Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the “distance” tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

RESUMO A anquilose alveolodentária consiste na fusão do cemento ou dentina radicular com o osso alveolar tanto em dentes decíduos como nos dentes permanentes. Isto leva a uma série de alterações clínicas e radiográficas importantes para o diagnóstico. Além disso, o conhecimento dos princípios biológicos envolvidos irá permitir o controle adequado dos dentes acometidos por este fenômeno.

ABSTRACT Alveolodental ankylosis is the fusion of cementum or root dentin with the alveolar bone in both deciduous and permanent teeth. This leads to important clinical and radiographic changes in the affected teeth. Moreover, knowledge of the biological principles involved allows adequate management of teeth affected by this phenomenon.

Resumo O objetivo deste estudo foi avaliar em humanos a manutenção do volume em alvéolos frescos preenchidos por osso integral de origem bovina por meio de um estudo clínico randomizado com monocegamento. Quarenta dentes uni radiculares foram extraídos em 40 pacientes (um dente em cada participante), e apos estes pacientes foram divididos aleatoriamente em 2 grupos: indivíduos que tiveram o alvéolo fresco preenchido por osso integral de origem bovina (Grupo Biomaterial) ou por coagulo sanguíneo (Grupo Controle). Apos a exodontia os alvéolos foram medidos em suas maiores distancias mesio-distal (MD) e vestíbulo lingual/palatina (VL/P) por meio de compasso de ponta seca. O fechamento primário dos alvéolos foi realizado com um tampão fibromucoso. Apos 120 dias pós-operatórios durante o procedimento de reabertura foram obtidas novamente as maiores medidas MD e VL/P para calcular em porcentagem o nível de remodelação do osso alveolar. No grupo biomaterial observou-se uma redução em porcentagem de 1,62% e 3,29% nas medidas MD e VL/P 120 dias apos as extrações, enquanto no grupo controle houve uma redução de 4,97% e 7,18% nas medidas MD e VL/P no mesmo período. Houve diferença estatisticamente significante (p<0,05) entre os dois grupos para as medidas vestíbulo/palatina e mesiodistal na maxila. Diante dos resultados obtidos conclui-se que o osso integral de origem bovina limitou, mas não impediu a remodelação óssea alveolar.

Abstract The purpose of this study was to evaluate the preservation of alveolar dimensions in human fresh extraction sockets filled with a composite bovine bone graft by means of design of single-blind randomized clinical trial. Forty participants had monoradicular teeth extracted (one teeth in each participant), and after were randomly divided into 2 groups: individuals whose fresh sockets were filled with the composite heterologous bone graft (Biomaterial Group), or with blood clot (Control Group). After extraction, the fresh sockets were measured at their greatest mesiodistal (MD) and bucco-lingual/palatal (BL/P) distance. Primary closure of the soft tissue was performed with a fibro-mucosal plug. After 120 post-operative days, the re-entry procedure was performed and the largest MD and BL/P measurements were again obtained to calculate the remodeling of the alveolar bone measured in percentage. In the biomaterial group, a percentage reduction of 1.62% and 3.29% in the MD and BL/P dimensions was observed 120 days after the extractions, whereas a reduction of 4.97% and 7.18% in the MD and BL/P dimensions occurred in the control group. There was a statistically significant difference (p<0.05) between the two groups for the bucco-palatal and mesiodistal measurements in the maxilla. In view of the results obtained, it can be concluded that composite bovine bone graft limited but did not impede alveolar bone remodeling.

