Effectiveness of Hyaluronic Acid Injection for Interdental Papillae Recovery in Esthetic Areas: A Randomized Clinical Trial.

The aim of this study was to evaluate the effectiveness of hyaluronic acid (HA) injections used to reduce defects in the gingival papillae in esthetic areas. This randomized study included six patients requiring black triangle treatment in 19 defective papillae. After local anesthesia, less than 0.2 mL of HA was injected 2 to 3 mm into the tip of the deficient papilla in the apical direction. Analysis of the target regions with standardized photographs and 3D intraoral scanning (CEREC 4.5 software with RST files, Dentsply Sirona) was performed at baseline (T0) and at 1 month (T1), 2 months (T2), 3 months (T3), and 4 months (T4) after the initial application of HA. At each time period, the photographic analysis showed no statistically significant differences in linear tissue gain after HA gel application. The 3D analysis showed improvements in the vertical papillae tissue recovery at T3 (0.41 ± 0.21 mm) and T4 (0.38 ± 0.21 mm) when compared to T1 (0.13 ± 0.08 mm; P < .0001). Regarding the reconstruction of the interdental papillae, the general dimensions of the tissue in the black triangle areas showed a significant increase in size percentage at T3 (58% ± 32.9%) compared to T1 (30.41% ± 23.4%; P = .0054). Thus, the application of injectable HA was effective for filling papillae in the esthetic area. Int J Periodontics Restorative Dent 2023;43:e73-e80. doi: 10.11607/prd.5814.

Is deoxycholic acid able to reduce submental fat and increase patient satisfaction when compared to placebo groups? A systematic review.

The accumulation of submental fat (SMF) can negatively impact facial harmony appearance, and one alternative treatment for this condition is the application of deoxycholic acid (DOC). The objective of this systematic review was to answer the following question: "Is DOC able to reduce SMF and increase patient satisfaction when compared to the placebo groups?". Therefore, a detailed search strategy was carried out in 6 scientific databases (PubMed, Scopus, Embase, Lilacs, SciELO, and Web of Science) as primary search sources, while OpenGrey and OpenThesis were also used to capture the "grey literature". Only six studies met all inclusion criteria and were considered in this review analysis. The selected sample included prospective clinical studies published from 2014 to 2018, covering a total sample of 3488 patients, with an average age ranging from 46 to 49.5 years old. All selected articles evaluated the effect of DOC at concentrations of 1 mg/cm² or 2 mg/cm², using saline or placebo as control solutions for the comparative analysis. The application interval was 28 days in all studies analyzed, and the treatment duration ranged from 4 to 6 weeks. In all studies evaluated, there was a reduction in SMF and patient satisfaction with the application of DOC was higher than in the control groups at the end of a 12-week period. Thus, it is possible to conclude that the application of DOC has a positive effect on reducing SMF and improving patient satisfaction concerning their facial appearance.

Botulinum Toxin Injections as an Adjunct to Surgical Lip Repositioning For Gummy Smile Treatment.

BACKGROUND: An attractive smile depends on the proper proportion and arrangement of lip, teeth gingiva scaffold. The ideal smile is the exposure of the entire length of maxillary teeth with 1 mm gingiva. A gingival display exceeding 3 mm is unpleasant and termed ''gummy smile (GS).'' Lip repositioning is a simple surgical procedure intended to minimize the gingival display by removing a strip of mucosa and shortening the vestibular depth. Botulinum toxin injecting overactive muscles with measured quantities results in a reduction of muscle activity, relaxing the lip muscles and decreasing upward pull on the lip. There are some contraindications: patients with short lips and gingival exposures less than 3 mm. PURPOSE: This case report describes the successful management of GS of a young man. CASE REPORT: The procedures were performed and these techniques resulted in shortened vestibule and restricted the muscle pull of the elevator muscles of the lip, reducing gingival display when the patient smiles. Surgical lip repositioning can be a minimally invasive alternative to orthognathic surgery. Botulinum Toxin injections can be a useful adjunct to enhance the esthetics and improve patient satisfaction, being a more conservative and immediate nonsurgical treatment modality available. CONCLUSIONS: In this way, the clinical case report demonstrated that lip repositioning surgery combined to botulinum toxin injections promising outcomes in the GS correction. The effect showed a marked reduction in gingival display at the 4-years follow-up.

