v. 07, no. 2
Dental Press Implantology – ISSN 2237-650X
Dental Press Implantol.
v. 07, no. 2
April / May / June
The metamorphosis of Dental Press Implantology
The best publishing houses in the world are continuously rethinking their business and seeking new ways to reach their readers. Additionally, publication of scientific literature is nowadays mainly in English language.
Dental Press Journal of Periodontology and Implantology came into existence in 2007, and has taken part in this process of rethinking: in 2012, the journal not only had its title changed into Dental Press Implantology, but also began to be officially published in English, despite keeping its Brazilian Portuguese version in order to meet the expectations of its former readers. At the head of its editorial board is Prof. Dr. Alberto Consolaro, with his experience and scientific charm, his desirable eagerness and love for scientific dissemination. Prof. Dr. Consolaro was invited to be the editor of this journal together with Prof. Dr. Carlos Eduardo Francischone.
In the company of these two editors, we are continuously encouraged by new challenges to create projects in order to solidify Dental Press Implantology. The journal is currently indexed in Ulrichs (2013), EBSCO (2012), LILACS (2007) and BBO (2007), and we hope that the articles published in Dental Press Implantology have their visibility as well as their impact increased, which will contribute to the indexation of the journal in internationally recognized databases — similarly to what happened with the Dental Press Journal of Orthodontics (Dental Press’ first periodical) which, 17 years after being released, became part of the MEDLINE/PubMed collection, the most important database in the Health Sciences field.
Prof. Dr. Carlos Eduardo Francischone has been the editor of this journal since it was firstly published. In the present issue, besides the articles selected for publication, we are delighted to have a propitious interview with such an important icon of the Dentistry field, whose personal trajectory is inspiring to all of us. It is a privilege to read not only about his accomplishments and the lessons he has compiled from great masters and researchers, but also about the course of national and international science and research.
To the delight of our eyes and to induce further reflection, the present issue also presents the photograph in the Image and Science section and the select group of abstracts in the Observatory section.
Furthermore, given that Biology, associated with technology, increasingly offers more options for Implantodontics to advance in terms of techniques and possibilities that provide proper oral rehabilitation to patients, every issue of Dental Press Implantology presents new approaches to biomaterials and rehabilitation techniques. The technical possibilities increase and, for this reason, systemically reading the articles becomes a compulsory task for clinicians, as well as Implantodontics researchers and professors, to constantly update their practice.
In modern society, there is no place for professionals who are highly specialized in one field of knowledge, only. Thus, interacting with other specialties and the possibilities that they offer is a demand of the way Implantodontics has advanced: by overlapping with other specialties. Bone biology gives support to the clinical practice and the implants are constantly being improved in order to optimize their relation with tissues, cells and molecules.
Dental Press Implantology is, therefore, offered on the basis of such a practice, by means of which it has significantly matured. Moreover, we believe that this journal is now able to prove that its goals and objectives have been fulfilled not only due to the efforts made by its staff, but also due to the receptiveness of those who fight for this field of knowledge — which has brought indispensable help in the increasingly intense and responsible development of this important mean of disclosing the dental literature.
Enjoy your reading!
Carlos Eduardo Francischone
The current issue of Dental Press Implantology presents to its readers an interview with one of the most highly respected and important Brazilian professors in the Dentistry field. Due to his restrained behavior — especially for having been one of the editors-in-chief of this journal for many years — he resisted as much as he could to his colleagues’ recurrent requests as well as to the continuous attempts of this journal editorial board to highlight him in this section.
After participating in the 1st Meeting of Prof. Dr. Carlos Eduardo Francischone’s students and former students, held in the city of Campinas/SP — Brazil — in April of 2013, during which Dr. Francischone was interviewed by his former students at an auditorium for about an hour and a half, he finally agreed on having his interview, which was recorded upon his own authorization, used by this journal. It brings curious as well as valuable information of general interest related to the history of Brazilian Dentistry.
Born in the city of Dois Córregos, located in the countryside of São Paulo, Prof. Francischone — as he is widely known — has reported details of his academic success, revealing the trajectory of a humble Brazilian who is persistent in his aims and endowed with a strong personality, an acknowledged career and numerous gifts.
He has received a degree in Dentistry from the School of Dentistry — University of São Paulo/ Bauru, where he is a full professor due to his own merits, acknowledgement and competence. He has become a member of the Brazilian Dentistry Academy as a result of his achievements as a researcher and author of many books. He has advised more than 80 masters and doctors coming from many different states in Brazil as well as from different Latin American, European and African countries.
