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1.
Clin Oral Investig ; 2021 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-33893557

RESUMO

PURPOSE: This paper aims to review the evidence comparing low-speed drilling without irrigation versus conventional drilling for dental implant osteotomy preparation. MATERIALS AND METHODS: A systematic review was carried out based on the PRISMA statement. Four databases and gray literature were searched up to November 2020. In vitro, animal, and clinical studies were included. The variables were temperature change, drilling time, quantity of harvested bone, osteotomy precision, marginal bone loss, implant success rate, osseointegration, and the histomorphologic characteristics and cellularity of the osteotomy and of the harvested bone. Different tools for the assessment of bias were applied for each study design. RESULTS: A total of 626 articles were identified, of which 13 were included. Both low-speed drilling without irrigation (test group) and conventional drilling (control group) maintained temperatures below the critical temperature of 47 °C. The test group yielded a greater quantity and more beneficial cellular and histomorphologic properties of harvested bone, with a longer drilling time and greater osteotomy precision (p < 0.05). No significant results were obtained regarding drill wear, osseointegration, marginal bone loss, implant success rate, and histomorphology of the dental implant osteotomy (p > 0.05). The results, in particular on the osteotomy precision and quantity of harvested bone chips, should be interpreted with caution because outcomes are based in only one in vitro study. CONCLUSIONS: Low-speed drilling without irrigation seems to be comparable to conventional drilling in preparing dental implant osteotomies. In some situations, low-speed drilling without irrigation might offer advantages over conventional drilling. The results should be interpreted with caution due to the low percentage of clinical human studies. Accordingly, more clinical studies are needed to improve the scientific evidence on this topic. CLINICAL RELEVANCE: The low-speed drilling without irrigation is a valid technique for dental implant osteotomy preparation. Its higher quantity and quality of harvested autologous bone might be particularly beneficial in cases of dental implant placement with minor simultaneous bone regeneration.

2.
BMC Oral Health ; 21(1): 143, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752651

RESUMO

BACKGROUND: Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth extraction. This systematic review and meta-analysis aims to determine the FAB thickness and modifying factors of anterior maxillary teeth measured by CBCT scans. A secondary objective was to assess the facial distance from the cementoenamel junction (CEJ) to the bone crest. METHODS: An electronic search was made of Medline, Embase, Web of Science, Cochrane Library and Google Scholar up to December 2019. Studies that analyze and quantitatively compare FAB thickness at maxillary teeth by CBCT scans were included. The methodological quality of the included studies was appraised using the ROBINS-I tool and the overall meta-evidence certainty using the GRADE approach. A single means random-effects meta-analysis was performed to obtain the weighted mean for 95% confidence interval. A meta-regression of covariates and subgroup analysis was conducted. The nullity Qh test and I2 index for heterogeneity was estimated. RESULTS: 2560 potentially relevant articles were recorded from which 29 studies were selected for the qualitative analysis, including 17,321 teeth. Seventeen studies considered the facial bone crest, and 12 the CEJ as a reference point for their measurements. Mean FAB thickness was ≤ 1 mm in maxillary incisors and canines (0.75-1.05 mm) and 1-2 mm in premolars. Patients over 50 years of age, females and thin gingival phenotype was associated with thinner FAB at some apico-coronal locations of maxillary incisors and canines. The geographical setting was an effect modifier that could explain up to 87% of the heterogeneity in FAB thickness, being Asian populations that showed the lowest FAB thickness values. The CEJ-bone crest distance was 2-2.5 mm in all teeth analyzed. Population over 50 years of age exhibited greater CEJ-bone crest distances, and males also showed a trend for greater distance. Evidence certainty has shown moderate quality in most analysis subsets. CONCLUSIONS: Facial alveolar bone at anterior maxillary teeth is thin, heterogeneous in width along its apico-coronal dimensions, and increases in thickness in maxillary premolars. The CEJ-bone crest distance presented homogeneous and similar values in all teeth analyzed.