Is interdental papilla filling using hyaluronic acid a stable approach to treat black triangles? A systematic review.

PURPOSE: To evaluate the stability of interdental papilla filling using hyaluronic acid (HA) to treat black triangles in esthetic regions. METHODS: The protocol was registered in PROSPERO. Six databases (PubMed, Scopus, Embase, Lilacs, SciELO, and Web of Science) were used as primary search sources, and OpenGrey and OpenThesis were used to capture the "gray literature." Only before-after studies were included. The JBI Checklist assessed the risk of bias. Only four studies met the inclusion criteria and were considered for the analyses. The studies were published from 2010 to 2016. All studies presented a low risk of bias. Considering the studies do not have control groups, a weighted average by sample size was calculated to obtain a general estimate of the percentage of papillary filling after 6 months and the number of HA applications. RESULTS: The studies showed the percentage of papillary reconstruction after 6 months of application, the weighted average by sample size was 77.41% (SD = 20.68), with an average number of applications of 3.17 (SD = 0.31). CONCLUSION: The application of HA may be used to repair anesthetic defects in the papilla. CLINICAL SIGNIFICANCE: Interdental papilla reconstruction with injectable HA is an option of nonsurgical treatment for interdental papilla deficiencies. However, there is still concern about the quality of the evidence available, considering that studies with different experimental designs can produce contradictory results. Moreover, further understanding is required on the stability of tissue gain promoted by HA in black triangles.

Is Low-Level Laser Therapy Effective for Pain Control After the Surgical Removal of Unerupted Third Molars? A Randomized Trial.

PURPOSE: One of the main challenges after extraction of unerupted third molars is pain control, and one of the treatments for pain control is low-level laser therapy (LLLT). Thus, this study aimed to assess the effectiveness of LLLT for pain control after extraction of lower third molars. MATERIALS AND METHODS: This randomized, double-blind, split-mouth study included patients who required bilateral extraction of unerupted lower third molars. Patients received LLLT on 1 side (laser group) but not on the opposite side (control group). On the experimental side, each patient received a laser application at 5 intraoral points for 30 seconds per point. This procedure was simulated on the control side. The pain control response was assessed with a modified pain visual analog scale at the following times: immediately after surgery (T0), after laser application (T1), 24 hours after surgery (T2), 48 hours after surgery (T3), and 72 hours after surgery (T4). RESULTS: Thirty-two patients, 56.25% of whom were women, underwent extraction; the average age was 22.2 years. At the times analyzed, the laser group presented better results than the control group. As for the times, there were differences in pain scores between T0 (8.03 ± 14.87) and T3 (2.66 ± 4.23), as well as T4 (3.36 ± 7.83), in the laser group and differences between T0 (19.76 ± 26.66) and T3 (7.11 ± 10.76), as well as T4 (6.26 ± 13.14), in the control group. CONCLUSION: LLLT was effective in reducing pain after surgical removal of unerupted third molars. At T3 and T4, pain reduction in relation to T0 was noted in both groups.

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

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

Analysis of Linear and Angular Deviations of Implants Installed With a Tomographic-Guided Surgery Technique: A Prospective Cohort Study.

The aim of this study was to evaluate the linear and angular deviations of the implants installed by the computerized tomography (CT)-guided surgery technique. Eighteen patients who underwent implant insertion by means of CT-guided surgery participated in this study. Ten of these patients had a fully edentulous maxilla, and 8 had a fully edentulous mandible. The patients received a total of 115 implants, of which 81 implants were installed in the maxilla and 34 installed in the mandible. Tomographic guides were made for tomographic examination in both the upper and lower jaws. After the image acquisition, the virtual planning of the positioning of the implants was performed in relation to the previously made prosthesis. The measurement of the linear and angular deviations between the virtual planning and the final position of the implants was performed with the overlap of the planning and postoperative tomography. There were no differences in the linear and angular deviations of the implants installed in the maxilla and mandible. Compared with the coronal region, there was a trend of greater linear deviations in the apical regions of the implants and a greater tendency toward deviations in the posterior regions than in the anterior regions of both arches. The CT-guided surgery promoted the installation of implants with high accuracy and allowed the installation of straight pillars in all cases evaluated. The linear deviations were not different in the different regions of the mouth or in the different portions of the implants.

