Analysis of primary stability of dental implants inserted in different substrates using the pullout test and insertion torque

The aim of the study was to evaluate mechanical behavior of implants inserted in three substrates, by measuring the pullout strength and the relative stiffness. 32 implants (Master Porous-Conexao, cylindrical, external hexagon, and surface treatment) were divided into 4 groups (n = 8): pig rib bone, polyurethane Synbone, polyurethane Nacional 40 PCF, and pinus wood. Implants were installed with the exact distance of 5 mm of another implant. The insertion torque (N·cm) was quantified using the digital Kratos torque meter and the pullout test (N) was performed by an axial traction force toward the long axis of the implant (2 min/mm) through mount implant devices attached to a piece adapted to a load cell of 200 Kg of a universal testing machine (Emic DL10000). Data of insertion torque and maximum pullout force were submitted to one-way ANOVA and Bonferroni tests (α = 0.05). Polyurethane Nacional 40 PCF and pinus wood showed the highest values of insertion torque and pullout force, with significant statistical difference (P < 0.05) with other groups. The analysis showed stiffness materials with the highest values for primary stability. © 2013 Nathalia Ferraz Oliscovicz et al.

Evaluation of degree of conversion and hardness of dental composites photoactivated with different light guide tips

Objective: The aim of this study was to evaluate the degree of conversion and hardness of different composite resins, photo-activated for 40 s with two different light guide tips, fiber optic and polymer. Methods: Five specimens were made for each group evaluated. The percentage of unreacted carbon double bonds (% C=C) was determined from the ratio of absorbance intensities of aliphatic C=C (peak at 1637 cm-1) against internal standard before and after curing of the specimen: aromatic C-C (peak at 1610 cm-1. The Vickers hardness measurements were performed in a universal testing machine. A 50 gf load was used and the indenter with a dwell time of 30 seconds. The degree of conversion and hardness mean values were analyzed separately by ANOVA and Tukey's test, with a significance level set at 5%. Results: The mean values of degree of conversion for the polymer and fiber optic light guide tip were statistically different (P<.001). The hardness mean values were statistically different among the light guide tips (P<.001), but also there was difference between top and bottom surfaces (P<.001). Conclusions: The results showed that the resins photo-activated with the fiber optic light guide tip promoted higher values for degree of conversion and hardness.

Mechanical Property Assessment of Bone Healing around a Titanium-Zirconium Alloy Dental Implant

Background: It has been reported that titanium-zirconium alloy with 13-17% zirconium (TiZr1317) implants show higher biomechanical stability and bone area percentage relative to commercially pure titanium (cpTi) grade 4 fixtures. Purpose: This study aimed to determine whether the higher stability for TiZr1317 implants is associated with higher mechanical properties of remodeling bone in the areas around the implants. Materials and Methods: This study utilized 36 implants (n=18: TiZr1317, n=18: cpTi), which were placed in the healed ridges of the mandibular premolar and first molar of 12 mini pigs (n=3 implants/animal). After 4 weeks in vivo, the samples were retrieved, and resin-embedded histologic sections of approximately 100μm in thickness were prepared. In order to determine the nanomechanical properties, nanoindentation (n=30 tests/specimen) was performed on the bone tissue of the sections under wet conditions with maximum load of 300μN (loading rate: 60μN/s). Results: The mean (±standard deviation) elastic modulus (E) and hardness (H) for the TiZr1317 group were 2.73±0.50GPa and 0.116±0.017GPa, respectively. For the cpTi group, values were 2.68±0.51GPa and 0.110±0.017GPa for E and H, respectively. Although slightly higher mechanical properties values were observed for the TiZr1317 implants relative to the cpTi for both elastic modulus and hardness, these differences were not significant (E=p>0.75; H=p>0.59). Conclusions: The titanium-zirconium alloy used in this study presented similar degrees of nanomechanical properties to that of the cpTi implants. © 2013 Wiley Periodicals, Inc.

