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OBJECTIVES: Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. METHODS: Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. RESULTS: In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessed biofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. CONCLUSION: Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.
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The objective of this study is to examine the mechanical behavior of two-piece abutments (Morse taper with 16° internal angulation and Morse taper with 11.5° internal angulation) before and after cyclic fatigue testing, following ISO 14801:2016 guidelines. The specimens were divided into three groups: a modified Morse taper with a taper angle of 16° (GM group), a conventional Morse taper (taper angle of 11.5° deg) with a two-piece (CMt group), and one-piece abutments (CMo group). Each experimental group was formed by ten implants and ten abutments (n = 10) for a total of 30 specimens (n = 30). The abutments were tightened and loosened, and a fatigue test was applied with 15 Hz and 5 × 106 cycles. Subsequently, the abutments were loosened, and a pull-out test was performed on the CMt group. Finite element analysis (FEA) was conducted on stress concentration regions. The statistical analysis of the loosening test was performed using two-way ANOVA and Tukey's tests (p < 0.05) to compare screw loosening within each group and between the groups with and without mechanical fatigue. Significant differences were found among the three groups in the loosening test when analyzing the values with and without fatigue (p < 0.001) within each group. When the groups were compared with each other, there was also a significant difference between them (p < 0.001), except between groups GM and CMt without fatigue (p = 0.840). In the pull-out test of the CMt group, the sample exhibited frictional locking only after fatigue (mean = 94.2 N). The FEA demonstrated a varied stress distribution in all groups. The stress was found to be more concentrated in the upper third and middle third regions of the implant, as well as in the opposite region of the load application for all three groups. Although the CMo group showed lower rates of loosening, it displayed a poorer stress distribution in comparison to the GM and CMt groups. On the other hand, the CMt group exhibited a satisfactory frictional lock after undergoing the fatigue tests.
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RESUMEN Antecedentes: El tratamiento con implantes dentales se ha incrementado rápidamente a nivel mundial, pero cabe resaltar que también han incrementado los casos con enfermedades periimplantarias, como la periimplantitis; por lo tanto, se debe valorar la importancia del conocimiento de estas enfermedades por parte de los especialistas en periodoncia e implantes, quienes en su práctica profesional evidenciarán esta patología, para que así puedan prevenir, diagnosticar y tratar la periimplantitis. Objetivo: Determinar el nivel de conocimiento sobre la periimplantitis de los residentes de la especialidad de Periodoncia e Implantes de la Escuela Profesional de Estomatología de la Universidad Andina del Cusco, durante el 2017. Material y métodos: El estudio fue aplicativo, cuantitativo, descriptivo y transversal; basado en la aplicación de un cuestionario validado en una muestra integrada por 50 estudiantes matriculados en la especialidad de Periodoncia e Implantes de la Escuela Profesional de Estomatología de la Universidad Andina del Cusco, durante el segundo semestre académico de 2017. Resultados: El 44 % de los residentes de la especialidad de Periodoncia e Implantes tiene un nivel medio de conocimiento sobre la periimplantitis; el 36 %, un nivel bajo; y el 20 %, un nivel alto. Conclusiones: Se determinó que los residentes encuestados de la especialidad de Periodoncia e Implantes de la Escuela Profesional de Estomatología de la Universidad Andina del Cusco tienen un nivel medio de conocimiento sobre la periimplantitis; de forma específica, se estableció que el nivel de conocimiento dependerá del año y semestre que cursen los residentes.
ABSTRACT Background: Treatment with dental implants has increased rapidly worldwide, but it should be noted that cases of peri-implant diseases such as peri-implantitis have also increased. Therefore, it is key that specialists in periodontics and implants acquire comprehensive knowledge about these diseases. This knowledge will enable them to effectively prevent, diagnose, and treat peri-implantitis in their professional practice. Objective: To determine the level of knowledge about peri-implantitis among residents of the Periodontics and Implants specialty at the Professional School of Stomatology of the Andean University of Cusco, 2017. Material and Methods: The study was applicative, quantitative, descriptive and cross-sectional, based on the application of a validated questionnaire to a sample made up of 50 students enrolled in the specialty of Periodontics and Implants at the Professional School of Stomatology of the Andean University of Cusco during the academic semester 2017-II. Results: The results revealed that 44% of the residents in the Periodontics and Implants specialty possessed a medium level of knowledge regarding peri-implantitis. Additionally, 36% had a low level of knowledge, while 20% demonstrated a high level of knowledge. Conclusions: It was determined that the surveyed residents of the Periodontics and Implants specialty at the Professional School of Stomatology of the Andean University of Cusco have a medium level of knowledge about peri-implantitis. Specifically, it was found that the level of knowledge depends on the year and semester of study for the residents.
