v. 06, no. 1
Dental Press Implantology – ISSN 2237-650X
Dental Press Implantol.
v. 06, no. 1
January / February / March
A new year means, always, new achievements and pleasant surprises
On this line, and starting in 2012, Dental Press IMPLANTOLOGY brings the experience and the scientific charm of Prof. Dr. ALBERTO CONSOLARO, invited to be editor of the journal. Especially interested in teaching, he wants especially to transmit the importance of education in different life stages and the need of deepening and later transfer of this range of knowledge for the scientific community in general. He plays his role brilliantly in the institutions to which he is linked, making clear in his interview - conducted by the assistant editors LUIZ ROGÉRIO DUARTE and FRANKLIN LEAHY — his ideas and opinions filled with modern, controversial and practically delineator content of achievements still sought.
This publication presents a new item, “Observatory”, which will enable access to current subjects treated in journals with international circulation, along with subjects addressed here by renowned professors and researchers, which, as always, are of high quality, science and practice.
Continuing the feature introduced in the previous edition, the content is presented, on Internet, in English, which represents a further reference to our journal, in addition to all the contemplated and highlighted sections.
Dental Press IMPLANTOLOGY is, therefore, being offered from this exercise with maturity and we believe that in its five volumes, got to demonstrate that the aim and objectives which have been proposed are being achieved, not only by the efforts of the whole team involved, but also receptivity from those who militate in the area, which has brought the subsidies needed to develop increasingly intense and responsible of this board of dental literature.
Profession: PROFESSOR. According to the definition found in the Aurélio Portuguese language dictionary, professor is the person who professes or teaches a science, an art, a technical discipline; a master. All these features are deeply rooted to the profile and history of the interviewee in this edition of Dental Press Implantology, Professor Dr. Alberto Consolaro.
He is Brazilian, born in the city of Araçatuba, São Paulo, and comes from a very poor family of farm workers of Italian descent. The third of four brothers, all of them very studious. His father, a carpenter by trade, even from very humble origins and little education, had inside him a certainty very well grounded in life experience and intuitive wisdom of those who carve the future of the family with fair dealing, honesty and sweat of their own face. Of those who wants the best for the future of their children. Those who definitely learned, with daily labor, to transform adverse conditions and big difficulties in solid and fruitful lessons! Convinced, he insisted daily, in prophetic tone and repeating a mantra, that it was necessary and fundamental “… to study hard to be someone and succeed in life!”. Professor Consolaro, besides having completely assimilated these teachings, has exaggerated, for luck and delight of those who know him well and enjoy their conviviality.
A man of surprising escalation in the academic sphere. Graduated in Dentistry (Unesp/Araçatuba), specialist (CFO), associate professor and doctor (USP), full professor (FOB-USP) and post-graduation professor (FORP-USP). Features of restless, curious, exciting and participatory are essential to any researcher of quality. Our interviewee is of remarkable generosity in eclectically sharing knowledge and, as few, of recognized capacity to convey scientific content in different areas of knowledge. In lectures, congresses or crowded classrooms within universities as a visiting professor, or supervisor of dissertations and theses, writing books or scientific articles, Dr. Consolaro shows always constant joy and enthusiasm of those who continue renewing himself, learning, studying and pleasantly dedicating the dynamic and fascinating art of teaching!
In the following pages, the reader can assess the answers given to several questions asked by professors in different locations in Brazil and South American countries - mostly ex-students of the professor himself - on controversial and general interest subjects related to Odontology, Implantology, academic formation, higher education in Brazil, Internet and computerization in education, teaching and many other subjects in which he moves with the recognized and usual easiness, efficiency and didacticism. In these responses, he confesses: “My dreams have always gone through teaching and research. To learn how to communicate well with words, postures and images were tools that I had to minimally dominate to be a good professor. “
The author of “Cárie Dentária: Histopatologia e Correlações Clínico-Radiográficas”, “Reabsorções Dentárias nas Especialidades Clínicas”, “O Ser Professor”, “Controvérsias em Ortodontia e Atlas de Movimentação Dentária” and “Inflamação e Reparo”, in addition to numerous scientific papers published in national and foreign journals, is also the newest acquisition to compose the editorial board of journal Dental Press Implantology, joining forces with Prof. Dr. Carlos Eduardo Francischone and other collaborators, adding even more competence, creativity, quality and scientific ambience. This subject is also part of this interview.
