RESUMO

This longitudinal study aimed to assess the performance of the Facility-Equator system as mandibular overdenture (MO) retainers from a prosthetic perspective during 2 years of loading and to investigate the oral health-related quality of life (OHRQoL) and whether prosthetic events can affect the OHRQoL. Twenty-four patients (68.1 ± 7.51 years) reported their OHRQoL through the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile (OHIP-EDENT) questionnaires before MO loading and after 1 and 2 years of usage. Prosthetic occurrences were recorded during this period. Data were analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation coefficients. Of the 127 prosthetic events that occurred in the first year, the most frequent events were prosthesis adjustments (16.5%), dislodgement of the Equator attachment (14.17%), and O-ring replacement (11.8%). Eighty-seven prosthetic events were recorded in the second year, the most frequent events being prosthesis adjustments (27.6%), O-ring replacement (20.7%), and recapturing the female matrix (11.5%). All domains of the GOHAI and OHIP-EDENT questionnaires exhibited a significant difference (p < 0.05) between the baseline and 1- and 2-year evaluations, except in the Social Disability and Psychological Discomfort domains (p > 0.05) of OHIP-EDENT after 1 year. Complications related to prosthetic maintenance, such as fracturing of the prosthesis, Equator dislodgement, prosthesis rebasing, and new overdenture confection, affect the OHRQoL (p < 0.05), primarily the Physical Pain and Discomfort domains, especially in the first year of MO loading.

Assuntos

RESUMO

OBJECTIVE: To compare peri-implant clinical and radiographic parameters between hydrophilic and hydrophobic narrow dental implants in patients with mandibular implant overdentures for 1 year. MATERIALS AND METHODS: In a randomized, double-blind, split-mouth study with a 1-year follow-up, sixteen edentulous participants received two narrow-diameter implants in the anterior mandibular region with 2 types of surfaces: hydrophobic (Neoporos surface, NS) and hydrophilic (Acqua surface, AS). During the osseointegration period and after loading with mandibular implant overdentures, the outcomes monitored were (i) peri-implant health: early healing index (EHI), visible plaque index (VPI), calculus presence (CP), peri-implant inflammation (PI), probing depth (PD), and bleeding on probing (BOP); (ii) implant stability quotient (ISQ), (iii) crestal bone loss (CBL) and bone level change (BLC); and (iv) implant success and survival rates. RESULTS: The PD in NS implants decreased by 31.78% between 15 and 30 days, while a similar reduction (-31.28%) occurred in the 3rd month in the AS group. The ISQ also decreased significantly during the 1st month in both groups: -10.95% after 7 days in the NS group and -7.46% after 15 days in the AS group. At 12 months, statistically significant differences were not observed; however, the AS surface presented 50.6% smaller CBL and 41.3% smaller BLC values. The success and survival rates were 62.5% for AS implants and 87.5% for NS implants. CONCLUSION: Narrow-diameter implants with hydrophilic and hydrophobic surfaces loaded with mandibular implant overdentures showed no differences in peri-implant healing, stability, and peri-implant bone remodeling in the 1st year of follow-up.

Assuntos

RESUMO

STATEMENT OF PROBLEM: Alveolar ridge regularization involves the smoothing and minimal reduction of rough alveolar bone ridge to achieve adequate bone thickness around the implant. The effect of this procedure on peri-implant health is unclear. PURPOSE: The purpose of this clinical study was to evaluate whether bone regularization affects the clinical and biological parameters of peri-implant health when narrow diameter implants are placed as mandibular implant overdenture retainers during initial healing and after occlusal loading. MATERIAL AND METHODS: The need for mandibular ridge regularization in the anterior mandibular region was analyzed before the placement of 2 implants (2.9×10 mm, Facility; Neodent) in 21 participants provided with mandibular overdentures. Primary stability was measured by the insertion torque and implant stability quotient (ISQ). Clinical and biological evaluations measuring the plaque index, presence of calculus, probing depth, bleeding on probing index, gingival index, secondary stability (ISQ), and interleukine-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) concentrations in peri-implant crevicular fluid were measured during osseointegration on days 7, 15, 30, 60, and 90 and after loading on day 180 after implant placement. Multilevel mixed-effects linear regression analysis and the Kaplan-Meier test were used to analyze the data (α=.05). RESULTS: The ISQ values showed significant differences on days 7 (P<.001) and 15 (P=.002) with higher values and on day 180 (P=.008) with a lower value compared with the baseline value in the ridge regularization group. Additionally, a significant decrease in probing depth was observed on days 60 (P=.008) and 180 (P=.027) compared with that on day 15 after implant placement. In the nonridge regularization group, significant decreases in probing depth were observed on days 30 and 180. Moreover, TNF-α levels in this group were significantly lower on days 30 (P=.001), 60, 90, and 180 (P<.001) when compared with the value on day 7 (P<.001). The ridge regularization group presented with significant differences in TNF-α and IL-1ß levels on days 60 (P=.004) and 30 (P=.007), respectively, when compared with the values on day 7. The ISQ and probing depth in the ridge regularization group were associated with changes in TNF-α and IL-1ß levels; furthermore, bone type, duration of edentulism, and mandibular bone atrophy were correlated with the clinical outcomes and TNF-α release. The implant survival rate was 67% in the nonridge regularization group and 100% in the ridge regularization group. CONCLUSIONS: Mandibular ridge regularization appeared to be beneficial for peri-implant healing during the early stages and after 3 months of occlusal loading in patients with an atrophic ridge, prolonged time since edentulism, and poor bone quality.

