Histological analysis of the osseointegration of Ti-30Ta dental implants after surface treatment

Metallic biomaterials are used to reinforce or to restore the form and function of hard tissues. Implants and prosthesis are used to replace shoulders, knees, hips and teeth. When these materials are inserted in bone several biological reactions happen. This process can be associated to surface properties (topography, roughness and surface energy). In this work, the influence of biomimetic surface treatment in the osseointegration of Ti-30Ta dental implants was evaluated. Ingots were obtained from titanium and tantalum by using an arc-melting furnace. They were submitted to heat treatment at 1,100°C for 1 h, cooled in water and cold worked by swaging. Then, screw-shaped implants (2.0 mm diameter by 2.5 mm length) were manufactured and they were implanted in a rat's femur. Animals were divided into two groups: untreated (control group) and treated (biomimetic surface treatment). They were sacrificed 30 days after implantation. For histological analysis, implants with surrounding tissue were removed and immersed in formaldehyde. Samples were embedded in polymethyl methacrylate and after polymerization, cut with a saw, polished and mounted on glass slides. The results obtained suggest that biomimetic surface treatment was able to promote an increase osseointegration on the surface of dental implants. © Springer-Verlag Berlin Heidelberg 2013.

A prospective study on implants installed with flapless-guided surgery using the all-on-four concept in the mandible

Aim: Clinical data are scarce on flapless-guided surgery in the mandible using the all-on-four concept. In addition, limited documentation exists on the latter under immediate loading conditions with a pre-fabricated implant bridge. The aim was to provide detailed documentation focusing on clinical and radiographic outcome and complications. Material and methods: Sixteen systemically healthy non-smoking patients (10 women, 6 men, average age 59 years) with sufficient bone volume in the mandible were operated via flapless-guided surgery using the all-on-four concept. Clinical and radiographic data and complications were registered at 3, 6 and 12 months. Results: The overall implant survival rate was 90% with a trend for higher failure of short implants (P = 0.098). The mean bone level after 12 months of function was 0.83 mm with a maximum of 1.07 mm. Technical complications were common (15/16 patients). These mainly related to a misfit between the pre-fabricated prosthesis and abutment(s) (13/16 patients). Conclusion: If immediate loading of implants is pursued fabrication of the implant bridge should be based on actual impression of the implants at the time of surgery and not on their virtual position. © 2011 John Wiley & Sons A/S.

A 12-month follow-up of hypopigmentation after laser hair removal

Introduction: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. Material and Methods: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm2 and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. Results: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. Conclusion: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur. © 2013 Informa UK, Ltd.

Photoelastic analysis of the influence of residual ridge inclination in conjugated class i mandibular prostheses with different attachment systems

Objectives: The aim of this study was to evaluate the stress distribution in mandibular free-end removable partial dentures (RPD) associated with FPD in the abutment teeth considering different inclinations of the residual ridge: (1) horizontal and (2) distal descending ridges and two designs of free-end RPD with different attachment systems were tested: (1) clasp and (2) system ERA. Methods. Axial loads (100 N) were applied on the teeth of the RPD. The images were recorded and the stress distribution was evaluated through photoelastic fringes. Results. In general, the distal descending ridge presented more photoelastic fringes in the region of the roots of the abutment teeth while the horizontal ridge exhibited higher compression in the base of the prosthesis. In the horizontal ridge, the denture with clasp presented more favourable stress distribution than the denture with the system ERA. In the distal descending ridge, the denture with the system ERA relieved the region of the abutment teeth and overloaded the residual ridge. Conclusion: The horizontal ridge presented more favourable performance; the dentures with clasp exhibited better performance for both ridges evaluated; the denture with the system ERA presented better results in the distal descending ridge. © 2013 Informa Healthcare.

Evaluation of the biocompatibility of silicone gel implants - histomorphometric study

Breast implants are medical devices that are used to augment breast size or to reconstruct the breast following mastectomy or to correct a congenital abnormality. Breast implants consist of a silicone outer shell and a filler (most commonly silicone gel or saline). Approximately 5 to 10 million women worldwide have breast implants. Histomorphometric study to evaluate the biological tissue compatibility of silicone implants suitable for plastic surgery and the adverse effects and risks of this material. Thirty Wistar white rats received subcutaneous implants and the revestiment of silicone gel Silimed ®®, and randomized into six groups of five animals each, according to the type of implanted material and the time of sacrifice. Eight areas of 60.11mm2 corresponding to the obtained surgical pieces were analyzed, counting mesenchymal cells, eosinophils, and foreign body giant cells, observing an acceptable biocompatibility in all implants, for subsequent statistical analysis by Tukey test. Silicone gel showed inflammation slightly greater than for other groups, with tissue reactions varying from light to moderate, whose result was the formation of a fibrous capsule around the material, recognized by the organism as a foreign body. Despite frequent local complications and adverse outcomes, this research showed that the silicone and top layer presented an acceptable chronic inflammatory reaction, which did not significantly differ from the control group. In general, it is possible to affirm that silicone gel had acceptable levels of biocompatibility, confirmed the rare presence of foreign body giant cells, and when of the rupture, formed a fibrous capsule around the material, separating the material of the organism. © AVICENA 2013.

