Análise de materiais para sistemas de fechamento ósseo através da caracterização superficial e comportamento mecânico

Pós-graduação em Engenharia Mecânica - FEB

Regeneração óssea guiada com o uso de membrana de copolímero PLA/PGA em levantamento da membrana do seio maxilar: estudo experimental com análises histomorfométrica e imunoistoquímica

Pós-graduação em Odontologia - FOA

Interdisciplinaridade do plano de tratamento após reimplante dentário: relato de caso

O tratamento de escolha para a avulsão dentária é o reimplante dentário, no entanto diversos fatores interferem no prognóstico e a reabsorção radicular é a principal seqüela podendo levar a perda dentária. O objetivo do trabalho foi relatar um caso clínico de reimplante dentário com perda dentária por extensa reabsorção radicular e os planos de tratamento instituídos para reposição do dente perdido. Paciente após acidente motociclístico apresentou avulsão dentária e fratura coronária do elemento 21 e subluxação e fratura coronária do 11. Após quatro anos do reimplante o dente foi perdido por reabsorção radicular externa. Um novo plano de tratamento foi instituído e como a paciente apresentava uma maloclusão foi realizado um tratamento ortodôntico e uma cirurgia ortognática seguido da colocação de um implante para reposição do 21. Como não ocorreu a osseointegração do implante após três tentativas foi realizada uma prótese fixa adesiva associada à laminado de porcelana para o restabelecimento da função e a estética. Desta forma a interdisciplinaridade permitiu a elaboração de planos de tratamento, capaz de eliminar os imprevistos e conduzir o caso a um sucesso.

The Fresh Frozen Bone Allograft (FFBA) to reconstruc the atrophic maxilla: evaluation of the clinical and histological viability at six and nine months in the maxillary sinus

This work aimed to analyze clinically and histologically the allogen bone graft behavior at 6 and 9 months. A leukoderm, female, 55 years old patient sought dental care for oral rehabilitation with dental implants and implant supported fixed prosthesis in the maxilla. Bilateral sinus lifting procedure were performed in a same patient, the analysis were made after 6 and 9 months, respectively. At 6 months, there was lack of a better bone remodeling in the region, associated to the presence of fibrous connective tissue within the collected tissue, showing us that this is not the best stage of tissue maturation to place dental implants. The 9 months period showed an improvement, with a more organized bone tissue surrounding particles of homogenous bone, what possibly had increased implant stability at the time of surgery. There is no doubt about the increase of clinical applications of FFBA, but there are no studies available regarding the standardization of time to load implants inserted in allografts. So papers with long-term monitoring are necessary to eliminate questions that still remain to be answered.

Reconstrução imediata de fenestração peri-implantar com enxerto autógeno em bloco de ramo mandibular

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types.

O efeito do consumo abusivo de alvool no torque de remoção de implantes de titânio

Studies have reported that alcohol may lead to imbalance in bone formation and resorption, however, its effects on osseointegration of titanium implants continues to be an inconclusive subject. In this context, the aim of this study was to make a biomechanical evaluation of the effect of abusive alcohol consumption on the removal torque of osseointegrated titanium implants. Male Wistar rats (n=30) were divided into two experimental groups (15 each) receiving only water (Control) or 36% alcohol solution oral administration. Thirty days later, all animals were submitted to titanium implant (2.2 mm x 4 mm) placement in the right and left tibiae. The surgical alveoli were prepared with a 2 mm drill mounted in a counter-angle hand-piece (20:1 ratio, 35 Ncm torque at 1200 rpm) under abundant cooling. Five animals from each group were euthanized at 15, 30, and 60 days. Tibiae were submitted to reverse torque analysis. Data obtained were submitted to statistical analysis by the non-parametric Kruskal-Wallis and Dunn Tests (p < 0.05). Animals in the alcohol group presented lower removal torque values when compared with control group animals for all periods tested (p < 0.05). It can be concluded that abusive alcohol consumption can reduce the removal torque of titanium implants placed in rat tibiae, suggesting that alcohol may interfere in the osseointegration process of titanium implants.