Assuntos

RESUMO

Abstract This longitudinal study aimed to assess the performance of the Facility-Equator system as mandibular overdenture (MO) retainers from a prosthetic perspective during 2 years of loading and to investigate the oral health-related quality of life (OHRQoL) and whether prosthetic events can affect the OHRQoL. Twenty-four patients (68.1 ± 7.51 years) reported their OHRQoL through the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile (OHIP-EDENT) questionnaires before MO loading and after 1 and 2 years of usage. Prosthetic occurrences were recorded during this period. Data were analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation coefficients. Of the 127 prosthetic events that occurred in the first year, the most frequent events were prosthesis adjustments (16.5%), dislodgement of the Equator attachment (14.17%), and O-ring replacement (11.8%). Eighty-seven prosthetic events were recorded in the second year, the most frequent events being prosthesis adjustments (27.6%), O-ring replacement (20.7%), and recapturing the female matrix (11.5%). All domains of the GOHAI and OHIP-EDENT questionnaires exhibited a significant difference (p < 0.05) between the baseline and 1- and 2-year evaluations, except in the Social Disability and Psychological Discomfort domains (p > 0.05) of OHIP-EDENT after 1 year. Complications related to prosthetic maintenance, such as fracturing of the prosthesis, Equator dislodgement, prosthesis rebasing, and new overdenture confection, affect the OHRQoL (p < 0.05), primarily the Physical Pain and Discomfort domains, especially in the first year of MO loading.

RESUMO

The use of mandibular overdentures (MO) for the rehabilitation of totally edentulous individuals with limited bone availability is widespread and has proven clinical success. Narrow diameter implants (NDI) are available on the market as MO retainers to solve problems related to limited bone availability and bone thickness, providing a low-cost, minimally invasive treatment option. This technique evolved over the years, and changes frequently involved the number of implants used as MO retainers, as the adoption of a smaller number of implants can generate biomechanical disadvantages, contributing to the increased stress in peri-implant tissues, which may accelerate marginal bone loss (MBL), in addition to reducing masticatory capacity and satisfaction with rehabilitation. Some studies pointed out that the use of 3 or more implants as MO retainers improves the biomechanics. Thus, the objective of this study was to report 3 different clinical cases where 3 or more NDI were adopted to retain mandibular overdentures in association with diverse loading protocols: (i) 3 implants adopting conventional loading, (ii) 4 implants using progressive loading, and (iii) 4 implants with hybrid loading. The case with 4 implants and progressive loading showed a slight worsening of masticatory function at 1 year, in addition to a more pronounced MBL compared to other cases, but with improvements in satisfaction and oral health-related quality of life. Thus, NDI can be used as MO retainers with predictability and clinical success, using different numbers of implants and loading protocols.

RESUMO

This cross-sectional observational study with 24 patients evaluated differences in bite force (BF) and masticatory performance (MP) between conventional complete denture (CCD) and implant mandibular overdenture (IMO) users and the correlation between these variables. The BF test was performed bilaterally with an occlusal force device. During the MP test, patients were asked to chew Optocal particles for 40 cycles. The Shapiro Wilk test was employed to verify the normality of the data, the student t test to identify differences between groups, and Pearson's correlation to investigate interrelationships between variables. A multiple linear regression was subsequently performed via the stepwise method. P values ≤0.05 were considered statistically significant. Unlike IMO users, CCD users presented a significant difference (25.6%) in BF between the dominant and non-dominant chewing side (p=0.04). IMO users presented significantly higher BF (p=0.01) without presenting a dominant side (p=0.38), and also performed significantly better for the following MP parameters: MPX50 values decreased by 27.25% in IMO users (p=0.01), MPB decreased by 48.38% (p=0.01), and ME 5.6 decreased by 53.25% (p=0.02), while ME2.8 increased by 151.57% (p=0.01). The BF and MPX50 in the IMO wearers group were negatively correlated (-0.57; p=0.05); this correlation coefficient was the only parameter included in the multivariate regression model. IMO users have higher BF and better masticatory performance than CCD users, especially in terms of chewed particles size reduction. MP is correlated with a higher BF in IMO users through better particle trituration.

