivary levels of sTREM-1, MMP-8, and TIMP-1 in the PI group and PGLYRP1 and TIMP-1 in the MU group were observed. Salivary levels of sTREM-1 were significantly reduced in patients with PI but not with MU. Additionally, peri-implant treatment had a significantly higher impact on MMP-8 reduction in patients with PI than in those with MU.

Color change, tooth sensitivity, aesthetic self-perceptions and quality of life after at-home dental bleaching / Mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro

Objective: The aim of this study was to determine the color change, tooth sensitivity, aesthetic self-perception and quality of life after at-home dental bleaching. Material and Methods: Dental examination was performed and the initial color of the upper right incisor was recorded using a spectrophotometer (Easyshade Compact, Vita Zahnfabrik) and CIELab parameters. Individual vinyl trays were delivered to the patients (n=37) who were instructed to use the carbamide peroxide 16% (Total Blanc Home C16%, DFL) for 2 hours daily for 2 weeks. One-week after the end of treatment, measurements were repeated to calculate color (ΔEab,ΔE00) and whiteness index (ΔWID) variations. Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires were applied before and 30 days after treatment. Tooth sensitivity was by checked by visual analogue scale (VAS). Spearnan's correlation tests were used to verify the possible relation between color change parameters and sensitivity. The Wilcoxon test was applied for results obtained by OHIP and PIDAQ questionnaires. Results: Significant color change was observed after 14 days, regardless of the considered parameter. There was no significant correlation between sensitivity and color change. The dental self-confidence domain increased after bleaching (p = 0.029) and the psychological impact decreased (p = 0.001). Conclusion:At-home dental bleaching was effective on the overall whitening and the color change was not related to tooth sensitivity. The bleaching treatment had a positive impact on the quality of life, reducing psychological discomfort and improving dental self-confidence and aesthetic self-perception. (AU)

Objetivo: O objetivo deste estudo foi determinar a mudança de cor, sensibilidade dental, autopercepção estética e qualidade de vida após clareamento dental caseiro. Material e Métodos: Uma consulta inicial foi realizada e a cor inicial do incisivo superior direito foi registrada usando um espectrofotômetro (Easyshade Compact, Vita Zahnfabrik) e parâmetros CIELab. Moldeiras individuais confeccionadas em vinil foram entregues aos pacientes participantes (n = 37), que foram instruídos a usar o gel à base de peróxido de carbamida 16% (Total Blanc Home C16%, DFL) durante 2 horas diárias durante 2 semanas. Uma semana após o término do tratamento, as medidas foram repetidas para calcular a variação de cor (ΔEab, ΔE00) e o índice de brancura (ΔWID). Os questionários OHIP (Oral Health Impact Profile) e PIDAQ (Psychosocial Impact of Dental Aesthetics Questionnaire) foram aplicados antes e 30 dias após o tratamento. A sensibilidade dental foi verificada por meio da escala visual análoga (VAS). Os testes de correlação de Spearnan foram utilizados para verificar a possível relação entre os parâmetros de mudança de cor e sensibilidade. O teste Wilcoxon foi aplicado para os resultados obtidos pelos questionários OHIP e PIDAQ. Resultados: Mudança de cor significativa foi observada após 14 dias, independentemente do parâmetro considerado. Não houve correlação significativa entre a sensibilidade e a mudança de cor. O domínio da autoconfiança dental aumentou após o branqueamento (p = 0,029) e o impacto psicológico diminuiu (p = 0,001). Conclusão: O clareamento dental caseiro foi eficaz no branqueamento geral e a mudança de cor não estava relacionada à sensibilidade dental. O tratamento clareador teve um impacto positivo na qualidade de vida, reduzindo o desconforto psicológico e melhorando a autoconfiança dental e a autopercepção estética.(AU)

Peri-implant treatment reduces the salivary levels of Colony stimulator factor-1 and S100A8/A9.

