Dental Press Implantology – ISSN 2237-650X
Dental Press Implantol.
v. 08, no. 1
January / February / March
The responsibility of a major challenge
With feelings of deep excitement and major responsibility, I step forward as the head of a journal that plays a major role in Brazilian Dentistry: Dental Press Implantology.
A journal that had as editors-in-chief some of the icons of Brazilian and international Dentistry, such as Prof. Dr. Carlos Eduardo Francischone and Dr. Maurício Araújo, lays responsibilities of massive proportions.
I took my first steps in Implantodontics in 1991, when I entered into the Master’s program of Oral and Maxillofacial Surgery after my residency in the USA. Since then, I have had Dr. Laércio Vasconcelos and Prof. Dr. Carlos Eduardo Francischone’s support. They opened me the doors to Implantology and let me work side by side with Prof. P-I Brånemark, the founder of osseointegration and with whom I had the golden opportunity to have a close relationship as a friend and as a learner. Prof. Francischone has always stimulated research, science and scientific evidence — areas in which I have great interest. These areas are part of my daily routine and, undoubtedly, have contributed to raise personal as well as professional affinity, which allowed me to be remembered for the position I occupy at present.
Prof. Francischone’s participation as an emeritus editor is key to Dental Press Implantology success. He works in partnership with another emeritus editor, my friend and colleague Maurício Araújo, an internationally renowned professor and researcher who, without a doubt, is the most noticeable name in Brazilian as well as international Dentistry nowadays. His publications are significantly cited as reference in modern Implantodontics, and have changed the way we treat our patients. I have had the opportunity to have a close relationship with Dr. Maurício, learning and admiring one of the most requested speakers around the world. I am sure that, as an emeritus editor, he will also devote some of his time, knowledge and experience to help us strength Dental Press Implantology.
Ever since its first issue, Implantology has excelled at high-quality design, modern layout and easy flow. The invitation made by Prof. Dr. Laurindo Furquim (Dental Press publisher), and the opportunity to work with a family, but extremely competent and professional company, were major stimuli that encouraged me to accept the position. I hope to meet all the trust Dr. Laurindo and his team have placed on me, and I promise to work hard and devote myself to meet the expectations of the invitation!
This new challenge brings along change and renewal. I deeply thank the editorial board of this journal and hope they keep on contributing and submitting papers. Nevertheless, we recognize the need to “oxygenate” the group by incorporating other colleagues not only from Brazil, but from all around the world, all of which will certainly share their experiences and contribute to increase the quality of Implantology. I henceforth thank the new associate editors and editorial consultants for their eagerness and immediate response to my invitation.
The first issue of 2014 remains similar to previous issues. However, significant changes will be implemented from the second issue on, with new sections, new assistant editors, stronger international contribution and new layout.
I deeply thank all the trust on me placed and I hope you keep on enjoying Dental Press Implantology!
José Carlos Martins da Rosa
The interviewee of this issue is a highly respected professional of excellent reputation in modern Brazilian Dentistry.
He graduated from the Federal University of Santa Maria/RS (UFSM) in 1988; received his specialist degree from the Association of Dental Surgeons/Bauru - São Paulo (APCD) in 1991; and his specialist and Masters degree in Prosthesis from the Dental Research Center São Leopoldo Mandic/Campinas – São Paulo in 2005. At present, he is a PhD resident in Implantodontics also at São Leopoldo Mandic.
Our interviewee is the author of “Restauração dentoalveolar imediada — Implantes com carga imediata em alvéolos comprometidos” (Immediate dentoalveolar restoration - Immediately loaded implants in compromised sockets) issued by Ed. Santos in 2010. His book has also got a Spanish (2012) and an English version (2014). Furthermore, he has several articles published in outstanding national and international journals.
José Carlos Martins Rosa is from São Vicente do Sul, a little town located in the countryside of Rio Grande do Sul. He is married to Ariádene Cristina Pértile Rosa who is also a dentist, his partner and contributor. According to Dr. Rosa, she is the active and essential author of the happiest moments of his professional and personal life. His wife is his balance.
His family and friends are responsible for a considerable portion of his emotional master pillar. For him, they are indispensable in his decision-making processes, as they always encourage him to move towards the correct direction.
Thus, Dental Press Implantology brings to the reader the outstanding profile of a young, competent talent of Brazilian Dentistry who also stands out for his polished civility and diplomatic genteelness not only in day-to-day social life, but also with those who are around him. Dr .Rosa is a strict professor and sensitive researcher. Methodical and organized, he is able to selectively identify and associate the skills that effectively contribute to add and multiply potential results.
