Aumento ósseo vertical com instalação simultânea de implante dentário pela técnica Bone Ring ­ acompanhamento clínico de dois anos / Vertical bone augmentation with simultaneous placement of dental implant using the bone ring technique ­ a 2-year clinical follow-up

Os procedimentos de enxertia óssea para ganho vertical ainda são temerários na Implantodontia. Não há um consenso na literatura sobre as técnicas para aumento em altura da crista óssea alveolar para futura colocação de implantes. Além disso, o tempo de tratamento é demasiadamente prolongado quando são realizadas as técnicas de enxerto ósseo com implantação tardia. Sendo assim, o objetivo deste trabalho foi descrever uma técnica para aumento ósseo vertical simultâneo à instalação de implante denominado bone ring. Paciente apresentando severo defeito ósseo em altura e largura na região do dente 14 foi reabilitada a partir da reconstrução óssea tridimensional com anel ósseo removido da área mentual e implantação imediata à fixação do enxerto. Após seis meses, foram realizados a reabertura e procedimentos protéticos de personalização de perfil de emergência, com posterior instalação de coroa metalocerâmica. Decorridos dois anos de acompanhamento, notou-se estabilidade tecidual peri-implantar sem remodelações severas do tecido ósseo peri-implantar. Pôde-se concluir que a técnica de reconstrução óssea tridimensional simultânea à instalação de implante ­ bone ring ­ é uma alternativa viável, mediante rigoroso planejamento e curva de aprendizado indicada para defeitos ósseos severos.

Bone grafting procedures for vertical bone augmentation are still an issue on implant dentistry. There is no literature consensus regarding techniques for alveolar ridge height increase for further implant placement. Besides, treatment times are extended in case of delayed implant placement. The aim of this paper was to describe a technique for vertical bone augmentation at the same time of implant installation (bone ring). A patient having a several bone defect in height and width at the region of tooth 14 received a 3D reconstruction with a bone ring removed from the chin area. Six months later, implant exposure was performed with procedures for soft tissue conditioning and delivery of a metalloceramic restoration. Tissue stability and no significant bone remodeling were observed after two years. The proposed technique for three-dimensional reconstruction ­ bone ring ­ is a viable alternative provided that judicious treatment planning and considerable learning curve are observed to manage severe bone defects.

Reconstrução de rebordo alveolar com enxerto de tecido conjuntivo subepitelial pediculado para obtenção de um correto perfil de emergência peri-implantar. Acompanhamento de cinco anos / Alveolar ridge augmentation with subepithelial connective tissue graft pedicle to achieve a correct peri-implant emergence profi le. A five year follow-up

As reabilitações assistidas sobre implantes necessitam do planejamento não só da fixação do implante no interior do tecido ósseo, mas também do planejamento da futura margem gengival. Tendo em vista a presença comum de defeitos anatômicos em pacientes edêntulos, este caso clínico teve como objetivo demonstrar a aplicação de uma técnica de correção de deficiências teciduais em zona estética, por meio de enxerto de tecido conjuntivo subeptelial rotacionado do palato. Um paciente de 39 anos de idade, com ausências nas regiões 11 e 21, foi submetido à fixação de dois implantes de hexágono externo pela técnica mediata. Na reabertura, foi planejado o enxerto de tecido conjuntivo pediculado (técnica do rolo modificada) para melhoria do suporte tecidual vestibular e favorecimento do perfil de emergência das coroas protéticas. Após cinco anos de acompanhamento, o enxerto de tecido conjuntivo subepitelial pediculado mostrou boa estabilidade na manutenção da espessura vestibular e margem peri-implantar. Este acompanhamento clínico de cinco anos permitiu concluir que o enxerto de tecido conjuntivo subepitelial pediculado pode promover e manter a melhoria do contorno tecidual em zona peri-implantar a longo prazo.

