Influência dos fatores locais e sistêmicos na osseointegração e perda óssea ao redor de implantes: estudo retrospectivo de 1 a 8 anos

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-graduação em Odontologia, Florianópolis, 2010A proposta deste estudo foi avaliar, retrospectivamente, o sucesso dos implantes e a influência de fatores locais e sistêmicos na osseointegração e perda óssea ao redor de implantes orais em pacientes que apresentam implantes em função por 1 a 8 anos. Foram selecionados 193 pacientes (753 implantes) que apresentavam implantes cilíndricos, conexão do tipo hexágono externo (Conexão, São Paulo, Brasil) com radiografias mensuráveis, informações dos prontuários preenchidas adequadamente e próteses provisórias ou definitivas por 1 ano, no mínimo. Implantes que se apresentavam osseointegrados sustentando e mantendo a função das respectivas próteses foram considerados como sucesso. Considerouse o restante como perda. Os implantes considerados como sucesso foram divididos em relação à quantidade de perda óssea: < 2 mm; e = 2 mm. Foram coletadas informações em relação a sexo, idade, escolaridade e saúde geral do paciente antes e após a instalação dos implantes. Em relação aos implantes, coletaram-se informações quanto a suas características, localização, momento da perda, tempo de instalação da prótese e tipo de prótese. Do total, 722 implantes (95,9%) obtiveram sucesso e 31 implantes (4,1%) foram perdidos, sendo 27 removidos na cirurgia de reabertura e 4 após a ativação da prótese. Observa-se que o fumo está associado a um aumento na taxa de perda dos implantes na razão de 2,9 (p < 0,05) antes da instalação dos implantes. Houve diferença estatística na taxa de falhas dos implantes com plataforma estreita #18,9% (p < 0,001). Dos implantes considerados com sucesso, 507 implantes apresentaram perda óssea < 2 mm (70,2%) e 215 implantes # em 67 acientes (34,7%) # apresentaram perda óssea = 2 mm (29,8%). Houve diferença estatística na avaliação da perda óssea no tempo de função do implante, tipo de prótese, comprimento dos implantes e fumo antes do procedimento cirúrgico. Conclui-se que implantes cilíndricos e conexão tipo hexágono externo apresentam excelentes taxas de sucesso e podem ser indicados em larga escala. Implantes com plataforma estreita são contra-indicados para reposição dentes posteriores. Dentre os fatores sistêmicos, apenas o fumo dificulta a obtenção e/ou manutenção da osseointegração. Além disso, o maior período em função do implante, implantes que suportam próteses parciais e totais, implantes = 10 mm e o fumo são fatores relacionados à maior perda óssea peri-implantar.The purpose of this study was to evaluate retrospectively the success of oral implants and the influence of local and systemic factors on osseointegration and bone loss around implants in patients with oral implants in function for 1-8 years. Were selected 193 patients (753 implants) who had cylindrical implants, with external hexagonal connection (Conexão, São Paulo, Brazil), measurable radiographs, medical records properly completed and provisional or final prosthesis for at least 1 year. Osseointegrated implants that presented themselves sustaining and maintaining the function of their prostheses and who met the inclusion criteria were considered as success. The remainder was considered as a loss. The implants were considered successfully divided over the amount of bone loss: <2 mm, and = 2 mm. Information was collected regarding sex, age, education and general health of the patient before and after the installation of implants. In relation to the implants were collected information regarding their characteristics, location, time of loss, period of installation of prosthesis and type of prosthesis. Of the total, 722 implants (95.9%) were successful, and 31 implants (4.1%) were lost, 27 removed at second stage surgery and 4 after activation of the prosthesis. It is observed that smoking is associated with an increased implants loss in the ratio of 2.9 (p <0.05) before the installation of the implants. There was statistical difference in failure rate of implants with narrow platform - 18.9% (p <0.001). The implants considered successful, 507 implants showed bone loss <2 mm (70.2%) and 215 implants - in 67 patients (34.7%) - showed bone loss = 2 mm (29.8%). There was statistical difference in the evaluation of bone loss at the time of implant function, type of prosthesis, size of implants and smoking before surgery. It is concluded that cylindrical implants with external connection shown excellent success rates and can be displayed on a large scale. Narrow platform implants are contraindicated for replacement posterior teeth. Among the systemic factors only smoking hinders the achievement or maintenance of osseointegration. Moreover, the longest period in function of the implant, implants that support partial and full dentures, implants = 10 mm and smoking are factors associated with greater bone loss around implant