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El propósito de este reporte es describir el tratamiento no quirúrgico y quirúrgico en una paciente con múltiples implantes con peri-implantitis. Inflamación, sangrado espontáneo, supuración y pérdida ósea fueron los signos clínicos y radiográficos observados en los 21 implantes presentes en su boca. Las profundidades al sondaje oscilaban entre 5 y 15 mm. Se llevó a cabo la terapia no quirúrgica asociada a antibióticos sistémicos (Metronidazol 500 mg) y antiséptico (Clorhexidina 0,12%) con la finalidad de reducir los signos de inflamación y sangrado. Durante la re-evaluación se colocaron gránulos de Minociclina de liberación controlada en las bolsas residuales. Los sitios que no respondieron fueron abordados quirúrgicamente, realizando además la implantoplastia de las espiras que quedaron expuestas al medio bucal. Uno de los implantes debió ser explantado. A los 9 meses, no presentaba signos de inflamación peri-implantar, sangrado al sondaje ni pérdida ósea progresiva.
The aim of this report is to describe the non-surgical and surgical treatment of a patient with multiple implants with peri-implantitis. Inflammation, spontaneous bleeding, suppuration and bone loss were the clinical and radiographic signs observed in the 21 implants present in her mouth. Probing depths ranged from 5 to 15 mm. Non-surgical therapy with systemic antibiotics (Metronidazole 500 mg) and antiseptic (Chlorhexidine 0.12%) was carried out in order to reduce the signs of inflammation and bleeding. During re-evaluation, controlled-release minocycline granules were placed in the residual pockets. The sites that did not respond were approached surgically. Also, the implantoplasty of the threads that were exposed to the oral environment was performed. One of the implants had to be explanted. At 9 months, there were no signs of peri-implant inflammation, bleeding on probing or progressive bone loss.
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Humanos , Feminino , Idoso , Implantes Dentários , Peri-Implantite/complicaçõesRESUMO
Introducción: la vitamina D es una hormona que se sintetiza por células de la piel mediante la luz ultravioleta (UV) y se obtiene a través de la dieta. La relación que se establece entre la deficiencia de vitamina D y el fracaso en injertos óseos o implantes se basa en las alteraciones inmunológicas e inflamatorias debido al vínculo que existe con la inmunidad innata y adaptativa. Objetivo: identificar los factores que se presentan en el periodonto cuando existen niveles bajos de vitamina D y se realizan tratamientos periodontales como injertos óseos e implantes. Material y métodos: se realizó la búsqueda primaria de artículos en bases de datos PubMed y Google Académico (en español e inglés), de acuerdo con las palabras claves: deficiencia, vitamina D, implantología y oseointegración. Resultados: la vitamina D afecta y predispone al rechazo de injertos, ausencia de oseointegración en implantes debido a la inmunomodulación. Conclusión: el éxito del tratamiento se vuelve predecible cuando se encuentran niveles óptimos de vitamina D en conjunto con técnicas de abordaje quirúrgico correctas que permitan generar una integración ideal de los tejidos periodontales (AU)
Introduction: vitamin D is a hormone that is synthesized by skin cells using UV light and consumed through the diet. The relationship established between vitamin D deficiency and the failure of bone grafts or implants is based on immunological and inflammatory alterations due to the intimate link with innate and adaptive immunity. Objective: to identify the factors that occur in the periodontium when there are low levels of vitamin D and periodontal treatments such as bone grafts and implants are performed. Material and methods: a search for articles was carried out in PubMed and Google Scholar (Spanish and English). Results: vitamin D affects and predisposes to graft rejection, absence of osseointegration in implants due to immunomodulation. Conclusion: the success of the treatment becomes predictable when optimal levels of vitamin D are found together with the correct surgical approach techniques that allow the generation of an ideal integration of the periodontal tissues.(AU)