This study evaluated the impact of peri-implant treatment in the salivary levels of Colony stimulator factor -1 (CSF-1), S100A8/A9 and S100A12 in patients having mucositis or peri-implantitis. As a secondary aim, we analysed the correlation between the salivary and peri-implant crevicular fluid (PICF) levels. Forty-seven patient, 27 having mucositis (mean age 63.11 ± 7.78) and 20 having peri-implantitis (61.25 ± 7.01) participated in the study. Clinical parameters, probing pocket depth, clinical attachment level, % of plaque and bleeding on probing were evaluated. Unstimulated whole saliva was collected from all patients, while PICF was collected only from a patient's subgroup (n = 20). Samples were collected before and 3 months after peri-implant treatment. Enzyme-linked immunosorbent assays determined levels of CSF-1, S100A8/A9 and S100A12. Clinical parameters improved and salivary levels of CSF-1 and S100A8/A9, but not S100A12, reduced significantly after treatment in both groups. No significant correlation was found in the salivary and PICF levels of the same molecule. In conclusion, the treatment of peri-implant disease significantly improved the clinical parameters and reduced the salivary levels of CSF-1 and S100A8/A9. The salivary expressions of CSF-1, S100A8/A9 and S100A12 did not correlate with their own expression in PICF.

In vitro evaluation of physicochemical properties of soft lining resins after incorporation of chlorhexidine.

STATEMENT OF PROBLEM: Incorporating chlorhexidine into soft lining materials has been suggested to reduce biofilm development on the material surface and treat denture stomatitis. However, evaluation of the physicochemical properties of this material is necessary. PURPOSE: The purpose of this in vitro study was to evaluate the physicochemical properties of resin-based denture soft lining materials modified with chlorhexidine diacetate (CDA). MATERIAL AND METHODS: Two soft lining resins were tested, one based on polymethyl methacrylate (PMMA) and the other on polyethyl methacrylate (PEMA), into which 0.5%, 1.0%, or 2.0% of CDA was incorporated; the control group had no CDA. The specimens were stored for 2 hours, 48 hours, 7, 14, 21, and 28 days and then analyzed for polymer crystallinity, Shore A hardness, degree of monomer conversion, residual monomer leaching, and CDA release. Data were analyzed by using a 3-way ANOVA and the Tukey HSD test (α=.05). RESULTS: The polymer crystallinity of PEMA and PMMA did not change after CDA incorporation. Shore A hardness increased over time, but not for any CDA concentrations tested after 28 days (P>.05). Considering the degree of conversion, PMMA-based resin showed no statistically significant difference (P>.05). However, PEMA-based resin showed a significant decrease (P<.05), which was reflected in a significant increase in residual monomer leaching from PEMA-based resin with the incorporation of 0.5% and 1.0% CDA (P<.05), mainly in the first 48 hours. PMMA-based resin showed no change in monomer leaching (P>.05). For both resins, the CDA release kinetics were related to monomer leaching; for PEMA-based resin, the values were significantly higher in the first 48 hours (P<.05), and for PMMA-based resin, the values were more sustained up to the last day of analysis. CONCLUSIONS: The incorporation of CDA did not affect the physicochemical properties of soft resins. The properties of PMMA were better than those of PEMA.

Evaluation of the physical and antifungal effects of chlorhexidine diacetate incorporated into polymethyl methacrylate.

OBJECTIVE: This study aimed to evaluate the physical properties and antifungal activities of polymethyl methacrylate (PMMA) acrylic resins after the incorporation of chlorhexidine diacetate salt (CDA). METHODOLOGY: First, acrylic resin specimens were fabricated with Vipi Cor® and DuraLay® resins with and without the incorporation of 0.5%, 1.0% or 2.0% CDA. The residual monomer and CDA release were measured at intervals ranging from 2 hours to 28 days using ultraviolet spectrometry combined with high-performance liquid chromatography. The antifungal activity against C. albicans was evaluated with the agar diffusion method. Fourier transform infrared spectroscopy was used to analyze the degree of resin conversion. Finally, the water sorption values of the resins were also measured. RESULTS: The incorporated CDA concentration significantly changed the rate of CDA release (p<0.0001); however, the brand of the material appeared to have no significant influence on drug release. Subsequently, the inhibition zones were compared between the tested groups and within the same brand, and only the comparisons between the CDA 2% and CDA 1% groups and between the CDA 1% and CDA 0.5% groups failed to yield significant differences. Regarding the degrees of conversion, the differences were not significant and were lower only in the CDA 2% groups. Water sorption was significantly increased at the 1.0% and 2.0% concentrations. CONCLUSIONS: We concluded that the incorporation of CDA into PMMA-based resins enabled the inhibition of C. albicans growth rate, did not alter the degrees of conversion of the tested resins and did not change the release of residual monomers.