Fatores potenciais relacionados à perda óssea peri-implantar

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2013.O objetivo do estudo foi avaliar a associação de fatores sistêmicos e características da reabilitação implantossuportada - implante, prótese e parâmetros clínicos - na perda óssea peri-implantar adicional = 2mm (POA). Foram selecionados para o estudo 297 pacientes, reabilitados com 1001 implantes por pelo menos 1 ano. Os efeitos de diversas variáveis potencialmente explicativas foram avaliados segundo condição sistêmica do paciente, e características do implante, prótese e parâmetros clínicos. A regressão logística não demonstrou associação de fatores sistêmicos na POA. Houve correlação estatística positiva para POA na carga mediata (pAbstract : The aim of the study was to retrospectively evaluate the association of systemic factors and implant-supported rehabilitation features - implant, prosthesis and clinical parameters - with additional peri-implant bone loss = 2mm (ABL). For this study, there were selected 297 patients rehabilitated with 1001 implants at least 1 year in function. The effects of several potentially explanatory variables were evaluated according patient?s systemic conditions and implant, prosthesis and clinical parameters? features. Logistic regression did not demonstrate any association of systemic factors in ABL. There was a positive statistical correlation for ABL in immediate loading (p<0,001), machined surface (p=0,007) and implants in function for more than 4 years (p<0,001) - implant level. Cemented prosthesis (p=0,008) and multiple prostheses (p<0,001) presented higher values for ABL. For clinical parameters analysis, higher ABL was observed in implants that presented adjacent biofilm (p<0,001), higher values of marginal recession (MR) (p<0,001) and clinical probing depth (PD) =5mm (p<0,001). No systemic factor influences ABL. Immediate loading and surface treatment favor the maintenance of peri-implant bone. Also, ABL is associated with cemented prosthesis; partial dentures; and implants in function for more than 4 years. Moreover, with the presence of adjacent biofilm and higher values of MR and PD =5mm. Hence, patients with such issues should be informed about the risk of ABL, prior to implant therapy, and attend periodically to maintenance consultations

Socioeconomic factors and attitudes towards household prevention of American cutaneous leishmaniasis in an endemic area in southern Bahia, Brazil

Foi realizado um inquérito visando identificar condições sócio-econômicas e atitudes de uma população em relação à prevenção domiciliar da LTA, na localidade de Corte de Pedra, Município de Tancredo Neves, área endêmica do sul da Bahia, Brasil. O questionário foi aplicado em julho de 1997, com perguntas sobre aspectos sociais e econômicos, hábitos e atitudes da população em relação à prevenção contra a picada de artrópodos. Foram entrevistadas 100% das famílias habitantes da área selecionada, distribuídas em 168 moradias, correspondendo a 851 pessoas. Cerca de 66,7% das famílias percebem um ou menos de um salário mínimo mensal para o sustento de uma média de 5,1 moradores por residência. A maioria das famílias (57,2%) não usa qualquer tipo de proteção. O meio de prevenção mais comum é a fumegação pela incineração de diversos tipos de materiais. As medidas de proteção individual são raramente usadas. Uma vez que na área de estudo têm sido relatadas evidências de transmissão intra e peridomiciliar de LTA, o uso de mosquiteiros impregnados com inseticida seria uma alternativa à proteção intradomiciliar.A survey was conducted to identify socioeconomic conditions and attitudes towards household prevention of American cutaneous leishmaniasis in Corte de Pedra, located in the county of Tancredo Neves, an endemic region in southern Bahia, Brazil. A questionnaire was applied in July 1997, focusing on social and economic variables, habits, and attitudes towards prevention of arthropod bites. All families (100%) living in the study area were surveyed, comprising 168 households with 851 individuals. Approximately 66.7% of the families earned up to one minimum wage, supporting an average of 5.1 residents per household. Most (57.2%) of the families did not use any type of protection against bites. Fumigation by burning various types of materials was the most customary form of prevention. Individual protection measures were rarely used. Since there was evidence of household and peridomiciliary transmission in the study area, use of impregnated bed nets is an alternative for intradomiciliary protection

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 (

Surgically treated megaesophagus: epidemiological profile of patients operated in the Clinical Hospital of the State University of Campinas between 1989 and 2005

