Análise clínica, tomográfica e histológica comparativa entre ha+β-tcp isolado ou associado a proteínas derivadas do esmalte utilizadas como enxertos após a elevação da membrana do seio maxilar e colocação de implantes: estudo piloto

The aim of this study was to evaluate the clinical, tomographic, and histological similarity within the use of HA+β-TCP (Boneceramic) alone or associated with enamel matrix derived (EMD) proteins in sinus lifting procedures with subsequent dental implant placement. We selected two patients with residual bony ridges between 3 mm and 5 mm in height in need of bone grafts. Six months later, eight implants were installed (two implants at each site). Biopsies were made, and the tissue was processed and stained with HE solution. Tomographic evaluation showed bone height gain up to 10.0 mm on average. Histology showed new bone formation for both groups, with similar bone density and trabecular interconnectivity. It can be concluded that the HA+β-TCP graft isolated or associated to EMD provided bone height gain in sinus lifting procedures, with similar clinical, tomographic and histological characteristics.

Uso de um distrator ósseo dentoimplantossuportado, feito a partir de tornos expansores convencionais, na reabilitação oral

Osteodistraction is a clinical reality, available in the last decades for the resolution of large bone deficiencies, in cases that there are pre-existing, but misplaced implants and teeth. The aims of thearticle is to present a case report in which a new possibility for bone distraction, based on tooth-implant bone distractors, made from standard orthodontic expansion-screws, was used in an area where there was an extensive need of alveolar bone and aesthetical recovery, allied to teeth and dental implant misplacement. This technique presented good clinical results, associated to effective simplicity and low cost, becoming viable clinical solution for bone tissue augmentation and aesthetical optimization. In resume, it is possible to say that the suggested technique achieved its objectives, improving the hard and soft tissue profile, whilst allowing completion of oral rehabilitation.

Uma opção terapêutica para o aumento da faixa de gengiva inserida: o enxerto de tecido conjuntivo livre

Several periodontal procedures have been described in the literature to correct mucogingival alterations or to achieve root coverage. The epithelized free gingival graft is a well established periodontal surgery to increase the width of keratinized gingiva with good stability in the long term follow up. However, this procedure is not commonly used in aesthetic areas since the grafted tissue presents differences of color and contrast. The free connective tissue graft emerges as a viable option to increase attached gingiva in areas where aesthetics results are required. The removal of an epithelized free gingival graft from the hard palate region creates a sore and raw surgical wound that slowly repairs, while the connective tissue graft produces only a line of incision that can be easily sutured promoting a more confortable outcome for the patient. This paper aims to report a case where a free connective tissue graft was used to increase the width of attached gingiva in a tooth with gingival recession. This technique presented satisfactory esthetics results, with a better contrast and color matching with the surrounding tissues.

The H2S-releasing naproxen derivative, ATB-346, inhibits alveolar bone loss and inflammation in rats with ligature-induced periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reabilitação oral de paciente com síndrome da combinação: relato de caso

The Combination Syndrome represents an important pathologic condition of the masticatory system that requires a complex rehabilitation treatment. The presence of flaccid mucosa is one of the most common features due to bone resorption of the pre-maxilla caused by anterior hyperfunction of the mandibular teeth on the maxillary complete denture, where the impact of oclusal loading in this region results in movement of the maxillary prosthesis into the ridge, resulting in increased resorption of the residual ridge, internal misfit and loss of the retention of the maxillary complete denture. The presence of flaccid mucosa, in such cases, leads to problems of support and stability of the maxillary complete denture, which can be treated by surgical reduction of the thickness of the tissue or using specific techniques of fabrication of prostheses. This article describes the oral rehabilitation of a patient with the Combination Syndrome where the surgical reduction of flaccid mucosa was not performed, using a modified technique of functional impression in two steps, with the objective of generating forces and less distortion in flaccid mucosa during functional impression.

Dynamic functional impression technique fo severely resorbed alveolar ridges

The process of bone resorption can reduce the volume of the alveolar crest, which makes may make difficult impression taking of the alveolar tissue and the subsequent fit of a new denture. This clinical report describes a fast and simple technique for impressions of edentulous ridges to replace complete dentures, using a temporary tissue conditioner material on the denture base. The existing denture must cover the whole supporting area and should be in harmony with the adjacent oral structures. This technique reduces the number of steps involved and minimizes treatment time and expenses.

Alveolar bone dynamics in osteoporotic rats treated with raloxifene or alendronate: confocal microscopy analysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization

ObjectiveThe aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation.Clinical ConsiderationsA 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity.ConclusionThis case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure.Clinical SignificanceIf appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time.