Assuntos

RESUMO

Abstract: This cross-sectional observational study with 24 patients evaluated differences in bite force (BF) and masticatory performance (MP) between conventional complete denture (CCD) and implant mandibular overdenture (IMO) users and the correlation between these variables. The BF test was performed bilaterally with an occlusal force device. During the MP test, patients were asked to chew Optocal particles for 40 cycles. The Shapiro Wilk test was employed to verify the normality of the data, the student t test to identify differences between groups, and Pearson's correlation to investigate interrelationships between variables. A multiple linear regression was subsequently performed via the stepwise method. P values ≤0.05 were considered statistically significant. Unlike IMO users, CCD users presented a significant difference (25.6%) in BF between the dominant and non-dominant chewing side (p=0.04). IMO users presented significantly higher BF (p=0.01) without presenting a dominant side (p=0.38), and also performed significantly better for the following MP parameters: MPX50 values decreased by 27.25% in IMO users (p=0.01), MPB decreased by 48.38% (p=0.01), and ME 5.6 decreased by 53.25% (p=0.02), while ME2.8 increased by 151.57% (p=0.01). The BF and MPX50 in the IMO wearers group were negatively correlated (-0.57; p=0.05); this correlation coefficient was the only parameter included in the multivariate regression model. IMO users have higher BF and better masticatory performance than CCD users, especially in terms of chewed particles size reduction. MP is correlated with a higher BF in IMO users through better particle trituration.

Resumo Este estudo observacional transversal com 24 participantes teve como objetivo avaliar as diferenças na força de mordida (FM) e na PM (performance mastigatória) entre usuários de prótese total convencional (PTC) e de overdenture mandibular (OM) e a correlação entre essas variáveis. O teste de FM foi realizado bilateralmente com um dispositivo de força oclusal. Durante o teste de PM, os pacientes foram solicitados a mastigar uma porção padronizada de Optocal por 40 ciclos mastigatórios. O teste de Shapiro Wilk foi empregado para verificar a normalidade dos dados, o teste T de Student para identificar diferenças entre os grupos e os coeficientes de correlação de Pearson para investigar inter-relações entre variáveis. Uma regressão linear múltipla foi realizada pelo método stepwise. Valores de p≤0,05 foram considerados estatisticamente significantes. Diferentemente dos usuários de OM, os usuários de PTC apresentaram uma diferença significativa (34%) na FM entre o lado dominante e o não dominante (p=0,04). Os usuários de OM apresentaram FM significativamente maior (p=0,01) sem apresentar um lado dominante (p=0,38) e obtiveram PM significativamente melhor nos seguintes parâmetros: os valores de PMX50 diminuíram 27,25% (p=0,01), PMB diminuiu em 48,38% (p=0,01), e EM 5.6 diminuiu 53,25% (p=0,02), enquanto EM2.8 aumentou 151,57% (p=0,01). A FM e PMX50 no grupo de usuários da IMO foram negativamente correlacionados (-0,57;p=0,05); esse coeficiente de correlação foi o único parâmetro incluído no modelo de regressão multivariada. Os usuários da OM possuem maior FM e melhor performance mastigatória do que os usuários de PTC, observados principalmente na redução do tamanho das partículas mastigadas. A PM está correlacionada com um maior FM nos usuários da OM através de uma melhor trituração de partículas.

Assuntos

RESUMO

OBJECTIVE: To monitor the cytokine release patterns in the peri-implant crevicular fluid (PICF) and to investigate which factors affect the success rate of narrow diameter implants (NDI) during the first year. MATERIAL AND METHODS: Mandibular implant overdentures (IOD) retained by 2 NDI were installed in 16 clinically atrophic edentulous patients. The following parameters were monitored during the first year: (i) peri-implant health parameters (plaque index (PI), calculus presence (CP), gingival index (GI), probing depth (PD) and bleeding on probing (BoP); (ii) cytokine concentrations in the PICF (TNF-α, IL-1ß, IL-6, IL-10); (iii) implant stability quotient (ISQ); (iv) marginal bone level (MBL) and bone level change (BLC); (v) implant success. The insertion torque, bone type, mandibular atrophy, time since edentulism, and smoking habits were also recorded. All data were analyzed using multivariable multilevel mixed-effects regression models. RESULTS: The variability in the TNF-α release patterns temporarily reduced at weeks (w) 8-12, while the IL-1ß concentrations remained low until they peaked at w48 [p < 0.05; + 177.55 pg/µl (+ 96.13 - + 258.97)]. Conversely, IL-10 release decreased significantly at w48 [p < 0.05; - 456.24 pg/µl (- 644.41 - - 268.07)]. The PD and ISQ decreased significantly (p < 0.05) over the follow-up period, while the MBL was stable after w48 with a BLC of 0.12 ± 0.71 mm. The overall success rate was 81.3%, and was influenced by TNF-α, IL-1ß, IL-10, PI, GI, PD, smoking, and time since edentulism. CONCLUSION: Pro- and anti-inflammatory cytokine release was balanced during the first 24 weeks. The GI, smoking, and time since edentulism are the most important factors determining the implant success. CLINICAL RELEVANCE: The study contributes to the understanding of the osseointegration process in a clinically atrophic population rehabilitated with IOD, and highlights the importance of monitoring clinical peri-implant health-related parameters, smoking habit, and time since edentulism to predict implant success rates.

