Implants placed in fresh extraction sockets in the maxilla: clinical and radiographic outcomes from a 3-year follow-up examination

AIM The aim of this prospective, randomized, controlled multicenter study was to determine the 3-year efficacy and stability of the soft and hard tissues at implants with a different geometry that were placed in fresh extraction sockets. MATERIAL AND METHODS Implants with two different configurations, cylindrical (Group A) or conical/cylindrical (Group B) were installed, and healing abutments were attached. Sixteen weeks after implant placement, subjects returned for a re-entry procedure. Prosthetic restorations were delivered 22 weeks after implant placement. Each subject was placed in a 3-year follow-up program, including examinations at yearly visits including various soft tissue and bone level parameters. RESULTS The percentage of sites that were considered inflamed during the follow-up period was stable and varied between 8.8% and 10.2%. The radiographic examinations documented improved bone levels at the final examination and the mean improvement from baseline (placement of permanent restoration; PR) amounted to 0.17 ± 0.67 mm. More than 70% (54 of 76) of the implants monitored in this study suffered no bone loss during the maintenance period. Moreover, there was an obvious "gain" of interproximal soft tissue volume and at the 3-year examination around 25% of all embrasure gaps were completely filled with "papillae". CONCLUSIONS Both conical/cylindrical and cylindrical implants placed in fresh extraction sockets allowed proper soft and hard tissue healing to occur. At both types of implants, mucosal inflammation was infrequent, marginal bone levels were maintained, and soft tissue volume increased gradually after the placement of the permanent restoration.

The future of fluorides and other protective agents in erosion prevention

The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H(+) at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.

Die chirurgische Kronenverlängerung zur Verbesserung der biologischen Breite und Ästhetik.

The aims of surgical crown lengthening procedures are to improve prosthetic reconstructions at teeth with limited hard tissue, to prevent periodontal problems and/or to improve esthetics. When planning and performing surgical crown lengthening, it is important to consider not only periodontal and technical aspects but also the gingival profile of the neighbouring teeth. This paper presents the systematic approach starting with the diagnosis and indication to the performed treatments and the obtained results and gives clinical recommendations.

Periodontal and peri-implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Prevalence of erosive tooth wear and associated factors in a group of Mexican adolescents.

BACKGROUND Erosive tooth wear is the irreversible loss of dental hard tissue as a result of chemical processes. When the surface of a tooth is attacked by acids, the resulting loss of structural integrity leaves a softened layer on the tooth's surface, which renders it vulnerable to abrasive forces. The authors' objective was to estimate the prevalence of erosive tooth wear and to identify associated factors in a sample of 14- to 19-year-old adolescents in Mexico. METHODS The authors performed a cross-sectional study on a convenience sample (N = 417) of adolescents in a school in Mexico City, Mexico. The authors used a questionnaire and an oral examination performed according to the Lussi index. RESULTS The prevalence of erosive tooth wear was 31.7% (10.8% with exposed dentin). The final logistic regression model included age (P < .01; odds ratio [OR], 1.64; 95% confidence interval [CI], 1.26-2.13), high intake of sweet carbonated drinks (P = .03; OR, 1.81; 95% CI, 1.06-3.07), and xerostomia (P = .04; OR, 2.31; 95% CI, 1.05-5.09). CONCLUSIONS Erosive tooth wear, mainly on the mandibular first molars, was associated with age, high intake of sweet carbonated drinks, and xerostomia. PRACTICAL IMPLICATIONS Knowledge regarding erosive tooth wear in adolescents with relatively few years of exposure to causal factors will increase the focus on effective preventive measures, the identification of people at high risk, and early treatment.

