Influência de laminados cerâmicos cimentados sobre dentes naturais sem término cervical na microbiota do fluido gengival crevicular: estudo clínico, prospectivo e longitudinal usando PCR em tempo real / Influence of laminate veneers cemented over natural teeth without finish line on the microbiota of gingival crevicular fluid: clinical, prospective and longitudinal study using real-time PCR

Objetivo: quantificar bactérias colonizadoras do sulco gengival em paralelo à verificação do comportamento clínico periodontal e da adaptação marginal de laminados cerâmicos cimentados sobre dentes sem término cervical. Métodos: 73 laminados cerâmicos em dissilicato de lítio monolítico foram cimentados sobre dentes naturais sem término cervical e com a margem cervical posicionada cerca de 0,5mm no interior do sulco gengival. Para todos os dentes foi feita a coleta do fluido gengival crevicular (FGC) previamente à cimentação da restauração (baseline) e em 7, 180 e 365 dias após a cimentação para quantificação das bactérias S. mitis, P. intermedia e P. gingivalis através de PCR em tempo real. Clinicamente foram avaliados os parâmetros índice de placa visível (IPV), sangramento à sondagem (SS), profundidade de sondagem (PS), perda de inserção clínica (PIC), recessão gengival (RG) e a adaptação marginal da restauração em baseline, 7, 15, 30, 60, 180 e 365 dias. Foram obtidas réplicas da região cervical para análise da adaptação marginal por microscopia eletrônica de varredura (MEV). Resultados: Não houve diferença estatisticamente significante para o IPV, PS, SS em todos os períodos analisados (Anova, p>0,05). Não houve registro de PIC e RG. Houve diferença estatisticamente significante para S. mitis na comparação entre 180 e 365 dias (Dunn, p=0,03). Não foi detectado P. intermedia em nenhum dos sítios e não houve diferença estatisticamente significante para P. gingivalis em todos os tempos do estudo (Friedman, p>0,05). Todas as restaurações receberam o conceito alfa para a adaptação marginal nas análises clínica e microscópica. Conclusões: o sobrecontorno causado pelo laminado cerâmico não contribuiu para o acúmulo de placa na região cervical e para alterações no comportamento clínico periodontal, microbiológico e microscópico em relação aos mesmos dentes antes do tratamento restaurador(AU)

Purpose: quantify colonizing bacteria of the gingival sulcus, in parallel to the verify of the periodontal clinical behavior and the marginal adaptation of natural teeth restored with ceramic veneers without finish line. Methods: 73 ceramic veneers in monolithic lithium disilicate were cemented onto natural teeth without finish line and with the cervical margin positioned about 0.5mm inside the gingival sulcus. Gingival crevicular fluid (GCF) was collected for all teeth prior to cementation of the restoration (baseline) and 7, 180 and 365 days after cementation to quantify the bacteria S. mitis, P. intermedia and P. gingivalis through of real-time PCR. Clinically, visible plaque index (PIV), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), gingival recession (GR) and marginal adaptation were evaluated at baseline, 7, 15, 30, 60, 180 and 365 days. Replicas of the cervical region were obtained for analysis of marginal adaptation by scanning electron microscopy (SEM). Results: There was no statistically significant difference for PIV, PD, BOP in all periods analyzed (Anova, p>0.05). There were no records of CAL and RG. There was a statistically significant difference for S. mitis in the comparison between 180 and 365 days (Dunn, p=0.03). P. intermedia was not detected in any of the analyzed samples. There was no statistically significant difference for P. gingivalis at all study times (Friedman, p>0.05). All restorations had an alpha concept for marginal adaptation in clinical and SEM analysis. Conclusions: the overcontouring caused by ceramic veneers did not contribute to the accumulation of plaque in the cervical region and to changes in the clinical, microbiological and microscopic behavior in relation to the same teeth before the restorative treatment(AU)

Restaurações cerâmicas delgadas sobre dentes sem preparo em diferentes regiões dos arcos dentais: relato de 2 casos clínicos / Thin ceramic restorations on unprepared teeth in different regions of the dental arches: report of 2 clinical cases / Restauraciones cerámicas finas en dientes no preparados en diferentes regiones de los arcos dentales: reporte de 2 casos clínicos

As reforçadas propriedades intrínsecas dos materiais cerâmicos, associados à adesão resinosa fundamentam a desenvoltura de técnicas restauradoras mais simplificadas, conservadoras e sem a necessidade de preparo dental prévio seja em dentição anterior ou posterior. Assim sendo, o trabalho tem como objetivo apresentar dois casos clínicos os quais abordaram a confecção de restaurações delgadas em dissilicato de lítio cimentadas sobre diferentes áreas dos arcos dentários, enfatizando o mesmo protocolo clínico, ou seja, ausência de preparos dentais e consequentemente a cimentação resinosa adesiva das restaurações. Caso Clínico 1: laminados cerâmicos nos elementos 13, 12, 11, 21, 22 e 23; Caso Clínico 2: facetas delgadas sobre os elementos 34, 35, 36 e 37. Ambos os casos clínicos com 1 ano de acompanhamento após a cimentação das restaurações. Conclui-se que houve a recuperação da estética e da função em ambos os casos apresentados e a confiabilidade e o sucesso em longo prazo do protocolo clínico descrito estão diretamente relacionados ao substrato dentário, aos fatores de adesividade dos materiais e as propriedades intrínsecas das cerâmicas(AU)