Use of Calcium Phosphate Cement for Repairing Bone Defects: Histomorphometric and Immunohistochemical Analyses.

This study aimed to assess the repair of surgically created bone defects filled with blood clot, autogenous bone, and calcium phosphate cement, by histomorphometric and immunohistochemical analyses. Ten adult male rabbits were used. Three bone defects were prepared with an 8-mm diameter trephine bur in the parietal region of each animal and filled with blood clot (Group BC), autogenous bone (Group AB), and calcium phosphate bone cement (Group CPC). The animals were euthanized at 40 and 90 postoperative days. The sections were subjected to histomorphometric analysis of the new bone formed inside the calvarial defects and immunohistochemical staining to determine the expression of osteocalcin (OC), osteopontin (OP), and tartrate-resistant acid phosphatase (TRAP) proteins. Histomorphometric data were analyzed statistically by analysis of variance and Tukey's post hoc test at 5% significance level. In the results at 40 and 90 days, Group AB differed significantly from Group CPC regarding the area of newly formed bone. The immunohistochemical analysis revealed expression of OP, OC, and TRAP proteins in all groups. Group AB showed prevalence of OC and OP, and lower TRAP expression. Therefore, the calcium phosphate bone cement assessed in the present study did not accelerate the protein expression dynamics during bone healing, compared with the autogenous group.

Semiautomatic device for in vitro/ experimental bone perforation in dental implant research.

PURPOSE: The present study presents a semiautomatic device developed to perform in vitro experiments using surgical drills for assisting dental implant research. It was built to perform tests independent of human direct contact, and contains an adjustable toolholder for engaging different types of implant contra angle hand pieces, in which different drills can be adapted. The researcher is able to make a range of adjustments on the machine, such as controlling the drilling force and depth. MATERIALS AND METHODS: The device was tested on samples of both synthetic and natural bone with type I density, and a sequence of drills selected to perform the perforations. Drilling time and perforation force exerted during drilling were evaluated, as both parameters are required to be standardized. RESULTS: It was observed that the drilling performed using the device was uniform using both types of bone, although the drilling time for the synthetic bone was higher. All perforations were exactly on the spot previously determined, and without variations in drill angulations. The perforation force was higher for the lance pilot drill for both bone types, and the natural bone required a higher axial force than the synthetic bone. CONCLUSION: Thus, we consider this device trustable to perform standardized analysis and provide accurate results. It can be used for tests performed in universities and companies that develop dental implant materials and products.

Is Low-Level Laser Therapy Effective on Sensorineural Recovery After Bilateral Sagittal Split Osteotomy? Randomized Trial.

PURPOSE: When performing a sagittal osteotomy of the mandibular ramus, one must consider the risk of long-term postsurgical sensory abnormalities from lesions to the inferior alveolar nerve. One treatment for these changes is low-level laser therapy (LLLT). Thus, the aim of this research was to evaluate the effectiveness of LLLT on sensorineural recovery after split ramus osteotomy of the mandible. MATERIALS AND METHODS: This randomized, double-blinded, split-mouth design trial included patients who underwent advanced surgery of the mandible and then received LLLT on 1 side of the mandible (experimental) and a random placebo (control) treatment on the opposite site. Patients were divided into 2 groups: group 1 was treated during the short postoperative period (within 30 days) and group 2 was treated for persistent sensory abnormalities during the late postoperative period (6 months to 1 yr). Each patient received 5 LLLT and control sessions with intervals of 3 to 4 weeks between sessions. The experimental side in each patient received LLLT in the extraoral area (mandibular ramus and entire length of the inferior alveolar nerve to the mental region) and the intraoral area (mental foramen region). The control side received simultaneous placebo treatments. The sensorineural response was analyzed before the onset of treatment and after each LLLT and control session using the Semmes-Weinstein monofilament test. RESULTS: Twenty adult patients (mean age, 35.6 years; 70.0% women) showed improvement in the experimental and control sides during the follow-up period. However, the experimental side in groups 1 and 2 exhibited a marked improvement in sensorineural recovery over the course of the sessions, and group 1 had the best results. CONCLUSION: LLLT was effective in the recovery from sensorineural disorders after orthognathic surgery during the short postoperative period, particularly in the fifth session.