A peptide that inhibits hydroxyapatite growth is in an extended conformation on the crystal surface

Proteins play an important role in the biological mechanisms controlling hard tissue development, but the details of molecular recognition at inorganic crystal interfaces remain poorly characterized. We have applied a recently developed homonuclear dipolar recoupling solid-state NMR technique, dipolar recoupling with a windowless sequence (DRAWS), to directly probe the conformation of an acidic peptide adsorbed to hydroxyapatite (HAP) crystals. The phosphorylated hexapeptide, DpSpSEEK (N6, where pS denotes phosphorylated serine), was derived from the N terminus of the salivary protein statherin. Constant-composition kinetic characterization demonstrated that, like the native statherin, this peptide inhibits the growth of HAP seed crystals when preadsorbed to the crystal surface. The DRAWS technique was used to measure the internuclear distance between two 13C labels at the carbonyl positions of the adjacent phosphoserine residues. Dipolar dephasing measured at short mixing times yielded a mean separation distance of 3.2 ± 0.1 Å. Data obtained by using longer mixing times suggest a broad distribution of conformations about this average distance. Using a more complex model with discrete α-helical and extended conformations did not yield a better fit to the data and was not consistent with chemical shift analysis. These results suggest that the peptide is predominantly in an extended conformation rather than an α-helical state on the HAP surface. Solid-state NMR approaches can thus be used to determine directly the conformation of biologically relevant peptides on HAP surfaces. A better understanding of peptide and protein conformation on biomineral surfaces may provide design principles useful for the modification of orthopedic and dental implants with coatings and biological growth factors that are designed to enhance biocompatibility with surrounding tissue.

Appendicular robusticity and the paleobiology of modern human emergence

The emergence of modern humans in the Late Pleistocene, whatever its phylogenetic history, was characterized by a series of behaviorally important shifts reflected in aspects of human hard tissue biology and the archeological record. To elucidate these shifts further, diaphyseal cross-sectional morphology was analyzed by using cross-sectional areas and second moments of area of the mid-distal humerus and midshaft femur. The humeral diaphysis indicates a gradual reduction in habitual load levels from Eurasian late archaic, to Early Upper Paleolithic early modern, to Middle Upper Paleolithic early modern hominids, with the Levantine Middle Paleolithic early modern humans being a gracile anomalous outlier. The femoral diaphysis, once variation in ecogeographically patterned body proportions is taken into account, indicates no changes across the pre-30,000 years B.P. samples in habitual locomotor load levels, followed by a modest decrease through the Middle Upper Paleolithic.

Stem cells in the periodontal ligament

The ability to identify and manipulate stem cells has been a significant advancement in regenerative medicine and has contributed to the development of tissue engineering-based clinical therapies. Difficulties associated with achieving predictable periodontal regeneration, means that novel techniques such as tissue engineering need to be developed in order to regenerate the extensive soft and hard tissue destruction that results from periodontitis. One of the critical requirements for a tissue engineering approach is the delivery of ex vivo expanded progenitor populations or the mobilization of endogenous progenitor cells capable of proliferating and differentiating into the required tissues. By definition, stem cells fulfill these requirements and the recent identification of stem cells within the periodontal ligament represents a significant development in the progress toward predictable periodontal regeneration. In order to explore the importance of stem cells in periodontal wound healing and regeneration, this review will examine contemporary concepts in stem cell biology, the role of periodontal ligament progenitor cells in the regenerative process, recent developments in identifying periodontal stem cells and the clinical implications of these findings.

Transglutaminase 2 cross-linking of matrix proteins: biological significance and medical applications

This review summarises the functions of the enzyme tissue transglutaminase (TG2) in the extracellular matrix (ECM) both as a matrix stabiliser through its protein cross-linking activity and as an important cell adhesion protein involved in cell survival. The contribution of extracellular TG2 to the pathology of important diseases such as cancer and fibrosis are discussed with a view to the potential importance of TG2 as a therapeutic target. The medical applications of TG2 are further expanded by detailing the use of transglutaminase cross-linking in the development of novel biocompatible biomaterials for use in soft and hard tissue repair.