He is a dental surgeon in the very true sense of the term. He is considered a remarkable professor within the Dentistry field not only for teaching how things should be done, but mainly for practicing to the utmost degree what he teaches, with neither restriction nor omission of details, but for the pleasure of teaching. In addition, he is regarded as a professor endowed with desirable creativity and manual abilities to solve potential problems, complications or incidents occurring in daily clinical practice. Due to his wide experience in clinical practice and teaching, Dr. Francischone is able to perfectly reconcile theory and practice — always with the admirable humbleness of those who know all shortcuts and the best alternatives very well; in addition to knowing the most appropriate paths which have been presented to him by knowledge and experience acquired during 42 years of hard work.
With more than 200 articles published in scientific journals and more than 700 lectures and courses given inside and outside Brazil, he often goes around the world from one scientific event to another, being acknowledged worldwide as a respectful researcher.
Those who are privileged to have a close relationship with Dr. Carlos Eduardo Francischone can easily notice his indefatigable enthusiasm, peculiar to those who love their occupation. An extremely honest, sincere and righteous man who is absolutely fair with everyone around him, acknowledging those who deserve it.
Additionally, this interview presents his special interest in different sports as well as his passion for music — a hobby he has had for most of his life. Graduated in music at the Jauense Conservatory of Music, in 1967, he is the author of his city’s anthem, written in partnership with Heusner Grael Tablas and Carlos Nascimento (a well-known Brazilian journalist). His family is definitely his greatest source of renewing positive energy, giving him emotional stability. He is married to Ana Luiza, father of Carlos Eduardo Júnior (dentist), Ana Carolina (dentist) and Fabricio (physician). He is also happy and proud to be little Lucca’s grandfather.
Hereinbelow, we present a written record of what has just been mentioned in this brief introduction.
Franklin Moreira Leahy
Image and Science
Histomorphometry of the interaction between implant and bone in rabbit mandible
Histomorphometric image with magnification of 40x, taken in the interface between bone and Nanotite™ implant (3i Biomet) in rabbit mandible 21 days after osseointegration, with toluidine blue staining. Close contact between bone and implant can be observed by the impregnation of the staining solution on the newly formed bone tissue.
Explanations and Applications
Attrition: aging of tooth shape, interdental spacing and its meanings
Tooth wear. Demastication.
Attrition may explain some of the alterations that occur after months or years of rehabilitation treatment, since it causes changes in shape and mesiodistal and occlusal-apical size of dental crowns, changing their position and relationship with dental implants. Dental attrition may: 1) represent a sign of occlusal maladjustment; 2) suggest the existence of parafunctional habits such as clenching and bruxism; 3) reduce the circumference of the dental arch because the proximal dental contact points turn into wear facets over the years; 4) age the mouth due to some morphological details that vary with age, namely: absence of serration caused by smoothing of the incisal edge until the dentin appears and a dark yellow line can be seen between the buccal and the incisal enamel of incisors and canines; 5) worsen aging caused by dental crowding; 6) aggravate aging by causing loss of facial vertical dimension; 7) be associated with diastemata between osseointegrated implants and natural teeth a few years after rehabilitation treatment is finished.
Cement-retained versus screw-retained dental prostheses: Literature review
Cement-retained prosthesis. Screw-retained prosthesis. Reversibility. Passivity. Occlusal aspects.
Due to the advancement of research related to osseointegration, Implantology has become a treatment with satisfactory prognostic in Dentistry. However, in order to achieve more lasting success in prosthetic work, it is very important to choose the proper type of retention of the prosthesis, whether it is cement-retained or screw-retained. The present study consists of a literature review on the subject concerning cement-retained prosthesis as opposed to the screw-retained ones, addressing their advantages and disadvantages, and issues such as aesthetics, passivity, reversibility, retention, and occlusal aspects. The choice between screw-retained or cement-retained prosthesis is of interest to the professional, as it will contribute to the long term success of treatment.
Topographic analysis of the surface of commercially pure titanium implants. Study using scanning electron microscopy
Titanium implants. Surface treatments. Scanning electron microscopy.
Objective: This study aims at carrying out a descriptive comparative analysis of four types of surfaces of commercially pure titanium implants by means of scanning electron microscopy (SEM).