Enxerto de tecido conjuntivo para correção da margem peri-implantar

Soft tissue recessions frequently cause esthetic disharmony and dissatisfaction. The results of coverage in peri-implant sites, in comparison with soft tissue coverage around a tooth, is less predictable. This clinical report describes the correction of an esthetic problem with a single-tooth implant-supported using a subepithelial connective tissue graft (SCTG) combined with the re-establishment of a new limit of gingival margin, and emergence crown profile. After anamnese and clinical exam it was observed an implant in the region of tooth 22 in vestibular position to alveolar ridge with a recession of 5 mm in its vestibular face. In the first cirurgical procedure the crown and the abutment were removed and a SCTG associated with a coronally positioned flap was performed in order to re-establish the limit of gingival margin. After 90 days, it was observed that the tissue in the implant site showed no adequate volume or thickness. Because of that, another SCTG was performed. The reopening procedure to install the healing cap was performed after 4 weeks. Then the prosthesis was installed. At 180 and 360 days postoperative, the implant adjacent tissue presented regular contour, color compatible with health and absence of bleeding. The patient was satisfied with the esthetic result. According to the clinical results and favorable esthetics it was possible to conclude that the use of ETC to correct an esthetic deficiency may be a feasible approach to establish new and stable peri-implant soft tissue contours.

Efeito do envelhecimento e do estresse crônico sobre a reação do tecido conjuntivo subcutâneo: estudo histológico em ratos

Physiological functions undergo a gradual retardation that begins around 25-30 years and extends to the death. Moreover, this change affects most severely the activities more complex and more intricate responses to tensions or stress. The purpose of this study was to evaluate histologically in aged rats the effect of chronic stress on the reaction of subcutaneous connective tissue. The purpose of this study was to evaluate histologically in aged rats the effect of chronic stress on the reaction of subcutaneous connective tissue. For this purpose, 60 rats were divided into four groups (GI (control), GII (stressed), GIII (elderly) and GIV (aged / stressed) received dorsal subcutaneous implants of polyethylene tubes containing saline solution. In groups of four animals were sacrificed at 7,14 and 28 days postoperatively. The results allowed to observe more intense inflammatory reaction and tissue organization later in the aged animals subjected to stress.

O tratamento com implantes dentários para pacientes com hiv é uma realidade?

Patients infected with HIV can present several complications related to oral health. Today, the reduction of morbidity and mortality is evidenttreatment with antiviral enhances the quality of life of patients. The increase in comfort, stability, function and improving quality of life have led these patients to seek treatment with osseointegrated implants. This study aimed to discuss, based on the literature, the rehabilitation treatment with osseointegrated implants in patients HIV positive. For this we carried out a literature review including the subject in the databases: PubMed, Cochrane, ISI Dentistry and Oral Science in the last 20 years. The issue was addressed for the first time in 1998, describing a clinical case, the patient had successful rehabilitation with osseointegrated implants. However, the literature states that the indications must be carefully analyzed (2007), since there are few prospective controlled studies. There is doubt as to the use of dental implant therapy in patients with HIV-positive, and the complications are related to the patient’s systemic condition. It is essential to understand the clinical manifestations and complications of the disease before the implant therapy. It is observed that the dental implant therapy in patients with HIV positive is a predictable treatment option, it´s need an adequate control of oral and systemic conditions, and studies with larger sample, longer follow-up and randomized studies are important for evaluating the success therapy.

A importância da geometria dos implantes para o planejamento em reabilitação oral: revisão de literatura

The design of implant structure is still a questioning to the professionals, while their variations can to influence of stress distribution favorably to bone. Therefore, the aim of study was to review addressing the topic of osseointegrated implants design establishing answers for the patient oral rehabilitation, according variations existing on the market. It was conducted a detailed search strategy by the PubMed/ Medline and Bireme, it was used as descriptors: “dental implants cylinder”; “dental implants thread”; “dental implants geometry”, until May 2014. From 798 articles, after review were selected 18 articles and 1 specific area book. The results were divided to compare design of implant and threads for further discussion and conclusions. Thus, conclude that the threads implants are best used because of its advantages with respect to the stress distribution and stability primary. The variations of the differents types of threads, have influence for stress distribution.