Abstract It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption. Objective The objective of this study was to evaluate the distance of the crest of alveolar ridge to the cementoenamel junction (CEJ) of the lower second molars and the bone density of the third molar socket filled with Gen-Tech®, 5 years after an exodontia using cone beam computed tomography (CBCT) to visualize the central region of the sockets, without overlapping of the buccal and lingual cortical bones. Material and Methods A total of 12 individuals from an initial group of 39 patients submitted to extraction of the unruptured lower third molars and grafting of an association of inorganic bovine bone matrix, organic bovine bone matrix, collagen and bone morphogenetic proteins (BMP) (Gen-Tech®) on one side and the contralateral sockets filled only by clot, returned to control after 5 years, and were submitted to CBCT. The distance from the crest of alveolar bone to the CEJ and the bone density (BD) were measured using the i-CAT Vision Software. Results The results showed that the distance from the crest of alveolar bone to the CEJ in the control group was similar to that observed before the exodontia; in the experimental group, this distance was smaller. Considering the BD measurement, a significantly higher density was observed in the experimental group (p<0.05). Conclusion Part of the biomaterial was not absorbed and allowed the stability of the evaluated parameters after 5 years, being able to be used as a bone substitute in the socket.

RESUMO Objetivo Avaliar a eficácia de dois protocolos de amoxicilina em cirurgias para instalação de implantes. Métodos Foi realizado um estudo clinico com 66 voluntários de ambos os gêneros (idade média 51,9±2,5 anos) que atenderam aos critérios de inclusão e que foram distribuídos por sorteio em 2 grupos: Grupo 1 (n=35) - amoxicilina (2g) por via oral 1h antes da cirurgia e Grupo 2 (n=31) - amoxicilina (2g) por via oral 1h antes da cirurgia e 500mg a cada 8 horas durante 7 dias. Os parâmetros avaliados no pós-operatório foram ocorrência de reações adversas, dor e perda de implantes. A dor foi avaliada no dia da cirurgia (antes, imediatamente após e à noite), 24h, 48h, 72h e 1 semana após as cirurgias, e os demais parâmetros foram avaliados em consultas diárias até o terceiro dia pós-cirúrgico, 7 dias e 3 meses após as cirurgias. Os resultados foram submetidos à análise estatística com nível de significância de 5%. Resultados Reações adversas (cefaleia, diarréia, dor estomacal e náusea) e perda de implantes ocorreram apenas em G2 (4 voluntários e 3 implantes, respectivamente), e em relação à dor foram observados valores maiores para G2 nos tempos “à noite (p=0,0043), 24h (p=0,0013), 48h (p=0,0187) e 72h (p=0,0445). Conclusão Os dados sugerem que a dose única de amoxicilina (2g) foi eficaz na profilaxia antibiótica para cirurgias de implantes, e que a amoxicilina no período pós-operatório não proporcionou benefício adicional.

ABSTRACT Objective The aim of this study was to evaluate the effectiveness of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries. Methods A clinical study was performed with 66 volunteers of both genders (mean 51,9 ± 2,5 years) that met the inclusion criteria and were randomly assigned into 2 groups: Group 1 (n=35) - oral administration of amoxicillin (2g) 1 hour before the surgical procedure and Group 2 (n=31) oral administration of amoxicillin (2g) 1 hour before the surgical procedure and 500mg every 8 hours during 7 days after the surgeries. The following clinical parameters were evaluated: adverse reactions, pain and implants failure. The pain was evaluated in the surgery day (before, immediately after and at night), 24h, 48h, 72h and one week after the surgery and other clinical parameters were evaluated in daily appointments until the third postoperative day, 7 days and three months after the surgeries. Data were analyzed and statistical significance was 5%. Results Adverse reactions (headache, diarrhea, stomachache and nauseas) and implant failure occurred only in G2 (4 volunteers and 3 implants, respectively). Regarding pain, higher values for G2 on “at the night (p=0.0043), 24h (p=0.0013), 48h (p=0.0187) e 72h (p=0.0445) were observed. Conclusion The present study showed that a single dose of amoxicillin was effective in antibiotic prophylaxis in implant placement surgeries, suggesting that the use of amoxicillin in the postoperative period did not bring additional benefit.

OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State-Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p =0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation.

