Modified one-stage technique of laterally positioned flap with sub-epithelial connective tissue graft for the treatment of peri-implant soft tissue dehiscence in the esthetic zone: A 5-year follow-up.

BACKGROUND: The state of art of tissue grafting allows significant improvements in the soft tissue phenotype. The importance of appropriate soft tissue phenotype around implants is supported by recent literature. The present case report aims to describe the application of a modified one-stage technique of laterally positioned flap with sub-epithelial connective tissue graft (CTG) for the treatment of peri-implant soft tissue dehiscence in the esthetic zone. METHODS AND RESULTS: A 38-year-old female presented 4 years following prosthetic restoration, with a localized soft tissue defect in height and thickness at the buccal aspect of the implant at #11, and the abutment exposed to the oral cavity. Incisions with internal and external bevels were performed in the medial and distal margins of the dehiscence, respectively, toward the alveolar mucosa. After intrasulcular incision, the area was de-epithelialized and a split thickness flap from mesial #11 to distal #14 was elevated. A tunnel was prepared at #21. CTG was stabilized mesially, within the tunnel prepared, and distally, through simple interrupted sutures. Vertical compressive sutures were performed on the CTG. The flap was laterally positioned and secured by means of suspended sutures. Healing was uneventful, increased thickness and height of the peri-implant mucosa were observed, with great esthetic outcome. The soft tissue margin was stable at the 5-year follow-up. CONCLUSION: The technique described in this case report showed promising results for covering exposed implant abutment in the esthetic zone, as well as for modification of the soft tissue phenotype around dental implants. KEY POINTS: Why is this case new information A modified one-stage technique that allows coverage of exposed metallic displays of titanium implants while modifying the soft tissue phenotype in the esthetic zone. What are the keys to successful management of this case? Meticulous incisions and internal and external bevels. Adequate elevation to allow repositioning without tension. Adequate graft size that extends through all the recipient bed; and tension-free suture. What are the primary limitations to success in this case? Presence of an implant installed in a non-satisfactory three-dimensional position. And poor hygiene and plaque accumulation postoperatively.

Odontometria eletrônica em dentes decíduos: revisão de literatura e relato de caso / Eletronic working length determination in primary tooth: review of literature and case report

Objetivo: Realizar uma revisão dos principais artigos encontra-dos na literatura acerca do uso dos Localizadores Eletrônicos Foraminais (LEF) em dentes decíduos e representar através de um relato de caso clínico, a importância do uso destes dispositivos durante o tratamento endodôntico em dentes decíduos. Revisão da literatura: Foi realizada uma busca nas principais bases de dados, e selecionados 13 artigos consi-derados mais relevantes. Todos os estudos mostraram que a determinação da odontometria em dentes decíduos utilizando o LEF é bastante segura e com boa acurácia, podendo ser utilizado o localizador para esta finalidade. Relato do caso:No caso clínico apresentado, o uso do LEF foi fundamental para a obtenção de uma odontometria precisa, além da diminuição do tempo de cadeira e identificar reabsorções não detectáveis radiograficamente. O caso foi conduzido em duas sessões, onde na primeira foi realizada a cirurgia de acesso, odontometria eletrônica, preparo manual dos canais e utilização de medicação intracanal de hidróxido de cálcio. Na segunda sessão foi removida a medicação intracanal e os canais foram obturados utilizando pasta iodoformada. Discussão: O uso do LEF no tratamento endodôntico de dentes decíduos tem se mostrado uma ferramenta segura e eficiente, tendo melhor performance na determinação do comprimento de trabalho quando comparado a outros métodos. Conclusão: De acordo com os estudos apresen-tados na revisão de literatura e o caso clínico apresentado, pudemos constatar que o uso do LEF contribui positivamente ao tratamento, principalmente quanto ao ganho de tempo e determinação confiável e segura do comprimento de trabalho.

Aim: To review the main articles found in the literature on the use of Electronic Apex Locators (EAL) in deci-duous teeth, and to represent, through a clinical case report, the importance of using these devices during endodontic treatment in deciduous teeth. Review of literature: A search was performed in the main data-bases, and 13 articles considered most relevant were selected. All studies showed that the determination of odontometry in deciduous teeth using LEF is quite safe and with good accuracy, and the localizer can be used for this purpose. Case report: In the clinical case presented, the use of EAL was fundamental to obtain an accurate odontometry, besides the reduction of chair time and exposure to ionizing radiation. The case was conducted in two sessions, where in the first one the access surgery was performed, electronic odontometry, manual preparation of the canals and use of intracanal medication of calcium hydroxide. In the second session the intracanal medication was removed and the canals were filled using iodoform paste. Discussion: The use of LEF in the endodontic treatment of primary teeth has been shown to be a safe and efficient tool, with better permormance in determining the working length when compared to other methods. Conclusion: According to the studies presented in the literature review and the clinical case presented, we could verify that the use of LEF contributes positively to treatment, especially in terms of time gain and acurate determination of working length.

Photomodulation multiple sessions as a promising preventive therapy for medication-related osteonecrosis of the jaws after tooth extraction in rats.