CSF-1 and IL-34 levels in peri-implant crevicular fluid and saliva from patients having peri-implant diseases.

OBJECTIVE: Colony-stimulating factor (CSF)-1 and interleukin (IL)-34 are growth factors that regulate myeloid cell functions and support osteoclastogenesis. CSF-1 and IL-34 levels in peri-implant diseases are yet unknown. This study evaluated CSF-1, IL-34, and IL-1ß levels in saliva and peri-implant crevicular fluid (PICF) from patients having mucositis or peri-implantitis, as well as their correlation to clinical parameters of disease. MATERIAL AND METHODS: Forty-three patients were included (mean age 61.1 ± 8.4; 62.8% female), 20 having mucositis and 23 having peri-implantitis. Patients were clinically examined and unstimulated whole saliva and PICF were collected. Levels of CSF-1, IL-34, and IL-1ß were determined by enzyme-linked immunosorbent assays. RESULTS: CSF-1 levels were higher in PICF from peri-implantitis compared with mucositis patients (p = 0.028), whereas IL-34 levels showed no significant difference between the groups (p = 0.060). No significant difference was found in PICF IL-1ß levels between the groups. Salivary levels of CSF-1 and IL-34 did not differ significantly between mucositis and peri-implantitis. No significant difference was observed in the salivary levels of IL-1ß between groups (p = 0.061). CSF-1 and IL-1ß correlated significantly in both saliva and PICF. CSF-1 levels in saliva correlated with its levels in PICF. PICF CSF-1 levels showed potential to discriminate between peri-implantitis and mucositis (AUC = 0.695, 95% CI 0.53-0.85; p = 0.029). CONCLUSION: Increased levels of CSF-1 in peri-implant crevicular fluid, but not in saliva, were found in peri-implantitis patients, which might aid to discriminate the early and late stages of peri-implant diseases. CLINICAL RELEVANCE: This result suggests an increased osteoclastogenic potential in peri-implantitis patients.

The modulation of the TREM-1/PGLYRP1/MMP-8 axis in peri-implant diseases.

OBJECTIVES: The aim of this study is to investigate the expression of sTREM-1 and its ligand PGLYRP1, as well as the expression of MMP-8 and its inhibitor TIMP-1, in peri-implant diseases. As a secondary aim, we analyzed the influence of the concomitant existence of periodontitis in the expression of these biomarkers. MATERIALS AND METHODS: This study included 77 patients (29 males and 48 females; mean age 55.0 ± 11.5), 18 having gingivitis, 16 having periodontitis, 20 having mucositis, and 23 having peri-implantitis. Patients were clinically examined, and unstimulated whole saliva was collected. sTREM-1, PGLYRP1, MMP-8, TIMP-1, and MMP-8/TIMP1 ratio were determined by ELISA. RESULTS: The periodontitis group presented higher probing depth (PD) mean, and higher clinical attachment loss, compared with the other groups. The peri-implantitis group presented higher PD mean in implants compared to the mucositis group. Patients with PD ≥ 6 mm showed significantly higher levels of PGLYRP1, MMP-8, and MMP-8/TIMP-1 ratio than patients with PD < 6 mm. When all four markers were assessed, there were no significant differences between mucositis and peri-implantitis groups. Concomitant periodontitis resulted in higher significant levels of MMP-8 in patients with peri-implant disease. CONCLUSION: We did not observe significant differences in the levels of the sTREM-1/PGLYRP1/MMP-8 axis between patients with periodontal and peri-implant diseases, suggesting that these markers are also involved in the inflammatory process around implants. Besides, the presence of periodontitis may affect the levels of MMP-8 in patients with peri-implant disease. CLINICAL RELEVANCE: The sTREM-1/PGLYRP1/MMP-8 axis could be useful as potent markers in periodontal and peri-implant diseases.