Implant-assisted oral rehabilitations require not only the planning of implant fixation within the bone tissue as well as planning for future soft tissue margin. Given the common presence of anatomical defects in edentulous patients, this clinical case aimed to demonstrate the application of a technique for correction of tissue defects in the esthetic zone, through the use of a subepithelial connective tissue graft rotated from the palate. A 39 years-old patient presented with partial edentulism at regions 11 and 21 was treated with two external hex dental implants. The second-stage surgery was planned and a pedicle tissue graft (modified roll technique) to improve the buccal tissue support and to enhance the emergence profile of prosthetic crowns was performed. After 5 years of follow-up, the graft still shows good stability maintaining labial thickness and the peri-implant margins. It can be concluded that the subepithelial connective tissue graft can promote and maintain tissue contours at the peri-implant zone over the long-term.

Enceramento diagnóstico e mock-up no planejamento das correções de sorrisos gengivais / Closing diagnosis and planning gummy smile corrections mock up

O sorriso gengival é uma condição que afeta negativamente a estética facial. Depois de avaliar as características do indivíduo e identificar a etilogia, traça-se um planejamento cirúrgico no qual se deve incluir a perspectiva do paciente. Para atender a esta condição, podemos realizar um enceramento diagnóstico e confecção do mock-up, os quais podem fornecer uma previsão bastante aproximada do aspecto final do tratamento estético. Tal planejamento pode contar com a participação do paciente na definição do que se deseja obter. Neste relato de caso, utilizou-se a técnica do enceramento diagnóstico e do mock-up no planejamento cirúrgico de correção do sorriso gengival da paciente, realizada através de gengivoplastia com remoção de tecido ósseo para devolver o espaço biológico. A escolha da técnica está vinculada à causa, que no caso era erupção passiva incompleta. O resultado foi altamente satisfatório, principalmente para a paciente, que participou das decisões estéticas, baseando-se no mock-up. Uma desvantagem desta técnica é que a expectativa dos pacientes fica bastante elevada, porém, a previsibilidade é igualmente aumentada.

Bone healing in critical-size defects treated with either bone graft, membrane, or a combination of both materials: a histological and histometric study in rat tibiae.

OBJECTIVES: The aim of the present investigation was to histologically analyze the effect of using lyophilized bovine bone (GenOx® organic matrix) with (or without) guided tissue regeneration (using a decalcified cortical osseous membrane [GenDerm®]) on bone healing in surgically created critical-size defects created in rat tibia. MATERIAL AND METHODS: Surgical critical-size bone defects were created in 64 animals that were randomly divided into four groups: group I (control); group II (defect filled with GenOx®); group III (defect covered by GenDerm®); group IV (defect filled with GenOx® and covered by GenDerm®). Animals were killed at 30 or 90 days post-surgery. The specimens were embedded in paraffin, serially cut, and stained with hematoxylin and eosin for analysis under light microscopy. The formation of new bone in the cortical area of the defect was histomorphometrically evaluated. RESULTS: All experimental groups demonstrated superior bone healing compared with the control group. However, group IV samples showed evidence of more advanced healing at both 30 and 90 days post-surgery as compared with the other experimental groups. CONCLUSIONS: The bovine organic bone graft GenOx® associated with GenDerm® this produced the best treatment results in the case of critical-size defects in rat tibia.

Influence of microgap location and configuration on radiographic bone loss around submerged implants: an experimental study in dogs.