Megaesophagus is one of the manifestations of Chagas disease and surgical treatment is the approach that presents the best results. In this retrospective study, the epidemiological profile of patients operated in the Clinical Hospital of University of Campinas between 1989 and 2005 was evaluated with regard to: place of birth, place of residence, probable place of infection, age, degree of megaesophagus, etiology, duration and evolution of dysphagia, other diseases in association and the type of surgery chosen. The method used was to analyze the 390 medical files of these patients, at the hospital's medical archive service. The results made it possible to establish the endemic regions, place of birth and place of residence of the patients with Chagas disease attended at our clinic, and to characterize the group. After detailed analysis, it was found that the mean age was 47 years and the mean duration of dysphagia was 9.47 years. It was observed that: a) in 84.4% of the patients, dysphagia took hold progressively; b) 306 (78.5%) patients presented Chagas disease etiology; c) grade 2 was prevalent in 48%; d) 89.8% of the patients underwent cardiomyotomy; and e) there were frequent associations with gastritis, esophagitis, megacolon, arterial hypertension and cardiopathy.O megaesôfago é uma das manifestações da doença de Chagas, cujo tratamento cirúrgico ó o que apresenta melhores resultados. Neste estudo retrospectivo, avaliou-se o perfil epidemiológico dos pacientes operados no Hospital de Clínicas da Universidade de Campinas entre 1989 e 2005, quanto a: naturalidade e procedência, provável local de contágio, idade, grau do megaesôfago, etiologia, duração da disfagia e sua evolução, outras doenças associadas e modalidade cirúrgica adotada. O método foi a análise de 390 prontuários desses doentes, junto ao Serviço de Arquivo Médico do Hospital de Clínicas da Universidade de Campinas. Os resultados permitiram estabelecer: as regiões endêmicas dos pacientes chagásicos atendidos nesse Serviço, a naturalidade/procedência e a caracterização do grupo. Após análise detalhada, foram obtidas a média de idade = 47 anos, e a duração média da disfagia = 9,47 anos. Observa-se que: a) em 84,4% dos pacientes a disfagia instalou-se progressivamente; b) 306 (78,5%) pacientes apresentaram etiologia chagásica; c) em 48% deles, houve prevalência do grau 2 (48%); d) 89,8% dos pacientes foram submetidos à cardiomiotomia; e) houve associações freqüentes a gastrites, esofagites, megacólon, hipertensão arterial e cardiopatias.18318

Results of the surgical treatment of non‐advanced megaesophagus using Heller–Pinotti's surgery: Laparotomy vs. Laparoscopy

INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients) and laparoscopy (26 patients). Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05). An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%). Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience

Use of arthroscopy in the treatment of fragmented medial coronoid process of the ulna: case report in a dog

The term elbow dysplasia (ED) describes the state of the elbow joint caused by abnormal development.The most common lesions found in the elbow joint are the fragmented medial coronoid process (FMCP) of the ulna, the osteochondritis dissecans (OCD) of the medial portion of the humeral condyle, the isolated processus anconeus (IPA) and articular incongruity (AI). The treatment for FMCP can be conservative or srrgical. Surgical techniques are varied but, usually, aim at removing the affected pieces of cartilage and, or, bone from the elbow joint. This paper reports the success of the arthroscopic technique in the treatment of FMCP in a dog.O termo displasia de cotovelo (DC) descreve um estado anormal da articulação úmero-rádio-ulnar, causada por desenvolvimento inadequado da mesma. As lesões mais comumente encontradas são fragmentação do processo coronóide medial (FPCM) da ulna, osteocondrite dissecante (OCD) da porção medial do côndilo umeral, não união do processo ancôneo (NUPA) e incongruência articular (IA). O tratamento para FPCM pode ser conservativo ou cirúrgico. As técnicas cirúrgicas empregadas são variadas, mas em geral se baseiam na remoção de "flaps" cartilaginosos ou ósseos da articulação. Este trabalho relata o êxito do tratamento da FPCM da ulna utilizando-se a técnica de artroscopia

Population analysis of xenobiotic metabolizing genes in South Brazilian Euro and Afro-descendants

Individual variability in xenobiotic metabolism has been associated with susceptibility to developing complex diseases. Genes involved in xenobiotic metabolism have been evaluated in association studies; the difficulty of obtaining accurate gene frequencies in mixed populations makes interpretation of the results difficult. We sought to estimate population parameters for the cytochrome P450 and glutathione S-transferase gene families, thus contributing to studies using these genes as markers. We describe the frequencies of six genes (CYP1A1, CYP2D6, CYP2E1, GSTM1, GSTT1, and GSTP1) and estimate population parameters in 115 Euro-descendants and 196 Afro-descendants from Curitiba, South of Brazil. PCR-based methods were used for genotyping, and statistical analysis were performed by AMOVA with ARLEQUIN software. The mutant allele frequencies in the Afro-descendants and Euro-descendants, respectively, were: CYP1A1*2A = 30.1% and 15.2%; CYP2D6*4 = 14.5% and 21.5%; CYP2E1*5B = 7.9% and 5%; GSTP1*B = 37.8% and 28.3%. The null genotype frequencies were: GSTM1*0 = 36.8% and 46.1%; GSTT1*0 = 24.2% and 17.4%