Self-cured resin modified by quaternary ammonium methacrylates and chlorhexidine: Cytotoxicity, antimicrobial, physical, and mechanical properties.

OBJECTIVE: To evaluate the addition of dimethylaminohexadecyl methacrylate (DMAHDM) and chlorhexidine diacetate on cytotoxicity, antimicrobial activity, physical, and mechanical properties of a self-cured resin. METHODS: 132 disk-shaped and 48 rectangular specimens were divided into four experimental groups as described: Control Group (CG - no addition), dCHX (1%), DMAHDM (5%), and DMAHDM+dCHX (5%+1%). The biofilm viability, flexural strength (FS - ISO 20795-1:2013), surface roughness (SR), and color stability (ΔE) were analyzed after being stored for 4 weeks in distilled water and immersed for 72h in coffee. Cytotoxicity was measured after 24h, 3, and 7 days of elution using an MTT test on L929 cells (ISO 10993-5:2009). SR and ΔE were measured by a contact profilometer and a spectrophotometer using the CIELab parameter. Data were submitted to ANOVA and Bonferroni's/Tukey's tests (p≤0.05). RESULTS: Significant antimicrobial activity against Streptococcus mutans and Candida albicans was detected in all groups when compared to the CG (p<0.05). Only the dCHX group, in 24h of elution, demonstrated no cytotoxicity effects. There was a statistical difference for FS on the tested groups (p<0.05). No differences were detected in the initial roughness' measurements among the groups (p>0.05). However, after storage and immersion in coffee, the groups containing DMAHDM presented with rougher surfaces and significantly lower color stability compared to the control (p<0.05). SIGNIFICANCE: The addition of dCHX and DMAHDM in self-cured resin presented antimicrobial properties; however, cytotoxicity, physical, and mechanical properties were compromised.

Evaluation of the physical and antifungal effects of chlorhexidine diacetate incorporated into polymethyl methacrylate

Abstract This study aimed to evaluate the physical properties and antifungal activities of polymethyl methacrylate (PMMA) acrylic resins after the incorporation of chlorhexidine diacetate salt (CDA). Methodology: First, acrylic resin specimens were fabricated with Vipi Cor® and DuraLay® resins with and without the incorporation of 0.5%, 1.0% or 2.0% CDA. The residual monomer and CDA release were measured at intervals ranging from 2 hours to 28 days using ultraviolet spectrometry combined with high-performance liquid chromatography. The antifungal activity against C. albicans was evaluated with the agar diffusion method. Fourier transform infrared spectroscopy was used to analyze the degree of resin conversion. Finally, the water sorption values of the resins were also measured. Results: The incorporated CDA concentration significantly changed the rate of CDA release (p<0.0001); however, the brand of the material appeared to have no significant influence on drug release. Subsequently, the inhibition zones were compared between the tested groups and within the same brand, and only the comparisons between the CDA 2% and CDA 1% groups and between the CDA 1% and CDA 0.5% groups failed to yield significant differences. Regarding the degrees of conversion, the differences were not significant and were lower only in the CDA 2% groups. Water sorption was significantly increased at the 1.0% and 2.0% concentrations. Conclusions: We concluded that the incorporation of CDA into PMMA-based resins enabled the inhibition of C. albicans growth rate, did not alter the degrees of conversion of the tested resins and did not change the release of residual monomers.

Do Oblique Cyclic Loads Influence the Tensile Strength of Different Morse Taper Connection Abutments?

PURPOSE: The purpose of this in vitro study was to evaluate the behavior of abutments attached to Morse taper connection implants, with and without internal index, against oblique cyclic loads. MATERIALS AND METHODS: Twenty test pieces composed of abutments connected to Morse taper implants solely by friction action were subdivided into two groups (n = 10): group NI (no index) and group I (index). The test units were submitted to tensile tests, before and after cycling loads. Paired t tests were used for intragroup data at different times, and independent t tests were used for the comparisons between the groups. RESULTS: There was a statistically significant difference in both the groups when the precycling and postcycling tensile values were compared. In the comparison between the no index and index groups, there was no statistically significant difference in precycling and postcycling tests. CONCLUSION: Within the limitations of this in vitro study, it can be concluded that the cyclic loads increased the tensile strength of abutments on Morse taper implants regardless of the index presence. On the other hand, the presence of an index did not significantly alter the values of tensile tests, before and after cyclic loads.