PURPOSE: The vertical location of the implant-abutment connection influences the subsequent reaction of the peri-implant bone. It is not known, however, whether any additional influence is exerted by different microgap configurations. Therefore, the radiographic bone reactions of two different implant systems were monitored for 6 months. MATERIALS AND METHODS: In eight mongrel dogs, two implants with an internal Morse-taper connection (INT group) were placed on one side of the mandible; the contralateral side received two implants with an external-hex connection (EXT group). On each side, one implant was aligned at the bone level (equicrestal) and the second implant was placed 1.5 mm subcrestal. Healing abutments were placed 3 months after submerged healing, and the implants were maintained for another 3 months without prosthetic loading. At implant placement and after 1, 2, 3, 4, 5, and 6 months, standardized radiographs were obtained, and peri-implant bone levels were measured with regard to microgap location and evaluated statistically. RESULTS: All implants osseointegrated clinically and radiographically. The overall mean bone loss was 0.68 ± 0.59 mm in the equicrestal INT group, 1.32 ± 0.49 mm in the equicrestal EXT group, 0.76 ± 0.49 mm in the subcrestal INT group, and 1.88 ± 0.81 mm in the subcrestal EXT group. The differences between the INT and EXT groups were statistically significant (paired t tests). The first significant differences between the internal and external groups were seen at month 1 in the subcrestal groups and at 3 months in the equicrestal groups. Bone loss was most pronounced in the subcrestal EXT group. CONCLUSIONS: Within the limits of this study, different microgap configurations can cause different amounts of bone loss, even before prosthetic loading. Subcrestal placement of a butt-joint microgap design may lead to more pronounced radiographic bone loss.

Influence of microgap location and configuration on radiographic bone loss in nonsubmerged implants: an experimental study in dogs.

PURPOSE: The implant-abutment connection (microgap) influences the peri-implant bone morphology. However, it is unclear if different microgap configurations additionally modify bone reactions. This preliminary study aimed to radiographically monitor peri-implant bone levels in two different microgap configurations during 3 months of nonsubmerged healing. MATERIALS AND METHODS: Six dogs received two implants with internal Morse taper connection (INT group) on one side of the mandible and two implants with external-hex connection (EXT group) on the other side. One implant on each side was positioned at bone level (equicrestal); the second implant was inserted 1.5 mm below the bone crest (subcrestal). Healing abutments were attached directly after implant insertion, and the implants were maintained for 3 months without prosthetic loading. At implant placement and 1, 2, and 3 months, standardized radiographs were taken to monitor peri-implant bone levels. RESULTS: All implants osseointegrated. A total bone loss of 0.48 ± 0.66 mm was measured in the equicrestal INT group, 0.69 ± 0.43 mm in the equicrestal EXT group, 0.79 ± 0.93 mm in the subcrestal INT group, and 1.56 ± 0.53 mm in the subcrestal EXT group (P > .05, paired t tests). Within the four groups, bone loss over time became significantly greater in the EXT groups than in the INT groups. The greatest bone loss was noted in the subcrestal EXT group. CONCLUSION: Within the limits of this animal study, it seems that even without prosthetic loading, different microgap configurations exhibit different patterns of bone loss during nonsubmerged healing. Subcrestal positioning of an external butt joint microgap may lead to faster radiographic bone loss.

Uso da prototipagem para lateralização do nervo alveolar inferior / Prototyping use for lateralization of the inferior alveolar nerve

A reabilitação bucal com implantes osseointegrados na região posterior de mandíbula, em pacientes com atrofia óssea em altura, torna-se limitada ou dificultada devido à presença do nervo alveolar inferior. Uma das formas de contornar esta limitação é a realização da técnica de lateralização do nervo alveolar inferior previamente à colocação dos implantes. O propósito deste trabalho foi de relatar um caso clínico de lateralização do nervo alveolar inferior para a colocação dos implantes com auxílio do recurso da prototipagem. Conclui-se que a utilização do recurso da prototipagem é um exame auxiliar de importância para diagnóstico, planejamento e execução da técnica de lateralização do NAI para colocação de implante e permite ao operador ter segurança e previsibilidade à intervenção cirúrgica.

Rehabilitation with dental implants at posterior quadrants in patients with bone height atrophy is complicated due to the presence of the inferior alveolar nerve canal. One possible solution is the lateralization of the inferior alveolar nerve (Lian). The aim of this paper was to report a clinical case using prototyping technique. It was concluded that, to perform the Lian technique, the use of tomographic and prototyping techniques are essential for correct diagnosis, planning, and execution. It allows the operator to manage fixtures with safe and predictability on surgical intervention.

