v. 07, no. 3
Dental Press Implantology – ISSN 2237-650X
Dental Press Implantol.
v. 07, no. 3
July / August / September
Every fifty years, pre-Columbian civilizations used to completely renew their methods and criteria for social and political organization, giving them a fresh new start, a new beginning, establishing a new cycle of progress during periods of renewal.
A scientific periodical has to follow the same path, cyclically renewing itself with new editors and advisers, new sections and new authors, new scientific and disclosure articles. This is what comprises any editorial dynamics around the world. By the way, “periodical” is strongly related to period, cycles!
Whenever a product was considered perfect and was fully accepted by its consumers, Steve Jobs would create new designs and a whole new product would be developed to replace it. When questioned why, he answered: “We have to practice autophagy if we want to keep our success. We cannot let our competitors do that for us. We have to do it before them!”
Research institutes and universities question, devise methods and criteria, employ them in their clinical and laboratory trials and, after discussing the results, present their conclusions in the format of an article.
Once completed, the research is published and that is when a new instance, which is not under the scientist’s control, but under publishers’ control, takes place. Those who write should not be the same people that publish, since this practice hinders selectivity. The editorial world of scientific journals should not be involved with the academic world. These two instances of science should not meddle! That is the reason why the advisors of a periodical are professionals with considerable scientific and academic experience, filled with articles and books, on which they base their decisions when selecting what other people wish to publish. They must be experts in research and publication.
And Dental Press Implantology has adopted such dynamism as well as other upcoming changes! For instance: What is the purpose of the interviews presented in a scientific journal? At first, they aim at giving the opportunity for the scientific community to know itself, in all of its facets, with its research groups, laboratories as well as researches and publishers. For a scientific journal evaluation board, the interviews are useless; but in Dental Press Implantology they fulfilled their role. And this was essential for Implantodontics, a new science whose practitioners came from Periodontology, Rehabilitation, Prosthesis and/or Surgery. It became necessary to know who embraced this new specialty and new research area.
Now that we know who and where we are, the systemic interviews will be replaced by new sections. Some interviews will be conducted in very special occasions, such as when a renowned researcher comes for a visit, internationally recognized research awards are received, or even when a creative and innovative businessman stands out.
New editors usually bring along new advisers, encourage the authors and try to give dynamism to the procedures of the periodical — always thinking of subscribers, advertisers and the best way to serve science, especially Dentistry. A journal is only apparently owned by a person; its real owner is the group of members of a certain scientific community!
Let the new come; and as the song says: “...it always does!”
In the context of renewing Dental Press Implantology, the current issue presents an example of attitude and conduct, the results of Prof. Dr. Paulo Perri’s trajectory and thinking. Dr. Perri has elegantly contributed — with discretion and ethics — to the fields of Surgery and Implantodontics. His higher education and academic career were accomplished at the School of Dentistry — State University of São Paulo (UNESP)/Araçatuba, but nowadays, he is a professor and researcher of the School of Dentistry — University of São Paulo (USP)/Bauru and School of Dentistry — São Leopoldo Mandic/Campinas.
His trajectory reveals how a group must cohesively work on common objectives previously determined, explained and discussed by its members. Silently, Prof. Dr. Paulo Perri works with strong feelings of solidarity, fraternity and love for people, although not everybody is able to sense such feelings, always present in our daily lives. Happy are his students as well as his life and work partners!
Let us always reflect!
The bone as a metamorphosis and the bisphosphonates!
Raul Seixas, one of my favorite Brazilian singers, has continuously played in my iPod. One of his songs used to say: “I would rather be a wandering metamorphosis, than have the same old opinion about everything!” One of these days, a lady complained about the fact that her 35-year-old husband had left her four years before. After that, I heard that he had come back with an exciting talk: “Honey, I am back. Now, I am a new man, I have changed, everything is new!” [...]
Paulo Sérgio Perri de Carvalho
Full professor at the State University of São Paulo (UNESP) and University of São Paulo (USP), Dr. Paulo Sérgio Perri de Carvalho has many qualities among which is his consistency in teaching classes with words strictly pronounced in a strong and invariable voice. Specialist, MSc, PhD and full professor of oral and maxillofacial surgery and traumatology, Professor Perri devotes 34 hours of his week to his academic career. For this reason, he is oftentimes found on Marechal Rondon road, where he goes from Araçatuba (his home town) to Bauru.
Dr. Perri devotes his spare time to employing his practical-scientific knowledge and treating patients at his private clinic where he can enjoy the company of his wife, Prof. MSc. Mariliza Comar Astolphi de Carvalho, specialist in Restorative Cosmetic Dentistry, Dental prosthesis and Periodontology. Throughout his brilliant career, he devoted himself to the study of bone tissue. Nowadays, he is seen as an authority on bone graft. Dr. Perri’s great clinical experience in techniques for harvesting bone graft from the skull has enabled him to give theoretical classes that are well-provided with case and scientific reports previously investigated by him, which give a more realistic and precise tone to his explanations.