Bacterial Profile and Radiographic Analysis Around Osseointegrated Implants With Morse Taper and External Hexagon Connections: Split-Mouth Model.

The aim of this clinical study was to evaluate bacterial colonization, marginal bone loss, and optical alveolar density in implants with Morse taper (MT) and external hexagon (EH) connections. Thirty-five implants were installed in 7 patients (mean age: 65.8 ± 6.7 years). Implants were divided into 2 groups, according to platform design: G1 - MT, installed 2mm infra-osseous and G2 - EH, positioned according to Branemark protocol. Patients were evaluated at baseline (T0), 21 days (T1), 3 months (T2), 6 months (T3), and 12 months (T4) after installations. Bone loss and alveolar density were evaluated by standardized periapical radiographs and bacterial profile with checkerboard DNA-DNA hybridization. Statistical analyses were performed using SPSS 23.0. To present the results, boxplots and a line graph of mean were used. P-values ≤ .05 were statistically significant. After 3 months, alveolar bone loss was significantly higher in the G2 (T2-T0: P = .006; T3-T0: P = .003; and T4-T0: P = .005). No significant differences between G1 and G2 groups were observed for optical alveolar density. Microbiological analysis showed similar profiles between studied groups; however, there were significantly higher counts of Tannerella forsythia (P = .048), Campylobacter showae (P = .038), and Actinomyces naeslundii (P = .027) in G1 after 12 months. Based on the results of this study, it can be concluded that there was less peri-implant bone loss in MT compared to EH connections, but microbiological profile did not seem to influence bone changes.

Factors associated with dental fractures in Brazilian individuals.

AIM: The aim of the present study was to assess the association of sex, age, group of teeth, and type of accident (exposure) with dental fractures (outcome: enamel-dentine fracture without [EDF] or with pulp exposure [EDPF] and root fracture RF]). METHODS: In total, 1046 patients were selected. Logistic binary regression was used. RESULTS: The findings showed that EDF has less change of affecting individuals ≤9 years of age than ≥40 years of age (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.35-0.95). Violence (OR: 3.07, 95% CI: 1.77-5.31), traffic accidents (OR: 1.50, 95% CI: 1.05-2.13), and sporting accidents (OR: 1.70, 95% CI: 1.19-2.44)] were associated with EDF. Regarding EDPF, the mandibular lateral incisors had a 10 times higher chance of being injured than canines and posterior teeth (OR: 10.43, 95% CI: 1.74-62.4). Those aged ≤9 years (OR: 0.21, 95% CI: 0.07-0.58) and 10-19 years (OR: 0.38, 95% CI: 0.17-0.88) had a significantly lower chance of being affected by RF. CONCLUSION: EDF and RF are associated with individuals ≥40 years of age; violence and traffic and sporting accidents are also associated with EDF, and mandibular incisors have a greater chance of being affected by EDPF.