Impacto do uso de fita adesiva na qualidade de vida de pacientes institucionalizados e usuários de próteses totais convencionais / Impact of the use of adhesive strip over the quality of life of institutionalized patients and wearers of conventional complete denture

Objetivo: Avaliar o impacto do uso de adesivos em formato de fita na qualidade de vida de pacientes institucionalizados e usuários de prótese total convencional. Material e método: Foram selecionados 29 pacientes portadores de próteses totais convencionais duplas e, após exame clínico, aplicou-se um questionário (adaptado e baseado nos índices "Oral Health Impact Profile" e "Oral Health Related Quality of Life") para avaliar questões epidemiológicas (gênero e idade), qualidade de vida (dor, desconforto, limitação funcional, fonética, social, psicológica e estética), paladar da prótese e anseio por tratamento com implantes. Em seguida, os pacientes receberam orientações para o uso de adesivos (Corega Fita Adesiva, GlaxoSmithKline, Rio de Janeiro, Brasil), sendo três na base protética maxilar e dois na base protética mandibular, durante um período de 30 dias. Decorrido esse período, o questionário foi reaplicado, acrescentando-se questões relativas ao desempenho do adesivo, para comparação antes e após o uso da fita adesiva em termos de percentagem. Resultado: Após o uso da fita, houve melhora dos aspectos de limitação funcional, social e psicológica; no entanto, sem aumento dos percentuais nos aspectos fonéticos e estético. Os dados obtidos mostraram 65,5% das respostas afirmando que a adesividade foi mantida entre 6 e 12 horas, que os adesivos mostraram-se ser de fácil remoção (68,9%), além de não alterarem o paladar (89,6%). Houve diminuição pelo anseio de tratamento com implantes, passando de 75,8 para 37,9%, depois do uso do adesivo. Conclusão: Os resultados evidenciaram um impacto positivo na qualidade de vida dos respondentes após o uso da fita adesiva, evidenciando diminuição de dor e desconforto, principalmente das próteses totais inferiores.

Objective: Evaluate the impact of the use of strip adhesive over the quality of life of institutionalized patients and wearers of complete dentures. Material and method: Twenty-nine institutionalized patients wearers of complete denture were selected to this study and after a clinical exam, a questionnaire (adjusted and based upon the index of Oral Health Impact Profile and Oral Health-Related Quality of Life, OHIP and OHQOL) was applied to evaluate issues related to epidemiological conditions (gender and age), quality of life (pain, discomfort, functional limitations, phonetic, social, psychological and esthetic), taste and notion of implant treatment. Following this part, the patients received instruction to use the strips adhesives (Corega Fita Adesiva, Glaxo-Smith-Kline, Rio de Janeiro, Brazil), considering three in maxillary prosthesis and two in the lower prosthesis during a period of 30 days. After this period, all the patients were recall and the questionnaire was reapplied; add some adhesive performance questions, to compare the results before and after the adhesive use in terms of percentage. Result: After the adhesive strips use there were improvement of the functional, social and physcological limitation aspects, but without percentual increasement of phonetic and esthetics aspects. The results showed 65.5% of the answers stating adhesive maintenance between 6-12 hours, easy removal (68.9%), and without change the taste (89.6%). The notion for implant treatment was decreased changing from 75.8 to 37.9% after the adhesive use. Conclusion: The results enhanced a positive impact over quality of life of the respondents after the strip adhesive use, showing decrease of pain and discomfort, mainly of inferior dental prosthesis.

Influence of microgap location and configuration on peri-implant bone morphology in nonsubmerged implants: an experimental study in dogs.