Avaliação da estabilidade primária de implantes curtos e convencionais instalados em ossos de diferentes densidades / Evaluation of primary stability of short and conventional implants in bones with different densities

O objetivo deste estudo foi avaliar a estabilidade primária de implantes curtos e convencionais instalados em ossos com densidades tipo I e tipo IV de origem sintética e natural. Implantes nos tamanhos (Diamêtro x Comprimento) 3,75 x 13 mm, 3,75 x 10 mm, 4,3 x 5,5 mm e 5 x 5,5 mm foram instalados em blocos ósseos seguindo uma sequência de fresagens e avaliados o torque de inserção e o coeficiente de estabilidade primária (CE) através da análise da frequência de ressonância (AFR). Os resultados mostraram que implantes de diferentes tamanhos e ossos de diferentes densidades e origens influenciam tanto nos valores de torque de inserção quanto de AFR (p<0.05). Todos os implantes instalados nos ossos tipo IV apresentaram menores torques de inserção e menores CE (p<0.05) comparados aos instalados nos ossos tipo I, e implantes curtos apresentaram maiores torques que os convencionais intalados no osso tipo I. Assim, a utilização de implantes curtos pode ser uma alternativa viável de tratamento, principalmente em sítios ósseos com maiores densidades (AU).

The aim of this study was to assess the primary stability of short and conventional implants placed in bone with type I and type IV densities of synthetic or natural origin. Implants (D x C) of 3.75 x 13 mm, 3.75 x 10 mm, 4.3 x 5.5 mm, and 5 x 5.5 mm were placed in bone blocks following a drilling sequence and assessment of insertion torque and primary stability coefficient (SC) through resonance frequency analysis (RFA). The results showed that implants of different sizes and bones of different densities and origins influence both insertion torque and RFA values (p <0.05). All implants placed in type IV bones presented lower insertion torques and lower SC (p <0.05) compared to those placed in type I bones, and short implants presented higher torques than conventional implants in type I bone. So the use of short implants may be a viable treatment alternative, mainly in bone areas with higher densities (AU).

Some aspects of bone remodeling around dental implants

ABSTRACT: Considering that success of dental implants is not only related to osseointegration, but also with their survival rates, the aim of this study was to perform a literature review about bone remodeling around osseointegrated implants. A detailed search strategy was used for this, and articles published between the years 1930 and 2012 were selected. The rare data found in the literature demonstrated that implants are osseointegrated 30 days after their placement. However, active bone remodeling with osteoclasts and osteoblasts working in synchrony continues to occur. Therefore, after osseointegration, the initially formed bone, which presents characteristics of spongy bone, is gradually resorbed and replaced by compact bone after 90 days. Furthermore, other portions of bone tissue a little more distant from the interface, which establish direct contact with the implant, are also damaged during the drilling process, and therefore, they also need to be remodeled. Among the rare studies found in the literature about bone remodeling after osseointegration, there were no verified studies on the possible influence of implant surface treatments on bone remodeling that occurs after osseointegration. Only studies involving implants with machined surfaces have been conducted up to now.

Clinical comparison of short and conventional implants placed in the posterior region of the mandible. A pilot study / Comparação clínica de implantes curtos e convencionais instalados na região posterior da mandíbula. Estudo piloto

Objective: To evaluate and correlate the values of radiographic bone density, peri-implant bone height and resonance frequency analysis (RFA) of short or conventional implants placed in the posterior region of the mandible after installing a prosthesis. Material and method: Eleven patients were selected for this prospective parallel pilot study. The prostheses were supported by two types of implants: short implants (n = 18) (5.0 x 5.5 mm and 5.0 x 7.0 mm) and conventional implants (n = 23) (4.0 x10 mm and 4.0 x 11.5 mm). The implants were evaluated by RFA, by measuring the bone height, and peri-implant bone density. The implants were evaluated at the periods T0 (immediately after installation of the prosthesis), T1 (after 90 days), and T2 (after 180 days). Result: There were no statistically significant differences between groups with respect to radiographic bone density (152.50 ± 15.39 vs. 157.60 ± 28.46, for conventional and short implants, respectively at T2), stability of the implants (Conventional implants: 66.76 ± 10.39 at T0, and 61.85 ± 8.38 at T2 vs. Short implants: 57.50 ± 12.17 at T0, and 61.53 ± 7.39 at T2) and peri-implant bone loss (0.03 mm vs.-0.17 mm, for conventional and short implants, respectively at T2). Additionally, a significant correlation between the evaluated parameters was not detected. Conclusion: The short and conventional implants presented similar stability, bone level and density after the activation of occlusion loading.