Assuntos
Processo Alveolar , Maxila , Processo Alveolar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Incisivo/diagnóstico por imagem , Masculino , Maxila/diagnóstico por imagem , Colo do Dente
3.
BMC Oral Health ; 21(1): 100, 2021 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676469

RESUMO

BACKGROUND: To introduce a theoretical solution to a posteriori describe the pose of a cylindrical dental fixture as appearing on radiographs; to experimentally validate the method described. METHODS: The pose of a conventional dental implant was described by a triplet of angles (phi-pitch, theta-roll, and psi-yaw) which was calculated throughout vector analysis. Radiographic- and simulated-image obtained with an algorithm were compared to test effectiveness, reproducibility, and accuracy of the method. The length of the dental implant as appearing on the simulated image was calculated by the trigonometric function and then compared with real length as it appeared on a two-dimensional radiograph. RESULTS: Twenty radiographs were analyzed for the present in silico and retrospective study. Among 40 fittings, 37 resulted as resolved with residuals ≤ 1 mm. Similar results were obtained for radiographic and simulated implants with absolute errors of - 1.1° ± 3.9° for phi; - 0.9° ± 4.1° for theta; 0° ± 1.1° for psi. The real and simulated length of the implants appeared to be heavily correlated. Linear dependence was verified by the results of the robust linear regression: 0.9757 (slope), + 0.1344 mm (intercept), and an adjusted coefficient of determination of 0.9054. CONCLUSIONS: The method allowed clinicians to calculate, a posteriori, a single real triplet of angles (phi, theta, psi) by analyzing a two-dimensional radiograph and to identify cases where standardization of repeated intraoral radiographies was not achieved. The a posteriori standardization of two-dimensional radiographs could allowed the clinicians to minimize the patient's exposure to ionizing radiations for the measurement of marginal bone levels around dental implants.


Assuntos
Implantes Dentários , Humanos , Imageamento Tridimensional , Radiografia , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Int J Implant Dent ; 7(1): 13, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33615421

RESUMO

BACKGROUND: The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation. OBJECTIVE: To learn about the effect of different SSS techniques on alveolar ridge preservation MATERIAL AND METHODS: Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at - 1, - 3, and - 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA). RESULTS: A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (- 1.42 mm in the experimental group versus - 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at - 1, - 3, and - 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences. CONCLUSIONS: There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.

5.
Clin Oral Investig ; 25(4): 1613-1626, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33474623

RESUMO

OBJECTIVE: This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. METHODS: Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value. RESULTS: From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW. CONCLUSION: The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use. CLINICAL RELEVANCE: To know if EMD could improve the results for root coverage.


Assuntos
Proteínas do Esmalte Dentário , Retração Gengival , Teorema de Bayes , Tecido Conjuntivo , Gengiva , Retração Gengival/cirurgia , Gengivoplastia , Humanos , Raiz Dentária , Resultado do Tratamento
6.
J Clin Exp Dent ; 12(11): e1091-e1095, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33262877

RESUMO

An apicomarginal defect can be explained as a total loss of buccal alveolus extending from the original crestal bone to the apex of the tooth. This study presents a case of an apicomarginal defect in a first left molar subjected to periapical surgery with vestibular cortex block replacement and A-PRF + membrane coating approximately one year ago. One-year clinical follow-up was performed, with no evidence of recurrence. This case report discusses periapical surgical treatment and the importance of an interdisciplinary approach to the management of teeth with apicomarginal defects. Key words:Periapical surgery, apicomarginal defect, A-PRF+, bone graft.

7.
J Endod ; 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33271177

RESUMO

INTRODUCTION: A study was made of the healing rate of teeth subjected to endodontic microsurgery after a minimum follow-up of 5 years, with an analysis of the influence of different pre- and postoperative factors upon the outcome. METHODS: A retrospective study was made of patients subjected to endodontic microsurgery with the use of mineral trioxide aggregate (MTA) for retrograde filling between January 2011 and December 2015. In patients with multiple treated teeth, only one random tooth was selected for the statistical analysis. Clinical and radiographic parameters were used to assess healing. Simple binary logistic regression models were used to analyze the influence of patient age and gender, the type of tooth, prior radiographic lesion size, the presence of a post, the type of restoration and the apical extent of prior filling of the root canal upon the endodontic microsurgery success rate. Two calibrated observers evaluated the periapical radiographs on an independent basis. RESULTS: A total of 111 patients (63.1% women and 36.9% men) were included in the study. Of the 111 teeth analyzed, 90 were classified as healed (mean healing rate 81.1%). Patient age and gender, the presence of a post, the type of tooth, the type of restoration and the apical extent of prior filling of the root canal had no significant impact upon the outcome. Large lesions (> 5 mm) were associated to a lower healing rate than smaller lesions, though the difference was not significant. Anterior teeth had a significantly higher healing rate (93.8% maxillary and 100% mandibular) than molars (70.8% maxillary and 57.1% mandibular) (p<0.05). The differences between the anterior teeth and the molars were statistically significant. CONCLUSIONS: The mean healing rate of teeth subjected to endodontic microsurgery was 81% after 5-9 years of follow-up. The success rate was lower for upper and lower molars than for teeth in the anterior zone, though the sample was small and further studies are needed to establish whether the type of tooth influences the treatment outcome.

