Influência dos fatores locais na prevalência da peri-implantite ao redor de implantes pilares de próteses totais fixas: estudo transversal

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em OdontologiaObjetivo: A proposta deste estudo foi avaliar a influência dos fatores locais na prevalência da peri-implantite em implantes osseointegrados instalados na mandíbula e maxila de pacientes que utilizavam próteses totais implantossuportadas. Materiais e Métodos: Foram examinados 27 pacientes (161 implantes) que apresentavam implantes cilíndricos, conexão do tipo hexágono externo (Conexão, São Paulo, Brasil), radiografias mensuráveis, informações dos prontuários preenchidas adequadamente e próteses totais implantossuportadas aparafusadas. Para este estudo, nenhum dos pacientes havia sido submetido à algum tipo de visita para manutenção da prótese e dos implantes no CEPID. Foram coletadas informações com relação ao sexo, idade, hábitos tabagistas, histórico de doença periodontal e saúde geral do paciente antes e após a instalação dos implantes. Com relação aos implantes, coletaram-se informações referentes às suas características tais como localização, posicionamento, tempo em função, quantidade de mucosa ceratinizada, profundidade de sondagem, índice de sangramento do sulco modificado, tipo de carga, índice de placa modificado, sangramento à sondagem, recessão e distância entre implantes. Com relação à prótese, os dados coletados estavam relacionados à dificuldade de higienização, tipo de pilar utilizado, presença ou não de pilar protético e extensão do cantiléver. Resultados: Dos 161 implantes analisados, 116 (72%) apresentaram-se sem peri-implantite enquanto que 45 (28%) apresentavam a doença. Houve significância estatística (p < 0.05) com relação à localização - implantes instalados na maxila possuem 2.98 vezes mais chances de apresentarem peri-implantite. Assim como os pacientes com idade ? 60 anos tem 3.24 vezes mais chances de apresentarem este tipo de doença. Outra análise com relevância estatística (p < 0.05) foi a de que se não obedecida a distância de no mínimo 3 mm entre implantes, as chances do surgimento da doença aumentam em 2.98 vezes. Não houve relevância estatística em nenhuma das outras análises. Conclusão: Conclui-se que pacientes com idade ? 60 anos possuem maior propensão à peri-implantite assim como implantes instalados na maxila e aqueles com distância entre sim < 3 mm.Objective: The purpose of this study was to evaluate the influence of local factors in peri-implantis' prevalence in osseointegrated implants installed either on mandible or maxilla of patients using full-arch prostheses. Materials and Methods: There were examined 27 patients (116 implants) that presented cylindric implants with external hex connection (Conexão, São Paulo, Brasil), radiographs, charts filled correctly and screwed full-arch prostheses. For this study, none of the patients attended any follow-up visit until the data collection. There were collected information regarding gender, age, smoking habits, periodontal disease historic and patient's general health before and after implants installation. In relation to the implant, information obtained were about its characteristics, positioning, time in function, bleeding on probing, width of keratinized mucosa, modified sulcus bleeding index, type of loading, modified plaque index, probing depth, recession and distance between implants. Considering full-arch prostheses, the data collected were related with hygiene difficulty, type of abutment, abutment presence or not and cantilever extension. Results: Of the 161 implants analysed, 116 (72%) showed no peri-implantitis whereas 45 (28%) presented signs and symptoms of the disease. There was statistical significance (p < 0.05) regarding implant positioning - implants installed in the maxilla are 2.98 times more likely to develop the disease. As well as patients aged = 60 years old are 3.24 times more likely of presenting peri-implantitis. Another analysis with statistical relevance (p <0.05) was that implants with less than 3mm between them, are 3 times more likely of having peri-implantitis. There was no statistical relevance considering the other analyses. Conclusion: It can be concluded that patients aged = 60 years have more chances of presenting peri-implantitis as well as implants positioned in the maxilla and those installed with distance between them < 3 mm

Meio condicionado de osso desmineralizado e liofilizado altera a expressão gênica de fibroblastos orais via receptores TGF-B in vitro