The aim of this study was to evaluate the effects of photobiomodulation (PBM) with multiple sessions of low-level laser on the alveolar repair process of rats with major risk factors for medication-related osteonecrosis of the jaws (MRONJ). Senile rats received 0.45 mL of vehicle (VEH and VEH-PBM) or 0.45 mL of 100 µg/kg zoledronate (ZOL and ZOL-PBM) administrated intraperitoneally every two days during seven weeks. After three weeks of initiation of drug treatment the first lower left molar was extracted. No local treatment was performed in VEH and ZOL. VEH-PBM and ZOL-PBM were submitted to laser irradiation (660 ±â€¯10 nm; 0.035 W; 2.1 J; 60 s) on the extraction site at 0, 2 and 4 days postoperatively. Euthanasia was performed 28 days after tooth extraction. Histological sections of the hemimandible were submitted to histopathological and histomorphometric analysis, as well as to histochemistry for collagen fiber maturation and immunohistochemistry for pro-inflammatory cytokines. In ZOL, general impairment of tissue repair, areas with osteonecrosis, lower newly formed bone tissue (NFBT), smaller amount of mature collagen fibers and increased immunoreactivity for TNFα, IL-1ß and IL-6 were observed when compared to VEH and VEH-PBM. ZOL-PBM showed significant improvement in some parameters compared to ZOL, such as positive repair tissue, higher NFBT, greater amount of mature collagen fibers, besides TNFα and IL-1ß immunoreactivity decrease. Zoledronate treatment severely compromised the tissue repair process of the tooth extraction site in rats with major risk factors for MRONJ. Based on parameters employed in the present study, PBM in multiple sessions can improve the alveolar repair process, constituting a promising preventive therapy to avoid the onset of post-extraction MRONJ.

Terapia fotodinâmica antimicrobiana no tratamento da periodontite em ratos tratados com dose oncológica de zoledronato / Antimicrobial photodynamic therapy in the treatment of periodontitis in treated rats with oncological dose of zoledronate

O objetivo do presente estudo foi avaliar a terapia fotodinâmica antimicrobiana (aPDT), como monoterapia ou como coadjuvante à raspagem e alisamento radicular (RAR) no tratamento da periodontite experimental (PE) em ratos tratados com dose oncológica de zoledronato. Cento e vinte ratos foram aleatoriamente distribuídos em quatro grupos experimentais, cada um composto por 30 ratos. Durante 8 semanas, foi administrado 100 µg/Kg de zoledronato com intervalo de três dias entre as injeções. No 14º dia do início do protocolo medicamentoso, foi instalada uma ligadura nos primeiros molares inferiores para indução de PE. Após 14 dias a ligadura foi removida e foram realizados os seguintes tratamentos: exclusivamente uma sessão de RAR (grupo PE-RAR), exclusivamente três sessões de aPDT (grupo PE-aPDT) e uma sessão de RAR associada à três sessões de aPDT (grupo PE-RAR-aPDT). As sessões de aPDT foram realizadas aos 0, 2 e 4 dias pós tratamento local. No grupo PE-NTL não foi realizado nenhum tratamento local. Após 7, 14 e 28 dias pós tratamento periodontal local foram realizadas as eutanásias. Foi realizada análise microtomografica (micro-CT), análise histopatológica, histométrica da porcentagem tecido ósseo (PTO) e porcentagem de tecido ósseo não vital (PTONV) e imunoistoquímica para fator de crescimento transformador beta (TGFß) nos tecidos periodontais. Os dados obtidos foram submetidos à análise quantitativa e estatística com nível de significancia de 5%. Não houve diferença estatisticamente significante nos seguintes parâmetros microtomográficos: perda óssea alveolar, volume ósseo na furca, número e espessura de trabéculas ósseas. O processo de reparação tecidual pós tratamento foi mais favorável em PE-aPDT e PE-RAR-aPDT. Não houve diferença estatisticamente significante na PTO, todavia, a PTONV foi menor tanto em PE-aPDT quanto em PE-RARaPDT. A imunomarcação para TGFß foi maior em PE-RAR, PE-aPDT e PE-RARaPDT aos 7 dias pós tratamento. Conclui-se que o emprego da aPDT, quando empregada como monoterapia ou como terapia coadjuvante à RAR, se mostrou mais efetiva e segura para tratamento da PE em ratos(AU)

The aim of the present study was to evaluate the antimicrobial photodynamic therapy (aPDT) as a monotherapy or adjunct to scaling and root planning (SRP) for the treatment of experimental periodontitis (EP) in rats treated with oncological dosage of zoledronate. A hundred and twenty rats were randomly divided in four experimental groups, each one of them composed by 30 rats. During a period of 8 weeks, 100 µg/Kg of zoledronate was administered every three days. After 14 days of the beginning of the drug protocol, a ligature was installed in the lower first molars for EP induction. After 14 days, ligature was removed and the following treatments were performed: a single session of SRP, exclusively (group EP-SRP), three sessions of aPDT, exclusively (group EP-aPDT), and one session of SRP associated to the three sessions of aPDT (group EP-SRP-aPDT). aPDT sessions were performed at days 0, 2, and 4 after the local treatment. In the fourth group, no local treatment was made (EP-NLT). After 7, 114, and 28 days after the local periodontal treatment, the animals were euthanized. Microcomputed tomography (micro-CT) analysis, histopathologic analysis, percentage of bone tissue (PBT), percentage of non-vital bone (PNVB), and immunohistochemistry for transforming growth factor beta (TGFß) in the periodontal tissues were performed. Obtained data underwent quantitative analysis and statistics considering 5% level of significance. No statistical difference was detected in the following microtomographic parameters: alveolar bone loss, bone volume in the furcation, number and thickness of the trabecullaes. Tissue healing after the treatment was more favorable in EP-aPDT and EP-RAR-aPDT groups. No significant differences were detected in PTO; however, PNVB was lower both in EP-aPDT and EP-SRP. Immunolabeling for TGFß was higher in EP-SRP, EP-aPDT and EP-SRP-aPDT at day 7 posttreatment. It is concluded that when aPDT is used as monotherapy or as adjunct therapy associated with SRP, it is more effective and safe for the treatment of EP in rats(AU)