8.
Spec Care Dentist ; 40 Suppl 1: 3-81, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33202040

RESUMO

BACKGROUND: Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. AIMS: To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. METHODS: Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting. RESULTS: This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided. CONCLUSIONS: Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.


Assuntos
Anestesia Dentária , Epidermólise Bolhosa Distrófica , Epidermólise Bolhosa , Adulto , Criança , Humanos , Saúde Bucal , Guias de Prática Clínica como Assunto , Qualidade de Vida
9.
J Clin Exp Dent ; 12(10): e902-e908, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33154790

RESUMO

Background: Non-surgical treatment of peri-implantitis includes a correct mechanical debridement of the implant surface to reduce the inflammation and recondition the soft tissues. The aim of the study was to evaluate the results of a single phase of non-surgical therapy by comparing the effect of curettes and ultrasounds versus curettes and abrasive air polisher (Air-Flow) in the peri-implant tissue conditions, and patient satisfaction. Material and Methods: A double-blind randomized and controlled prospective clinical study was conducted on patients in peri-implant maintenance phase diagnosed of peri-implantitis treated in the Oral Surgery Unit of the Stomatology Department of the Faculty of Medicine and Dentistry of the University of Valencia, between September of 2017 and May of 2018. They were divided into 2 groups: Group 1: curettes and ultrasounds, and Group 2: curettes and Air-Flow. The clinical and radiological baseline parameters were evaluated after 3-weeks of treatment, as well as patient satisfaction. Results: The sample included 34 patients. Group 1 (17 patients, 38 implants) and Group 2 (17 patients, 32 implants). All the variables improved statistically significantly after treatment in both groups, with the exception of recessions and keratinized mucosa and bone loss that did not vary. When comparing both groups, the type of treatment did not influence the majority of the variables, with the exception of the plaque index (p=0.011) and modified bleeding index from the palatine (p=0.048), which reduced statistically significant in the group 2, as well as the patient satisfaction which was higher in the group 2 (p<0.001). Conclusions: An initial phase of non-surgical treatment achieves an improvement of the peri-implant clinical parameters, thought the method of debridement used seems not to influence. Key words:Peri-implantitis, peri-implant disease, non-surgical treatment, air-abrasive device, mechanical debridement.

10.
J Clin Exp Dent ; 12(10): e972-e978, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33154800

RESUMO

Background: A systematic review of clinical studies with at least one year of follow-up was done to assess the success rate of endodontic surgery including endoscopy for magnification and illumination. Material and Methods: Five electronic databases were searched, including MEDLINE (via PubMed), Embase, Web of Science, Scopus and the Cochrane Library of the Cochrane Collabora-tion (CENTRAL). There were no language restrictions, and the search covered the period up to October 2019. The risk of bias was evaluated with the Cochrane Collaboration tool for randomized clinical trials and the ROBINS-I tool for non-randomized studies of inter-ventions. Results: From the 278 initially identified titles, finally 2 randomized controlled trials and 3 non-randomized studies met the inclusion criteria. All the included studies analyzed the success rate of endodontic surgery performed with the help of endoscope for magnifica-tion and illumination. The risk of bias was high for allocation sequence concealment and blinding of participants and personnel in the randomized controlled trials. The nonran-domized studies showed limitations in terms of confounding bias and blinding of outcome assessment. Endodontic surgery with the help of an endoscope is associated with high success rates (88.9-94.9%). Conclusions: The endoscope was associated with high success rates of endodontic sur-gery in the included studies. Future studies on this topic are warranted, due to the meth-odological issues and the scarce number of randomized clinical trials. Key words:Endodontic surgery, magnification, endoscope, success.