ResumoIntroduçãoEnxertos ósseos retirados da sínfise ou do ramo mandibular podem ser empregados para reconstrução de defeitos localizados dos maxilares, para permitir a instalação adequada de implantes dentários.ObjetivoEste estudo tem por objetivo avaliar a ocorrência de complicações associadas com as áreas doadoras e receptoras de enxerto ósseo mandibular, e a sobrevivência de implantes dentários instalados nesses sítios reconstruídos.Material e métodoAvaliaram-se 730 prontuários de pacientes submetidos a tratamento com implantes dentários. Desse universo, 72 pacientes, de ambos os gêneros, foram submetidos à reconstrução óssea com enxerto retirado da sínfise ou do ramo mandibular.ResultadoForam observadas 13 complicações e não houve diferença estatística significante quanto à ocorrência de complicações das áreas doadoras e receptoras, e da sobrevivência de implantes dentários instalados nos sítios reconstruídos com enxerto ósseo mandibular.ConclusãoOs enxertos ósseos mandibulares permitem a reconstrução de defeitos localizados dos maxilares e não são fatores de risco para a falha de implantes dentários.

AbstractIntroductionGrafts bone removed of the symphysis or mandibular ramus can be used for reconstruction located defect jaws to allow adequate installation of dental implants.ObjectiveThis study aims evaluate the occurrence of complications associated with donor and receptor sites of mandibular bone graft and survival of dental implants these reconstructed sites.Material and methodEvaluated seven hundred thirty records of patients submitted treatment with dental implants. This universe, seventy-two patients of both genders, was submitted bone reconstruction with graft removed from the symphysis or the mandibular ramus.ResultThirteen complications were observed and there was no statistically significant difference in the occurrence of complications of donor and recipient areas and survival of dental implants installed in sites reconstruction with mandibular bone graft.ConclusionThe mandibular bone grafts allow the reconstruction of defects located in jaws and don't risk factors for failure of dental implants.

Este estudo in vitro avaliou o efeito da ciclagem mecânica no torque dos parafusos de retenção em implantes de hexágono externo com plataforma switching (PS), plataforma regular (RP) e plataforma larga (WP). Foram utilizados 30 corpos de prova divididos em 3 grupos equitativamente: PS, RP e WP. Cada corpo de prova foi preparado com implantes: 3,75x10 mm para o grupo RP e 5,0x10 mm para os grupos PS e WP, e seu respectivo abutment com o torque de 32 Ncm. Todos os grupos foram submetidos a 106 ciclos com 100 N de força (o que corresponde a aproximadamente 40 meses de mastigação). Os resultados foram obtidos com o torque reverso de cada espécime e os dados foram avaliados com ANOVA comparado com o teste de Tukey (p<0,05). O grupo PS apresentou diferença estatisticamente significante no torque de remoção do parafuso (30,06±5,42) comparado com os grupos RP (23,75±2,76) e WP (21,32±3,53) (p<0,05); os grupos RP e WP não apresentaram diferença estatisticamente significante entre si. Concluiu-se que o grupo PS apresentou maior valor de torque reverso sugerindo menor susceptibilidade de afrouxamento do parafuso de fixação do abutment.

This in vitro study evaluated the effect of mechanical cycling on the torque of retaining screw in external hexagon implants with platform switching (PS), regular platform (RP) and wide platform (WP). A total of 30 specimens were equally divided into 3 groups: PS, PR and WP. Each specimen was prepared with implants: 3.75 x 10 mm for RP group and 5.0x10 mm for PS and WP groups and its respective abutment with 32 Ncm torque. All groups were subjected to 106 cycles with 100 N (corresponding to about 40 months of chewing). The results were obtained with the reverse torque of each specimen and data were evaluated using ANOVA and Tukey test (p<0.05). The PS group showed statistically significant difference in screw removal torque (30.06±5.42) compared with RP (23.75±2.76) and WP (21.32±3.53) (p<0.05) groups; the RP and WP groups showed no statistically significant difference between them. It was concluded that the PS group showed higher reverse torque value, suggesting lower susceptibility of the abutment screw loosening.