Compressive strength of dental composites photo-activated with different light tips

The aim of this study was to evaluate the compressive strength of microhybrid (Filtek™ Z250) and nanofilled (Filtek™ Supreme XT) composite resins photo-activated with two different light guide tips, fiber optic and polymer, coupled with one LED. The power density was 653 mW cm -2 when using the fiber optic light tip and 596 mW cm-2 with the polymer. After storage in distilled water at 37 ± 2 °C for seven days, the samples were subjected to mechanical testing of compressive strength in an EMIC universal mechanical testing machine with a load cell of 5 kN and speed of 0.5 mm min-1. The statistical analysis was performed using ANOVA with a confidence interval of 95% and Tamhane's test. The results showed that the mean values of compressive strength were not influenced by the different light tips (p > 0.05). However, a statistical difference was observed (p < 0.001) between the microhybrid composite resin photo-activated with the fiber optic light tip and the nanofilled composite resin. Based on these results, it can be concluded that microhybrid composite resin photo-activated with the fiber optic light tip showed better results than nanofilled, regardless of the tip used, and the type of the light tip did not influence the compressive strength of either composite. Thus, the presented results suggest that both the fiber optic and polymer light guide tips provide adequate compressive strength to be used to make restorations. However, the fiber optic light tip associated with microhybrid composite resin may be an interesting option for restorations mainly in posterior teeth. © 2013 Astro Ltd.

Histomorphometrical and molecular evaluation of endosseous dental implants sites in humans: Correlation with clinical and radiographic aspects

Objective: To evaluate the correlations between clinical-radiographical aspects and histomorphometric-molecular parameters of endosseous dental implant sites in humans. Material and methods: The study sample consisted of bone implant sites from the jawbones of 32 volunteers, which were classified according to two different systems: (1) based only on periapical and panoramic images (PP); (2) as proposed by Lekholm & Zarb (L&Z). Bone biopsies were removed using trephine during the first drilling for implant placement. Samples were stained with haematoxylin-eosin (HE), and histomorphometric analysis was performed to obtain the following parameters: trabecular thickness (Tb.Th), trabecular number, bone volume density (BV/TV), bone specific surface (BS/BV), bone surface density and trabecular separation (Tb.Sp). In addition, immunohistochemistry analysis was performed on bone tissue samples for the proteins, Receptor activator of nuclear factor kappa-B (RANK), RANK ligand (RANKL), osteoprotegerin (OPG) and Osteocalcin (OC). Also, the determination of the relative levels of gene expression was performed using Reverse transcription-real-time Polymerase Chain Reaction (RT-PCR). Results: PP and L&Z classification systems revealed a moderate correlation with BV/TV, BS/BV, Tb.Th and Tb.Sp. L&Z's system identified differences among bone types when BV/TV, BS/BV, Tb.Th and Tb.Sp were compared. A weak correlation between PP/L&Z classifications and the expression of bone metabolism regulators (RANK, RANKL, OPG e OC) was found. The analysis of mRNA expression showed no difference between the bone types evaluated. Conclusions: Our results suggest that PP and L&Z subjective bone-type classification systems are related to histomorphometric aspects. These data may contribute to the validation of these classifications. Bone remodelling regulatory molecules do not seem to influence morphological aspects of the jawbone © 2011 John Wiley & Sons A/S.

Occupational ergonomics: Work posture among Brazilian dental students

This study involved observational assessment of work posture in relation to recommended ergonomic posture the requirements necessary for ergonomic posture among students in the final year of a degree program at the School of Dentistry of Araraquara-UNESP/Brazil (n =73) and investigation of the association of work posture with sex, the type of procedure, four-handed dentistry, and the region of the mouth being treated. The work posture of the students during 250 clinical procedures was observed by means of pictures. Each procedure received a posture classification: Adequate, partially adequate, or inadequate. A descriptive statistical analysis was conducted. The prevalence of final posture classification was calculated using 95% confidence intervals and point estimate. Associations of interest were studied using the chi-square test, with a 5% significance level. It was concluded that the prevalence of procedures performed with partially adequate posture was high, and that the final work posture classification was not associated with the variables of interest. © 2013 Taylor & Francis Group.

