Immediate loading of implants installed in a healed alveolar bony ridge or immediately after tooth extraction: an experimental study in dogs

ObjectiveTo compare the sequential healing at immediately loaded implants installed in a healed alveolar bony ridge or immediately after tooth extraction.Material and methodsIn the mandible of 12 dogs, the second premolars were extracted. After 3months, the mesial roots of the third premolars were endodontically treated and the distal roots extracted. Implants were placed immediately into the extraction sockets (test) and in the second premolar region (control). Crowns were applied at the second and third maxillary premolars, and healing abutments of appropriate length were applied at both implants placed in the mandible and adapted to allow occlusal contacts with the crowns in the maxilla. The time of surgery and time of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2weeks and 1 and 3months. Ground sections were prepared for histological analyses.ResultsAt the control sites, a resorption of the buccal bone of 1mm was found after 1week and remained stable thereafter. At the test sites, the resorption was 0.4mm at 1-week period and further loss was observed after 1month. The height of the peri-implant soft tissue was 3.8mm both at test and control sites. Higher values of mineralized bone-to-implant contact and bone density were seen at the controls compared with the test sites. The differences, however, were not statistically significant.ConclusionsDifferent patterns of sequential early healing were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extractions. However, three months after implant installation, no statistically significant differences were found for the hard- and soft-tissue dimensions.

[Tooth extraction under medication with acetylsalicylic acid.]

PURPOSE: The purpose of this prospective study was to show and analyze the bleeding complications after teeth extraction under therapy with 100 mg acetylsalicylic acid (ASA) and to compare them to bleeding complications after teeth extraction in patients with a healthy blood profile.PATIENTS AND METHODS: In 65 patients under medication with 100 mg ASA and in 252 healthy patients, 151/ 543 teeth were extracted and the bleeding complications monitored.RESULTS: The postoperative bleeding frequency was 1.54% in the ASA 100 group and 1.59% in the healthy control group without any medication. No serious or uncontrollable postoperative bleedings arose in either group. All bleedings could be easily handled. No obvious difference concerning the bleeding frequency between the two groups was observed. The small number of bleeding events and the complexity of affecting parameters did not permit statistical tests.CONCLUSION: It is not necessary to interrupt the medication of 100 mg acetylsalicylic acid given to prevent thromboembolism before tooth extractions.

Associação entre as narrativas em saúde bucal e condições socioeconômico-culturais: a dentição como reflexo da desigualdade social

This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

Influence of Microgap Location and Configuration on Peri-implant Bone Morphology in Nonsubmerged Implants: An Experimental Study in Dogs

Purpose: It is unknown whether different micro gap configurations can cause different pen-implant bone reactions. Therefore, this study sought to compare the peri-implant bone morphologies of two implant systems with different implant-abutment connections. Materials and Methods: Three months after mandibular tooth extractions in six mongrel dogs, two oxidized screw implants with an external-hex connection were inserted (hexed group) on one side, whereas on the contralateral side two grit-blasted screw implants with an internal Morse-taper connection (Morse group) were placed. on each side, one implant was inserted level with the bone (equicrestal) and the second implant was inserted 1.5 mm below the bony crest (subcrestal). Healing abutments were inserted immediately after implant placement. Three months later, the peri-implant bone levels, the first bone-to-implant contact points, and the width and steepness of the peri-implant bone defects were evaluated histometrically. Results: All 24 implants osseointegrated clinically and histologically. No statistically significant differences between the hexed group and Morse group were detected for either the vertical position for peri-implant bone levels (Morse equicrestal -0.16 mm, hexed equicrestal -0.22 mm, Morse subcrestal 1.50 mm, hexed subcrestal 0.94 mm) or for the first bone-to-implant contact points (Morse equicrestal -2.08 mm, hexed equicrestal -0.98 mm, Morse subcrestal -1.26 mm, hexed subcrestal -0.76 mm). For the parameters width (Morse equicrestal -0.15 mm, hexed equicrestal -0.59 mm, Morse subcrestal 0.28 mm, hexed subcrestal -0.70 mm) and steepness (Morse equicrestal 25.27 degree, hexed equicrestal 57.21 degree, Morse subcrestal 15.35 degree, hexed subcrestal 37.97 degree) of the pen-implant defect, highly significant differences were noted between the Morse group and the hexed group. Conclusion: Within the limits of this experiment, it can be concluded that different microgap configurations influence the size and shape of the peri-implant bone defect in nonsubmerged implants placed both at the crest and subcrestally. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:540-547