PURPOSE: It is unknown whether different microgap configurations can cause different peri-implant bone reactions. Therefore, this study sought to compare the peri-implant bone morphologies of two implant systems with different implant-abutment connections. MATERIALS AND METHODS: Three months after mandibular tooth extractions in six mongrel dogs, two oxidized screw implants with an external-hex connection were inserted (hexed group) on one side, whereas on the contralateral side two grit-blasted screw implants with an internal Morse-taper connection (Morse group) were placed. On each side, one implant was inserted level with the bone (equicrestal) and the second implant was inserted 1.5 mm below the bony crest (subcrestal). Healing abutments were inserted immediately after implant placement. Three months later, the peri-implant bone levels, the first bone-to-implant contact points, and the width and steepness of the peri-implant bone defects were evaluated histometrically. RESULTS: All 24 implants osseointegrated clinically and histologically. No statistically significant differences between the hexed group and Morse group were detected for either the vertical position for peri-implant bone levels (Morse equicrestal -0.16 mm, hexed equicrestal -0.22 mm, Morse subcrestal 1.50 mm, hexed subcrestal 0.94 mm) or for the first bone-to-implant contact points (Morse equicrestal -2.08 mm, hexed equicrestal -0.98 mm, Morse subcrestal -1.26 mm, hexed subcrestal -0.76 mm). For the parameters width (Morse equicrestal -0.15 mm, hexed equicrestal -0.59 mm, Morse subcrestal 0.28 mm, hexed subcrestal -0.70 mm) and steepness (Morse equicrestal 25.27 degree, hexed equicrestal 57.21 degree, Morse subcrestal 15.35 degree, hexed subcrestal 37.97 degree) of the peri-implant defect, highly significant differences were noted between the Morse group and the hexed group. CONCLUSION: Within the limits of this experiment, it can be concluded that different microgap configurations influence the size and shape of the peri-implant bone defect in nonsubmerged implants placed both at the crest and subcrestally.

Análise da eficiência do protocolo de dupla centrifugação para o preparo do plasma rico em plaquetas (PRP) - estudo experimental em coelhos / Analysis of efficiency of the double-centrifugation protocol to prepare platelet rich plasma (PRP) - an experimental study in rabbits

Introdução e objetivo: O objetivo deste estudo foi avaliar as concentrações de plaquetas obtidas de plasma rico em plaquetas (PRP) preparado de acordo com um protocolo de dupla centrifugação. Material e métodos: Foram utilizados 8 coelhos (White New Zealand) machos, adultos, com pesos entre 2,8 e 4 kg. Após anestesia geral, realizou-se punção cardíaca, obtendo-se 10 mL de sangue de cada animal. Cada amostra de sangue foi centrifugada de acordo com o protocolo de Sonnleitner et al. (2000). Fez-se, então, a contagem manual de plaquetas do sangue periférico (total) coletado de cada animal e das amostras de PRP. Os dados obtidos foram submetidos a análise estatística. A normalidade dos dados foi comprovada e o teste t de Student foi utilizado (p < 0,05). Resultados: As amostras de PRP apresentaram uma quantidade média de plaquetas significativamente maior que a do sangue periférico. Conclusão: Dentro dos limites deste estudo, concluiu-se que o protocolo de dupla centrifugação foi apropriado para a produção do PRP.

Introduction and objective: The purpose of this study was to evaluate the concentrations of platelets obtained from platelet rich plasma (PRP) prepared according to the double-centrifugation protocol. Material and methods: Eight adult male rabbits (White New Zealand) weighing 2.8 to 4 kg were used. After general anesthesia, 10 ml of blood were drawn from each animal via cardiac puncture. Each blood sample was centrifuged according to the protocol of Sonnleitner et al. (2000). The peripheral blood (total) from each animal and the PRP samples platelets were counted manually. Data were submitted to statistical analysis. The normality of the data was confirmed and the Student?s t test was applied (p < 0.05). Results: PRP samples presented an average platelet count significantly higher than that of peripheral blood. Conclusion: Within the limits of this study, it was concluded that the double-centrifugation protocol was adequate to prepare PRP.