Assuntos

RESUMO

OBJECTIVES: To assess whether subgingival irrigation with 0.12 % or 0.2 % chlorhexidine (CHX) immediately after scaling and root planing (SRP) enhances periodontal tissue repair compared to irrigation with saline solution (control). MATERIALS AND METHODS: Periodontitis was ligature-induced in rat molars for 7 days. Animals were distributed into three groups: 1) SRP group, SRP and irrigation with 0.9 % saline (n = 30); 2) SRP + 0.12 % CHX group, SRP and irrigation with 0.12 % CHX (n = 30); 3) SRP + 0.2 % CHX group, SRP and irrigation with 0.2 % CHX (n = 30). Animals were killed at 7, 15, and 30 days after treatment. Furcation region was histometrically analyzed to determine the bone area. Immunohistochemical reactions were performed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG) and tartrate-resistant acid phosphatase (TRAP). RESULTS: Both chlorhexidine groups presented less inflammation and improved tissue repair along the entire experiment when compared with the SRP group. In the histometric analysis at 7, 15 and 30 days, SRP group (4.58 ±â€¯2.51 mm2, 4.21 ±â€¯1.25 mm2, 3.49 ±â€¯1.48 mm2), showed statistically less bone area than groups SRP + 0.12 % CHX (1.86 ±â€¯1.11 mm2; 0.79 ±â€¯0.27 mm2; 0.34 ±â€¯0.14 mm2) and SRP + 0.2 % CHX (1.14 ±â€¯0.51 mm2; 0.98 ±â€¯0.40 mm2; 0.41 ±â€¯0.21 mm2). Both chlorhexidine concentrations modulated the expression of TRAP, RANKL and OPG. CONCLUSIONS: Subgingival irrigation with chlorhexidine contributed for a quicker shift from a proinflammatory destructive profile to healing of periodontal tissues.

Assuntos

RESUMO

AIM: To evaluate the influence of primary insertion torque (IT) values of narrow dental implants on the peri-implant health, implant stability, immunoinflammatory responses, bone loss, and success and survival rates. METHODS: Thirty-one edentulous patients received two narrow implants (2.9x10mm, Facility NeoPoros) to retain mandibular overdentures. The implants were categorized in four groups according to their IT: (G1) IT > 10 Ncm; (G2) IT ≥ 10Ncm and ≤ 30 Ncm; (G3) IT >30Ncm and < 45Ncm; (G4) IT ≥ 45Ncm, and all implants were loaded after 3 months of healing. The following clinical outcomes were evaluated 1, 3, 6, and 12 months after implant insertion: (i) peri-implant tissue health (PH), gingival index (GI), plaque index (PI), calculus presence (CP), probing depth (PD), and bleeding on probing (BOP); (ii) implant stability quotient (ISQ) by resonance frequency analysis; and (iii) IL-1ß and TNF-α concentration in the peri-implant crevicular fluid. The marginal bone level (MBL) and changes (MBC) were evaluated. The Chi2 test, Kruskal-Wallis test, mixed-effects regression analysis, and the Kendall rank correlation coefficient were used for statistical analysis (α = 5%). RESULTS: G1 presented the highest PD at all evaluated periods. G2 presented higher PI at month 6 and 12. G4 showed increased GI at month 3 and 12 and more CP at month 1 (p=.003). G2 and G4 had higher ISQ values over the study period, while those from G1 and G3 presented lower ISQ values. The IL-1ß concentration increased until month 12 and was independent of IT and bone type; G4 had a higher IL-1ß concentration in month 3 than the other groups (p=.015). The TNF-α release was negatively correlated with IT, and TNF-α release was highest in G1 at month 12. The MBL immediately after surgery and the MBC at month 12 were similar between the groups, and G4 presented a positive MBC at month 12. The survival and success rates were 75% for G1, 81.3% for G2, 64.3% for G3, and 95% for G4. CONCLUSION: The IT did not influence the clinical outcomes and the peri-implant immunoinflammatory responses and was weakly correlated with the narrow dental implants primary stability. The observed success rates suggest that the ideal IT for atrophic fully edentulous patients may deviate from the standardized IT of 32 Ncm.

Assuntos