In vitro comparisons of casting retention on implant abutments among commercially available and experimental castor oil-containing dental luting agents

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

Dental caries experience and Molar-Incisor Hypomineralization

Objective. This cross-sectional study assessed the prevalence and severity of the enamel defects, known as Molar-Incisor Hypomineralization (MIH) and its relationship to dental caries. Materials and methods. A sample of 1157 schoolchildren (population based), aged 6-12 years, of the Araraquara city-Brazil, was evaluated according to the European Academy of Paediatric Dentistry (EAPD) criteria by two trained examiners. The dental impact caused by MIH was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index (WHO). Data were analyzed using ANOVA and Chi-square tests (p < 0.05). The socioeconomic status was collected using a questionnaire answered by parents. Results. The prevalence of MIH was 12.3%. Mild impairment was the most frequent diagnosis. DMFT of children with MIH was 0.89 (±1.18), which are higher than those of the unaffected group (0.43 ± 1.01). An association was found between dental caries only in the permanent dentition of children with MIH (p = 0.0001). Family income was considered low in 85% of the families of children with MIH in the public system, while in private school it was 18% (p < 0.05). Conclusion. The prevalence of MIH in Araraquara was associated with greater caries experience in the permanent dentition. © 2013 Informa Healthcare.

Comparison of the caries-preventive effect of a glass ionomer sealant and fluoride varnish on newly erupted first permanent molars of children with and without dental caries experience

Purpose: This longitudinal clinic study evaluated the effect of a glass ionomer sealant (GIS) and a fluoride varnish (FV) in the prevention of dental decay on newly erupted permanent molars of children with and without caries experience. Materials and methods: Eighty children, aged 6-8 years, with all four newly erupted first permanent molars, were divided into two groups. Group 1 consisted of 53 children without caries experience and group 2 consisted of 27 children with dental caries experience. Permanent molars of the right side were sealed with GIS and the fluoride varnish was applied on the other two permanent first molars. Evaluation of GIS retention and the effectiveness of both materials in the prevention of dental caries were performed after 6, 12 and 18 months. Results: After 18 months, of the 299 teeth, 271 (91%) showed no caries lesions and 28 presented caries lesions (9%). Teeth sealed with GIS had more carious lesions (15) than teeth with fluoride varnish (13). Most of the teeth (70%) that presented carious lesions were in group 2. Of the 138 sealed teeth, only one showed GIS to be totally present, 95 were partially present and 42 teeth were absent. Conclusion: The caries-preventive effect was very similar between both treatments. The presence of dental caries prevailed in the children with caries experience. © 2013 Informa Healthcare.

Effect of low fluoride acidic dentifrices on dental remineralization

This study evaluated the capacity of fluoride acidic dentifrices (pH 4.5) to promote enamel remineralization using a pH cycling model, comparing them with a standard dentifrice (1,100 μgF/g). Enamel blocks had their surface polished and surface hardness determined (SH). Next, they were submitted to subsurface enamel demineralization and to postdemineralization surface hardness analysis. The blocks were divided into 6 experimental groups (n=10): placebo (without F, pH 4.5, negative control), 275, 412, 550, 1,100 μgF/g and a standard dentifrice (positive control). The blocks were submitted to pH cycling for 6 days and treatment with dentifrice slurries twice a day. After pH cycling, surface and crosssectional hardness were assessed to obtain the percentage of surface hardness recovery (%SHR) and the integrated loss of subsurface hardness (δKHN). The results showed that %SHR was similar among acidic dentifrices with 412, 550, 1,100 μgF/g and to the positive control (Tukey's test; p>0.05). For ΔKHN, the acidic dentifrice with 550 μg F/g showed a better performance when compared with the positive control. It can be concluded that acidic dentifrice 550 μgF/g had similar remineralization capacity to that of positive control.

