Stress Distribution in an Implant-Supported Mandibular Complete Denture Using Different Cantilever Lengths and Occlusal Coating Materials.

PURPOSE: The aim of this study was to assess stress distribution in the bone-implant interface of a mandibular implant-supported prosthesis with different cantilever lengths, aesthetic coating materials, and implant abutments. MATERIALS AND METHODS: A photoelastic model of an edentulous mandible, containing 5 external hexagon implants, was constructed. Experimental models were divided into 6 groups: group 1-UCLA component and metal bar; group 2-UCLA component and acrylic resin coating; group 3-UCLA component and porcelain coating; group 4-abutment and metal bar; group 5-abutment and acrylic resin coating; and group 6-abutment and porcelain coating. Forces were applied to the most anterior implant, the most posterior implant, and different cantilever lengths. RESULTS: The results showed a higher number of high-stress fringes as the cantilever length increased. Fringes were better distributed in groups with prostheses composed of acrylic resin and in groups that contained an abutment. CONCLUSION: The stress distribution in the bone-implant interface is improved when the cantilever is eliminated and when abutments in an acrylic resin prosthesis are used.

Biocompatibility of primers and an adhesive used for implant-retained maxillofacial prostheses: An in vitro analysis.

STATEMENT OF PROBLEM: Implant-retained maxillofacial prostheses should be biocompatible, regardless of the primers and adhesives used to bond the acrylic resin and facial silicone. The authors are unaware of any study evaluating the influence of these primers and adhesives on the biocompatibility of maxillofacial prostheses. PURPOSE: The purpose of this in vitro study was to evaluate the cytotoxic effect of primers and an adhesive used to bond acrylic resin and facial silicone during the fabrication of implant-retained maxillofacial prostheses. MATERIAL AND METHODS: Twenty-eight circular specimens made of resin and silicone were fabricated, either bonded or nonbonded with primer and adhesive. The specimens were divided into 7 groups: resin; silicone; resin+silastic medical adhesive type A+silicone; resin+DC 1205 primer silicone; resin+Sofreliner primer+silicone; resin+DC 1205 primer+silastic medical adhesive type A+silicone; and resin+Sofreliner primer+silastic medical adhesive type A+silicone. Eluates of the materials tested were prepared by setting 4 specimens of each experimental group in Falcon tubes with medium and incubating at 37°C for 24 hours. The eluate cytotoxicity was evaluated by an assay of survival/proliferation ((3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide [MTT] test) in cultures of human keratinocytes. The levels of IL1, IL6, TNFα, and the chemokine MIP-1α were evaluated by enzyme-linked immunosorbent assay. The mRNA expressions for MMP-9, TGF-ß, and collagen type IV were analyzed by the real time polymerase chain reaction. Data were submitted to analysis of variance with Bonferroni post hoc tests (α=.05). RESULTS: An increased cell proliferation was observed for the RAS group, with statistically significant differences (P<.001) compared with the unstimulated group. The RDCpS group showed the highest IL6 concentration values (P<.001). No significant statistical difference was found in the relative quantification of mRNA for collagen type IV, MMP9, or TGFß between the groups (P>.05). CONCLUSIONS: The RAS group showed the highest cell proliferation percentage, while the RDCpS group exhibited the highest IL6 concentration values. No detectable levels of IL1ß, TNF α, or CCL3/MIP1α were observed. The tested materials showed no toxic effects on the HaCaT cell line.

Effect of different methods of polymerizing ocular prosthesis acrylic resin on a human conjunctival cell line.

