Avaliação comparativa da remodelação óssea periimplantar em implantes com junção cone-morse e hexágono externo: estudo clínico randomizado controlado, duplo cego, boca dividida

Background: Several theories, such as the biological width formation, the inflammatory reactions due to the implant-abutment microgap contamination, and the periimplant stress/strain concentration causing bone microdamage accumulation, have been suggested to explain early periimplant bone loss. However, it is yet not well understood to which extent the implant-abutment connection type may influence the remodeling process around dental implants. Aim: to evaluate clinical, bacteriological, and biomechanical parameters related to periimplant bone loss at the crestal region, comparing external hexagon (EH) and Morse-taper (MT) connections. Materials and methods: Twelve patients with totally edentulous mandibles received four custom made Ø 3.8 x 13 mm implants in the interforaminal region of the mandible, with the same design, but different prosthetic connections (two of them EH or MT, randomly placed based on a split-mouth design), and a immediate implant- supported prosthesis. Clinical parameters (periimplant probing pocket depth, modified gingival index and mucosal thickness) were evaluated at 6 sites around the implants, at a 12 month follow-up. The distance from the top of the implant to the first bone-to-implant contact – IT-FBIC was evaluated on standardized digital peri-apical radiographs acquired at 1, 3, 6 and 12 months follow-up. Samples of the subgingival microbiota were collected 1, 3 and 6 months after implant loading. DNA were extracted and used for the quantification of Tanerella forsythia, Porphyromonas gingivalis, Aggragatibacter actinomycetemcomitans, Prevotella intermedia and Fusobacterium nucleatum. Comparison among multiple periods of observation were performed using repeated-measures Analysis of Variance (ANOVA), followed by a Tukey post-hoc test, while two-period based comparisons were made using paired t- test. Further, 36 computer-tomographic based finite element (FE) models were accomplished, simulating each patient in 3 loading conditions. The results for the peak EQV strain in periimplant bone were interpreted by means of a general linear model (ANOVA). Results: The variation in periimplant bone loss assessed by means of radiographs was significantly different between the connection types (P<0.001). Mean IT-FBIC was 1.17±0.44 mm for EH, and 0.17±0.54 mm for MT, considering all evaluated time periods. All clinical parameters presented not significant differences. No significant microbiological differences could be observed between both connection types. Most of the collected samples had very few pathogens, meaning that these regions were healthy from a microbiological point of view. In FE analysis, a significantly higher peak of EQV strain (P=0.005) was found for EH (mean 3438.65 µ∑) compared to MT (mean 840.98 µ∑) connection. Conclusions: Varying implant-abutment connection type will result in diverse periimplant bone remodeling, regardless of clinical and microbiological conditions. This fact is more likely attributed to the singular loading transmission through different implant-abutment connections to the periimplant bone. The present findings suggest that Morse-taper connection is more efficient to prevent periimplant bone loss, compared to an external hexagon connection.

The Impact of Internal Market Orientation on Staff Service Behaviours

The impact of service direction, service training and staff behaviours on perceptions of service delivery are examined. The impact of managerial behaviour in the form of internal market orientation (IMO) on the attitudes of frontline staff towards the firm and its consequent influence on their customer oriented behaviours is also examined. Frontline service staff working in the consumer transport industry were surveyed to provide subjective data about the constructs of interest in this study, and the data were analysed using structural equations modelling employing partial least squares estimation. The data indicate significant relationships between internal market orientation (IMO), the attitudes of the employees to the firm and their consequent behaviour towards customers. Customer orientation, service direction and service training are all identified as antecedents to high levels of service delivery. The study contributes to marketing theory by providing quantitative evidence to support assumptions that internal marketing has an impact on services success. For marketing practitioners, the research findings offer additional information about the management, training and motivation of service staff towards service excellence.

Built environment education and research : making connections

This conference is a landmark gathering of those from around the world concerned with the future of Built environment education and Research. It takes place at a time of great change and opportunity. Around the world the long-standing principles of what, how and who we teach for graduate entry into Built environment professions, is increasingly under review. The need for research and the way in which it is funded, conducted and knowledge shared is also under increasing pressure. Both changes are being triggered by a fast changing and increasingly challenging competitive environment for education and research. Competition for the highest quality of graduate entrants in the right numbers is becoming more intense. Competition between Universities, as funding for education and research comes under ever close scrutiny, is intensifying and we are all being forced to look for more effective and exciting ways of recruting, retaining, enhancing and maximising the achievement of our students and of our staff in their research activities. Competition amongst employees in industry is becoming more intense as professional employers increasingly recognise that people and knowledge are their key strategic resources. Universities are increasingly looking to partnerships with industry, the professions and other Universities to further improve their eduacation, research and innovation activities. These challenges are unfolding at a time of accelerating development in information technologies and systems and in our understanding of principles of knowledge management and pedagogical advancement. This environment presents both opportunities and threats to the world of education.