Immediate loading of implants installed in a healed alveolar bony ridge or immediately after tooth extraction: an experimental study in dogs

ObjectiveTo compare the sequential healing at immediately loaded implants installed in a healed alveolar bony ridge or immediately after tooth extraction.Material and methodsIn the mandible of 12 dogs, the second premolars were extracted. After 3months, the mesial roots of the third premolars were endodontically treated and the distal roots extracted. Implants were placed immediately into the extraction sockets (test) and in the second premolar region (control). Crowns were applied at the second and third maxillary premolars, and healing abutments of appropriate length were applied at both implants placed in the mandible and adapted to allow occlusal contacts with the crowns in the maxilla. The time of surgery and time of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2weeks and 1 and 3months. Ground sections were prepared for histological analyses.ResultsAt the control sites, a resorption of the buccal bone of 1mm was found after 1week and remained stable thereafter. At the test sites, the resorption was 0.4mm at 1-week period and further loss was observed after 1month. The height of the peri-implant soft tissue was 3.8mm both at test and control sites. Higher values of mineralized bone-to-implant contact and bone density were seen at the controls compared with the test sites. The differences, however, were not statistically significant.ConclusionsDifferent patterns of sequential early healing were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extractions. However, three months after implant installation, no statistically significant differences were found for the hard- and soft-tissue dimensions.

Influência do contexto silábico da palavra no julgamento perceptivo-auditivo do ceceio produzido por pré-escolares

OBJETIVOS: investigar a ocorrência do ceceio em fricativas produzidas por crianças com alterações oclusais e analisar a influência do contexto silábico da fricativa no julgamento auditivo do ceceio. M ÉTODO: estudo prospectivo, em que as gravações de 428 palavras, produzidas por 15 crianças (idade média de 5 anos e 1 mês) foram julgadas auditivamente por três fonoaudiólogos com experiência no julgamento de alterações de fala. As palavras utilizadas foram constituídas pelas consoantes fricativas não vozeadas, alveolar e pós-alveolar, inseridas em posição tônica, precedida das vogais [i, a, u]. Obteve-se concordância intra-juiz (quase perfeita) e inter-juiz (total, 100%) previamente à análise dos aspectos de interesse. RESULTADOS: embora presente na fala de todas as crianças, identificou-se ceceio em 25,23% do total das palavras. Houve aumento significante do ceceio para: (a) fricativa alveolar em ataque inicial, (b) fricativa alveolar em ataque inicial em relação à coda medial (p=0,001) e (c) fricativa alveolar em relação à fricativa pós- alveolar (p<0,001). Não se observou diminuição do ceceio em relação às vogais co-articuladas. CONCLUSÃO: a ocorrência do ceceio é dependente do contexto silábico, (com maior ocorrência na fricativa alveolar, em posição de ataque inicial), devendo o mesmo ser considerado para fins clínicos e de pesquisa sobre o ceceio.

Is bone transplantation the gold standard for repair of alveolar bone defects?

New strategies to fulfill craniofacial bone defects have gained attention in recent years due to the morbidity of autologous bone graft harvesting. We aimed to evaluate the in vivo efficacy of bone tissue engineering strategy using mesenchymal stem cells associated with two matrices (bovine bone mineral and α-tricalcium phosphate), compared to an autologous bone transfer. A total of 28 adult, male, non-immunosuppressed Wistar rats underwent a critical-sized osseous defect of 5 mm diameter in the alveolar region. Animals were divided into five groups. Group 1 (n = 7) defects were repaired with autogenous bone grafts; Group 2 (n = 5) defects were repaired with bovine bone mineral free of cells; Group 3 (n = 5) defects were repaired with bovine bone mineral loaded with mesenchymal stem cells; Group 4 (n = 5) defects were repaired with α-tricalcium phosphate free of cells; and Group 5 (n = 6) defects were repaired with α-tricalcium phosphate loaded with mesenchymal stem cells. Groups 2-5 were compared to Group 1, the reference group. Healing response was evaluated by histomorphometry and computerized tomography. Histomorphometrically, Group 1 showed 60.27% ± 16.13% of bone in the defect. Groups 2 and 3 showed 23.02% ± 8.6% (p = 0.01) and 38.35% ± 19.59% (p = 0.06) of bone in the defect, respectively. Groups 4 and 5 showed 51.48% ± 11.7% (p = 0.30) and 61.80% ± 2.14% (p = 0.88) of bone in the defect, respectively. Animals whose bone defects were repaired with α-tricalcium phosphate and mesenchymal stem cells presented the highest bone volume filling the defects; both were not statistically different from autogenous bone.

Reconstruction of alveolar bone defect with autogenous bone particles and osseointegrated implants: histologic analysis and 10 years monitoring

Maintaining the volume of the alveolar process after extraction can be achieved by immediate implant placement and guided bone regeneration, with or without the use of biomaterials. The authors present a case report with a 10 years follow-up, rehabilitation using osseointegrated implants in the extraction area and maintenance of the volume of the alveolar process with autogenous cortical bone shavings.

Exenatide and sitagliptin decrease interleukin 1β, matrix metalloproteinase 9, and nitric oxide synthase 2 gene expression but does not reduce alveolar bone loss in rats with periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)