Search

An attractive smile depends on the proper proportion and arrangement of lip, teeth gingiva scaffold. The ideal smile is the exposure of the entire length of maxillary teeth with 1 mm gingiva. A gingival display exceeding 3 mm is unpleasant and termed ''gummy smile (GS).'' Lip repositioning is a simple surgical procedure intended to minimize the gingival display by removing a strip of mucosa and shortening the vestibular depth. Botulinum toxin injecting overactive muscles with measured quantities results in a reduction of muscle activity, relaxing the lip muscles and decreasing upward pull on the lip. There are some contraindications: patients with short lips and gingival exposures less than 3 mm.This case report describes the successful management of GS of a young man.The procedures were performed and these techniques resulted in shortened vestibule and restricted the muscle pull of the elevator muscles of the lip, reducing gingival display when the patient smiles. Surgical lip repositioning can be a minimally invasive alternative to orthognathic surgery. Botulinum Toxin injections can be a useful adjunct to enhance the esthetics and improve patient satisfaction, being a more conservative and immediate nonsurgical treatment modality available.In this way, the clinical case report demonstrated that lip repositioning surgery combined to botulinum toxin injections promising outcomes in the GS correction. The effect showed a marked reduction in gingival display at the 4-years follow-up.

Made available in DSpace on 2018-12-11T17:04:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-06-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: The aim of this study is to evaluate the alendronate and raloxifene influence in the alveolar healing process of osteoporotic rats. Materials and methods: Sixty-four female rats were divided in four groups: sham rats (SHAM), ovariectomized rats and no medical treatment (OVX NT), ovariectomized rats and submitted to alendronate treatment (OVX ALE), and ovariectomized and submitted to raloxifene treatment (OVX RAL). The histomorphometrical and immunohistochemical analysis was performed. The quantitative data were analyzed through Kruskal-Wallis and Dunn tests (α = 0.05). Results: In the longest period, SHAM and OVX RAL groups showed the better bone formation responses (P

Univ Ctr Araraquara UNIARA, Sch Dent, Implantol Post Grad Course, Dept Hlth Sci, Sao Paulo, Brazil

The aim of this study was to evaluate the dental socket bone healing process by histomorphometric and immunohistochemical analysis of osteoprotegerin (OPG), receptor activator of nuclear factor-κβ (RANK), and receptor activator of nuclear factor-κβ ligand (RANKL) proteins in spontaneously hypertensive rats (SHR). Under general anesthesia, 25 Wistar rats and 25 SHRs underwent upper right incisor extraction. Rats were euthanized after 7, 14, 21, 28, or 42 days of dental extractions. Histomorphometric and immunohistochemical analyses of OPG, RANK, and RANKL proteins were performed. Histomorphometric results showed decreased bone healing and reduced bone trabecular thickness in SHRs. Immunohistochemical reactions showed intense RANKL and RANK immunolabeling at 14 and 28 postoperative days and mild OPG immunolabeling at 7, 14, and 21 days after surgery in SHRs. The results of this study show that RANK, RANKL, and OPG immunolabeling was altered in SHRs, and these results are associated with bone healing delay and decreased trabecular thickness in SHRs. Hypertension alters the expression of RANK, RANKL, and OPG and delays the socket bone healing process. These alterations could influence some dental procedures such as orthodontic treatment and implant placement.

Purpose Extensive bone defects in maxillofacial region can be corrected with autograft. However the disadvantages of this type of therapy lead to the search for new bone substitutes. Thus, we evaluated the biological behavior and osteoinductive platelet-derived growth factor type BB (PDGF-BB) associated with different carriers, by histological analysis and immunohistochemical histometric critical defects performed in rat calvaria. Materials and methods Critical defects were created with 5-mm diameter calvaria of rats. Each defect was randomly divided into 8 experimental groups, evaluated at 15 and 30 postoperative days for histomorphometry and immunohistochemistry. Results The results showed new bone formation in all groups, independent of postoperative time. At 30 days, the beta-tricalcium phosphate matrix (TCP) group just did not differ from bone matrix mineralized bovine (BIO) group in the new bone formation (P = 0.1403). In none of the groups' analyzed biomaterials, growth factor stimulated increase in bone formation (P > 0.05). Conclusion With the methodology used, the growth factor associated with the tested biomaterials did not induce new bone formation.