11.
Oral Dis ; 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33031620

RESUMO

OBJECTIVES: To use tissue engineering muscle repair (TEMR) for regenerating the lingual musculature of hemiglossectomized rats using neonatal myoblasts (NM) on porcine acellular urinary bladder matrix (AUBM). MATERIAL AND METHODS: The study used 80 male rats. A volumetric muscle loss (VML) injury was created on the left side of the tongue. The rats were randomized into four groups: Group 1 (AUBM + myoblasts); Group 2 (AUBM); Group 3 (myoblasts); and Group 4 (control). NM were obtained from neonatal rats. The animals were weighed on day 0 and just before euthanasia. Five rats in each group were euthanized at days 2, 14, 28, and 42; the tongues were prepared for morphometric analysis, postoperative left hemitongue weight, and immunohistochemical analysis (desmin, CD-31, and anti-neurofilament). RESULTS: The weight gain from greatest to least was as follows: AUBM + myoblasts > myoblasts > AUBM > control. The tongue dorsum occupied by VML, and difference in mg between control side and intervened side from least to great was as follows: AUBM + myoblasts < myoblasts < AUBM < control. The order from highest to lowest antibody positivity was as follows: AUBM + myoblasts > myoblasts > AUBM > control. CONCLUSION: The use of porcine AUBM and NM for the regeneration of lingual musculature was found to be an effective TEMR treatment for repairing tongue VML injury.

12.
Int J Implant Dent ; 6(1): 71, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33111201

RESUMO

OBJECTIVE: The objective of the study was to evaluate the relation between occlusal loading and peri-implant crevicular fluid cytokine expression in patients with implant-supported complete fixed prostheses in both arches. MATERIAL AND METHODS: A prospective longitudinal clinical study was performed at a university clinic. Fifteen patients were selected and 11 were included. All patients had bimaxillary implant-supported complete fixed ceramo-metallic prostheses loaded at least 12 months before the beginning of the study. Allocation was established for each patient using a computerized occlusal analysis system. The test implant was the maxillary implant closest to the point of highest occlusal loading. The maxillary implant with least loading was the control implant. Occlusal adjustment was performed using a round diamond burr. This occlusal distribution was verified with the occlusal analysis system. Expression of cytokines from peri-implant crevicular fluid (TNF-α, IL-10, IL-6, IL-1ß, IL-8) were recorded and analyzed in both test and control implants before (baseline: T0) and 2 (T1) and 12 months (T2) after occlusal adjustment. The Brunner-Langer non-parametric test was performed. RESULTS: At T0, the expression of IL-10 was significantly higher in the test group implants (p = 0.018). Between T0 and T1, the expression of all the cytokines decreased in the implants of both groups with statistically significant differences, except for TNF (p = 0.271). When comparing both groups at T1, there was no statistically significant difference in any of the analyzed cytokines. At T2, TNF-α suffered when compared with baseline, a statistical decrease in both study and control implants (p < 0,001). At T2, there were no statistically significant differences between groups in any of the cytokines analyzed. CONCLUSIONS: Implants with higher occlusal load presented higher expression of IL-10 in peri-implant crevicular fluid. Occlusal adjustment produced a decrease in the expression of all the analyzed cytokines, both in test and control implants.

13.
J Clin Exp Dent ; 12(9): e870-e876, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32994877

RESUMO

Background: Subcrestal implant placement has been suggested as a method that could contribute to maintain the periimplant soft and hard tissues in comparison with crestal placement. The objective of this study was to investigate the relationship between implant placement at different depths in the alveolar bone and (a) the thickness of the buccal bone plate (BBP); and (b) crestal cortical bone thickness, based on the use of cone-beam computed tomography (CBCT). Material and Methods: A cross-sectional study was performed, analyzing CBCT scans from the database of the Oral Surgery Unit of the University of Valencia. Individuals with single missing teeth in posterior sectors were included. Two trained dentists used a software application to plan implant placement at four different depths from the bone crest (from 0-2 mm subcrestal). The thickness of the BBP was measured at each established depth, tracing a line from the implant platform to the outermost part of the facial alveolar bone, and the ratio between the implant platform and cortical bone thickness was calculated. Results: The study sample consisted of 64 patients. In the case of implants placed in a crestal position, the distance from the platform to the BBP was 1.99±1.10 mm. This distance increased significantly (p<0.001) with the planned implant placement depth, reaching an average of 2.90±1.22 mm when placement was 2 mm subcrestal. Subcrestal implant placement at this depth implied surpassing the cortical bone in 91% of the cases. Conclusions: Radiological planning of implant placement in a subcrestal position results in a greater distance from the implant platform to the BBP. In general terms, planning implant placement at a depth of 2 mm subcrestal surpassed the cortical bone in 91% of the cases. Key words:Subcrestal implant, cortical bone thickness, buccal bone plate, cone-beam computed tomography.