Análise de um protocolo de única centrifugação para o preparo do plasma rico em plaquetas (PRP): estudo em coelhos / Analysis of a single-centrifugation protocol to prepare platelet-rich plasma (PRP): a study in rabbits

Introdução e objetivo: O objetivo deste estudo foi avaliar um protocolo de única centrifugação para o preparo do plasma rico em plaquetas (PRP). Material e métodos: Foram utilizados 10 coelhos (White New Zealand) machos, adultos, com peso entre 2,8 e 4 kg. Após anestesia geral, foi realizada punção cardíaca, obtendo-se 10 mL de sangue de cada animal. Cada amostra de sangue foi centrifugada de acordo com um protocolo de única centrifugação para o preparo do PRP. Foi feita, então, a contagem manual de plaquetas do sangue periférico (total) coletado de cada animal e das amostras de PRP. Os dados obtidos foram submetidos a análise estatística. Resultados: A normalidade dos dados foi comprovada e o teste t de Student foi utilizado (p < 0,05). As amostras de PRP apresentaram uma quantidade média de plaquetas significativamente maior que a do sangue periférico (781875±217693 e 446389±181538, respectivamente). A concentração média de plaquetas das amostras de PRP em relação às amostras de sangue periférico foi de 180,73%±31,01. Conclusão: Dentro dos limites deste estudo, pôde-se concluir que o protocolo de única centrifugação para o preparo do PRP foi capaz de concentrar plaquetas em níveis menores do que o dobro da quantidade presente no sangue periférico. Futuros estudos são necessários para avaliar os reais efeitos biológicos de amostras de PRP preparadas de acordo com esse protocolo.

Introduction and objective: The purpose of this study was to evaluate a single-centrifugation protocol to prepare platelet-rich plasma (PRP). Material and methods: Ten white adult male (New Zealand) rabbits weighing 2.8 to 4 kg were used. After general anesthesia, 10 ml of blood were drawn from each animal via cardiac puncture. Each blood sample was centrifuged according to a single-centrifugation protocol to prepare PRP. The platelets in the whole blood and PRP samples from each animal were counted manually. Data were submitted to statistical analysis. Results: The normality of the data was confirmed and the Student's t test was applied (p < 0.05). PRP samples presented an average platelet count significantly higher than that of whole blood (781.875 ± 217.693 and 446.389 ± 181.538, respectively). The average percentage increase in PRP platelet count in relation to the whole blood was 180.73% ± 31.01. Conclusion: Within the limits of this study, it can be concluded that the single-centrifugation protocol achieved lower platelet concentrations than the double amount of platelets presented in the whole blood. Further studies are required to evaluate the biological effects of PRP samples prepared according to this protocol.

Oclusão e periodontia: uma análise crítica da literatura / Occlusion and periodontics: a critical literature review

Introdução: O trauma oclusal é definido como a injúria que resulta em mudanças teciduais dentro do aparato de inserção dos dentes como resultado de forças oclusais. Desde 1901, quando Karolyi relatou sobre a possível existência de uma ligação entre desarmonias oclusais e alterações periodontais, a literatura científica tem buscado indícios que corroborem ou não esta inter-relação. Objetivo e Revisão de Literatura: Os autores revisam, neste trabalho, os estudos que analisam a oclusão traumática como suposta agravante da doença periodontal, assim como as possíveis vantagens quando da associação da terapia oclusal à periodontal. Embora ainda existam muitas dúvidas a serem esclarecidas para o completo entendimento dos efeitos das forças oclusais sobre o periodonto, uma oclusão funcional é fundamental para o equilíbrio dos diversos componentes do sistema estomatognático, onde as estruturas periodontais estão incluídas. Conclusão: Desta forma, o ajuste oclusal, quando indicado, deve ser realizado como rotina durante o tratamento periodontal. Ainda, é evidente a necessidade de estudos adicionais, com metodologias mais precisas e reproduzíveis, para a elucidação da real interação da oclusão com os tecidos periodontais.