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Deficiência de Vitamina D/complicações , Osseointegração/fisiologia , Implantação Dentária Endóssea/efeitos adversos , Vitamina D/metabolismo , Transplante Ósseo/efeitos adversosRESUMO
Objetivo: O presente estudo avaliou, por meio da extensometria, as microdeformações geradas ao redor de implantes, em duas conexões protéticas: hexágono externo(HE) e cone morse(CM), em duas diferentes níveis ósseos: sem perda e com perda de 5 milímetros, em coroas unitárias implantossuportada, confeccionadas em diferentes materiais restauradores: resina acrílica, totalmente metálica, metalocerâmica e cerâmica pura. Material e Métodos: Sete blocos retangulares de: 95 x 45 x 30 mm foram utilizados para simular o tecido ósseo, possuindo um degrau de 5 mm, que simulou uma perda óssea. Foram utilizados 28 implantes (3,75 x 13 mm) de mesmo desenho externo, mas diferentes plataformas protéticas, o pilar protético selecionado para o HE foi o UCLA e para o CM o CMN. O ensaio mecânico foi realizado por meio de um dispositivo de aplicação de carga (DAC) com carregamentos estáticos axiais sobre a superfície oclusal das coroas, com carga de 31,5 kgf por 10 segundos, sob três repetições. Os dados foram avaliados por teste ANOVA e Tukey com nível de significância 5% (P - 0,05). Resultados: Os resultados obtidos pela extensômetros demonstraram que: em relação ao nível ósseo e a conexão protética, houve diferença estatística entre os grupos de implantes à nível ósseo (HE - 308,6793 µÎµ e CM - 457,0536 µÎµ), contudo com a simulação de perda óssea de 5mm não registraram diferença estatística ( HE - 563,0707 µÎµ e CM - 522,8788 ). Em relação ao material da coroa, não houve diferença estatística independente da conexão protética e do nível ósseo ( Co-cr: 528,99µÎµ, metalocerâmica:420,57µÎµ, resina: 435,33µÎµ e cerâmica pura: 462,92µÎµ). Conclusão:O estudo concluiu que os implantes à nível ósseo com a conexão protética HE registrou valores de microdeformações estatisticamente menores que o CM, mas com 5 mm de perda o comportamento foi semelhante. Os diferentes materiais das coroas avaliados, não foram capazes de reduzir os valores de microdeformação, independente do nível ósseo do implante. (AU)
Objective: The present study evaluated, by means of extensometry, the microdeformations generated around implants, in different systems: External Hexagon (EH) and Cone Morse (CM), in two different bone heights: No bone loss and 5mm bone loss, in unitary crown implant, of different restorative materials (acrylic resin, metallic, metal-ceramic or all-ceramic). Material and Methods: Seven rectangular block with dimensions of 95 x 45 x 30 mm was used to simulate bone tissue, containing a 5 mm step, which simulated bone loss. 28 implants (3.75 x 13 mm) with the same geometry and different prosthetic platforms were used, the abutment of choice for the EH was the UCLA and for the CM the CMN. The mechanical test was performed using a load application device (DAC) with axial static loads on the occlusal surface of the crowns, the load used was 31.5 kgf for 10 seconds, with three repetitions. Data were evaluated by ANOVA and Tukey tests with significance level 5% (P - 0.05). Results: The results obtained by the strain gauges showed that: in relation to the bone level and the prosthetic connection, there was a statistical difference between the groups of implants at the bone level (EH - 308.6793 µÎµ and CM - 457.0536 µÎµ), however, with the simulation of 5mm bone loss, there was no statistical difference (EH - 563.0707 µÎµ and CM - 522.8788). Regarding crown material, there was no statistical difference regardless of the prosthetic connection and bone level. (Co-Cr 528.99µ).Conclusion: The study concluded that bone-level implants with the HE prosthetic connection registered statistically lower microdeformation values than the CM, but with 5 mm of loss the behavior was similar. The different crown materials evaluated were not able to reduce the microdeformation values, regardless of the bone level of the implant. (AU)