Material and Methods: Four implants of different commercial brands were used, as follows: Conexão – Sistemas de Próteses (Prosthesis system) and Straumann. The samples had their surfaces machined by means of acid etching, anodization (Conexão) and blasting followed by acid etching (Straumann) techniques, and were divided into four groups with one implant each. The areas of thread top and valley were determined for SEM analysis at different magnifications.
Results: All samples assessed presented characteristics of surface rugosity, including the machined surfaces. The implants treated by anodization and blasting followed by acid etching had a greater surface pattern in comparison to the implants treated by acid etching due to their greater degree of rugosity.
Conclusion: Surface treatment influences surface macro structure. Surfaces treated by anodization and blasting followed by acid etching presented a surface pattern that provides a greater area for bone apposition.
The interaction between Implantology and Materials Science
Materials Science. Biomaterials. Membranes. Implant surface.
Introduction: Materials Science has been of paramount importance to Dentistry because the biomaterials involved have specific characteristics that allow them to have a predictable application. In Implantology, the following may be emphasized: biomaterials, membranes and implant surfaces. It is of vital importance to study the physicochemical characteristics of biomaterials in order to correctly choose what provides a specific biological outcome. Therefore, analysis of properties such as crystallinity, particle size, porosity, and specific surface area is crucial to understand the in vivo performance of materials. Implant surfaces have also been developed to improve the osseointegration process in areas with poor quantity or quality of bone.
Objective: The aim of this study is to carry out a literature review about the importance of Materials Science in the development of biomaterials used in Implantology.
Immediate implant placement in esthetic zone
Dental implants. Single tooth. Dental prosthesis. Implant supported. Dental implantation.
Immediate implant placement is considered a viable technique due to its reduced surgical time. However, many factors such as quality and position of the attached gingiva, alveolar process integrity, gingival height and shape must be taken into consideration in order to yield excellent final esthetic results. The characteristics of an ideal surgery include tooth extraction with low trauma, placement of a temporary smooth crown as well as a polished and emergence profile that keeps the gingival contour. As a requirement for the use of immediate loading, we should analyze, immediately after implant placement, primary stability (existence of bone for the initial stabilization of the implant), integrity of the alveolar walls, gingival phenotype as well as integrity and amount of soft tissue. Although it is considered a predictable procedure, its indication depends on careful planning.
Determining factors for formation and/or maintenance of peri-implant papilla: Literature review
Gingiva. Dental implants. Periapical tissue.
Introduction: The interproximal papilla, among other requirements, is considered essential to achieve success in esthetic prostheses placed over implants.
Methods: This article is based on a literature review carried out with periodicals published from 1984 to 2011 on LILACS and MEDLINE. Twenty-one articles were selected in order to highlight the determining factors for the formation and/or maintenance of peri-implant papilla, namely: the ideal distance between a tooth and an implant, the distance between implants, the above/bellow bone level positioning of an implant and the necessary distance from the contact point to the bone crest.
Conclusions: We concluded that the ideal distance between a tooth and an implant is 2 mm, whereas the distance between implants is 3 mm, given that the height of the gingival papilla is supported by the formation of biological space. With regard to the positioning of the implant, above/bellow bone level, no differences regarding papilla formation were reported. The height from the contact point of the crown to the bone crest, which is a determining factor for papilla formation, should be up to 5 mm.
Minimally invasive peri-implant procedures to obtain esthetics in the transmucosal profile
Dental implant. Tooth movement. Composite resins. Dental polishing. Healing. Friction.
Introduction: Connective tissue graft techniques are widely used previously and during placement and rehabilitation of dental implants with the purpose of obtaining satisfactory esthetic results. However, surgical techniques are not the only options for correcting tissue volume deficiencies.
Objectives: The aim of this article is to present through a clinical case, the slow orthodontic extrusion, the semilunar incision during the implant second surgical stage and the use of composite resin flow for soft tissue conditioning in three phases: the ovate pontic, the polymer healing abutment and the provisional crown on the implant.
Results: Slow orthodontic extrusion promoted better leveling in the gingival collar height. Semilunar incision favored the displacement of the buccal mucosal tissue and the preservation of adjacent papillae. The composite resin flow proved to be easy to handle, in addition to having good polishing, which contributed to obtain an appropriate transmucosal profile.
Conclusion: After an 1-year follow-up, we concluded that the combined procedures not only aided to yield esthetic peri-implant results, but also contributed to the practice of a minimally invasive Implantology.