Introduction: Occlusal trauma is defined as a injury resulting in tissues changes within the attachment apparatus as a result of occlusal force(s). Since 1901, when Karolyi reported a possible interaction between occlusal disharmony and periodontal alterations, several studies have tried to find scientific evidence that corroborates this relationship. Objective and Literature Review: In this paper, the authors review the studies that have analyzed traumatic occlusion as a presumed aggravating factor in periodontal disease, as well as those suggesting possible advantages with the concomitant use of occlusal and periodontal therapies. Even though there are still many doubts to be clarified in order to completely understand the effects of occlusal forces on the periodontium, it is well known that a functional occlusion is fundamental for the equilibrium of the diverse components of the stomatognathic system, including the periodontal tissues. Conclusion: Therefore, an occlusal adjustment should be done, whenever it is indicated, as a routine procedure during periodontal treatment. Furthermore, it is evident that additional studies, with more precise and reproducible methodology, are needed in order to clarify the interaction between the occlusion with the periodontal tissues.

Influence of bioactive glass and/or acellular dermal matrix on bone healing of surgically created defects in rat tibiae: a histological and histometric study.

PURPOSE: The purpose of this study was to histologically analyze the influence of bioactive glass and/or acellular dermal matrix on bone healing in surgically created defects in the tibiae of 64 rats (Rattus norvegicus, albinus, Wistar). MATERIALS AND METHODS: A 4-mm x 3-mm unicortical defect was created on the anterolateral surface of the tibia. Animals were divided into 4 groups: C, control; BG, the defect was filled with bioactive glass; ADM, the defect was covered with acellular dermal matrix; and BG/ADM, the defect was filled with bioactive glass and covered with acellular dermal matrix. Animals were sacrificed at 10 or 30 days postoperatively, and the specimens were removed for histologic processing. The formation of new bone in the cortical area of the defect was evaluated histomorphometrically. RESULTS: At 10 and 30 days postoperatively, groups C (39.65% +/- 5.63%/63.34% +/- 5.22%) and ADM (38.12% +/- 5.53/58.96% +/- 7.05%) presented a larger amount of bone formation compared to the other groups (P < .05). In the same periods, groups BG (13.10% +/- 6.29%/29.5% +/- 5.56%) and BG/ADM (20.72% +/- 8.31%/24.19% +/- 6.69%) exhibited statistically similar new bone formation. However, unlike the other groups, group BG/ADM did not present a significant increase in bone formation between the 2 time points. CONCLUSION: Based on these results, it can be concluded that all of the materials used in this study delayed bone healing in non-critical-size defects.

Influence of microgap location and configuration on the periimplant bone morphology in submerged implants. An experimental study in dogs.

OBJECTIVES: The vertical location of the implant-abutment connection influences the periimplant bone morphology. It is unknown, however, whether different microgap configurations cause different bone reactions. Therefore, in this study the bone morphologies of two different implant systems were compared. MATERIAL AND METHODS: Three months after tooth extraction in eight mongrel dogs, two grit-blasted screw implants with internal Morse taper connection (ANK group) were placed on one side whereas the contralateral side received two oxidized screw implants with external hex (TIU group). One implant on each side was placed level with the bone (equicrestal), the second implant was inserted 1.5 mm below bone level (subcrestal). After 3 months the implants were uncovered. Three months after stage two surgery, histometrical evaluations were performed in order to assess the periimplant bone levels (PBL), the first bone-to-implant contact points (BICP), the width (HBD) and the steepness (SLO) of the bone defect. RESULTS: All implants osseointegrated clinically and histologically. Bone overgrowth of the microgap was seen in ANK implants only. No significant differences between ANK and TIU could be detected in neither vertical position for PBL and BICP. However, a tendency in favor of ANK was visible when the implants were placed subcrestally. In the parameters HBD (ANK equicrestal -0.23 mm; TIU equicrestal -0.51 mm; ANK subcrestal +0.19 mm; TIU subcrestal -0.57 mm) and SLO (ANK equicrestal 35.36 degrees; TIU equicrestal 63.22 degrees; ANK subcrestal 20.40 degrees; TIU subcrestal 44.43 degrees) more pronounced and significant differences were noted. CONCLUSIONS: Within the limits of this study, it is concluded that different microgap designs cause different shapes and sizes of the periimplant ('dish-shaped') bone defect in submerged implants both in equicrestal and subcrestal positions.

