Implantes dentais em pacientes com diabetes mellitus

Dental implants represent a great improvement in Dentistry in respect to rehabilitation of edentulous ridges due to the functional and aesthetic reestablishment with long-term predictability and success. However, the effectiveness of this treatment relies on successful osseointegration during the healing period. In this way, the applicability of dental implants in patients with diabetes mellitus (DM) remains controversial, by the fact that the hyperglycemic status presents a negative effect on the osseointegration. It is not clear yet if the therapy with dental implants is an absolute contraindication to these patients. For this reason, the aim of the present study is to review the literature about the treatment with dental implants in patients with diabetes and to propose a protocol to perform dental implants in patients with diabetes. Diabetes has been considered a relative contraindication to dental implants, as the patients with adequate metabolic control can be treated with this kind of therapy, because inadequate metabolic control can lead to the failure of the treatment. Besides, there are risk factors for the diabetic implant patient that may decrease the success rates of dental implants therapy. In this way, the dentist should understand all the relevant implications before considering the indication of dental implants to patients with diabetes. It is important to have more controlled studies to evaluate the effects of diabetes on the implant-tissue interface and further investigations are necessary in order to elucidate the role of insulin and molecular mechanisms that might interfere on the osseointegration in patients with diabetes.Os implantes osseointegráveis representam um grande avanço da Odontologia, no que diz respeito à reabilitação de áreas edêntulas, uma vez que permite o restabelecimento estético-funcional com previsibilidade e sucesso em longo prazo. No entanto, a efetividade deste tratamento depende do processo de osseointegração, sendo consequentemente dependente do estado de saúde geral do paciente. Sob esse aspecto, a aplicabilidade de implantes em indivíduos portadores de diabetes mellitus (DM) permanece controversa, uma vez que o estado hiperglicêmico pode representar um fator negativo para a osseointegração, conduzindo ao insucesso do tratamento. Além disso, existem fatores de risco inerentes ao diabetes que podem aumentar as taxas de insucesso na terapia com implantes dentários, permanecendo a dúvida se o diabetes seria uma contraindicação absoluta a este tipo de terapia. Dessa forma, o diabetes tem sido considerado uma contraindicação relativa para realização de implantes dentários, de modo que pacientes com controle metabólico adequado são considerados aptos a este tipo de tratamento. Em função desses questionamentos, foi realizada uma revisão da literatura sobre a aplicabilidade de implantes dentais em portadores de diabetes

Substituição de uréia por cloreto de amônio em dietas de bovinos: digestibilidade, síntese de proteína microbiana, parâmetros ruminais e sanguíneos - DOI: 10.4025/actascianimsci.v31i3.5938

Five Holstein steers weighting 450 kg were used in a 5 x 5 Latin square statistical design, where treatments consisted of five replacement levels: 0, 25, 50, 75 and 100% of urea by ammonium chloride, as non-protein nitrogen in the diet. There was a linear decrease (p 0.05) daily excretion of allantoin, purine derivatives, absorbed purines, as well as microbial nitrogen compounds and microbial efficiency synthesis. Rumen pH and plasma urea nitrogen decreased linearly (p 0.05) ruminal ammonia concentration as urea was replaced by ammonium chloride. Ammonium chloride can be used as a non-protein nitrogen source in ruminant diets up to level of 1.4% of diet dry matter.Foram utilizados cinco bovinos machos, castrados, da raça Holandesa Preta e Branca, com 450 kg de peso vivo em um delineamento quadrado latino 5 x 5, sendo os tratamentos cinco níveis de substituição, 0, 25, 50, 75 e 100% de ureia por cloreto de amônio, como fontes de nitrogênio não-proteico da dieta. Houve redução linear (p 0,05) a excreção de alantoína e de derivados de purinas na urina, purinas absorvidas, síntese de compostos nitrogenados microbianos e eficiência de síntese de proteína microbiana. Houve queda linear (p 0,05) a concentração de amônia no rúmen. O cloreto de amônio pode ser utilizado como fonte de NNP para bovinos em níveis de até 1,4% da matéria seca total da dieta

Radiographic assessment of bone density around integrated titanium implants after ovariectomy in rats