This interview gives us the opportunity to know about a dental surgeon who chose to make a difference by working as a professor, a researcher and a clinician, and in addition to that, by being a great person who goes from one dental specialty to another without further issues.
Luis Rogério Duarte
Esthetic prosthetic resolution in Morse Taper platform
Morse Taper dental implant-abutment connection. Dental prosthesis.
The issues arising from tooth loss in esthetic zones have been the subject of intense scientific dedication and clinical commitment of which purpose is to achieve favorable mechanical and esthetic stability. The advent of osseointegrated dental implants has satisfied the need for mechanical support; however, cervical bone remodeling around implants with conventional platform may significantly compromise the maintenance of peri-implant tissues, causing serious esthetic injuries. The purpose of Morse Taper implant placement goes beyond the current evolutionary trend in Implantology. It provides maintenance of peri-implant tissue characteristics and facilitates esthetic prosthesis design, thus allowing an ideal emergence profile and a natural and harmonious relationship with surrounding tissues to be achieved during the entire therapeutic process. Therefore, this literature review aims at presenting the characteristics that confer a high rate of success and longevity to prosthetic parts, ensuring greater predictability of maintenance in prosthetic rehabilitation.
Image and Science
Volcanoes or corals?!
Brånemark System MKIII TiUnite implant surface (Nobel Biocare) seen through scanning electron microscopy and atomic force microscopy (Piotto, M.A.B., 2011*).
Explanations and Applications
Subtleties of scientific communication: Precision, synonym, “Material and Methods” and “biomaterials”
Material. Materials. Material and Methods. Methodology. Biocompatibility. Biomaterials.
The “Material and Methods” section has not been uniformly used by all journals and institutions. In addition to that, “Materials and Methods” or “Material and Method” have been mistakenly employed. The term “material”, in its singular form, is a collective noun of intrinsic plurality. It also functions as a qualifying adjective for solid, liquid or gaseous substances that occupy space as an aggregate of particles that has mass.
“Methods” must be used in its plural form because no collective term is able to cover all procedures employed in a research, which often includes more than one single investigation method, for instance, reading, tests, calculations, trials and illustrations. The terms used for products known as “materials” or “biomaterials” are inappropriate for the meaning they convey in the Portuguese language. For this reason, they must be adapted. Or the language must change, which is perfectly possible given its dynamic nature! This article presents the basis for discussions on the theme.
Behavior of peri-implant tissues in immediate implant with provisionalization: A literature review
Immediate dental implant loading. Tooth extraction. Single-tooth dental implants. Tooth alveolus.
Introduction: Implantodontics has reached a level in which osseointegration alone is no longer enough for treatment success. Today, in addition to recovering function, the implant must be associated with esthetic restorations that are similar to natural dentition, in harmony with surrounding teeth and with other peri-implant structures. The healing process after tooth loss is unfavorable to soft tissues that follow bone remodeling, compromising esthetics. The use of immediate implants and provisionalization enables a treatment approach that aims at maintaining peri-implant tissues, replacing treatment of atrophy sequelae after extraction.
Objective: The aim of this paper is to conduct a literature review in order to identify and discuss the determinants of morpho-esthetic-functional tissue peri-implant behavior in immediate implant placement with provisionalization.
Methods: PubMed database was used as a research resource considering the period between 2003 and 2012.
Results: Within the limits of this review, it was reasonable to conclude that the esthetic results in implant therapy are influenced by tissue biotype, especially in the peri-implant mucosa. The thin biotype revealed higher susceptibility to gingival recession. Conversely, tissue biotype revealed little influence over the height of the interproximal papilla. Filling the gap with autogenous bone graft contributed to the maintenance of the structures around the implant, but we can not affirm the existence of superiority between different graft materials. Conclusion: Subepithelial connective tissue graft seems to positively influence the level of marginal mucosa.
Lower protocol in patient submitted to radiotherapy: Case report
Dental implants. Osseointegration. Radiotherapy.
Introduction: Combining surgery and radiotherapy is common to treat malignant tumors of the head and neck. Such procedure establishes tissue alterations that result in fragile mucosa, xerostomia, improper anatomical shape and myodynamic disorders, which hinders patient’s oral function and rehabilitation. Placement of implant-supported prosthesis proves useful for rehabilitation of those patients.
Objective: The present study reports a case of a patient subjected to high doses of radiotherapy after surgical removal of a malignant tumor located on the floor of the mouth.
Methods: Six implants were installed in the anterior region of the mandible and a prosthesis was fabricated according to Brånemark’s protocol.