Avaliação radiográfica do comportamento dos terceiros molares inferiores em pacientes tratados ortodonticamente com e sem extrações de primeiros pré-molares

OBJETIVO: o presente trabalho objetivou avaliar as alterações ocorridas nas posições dos terceiros molares inferiores em pacientes tratados ortodonticamente com extrações dos primeiros pré-molares. METODOLOGIA: utilizou-se 80 ortopantomografias, obtidas no pré e pós-tratamento ortodôntico corretivo de 40 pacientes, divididos em dois grupos. O grupo 1 constou de 20 pacientes (13 femininos e 7 masculinos) que se submeteram a tratamento ortodôntico com extrações de primeiros pré-molares. O grupo 2 foi constituído por 20 pacientes (13 femininos e 7 masculinos) tratados ortodonticamente sem extrações. Foram estabelecidas medidas angulares, com o objetivo de avaliar as inclinações e medidas lineares, para analisar as modificações no sentido vertical dos terceiros molares. Todos os dados foram mensurados duas vezes, cujos valores médios foram submetidos dos testes t emparelhado e teste t independente. RESULTADOS: os resultados mostraram diferenças estatisticamente significantes (p<0,01) entre as medidas angulares finais e iniciais do grupo 1. CONCLUSÕES: concluiu-se que os deslocamentos verticais dos terceiros molares inferiores são semelhantes nos casos tratados ortodonticamente com e sem extrações e que estes elementos dentários tornam-se mais verticalizados ao final da terapia realizada com extrações de primeiros pré-molares inferiores.

O efeito da retração dos dentes anteriores sobre o ponto A em pacientes submetidos ao tratamento ortodôntico corretivo

OBJETIVO: avaliar o efeito da retração anterior sobre o ponto A sagital e verticalmente, bem como a correlação e a previsibilidade do comportamento dessas estruturas. METODOLOGIA: sessenta telerradiografias em norma lateral foram usadas, tomadas no início e no final do tratamento ortodôntico corretivo, a partir de 30 pacientes (22 feminino e 8 masculino) com idade entre 10 e 17 anos antes do tratamento, com má oclusão de Classe II, divisão 1 ou Classe I, que foram submetidos às extrações dos quatro primeiros pré-molares ou somente dois primeiros pré-molares superiores. Além das variáveis .1NA,1-NA, 1.PP e 1-A, mensurações lineares horizontais e verticais foram feitas em relação a uma linha de referência construída a partir da linha SN menos 7º e uma linha perpendicular a ela. Todos os dados foram mensurados duas vezes, e as médias foram submetidas ao teste t emparelhado, de correlação linear e de regressão. RESULTADOS: em média, o ponto A retraiu 0,71mm e movimentou para baixo 2,38mm, seguindo 1,03mm e 4,13mm de retração, respectivamente, do ápice radicular e da borda incisal, e 2,35mm de extrusão dentária. A retração do ponto A apresentou correlação positiva em relação ao ápice radicular (r = 0,75; alfa < 0,0001) e em relação à retração da borda incisal (r = 0,70; alfa < 0,0001), mostrando um comportamento ântero-posterior previsível. CONCLUSÕES: concluiu-se que o ponto A retraiu-se e movimentou-se para baixo seguindo o dente, e a retração do ponto A em relação aos incisivos foi previsível.

Fibrin adhesive implant in wound healing repair of dental sockets with topical application of epsilon aminocaproic acid: Histological analysis

The aim of the study was to evaluate wound healing repair of dental sockets after topical application of 5% epsilon-aminocaproic acid (EACA) and the use of fibrin adhesive implant in rats under anticoagulant therapy with warfarin. Sixty Albinus wistar rats were used, divided into three groups of 20. In Group I, the animals were given 0.1 mL/100 mg of 0.9% saline solution per day, beginning 6 days before dental extraction and continuing throughout the experimental period. In Group II, the animals received 0.03 mL of sodium warfarin daily, beginning 6 days before the surgery and continuing until the day of sacrifice; after tooth extractions, the sockets were filled with fibrin adhesive material. In Group III the animals were treated as in Group II, and after extractions, the sockets were irrigated with 5 mL of 5% EACA and filled with the same fibrin adhesive material. All groups presented biological phases of wound healing repair, the differences being evident only in the chronology. The results obtained in Group III were very similar to those of Group I in the last period of wound repair, whereas Group II presented a late chronology compared to the other groups. © 2005 Wiley Periodicals, Inc.