O objetivo deste estudo foi avaliar comparativamente, por meio de análise microbiológica in vitro, a capacidade de selamento bacteriano de dois modelos de implante de encaixe morse. Foram utilizados 15 implantes com travamento de seus respectivos mini-pilares por fricção, sem auxílio de parafuso (Grupo 1) e 30 implantes com travamento de seus respectivos mini-pilares sólidos reforçado pela presença de parafuso, sendo que 15 destes implantes receberam torque de inserção de 20 N.cm (Grupo 2) e o restante 30 N.cm (Grupo 3). A análise microbiológica foi realizada utilizando colônias de Escherichia coli transportadas diretamente da placa de cultivo para o componente protético. Os implantes friccionais (Grupo 1) foram ativados por meio do dispositivo bate conexão e para os aparafusados foi usada a chave de torque (Grupos 2 e 3). Cada conjunto de pilar/implante foi imerso em tubos de ensaio contendo 5 mL de caldo BHI (Brain-Heart Infusion) e incubados a 37 °C durante 14 dias com verificação diária de presença de contaminação. Foi observada diferença estatisticamente significante, com relação ao número de implantes contaminados. Para os implantes do Grupo 2, houve maior contaminação (60%, p<0,05), não sendo observada diferença significativa entre os outros grupos (Grupo 1 = 20% e Grupo 3 = 0%). Conclui-se neste estudo que não houve diferença estatística significante quanto ao selamento bacteriano in vitro entre os Grupos 1 e 3. A diferença de torque de inserção alterou a capacidade de selamento in vitro dos pilares testados, sendo observada uma maior contaminação para os componentes que receberam o torque de 20 N.cm.

The objective of this study was to evaluate the bacterial seal at the implant-abutment interface using two morse taper implant models, by means of an in vitro microbiological analysis. For that were used 15 implants with mini-abutments tightened by friction, no screws (Group 1); and 30 implants with screw-tightened abutments, of which 15 received 20 N.cm of closing torque (Group 2) and the other 15 received 30 N.cm (Group 3). Microbiological analysis was carried out using colonies of Escherichia coli transported directly from a culture dish to the prosthetic component. Friction implants (Group 1) were activated by tapping and a torque wrench was used for screw-tightened implants (Groups 2 and 3). Each abutment/implant set was immersed in test tubes containing 5 mL of brain-heart infusion broth and incubated at 37 °C for 14 days, observed daily for the presence of contamination. A statistically significant difference was observed regarding the number of contaminated implants. There was greater contamination in Group 2 implants (p<0.05), with no statistically significant difference between the other groups (Group 1 = 20% and Group 3 = 0%). It was concluded that there was no significant difference in in vitro bacterial sealing between implants with mini-abutments tightened by friction without screws and implants with screw-tightened abutments with 30 N.cm of closing torque. The difference in closing torque altered the in vitro sealing ability of the tested abutments, with a greater contamination for components that received a closing torque of 20 N.cm.

The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

O objetivo deste trabalho foi avaliar os efeitos do PRP associado ao osso bovino inorgânico ou vidro bioativo no processo de reparo ósseo. Foram utilizados 4 cães adultos, onde foram preparadas cavidades ósseas em região mandibular dos dois lados. As cavidades foram divididas em 4 grupos de acordo com o material utilizado: controle, PRP, PRP/Bio-Oss®, PRP/Bio-Gran®. O sacrifício dos animais foi realizado 120 dias depois do procedimento cirúrgico e análises histológicas e histomorfométricas foram realizadas. O grupo controle demonstrou 80,6% de formação óssea no corte longitudinal com profundidade de 6 mm e 83,7% no corte longitudinal com profundidade de 13 mm. Nos cortes transversais de 6 e 13 mm de profundidade mostrou 74,2% de formação óssea. O grupo PRP demonstrou 21,1% de formação óssea no corte longitudinal com profundidade de 6 mm e 23,1% no corte longitudinal com profundidade de 13 mm. Nos cortes transversais de 6 mm de profundidade mostrou 28,98% e 41,2% nos de 13 mm. O grupo PRP/bio-Gran® demonstrou 25,1% de formação óssea no corte longitudinal com profundidade de 6 mm e 30,4% no corte longitudinal com profundidade de 13 mm. Nos cortes transversais de 6 mm de profundidade mostrou 43,0% de formação óssea e 39,7% nos de 13 mm. Para o grupo PRP/Bio-Oss® nos cortes longitudinais obtivemos 35,5% para os cortes de 6 mm e 42% para os 13 mm. Nos cortes transversais a formação óssea encontrada foi de 26,8% e 31,2% paras as profundidades de 6 e 13 mm respectivamente. Conclui-se que o uso isolado associado do PRP com o osso bovino inorgânico ou vidro bioativo não possui um efeito significativo no processo de reparo ósseo.