Genes expressed in dental enamel development are associated with molar-incisor hypomineralization

Genetic disturbances during dental development influence variation of number and shape of the dentition. In this study, we tested if genetic variation in enamel formation genes is associated with molar-incisor hypomineralization (MIH), also taking into consideration caries experience. DNA samples from 163 cases with MIH and 82 unaffected controls from Turkey, and 71 cases with MIH and 89 unaffected controls from Brazil were studied. Eleven markers in five genes [ameloblastin (AMBN), amelogenin (AMELX), enamelin (ENAM), tuftelin (TUFT1), and tuftelin-interacting protein 11 (TFIP11)] were genotyped by the TaqMan method. Chi-square was used to compare allele and genotype frequencies between cases with MIH and controls. In the Brazilian data, distinct caries experience within the MIH group was also tested for association with genetic variation in enamel formation genes. The ENAM rs3796704 marker was associated with MIH in both populations (Brazil: p = 0.03; OR = 0.28; 95% C.I. = 0.06-1.0; Turkey: p = 1.22e-012; OR = 17.36; 95% C.I. = 5.98-56.78). Associations between TFIP11 (p = 0.02), ENAM (p = 0.00001), and AMELX (p = 0.01) could be seen with caries independent of having MIH or genomic DNA copies of Streptococcus mutans detected by real time PCR in the Brazilian sample. Several genes involved in enamel formation appear to contribute to MIH. © 2013.

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.

Increased osseointegration effect of bone morphogenetic protein 2 on dental implants: An in vivo study

Application of recombinant human bone morphogenetic protein 2 (rhBMP-2) to implant surfaces has been of great interest due to its osteoinductive potential. However, the optimal coating methodology has not been clarified. The objective of the study was to determine whether the application of rhBMP-2 onto plasma-sprayed hydroxyapatite implant surfaces by immersion in protein solution before implant installation would result in significantly improved bone apposition. Using a sheep iliac model, titanium (Ti) and plasma-sprayed calcium-phosphate (PSCaP)-coated implants uncoated and coated with rhBMP-2 were assessed for their osteogenic effects in the peri-implant area over time in terms of osseointegration and de novo bone formation. After 3 and 6 weeks postoperatively, the samples were retrieved and were subjected to bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) evaluation. When rhBMP-2 was applied to the PSCaP surface, significant increases in BIC and BAFO were observed at 3 weeks in vivo, whereas when adsorbed directly onto the titanium implant surface, rhBMP-2 did not as effectively improve the bone response (although significantly higher than control Ti). The outcomes of the present study suggested that the combination of plasma-sprayed calcium-phosphate surface and rhBMP-2 coating significantly enhanced osseointegration, which validated the postulated hypothesis. © 2013 Wiley Periodicals, Inc.

Dental fluorescence: Potential forensic use

In cases of identification of bones, skeletal segments or isolated bones, searching for biotypologic diagnostic data to estimate an individual's age enables comparing these data with those of missing individuals. Enamel, dentin and pulp undergo remarkable changes during an individual's life. The enamel becomes more mineralized, smoother and thinner, and deteriorates because of physiological and pathological factors. Dental pulp decreases in volume due to the deposition of secondary dentin; thus, the dentin becomes thicker with time. In natural teeth, the fluorescence phenomenon occurs in dentin and enamel and changes in those tissues may alter the expression of the natural tooth color. The aim of this study was to assess the correlation between age and teeth fluorescence for individuals from different age groups. The sample consisted of 66 randomly selected Brazilians of both genders aged 7-63 years old. They were divided into 6 groups: Group 1 - aged 7-12 years, Group 2 - aged 13-20 years, Group 3 - aged 21-30 years, Group 4 - aged 31-40 years, Group 5 - aged 41-50 years and Group 6 - aged between 51 and 63 years. Upper right or left central incisors were used for the study. Restored and aesthetic rehabilitated teeth were excluded from the sample. The measurement of tooth fluorescence was carried out via computer analysis of digital images using the software ScanWhite DMC/Darwin Systems - Brazil. It was observed that dental fluorescence decreases when comparing the age groups 21-30, 31-40, 41-50 and 51-63 years. The results also showed that there is a statistically significant difference between the groups 41-50 years and 21-30 years (p=. 0.005) and also among the group 51-63 years and all other groups (p< 0.005). It can be concluded that dental fluorescence is correlated with age and has a similar and stable behavior from 7 to 20 years of age. It reaches its maximum expected value at the age of 26.5 years and thereafter decreases. © 2013 Elsevier B.V.