INFLUENCE OF INTERIMPLANT DISTANCES AND PLACEMENT DEPTH ON PAPILLA FORMATION AND CRESTAL RESORPTION: A CLINICAL AND RADIOGRAPHIC STUDY IN DOGS

Among the factors that contribute to the papilla formation and crestal bone preservation between contiguous implants, this animal study clinically and radiographically evaluated the interimplant distances (IDs) of 2 and 3 mm and the placement depths of Morse cone connection implants restored with platform switch. Bilateral mandibular premolars of 6 dogs were extracted, and after 12 weeks, the implants were placed. Four experimental groups were constituted: subcrestally with ID of 2 mm (2 SCL) and 3 mm (3 SCL) and crestally with ID of 2 mm (2 CL) and 3 mm (3 CL). Metallic crowns were immediately installed with a distance of 3 mm between the contact point and the bone crest. Eight weeks later, clinical measurements were performed to evaluate papilla formation, and radiographic images were taken to analyze the crestal bone remodeling. The subcrestal groups achieved better levels of papillae formation when compared with the crestal groups, with a significant difference between the 3 SCL and 3 CL groups (P = .026). Radiographically, the crestal bone preservation was also better in the subcrestal groups, with statistically significant differences between the 2SCL and 2CL groups (P = .002) and between the 3SCL and 3CL groups (P = .008). With the present conditions, it could be concluded that subcrestal implant placement had a positive impact on papilla formation and crestal bone preservation, which could favor the esthetic of anterior regions. However, the IDs of 2 and 3 mm did not show significantly different results.

Optimization in multi-implant placement for immediate loading in edentulous arches using a modified surgical template and prototyping: A case report

Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance throughout the treatment period. Placement of dental implants requires precise planning that accounts for anatomic limitations and restorative goals. Diagnosis can be made with the assistance of computerized tomographic scanning, but transfer of planning to the surgical field is limited. Recently, novel CAD/CAM techniques such as stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. The aim of this case report was to show a modified surgical template used throughout implant placement as an alternative to a conventional surgical guide.

Bacterial leakage along the implant-abutment interface of premachined or cast components

In recent clinical studies, contamination of the inner parts of dental implants through bacterial penetration along the implant components has been observed. The aim of the present in-vitro study was to investigate leakage of Fusobacterium. nucleatum through the interface between implants and premachined or cast abutments. Both premachined (n = 10) and cast (n = 10) implant abutment assemblies were inoculated with 3.0 mu L of microbial inoculum. The assemblies were completely immersed in 5.0 mL of tryptic soy broth culture medium to observe leakage at the implant-abutment interface after 14 days of anaerobic incubation. Bacterial growth in the medium, indicative of microbial leakage, was found only in 1 out of 9 samples (11.1%) in each group. Both premachined and cast abutments connected to external hexagonal implants provide low percentages of bacterial leakage through the interface in in vitro unloaded conditions if the manufacturer`s instructions and casting procedures are properly followed.

Evaluation of in vitro resistance of titanium and resorbable (poly-L-DL-lactic acid) fixation systems on the mandibular angle fracture

The purpose of this study was to compare, by mechanical in vitro testing, a 2.0-mm system made with poly-L-DL-lactide acid with an analogue titanium-based system. Mandible replicas were used as a substrate and uniformly sectioned on the left mandibular angle. The 4-hole plates were adapted and stabilized passively in the same site in both groups using four screws, 6.0 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side; first molar at the contralateral side; and between the central incisors. At 1 mm of displacement, no statistically significant difference was found. At 2 mm displacement, a statistically significant difference was observed when an unfavourable fracture was simulated and the load was applied in the contralateral first molar and when a favourable fracture was simulated and the load was applied between the central incisors. At the failure displacement, a statistically significant difference was observed only when the favourable fracture was simulated and the load was applied on the first molar at the plated side. In conclusion, despite more failure, the poly-L-DL-lactic acid-based system was effective.

Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: Aesthetic and technical refinements

Although the biodimensional anatomical expander-implant system (BEIS) is a reliable technique, little information has been available regarding outcome following nipple-areola sparing mastectomy (NSM). To perform the resection of glandular tissue, while improving the surgical access and maintaining the nipple-areola vascularization we have developed a new approach for NSM based on the double concentric periareolar incision (DCPI). The purpose of this study is to analyze the feasibility, surgical planning and its outcome following NSM. 18 patients underwent NSM reconstructions. Mean time of follow-up was 29 months. The technique was indicated in patients with small/moderate volume breasts. Flap complications were evaluated and information on aesthetic results and patient satisfaction were collected. 83.3% had tumors measuring 2 cm or less (T1) and 72.1% were stage 0 and 1. All patients presented peripherally tumors located (at least 5 cm from the nipple). Skin complications occurred in 11.1%. One patient (5.5%) presented small skin necrosis and a wound dehiscence was observed in one patient (5.5%). The aesthetic result was good/very good in 94.4 percent and the majority of patients were very satisfied/satisfied. No local recurrences were observed. All complications except one were treated by a conservative approach. DCPI-BEIS is a simple and reliable technique for NSM reconstruction. The success depends on patient selection, coordinated planning with the oncologic surgeon and careful intra-operative and post-operative management. (C) 2009 Elsevier Ltd. All rights reserved.

Histomorphologic evaluation of Ti-13Nb-13Zr alloys processed via powder metallurgy. A study in rabbits

This study presents the in-vivo evaluation of Ti-13Nb-13Zr alloy implants obtained by the hydride route via powder metallurgy. The cylindrical implants were processed at different sintering and holding times. The implants` were characterized for density, microstructure (SEM), crystalline phases (XRD), and bulk (EDS) and surface composition (XPS). The implants were then sterilized and surgically placed in the central region of the rabbit`s tibiae. Two double fluorescent markers were applied at 2 and 3 weeks, and 6 and 7 weeks after implantation. After an 8-week healing period, the implants were retrieved, non-decalcified section processed, and evaluated by electron, UV light (fluorescent labeling), and light microscopy (toluidine blue). BSE-SEM showed close contact between bone and implants. Fluorescent labeling assessment showed high bone activity levels at regions close to the implant surface. Toluidine blue staining revealed regions comprising osteoblasts at regions of newly forming/formed bone close to the implant surface. The results obtained in this study support biocompatible and osseoconductive properties of Ti-13Nb-13Zr processed through the hydride powder route. (c) 2007 Published by Elsevier B.V.

Systemic Inflammatory Reaction After Silicone Breast Implant

Systemic inflammation after augmentation mammaplasty with modern silicone implants is not currently recognized. In a prospective controlled study, C-reactive protein and other variables were monitored, aiming to test this hypothesis in a young cohort of patients. Females (18-30 years old, BMI = 18.5-30 kg/m(2), N = 52) were consecutively recruited for breast implant (n = 24, Group I) and for abdominal liposuction (n = 28, Group II/Controls). Patients were interviewed at baseline and followed until 6 months after operation. Variables included demographic and clinical information, surgical outcome, inflammatory markers and autoantibodies. Operations were well tolerated, without surgical or infectious complications. Mean prosthesis size was 258 +/- A 21 ml (range = 220-280) and mean aspirate of liposuction was 1972 +/- A 499 ml (range = 1200-3000). Preoperative, 2-month, and 6-month C-reactive protein concentrations for breast implant patients were 1.3 +/- A 1.2, 4.8 +/- A 3.0, and 4.3 +/- A 6.4 mg/l and for liposuction 3.5 +/- A 2.7, 3.5 +/- A 2.1, and 2.2 +/- A 2.2 mg/l, respectively. Change at 2 months was significant (p = 0.001). Autoantibody investigation failed to reveal remarkable aberrations, except for anticardiolipin elevation, which was nearly symmetrical in the two groups. C-reactive protein levels increased after operation and correlated with proinflammatory and procoagulatory indices. A mild increase in anticardiolipin IgM occurred but differences between populations were lacking. Despite excellent cosmetic outcomes and lack of complications, acute phase reaction could signal ongoing immunogenicity of silicone and long-term monitoring is recommended.

Unravelling the Chemical Morphology of a Mesoporous Titanium Dioxide Interface by Confocal Raman Microscopy: New Clues for Improving the Efficiency of Dye Solar Cells and Photocatalysts

The presence of anatase and rutile domains on nanocrystalline films of P25 TiO(2), as well as the distinct coordination modes of carboxylates on those phases, were revealed by confocal Raman microscopy, a technique that showed to be suitable for imaging the chemical morphology down to submicrometric size.