The reinforced intrinsic properties of the ceramic materials, associated with the resinous adhesion, support the development of restorative techniques that are simplified, conservative and without the need of previous dental preparation, either in anterior or posterior dentition. The objective of this study was to present two clinical cases which used thin restorations in lithium disilicate cemented in different areas of the dental arches, emphasizing the same clinical protocol, that is, the absence of dental preparations and, consequently, resinous cementation. Clinical Case 1: ceramic laminates veneers in elements 13, 12, 11, 21, 22 and 23; Clinical case 2: thin ceramic restorations on elements 34, 35, 36 and 37. At both cases with 1 year of follow-up after cementation of the restorations. It was concluded that there was recovery of aesthetics and function in both cases presented and the reliability and long-term success of the described clinical protocol are directly related to the dental substrate, the material adhesion factors and the intrinsic properties of the ceramics(AU)

Las propiedades intrínsecas reforzadas de los materiales cerámicos, asociadas con la adhesión resinosa, apoyan el desarrollo de técnicas restaurativas que son simplificadas, conservadoras y sin la necesidad de una preparación dental previa, ya sea en la dentición anterior o posterior. El objetivo de este estudio fue presentar dos casos clínicos que utilizaron restauraciones delgadas en disilicato de litio cementadas en diferentes áreas de los arcos dentales, enfatizando el mismo protocolo clínico, es decir, la ausencia de preparaciones dentales y, en consecuencia, la cementación resinosa. Caso Clínico 1: carillas cerámicas en los elementos 13, 12, 11, 21, 22 y 23; Caso clínico 2: restauraciones cerámicas delgadas en los elementos 34, 35, 36 y 37. Ambos casos con 1 año de seguimiento después de la cementación de las restauraciones. Se concluyó que hubo recuperación de la estética y la función en ambos casos presentados y la fiabilidad y el éxito a largo plazo del protocolo clínico descrito están directamente relacionados con el sustrato dental, los factores de adhesión del material y las propiedades intrínsecas de la cerámica(AU)

Restabelecimento estético e funcional de paciente com amelogênese imperfeita utilizando restaurações cerâmicas metal-free / Aesthetic and functional re-establishment of patient with imperfect amelogenesis using metal-free ceramic restorations / Restablecimiento estético y funcional del paciente con amelogénesis imperfecta con restauraciones de cerámica sin metal

A amelogênese imperfeita compreende um grupo de condições com alterações do desenvolvimento na estrutura do esmalte dentário que afetam a dentição decídua e permanente e as principais implicações clínicas são: estética prejudicada, hipersensibilidade dentinária, dificuldade na higiene bucal, cáries recorrentes, inflamação gengival e perda da dimensão vertical. O tratamento varia de acordo com o tipo e a gravidade do caso, a fase do desenvolvimento dentário, o nível socioeconômico e as expectativas e anseios do paciente, podendo ser levados anos até o estabelecimento do tratamento definitivo. O presente trabalho tem como objetivo relatar e descrever as etapas clínicas de um caso de amelogênese imperfeita com restabelecimento da estética e função através de laminados cerâmicos ultrafinos, confeccionados em IPS e.max (IvoclarVivadent), com acompanhamento de um ano após a cimentação das restaurações. Conclui-se que os laminados cerâmicos podem ser uma alternativa interessante para o tratamento definitivo de casos mais brandos de amelogênese imperfeita, com otimização dos resultados estéticos e recuperação da autoestima do paciente(AU)

The imperfect amelogenesis comprises a group of conditions with developmental changes in dental enamel structure that affect the deciduous and permanent dentition and the main clinical implications are: impaired esthetics, dentine hypersensitivity, difficulty in oral hygiene, recurrent caries, gingival inflammation and loss of vertical dimension. Treatment varies according to the type and severity of the case, the dental development phase, the socioeconomic level, and the expectations and wishes of the patient, and it may take years to establish definitive treatment. The objective of the present study is to report and describe the clinical stages of a case of imperfect amelogenesis with re-establishment of aesthetics and function through ultrafine ceramic laminates, made of IPS e.max (IvoclarVivadent), followed one year after the cementation of restorations. It is concluded that ceramic laminates can be an interesting alternative for the definitive treatment of milder cases of imperfect amelogenesis, with optimization of aesthetic results and recovery of the patient's self-esteem(AU)