Explanations and Applications
Hypercementosis and increased cementum thickness over the age: Clinical implications and meanings
Cementum. Hypercementosis. Dental root.
A very common alteration that raises many questions about its etiopathogenesis and meaning is the hypercementosis. The pertinent literature is reduced and cementum represents the less studied dental tissue, and even its reactivity level under stimulation and aggression is ignored. Cementum thickness and structure change overtime. It must be noticed the difference between cementum thickness increase and hypercementosis. In hypercementosis there is an excessive formation of cementum beyond the limit necessary to allow its regular functions, with macroscopic root shape alteration, specially regarding to its diameter. Each hypercementosis type has different meanings: How to understand them when planning and/or on treatment follow-up? From a biological point of view, must a special care be taken while setting an implant in the neighborhood of a tooth with hypercementosis? To help answering these questions and at once collaborate to more secure hypercementosis diagnoses, appreciating its clinical and biological meaning, we have set ourselves out to reanalyze the literature and a sample studied over the years in papers, dissertations and thesis.
Ask the Expert
When to indicate the autogenous bone grafts or bone substitutes in implant dentistry? Part II
Physiology of the alveolar bone loss
One of the greatest and most constant challenges for professionals in Dentistry and more specifically for Implantodontists has been the recovery of edentulous regions after the loss of one or more teeth. Despite all visible progress in the prevention of caries and periodontal disease, tooth extraction is still a prevalent and mutilating treatment.
Letter to the Editor
This is a special opportunity in Dentistry to expand our horizons and for scientists and clinicians to undertake exploration of the future on issues of bioengineering, growth and differentiation factors. In the past, some scientists were accused of providing a futuristic vision of the clinical impact on the biological and technological advances under the perspective of their specialties. This reminds me when I, a freshman at the college of Dentistry, heard a global specialist in Cardiology, telling us that we had made a mistake in choosing Dentistry as a profession, because within 18 months, the market would have a vaccine for caries. I suggest that each one treasure the information that will get today, as I should have done at that time based on what I heard. This is related to the need of pre-marketing research on new products. In the early osseintegration, much time was spent before there were changes in the products. Contemporary system reversed the process in a way that new products are routinely available to the professional with an inadequate investigation. It is often asked to dental professionals to use new devices and report the success of their treatment results without having informed the patient about researches including them. This is an unscientific approach that does not bring anything good to the implantologist.
Rehabilitation with total fixed prosthesis on unfavorably positioned implants in maxilla: Case report
Unfavorable implants position. Implant supported prostheses. Unfavorable inclined implants.
The contemporary Implantology associated with dental prosthesis, provides various and very well substantiated alternatives for resolution of the most varied and critical situations in the dental clinic. These conditions naturally tend to be grouped into classifications extensively investigated and already enshrined in the international literature, considering, inclusively the importance of results continuously revealed by scientific evidence in this wide context. Within very well defined limits, it is feasible the indication and possibility of reutilization of unfavorable installed implants, as the starting point for another prosthetic planning. A new surgery to remove them and later install implants into supposedly ideal positions considering the resources available today, it may even be more logical or recommended, but not always technically possible, without having more complex procedures being required, adding greater discomfort, morbidity, taking longer for finalization. Considering all possible aspects which may involve the patient and the presented problem, together with the consistency of a more conservative approach in the planning of any treatment, causes the boldness and impetuosity inherent to knowledge of the innovative or cutting-edge, even if consecrated techniques, merge providentially with prudence and calibrated restraint in the field of interpretive treatments, resulting in significant benefits for patients. This article reports a case that illustrates this combination of analytical expectations. It brings together science, consciousness and experience. It merges theory and practice, combined with the expectation of good sense and good prognosis.
Repair of defects in the alveolar ridge using rhBMP-2 in baboons
rhBMP-2. Alveolar bone. Bone graft.