Novel hydrogel copolymers and semi-interpenetraing polymer networks

Interpenetrating polymer networks (lPN's), have been defined as a combination of two polymers each in network form, at least one of which has been synthesised and / or crosslinked in the presence of the other. A semi-lPN, is formed when only one of the polymers in the system is crosslinked, the other being linear. lPN's have potential advantages over homogeneous materials presently used in biomedical applications, in that their composite nature gives them a useful combination of properties. Such materials have potential uses in the biomedical field, specifically for use in hard tissue replacements, rigid gas permeable contact lenses and dental materials. Work on simply two or three component systems in both low water containing lPN's supplemented by the study of hydrogels (water swollen hydrophilic polymers) can provide information useful in the future development of more complex systems. A range of copolymers have been synthesised using a variety of methacrylates and acrylates. Hydrogels were obtained by the addition of N-vinyl pyrrolidone to these copolymers. A selection of interpenetrants were incorporated into the samples and their effect on the copolymer properties was investigated. By studying glass transition temperatures, mechanical, surface, water binding and oxygen permeability properties samples were assessed for their suitability for use as biomaterials. In addition copolymers containing tris-(trimethylsiloxy)-y-methacryloxypropyl silane, commonly abbreviated to 'TRlS', have been investigated. This material has been shown to enhance oxygen permeability, a desirable property when considering the design of contact lenses. However, 'TRIS' has a low polar component of surface free energy and hence low wettability. Copolymerisation with a range of methacrylates has shown that significant increases in surface wettability can be obtained without a detrimental effect on oxygen permeability. To further enhance to surface wettability 4-methacryloxyethyl trimellitic anhydride was incorporated into a range of promising samples. This study has shown that by careful choice of monomers it is possible to synthesise polymers that possess a range of properties desirable in biomedical applications.

The effect of bioglass addition on mechanical and physical properties of photoactive UDMA-TEGDMA resin composites

Light curable dimethacrylate resin composites undergo free radical photopolymerisation in response to blue light (wavelength 450-500 nm) and may offer superior handling and setting characteristics for novel hard tissue repair materials. The current investigation aims to determine the optimum formulation of bisphenol-A glycidyl methacrylate and triethyleneglycoldimethacrylate (bisGMA/TEGDMA) or urethane dimethacrylate (UDMA)/TEGDMA resin mixtures and the effect of Bioglass incorporation on the rate of polymerisation (RP), degree of conversion (DC) and flexural strength (FS) of light-curable filled resin composites (FRCs). Experimental photoactive resins containing a range of bisGMA, UDMA and TEGDMA ratios and/or filled with non-silanised irregular or spherical 45S5-Bioglass (50 μm; 5-40 wt%) and/or silanised silicate glass filler particulates (0.7 μm; 50-70 wt%) were tested. RP and DC were analysed in real-time using nearinfrared spectroscopy. FS of resins and FRCs were determined using three-point flexural strength tests. UDMA/TEGDMA resins exhibited increased DC compared with bisGMA/TEGDMA resins (p<0.05). The addition of spherical particles of Bioglass had a detrimental effect on the FS (p>0.05), whereas they increased DC of UDMA/TEGDMA resins (p<0.05). Addition of irregular shaped Bioglass particles increased the FS of UDMA/TEGDMA resins up to 20 wt% Bioglass (p<0.05). The flexibility and strength conferred by the urethane group in UDMA may result in enhanced physical and mechanical properties compared with conventional resins containing bulky (bisGMA) molecules. Addition of 45S5-Bioglass with specific filler content, size and morphology resulted in enhanced mechanical and physical properties of UDMA/TEGDMA composites. © (2014) Trans Tech Publications, Switzerland.