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Implantes Dentários , Perda do Osso AlveolarRESUMO
Objective: The aim of the present study was to evaluate the impact of the COVID-19 pandemic on the number of publications in the field of periodontology and implantology in Turkey. Material and Methods: A sensitive search strategy was developed to identify relevant articles, focusing on the periodontology and implantology research fields published two years before and after the declaration of the pandemic (March 2020). The search was performed through Web of Science, Medline, SCOPUS and CENTRAL databases. A three-stage screening (titles, abstract, full-text) was carried out in duplicate and independently by two reviewers. Results: A total of 382 studies were identified before the pandemic and 307 studies during the pandemic. While there was a downward trend in the number of observational studies (185 vs 168), the number of clinical trials (CCT/RCT) slightly increased compared to the pre-pandemic period (72 vs 74). Conclusion: Limited to the selected period of time (two years) and field, publication rate on periodontology and implantology in Turkey was decreased during the pandemic. Although the present research highlights current trends, large-scale investigations are needed to probe consequences of COVID-19 pandemic on research activities in the long-run (AU).
Objetivo: O objetivo do presente estudo foi avaliar o impacto da pandemia de COVID-19 no número de publicações na área de periodontia e implantodontia na Turquia. Material e Métodos:Foi desenvolvida uma estratégia de busca sensível para identificar artigos relevantes, com foco nas áreas de pesquisa em periodontia e implantodontia publicados dois anos antes e depois da declaração da pandemia (março de 2020). A busca foi realizada nas bases de dados Web of Science, Medline, SCOPUS e CENTRAL. Uma triagem de três etapas (títulos, resumo, texto completo) foi realizada em duplicata e de forma independente por dois revisores. Resultados: Foram identificados 382 estudos antes da pandemia e 307 estudos durante a pandemia. Embora tenha havido uma tendência de queda no número de estudos observacionais (185 vs 168), o número de ensaios clínicos (CCT/RCT) aumentou ligeiramente em comparação com o período pré-pandêmico (72 vs 74). Conclusão: Limitada ao período de tempo selecionado (dois anos) e área, a taxa de publicação em periodontia e implantodontia na Turquia diminuiu durante a pandemia. Embora a presente pesquisa destaque as tendências atuais, são necessárias investigações em larga escala para investigar as consequências da pandemia de COVID-19 nas atividades de pesquisa a longo prazo.(AU)
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Periodontia , Carga Imediata em Implante Dentário , Pandemias , SARS-CoV-2 , COVID-19RESUMO
O "planejamento reverso" em implantodontia busca alcançar um melhor prognóstico para a reabilitação do paciente, permitindo uma maior previsibilidade para o tratamento a partir do momento em que se planeja a reabilitação oral protética antes mesmo de planejar os implantes osseointegráveis. O dispositivo de resina acrílica chamado guia multifuncional representa a disposição final dos dentes na reabilitação e auxilia demasiadamente na etapa protética em casos em que não é possível a carga imediata. Ainda, otimiza o número de consultas do tratamento pois orienta a relação maxilomandibular, dimensão vertical e correta posição dos dentes. O presente trabalho tem como objetivo apresentar um caso clínico da utilização do guia multifuncional para moldagem dos implantes em caso de protocolo Branemark com dois tempos cirúrgicos, mostrando sua utilidade para diminuição do número de consultas na etapa de confecção da prótese total inferior definitiva. Diante dos resultados obtidos na realização do caso, foi possível concluir que nos casos de protocolo Branemark quando não é possível realizar a carga imediata, o guia multifuncional pode ser aproveitado e utilizado com sucesso, para a moldagem e confecção da prótese definitiva, diminuindo o número de consultas e otimizando o tratamento.