The aim of this study was to evaluate the effect of platelet rich plasma (PRP) associated to bovine inorganic bone (Bio-Oss®; Geistlich) or bioactive glass (Bio-Gran®; Orthovita, Implant Innovations) on bone healing. Bone cavities were prepared in both sides of the mandible of 4 adult male dogs. The cavities were divided into 4 groups according to the filling material as follows: control, PRP, PRP/Bio-Oss, PRP/Bio-Gran. The animals were sacrificed after 120 days and histological and histomorphometrical analysis was performed. The control group showed 80.6% of bone formation in the longitudinal sections at 6 mm depth and 83.7% at 13 mm depth. The transverse sections displayed 74.2% at both 6 and 13 mm depths. The PRP group showed 21.1% of bone formation in the longitudinal sections at 6 mm depth, and 23.1% at 13 mm depth. The transverse sections presented 28.98% of bone formation at 6 mm depth and 41.2% at 13 mm depth. The PRP/Bio-Gran group showed 25.1% of bone formation in the longitudinal sections at 6 mm depth and 30.4% at 13 mm depth. In the transverse sections, the bone formation was 43.0% at 6 mm depth and 39.7% at 13 mm depth. The PRP/Bio-Oss group showed 35.5% of bone formation in the longitudinal sections at 6 mm depth and 42% at 13 mm depth. In the transversal sections, the bone formation was 26.8% and 31.2% at the depths of 6 and 13 mm, respectively. PRP alone or associated with bovine inorganic bone or bioglass had no significant effect in bone healing.

O objetivo deste estudo foi caracterizar a microestrutura de uma superfície de titânio comercialmente puro (cpTi) condicionada com HCl/H2SO4 (acid etched) (AE-cpTi) e investigar sua citocompatibilidade in vitro, comparada à do cpTi usinado (turned) (T-cpTi). O T-cpTi apresentou uma superfície com sulcos e o AE-cpTi exibiu uma superfície caracterizada pela presença de micro-vales. Os parâmetros de superfície indicaram que a superfície AE-cpTi é mais isotrópica e apresenta uma área maior quando comparada à superfície T-cpTi. A espessura da camada de óxido foi similar para as duas superfícies; no entanto, a AE-cpTi apresentou maiores quantidades de Ti e O e menor, de C. A proliferação de células osteoblásticas, a atividade de fosfatase alcalina e a formação de matriz mineralizada foram maiores na superfície T-cpTi que na AE-cpTi. Esses resultados mostram que o condicionamento ácido produziu uma superfície com características topográficas e químicas diferentes quando comparadas às da superfície usinada. Além disso, observou-se que essas modificações de superfície afetaram de forma negativa a citocompatibilidade in vitro do cpTi como demonstrado pela inibição da proliferação celular e da expressão do fenótipo osteoblástico.

The aims of this study were to characterize the microstructure of a commercially pure titanium (cpTi) surface etched with HCl/H2SO4 (AE-cpTi) and to investigate its in vitro cytocompatibility compared to turned cpTi (T-cpTi). T-cpTi showed a grooved surface and AE-cpTi revealed a surface characterized by the presence of micropits. Surface parameters indicated that the AE-cpTi surface is more isotropic and present a greater area compared to T-cpTi. The oxide film thickness was similar between both surfaces; however, AE-cpTi presented more Ti and O and less C. Osteoblastic cell proliferation, alkaline phosphatase activity, and bone-like nodule formation were greater on T-cpTi than on AE-cpTi. These results show that acid etching treatment produced a surface with different topographical and chemical features compared to the turned one, and such surface modification affected negatively the in vitro cytocompatibility of cpTi as demonstrated by decreasing culture growth and expression of osteoblastic phenotype.