Titanium in Dentistry: Historical development, state of the art and future perspectives

Titanium is a metallic element known by several attractive characteristics, such as biocompatibility, excellent corrosion resistance and high mechanical resistance. It is widely used in Dentistry, with high success rates, providing a favorable biological response when in contact with live tissues. Therefore, the objective of this study was to describe the different uses of titanium in Dentistry, reviewing its historical development and discoursing about its state of art and future perspective of its utilization. A search in the MEDLINE/PubMed database was performed using the terms 'titanium', 'dentistry' and 'implants'. The title and abstract of articles were read, and after this first screening 20 articles were selected and their full-texts were downloaded. Additional text books and manual search of reference lists within selected articles were included. Correlated literature showed that titanium is the most used metal in Implantology for manufacturing osseointegrated implants and their systems, with a totally consolidated utilization. Moreover, titanium can be also employed in prosthodontics to obtain frameworks. However, problems related to its machining, casting, welding and ceramic application for dental prosthesis are still limiting its use. In Endodontics, titanium has been used in association to nickel for manufacturing rotatory instruments, providing a higher resistance to deformation. However, although the different possibilities of using titanium in modern Dentistry, its use for prostheses frameworks still needs technological improvements in order to surpass its limitations. © 2012 Indian Prosthodontic Society.

An alternate impression technique for ocular prostheses

This article describes an alternative two-step ocular prosthesis impression technique that employs two materials of different consistencies. The method is intended to provide better adaptation to underlying tissues, increased mobility of the prosthesis owing to improvements in facial contours, and improved esthetics, as well as offering the patient greater comfort and security. These advantages and this prosthesis' relative ease of fabrication mean it should be considered as the first step in the management of untreated anophthalmic sockets. © 2012 by the American College of Prosthodontists.

Regular and switching platform: Bone stress analysis with varying implant diameter

The aim of this study was to evaluate stress distribution of the peri-implant bone by simulating the biomechanical influence of implants with different diameters of regular or platform switched connections by means of 3-dimensional finite element analysis. Five mathematical models of an implant-supported central incisor were created by varying the diameter (5.5 and 4.5 mm, internal hexagon) and abutment platform (regular and platform switched). For the cortical bone, the highest stress values (rmax and rvm) were observed in situation R1, followed by situations S1, R2, S3, and S2. For the trabecular bone, the highest stress values (rmax) were observed in situation S3, followed by situations R1, S1, R2, and S2. The influence of platform switching was more evident for cortical bone than for trabecular bone and was mainly seen in large platform diameter reduction.

Influence of Abutment Type and Esthetic Veneering on Preload Maintenance of Abutment Screw of Implant-Supported Crowns

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

Vestibuloplasty by modified kazanjian technique in treatment with dental implants

Dentists are often faced with extensively resorbed mandibular ridges with shallow buccal vestibule and high insertion of the mentalis muscle in relation to the crest of the ridge, causing the displacement of the prosthesis. Vestibuloplasty techniques aim at eliminating the muscle insertions, reposition the mucosa, and increase the area chapeável, giving more stability to the prosthesis. Among the techniques to deepen the vestibule are submucosal vestibuloplasties by secondary epithelialization and with mucosal and skin grafts. We will discuss vestibuloplasty by secondary epithelialization with emphasis on the so-called modified Kazanjian technique. This technique provides an appropriate result and does not require hospitalization, additional surgery at the donor, or prolonged periods without the use of prosthesis. © 2013 by Mutaz B. Habal, MD.

The success rate of immediate implant placement of mandibular molars: A clinical and radiographic retrospective evaluation between 2 and 8 years

Background: Dental implants, indicated for re-establishing both mastigatory and aesthetic functions, can be placed in the sockets immediately after tooth extraction. Most studies investigate the anterior and upper regions of the dental arch, whereas few examine longitudinal appraisal of immediate implant installation in the mandibular molar region. Objective: The aim of this retrospective study was to evaluate the success rate of immediate dental implants placement in mandibular molars within a follow-up period as long as 8 years. Materials and methods: Seventy-four mandibular molar implants after non-traumatic tooth extraction between 2002 and 2008 were examined in the study. All implants were evaluated radiographically immediately after prosthesis placement, 1 year after implantation, and by the end of the experimental period, in 2010. Clinical evaluation was done according to [Albrektsson et al. (1986) The International Journal of Oral & Maxillofacial Implants, 1, 11-25] success criteria for marginal bone loss. The mean bone losses, calculated as the difference between the final evaluation measures and those taken by the end of the first year of implant, were compared using Kruskal-Wallis test with a significance level of 5%. Results: All implants presented clinical and radiographic stable conditions, that is, 100% success rate. Significant bone loss was not found between final evaluation and that of the first functional year (P > 0.05). Conclusion: Immediate implant placement of mandibular molars proved to be a viable surgical treatment given the high success rate up to 8 years after implantation. © 2012 John Wiley & Sons A/S.