STATEMENT OF PROBLEM: Ocular prosthesis acrylic resins should be biocompatible regardless of the polymerization method. The authors are unaware of a study that evaluated the biocompatibility of ocular prostheses. PURPOSE: The purpose of this in vitro study was to evaluate the cytotoxicity of different methods of polymerizing ocular prosthesis acrylic resin. This was accomplished by analyzing the cell proliferation, production of proinflammatory cytokines, and expression of extracellular matrix proteins related to tissue remodeling and repair of a human conjunctival cell line. MATERIAL AND METHODS: Nine acrylic resin specimens were divided into 3 groups: polymerization in a water bath, by microwave, or by autopolymerization. Eluates (prepared for 72 hours) were exposed to cells for 72 hours. A medium without specimens served as negative control (nonstimulated group). The tetrazolium dye MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay was performed to evaluate the cytotoxic effect, and an enzyme-linked immunosorbent assay was executed for analysis of interleukin 1 ß (IL1ß), IL6, tumor necrosis factor α (TNFα), and CCL3/MIP1α production. Also, real-time reverse transcriptase (RT)-PCR was performed for analysis of mRNA expression of type IV collagen (COL IV), TGFß, and MMP9, and data were tested using ANOVA with Bonferroni post hoc test (α=.05). RESULTS: Microwave-processed resin showed slight cytotoxicity due to a significant reduction in cell proliferation and an increase in IL6 quantity. Higher levels of mRNA expression of COL IV, MMP9, and TGFß were verified in water bath-processed resin, which were similar to those in the nonstimulated group. CONCLUSIONS: Microwave-processed resin showed a significant reduction in cell proliferation and an increase in IL6 quantity. Heat-polymerized resin exhibited a higher mRNA expression of COL IV, MMP9, and TGFß; this result was similar to that in the nonstimulated group.

Influence of colorant solutions in properties of indirect resin composites.

PURPOSE: To evaluate the influence of colorant solutions on color stability and surface roughness of indirect resin composites submitted to prior immersion in mouthwashes. METHODS: Five brands of indirect resin composites were assessed: Adoro, Resilab, Cristobal, Sinfony and Epricord. The specimens were immersed in five different solutions (n = 10): four mouthwashes (Listerine, Oral-B, Plax, Periogard) and artificial saliva (control). 60 hours after immersion in mouthwashes, the specimens were exposed to coffee solution. Shade stability and surface roughness were tested by a spectrophotometer and by a profilometer, respectively. A three-way repeated-measures ANOVA was performed. Differences between the values were compared by the Tukey-Kramer test (P < 0.05). RESULTS: The majority of the specimens showed human-perceptible color change. Greater color change was observed after immersion in coffee, except for Cristobal. The color change was even higher for specimens previously immersed in mouthwashes. The Epricord resin showed the lowest roughness value and the Cristobal showed the highest value, regardless of the period. The highest roughness change occurred after immersion in Listerine.

Surface characterization of lithium disilicate ceramic after nonthermal plasma treatment.

STATEMENT OF PROBLEM: Surface transformation with nonthermal plasma may be a suitable treatment for dental ceramics, because it does not affect the physical properties of the ceramic material. PURPOSE: The purpose of this study was to characterize the chemical composition of lithium disilicate ceramic and evaluate the surface of this material after nonthermal plasma treatment. MATERIAL AND METHODS: A total of 21 specimens of lithium disilicate (10 mm in diameter and 3 mm thick) were fabricated and randomly divided into 3 groups (n=7) according to surface treatment. The control group was not subjected to any treatment except surface polishing with abrasive paper. In the hydrofluoric acid group, the specimens were subjected to hydrofluoric acid gel before silane application. Specimens in the nonthermal plasma group were subjected to the nonthermal plasma treatment. The contact angle was measured to calculate surface energy. In addition, superficial roughness was measured and was examined with scanning electron microscopy, and the chemical composition was characterized with energy-dispersive spectroscopy analysis. The results were analyzed with ANOVA and the Tukey honestly significant difference test (α=.05). RESULTS: The water contact angle was decreased to 0 degrees after nonthermal plasma treatment. No significant difference in surface roughness was observed between the control and nonthermal plasma groups. Scanning electron microscopy and energy-dispersive spectroscopy images indicated higher amounts of oxygen (O) and silicon (Si) and a considerable reduction in carbon (C) in the specimens after nonthermal plasma treatment. CONCLUSIONS: Nonthermal plasma treatment can transform the characteristics of a ceramic surface without affecting its surface roughness. A reduction in C levels and an increase in O and Si levels were observed with the energy-dispersive spectroscopy analysis, indicating that the deposition of the thin silica film was efficient.

