Rank Protein Immunolabeling during Bone-Implant Interface Healing Process

The purpose of this paper was to evaluate the expression of RANK protein during bone-healing process around machined surface implants. Twenty male Wistar rats, 90 days old, after having had a 2 mm diameter and 6 mm long implant inserted in their right tibias, were evaluated at 7, 14, 21, and 42 days after healing. After obtaining the histological samples, slides were subjected to RANK immunostaining reaction. Results were quantitatively evaluated. Results. Immunolabeling analysis showed expressions of RANK in osteoclast and osteoblast lineage cells. The statistical analysis showed an increase in the expression of RANK in osteoblasts at 7 postoperative days and a gradual decrease during the chronology of the healing process demonstrated by mild cellular activity in the final stage (P < .05). Conclusion. RANK immunolabeling was observed especially in osteoclast and osteoblast cells in primary bone during the initial periods of bone-healing/implant interface

Bifosfonatos e Denosumabes: mecanismos de ação e algumas implicações para a implantodontia

Antirreabsortivos são potentes inibidores da reabsorção óssea empregados no tratamento da osteoporose e das alterações do metabolismo ósseo associadas ou não a neoplasias. Devido à sua eficácia, antirreabsortivos como bifosfonatos (BPs) e denosumabes (DMABs) são amplamente utilizados. Porém, esses medicamentos têm sido associados à ocorrência de osteonecrose dos maxilares (ONJ), denominada “medication-related osteonecrosis of jaw (MRONJ)”. Parece haver uma relação entre a MRONJ e cirurgias odontológicas em pacientes tratados com BPs e DMABs. Porém, a relação entre a ocorrência de MRONJ e a instalação de implantes dentários não é muito discutida. O objetivo deste artigo foi realizar uma revisão de literatura a respeito do uso de antirreabsortivos, descrevendo seus mecanismos de ação, bem como sua inter-relação no tratamento com implantes. Foram também discutas estratégias prévias à realização de implantes em pacientes que fazem ou fizeram uso recente dos mesmos. Com isso, foi possível concluir que BPs e DMABs inibem a reabsorção óssea por mecanismos distintos. Os BPs se ligam ao tecido ósseo e quando incorporados por osteoclastos induzem sua apoptose. Já os DMABs, atuam inibindo a formação osteoclastica. Com relação entre o uso de BPs ou DMABs, a instalação de implantes e a MRONJ, a literatura é controversa. Cabe ao cirurgião-dentista e ao o médico, avaliarem os riscos e benefícios da suspensão do tratamento, para cada indivíduo candidato à implantodontia. Na tomada de decisão da suspensão ou não da medicação deve-se considerar variáveis associadas ao medicamento e ao paciente,  prezando sempre pela prevenção da ONJ.

Bone Substitutes for Peri-Implant Defects of Postextraction Implants

Placement of implants in fresh sockets is an alternative to try to reduce physiological resorption of alveolar ridge after tooth extraction. This surgery can be used to preserve the bone architecture and also accelerate the restorative procedure. However, the diastasis observed between bone and implant may influence osseointegration. So, autogenous bone graft and/or biomaterials have been used to fill this gap. Considering the importance of bone repair for treatment with implants placed immediately after tooth extraction, this study aimed to present a literature review about biomaterials surrounding immediate dental implants. The search included 56 articles published from 1969 to 2012. The results were based on data analysis and discussion. It was observed that implant fixation immediately after extraction is a reliable alternative to reduce the treatment length of prosthetic restoration. In general, the biomaterial should be used to increase bone/implant contact and enhance osseointegration

Evaluation of Bone Heating, Drill Deformation, and Drill Roughness After Implant Osteotomy: Guided Surgery and Classic Drilling Procedure

Purpose: This study evaluated and compared bone heating, drill deformation, and drill roughness after several implant osteotomies in the guided surgery technique and the classic drilling procedure. Materials and Methods: The tibias of 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG); subgroups were then designated (G0, G1, G2, G3, and G4, corresponding to drills used 0, 10, 20, 30 and 40 times, respectively). Each animal received 10 sequential osteotomies (5 in each tibia) with each technique. Thermal changes were quantified, drill roughness was measured, and the drills were subjected to scanning electron microscopy. Results: Bone temperature generated by drilling was significantly higher in the GG than in the CG. Drill deformation in the GG and CG increased with drill use, and in the CG a significant difference between GO and groups G3 and G4 was observed. In the GG, a significant difference between GO and all other groups was found. For GG versus CG, a significant difference was found in the 40th osteotomy. Drill roughness in both groups was progressive in accordance with increased use, but there was no statistically significant difference between subgroups or between GG and CG overall. Conclusion: During preparation of implant osteotomies, the guided surgery technique generated a higher bone temperature and deformed drills more than the classic drilling procedure. The increase in tissue temperature was directly proportional to the number of times drills were used, but neither technique generated critical necrosis-inducing temperatures. Drill deformation was directly proportional to the number of times the drills were used. The roughness of the drills was directly proportional to the number of reuses in both groups but tended to be higher in the GG group

O MÚLTIPLO E O DIVERSO EM "VÍCIOS E VIRTUDES"