La amelogénesis imperfecta comprende un grupo de condiciones con alteraciones del desarrollo en la estructura del esmalte dental que afectan la dentición decidua y permanente y las principales implicaciones clínicas son: estética prejudicada, hipersensibilidad dentinaria, dificultad en la higiene bucal, caries recurrentes, inflamación gingival y pérdida de la enfermedad dimensión vertical. El tratamiento varía de acuerdo con el tipo y la gravedad del caso, la fase del desarrollo dental, el nivel socioeconómico y las expectativas y anhelos del paciente, pudiendo ser llevados años hasta el establecimiento del tratamiento definitivo. El presente trabajo tiene como objetivo relatar y describir las etapas clínicas de un caso de amelogénesis imperfecta con restablecimiento de la estética y función con carillas de cerâmica realizadas con IPS e.max (IvoclarVivadent), con acompañamiento de un año después de la cementación de las restauraciones . Se concluye que las carrillas cerámicas pueden ser una alternativa interesante para el tratamiento definitivo de casos más blandos de amelogénesis imperfecta, con optimización de los resultados estéticos y recuperación de la autoestima del paciente(AU)

Short term sodium alendronate administration improves the peri-implant bone quality in osteoporotic animals.

OBJECTIVE: The aim of this study was to evaluate the bone repair process at the bone/implant interface of osteoporotic rats treated with sodium alendronate through the analysis of microtomography, real time polymerase chain reactions and immunohistochemistry (RUNX2 protein, bone sialoprotein (BSP), alkaline phosphatase, osteopontin and osteocalcin). MATERIAL AND METHODS: A total of 42 rats were used and divided in to the following experimental groups: CTL: control group (rats submitted to fictitious surgery and fed with a balanced diet), OST: osteoporosis group (rats submitted to a bilateral ovariectomy and fed with a low calcium diet) and ALE: alendronate group (rats submitted to a bilateral ovariectomy, fed with a low calcium diet and treated with sodium alendronate). A surface treated implant was installed in both tibial metaphyses of each rat. Euthanasia of the animals was conducted at 14 (immunhostochemistry) and 42 days (immunohistochemistry, micro CT and PCR). Data were subjected to statistical analysis with a 5% significance level. RESULTS: Bone volume (BV) and total pore volume were higher for ALE group (P<0.05). Molecular data for RUNX2 and BSP proteins were significantly expressed in the ALE group (P<0.05), in comparison with the other groups. ALP expression was higher in the CTL group (P<0.05). The immunostaining for RUNX2 and osteopontin was positive in the osteoblastic lineage cells of neoformed bone for the CTL and ALE groups in both periods (14 and 42 days). Alkaline phosphatase presented a lower staining area in the OST group compared to the CTL in both periods and the ALE at 42 days. CONCLUSION: There was a decrease of osteocalcin precipitation at 42 days for the ALE and OST groups. Therefore, treatment with short-term sodium alendronate improved bone repair around the implants installed in the tibia of osteoporotic rats.

Short term sodium alendronate administration improves the peri-implant bone quality in osteoporotic animals

Abstract Sodium alendronate is a bisphosphonate drug that exerts antiresorptive action and is used to treat osteoporosis. Objective The aim of this study was to evaluate the bone repair process at the bone/implant interface of osteoporotic rats treated with sodium alendronate through the analysis of microtomography, real time polymerase chain reactions and immunohistochemistry (RUNX2 protein, bone sialoprotein (BSP), alkaline phosphatase, osteopontin and osteocalcin). Material and Methods A total of 42 rats were used and divided in to the following experimental groups: CTL: control group (rats submitted to fictitious surgery and fed with a balanced diet), OST: osteoporosis group (rats submitted to a bilateral ovariectomy and fed with a low calcium diet) and ALE: alendronate group (rats submitted to a bilateral ovariectomy, fed with a low calcium diet and treated with sodium alendronate). A surface treated implant was installed in both tibial metaphyses of each rat. Euthanasia of the animals was conducted at 14 (immunhostochemistry) and 42 days (immunohistochemistry, micro CT and PCR). Data were subjected to statistical analysis with a 5% significance level. Results Bone volume (BV) and total pore volume were higher for ALE group (P<0.05). Molecular data for RUNX2 and BSP proteins were significantly expressed in the ALE group (P<0.05), in comparison with the other groups. ALP expression was higher in the CTL group (P<0.05). The immunostaining for RUNX2 and osteopontin was positive in the osteoblastic lineage cells of neoformed bone for the CTL and ALE groups in both periods (14 and 42 days). Alkaline phosphatase presented a lower staining area in the OST group compared to the CTL in both periods and the ALE at 42 days. Conclusion There was a decrease of osteocalcin precipitation at 42 days for the ALE and OST groups. Therefore, treatment with short-term sodium alendronate improved bone repair around the implants installed in the tibia of osteoporotic rats.