In vitro analysis of different properties of acrylic resins for ocular prosthesis submitted to accelerated aging with or without photopolymerized glaze.

The effect of a photopolymerized glaze on different properties of acrylic resin (AR) for ocular prostheses submitted to accelerated aging was investigated. Forty discs were divided into 4 groups: N1 AR without glaze (G1); colorless AR without glaze (G2); N1 AR with glaze (G3); and colorless AR with glaze (G4). All samples were polished with sandpaper (240, 600 and 800-grit). In G1 and G2, a 1200-grit sandpaper was also used. In G3 and G4, samples were coated with MegaSeal glaze. Property analysis of color stability, microhardness, roughness, and surface energy, and assays of atomic force microscopy, scanning electron microscopy, and energy-dispersive spectroscopy were performed before and after the accelerated aging (1008h). Data were submitted to the ANOVA and Tukey Test (p<0.05). Groups with glaze exhibited statistically higher color change and roughness after aging. The surface microhardness significantly decreased in groups with glaze and increased in groups without glaze. The surface energy increased after the aging, independent of the polishing procedure. All groups showed an increase of surface irregularities. Photopolymerized glaze is an inadequate surface treatment for AR for ocular prostheses and it affected the color stability, roughness, and microhardness. The accelerated aging interfered negatively with the properties of resins.

Toxicity analysis of ocular prosthesis acrylic resin with or without pigment incorporation in human conjunctival cell line.

The aim of this study was to evaluate the influence of pigment incorporation on the cytotoxicity of ocular prosthesis N1 color acrylic resin. Nine samples were manufactured by heat-polymerization in water bath and divided into 3 groups: acrylic resin without pigment incorporation (group R), acrylic resin with pigment incorporation (group RP), and acrylic pigment (group P). Eluates formed after 72h of sample immersion in medium were incubated with conjunctival cell line (Chang conjunctival cells) for 72h. The negative control group consisted in medium without samples (group C). The cytotoxic effect from the eluates was evaluated using MTT assay (cell proliferation), ELISA assay (quantification of IL1ß, IL6, TNF α and CCL3/MIP1α) and RT-PCR assay (mRNA expression of COL IV, TGF ß and MMP9). Data were submitted to ANOVA with Bonferroni post-tests (p<0.05). All groups were considered non-cytotoxic based on cell proliferation. However, resin with pigment incorporation showed significant IL6 quantity increase. Resin without pigment incorporation exhibited higher mRNA expression of COL IV, MMP9 and TGF ß, however it was also observed for the negative control group. The materials exhibited divergent biological behavior. Despite the pigment incorporation that resulted in an increase of IL6, no cytotoxicity was observed based on cell proliferation.

Is the internal connection more efficient than external connection in mechanical, biological, and esthetical point of views? A systematic review.

PURPOSE: This systematic review aimed to evaluate if the internal connection is more efficient than the external connection and its associated influencing factors. METHODS: A specific question was formulated according to the Population, Intervention, Control, and Outcome (PICO): Is internal connection more efficient than external connection in mechanical, biological, and esthetical point of views? An electronic search of the MEDLINE and the Web of Knowledge databases was performed for relevant studies published in English up to November 2013 by two independent reviewers. The keywords used in the search included a combination of "dental implant" and "internal connection" or "Morse connection" or "external connection." Selected studies were randomized clinical trials, prospective or retrospective studies, and in vitro studies with a clear aim of investigating the internal and/or external implant connection use. RESULTS: From an initial screening yield of 674 articles, 64 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full texts of these articles were obtained with 29 articles fulfilling the inclusion criteria. Morse taper connection has the best sealing ability. Concerning crestal bone loss, internal connections presented better results than external connections. The limitation of the present study was the absence of randomized clinical trials that investigated if the internal connection was more efficient than the external connection. CONCLUSIONS: The external and internal connections have different mechanical, biological, and esthetical characteristics. Besides all systems that show proper success rates and effectiveness, crestal bone level maintenance is more important around internal connections than external connections. The Morse taper connection seems to be more efficient concerning biological aspects, allowing lower bacterial leakage and bone loss in single implants, including aesthetic regions. Additionally, this connection type can be successfully indicated for fixed partial prostheses and overdenture planning, since it exhibits high mechanical stability.