OBJECTIVE Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. MATERIAL AND METHODS Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had

The placement of dental implants and subsequent placement of immediate temporary dentures after extractions has become a treatment modality accepted by the scientific community. In addition to the functional factor, the surgical procedure in a single stage in the anterior region of the maxilla offers an esthetic appearance, and relieves the psychological concerns of patients. To guarantee the success and longevity of treatments performed, the fabrication of surgical guides is a helpful method in these situations. Guided surgery has gained attention because it restores esthetics with immediate restoration, provides the patient with comfort in addition to dispensing with the need for performing surgical flaps. This auxiliary method allows the position and design of the implant, as well as the perforation sequence to be programmed, thus optimizing the clinical results. In this study, the authors present a clinical case of a patient who was submitted to extraction and subsequent implant placement with immediate loading in the anterior region of the maxilla, performed in a satisfactory manner.

Purpose We sought to evaluate the effectiveness of bone substitutes in circumferential peri-implant defects created in the rabbit tibia. Methods Thirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant (4.1 mm × 8.5 mm) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss® (BI), and Bio-Oss® Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated. Results For biomechanics, BC showed a better biological response (61.00±15.28 Ncm) than CO (31.60±14.38 Ncm) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group. Conclusions Collectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps., Graphical Abstract

The aim of this study was to evaluate implants installed with compromised primary stability associated or not with polylactide and polyglycolide copolymer (PLA/PGA). Two 0.4-mm overdrilled defects (3 mm in diameter and 6 mm long) were produced in the right tibia of 25 rabbits. Half of the defects were left untreated, and the other half was filled with PLA/PGA. Implants of 2.6 mm in diameter and 6 mm long were placed into all defects. Animals were killed at 5, 15, 40, and 60 postoperative days, and biomechanical analysis (torque-reverse), histomorphometry, and immunohistochemistry (osteoprotegerin, receptor activator of NF-κB ligand [RANKL], osteocalcin, and collagen-1 [COL-I] staining) were performed. All the implants achieved osseointegration. There were no statistically significant differences in the torque-reverse and in linear contact extension between bone tissue and implant surface and no statistically significant difference in osteoprotegerin, RANKL, osteocalcin, and collagen-1 expression between the studied groups in all studied periods (P0.05). We can conclude that osseointegration can occur in compromised primary implant stability situations, and the addition of PLA/PGA did not improve the osseointegration process in this experimental model.

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non-syndromic 10-year-old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.

The peripheral ossifying fibroma (POF) is a common gingival growth usually arising from the interdental papilla. The anterior maxilla is the most common location of involvement. The etiology and pathogenesis of POF remains unknown. Some investigators consider it a neoplastic process, whereas others argue that it is a reactive process; in either case, the lesion is thought to arise from cells in the periodontal ligament. Trauma or local irritants, such as dental plaque, calculus, microorganisms, masticatory force, ill-fitting dentures, and poor quality restorations, have been implicated in the etiology of POF. The recommended treatment is the excisional biopsy; however, it can leave a defect if the procedure is not followed by a subepithelial connective tissue graft. The main objective of this article was to present a clinical case of excisional biopsy of a POF followed by a subepithelial connective tissue graft to correct the defect caused by the biopsy. The biopsy defect was satisfactorily repaired, and the lesion has not recurred after 6 years of follow-up.

This study evaluated the repair process after delayed replantation of rat teeth, using calcium hydroxide (Ca(OH)2) mixed with camphorated p-monochlorophenol (CMCP), chlorhexidine 2% (CHX), or saline as temporary root canal dressing to prevent and/or control inflammatory radicular resorption. Thirty Wistar rats (Rattus norvegicus albinos) had their right upper incisor extracted, which was bench-dried for 60 minutes. The dental papilla, the enamel organ, the dental pulp, and the periodontal ligament were removed. The teeth were immersed in 2% acidulated-phosphate sodium fluoride solution for 10 minutes. The root canals were dried with absorbent paper cones and divided into 3 groups of 10 animals according to root canal dressing used: group 1: Ca(OH)2 + saline, group 2: Ca(OH)2 + CMCP, and group 3: Ca(OH)2 + CHX 2%. Before replanting, the teeth sockets were irrigated with saline. Histological analysis revealed the presence of inflammatory resorption, replacement resorption, and ankylosis in all 3 groups. Statistical analysis showed a significant difference between group 3 and the other groups. The use of Ca(OH)2 mixed with CMCP or CHX did not show an advantage over the use of Ca(OH)2 mixed with saline in preventing and/or controlling inflammatory resorption in delayed replantation of rat teeth.