Rehabilitation with dental implants and fixed prosthesis for esthetic and occlusal correction in partially edentulous patients
Dental implants. Dental occlusion. Dental prosthesis.
Introduction: Rehabilitation of partially edentulous patients using implant-supported fixed prostheses is now a predictable treatment and of proven success in the long term.
Objective: The purpose of this paper is to outline a systematic approach to prosthetic rehabilitation of partially edentulous patients, exemplified by a clinical case with bone reconstruction and recovery of the vertical dimension of occlusion, occlusal plane leveling and correction of upside down smile.
Methods: Oral rehabilitation of the patient was performed with dental implants and fixed partial prostheses.
Conclusion: Treatment was able to restore function, comfort and aesthetics.
Accuracy of linear bone measurements with cone-beam and spiral computed tomography in human mandibles
Spiral computed tomography. Cone-beam computed tomography. Dental implants. Three-dimensional imaging.
Introduction: Availability of imaging methods able to accurately reproduce the maxillomandibular dimensions is important for diagnosis and safe planning of surgical procedures. Objective: The aim of this in vitro study was to verify the accuracy of linear measurements in images obtained with a system of spiral and two systems of cone-beam computed tomography (CT).
Methods: Ten dry human mandibles were subjected to three different CT scans: i-CAT® CBCT, NewTom-3G® CBCT, and Picker® SCT. Measurements in the mandible were taken with a digital caliper and measurements in the images were taken with the ImplantViewer® software. Six regions were measured in each dry mandible, being distributed into two regions in each of the lower first molar (LFM), lower first pre-molar (LFPM), and lower lateral incisor (LLI) sites.
Results: Similar accuracy was observed among the three images at sites LLI and LFPM. Measurements obtained with the i-CAT CBCT scan at site LFM were shown to be more accurate than those obtained with the other two CT scan systems.
Conclusions: It can be concluded that the three CTs studied herein showed similar limits of agreement and precision at sites LLI and LFPM, and i-CAT CBCT showed limits of agreement with smaller amplitude and greater accuracy than other examinations performed at site LFM.
Conclusion: It can be concluded that the three CTs studied herein showed similar limits of agreement and precision at sites LLI and LFPM, and i-CAT CBCT at site LFM showed limits of agreement with lower amplitude and greater accuracy than other examinations performed.
Mandibular osteonecrosis associated with bisphosphonate use after implant placement: Case report
Osteonecrosis. Bisphosphonate-related osteonecrosis of the jaw. Dental implants.
Oral rehabilitation of patients with single or multiple tooth loss using osseointegrated implants has become a successful treatment option. Nevertheless, a serious complication can affect the survival of these implants: osteonecrosis of the jaw associated with the use of bisphosphonates. Bisphosphonates are a class of drugs that have the function of inhibiting the activity of osteoclasts, interfering with bone remodeling and turnover. They are recommended to postpone bone impairment in some malign conditions such as multiple myeloma as well as metastatic breast cancer and prostate cancer, also in the treatment of Paget's disease and osteoporosis. Clinically, BRONJ (Bisphosphonate-Related Osteonecrosis of the Jaw) appears as loss of continuity of the oral mucosa with exposure of the underlying bone. It can be extremely painful, persistent and does not respond to conventional treatments. The objective of this paper is to conduct a literature review on the subject and report a case of BRONJ after implant placement.
Evaluation of the influence of compression (megapixels) in the diagnosis of alveolar bone loss in digitized radiographs using digital cameras
Digital radiograph. Resolution. Scanning.
Introduction: This study aimed at evaluating the required digital camera resolution used for radiograph digitalization.
Material and Methods: Periapical radiographs were selected from the undergraduate dental clinics at Ingá University (UNINGÁ) and digitalized with three different amateur digital cameras which were set at different megapixel resolutions.
Results: Sony W110 digital camera showed similar acceptability results in all evaluated resolutions, which were VGA, 3, 5 and 7 megapixels (96.6%, 94.7%, 97. 3% and 97.3% respectively). Fuji Finepix 2800HD digital camera presented a 100% of acceptability when set at 7 megapixels resolution. Sony T110 digital camera showed acceptable results when set at 5 megapixels resolution or higher.
Conclusions: The best results were obtained with Fuji Finepix 2800HD digital camera when set at a 7 megapixels resolution. The three brands evaluated, when set at a 5 megapixels resolution or higher, showed adequate results for diagnosis.
Abstracts of articles published in important Implantology, Prosthodontics and Periodontics journals from around the world