Atributos físico-hídricos do solo sob café conilon orgânico consorciado com espécies arbóreas e frutíferas

The objective of this work was to evaluate the cultivation effects of organic conilon coffee (Coffea canephora) intercropped with tree and fruit species on soil physico-hydraulic properties. Conilon coffee managements in the organic system were: T1, full-sun monoculture; T2, T3, T4, and T5, intercropping with peach palm (Bactris gasipae), gliricidia (Gliricidia sepium), banana (Musa sp.), and inga (Inga edulis), respectively; and T6, an area of secondary native forest used as a control. The evaluated soil physico-hydraulic properties were: bulk density, porosity, plant-available water capacity, soil-penetration resistance, soil-water content, soil temperature, and least limiting water range. Conilon coffee intercropped with peach palm and gliricidia resulted in lower soil bulk density and penetration resistance, and in higher total porosity, microporosity, and soil-water content. Organic coffee shaded with peach palm and gliricidia improve the soil physico-hydraulic quality, in comparison with the soil under monoculture in full sun and with the soil of secondary native forest.O objetivo deste trabalho foi avaliar os efeitos do cultivo de cafeeiro conilon (Coffea canephora) orgânico consorciado com espécies arbóreas e frutíferas sobre os atributos físico-hídricos do solo. Os manejos do cafeeiro conilon, no sistema orgânico, foram: T1, monocultivo a pleno sol; T2, T3, T4 e T5, consórcios com pupunha (Bactris gasipae), gliricídia (Gliricidia sepium), banana (Musa sp.) e ingá (Inga edulis), respectivamente; e T6, uma área de mata nativa secundária utilizada como controle. Os atributos físico-hídricos do solo avaliados foram: densidade, porosidade, capacidade de água disponível para as plantas, resistência à penetração, conteúdo de água, temperatura e intervalo hídrico ótimo do solo. Os consórcios de café conilon com pupunha e gliricídia resultaram em menores densidade do solo e resistência à penetração, e em maiores valores de porosidade total, microporosidade e conteúdo de água no solo. Cafezais orgânicos sombreados com pupunha e gliricídia melhoram a qualidade físico-hídrica do solo, em comparação ao solo com monocultivo a pleno sol e ao solo de mata secundária

Manejo orgânico de pastagens com uso de termopotássio e termofosfato na região do Cerrado

The objective of this work was to evaluate the performance of the thermopotassium and thermophosphate agrominerals, as sources of P and K, in an organic pasture consortium of 'Marandu' Urochloa brizantha + Stylosanthes spp. in the Brazilian Cerrado. The organic management was compared with conventional farming using chemical fertilizers, during three years, in two adjacent experiments, one with and the other without previous growth of green manure (Crotalaria juncea). The management treatments were: conventional, with the application of 200 kg ha-1 potassium chloride, 260 kg ha-1 triple superphosphate, and 217 kg ha-1 urea; organic, with the application of 1.0 Mg ha-1 thermophosphate, 2.0 Mg ha-1 termopotassium, and 7.0 Mg ha-1 chicken manure; and control, without fertilizers. Soil fertility, dry mass production, and legume content in the pasture were evaluated. The experiment with green manure resulted in a significant increase in the soil-extractable contents of P and K and in pasture productivity. In the organic treatment, due to the slow release of agromineral nutrients, long-term effects are observed on the soil-extractable contents of P and K.O objetivo deste trabalho foi avaliar o desempenho dos agrominerais termopotássio e termofosfato, como fontes de P e K, em consórcio de pastagem orgânica de Urochloa brizantha 'Marandu' + Stylosanthes spp. no Cerrado brasileiro. O manejo orgânico foi comparado ao convencional com uso de fertilizantes químicos, durante três anos, em dois experimentos adjacentes, um com e outro sem cultivo prévio de adubo verde (Crotalaria juncea). Os tratamentos de manejo foram: convencional, com aplicação de 200 kg ha-1 de cloreto de potássio, 260 kg ha-1 de superfosfato triplo e 217 kg ha-1 de ureia; orgânico, com aplicação de 1,0 Mg ha-1 termopotássio, 2,0 Mg ha-1 termofosfato e 7,0 Mg ha-1 cama de frango; e controle, sem adubação. Foram avaliadas fertilidade do solo, produção de matéria seca e contribuição da leguminosa na pastagem. O experimento com adubação verde proporcionou aumento significativo nos teores de P e K extraíveis do solo e na produtividade da pastagem. No tratamento orgânico, devido à liberação lenta dos nutrientes dos agrominerais, são observados efeitos de longo prazo nos teores extraíveis de P e K do solo