Made available in DSpace on 2013-09-27T14:54:20Z (GMT). No. of bitstreams: 1 WOS000296112200007.pdf: 1300956 bytes, checksum: 37299f22d0bc17aa758dc896fa956fff (MD5) Previous issue date: 2011-10-01 Made available in DSpace on 2013-09-30T18:29:49Z (GMT). No. of bitstreams: 1 WOS000296112200007.pdf: 1300956 bytes, checksum: 37299f22d0bc17aa758dc896fa956fff (MD5) Previous issue date: 2011-10-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:42:59Z No. of bitstreams: 1 WOS000296112200007.pdf: 1300956 bytes, checksum: 37299f22d0bc17aa758dc896fa956fff (MD5) Made available in DSpace on 2014-05-20T13:42:59Z (GMT). No. of bitstreams: 1 WOS000296112200007.pdf: 1300956 bytes, checksum: 37299f22d0bc17aa758dc896fa956fff (MD5) Previous issue date: 2011-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To investigate the expression of OPG, RANKL and TRAP during alveolar healing process (7, 14, 21, 28 and 42 postoperative days) in ovariectomized rats treated with raloxifene or with oestrogen replacement therapy, using immunohistochemistry reaction approach.Materials and methods: Wistar female rats (10 weeks age) were submitted to ovariectomy surgery (OVX) or sham surgery. The female rats were divided in four groups: (1) sham; (2) OVX/O (ovariectomy and oil); (3) OVX/E2 (ovariectomy and oestrogen replacement); (4) OVX/RLX (ovariectomy and raloxifene therapy).Results: It was observed high amount of OPG immunolabelling with predominance at 14 and 21 postoperative days on sham and OVX/RLX groups, respectively. At 7 postoperative days, there was no difference between the groups for TRAP protein. Otherwise, to the other periods, it was observed greater expression of TRAP and RANKL protein on OVX/O group compared to sham, OVX/E2 and OVX/RLX groups. It was also observed a discrete TRAP immunolabelling at 28 and 42 postoperative days on OVX/RLX group.Conclusions: Oestrogen deficiency induces osteoclastogenesis in the alveolar healing process. Quantitative changes in the osteoclastic activity could be prevented through the raloxifene therapy. (C) 2011 Elsevier Ltd. All rights reserved. Univ Sagrado Coracao USC Bauru, Dept Res & Post Grad, Bauru, SP, Brazil UNESP Univ Estadual Paulista, Aracatuba Dent Sch, Dept Surg & Integrated Clin, Jaboticabal, Brazil UNESP Univ Estadual Paulista, Aracatuba Dent Sch, Dept Basic Sci, Jaboticabal, Brazil UNESP Univ Estadual Paulista, Aracatuba Dent Sch, Dept Surg & Integrated Clin, Jaboticabal, Brazil UNESP Univ Estadual Paulista, Aracatuba Dent Sch, Dept Basic Sci, Jaboticabal, Brazil FAPESP: 04/07562-5 FAPESP: 05/51367-5

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Teriparatide is an anabolic osteoporosis therapeutic agent that can improve healing after fractures and periodontal surgeries. Clinical studies investigating the effects of teriparatide on the osseointegration of titanium implants have not been performed. We conducted an open-label randomized controlled feasibility study and included 24 individuals with edentulous lower jaws. The participants received 2 study implants in the mandible during interforaminal dental implant surgery. They were randomly assigned to receive either 20 µg of teriparatide once daily for 28 days or no treatment. Study implants were retrieved from 23 participants after 9 weeks and were subjected to histomorphometric analyses. Endpoints were new bone-volume-per-tissue-volume (NBV/TV) and new bone-to-implant-contact (NBIC). We report here that median values of NBV/TV in the control and the teriparatide groups were 15.4% vs. 17.6% in the periosteal compartment, 11.3% vs. 16.5% in the cortical compartment, and 7.3% vs. 12.0% in the medullary compartment, respectively. NBIC median values in the control and the teriparatide groups were 3.3% vs. 4.1% in the periosteal compartment, 5.0% vs. 4.4% in the cortical compartment, and 0.3% vs. 1.4% in the medullary compartment, respectively. The results provide the first histological data on the osseointegration of titanium study implants in individuals treated with teriparatide. ClinicalTrials.gov number, NCT00089674. Abbreviations: NBV/ TV, new bone-volume per tissue volume; NBIC, new bone-to-implant contact; BV/TV, bone-volume per tissue volume; BIC, bone-to-implant contact; ROI, region of interest.