Conclusion: It is reasonable to conclude that osseointegrated implants can be safely employed, provided that special care be taken with regard to the adverse effects produced by resection and radiotherapy. Improvements in mastication, speech and esthetics promote patient’s social reintegration, thus minimizing discomfort and suffering, in addition to optimizing therapeutic results and quality of life.
The posterior maxilla: An update of anatomical notions based on advances in endosseous implant surface technology. A case report
Maxilla. Dental implants. Osteotomy. Osseointegration. Anatomy.
Objective: Fixed implant-supported rehabilitation of the posterior maxilla is a challenge to dental professionals. Limitations of technique and material have established wrong concepts, especially with regard to bone classification. For instance, the concept of poor-quality bone has been associated with high rates of therapeutic failure because of implants with poorly evolved surfaces. A literature review on the embryological origin of tissues and the anatomy of the maxilla highlight the high regenerative ability of trabecular bone, which is rich in mesenchymal cells.
Methods: The present report describes a case of failure of a machined-surface implant placed by osteotomy at the maxillary first molar region. The implant was replaced by a sandblasted, large grit, acid-etched SLA surface with a six-year survival rate follow-up. Clinical and radiographic assessments were performed every six months.
Results: Data revealed implant osseointegration stability as well as tissue biocompatibility and prosthetic functionality.
Conclusion: The literature on technically advanced implant surfaces suggests that the posterior maxilla is a safe and predictable site for fixed implant-supported rehabilitation.
Evaluation using FEM on the stress distribution on the implant, prosthetic components and crown, with Cone Morse, external and internal hexagon connections
Finite element method. Bone/implant connection. Von Mises stresses.
Objective: The aim of this study was to compare the stress distribution between implant systems with different types of connections, i.e., external hexagon, internal hexagon and morse taper, by applying the Two-Dimensional Finite Element Method.
Methods: A 100-N load was applied to the buccal cusp of an inferior second premolar in the axial direction and thereafter at an inclination of 45o on each system. Analysis was performed by means of the von Mises stresses criteria.
Results: The results showed that in, all systems, the highest stress concentration occurred in the neck of the implant in contact with the cortical bone, except for the morse taper models, where the stress was concentrated in the inner portion of the implant in contact with the abutment. It also became apparent that oblique forces resulted in higher stress values than those obtained with axial loads.
Conclusion: It could be concluded that abutment screws are the most fragile portion of the systems. Internal connection implant systems exhibited a more uniform distribution of stresses than external connection implant systems.
A retrospective clinical trial of the early success rate of osseointegrated implants
Dental implant. Osseointegration. Epidemiological studies.
Introduction: Dental implants have become an alternative to treat edentulism, however, some variants involving the implant itself and the receptor site can hinder treatment success. Dental implant failure is classified into late or early, depending on when it occurs.
Objective: To determine the early success rate of implants installed during a specialization course in Implantodontics carried out between 2009 and 2012.
Methods: The records of patients treated between 2009 and 2012 were analyzed. The following inclusion criteria were applied: P-I Brånemark Philosophy implants installed by means of the two-stage surgical technique, with implants submerged for a minimum period of three months. The selected patients underwent implant placement in the maxilla and mandible, subjected or not to bone graft. Evaluation was implemented at implant reopening. Implant survival after prosthetic loading was not considered.
Results: The success rate was of 97%, with the presence or absence of bone graft, with implant positioning significantly influencing the final results.
Conclusions: The success rate observed by this study not only corroborates the literature, but also reveals that the operator’s experience does not necessarily interferes in treatment outcomes. The findings also show that the posterior region had the highest number of failures, whereas bone graft sites had a higher success rate in comparison to other studies.
Immediate implant in inter-radicular septum area: Case report
Mandible. Dental implants. Tooth extraction.
Introduction: The purpose of rehabilitation after tooth loss is the optimal healing of soft tissues around the prosthesis so that an adequate emergence profile can be achieved. Excessive handling of these tissues may be avoided by using existing bone.
Objective: This case report describes the atraumatic extraction of a fractured mandibular first molar and the immediate placement of an implant in the inter-radicular septum.
Methods: The atraumatic technique and the immediate placement of the implant preserved hard and soft tissues in the extraction site.
Results: The patient had no clinical evidence of complications, the definitive implant-supported prosthesis was immediately placed. The adaptation of peri-implant tissues was satisfactory; function and comfort were restored, and, above all, tissues were preserved.
Immediate loading on reconstructed maxilla with alogenous bone by means of guided surgery: A case report
Dental implant. Allograft. Guided surgery. Immediate loading.
Introduction: Implant placement by means of virtual planning and guided surgery can facilitate and optimize surgery, increasing predictability of final outcomes in areas with severe bone resorption.
Objective: To report a case of guided surgery employed for immediate implant placement in edentulous maxilla previously reconstructed with allograft.
Methods: Proper care and major advantages of the technique were discussed.
Abstracts of articles published in important Implantology, Prosthodontics and Periodontics journals from around the world