The objective of this research was to evaluate the regeneration of alveolar ridge width defects following surgical implantation of recombinant bone morphogenetic protein-2 (rhBMP-2) using two different carriers: a) Tricalcium Phosphate (TCP) / Hydroxyapatite (HA) / Absorbable collagen sponge (ACS) and b) α-BSM cement (CaPO4) in the baboon model. Standardized alveolar ridge defects (15 X 8 X 5 mm) were made in 4 edentulous areas, in 4 baboons. Sites were balanced as to treatments and maxilla/mandible. Two titanium pins were placed at the mid apical and coronal levels to provide landmarks for defect measurements (width) and comparisons pre and post – treatment reentry. Impressions of the pre and post treatment ridges were also taken and models made to determine changes in clinical defect volume. Five treatments were performed: rhBMP-2/TCP/HA/ACS, TCP/HA/ACS alone, rhBMP-2/α-BSM(CaPO4), α-BSM(CaPO4) alone and unimplanted Control. A dose of 0.4-mg/ml rhBMP-2 was used in rhBMP-2 treated sites. Qualitative radiographic observations were recorded at pre implantation and before reentry. Block sections (mid-defects) were harvested at 12 -16 weeks, processed for light microscopy and stained with Mason’s Trichrome. Three central histologic sections were evaluated for trabecular bone area, marrow space area and bone density using the Computerized Image Program. Statistical comparisons between treatments were made using ANOVA. Carriers by themselves demonstrated sufficient rigidity, resistance to compression and osteoconductive capacity to provide for modest ridge augmentation. Addition of rhBMP-2 resulted in almost double the increase in width and volume, and statistically significant more trabecular bone, less marrow space and higher density than the carriers alone. The rhBMP-2/α-BSM(CaPO4) construct demonstrated superior, but not statistically significant (p ≥ 0.05) results over the rhBMP-2/TCP/HA/ACS implant Both TCP/HA/ACS and α-BSM(CaPO4) appear to be suitable carriers for rhBMP-2. The enhancement of both carrier systems with rhBMP-2 provided a viable alternative to second site grafting for the augmentation of alveolar ridge defects prior to implant placement. In addition, these treatments were the only ones that provided enough clinical ridge width for implant placement.
Reduced dental arch: Concepts and updates — Literature review
Dental occlusion. Dental implants. Dental arch.
Objective: To highlight the advantages and disadvantages of the concept of shortened dental arch in the rehabilitation of a dentition with conventional and implant supported prosthesis, expanding treatment options to patients.
Literature review: The traditional restorative concept makes the dentition a cycle of permanent repair, more than 50% of the restorative treatments consists on the repair of previous restorations. The shortened dental arch has been studied for some time and there is evidence that shows its predictability as an option in dental treatments.
Discussion: The shortened dental arch is indicated to simplify the treatment plan, but it is important to consider their limitations in young patients that frequently have a high requirement for functionality, in patients with anterior open bite or with occlusal relationship type Class II and III, severe occlusal wear and in patients with bruxism.
Conclusion: Dental treatment aims to maintain the natural function of the dentition during life, including social and biological functions, such as self-esteem, aesthetics, phonetics, chewing and oral comfort. The philosophy of the shortened dental arch meets all these requirements, expanding treatment options to patients.
Micrometric characterization of implant surfaces of the five largest companies in the Brazilian market. Part I: Neodent implants
Dental implant. Brazilian implants. Neodent implants. Implant surface. Roughness.
Introduction: The quality of the bone-implant interface is directly influenced by implant surface roughness and a roughness average, with the Sa between 1 to 2 µm, has demonstrated better clinical and laboratory results. In Brazil, are installed more than two million implants per year, where 79% are manufactured by domestic companies. However, very little is known or published about the characterization of surfaces of these implants, on the micrometer level. The aims of this study are to evaluate and characterize numerically the surface of the implants of Neodent company, one of the five largest companies in the Brazilian market. Methods: Were evaluated a total of 9 implants, purchased directly on the market, of 3 different designs and different batches of the company, using a light interferometer. Were performed 9 measurements randomly chosen for each unit, 3 on the tops, 3 on the valleys and 3 on the flanks of the threads. The same pattern was followed for evaluation by scanning electron microscope. Results: In general, implants analyzed in this company, showed Sa values of 0.75 µm, 0.67 µm and 0.65 µm, respectively, for each design. Comparing the batches, all designs presented statistically significant differences between at least one batches in relation to other. Conclusions: The roughness values found, classify the surfaces of the three implants evaluated as minimally rough.