Particulate inlay nasal graft with immediate dental implant placement in a patient with repaired alveolar cleft: case report.

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Correction of a mucogingival defect using an implant-retained postoperative stent in a severely resorbed mandible: case report.

This case report describes a technique that uses a palatal mucosal graft and an acrylic resin postoperative stent in an attempt to increase the layer of keratinized tissue around osseointegrated implants in an atrophic mandible. During second-stage surgery, a split-thickness labial flap is reflected and apically repositioned by being sutured onto the periosteum and connective tissue. A palatal mucosal graft is then sutured onto the recipient site. The stent is worn for at least 4 weeks following surgery. This procedure helps to eliminate mobility of the mucosa in the area, deepen the vestibule, and prevent muscle reinsertion.

Influência da associação do plasma rico em plaquetas ao enxerto de osso autógeno no reparo ósseo de defeitos de tamanho crítico em calvárias de coelhos: estudo histológico e histométrico / Effect of platelet-rich plasma on bone healing in autogenous bone graft in critical-size defects: a histologic and histometric study in rabbit calvaria

O objetivo do presente trabalho foi avaliar, histologicamente, a influência da associação do plasma rico em plaquetas (PRP) ao enxerto de osso autógeno (OA) no reparo ósseo de defeitos de tamanho crítico (DTC) em calvárias de coelhos. Sessenta coelhos foram divididos em 3 grupos: C (controle), OA (osso autógeno) e OA/PRP (osso autógeno associado ao plasma rico em plaquetas). Um defeito de tamanho crítico, com 15 mm de diâmetro, foi criado na calvária de cada animal. No Grupo C, o defeito foi preenchido somente com coágulo sanguíneo. No Grupo OA, o defeito foi preenchido com osso autógeno particulado. No Grupo OA/PRP, o defeito foi preenchido com osso autógeno particulado associado ao PRP. Todos os grupos foram divididos em subgrupos (n = 10) para eutanásia aos 30 ou 90 dias pós-operatórios. Foram realizadas análises histológica e histométrica. A quantidade de osso neoformado foi calculada como uma porcentagem da área total do defeito original. Os dados em porcentagem foram transformados em raiz quadrada para análise estatística (ANOVA, teste t, p<0,05). Aos 30 dias pós-operatórios, o Grupo OA/PRP apresentou uma quantidade significativamente maior de osso neoformado que o Grupo OA (64,44% e 46,88%, respectivamente). Aos 90 dias, todos os espécimes dos Grupos OA/PRP e OA mostraram fechamento ósseo completo do defeito, com quantidades similares de osso neoformado (77,9% e 75%, respectivamente). Dentro dos limites deste trabalho, pode-se concluir que o PRP acelerou o processo de reparo do enxerto de osso autógeno em defeitos de tamanho crítico em calvária de coelhos.

Métodos para localização de agulhas quebradas durante anestesia intra-bucal: ênfase para o emprego do radioscópio / Methods for needle broken localization during intra oral anesthesia: emphasis about utilization of radioscophic

A quebra de agulhas durante anestesias intra-bucais em odontologia é um acidente raro, mas não impossíve;/Quando acontece é uma experiência desagradável para o profissional e o paciente. Ela pode resultar de defeitos estruturais do metal, movimentos bruscos do paciente e quando da realização de técnicas anestésicas incorretas. Por isso, as agulhas para anestesia devem ser inspecionadas antes de serem usadas ou quando se complementa a técnica anestésica. Os autores comentam os vários recursos empregados para localizar fragmentos de agulhas, dando ênfase ao emprego do radioscópio. Este último recurso permite visão em três dimensões, facilitando a localização de fragmentos pequenos e/ou localizados profundamente, no interior de músculos e em crianças