Oral myofunctional and electromyographic evaluation of the anterior suprahyoid muscles and tongue thrust in patients with class II/1 malocclusion submitted to first premolar extraction

Objective: The aim of this study was to assess the existence of myofunctional alterations before and after first premolar extraction in Class II/1 malocclusion patients that could endanger the long-term dental arch stability. Materials and Methods: The study was performed by means of morphological, functional and electromyographic analyses in 17 Class II/1 malocclusion patients (group T) and 17 Class I malocclusion patients (group C), both groups with 12-30-year age range (mean age: 20.93 ± 4.94 years). Results: Data analyzed statistically by Student's t-test showed a significant decrease in the maxillary and mandibular dental arch perimeters after orthodontic treatment (p<0.05). The Kruskal-Wallis test analyzed data from tongue posture at rest and during swallowing, not showing significant differences after treatment (groups Tb and Ta) (p>0.05). However, group T differed significantly from group C (p<0.05). The electromyographic data showed that the anterior right and left suprahyoid muscles acted synergistically in both groups, while having a lower myoelectric activity in group T during swallowing. Conclusions: Myofunctional alterations observed after the orthodontic treatment in Class II/1 malocclusion seemed to jeopardize the long-term orthodontic stability, making recurrence possible. Further research should be conducted to compare electromyographic data before and after orthodontic treatment in order to corroborate the results of the present investigation.

Influence of the hybrid layer thickness and resin tag length on microtensile bond strength.

The purpose of this study was to evaluate the correlation between the hybrid layer thickness/resin tag length and the microtensile bond strength of conventional two-step adhesive system, when applied to healthy dentinal tissue. After performing the restorative adhesive procedures and tooth extractions, ten specimens were sectioned in the mesiodistal direction. One section was used for microscopic analysis of the resin tag lengths and the hybrid layer thickness, while the other was used for the microtensile bond strength test (0.5 mm/min). The fractured surface was classified according to the fracture pattern, under a stereoscopic microscope at 40x magnification. Data obtained were submitted to analysis using one-way ANOVA and Pearson's Correlation test (alpha=0.05). The means corresponding to the hybrid layer thickness, resin tag lengths and the microtensile test were 2.68 microm, 6.43 microm and 16.23 MPa, respectively. There was no correlation between the means of the values obtained for the microtensile test, and those presented by the hybrid layer (r2=0.40, p>0.05) and resin tags (r2=0.21, p>0.05). The microtensile bond strength of the conventional two-step adhesive system Adper Single Bond 2 did not depend on the thickness of the hybrid layer and length of resin tags.

Correlation between hybrid layer thickness, resin tag length and microtensile bond strength of a self-etching adhesive system

The purpose of this study was to evaluate the correlation between the hybrid layer thickness, resin tag length and resin bond strength of a self-etching adhesive system to sound dentin tissue in vivo. After performing restorative procedures and tooth extractions, ten specimens were sectioned in a mesiodistal direction. One dental section was used for light microscope analysis, in which both the resin tag length and hybrid layer thickness were measured, while the other section was analyzed using a microtensile test (0.5 mm/min). The fractured surface of the latter section was characterized using a stereoscopic magnifying glass (40x magnifcation). The results were subject to statistical analysis using the Pearson Correlation Test (a = 0.05). The hybrid layer thickness, resin tag length and resin bond strength mean values were 2.19 microm (0.34), 4.34 microm (0.28) and 9.73 MPa (5,55), respectively. In addition, correlation tests between the resin tag length and the resin bond strength (r=0.014) and also between the hybrid layer thickness and bond strength (r=0.43), showed no statistically significant correlation. The microtensile bond strength of Adper Prompt L Pop self-etching adhesive system does not depend on hybrid layer thickness or resin tag length.