Objetivo: Avaliar e correlacionar os valores de densidade óssea radiográfica, altura óssea peri-implantar e de frequência de ressonância nos implantes curtos e convencionais instalados na região posterior da mandíbula após a instalação da prótese provisória. Material e método: Esse estudo piloto clínico prospectivo contou com a participação de 11 pacientes que foram divididos previamente em dois grupos: implantes curtos (n=18) (5,0 x 5,5 mm e 5,0 x 7,0 mm) e implantes convencionais (n=23) (4,0 x 10 mm e 4,0 x 11,5 mm). Foram executadas análise da frequência de ressonância, altura óssea e densidade óssea peri-implantar. Os implantes foram avaliados nos períodos T0 (imediatamente após a instalação do provisório), T1 (após 90 dias) e T2 (após 180 dias). Resultado: Não houve diferenças estatisticamente significativas entre os grupos com relação a densidade óssea radiográfica (152,50 ± 15,39 vs. 157,60 ± 28,46, para implantes convencionais e curtos respectivamente no período T2), estabilidade dos implantes (Implantes convencionais: 66,76 ± 10,39 no período T0 e 61,85 ± 8,38 no período T2 vs. Implantes curtos: 57,50 ± 12,17 no período T0 e 61,53 ± 7,39 no período T2) e quanto a perda óssea periimplantar (0,03 mm vs. -0,17 mm, em implantes convencionais e curtos no período T2, respectivamente). Adicionalmente a isso, não foram detectados correlação significativa entre densidade radiográfica com altura óssea peri-implantar e nem com a frequência de ressonância. Conclusão: Verificou-se que os implantes curtos apresentaram um comportamento semelhante aos implantes de comprimento convencionais com relação à frequência de ressonância, a densidade radiográfica peri-implantar e a manutenção dos níveis ósseos periimplantares.

Relationship between implant stability on the abutment and platform level by means of resonance frequency analysis: A cross-sectional study.

Resonance frequency analysis (RFA) has become the main tool used to assess the osseointegration of dental implants. The objective of this study was to verify the relationship between the ISQ values with different prosthetic abutments and with the implant platform. The hypothesis was that ISQ values changes according to the abutment height. Twelve patients were included, whose contribution to the study was 31 dental implants (external hexagon connection implants, 4.1x10 mm). The temporary implant-supported crown and prosthetic components were removed and the following smartpegs were inserted, one at a time: type 1, in the implant platform (G1); type A3, in the microunit component with 1mm transmucosal height (G2) and type A3, in the microunit component with 5mm transmucosal height (G3). In all the smartpegs, RFA measurements were taken on mesial, distal, buccal and lingual surfaces. All evaluations were performed by a single calibrated examiner (ICC = 0.989). Data were analyzed by Friedman and Spearman correlation tests and log-linear marginal regression (p<0.05). The mean age of participants was 52.83 (± 3.77) years. There was statistically significant difference (p<0.001) among the mean ISQ of G1 (88.27 ±5.70); G2 (72.75 ±4.73) and G3 (66.33 ±3.67). There was statistically significant negative correlation between the ISQ and the measurement distance (rs:-0.852; p<0.001; R2:0.553). Measurement distance was significantly associated (p<0.001) with ISQ value in the log-linear regression. The abutment height has a significant impact on resonance frequency analysis measurements. The higher the transmucosal abutment height, the lower the implant stability quotient value. Clinically, the ISQ measured on the abutment cannot be compared with values measured on the implant platform.

In vivo evaluation of cp Ti implants with modified surfaces by laser beam with and without hydroxyapatite chemical deposition and without and with thermal treatment: topographic characterization and histomorphometric analysis in rabbits.