He is the owner of an avant-garde dental center equipped with modern facilities strategically associated with important hospital resources planned with a view to working with excellence, biosafety and high technology. His clinic also has a center for professional enhancement and qualification consisting of an auditorium with integrated clinics for events, immersion courses, as well as study and research groups. Renowned professionals from all around the world have taught courses and given workshops at the dental center owned by Prof. Rosa.
In this interview, José Carlos Martins Rosa talks about the administrative vision and management model employed at the dental center he founded. Furthermore, he helps us understand the IDR protocol, a technique he strongly advocates.
He also talks about family, his greatest influences, the professors who inspired him, his publications, courses, and future plans. This interview is an interesting, productive and illustrated journey across human and scientific values that directly display the pathways of good example, simplicity, interest in research and deep love for everything that is done.
While talking about his plans for the future, Prof. Rosa mentions:
“...I intend to develop other projects inside and outside the field of Dentistry, activities that will contribute to our growth as human beings, helping people in need or difficulties. I intend to spend more time with my family, to be more present by giving and valuing the simplest things. I believe this is the essence of life. Life! God has bestowed on me so many good things! It is high time I gave it back...”.
We are certain that such gratitude is partially achieved by the generous sharing of information provided in the following pages.
Franklin Moreira Leahy
Level of knowledge of dentists about the diagnosis and treatment of peri-implantitis
Diagnosis. Osseointegration. Bone resorption. Inflammation.
Abstract / Introduction: Peri-implantitis is defined as an inflammatory process that affects the bone tissue around osseointegrated implants and may therefore be a cause of dental implant failure.
Objective: The objective of this study was to evaluate dentists’ knowledge of the diagnosis and treatment of peri-implantitis using a questionnaire applied to dentists from the towns of Cascavel and Maringá, State of Paraná, Brazil.
Methods: The sample consisted of specialists in Implantology. The same researcher explained and applied the questionnaire. With respect to the clinical characteristics of peri-implantitis, 33% of the respondents associated the condition with inflammation, 28% with radiographic bone loss around the implant, 26% with bleeding, 24% with the presence of plaque and calculus, and 5% with implant mobility. Approximately 16% of the respondents were unable to answer the questions related to peri-implantitis.
Results: In the presence of a diagnosis of peri-implantitis, the most frequently used treatment was maintenance by peri-implant curettage, followed by antibiotic therapy. More than half the dentists suggested surgical treatment of peri-implantitis by guided bone regeneration combined with bone grafting. Eighty percent of the respondents considered the failure rate of osseointegration to be related to the surface, shape and material of the implant.
Conclusion: We conclude that diagnostic methods and treatment modalities of peri-implantitis should be further clarified by scientific literature, since this study showed a lack of knowledge of dentists regarding specific aspects related to peri-implantitis.
Stem cells for bone reconstruction in sinus lifting
Stem cells. Bone transplant. Dental implants. Osseointegration. Bone marrow.
Abstract / Introduction: The demand for bone reconstruction in oral rehabilitation has been growing substantially. However, patients willing to undergo reconstructive surgery want less invasive procedures with less postoperative morbidity. Less invasive bone reconstruction techniques have used bone substitutes to achieve these objectives. Nevertheless, recent studies about tissue engineering have demonstrated that stem cells, in combination with bone grafts, may potentially improve the biological characteristics of grafting material.
Objective: To describe a clinical case of sinus elevation using autologous bone marrow aspirate resulting from the isolation of a bone marrow mononuclear fraction combined with Bio-Oss.
Results: Five months after the combined grafting procedure (Bio-Oss + bone marrow stem cells), bone biopsies were harvested during implant placement surgery. Histological images revealed a large amount of vital mineralized tissue for a 5-month postoperative time.
Conclusion: The clinical use of bone marrow mononuclear fraction combined with Bio-Oss — a xenogeneic bone substitute — in maxillary sinus elevation seems to result in good bone repair and shorter healing time.
Morse taper implant: A case report
Three-dimensional imaging. Dental implant immediate loading. Dental implant design.
Abstract / Introduction: Improvements in oral rehabilitation techniques allow esthetically demanding treatments to yield better and more predictable results.
Methods: This paper reports a case of root fracture of tooth #11 treated by means of reverse planning comprising the following steps: tooth extraction, immediate implant placement associated with guided bone regeneration and immediate temporary crown placement. Due to its biomechanical stability and bacterial sealing properties, a Morse taper connection implant was used to reduce peri-implant bone resorption, preserve periodontal tissue health and yield highly satisfactory esthetic results. The temporary tooth had been previously fabricated in accordance with the symmetry of adjacent teeth, lips and gingival tissue, which resulted in a pleasant smile.