Análise experimental de copolímero na estabilidade primária de implantes osseointegráveis: avaliação microscópica em ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Factors related to orthodontic treatment time in adult patients

INTRODUÇÃO: o tratamento ortodôntico de pacientes adultos apresenta grande variabilidade no tempo necessário para sua realização. OBJETIVO: o objetivo desse trabalho foi investigar a influência de diversas variáveis sobre o tempo de tratamento. MÉTODOS: foram examinados 70 casos clínicos, de pacientes adultos, com bom resultado final, coletados em clínicas de três ortodontistas experientes, cujo acervo total inicial era de 4.723 prontuários. A influência das variáveis idade, sexo, padrão facial, severidade inicial da má oclusão (medida por meio do índice PAR), relação sagital de caninos, tipo de braquetes (estético ou metálico), exodontias, faltas às consultas e "quebras" de aparelho, sobre o tempo de tratamento (variável dependente), foram avaliadas por meio da análise de regressão linear múltipla, seguida do método Stepwise, com p < 0,05. RESULTADOS: a quantidade de faltas (R² = 14,04%, p < 0,0001) e o número de "quebras" do aparelho (R² = 29,71%, p = 0,0037) tiveram influência significativa na variação do tempo de tratamento, sendo essas duas variáveis juntas capazes de prever 43,75% (R² total) da variação no tempo de tratamento. Outros fatores, como a relação de caninos ao início do tratamento, o tipo de braquete usado (metálico ou cerâmico), exodontias, a idade ao início do tratamento, a severidade inicial da má oclusão, o sexo do paciente e o padrão facial não tiveram influência significativa sobre o tempo de tratamento. CONCLUSÃO: a duração do tratamento ortodôntico em adultos, quando realizado por ortodontistas experientes, sofre influência, principalmente, de fatores associados à colaboração do próprio paciente. Entretanto, diversos fatores não incluídos nesse estudo podem contribuir para a variação na duração do tratamento ortodôntico.

Inhibition of osteoblast activity by zoledronic acid

INTRODUCTION: Patients treated with nitrogen-containing bisphosphonates, such as zoledronic acid (ZA), have frequently shown oral bone exposure areas, termed osteonecrosis. In addition, these patients may also present low repair and regeneration potential, mainly after tooth extractions. These side-effects caused by bisphosphonates may be due to their inhibitory effects on oral mucosa and local bone cells. OBJECTIVE: To evaluate the effects of ZA on the mineralization capacity of cultured osteoblasts. MATERIALS AND METHODS: Human immortalized osteoblasts (SaOs-2) were grown in plain culture medium (Dulbecco's Modified Eagle Medium [DMEM] + 10% fetal bovine serum [FBS]) in wells of 24-well plates. After 48-hour incubation, the plain DMEM was replaced by a solution with ZA at 5 µM which was maintained in contact with cells for seven, 14 or 21 days. After these periods, cells were evaluated regarding alkaline phosphatase (ALP) activity and mineral nodule formation (alizarin red). Data were statistically analyzed by Mann-Whitney test, at 5% of significance level. RESULTS: ZA caused significant reduction on ALP activity and mineral nodules formation by cultured osteoblasts in all evaluated periods (p < 0.05). CONCLUSION: These data indicate that ZA causes inhibition on the osteogenic phenotype of cultured human osteoblasts, which, in turn, may reduce bone repair in patients subjected to ZA therapy.

Confecção e montagem do set-up ortodôntico

Diagnosis and planning stages are critical to the success of orthodontic treatment, in which the orthodontist should have many elements that contribute to the most appropriate decision-making. The orthodontic set-up is an important resource in the planning of corrective orthodontics therapy. It consists of the repositioning of the teeth previously removed from the study dental casts and reassembled on its remaining basis. When properly made, the set-up allows a three-dimensional preview of problems and limitations of the case, assisting in decision-making regarding tooth extractions in cases with problems of space, amount of anchorage loss extent and type of tooth movement, discrepancy of dental arch perimeter, discrepancy of inter-arch tooth volume, among others, indicating the best option for treatment. This paper outlines the most important steps for its confection, an evaluation system and its application in the preparation of orthodontic treatment planning.

Montagem e confecção do set up ortodôntico

Diagnosis and planning stages are critical to the success of orthodontic treatment, in which the orthodontist should have many elements that contribute to the most appropriate decision-making. The orthodontic set-up is an important resource in the planning of corrective orthodontics therapy. It consists of the repositioning of the teeth previously removed from the study dental casts and reassembled on its remaining basis. When properly made, the set-up allows a three-dimensional preview of problems and limitations of the case, assisting in decision-making regarding tooth extractions in cases with problems of space, amount of anchorage loss extent and type of tooth movement, discrepancy of dental arch perimeter, discrepancy of inter-arch tooth volume, among others, indicating the best option for treatment. This paper outlines the most important steps for its confection, an evaluation system and its application in the preparation of orthodontic treatment planning.