The importance of the lifelike esthetic appearance of all-ceramic restorations on anterior teeth.

The success of rehabilitation will not depend on just clinical procedures. A proper dental technique (ceramist) is required as well as the respect for some biomimetic principles to obtain the desired final result. This study has the purpose of describing a prosthetic rehabilitation with laminate veneers and all-ceramic crowns of a patient unsatisfied with a previous esthetic treatment because of the negligence of some biomimetic principles. A 45-year-old female patient was admitted to the dental clinic complaining about the lifelike appearance of her all-ceramic restorations. Before the fabrication of new restorations, a mock-up was conducted to verify the patient's satisfaction. A ceramist conducted all the fabrication process so that surface characterizations could be visually verified and the lifelike appearance of natural tooth could be reproduced. After the cementation procedure, the patient reported being satisfied with the lifelike appearance of the new restorations. Based on the clinical findings of the present case report, it can be concluded that the reproduction of the lifelike esthetic appearance of natural teeth and the visualization of the final results before definitive procedures are essential to obtain the clinical success.

Fratura de côndilo mandibular não tratada e disfunção temporomandibular: relato de caso / Untreated mandibular condyle fracture and temporomandibular dysfunction: a case report

A fratura de côndilo mandibular é um dos tipos de traumas faciais mais comuns, podendo ser diagnosticado por diversos meios, sendo que uma variedade de planos de tratamentos podem ser instaurados. Este tipo de fratura configura também uma das etiologias da disfunção temporomandibular (DTM), portanto, é indispensável que o profissional realize exames minuciosos, inclusive por meio de exames complementares de imagem para o correto diagnóstico e conduta curativa, tanto da fratura, quanto da disfunção. Sendo assim, o objetivo deste estudo foi descrever um caso de fratura de côndilo mandibular não tratada seguida de DTM. Paciente de 36 anos do gênero masculino com histórico de acidente automobilístico há cinco anos, resultando em fratura de côndilo, com diagnóstico tardio e consolidação em posição inadequada buscou tratamento na Faculdade de Odontologia de Araçatuba - UNESP. A conduta por meio do uso de placa interoclusal levou à eliminação da sintomatologia dolorosa(AU)

The condylar fracture is one of the most common types of facial trauma and can be diagnosed by different methods, and a variety of treatment plans can be used. This type of fracture also constitutes one of the etiologies of temporomandibular disorders (TMD). Therefore, it is essential that the professional conduct thorough examinations, including complementary imaging tests for the correct diagnosis and treatment of the fracture and the dysfunction. Thus, the aim of this study was to describe a case of untreated condylar fracture followed by the development of TMD. A 36-year-old male patient with a history of automobile accident five years ago, resulting in condylar fracture, sought treatment at the Aracatuba Dental School - UNESP. The fracture had late diagnosis and consolidation in a wrong position. The conduct treatment through the use of occlusal splint led to the elimination of the painful symptomatology(AU)

Biocompatibilidade de primers e adesivo utilizados na confecção de próteses maxilofaciais implantorretidas: análise in vitro / Biocompatibility of primers and adhesive utilized for implant-retained maxillofacial prostheses: in vitro analysis