OBJECTIVE: We aimed to assess the surfaces of commercially pure titanium implants (cp Ti) with modified surfaces by laser beam (LS) with and without hydroxyapatite (HA) deposition, without (HAB) and with (HABT) thermal treatment. Furthermore, we have compared them with implants with surfaces modified by acid treatment (AS) and with machined surfaces (MS) utilizing histomorphometric and descriptive histologic analyses. MATERIAL AND METHODS: Surface topography characterization was analyzed by scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDX), and surface roughness (Ra) before implant installation. Forty-five rabbits received seventy-five implants in their left and right tibias and were randomly divided into five groups (n = 5 implants per group): (1) cp Ti implant modified by LS, (2) cp Ti implant modified by laser beam associated with HA deposition without heat treatment (HAB), (3) cp Ti implant modified by laser beam associated with HA deposition with heat treatment (HABT), (4) cp Ti implant with modified surface by means of acid treatment (Master Porous) commercially available (AS), and (5) cp Ti implant with MS commercially available. After 30, 60, and 90 days, the animals were euthanized and the implants and surrounding bone were removed and prepared by a non-decalcified histological process. The percentage of bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) between the first three threads was evaluated to the higher cortical region. RESULTS: BIC (%) was statistically superior (p < 0.001) on the LS (69.36 ± 7.91, 71.67 ± 8.79, and 79.69 ± 3.3), HAB (73.22 ± 3.75, 69.48 ± 1.89, and 75.7 ± 4.62), and HABT (65.41 ± 5.51, 71.3 ± 2.5, and 79.68 ± 5.01) compared with AS (49.15 ± 5.76, 41.94 ± 2.85, and 57.18 ± 7.81) and MS (36.69 ± 7.24, 52.52 ± 2.75, and 51.31 ± 6.96) in the 30, 60, and 90-day periods, respectively. BAFO (%) of HAB at 30 days (90.17 ± 6.24) was statistically superior (p < 0.01) to all the other groups. At 60 and 90 days, BAFO of LS (87.17 ± 5.9 and 87.99 ± 2.52), HAB (85.95 ± 3.93 and 82.17 ± 3.65), and HABT (83.27 ± 1.44 and 88.67 ± 2.67) was higher than the AS (77.49 ± 5.83 and 76.42 ± 5.98) and MS (74.01 ± 4.68 and 73.81 ± 4.91). CONCLUSIONS: Collectively, our data indicate that the modified surfaces LS, HAB, and HABT favored the interaction between bone and implant and increased bone formation. In addition, HAB showed higher biological behavior favoring the osseointegration. CLINICAL RELEVANCE: Our study provides evidence that LS, HAB, and HABT-modified surfaces improved bone-to-implant contact and increased bone formation around osseointegrated implants compared to conventional machined implants favoring the osseointegration process.

Planejamento virtual em cirurgia guiada ­ uma realidade na Implantodontia / Virtual planning in guided surgery ­ a reality in Implantology

O planejamento virtual para cirurgia guiada é uma técnica que vem sendo cada vez mais utilizada na Implantodontia. Sendo assim, o objetivo desse estudo foi realizar uma revisão da literatura sobre a técnica de planejamento virtual para cirurgia guiada sem retalho em reabilitação oral com implantes osseointegráveis, de modo a fornecer informação sobre as características, vantagens e limitações dessa modalidade. Diversos estudos demonstraram a confiabilidade e vantagens da técnica quanto à precisão do planejamento, inserção dos implantes, fabricação da prótese e satisfação do paciente. No entanto, alguns autores relataram que desvios podem ocorrer quanto ao posicionamento dos implantes em relação ao planejamento virtual, o que ressalta a importância da utilização do guia cirúrgico, bem como precisão durante a execução de todas as etapas clínicas e laboratoriais. Concluiu-se que, apesar das limitações relatadas por alguns autores, o método apresenta diversas vantagens que garantem a sua previsibilidade quando indicado e executado corretamente (AU).