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2016A matriz óssea desmineralizada (MOD) é utilizada para o tratamento de defeitos ósseos. O meio condicionado obtido a partir de partículas ósseas de origem autógena tem o potencial de ativar a sinalização do fator de crescimento transformador-ß (TGF-ß) em células mesenquimais. O objetivo deste estudo foi determinar se o processamento do osso autógeno em MOD afeta a atividade do meio condicionado. Métodos: Blocos corticais suínos foram submetidos ao desengorduramento, à desmineralização com diferentes concentrações de ácido clorídrico (HCl), e a diferentes temperaturas durante sua etapa de preparo. Posteriormente, o osso foi liofilizado e particulado até a obtenção da matriz óssea desmineralizada. Fibroblastos gengivais e do ligamento periodontal foram expostos ao meio condicionado obtido a partir da matriz óssea desmineralizada (MOCD). Alterações na expressão dos genes alvos do fator de crescimento transformador-ß foram determinados. Resultados: O MOCD alterou consideravelmente a expressão dos genes alvos (ADM, PTX3, KANK4, IL11, NOX4, e BTBD11). Esta resposta foi observada nos fibroblastos gengivais e do ligamento periodontal. A etapa de desengorduramento diminuiu a atividade do MOCD. O inibidor seletivo SB431542 de receptores TGF-ß bloqueou os efeitos do MOCD sobre a expressão gênica. No entanto a dorsomorfina, inibidora seletiva dos receptores da proteína óssea morforgenética (BMP), não teve efeito semelhante. O meio ósseo condicionado obtido a partir da MOD comercial humana, também alterou a expressão gênica. Conclusão: Os achados sugerem que o meio condicionado obtido a partir da matriz óssea desmineralizada pode ativar a sinalização do fator de crescimento transformador-ß de fibroblastos gengivais e do ligamento periodontal. Abstract : Demineralized bone matrix (DBM) is used for the treatment of osseous defects. Conditioned medium from native bone chips can activate transforming growth fator-ß (TGF-ß) signaling in mesenchymal cells. The aim of this study was to determine whether processing of native bone into DBM affects the activity of the conditioned medium. Methods: Porcine cortical bone blocks were subjected to defatting, different concentrations of hydrochloric acid (HCl), and various temperatures. DBM was lyophilized, ground, and placed into culture medium. Human gingiva and periodontal fibroblasts were exposed to the respective conditioned medium obtained from DBM (DBCM). Changes in the expression of TGF-ß target genes were determined. Results: DBCM altered the expression of TGF-ß target genes (e.g., adrenomedullin, pentraxin 3, KN motif and ankyrin repeat domains 4, interleukin 11, NADPH oxidase 4, and BTB [POZ] domain containing 11) by at least five-fold. The response was observed in fibroblasts from both sources. Defatting lowered the activity of DBCM. The TGF-ß receptor type I kinase inhibitor SB431542 [4-(4 (benzo[d] 1,3]dioxol-5-yl)-5-(pyridin-2-yl)-1H-imidazol-2 yl)benzamide] but not the inhibitor of bone morphogenetic protein receptor dorsomorphin, blocked the effects of DBCM on gene expression. Moreover, conditioned medium obtained from commercial human DBM modulated the expression of TGF-ß target genes. Conclusion: The findings suggest that the conditioned medium obtained from demineralized bone matrix can activate TGF-ß signaling in oral fibroblasts

Does the number of implants have any relation with peri-implant disease?

Objective: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. Material and Methods: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >;5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. Results: Clinical parameters were compared between groups using Student’s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (

Does the number of implants have any relation with peri-implant disease?

Objective: The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease. Material and Methods: Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis. Results: Clinical parameters were compared between groups using Student’s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 – 19 (20.43%) – compared with G2 – 26 (38.24%) – showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210). Conclusion: It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis

Application of Immediate Dentoalveolar Restoration in Alveolus Compromised with Loss of Immediate Implant in Esthetic Area

In the reported clinical case, the immediate dentoalveolar restoration (IDR) technique was applied to reconstruct the buccal bone wall, with autogenous graft of the maxillary tuberosity, which had been lost due to a root fracture, and to provide the necessary bone substrate for the installation of an implant and its provisioning. One of the greatest risks inherent in the survival of immediate implants is the maintenance of their stability during the healing period. In this case, due to a mechanical trauma in sports activity in the first postoperative month, there was a total failure in the osseointegration process, confirmed by tomographic examination of both the implant and the bone graft. The deleterious effects of this accident were compensated with a new approach and reapplication of IDR technique using a smaller-diameter implant and with conical macrogeometry in conjunction with the new bone reconstruction under the same compromised alveolus; associated, after the period of osseointegration, with the maneuvers of volume increase of the gingival tissue by subepithelial connective tissue graft. The tomographic result demonstrated the success of the surgical procedures, and the clinical/photographic analysis obtained showed the stability of the gingival margin without compromising the esthetic result of the prosthetic restoration

A Prosthetic Solution to Poorly Placed Implants in the Posterior Mandible

The objective of the present study is to find a solution for patients who have multiple implants that are poorly placed in the posterior mandible and require a solution to be rehabilitated, taking into account some diagnostic principles such as maintenance of the occlusal plane, maintenance of correct dental arch inclination, and adequate vertical dimension

Biofilm Analysis of Retrieved Dental Implants after Different Peri-Implantitis Treatments

The aim of the current study was to analyse the planktonic growth of Streptococcus mutans on the surfaces of three implants retrieved after three different peri-implantitis treatments. Three implants from a male patient with high levels of bone loss were treated by mechanical debridement, chemical decontamination, and implantoplasty. After 4 months of follow-up, the implants were removed. The growth and biofilm formation were measured by spectrophotometry (OD630 nm) and scanning electron microscopy (SEM), after 48 hours of incubation. Results showed an average of Streptococcus mutans planktonic growth over the implants of 0.21 nm (mechanical debridement), 0.16 nm (chemical decontamination), and 0.15 nm (implantoplasty). Data were analysed by ANOVA and Tukey’s test (p<0.05 for chemical decontamination and implantoplasty). Implantoplasty and chemical decontamination showed the lowest levels of planktonic growth, indicating a possible influence of the modification procedures on the titanium surface on the initial biofilm attachment