Hipotermia neuroprotetora tardia / Late hypothermic neuroprotection

A parada cardiorrespiratória é um evento de alta mortalidade. A isquemia cerebral difusa relacionada ao hipofluxo cerebral frequentemente leva à injúria neurológica grave e ao desenvolvimento de estado vegetativo persistente. A hipotermia terapêutica representa um importante avanço no tratamento da encefalopatia anóxica pós-parada cardíaca. Seus efeitos neuroprotetores têm sido amplamente demonstrados em várias situações de isquemia neuronal. Apesar de ser um procedimento associado com redução de mortalidade nestes pacientes, a hipotermia ainda é um tratamento subutilizado no manejo da síndrome pós-ressuscitação. Nosso objetivo foi demonstrar que a hipotermia neuroprotetora tem efeito benéfico mesmo realizada tardiamente naqueles pacientes comprovadamente encefalopatas como consequência de baixo fluxo cerebral devido à parada cardiorrespiratória que mantém um nível neurológico baixo (Glasgow abaixo de 8). Este fato é demonstrado pelo não uso de substâncias neurodepressoras nas últimas 48 horas, e o ganho para o paciente seria maior que os prováveis riscos que a hipotermia pode ocasionar. Este relato mostra os efeitos benéficos no paciente submetido ao tratamento da hipotermia neuroprotetora tardiamente, evoluindo satisfatoriamente, visto que foi devolvido à sociedade em Glasgow 14 e com independência suficiente para atender suas necessidades humanas básicas. Era um paciente do sexo masculino, 25 anos, pardo, solteiro, imigrante ilegal oriundo da Bolívia, auxiliar de costura, com história de mal súbito enquanto praticava futebol com amigos em quadra ao ar livre. Deu entrada no pronto-socorro em parada cardiorrespiratória por taquicardia ventricular. Foram realizadas manobras de reanimação com cardioversão elétrica e massagem cardíaca e não houve relato do tempo de parada cardíaca. Foi transferido para a unidade de terapia intensiva adulto com hipótese diagnóstica de encefalopatia anóxica pós-parada cardiorrespiratória sem uso de drogas vasoativas em Glasgow 6.(AU)

Cardiac arrest is a high-mortality event. Brain hypoflow-related diffuse cerebral ischemia often leads to severe neurological injury, and to the development of a persistent vegetative state. Therapeutic hypothermia is an important advance in the treatment of anoxic encephalopathy after cardiac arrest. Its neuroprotective effects have been widely demonstrated in several situations of neuronal ischemia. Although the procedure is associated with reduced mortality, hypothermia is still an underused treatment in the management of post-resuscitation syndrome. Our goal was to demonstrate that neuroprotective hypothermia is effective even when performed late in patients with encephalopathies from brain hypoflow due to cardiac arrest with a low neurological level (Glasgow below 8). This is demonstrated by the lack of neurodepressant substances in the previous 48 hours, and patient benefit would be higher than the probable risks that hypothermia could cause. This report shows the beneficial effects in the patient undergoing delayed neuroprotective hypothermia, who progressed satisfactorily, since taken back to Glasgow 13 with sufficient independence to meet basic human needs. The patient was a male of 25 years old, dark-skinned, single, an illegal immigrant from Bolivia, sewing assistant, with a history of sudden cardiac arrest, which occured while playing soccer outdoors. He was admitted to the emergency room in cardiopulmonary arrest (CPA) due to ventricular tachycardia. Resuscitation maneuvers with electrical cardioversion and cardiac massage were performed, and there is no reported time of cardiac arrest. He was transferred to the Adult Intensive Care Unit with a diagnosis hypothesis of anoxic encephalopathy after cardiac arrest, with no use of vasoactive drugs in Glasgow 6.(AU)

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses.

This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

Th17-related cytokines in mucositis: is there any difference between peri-implantitis and periodontitis patients?

OBJECTIVE: This study aimed to compare Th17-related cytokines named IL-1ß, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L and TNF-α in peri-implant fluid (PIF) from mucositis sites in patients having either peri-implantitis, periodontitis or without interproximal alveolar bone loss. MATERIAL AND METHODS: Thirty-three patients diagnosed with peri-implant mucositis were divided into three groups: individuals with peri-implant mucositis but without any signs of interproximal alveolar bone loss (group 1, n = 10), individuals with peri-implantitis (group 2, n = 14) and individuals with periodontitis (group 3, n = 9). Probing depth (PD), clinical attachment level (CAL), visible plaque index and bleeding on probing were measured. PIF was collected from mucositis sites in patients from the three groups and from peri-implantitis (group 2) and periodontitis sites (group 3). Cytokines were measured by a bead-based multiplex assay. RESULTS: Probing depth was significantly lower in group 1 when compared to both groups 2 and 3 (P < 0.001 and P = 0.01, respectively). There was no significant difference in cytokine levels in mucositis sites among the three groups. In group 2, IL-21 level was significantly higher in mucositis compared to peri-implantitis sites (P = 0.04). CONCLUSION: The expression of Th17-related cytokines in PIF from mucositis sites seems to be similar regardless the presence or not of alveolar bone loss around implants or teeth.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses

Abstract This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.