The Helder Macedo's narrative presents us the writer who meets a friend, also writer, and listens from him the story of his loves. The text inside the text leads us, in a spiral movement, from the author to the character, from the present to the past, from the contingent to the history. The present work aims to reflect on the games of masks formulated by Macedo from the overlapping of registers and narrative plans that is presented in his novel.A narrativa de Helder Macedo conta-nos do escritor que encontra o amigo, também escritor, e ouve desse a história de seus amores. O texto dentro do texto vai nos levando, em espiral, do autor à personagem, do presente ao passado, do contingente ao  histórico.  Este  trabalho  pretende  refletir  sobre  os  jogos  de  máscaras  e  fingimentos formulados por Macedo a partir da sobreposição de registros e de planos narrativos que este seu livro apresenta

Avaliação do copolímero de ácido polilático e poliglicólico ao redor de implantes osseointegráveis sem estabilidade primária: análise biomecânica, histométrica e imunoistoquímica em coelhos

A proposta deste estudo foi avaliar a associação do PLA/PGA ao redor de implantes osseointegráveis instalados sem estabilidade primária, por meio da análise biomecânica, histométrica e da expressão das proteínas OPG, RANKL, OC e COL-I. Vinte e cinco coelhos receberam 2 implantes de 2,6/ 6,0mm na tíbia direita em leitos receptores preparados com 3,0mm. Um defeito foi preenchido com coágulo sanguíneo e o outro com o PLA/PGA previamente à instalação dos implantes. A eutanásia dos animais foi realizada nos períodos de 5, 15, 40 e 60 dias pósoperatórios e o teste biomecânico foi realizado nos períodos de 40 e 60 dias. As peças foram submetidas ao processamento imunoistoquímico e coradas por HE. As peças de 5 animais do período de 60 dias foram desgastadas e coradas com vermelho de alizarina e azul de Stevenel. Não houve diferenças nos valores de torque-reverso na comparação entre os grupos e os períodos avaliados. A análise das imunomarcações não evidenciou diferença estatística entre os grupos para cada período. Houve evidência estatística de maior expressão de RANKL no período de 15 dias no grupo tratado em relação à expressão de colágeno I. A proteína RANKL apresentou mais percentuais de marcações celulares acima de 50% quando comparada às outras proteínas. Não houve diferença estatística entre os grupos quanto à extensão linear de contato entre tecido ósseo e implante. Conclui-se que o copolímero apresentou biocompatibilidade e permitiu neoformação óssea em contato com o implante. Além disso, ocorreu o processo de osseointegração em ambos os grupos, mesmo na ausência de estabilidade primária dos implantes.The purpose of this study was to evaluate the association of the PLA/PGA around of osseointegrated implants installed without primary stability, through the biomechanics, histometric analysis and of the OPG, RANKL, OC and COL-I proteins expression. Twenty-five rabbits received 2 implants of 2.6 / 6.0mm in the right tibia in receptor beds prepared with 3,0mm. A defect was fulfiled with blood clot and the other with the PLA/PGA, previously to the implants installation. The euthanasia of 25 animals was performed at 5, 15, 40 and 60 days and the biomechanical test was performed at 40 and 60 days. The samples followed immunoistochemistry processing and were stained with HE. The pieces of 5 animals of 60 days were trimmed and stained with alizarin red and Stevenel's blue. There were not differences in the torque-reverse between the groups and periods. The analysis of the immunolabelings did not evidence statistic difference between the groups for each period. There was statistics evidence of increase in the RANKL expression in the 15 days period, in the treated group, when compared to the COL-I. The RANKL protein presented more percentiles of immunolabelings above 50% when compared to the other proteins. There was no statistics difference between the groups regarding contact linear extension between bone tissue and implant. It can be concluded that the copolymer presented biocompatibility and it allowed bone neoformation in contact with the implant. Besides, the osseointegration process happened in both groups, even in the absence of primary stability of the implants.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Utilização de biomateriais poliméricos associados a implantes dentários: revisão de literatura

A remodelação óssea é um processo contínuo, que possibilita a substituição de osso envelhecido e danificado por tecido novo. A reparação ao redor de implantes osseointegráveis e enxertos ósseos em situações desfavoráveis depende do estabelecimento de um adequado contato entre tecido ósseo e implante por meio da estabilidade primária. Tendo em vista a importância da estabilidade primária do implante na biomecânica e conseqüente osseointegração, a associação de biomateriais reabsorvíveis ao sítio de instalação dos implantes se torna relevante. Destes biomateriais, destaca-se o copolímero de ácido polilático/ poliglicólico (PLA/PGA), que poderia contribuir com a estabilidade temporária dos implantes

A CAD/CAM flapless surgical technique and immediate prosthesis: A clinical report

Background: This article describes a clinical report with a new system for guided surgical treatment and immediate load prosthesis in the flapless surgical technique. Case report: Based on a computed tomography (CT) of a 64 - year-old edentulous patient, the cross sections were reformatted and used to construct a virtual planning of the implants and a guide template in Dental Slice. Six dental implants were placed in the maxilla and mandible using a Slice Guide System. Following a 30-month in maxilla and 24-month in mandible healing period, the clinical and radiographic evaluation and computed tomography (CT) showed good clinical stability. The Slice Guide System proved satisfactory for the Flapless Surgical Technique in dental implants

Wax Teeth and Metallic Superstructure Trials at the Same Session: Simplified Technique for Implant-Supported Prosthesis

This clinical report describes a method to reduce the number of clinical sessions for the rehabilitation of implant-supported fixed dentures through a simplified and versatile procedure indicated mainly for immediate loading. According to this method, the immediate implant-supported fixed dentures for edentulous patients can be safely fabricated within 2 days. In this technique, the teeth in the wax are prepared on a base of light-polymerized resin, and both wax teeth and metallic superstructure trials are accomplished at the same session