14.
Artigo em Inglês | MEDLINE | ID: mdl-32971869

RESUMO

Background: to assess the radiological marginal bone loss between bone-level or tissue-level dental implants through a systematic review of literature until September 2019. Methods: MEDLINE, Embase and other database were searched by two independent authors including only English articles. Results: The search provided 1028 records and, after removing the duplicates through titles and abstracts screening, 45 full-text articles were assessed for eligibility. For qualitative analysis 20 articles were included, 17 articles of them for quantitative analysis counting a total of 1161 patients (mean age 54.4 years) and 2933 implants, 1427 inserted at Tissue-level (TL) and 1506 inserted at Bone-level (BL). The survival rate and the success rate were more than 90%, except for 2 studies with a success rate of 88% and 86.2%. No studies reported any differences between groups in term of success and survival rates. Three studies showed that BL-implants had statistically less marginal bone loss (p < 0.05). Only one study reported statistically less marginal bone loss in TL-implants (p < 0.05). Conclusion: In the most part of the studies, differences between implant types in marginal bone loss were not statistically significant after a variable period of follow-up ranged between 1 and 5 years.

15.
Med. oral patol. oral cir. bucal (Internet) ; 25(5): e634-e643, sept. 2020. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-196519

RESUMO

BACKGROUND: Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery. MATERIAL AND METHODS: A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl(TM)) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR = 0.11; p = 0.06). CONCLUSIONS: No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hemostasia Cirúrgica/métodos , Raiz Dentária/cirurgia , Cavidade Pulpar/cirurgia , Hemostáticos/uso terapêutico , Dente Molar/cirurgia , Politetrafluoretileno/uso terapêutico , Epinefrina/uso terapêutico , Cloreto de Alumínio/uso terapêutico , Tratamento do Canal Radicular/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Modelos Logísticos , Resultado do Tratamento , Maxila/cirurgia
16.
Odontology ; 2020 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772215

RESUMO

To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. - 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance.

17.
J Clin Exp Dent ; 12(6): e581-e587, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32665818

RESUMO

Background: The aims of this study were: 1) compare the amount of anesthesia used with the anesthetic technique; 2) relate the quantity of anesthesia needed with the level of anxiety of the patient; 3) study the relationship between the anesthetic technique and the level of hemostasis; 4) correlate the amount of anesthesia with patient and tooth dependent variables. Material and Methods: A randomized controlled trial was designed with two parallel groups according to the anesthetic technique: infiltrative local anesthesia (infiltrative group) and inferior alveolar nerve block (block group). The following variables were collected: sex, age, smoking habits, plaque index, symptoms, signs, position of the tooth and amount of anesthesia. Before surgery, all patients were asked to assess their anxiety on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The analysis of the hemorrhage control of aluminum chloride was judged by the surgeon and two examiners independently and recorded it as: 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). Results: Twenty patients were included in this preliminary report. The amount of anesthesia used was lower in block group and in less anxious patients, although these results did not reach statistical significance. A relationship was found between the quantity of anesthesia used and a good hemostasis of the bony crypt before the application of the hemostatic agent (p<.05); and between elderly patients and a lower amount of anesthetic reinforcement (p<.05). Conclusions: Based on these preliminary results, we can conclude that no statistical significance difference was found between the amount of anesthesia used and the anesthetic technique or the anxiety. A relationship was found between hemostasis of the bony crypt and the quantity of anesthesia used; and between younger patients and a greater amount of anesthetic reinforcement. Key words:Anesthesia, anxiety, endodontic surgery, hemostasis, hemostatic agents,periradicular surgery.

18.
Med. oral patol. oral cir. bucal (Internet) ; 25(4): e449-e454, jul. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-196495

RESUMO

BACKGROUND: The aim of the authors was to examine the abutment-fixture interface in Morse-type conical implants in order to verify gaps at this level using a new microscopical approach. MATERIAL AND METHODS: In this in vitro study, 20 abutment-fixture complexes were prepared by sectioning (longitudinal and cross-sectional to the long axis) with a microtome and then with a focused ion beam (FIB). This is a micrometric machine tool that uses gallium ions to abrade circumscribed areas to dig deeper into the cuts obtained with the microtome in order to eliminate cut-induced artifacts. This is because the FIB abrasion is practically free from artifacts, which are normally generated by the action of the microtome blades or other techniques. Samples were then observed by scanning electron microscopy (SEM). RESULTS: The observation of the abraded parts with the FIB permitted measurement of the real gap between the implant-abutment components. A variable amount of gap was retrieved (from 0 to 3 μm) by the observations, confirming the non-hermetic nature of the connection. It has to be pointed out that in approximately 65% of cases, the gap accounted for less than 1 μm. CONCLUSIONS: The reported data confirmed that the analyzed connection system allowed for minimal gap. However, from the evidence of the present analysis, it cannot be assumed that the 2 parts of a Morse-type conical implant are fused in 1 piece, which would create a perfectly matched hermetic connection