Adesivo tecidual de fibrina e sua aplicação na implantodontia

The purpose of this literature review was to evaluate the use of fibrin tissue adhesive in implant dentistry. Materials and Methods: A literature search of Medline-PubMed for articles published, describing the use of fibrin tissue adhesive in implant dentistry was performed and articles were critically reviewed. Results: The literature review reveals clinical trials and experimental studies with regard to the use of fibrin tissue adhesive in implant dentistry. This material consists of 2 components: highly purified, freeze-dried human fibrinogen with factor XIII and a starter solution containing human thrombin. Clotting factor XIII is admitted for reinforcement of the fibrin network. The components are reconstituted before use and when mixed form a clot by mimicking the terminal phase of the physiological clotting cascade. Several studies showed that fibrin tissue adhesive is fully absorbed by macrophages within 2 weeks of application. Adhesive fibrin tissue may be used for to prevent bone loss, to create contour in the periimplant soft tissue and osseous tissue, to sculpt emergence profile for prosthetic components and to mimic tissue architecture. In the last years fibrin tissue adhesive also find use as material for the controlled delivery of drugs and biologics. Conclusions: The fibrin tissue adhesive presents good properties such as biocompatibility, hemostatic properties and ability to break down like the physiologic clot. This material, alone or associated with other materials, can be used with the implants immediately after extraction. In this condition it brings the necessary anchoring and efficient maintenance of osseous/mucosal contour, which it is important for the clinical success.

Impacto do controle glicêmico sobre as complicações associadas ao diabetes mellitus na osseointegração

The increased prevalence of diabetic individuals has become a public health problem. Diabetes Mellitus is a metabolic disorder characterized by an increase in plasma glucose levels. It impairs the physiological equilibrium in utilization of carbohydrate by tissues. The persistent hyperglycemia can produce deleterious effects on bone formation due the microvascular complication. The present paper reviews the bibliography linking the impact of glycemic control at complications associated at diabetes mellitus on osseointegration. In experimental models of diabetes it was observed a reduced level of bone-implant contact. This failure can be reduced by means of hyperglycemia control. Also, several studies point the beneficial effect of coated implant on osseointegration process. It is necessary to take special care into account for the placement of implants in diabetic patient and improve the percentages of implant survival. A rigorous control of plasma glycaemia, together with other measures, like as absence of chronic complications, good oral hygiene and regular medical follow-up has been related to rising the percentages of successful in diabetic patients.

Aspectos legais e éticos na implantodontia

There are few studies that evaluate the legal aspects, consent forms and ethical considerations facing implantology. This paper reviews and discusses the most important criteria in relation to the care of patients needing dental implants. Used the following databases: Medline (Pubmed), Dentistry Oral Science , Scielo, Athenas (Dissertation / Thesis), Digital Library of UNICAMP (Dissertation / Thesis), Digital Library of USP (Dissertation / Thesis) over the past 15 years . The inclusion and exclusion criteria were clinical articles, resulting from expert opinion on the subject of review and longitudinal follow-up who have studied or reported on the ethical aspects in implant dentistry; were excluded studies whose language was not English or Portuguese. Of a total of 52 articles and theses, after an analysis according to inclusion and exclusion criteria, 26 were selected. The literature shows that the safe practice of implantology is indispensable for the success of therapy. Respect the ethical, legal and make it explicit relationship with the patient (informed consent, information) are an important factor in the success of rehabilitative treatment. Since this treatment is long term, professional dental implant requires all documentation and clarity in time to offer treatment to the patient and professional expectations are met.

Reabilitação protética implantossuportada em região anterior maxilar com utilização de gengiva artificial cerâmica: relato de caso

The osseointegrated implants created a progress in oral rehabilitation. But this rehabilitation may be complicated by anatomical conditions, mainly in maxillary anterior region, where a higher aesthetic is required. The aim of study was to report one case which the use of angled abutments were necessary to allow the correct positioning of the prosthesis and also the prosthetic reconstruction with gingival-colored ceramic to provide best aesthetic result for patient. The aesthetic and functional results provided greater patient satisfaction with her smile. The correct planning is essential to provide to patient the best aesthetic and functional results, being necessary the use of abutments and gingival-colored ceramic to reach better results. Uniterms: dental implantacion, esthetics, mouth rehabilitation.