Reverse planning in implantology aims to improve patient's rehabilitation prognosis allowing greater treatment predictability from the prosthetic planning and before the implants installation. The acrylic resin device called multifunctional guide represents the final teeth disposition and is very useful in the prosthetic step when immediate loading is not possible. And it optimizes appointments treatment number since it guides the maxillomandibular relation, vertical dimension and correct teeth position. The aim of this study was to present a clinical case using the multifunctional guide for implant molding a two steps Branemark protocol, showing its usefulness to reduce the appointments number during the inferior total denture preparation step. Based on these results, it was possible to conclude that in Branemark protocol, when it immediate loading is not possible, the multifunctional guide can be used successfully for molding and making the final prosthesis, reducing the number of visits and optimizing treatment.
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Humanos , Masculino , Pessoa de Meia-Idade , Resinas Acrílicas , Protocolos Clínicos , Prótese Total Inferior , Reabilitação BucalRESUMO
This study evaluated the influence of photobiomodulation (PBM) using low-level laser therapy (PBM/LLLT) or light-emitting diode (PBM/LED) therapy on peri-implant tissue healing. A laboratory model was used to assess the adhesion and metabolism of osteoblasts (SaOs-2), human gingival fibroblasts (HGF), and normal oral keratinocytes (NOK) seeded on a titanium (Ti) surface. After seeding the cells on disks of Ti placed in wells of 24-well plates, three irradiations were performed every 24 h at energy density of 3 J/cm2. For PBM/LLLT, a LaserTABLE device was used with a wavelength of 780 nm and 25 mW, while for PBM/LED irradiation, a LEDTABLE device was used at 810 nm, 20 mW, at a density of 3 J/cm2. After irradiations, the number of cells (NC) attached and spread on the Ti surface, cell viability (CV), total protein (TP), and collagen (Col) synthesis were assessed. Alkaline phosphate activity (ALP) was evaluated only for SaOs-2. Data were submitted to ANOVA complemented by Turkey statistical tests at a 5% significance level. PBM significantly increased adherence of NOK to the Ti surface, while no significant effect was observed for SaOs-2 and HGF. PBM positively affected CV, as well as Col and TP synthesis, in distinct patterns according to the cell line. Increased ALP activity was observed only in those cells exposed to PBM/LLLT. Considering cell specificity, this investigation reports that photobiomodulation with low-power laser and LED at determined parameters enhances cellular functions related to peri-implant tissue healing in a laboratory model.
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Terapia com Luz de Baixa Intensidade , Proliferação de Células , Gengiva , Humanos , Osseointegração , OsteoblastosRESUMO
OBJECTIVES: To evaluate the relationship between the tomographic sagittal root position (SRP) of maxillary anterior teeth and periodontal phenotype (PP). MATERIAL AND METHODS: Seventy volunteers (420 teeth) were evaluated. Clinical and photographic exams included the evaluation of gingival phenotype (GP) by transparency of the periodontal probe, keratinized tissue width (KTW), gingival architecture, tooth shape, and papilla height (PH). Soft tissue tomographic scan (ST-CBCT) measurements included the SRP classification, GP, gingival thickness in the tissue zone (GT-TZ) and in the bone zone (GT-BZ), buccal bone thickness (BBT), and the distances from the gingival margin and from cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC). Kruskal-Wallis test and a linear regression analysis model were used. RESULTS: The frequency of SRP over the 420 teeth was 65.2% (class I), 9.3% (class II), 0.7% (class III), and 24.8% (class IV). Linear regression analysis showed that SRP is related to PP (p < 0.05). Significantly different measurements of PP parameters were found in SRP classes. The higher and lower GT and BBT were found in classes II and I, respectively. Class IV presented the highest KTW, PH, CEJ-BBC, and GM-BBC. Central incisors (CI) classes I and II were most frequently square-shaped, while 89% of CI Class IV were triangular-shaped. CONCLUSION: The SRP of maxillary anterior teeth is related to periodontal phenotype. CLINICAL RELEVANCE: Clinical and ST-CBCT individual analysis of PP and SRP may be helpful for an esthetic and functional treatment plan based on soft and hard tissue thickness and tooth positioning.