A novel approach revealing the effect of a collagenous membrane on osteoconduction in maxillary sinus floor elevation with β-tricalcium phosphate

Calcium phosphates are used in maxillary sinus floor elevation (MSFE) procedures to increase bone height prior to dental implant placement. Whether a collagenous barrier membrane coverage of the lateral window affects bone formation within a bone substitute augmentation is currently an important matter of debate, since its benefit has not been irrefutably proven. Therefore, in this clinical study twelve patients underwent an MSFE procedure with β-tricalcium phosphate (β-TCP). The lateral window was either left uncovered, or covered with a resorbable collagenous barrier membrane. After a 6-months healing period, bone biopsies were retrieved during implant placement. Consecutive 1 mm regions of interest of these biopsies were assessed for bone formation, resorption parameters, as well as bone architecture using histology, histomorphometry and micro-computed tomography. Comparable outcomes between the groups with and without membrane were observed regarding osteoconduction rate, bone and graft volume, osteoclast number and structural parameters of newly formed bone per region of interest. However, osteoid volume in grafted maxillary sinus floors without membrane was significantly higher than with membrane. In conclusion, our results – obtained with a novel method employed using 1 mm regions of interest – demonstrate that the clinical application of a bioresorbable collagenous barrier membrane covering the lateral window, after an MSFE procedure with β-TCP, was not beneficial for bone regeneration and even decreased osteoid production which might lead to diminished bone formation in the long run

Photoelastic analysis of stress distribution on parallel and angled implants after installation of fixed prostheses Análise fotoelástica de distribuição de tensões em implantes paralelos e angulados após a instalação de próteses fixas

The longevity of implant-supported prosthetic rehabilitation depends largely on how the masticatory forces are transferred to the implants and surrounding bone. Anatomical conditions, bone morphology and aesthetics usually dictate implant placement in less than ideal positions for prosthetic rehabilitation and sometimes it is possible to find them with different inclinations. The purpose of this paper was to compare, through photoelastic analysis, the stress distribution in a fixed prosthesis with 3 parallel implants, to the stress distribution in the same prosthesis in the existence of an angled central implant. Two photoelastic resin models were made and a polariscope was used in the visualization of isochromatic fringes formed in the models when axial loads of 2 kg, 5 kg and 10 kg were applied to a unique central point of the prosthesis. The presence of inducted tensions (preloads) was observed in the models after applying torque to the retention screws. Preloads were intensified with the incidence of occlusal forces. In the parallel implants, the force dissipation followed the long axis. The angled implant had a smaller quantity of fringes and the stresses were located mostly around the apical region of the lateral implants.<br>A longevidade das reabilitações orais implanto-suportadas depende, em grande parte, de como as forças mastigatórias são transferidas aos implantes e ao osso que os circunda. Condições anatômicas, morfologia óssea e estética muitas vezes ditam a colocação de implantes em posições que não são ideais para a reabilitação protética, e podemos encontrá-los com diferentes inclinações. A proposta deste trabalho foi comparar, através de análise fotoelástica, a dissipação de tensões em uma prótese fixa com 3 implantes paralelos entre si com a dissipação de tensões na mesma prótese na existência do implante central angulado. Foram confeccionados dois modelos de resina fotoelástica. Utilizou-se um polariscópio para visualização das franjas isocromáticas que se formaram nos modelos fotoelásticos quando cargas axiais de 2 kg, 5 kg e 10 kg foram aplicadas em um mesmo ponto central da prótese. Verificou-se a indução de tensões (pré-tensões) nos modelos após o apertamento dos parafusos de retenção das próteses. As pré-tensões foram agravadas com a incidência de forças oclusais. Nos implantes paralelos, a dissipação de forças seguiu os longos eixos. No implante angulado houve menor quantidade de franjas, e as tensões estavam localizadas principalmente ao redor da região apical dos implantes laterais