Conclusion: It is reasonable to conclude that establishing an appropriate three-dimensional positioning of implants is not enough for Implantodontics. It requires that an appropriate planning be associated with an efficient connection so as to place an implant in accordance with patient’s periodontal biotype, thus predicting a satisfactory emergence profile, in addition to recovering patient’s esthetics, function and speech.
Optimization of guided bone regeneration in post-extraction socket by means of the Fugazzoto technique
Maxillary sinus elevation. Bone regeneration. Oral surgery. Maxillary sinus.
Abstract / Introduction: During the surgical planning for prosthetic rehabilitation performed by means of osseointegrated implants, we often face some limitations such as pneumatized maxillary sinus, in which case we can make use of alveolar regeneration and bone grafting procedures.
Objective: This article discusses and reports a case of alveolar regeneration.
Results: Treatment resulted in bone gain that allows implant placement without further grafting procedures.
Conclusion: Guided bone regeneration (GBR) provided predictability and optimization of surgical treatment.
Explanations and Applications
Membranes function in bone fracture healing and bone surgery
Bone repair. Membranes. Periosteum. Bone fracture.
“Essence” is the primary reason for being, using or understanding something. The essence of a membrane, regarding the mechanisms of socket bone repair, is to replace the injured or damaged periosteum so as to prevent non-osteogenic cells from colonizing blood clot and exudate, forming a fibrous or adipose tissue to fill the “empty” spaces. Bone cells are slower in comparison to other cells; and the membranes, which substitute the periosteum, preserve or restore the bone cavity which becomes an area restricted to bone cells. Furthermore, due to its organization and productive capacity, the periosteum plays an essential role in bone reconstruction and remodeling, adapting the bone to potential functional demands.
Connection between periodontal disease and chronic kidney disease: A literature review
Chronic renal insufficiency. Periodontitis. Renal dialysis.
Abstract / Introduction: The association between periodontal disease (PD) and chronic kidney disease (CKD) is bidirectional, as individuals with CKD may have oral manifestations, and PD may develop as a complicating factor of CKD. The systemic inflammatory response found in periodontal patients may have a synergistic effect on the chronic inflammation found in CKD.
Objective: To review the literature to find evidence of the importance of the association between these two conditions.
Methods: A PubMed search of studies published between 2003 and 2013 was conducted to retrieve clinical trials and systematic reviews.
Results: Six clinical trials and one systematic review met the established criteria. Clinical trials used different approaches for the association between PD and CKD. Studies investigating the association between PD and CKD used a crossover design, evaluation of the oral manifestations in patients with CKD, and analysis of the effect of periodontal treatment on markers of renal disease.
Conclusion: In addition to systemic functions, CKD also affects oral health, particularly causing periodontal tissues. Moreover, PD may affect kidney functions and lead to complications in individuals with CKD.
Recovering function and aesthetics of a fractured tooth using the immediate dentoalveolar restoration technique: Case report with a 3-year follow-up
Dental implant. Fresh socket. Bone graft. Immediate loading.
The prognoses of root fracture, endodontic failure or advanced periodontal disease are not favorable. The treatment of choice for such patients includes removal of the tooth and implant therapy. Root fracture is commonly associated with bone loss, especially in the buccal wall, and the aesthetic risk is increased. This article describes the use of the Immediate Dentoalveolar Restoration technique to restore a compromised socket through bone graft, implant placement and immediate function in a patient with a complicated crown-root fracture in the maxillary central incisor. The patient was followed up clinically and tomographically for 3 years.
Image and Science
Natural versus artificial: Comparative study of the root cementum and the nanotexturized surface of osseointegrated implants
Comparison between two photomicrographs, obtained by scanning electron microscopy (under magnification of 4,000x), of the root surface of a tooth and the nanotexturized surface of an osseointegrated implant (NanoTite, BIOMET 3i). Note the strong similarity between the rugosity created by nature over the root cementum (A) and the texture of the implant surface (B).
A literature review on the clinical performance of fixed prostheses with tooth-implant connection
Dental prosthesis. Dental implant. Treatment.
Dental implants are widely accepted in the Dentistry field. New restorative procedures, employed in edentulous patients with no prospect of satisfactory treatment, have been established on the basis of Implantodontics. Thus, not only patients, but also specialists have gained the benefits of the new procedures for oral rehabilitation. However, fixed prostheses in which natural teeth connect with osseointegrated implants are still an issue. Thus, this paper aimed at conducting a literature review on implant/tooth-supported fixed prostheses, taking into account the new procedures established for restoration of partially edentulous patients.
Abstracts of articles published in important Implantology, Prosthodontics and Periodontics journals from around the world