A prótese bucomaxilofacial implantorretida pode ser suportada por pele ou por mucosa. Subprodutos dos materiais utilizados na confecção destas próteses podem atuar como irritantes ou causadores de reações alérgicas a tais tecidos. A proposta do presente estudo foi avaliar a citotoxicidade de primers e adesivo utilizados na confecção de próteses maxilofaciais retidas por implantes, por meio da análise da proliferação celular e da produção de citocinas pró-inflamatórias e de proteínas de matriz extracelular por queratinócitos humanos. Foram confeccionadas 28 amostras de resina e silicone, em forma de discos (10 x 1 mm), unidas ou não pela aplicação de primer e/ou adesivo. Estas amostras foram distribuídas em 7 grupos: Resina (R), Silicone (S), Resina + Silastic Medhical Adhesive Type A + Silicone (RAS), Resina + DC 1205 primer + Silicone (RDCpS), Resina + Sofreliner primer + Silicone (RSpS), Resina + DC 1205 primer + Silastic Medhical Adhesive Type A + Silicone (RDCpAS) e Resina + Sofreliner primer + Silastic Medhical Adhesive Type A + Silicone (RSpAS). Os extratos dos materiais testados foram preparados colocando-se quatro amostras de cada grupo experimental em tubos de ensaio contendo 9 mL de meio de cultura DMEM (Dulbecco’s Modified Eagle’s) e incubados a 37°C por 24 horas. Após o período de incubação, a citotoxicidade dos extratos foi avaliada pelo ensaio de MTT em cultura de queratinócitos humanos (HaCaT). Foi avaliada, também, a produção das citocinas IL-1, IL-6 e TNF-α e a quimiocina MIP-1α por meio do ensaio ELISA (Ensaio Imunoabsorbente de Ligação Enzimática). Também foi avaliada a expressão de RNAm para MMP-9, TGF-β e COL-IV por meio da técnica de RT-PCR em tempo real (Reação em Cadeia da Polimerase em Tempo Real). Os dados obtidos foram submetidos à Análise de Variância (ANOVA), seguido pelo teste Bonferroni, com nível de significância de 5%. Foi possível verificar maiores percentuais de proliferação celular para o grupo RAS, com diferença...

The implant-retained maxillofacial prosthesis can be supported by skin and mucosa. The sub-products produced by the materials used to fabricate these prostheses may act as an irritant factor and cause allergy in these tissues. The aim of this study was to evaluate the cytotoxic effect of primers and adhesive used to bond the acrylic resin and the facial silicone during implant-retained maxillofacial prosthesis fabrication, through the analysis of the cell proliferation, and the production of proinflammatory cytokines and extracellular matrix proteins by keratinocytes. A total of 28 round shape samples (10 x 1 mm) made of resin and silicone bonded or not with primer and adhesive was fabricated. Samples were divided into 7 groups: Resin (R), Silicone (S), Resin + Silastic Medical Adhesive Type A + Silicone (RAS), Resin + DC 1205 primer + Silicone (RDCpS), Resin + Sofreliner primer + Silicone (RSpS), Resin + DC 1205 primer + Silastic Medical Adhesive Type A + Silicone (RDCpAS), and Resin + Sofreliner primer + Silastic Medical Adhesive Type A + Silicone (RSpAS). Extracts of tested materials were prepared setting four samples of each experimental group in Falcon tube with 9mL of medium (Bulbecco’s Modified Eagle’s) and incubated at 37°C for 24 hours. After incubation period, the extract cytotoxicity was evaluated by an assay of cell survival/proliferation (MTT test) in cultures of human keratinocytes (HaCaT). The levels of IL-1, IL-6 and TNF-α and the chemokine MIP-1α were evaluated by ELISA (Enzyme-Linked Immunoabsorbent Assay). The mRNA expression for MMP-9, TGF-β and collagen type IV were analyzed by the RT-PCR (Real time polymerase chain reaction). Data were submitted to the analysis of variance with Bonferroni post-tests (p<0.05). The results showed increased cell proliferation for the RAS group. The RDCpS group showed the highest IL6 concentration values when compared to other groups. Regarding the relative quantification of mRNA for collagen type IV, MMP9...