Surface Properties of Calcinated Titanium Dioxide Probed by Solvatochromic Indicators: Relevance to Catalytic Applications

Titanium dioxide was obtained by hydrolysis of the corresponding ethoxide, followed by washing, drying, and calcination at 80, 160, 240, 320, 400, and 700 C, respectively. The following surface properties of the solids obtained were determined as a function of the calcinations temperature: T(Calcn); area by the BET method; BrOnsted acidity by titration with sodium hydroxide; empirical polarity, ET(30); Lewis acidity, alpha(Surf); Lewis basicity, beta(Surf); and dipolarity/polarizability pi*(Sturf), by use of solvatochromic indicators. Except for le surf whose value increased slightly, heating the samples resulted in a decrease of all of the above-mentioned surface properties, due to the decrease of surface hydroxyl groups. This conclusion has been corroborated by FTIR. Values of E(T)(30), alpha(Surf), and pi*(Surf) are higher than those of water and alcohols; the BrOnsted and Lewis acidities of the samples correlate linearly. The advantages of using solvatochromic indicators to probe the surface properties and relevance of the results to the applications of TiO(2) are discussed.

Effects of alloying elements on the cytotoxic response of titanium alloys

Titanium alloys, alloys, especially beta-type alloys containing beta-stabilizing elements, constitute a highly versatile category of metallic materials that have been under constant development for application in orthopedics and dentistry. This type of alloy generally presents a high mechanical strength-to-weight ratio, excellent corrosion resistance and low elastic modulus. The purpose of this study is to evaluate the cytotoxicity and adhesion of fibroblast cells on titanium alloy substrates containing Nb, Ta, Zr, Cu, Sn and Mo alloying elements. Cells cultured on polystyrene were used as controls. In vitro results with Vero cells demonstrated that the tested materials, except Cu-based alloy, presented high viability in short-term testing. Adhesion of cells cultured on disks showed no differences between the materials and reference except for the Ti-Cu alloy, which showed reduced adhesion attributed to poor metabolic activity. Titanium alloys with the addition of Nb, Ta, Zr, Sn and Mo elements show a promising potential for biomedical applications. (C) 2011 Elsevier B.V. All rights reserved.

Avaliação do estresse oxidativo induzido por superfícies de titânio

Commercially pure Titanium (cp Ti) is a material largely used in orthopedic and dental implants due to its biocompatibility properties. Changes in the surface of cp Ti can determine the functional response of the cells such as facilitating implant fixation and stabilization, and increased roughness of the surface has been shown to improve adhesion and cellular proliferation. Various surface modification methods have been developed to increase roughness, such as mechanical, chemical, electrochemical and plasma treatment. An argon plasma treatment generates a surface that has good mechanical proprieties without chemical composition modification. Besides the topography, biological responses to the implant contribute significantly to its success. Oxidative stress induced by the biomaterials is considered one of the major causes of implant failure. For this reason the oxidative potential of titanium surfaces subjected to plasma treatment was evaluated on this work. CHO-k1 cells were cultivated on smooth or roughed Ti disks, and after three days, the redox balance was investigated measuring reactive oxygen species (ROS) generation, total antioxidant capacity and biomarkers of ROS attack. The results showed cells grown on titanium surfaces are subjected to intracellular oxidative stress due to hydrogen peroxide generation. Titanium discs subjected to the plasma treatment induced less oxidative stress than the untreated ones, which resulted in improved cellular ability. Our data suggest that plasma treated titanium may be a more biocompatible biomaterial.