Stress analysis in oral obturator prostheses: Imaging photoelastic

Maxillary defects resulting from cancer, trauma, and congenital malformation affect the chewing efficiency and retention of dentures in these patients. The use of implant-retained palatal obturator dentures has improved the self-esteem and quality of life of several subjects. We evaluate the stress distribution of implant-retained palatal obturator dentures with different attachment systems by using the photoelastic analysis images. Two photoelastic models of the maxilla with oral-sinus-nasal communication were fabricated. One model received three implants on the left side of the alveolar ridge (incisive, canine, and first molar regions) and the other did not receive implants. Afterwards, a conventional palatal obturator denture (control) and two implant-retained palatal obturator dentures with different attachment systems (O-ring; bar-clip) were constructed. Models were placed in a circular polariscope and a 100-N axial load was applied in three different regions (incisive, canine, and first molar regions) by using a universal testing machine. The results were photographed and analyzed qualitatively using a software (Adobe Photoshop). The bar-clip system exhibited the highest stress concentration followed by the O-ring system and conventional denture (control). Images generated by the photoelastic method help in the oral rehabilitator planning. © 2013 SPIE.

Opportunistic microorganisms in individuals with lesions of denture stomatitis

The aim of this study was to isolate, quantify, identify, and compare opportunistic microorganisms (Candida and Staphylococcus genera and Enterobacteriaceae/Pseudomonadaceae families) from prosthesis-fitting surfaces, the hard palate, and mouth rinses of individuals wearing removable maxillary prosthesis with (50) and without (50) lesions of denture stomatitis (DS). The strains were collected and identified using phenotypic, biochemical and molecular tests. The counts of microorganisms were significantly higher in the group of individuals with DS (P < 0.05). C. albicans was the most frequently isolated yeast species in both groups, following by C. tropicalis and C. glabrata. Six isolates were identified as C. dubliniensis. S. aureus and S. epidermidis were the most frequent Staphylococcus species in both groups. Klebsiella pneumoniae was the predominant species in both groups. The association between Candida spp. and bacteria isolated in this study with DS suggests that these microorganisms may play important roles in the establishment and persistence of this disease. © 2013 Elsevier Inc.

Airway space changes after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts® total joint prostheses: Three-dimensional assessment

This study focused on three-dimensional (3D) airway space changes and stability following simultaneous maxillomandibular counterclockwise rotation, mandibular advancement, and temporomandibular joint (TMJ) reconstruction with custom-made total joint prostheses (TMJ Concepts®). Cone beam computed tomography (CBCT) scans of 30 consecutive female patients with irreversibly compromised TMJs were obtained at the following intervals: T1, presurgery; T2, immediately after surgery; and T3, at least 6 months after surgery. The CBCT volumetric datasets were analysed with Dolphin Imaging ® software to evaluate surgical and postsurgical changes to oropharyngeal airway parameters. The average changes in airway surface area (SA), volume (VOL), and minimum axial area (MAA) were, 179.50 mm2, 6302.60 mm3, and 92.23 mm2, respectively, at the longest follow-up (T3 - T1) (P ≤ 0.001). Significant correlations between the amount of mandibular advancement and counterclockwise rotation of the occlusal plane and 3D airway changes were also found (P ≤ 0.01). The results of this investigation showed a significant immediate 3D airway space increase after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses, which remained stable over the follow-up period. © 2013 International Association of Oral and Maxillofacial Surgeons.

Influence of the implant diameter with different sizes of hexagon: Analysis by 3-dimensional finite element method

The aim of this study was to evaluate the stress distribution in implants of regular platforms and of wide diameter with different sizes of hexagon by the 3-dimensional finite element method. We used simulated 3-dimensional models with the aid of Solidworks 2006 and Rhinoceros 4.0 software for the design of the implant and abutment and the InVesalius software for the design of the bone. Each model represented a block of bone from the mandibular molar region with an implant 10 mm in length and different diameters. Model A was an implant 3.75 mm/regular hexagon, model B was an implant 5.00 mm/regular hexagon, and model C was an implant 5.00 mm/ expanded hexagon. A load of 200 N was applied in the axial, lateral, and oblique directions. At implant, applying the load (axial, lateral, and oblique), the 3 models presented stress concentration at the threads in the cervical and middle regions, and the stress was higher for model A. At the abutment, models A and B showed a similar stress distribution, concentrated at the cervical and middle third; model C showed the highest stresses. On the cortical bone, the stress was concentrated at the cervical region for the 3 models and was higher for model A. In the trabecular bone, the stresses were less intense and concentrated around the implant body, and were more intense for model A. Among the models of wide diameter (models B and C), model B (implant 5.00 mm/regular hexagon) was more favorable with regard to distribution of stresses. Model A (implant 3.75 mm/regular hexagon) showed the largest areas and the most intense stress, and model B (implant 5.00 mm/regular hexagon) showed a more favorable stress distribution. The highest stresses were observed in the application of lateral load.