Fraturas dentárias

Uma lesão traumática é, a seguir à cárie dentária, um dos problemas mais comuns da saúde oral. O traumatismo dentário consiste numa agressão que afeta os dentes ou os tecidos de suporte, podendo levar ao rompimento do ligamento periodontal, fratura dentária, fratura óssea ou alterações pulpares. Este problema causa desconforto físico, emocional e comprometimento estético. Quando os traumatismos afetam os tecidos duros ou polpa denominam-se de fraturas dentárias. Estas podem ser divididas em fraturas coronárias de esmalte; fraturas coronárias de esmalte e dentina sem exposição pulpar; fraturas coronárias de esmalte e dentina com exposição pulpar; fraturas corono-radiculares de esmalte, dentina e cemento sem exposição pulpar; fraturas corono-radiculares com exposição pulpar e fratura radicular envolvendo cemento, dentina e polpa. O objetivo deste trabalho monográfico foi fazer uma revisão bibliográfica de estudos científicos sobre fraturas dentárias. Assim, serão abordados os diversos tipos de fraturas dentárias, as suas etiologias, prevalências e fatores associados, também definir planos de tratamento, técnicas de restauração direta de fraturas coronárias e possíveis medidas de prevenção. A pesquisa bibliográfica para esta revisão foi realizada em bases eletrónicas de referência como Pubmed, Scielo, selecionando artigos entre os anos 2006 e 2016. Foram também utilizados como elementos de pesquisa o site Dental Trauma Guide (DTG), o site International Association of Dental Traumatology (IADT), livros da especialidade existentes na Biblioteca da Universidade Fernando Pessoa que embora com datas de publicação mais antigas (2001) foram imprescindíveis para o desenvolvimento da monografia. A pesquisa foi realizada em duas línguas, português e inglês. Como conclusão pode-se dizer que nos dias de hoje, o médico dentista tem muitas opções de tratamento de dentes fraturados. Para restaurar a fratura o médico pode optar por colar o fragmento, restaurar usando uma matriz guia ou restaurar à mão livre. A escolha da técnica deve ser estudada de acordo com cada paciente e suas expectativas.

Biomimetic Scaffold with Aligned Microporosity Designed for Dentin Regeneration

Tooth loss is a common result of a variety of oral diseases due to physiological causes, trauma, genetic disorders, and aging and can lead to physical and mental suffering that markedly lowers the individual’s quality of life. Tooth is a complex organ that is composed of mineralized tissues and soft connective tissues. Dentin is the most voluminous tissue of the tooth and its formation (dentinogenesis) is a highly regulated process displaying several similarities with osteogenesis. In this study, gelatin, thermally denatured collagen, was used as a promising low-cost material to develop scaffolds for hard tissue engineering. We synthetized dentin-like scaffolds using gelatin biomineralized with magnesium-doped hydroxyapatite and blended it with alginate. With a controlled freeze-drying process and alginate cross-linking, it is possible to obtain scaffolds with microscopic aligned channels suitable for tissue engineering. 3D cell culture with mesenchymal stem cells showed the promising properties of the new scaffolds for tooth regeneration. In detail, the chemical–physical features of the scaffolds, mimicking those of natural tissue, facilitate the cell adhesion, and the porosity is suitable for long-term cell colonization and fine cell–material interactions.

Assessment of seawater pollution by heavy metals (lead & cadmium) in the Qeshm rocky shore: use of the sea urchin, Echinometra mathaei, as a bioindicator

The general purpose of this study is to investigate the degree of heavy metal accumulation in hard and soft tissue of sea urchin, and determining these tissues as the most suitable bioindicator for lead and cadmium in the environment of the sampling stations. The way of doing this assessment was MOOPAM. Samples were prepared and classified according to sea urchin organ (soft tissue, hard tissue, Tube feet, Test, Lantern Structure and spines) and then lead and cadmium were measured in them. Result of this study shows that hard tissue is a better index of lead and cadmium than soft tissue. The result of bioaccumulation of lead in the related tissue was found to be in the following order: Soft tissue=21, hard tissue=28.1, Test=20.8, Lantern Structure=20.5 and spines=23.9. The result of bioaccumulation of cadmium in the related tissue was found to be in the following order: Soft tissue=9. 7, hard tissue=5.01, Test=4.2, Lantern Structure=4.06 and spines=5.53.