Análise da estabilidade genética de células-tronco mesenquimais humanas

Human multipotent mesenchymal stromal cells (MSCs), also known as mesenchymal stem cells, have become an important and attractive therapeutic tool since they are easily isolated and cultured, have in vitro expansion potential, substantial plasticity and secrete bioactive molecules that exert trophic effects. The human umbilical cord as a cell source for cell therapy will help to avoid several ethical, political, religious and technical issues. One of the main issues with SC lines from different sources, mainly those of embryonic origin, is the possibility of chromosomal alterations and genomic instability during in vitro expansion. Cells isolated from one umbilical cord exhibited a rare balanced paracentric inversion, likely a cytogenetic constitutional alteration, karyotype: 46,XY,inv(3)(p13p25~26). Important genes related to cancer predisposition and others involved in DNA repair are located in 3p25~26. Titanium is an excellent biomaterial for bone-implant integration; however, the use can result in the generation of particulate debris that can accumulate in the tissues adjacent to the prosthesis, in the local bone marrow, in the lymph nodes, liver and spleen. Subsequently may elicit important biological responses that aren´t well studied. In this work, we have studied the genetic stability of MSC isolated from the umbilical cord vein during in vitro expansion, after the cryopreservation, and under different concentrations and time of exposition to titanium microparticles. Cells were isolated, in vitro expanded, demonstrated capacity for osteogenic, adipogenic and chondrogenic differentiation and were evaluated using flow cytometry, so they met the minimum requirements for characterization as MSCs. The cells were expanded under different concentrations and time of exposition to titanium microparticles. The genetic stability of MSCs was assessed by cytogenetic analysis, fluorescence in situ hybridization (FISH) and analysis of micronucleus and other nuclear alterations (CBMN). The cells were able to internalize the titanium microparticles, but MSCs preserve their morphology, differentiation capacity and surface marker expression profiles. Furthermore, there was an increase in the genomic instability after long time of in vitro expansion, and this instability was greater when cells were exposed to high doses of titanium microparticles that induced oxidative stress. It is necessary always assess the risks/ benefits of using titanium in tissue therapy involving MSCs, considering the biosafety of the use of bone regeneration using titanium and MSCs. Even without using titanium, it is important that the therapeutic use of such cells is based on analyzes that ensure quality, security and cellular stability, with the standardization of quality control programs appropriate. In conclusion, it is suggested that cytogenetic analysis, FISH analysis and the micronucleus and other nuclear alterations are carried out in CTMH before implanting in a patient

Biomecânica e otimização topológica com H-adaptatividade em implantes dentários nitretados a plasma em cátodo oco

In recent years there has been a significant growth in technologies that modify implant surfaces, reducing healing time and allowing their successful use in areas with low bone density. One of the most widely used techniques is plasma nitration, applied with excellent results in titanium and its alloys, with greater frequency in the manufacture of hip, ankle and shoulder implants. However, its use in dental implants is very limited due to high process temperatures (between 700 C o and 800 C o ), resulting in distortions in these geometrically complex and highly precise components. The aim of the present study is to assess osseointegration and mechanical strength of grade II nitrided titanium samples, through configuration of hollow cathode discharge. Moreover, new formulations are proposed to determine the optimum structural topology of the dental implant under study, in order to perfect its shape, make it efficient, competitive and with high definition. In the nitriding process, the samples were treated at a temperature of 450 C o and pressure of 150 Pa , during 1 hour of treatment. This condition was selected because it obtains the best wettability results in previous studies, where different pressure, temperature and time conditions were systematized. The samples were characterized by X-ray diffraction, scanning electron microscope, roughness, microhardness and wettability. Biomechanical fatigue tests were then conducted. Finally, a formulation using the three dimensional structural topology optimization method was proposed, in conjunction with an hadaptive refinement process. The results showed that plasma nitriding, using the hollow cathode discharge technique, caused changes in the surface texture of test specimens, increases surface roughness, wettability and microhardness when compared to the untreated sample. In the biomechanical fatigue test, the treated implant showed no flaws, after five million cycles, at a maximum fatigue load of 84.46 N. The results of the topological optimization process showed well-defined optimized layouts of the dental implant, with a clear distribution of material and a defined edge

Influence of Heat Treatment and Oxygen Doping on the Mechanical Properties and Biocompatibility of Titanium-Niobium Binary Alloys

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diffusion of Interstitial Elements in Ti Alloys used as Biomaterials

Titanium alloys are excellent implant materials for orthopedic applications due to their desirable properties, such as good corrosion resistance, low elasticity modulus, and excellent biocompatibility. The presence of interstitial elements (such as oxygen and nitrogen) causes strong changes in the material's mechanical properties, mainly in its elastic properties. Study of the interaction among interstitial elements present in metals began with Snoek's postulate, that a stress-induced ordering of interstitials gives rise to a peak in the mechanical relaxation (internal friction) spectra. In the mechanical relaxation spectra, each species of interstitial solute atom gives rise to a distinct Snoek's peak, whose temperature and position depend on the measurement frequency. This effect is very interesting because its peculiar parameters are directly related to the diffusion coefficient (D) for the interstitial solute. This paper presents a study of diffusion of heavy interstitial elements in Ti-35Nb-7Zr-5Ta alloys using mechanical spectroscopy. Pre-exponential factors and activation energies are calculated for oxygen and nitrogen in theses alloys.