Objectives:This study evaluated the influence of ovariectomy 8 weeks after implant placement on bone integrated to titanium implants.Materials and methods:Thirty-eight female rats were submitted to a titanium implant at the tibiae proximal methaphysis. After a healing period of 8 weeks the animals were randomly divided into three groups: control (CTL-10 animals), sham-operated (SHAM-14 animals) and ovariectomy (OVX-14 animals). The CTL group was then sacrificed in order to confirm integration of the implant. The SHAM group was submitted to fictitious surgery and the OVX group was submitted to bilateral ovariectomy. After 12 weeks post-implant placement, the SHAM and OVX groups were sacrificed. In order to confirm the systemic osteopenia in rats, a dual-energy X-ray absorptiometry (DXA) was performed. For the evaluation of bone density, digital radiographs were taken. The grey level of the bone adjacent to implant was measured using image software and the bone density was calculated at six points on both sides of the implant.Results:Densitometry measurements of the femur confirmed systemic bone mass loss in the OVX group. Individualized bone analyses of different regions surrounding the implant showed a significantly lower radiographic bone density (P < 0.05) in the cancellous region of the OVX group (77.48 +/- 23.39 grey levels) when compared with the CTL and SHAM groups (91.61 +/- 32.10 and 102.57 +/- 32.50 grey levels, respectively).Conclusions:The present study showed a decrease of the radiographic bone density in the cancellous region of bone around titanium implants placed 8 weeks before ovariectomy in rats

Effect of 17 beta-estradiol and alendronate on the removal torque of osseointegrated titanium implants in ovariectomized rats

Background: This study investigated the influence of estrogen deficiency and its treatment with estrogen and alendronate on the removal torque of osseointegrated titanium implants.Methods: Fifty-eight female Wistar rats received a titanium implant in the tibia metaphysis. After 60 days, which was needed for implant osseointegration, the animals were randomly divided into five groups: control (CTLE; N = 10), sham surgery (SHAM; N = 12), ovariectomy (OVX; N = 12), ovariectomy followed by hormone replacement (EST; N = 12), and ovariectomy followed by treatment with alendronate (ALE; N = 12). The CTLE group was sacrificed to confirm osseointegration, whereas the remaining groups were submitted to sham surgery or ovariectomy according to their designations. After 90 days, these animals were also sacrificed. Densitometry of femur and lumbar vertebrae was performed by dual-energy x-ray absorptiometry (DXA) to confirm systemic impairment of the animals. All implants were subjected to removal torque.Results: Densitometric analysis of the femur and lumbar vertebrae confirmed a systemic impairment of the animals, disclosing lower values of bone mineral density for OVX. Analysis of the removal torque of the implants showed statistically lower values (P <0.05) for the OVX group in relation to the other groups. However, the group treated with alendronate (ALE group) presented significantly higher torque values compared to the others.Conclusion: According to this study, estrogen deficiency was observed to have a negative influence on the removal torque of osseointegrated implants, whereas treatment with alendronat

The effect of oestrogen and alendronate therapies on postmenopausal bone loss around osseointegrated titanium implants

Objectives This study evaluated the influence of oestrogen deficiency and its therapies on bone tissue around osseointegrated implants. Methods Implants were placed in 66 female rats tibiae. The animals were assigned into five groups: control (CTL), sham, ovariectomy (OVX), oestrogen (EST), and alendronate (ALE). While CTL was sacrificed 60 days after implant placement, other groups were subjected to ovariectomy or sham surgery according to group and euthanized after 90 days. Blood and urine samples were collected at sacrifice day for osteocalcin (OCN) and deoxypyridinoline (DPD) quantification. Densitometry of femur and lumbar vertebrae was performed in order to evaluate rats` skeletal impairment. Non-decalcified sections were referred to fluorescent and light microscopy for analyses of mineral apposition rate (MAR), eroded and osteoclastic surfaces, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO). Results Results from the OVX group showed significantly lower bone mineral density (BMD), BIC, BAFO, and MAR, while OCN, deoxipiridinoline, eroded surface and ostecoclastic surface were increased compared with the other groups of the study. ALE reduced OCN and DPD concentrations, MAR, osteoclastic and eroded surfaces, and no difference was in BIC and BAFO relative to SHAM. EST and CTL showed similar results to SHAM for measurements. Conclusions Oestrogen deficiency exerted a negative influence on bone tissue around implants, while oestrogen replacement therapy and alendronate were effective against its effects. Although alendronate therapy maintained the quantity of bone around implants, studies evaluating bone turnover kinetics are warranted. To cite this article:Giro G, Coelho PG, Pereira RMR, Jorgetti V, Marcantonio E Jr, Orrico SRP. The effect of oestrogen and alendronate therapies on postmenopausal bone loss around osseointegrated titanium implants.Clin. Oral Impl. Res. 22, 2011; 259-264.doi: 10.1111/j.1600-0501.2010.01989.x.State of Sao Paulo Research Foundation (FAPESP)Coordination for Improvement of Higher Education Personnel (CAPES