No disponible


Assuntos
Projeto do Implante Dentário-Pivô/métodos , Implantação Dentária Endo-Óssea/métodos , Propriedades de Superfície , Valores de Referência , Microscopia Eletrônica de Varredura , Reprodutibilidade dos Testes
19.
Int J Oral Implantol (Berl) ; 13(2): 161-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32424382

RESUMO

PURPOSE: To describe implant survival at least 1 year after the surgical treatment of early apical peri-implantitis (EAP) and explore potential risk factors of failure of such treatment. MATERIALS AND METHODS: An ambispective cohort study was conducted, involving all patients in whom EAP was detected and surgically treated between 1996 and 2016. Reporting followed the STROBE guidelines. The time from implant placement (IP) to EAP surgery (EAPS), the diagnostic stage and intraoperative variables (location, apical lesion in the tooth being replaced, mesial and distal tooth-implant distance measured at the apex, periapical surgery of the adjacent tooth, guided bone regeneration, implant resection, explantation) were recorded to determine their impact upon treatment outcome. RESULTS: The initial sample consisted of 58 implants in 46 patients. The mean time from IP to EAPS was 21.7 ± 10.1 days. At the time of surgery, eight implants presented mobility and were explanted. The final sample consisted of 50 implants in 39 patients evaluated for implant survival after surgical treatment. A cumulative survival rate of 78.3% was recorded. The mean survival time of the EAP treated implants was 85.4 months (standard deviation [SD] 5.94). The diagnostic stage (P < 0.001) and the existence of a previous periapical lesion in the tooth being replaced (P = 0.022) had a significant influence upon implant survival. CONCLUSIONS: The cumulative survival rate was 78.3%, with a mean survival time of 85.4 months. The diagnostic stage of EAP and the presence of a lesion in the tooth being replaced significantly influenced the survival of implants with EAP subjected to surgical treatment.


Assuntos
Implantes Dentários , Peri-Implantite , Estudos de Coortes , Humanos , Fatores de Risco , Resultado do Tratamento
20.
Materials (Basel) ; 13(8)2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32325829

RESUMO

OBJECTIVE: An in vitro study was made to compare mean thermal variation according to the material, design and wear of the surgical drills used during dental implant site preparation. MATERIAL AND METHODS: Three study groups (stainless steel drills with straight blades; diamond-like carbon-coated drills with straight blades; and diamond-like carbon-coated drills with twisted blades) were tested to compare material, design and wear of the surgical drill in terms of overall mean values (complete sequence of drills) and specific mean values (each drill separately). The groups comprised four drills: initial, pilot, progressive and final drill. Implant site configuration was performed through an intermittent and gradual drilling technique without irrigation at 800 rpm in standardized synthetic blocks. Maximum axial loading of two kilograms was controlled by an automatic press. Each surgical drill was submitted to 50 drillings and was sterilized every five uses. A thermographic camera analyzed the mean thermal changes. The software-controlled automatic press kept systematic drilling, axial loading and operational speed constant without any human intervention. Student's t-test, ANOVA and multiple linear regression models were performed. The level of significance was 5% (p = 0.05). RESULTS: The overall mean comparison between the stainless steel and diamond-like carbon-coated materials showed no statistically significant differences (p > 0.05), though specific mean comparison showed statistically significant differences between the drills of the different groups (p < 0.05). The twisted blades exhibited less overall and specific mean thermal variation than straight blades for the progressive and final drills (p < 0.01). In addition, the initial and pilot drills showed a greater mean thermal change than the progressive and final drills. The mean thermal variation was seen to increase during the 50 drillings. CONCLUSIONS: Within the limitations of this study, it can be concluded that the drill material did not significantly influence the overall mean thermal variation except for the pilot drill. The drill design affected overall and specific mean thermal variation since the twisted blades heated less than the straight blades. The initial and pilot drills increased the specific mean thermal variation with respect to the progressive and final drills. In addition, all drills in each group produced a gradual increase in mean temperature during the 50 drillings.

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