Assessment of the effect of non-surgical periodontal treatment on the dentin hypersensitivity
Root planing. Dentin sensitivity. Periodontitis.
Objective: The aim of this study was to evaluate the periodontal treatment effect on dentin hypersensitivity.
Methods: This study comprised 20 patients diagnosed and treated of chronic periodontitis in the Dental Clinic of Uningá School of Dentistry (Maringá, Brazil). Patients were evaluated for dentin sensitivity by VAS scale before non-surgical periodontal treatment and after 10 to 14 days of its conclusion. Results: According to the VAS scale, patients presented an average sensitivity of 3.05 + 3.00 before the beginning of periodontal treatment. At the end of the treatment there was a significant reduction to 1.00 + 1.45 in the average dentin hypersensitivity. Conclusion: Based on the outcomes of the present study, it can be concluded that non-surgical periodontal treatment, associated to a modification of oral hygiene habits, was able to reduce dentin hypersensitivity in subjects with chronic periodontitis.
Biomechanical risk factors for implantosupported prostheses — literature review
Dental implants. Risk factors. Prostheses and implants.
Introduction: The masticatory efforts applied over the prosthesis implant-supported may compromise the success of treatment. Implants are susceptible to various risk factors, including the biomechanics of order, involving the understanding of applied occlusal loads or overloads on all components of the biological system (bone and periodontal support) and mechanical (prosthesis-implant components).
Objective: The purpose of this review is to discuss the risk factors of order biomechanics and its influence on the success of implant prostheses.
Conclusions: The authors concluded that the control of biomechanical loads received by the implant-prosthesis are critical to the longevity of the treatment, because they act directly on the prosthesis, screws, intermediate, implant and bone support.
Peripheral ossifying fibroma related to Class II furcation defects in upper molar: Clinical case report
Ossifying fibroma. Periodontitis. Periodontal attachment loss.
Background: Peripheral ossifying fibroma (POF) is a hyperplastic inflammatory reaction that occurs exclusively on gingiva and affects women. Recurrence is not uncommon and the presence of severe periodontitis increases the recurrence risk because sites with furcation involvement or bone defects may complicate the total lesion removal. This paper aims to report a case of POF associated to a class II furcation in a patient with periodontitis.
Case report: Female patient, 58 years old, with recurrence of gingival tissue growth, which had been excised 6 months earlier and diagnosed as POF. The lesion presented as an asymptomatic nodular mass in the posterior maxilla, non-ulcerated, erythematous, sessile, firm and non-tender. Clinical examination also showed presence of periodontitis as a manifestation of systemic diseases. At the lesion site was present probing depth of 9 mm, bleeding on probing and Class II furcation defect. Surgical resection and meticulous scaling and root planing were performed, taking care to completely exscind the lesion. There was no recurrence of the lesion one year later, with improvement in health clinical parameters, such as reduction in probing depth to 3 mm, no bleeding on probe, clinical attachment level gain and furcation closure.
Conclusion: Within the limits of this case report, it can be concluded that when POF occurs concurrently with a furcation involvement, because of its anatomical features, it represents a challenge for clinicians and increases the recurrence risk.
Image and Science
Selective use of flash systems for the production of photographic documentation in Dentistry
A 32 years old, female patient suffered a car accident with the presence of craniofacial trauma and multiple lesions in soft tissues in the face area . She sought dental care to verify the existence of traumatic dental lesions. Radiographic exams and CT scans showed no changes and lesions in the facial bones and the root portion of teeth. With the selective use of the inclination of twin flash (Macro Twin Flash) can produce photographic documentation for initial registration and elucidation to the patient, showing a number of microcleft in the coronal portion in the element 11. The patient was warned to future potential complications in response to clinical finding and the same will be constantly assessed in the coming months to identify future complications.