Study on different solutions to reduce the dynamic impacts in transition zones for high-speed rail

One of the most important factors influencing the track maintenance is the transitions between parts of the track with different vertical stiffness. The dynamic forces in the super-structure, i.e. from rail to ballast/slab and subgrade, including every layer under ballast/slab until natural ground, are influenced by the type of materials, layer configuration and geometry. One way to mitigate track transition problems is to have a more gradual transition with a reduced stiffness differential. The aim of this research is to reduce vertical transiente stresses and displacements under track supports at track transition areas by combining different structural configurations. For this purpose, the train-track dynamic interaction in the transition zones with different vertical stiffness values is analysed using a finite element software. A high-speed train moving on a slab and ballasted track is considered travelling in both directions. The effect of different structural track designs is studied in realistic operation scenarios. The results allow concluding that the sleeper displacements and ballast stresses can be significantly reduced in the transition zones by making small changes in the track structural elements.info:eu-repo/semantics/publishedVersio

Estudo do encurtamento global do átrio esquerdo em fetos de mães diabéticas Study of global left atrial shortening in fetuses of diabetic mothers

OBJETIVO: Testar a hipótese de que a fração de encurtamento atrial esquerda seja menor nos fetos de mães diabéticas do que em fetos de mães sem doenças sistêmicas. MÉTODOS: Foram examinados, por ecocardiografia, 42 fetos de mães com diabetes prévio ou gestacional e 39 fetos normais de mães sem doença sistêmica (controles), com idades gestacionais a partir da 25ª semana até o termo. A fração de encurtamento atrial esquerda foi obtida pelo quociente diâmetro máximo do átrio esquerdo (AE) - diâmetro mínimo AE/diâmetro máximo AE. Os dados foram comparados pelo teste t de Student, com um alfa crítico de 0,05. RESULTADOS: Os filhos de mães diabéticas apresentaram fração de encurtamento atrial esquerda média de 0,39 &plusmn; 0,15 e os fetos do grupo controle de 0,51 &plusmn; 0,11. Esta diferença foi significativa, com p < 0,001. CONCLUSÃO: A dinâmica atrial esquerda, com diminuição do seu encurtamento global, está acentuada nos filhos de mães diabéticas. Especulamos que este parâmetro possa ser útil na avaliação da função diastólica ventricular esquerda fetal.<br>OBJECTIVE: To test the hypothesis that left atrial shortening fraction is lower in fetuses of diabetic mothers than in fetuses of mothers with no systemic disease. METHODS: Forty-two fetuses of mothers with previous diabetes or gestational diabetes and 39 healthy fetuses of mothers with no systemic disease (controls) underwent echocardiographic examination. Their gestational ages ranged from 25 weeks to term. The left atrial shortening fraction was obtained with the following formula: (left atrial maximum diameter - left atrial minimum diameter)/left atrial maximum diameter. Data were compared using the Student t test, with an alpha level of 0.05. RESULTS: Mean left atrial shortening fractions in fetuses of diabetic mothers and in those in the control group were 0.39&plusmn;0.15 and 0.51&plusmn;0.11, respectively. This difference was significant with P < 0.001. CONCLUSION: Left atrial dynamics, with a reduction in global left atrial shortening, is increased in fetuses of diabetic mothers. We speculate that this parameter may be useful in assessing fetal left ventricular diastolic function

The influence of different implant surfaces on osseointegration in diabetes: a systematic review of the literature

AIM: The aim of this study was to evaluate, through a systematic review of the literature, the effects of different implant surface modifications on osseointegration in diabetic subjects. METHODS: A search was performed of the PubMed database, using a combination of the following keywords: “Implant surface” OR “Dental implants” AND “Diabetes” OR “Hyperglycemia”. Papers published in English between January 1960 and November 2013 were selected. All experimental models were considered in this search, but case reports and in vitro studies were excluded from this review. RESULTS: The initial search identified 182 articles. After reading the titles and abstracts, 39 articles were selected for full reading. Finally, 4 papers were selected after evaluation of all the papers, and these papers are discussed in this review. Due to the methodological heterogeneity of the selected studies, it was not possible to perform a meta-analysis of the data. CONCLUSION: It can be concluded that although the benefits of surface modifications present in individuals with diabetes have biological plausibility, there is little evidence of the benefits of these modifications