The virtual planning for guided surgery has been a widely used technique in Implantology. Thus, the aim of this study was to conduct a literatura review about the virtual planning for flapless guided surgery in oral rehabilitation with dental implants regarding its characteristics, advantages, and limitations. Several studies demonstrated the reliability and advantages of this approach as a consequence of accuracy during treatment planning, implants insertion, prosthesis fabrication, and patient's satisfaction. However, some authors reported deviations of implants positioning compared to the virtual planning, which highlighted the importance of using the surgical guide as well as the accuracy during all clinical and laboratorial steps. Despite of the limitations demonstrated by some authors, it was concluded that this method presents several advantages to enhance its predictability when the procedures are well indicated and performed (AU).

Dental Implants With Immediate Loading Using Insertion Torque of 30 Ncm: A Systematic Review.

OBJECTIVE: This study aimed to perform a review of the literature regarding the survival rate of dental implants with immediate loading using insertion torque of 30 Ncm. MATERIAL AND METHODS: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (PROSPERO CRD42014015323). The search was performed in the PubMed, Web of Science, Cochrane Library electronic, OVID, and Scielo databases. Manual searches were also performed. The articles identified were assessed independently by 3 researchers. Clinical trials reporting dental implants with immediate loading and 30 Ncm torque in patients ages 18 years or older were included. RESULTS: The searches yielded 589 studies. Six studies were included in the systematic review. The survival rate of dental implants was 96.8%. Three studies showed a low potential risk of bias. CONCLUSION: There is not strong evidence that insertion torque of 30 Ncm is enough for implant survival in cases of immediate loading.

Evaluation of bone substitutes for treatment of peri-implant bone defects: biomechanical, histological, and immunohistochemical analyses in the rabbit tibia.

PURPOSE: We sought to evaluate the effectiveness of bone substitutes in circumferential peri-implant defects created in the rabbit tibia. METHODS: Thirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant (4.1 mm × 8.5 mm) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss(®) (BI), and Bio-Oss(®) Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated. RESULTS: For biomechanics, BC showed a better biological response (61.00±15.28 Ncm) than CO (31.60±14.38 Ncm) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group. CONCLUSIONS: Collectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps.

Guided Surgery in Esthetic Region.

The placement of dental implants and subsequent placement of immediate temporary dentures after extractions has become a treatment modality accepted by the scientific community. In addition to the functional factor, the surgical procedure in a single stage in the anterior region of the maxilla offers an esthetic appearance, and relieves the psychological concerns of patients. To guarantee the success and longevity of treatments performed, the fabrication of surgical guides is a helpful method in these situations. Guided surgery has gained attention because it restores esthetics with immediate restoration, provides the patient with comfort in addition to dispensing with the need for performing surgical flaps. This auxiliary method allows the position and design of the implant, as well as the perforation sequence to be programmed, thus optimizing the clinical results. In this study, the authors present a clinical case of a patient who was submitted to extraction and subsequent implant placement with immediate loading in the anterior region of the maxilla, performed in a satisfactory manner.

Cinco anos de reabilitação total de mandíbula atrófica com implantes curtos em carga imediata ­ relato de caso / Five years of total rehabilitation in atrophic mandible with immediate loading short implants ­ case report

O presente artigo apresenta um caso clínico de reabilitação total de mandíbula atrófica empregando-se implantes curtos em carga imediata com avaliação longitudinal de cinco anos. Paciente do sexo feminino, 70 anos, compareceu ao consultório particular queixando-se de prótese total inferior insatisfatória, sendo diagnosticada severa atrofia óssea maxilomandibular. Planejou-se a instalação de 4 implantes curtos inferiores e a confecção de prótese do tipo protocolo com carga imediata associada à nova prótese total removível superior. A paciente manteve-se em reavaliações anuais para manutenção e controle do trabalho realizado e não se observou nada digno de nota, demonstrando a previsibilidade e sucesso desta técnica para resolução de casos limítrofes (AU).

The present article reports a case of complete rehabilitation of atrophic mandible with immediate loading short implants with longitudinal assessment of five years. A female patient, 70 years old, attended to the private practice complaining of unsatisfactory lower removable denture, being diagnosed as severe maxillo-mandibular bone atrophy. It was planned to install four lower short implants and to make protocol prosthesis with immediate loading associated with the new upper removable denture. The patient remained in annual reassessments for maintenance and control of the work done, it was observed nothing noteworthy, demonstrating the predictability and success of this technique for resolving borderline cases (AU).