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

The influence of an estrogen-deficient state was evaluated in this study and also its treatments with estrogen (E(2)) or with raloxifene (RLX) on the expression of osteocalcin during the periods of the chronology of the alveolar bone healing process (7, 14, 21, 28 and 42 post-extraction days) by means of immunohistochemistry reactions and histomorphometric analysis. Rats (200-220 g) with oestrus cycles normal were either OVX or sham-operated and divided into four groups: sham, OVX control (OVX/O), estrogen (OVX/E(2); 17 beta-estradiol, 400 microg/mo) and raloxifene (OVX/RLX; 1 mg/kg bw/d) groups. Histomorphometric analysis showed the sham group presented the highest mean value of bone formation post-extraction. The reaction of immunohistochemistry for osteocalcin presented stronger expression of osteocalcin with predominance at 14 and 21 days on sham group. The OVX/RLX group presented better results than OVX/E(2), considering the expression of osteocalcin in osteoblastic lineage cells, but still inferior than the sham group. It was concluded that ovariectomy decreases the mineralization process and the osteocalcin expression during the chronology of the alveolar healing process that is not totally recovered with estrogen replacement or raloxifene treatment.

The purpose of this paper was to evaluate the expression of RANK protein during bone-healing process around machined surface implants. Twenty male Wistar rats, 90 days old, after having had a 2 mm diameter and 6 mm long implant inserted in their right tibias, were evaluated at 7, 14, 21, and 42 days after healing. After obtaining the histological samples, slides were subjected to RANK immunostaining reaction. Results were quantitatively evaluated.Results. Immunolabeling analysis showed expressions of RANK in osteoclast and osteoblast lineage cells. The statistical analysis showed an increase in the expression of RANK in osteoblasts at 7 postoperative days and a gradual decrease during the chronology of the healing process demonstrated by mild cellular activity in the final stage (P<.05).Conclusion. RANK immunolabeling was observed especially in osteoclast and osteoblast cells in primary bone during the initial periods of bone-healing/implant interface.

Department of Orthodontics School of Dentistry Araraquara University Center (UNIARA) Araraquara Sao Paulo, Brazil

Univ Ctr Araraquara UNIARA, Sch Dent, Dept Hlth Sci, Implantol Post Grad Course, Sao Paulo, Brazil

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

The aims of this article were to describe the surgical technique of the inferior alveolar nerve lateralization followed by implant installation by means of a clinical report and also to discuss the importance of an adequate surgical and prosthetic planning for atrophic posterior mandible rehabilitation.

Gingival overgrowth (GO) may be related to the frequent use of certain medications, such as cyclosporin, phenytoin (PHT), and nifedipine, and is therefore denominated drug-induced GO. This article reports a case of a patient who with chronic periodontitis made use of PHT and presented generalized GO. A 30-year-old man with GO was referred to the clinic of the Universidade Estadual Paulista, Brazil. The complaint was poor aesthetics because of the GO. The patient had a medical history of a controlled epileptic state, and PHT was administered as an anticonvulsant medication. The clinical examination showed generalized edematous gingival tissues and presence of bacterial plaque and calculus on the surfaces of the teeth. The diagnosis was GO associated with PHT because no other risk factors were identified. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation, prophylaxis, and daily chlorhexidine mouth rinses. After this stage, periodontal surgery was performed, and histopathologic evaluation was made. The patient has been under control for 3 years after the periodontal surgery, and up to the present time, there has been no recurrence. It can be concluded that PHT associated with the presence of irritants favored gingival growth and that the association of nonsurgical and surgical periodontal therapies was effective in the treatment of GO. Besides, motivating the patient to maintain oral hygiene is a prerequisite for the maintenance of periodontal health.

The Ramsay Hunt syndrome is a rare disease caused by an infection of the geniculate ganglion by the varicella-zoster virus. The main clinical features of the syndrome are as follows: Bell palsy unilateral or bilateral, vesicular eruptions on the ears, ear pain, dizziness, preauricular swelling, tingling, tearing, loss of taste sensation, and nystagmus. We describe a 23-year-old white woman, who presented with facial paralysis on the left side of the face, pain, fever, ear pain, and swelling in the neck and auricular region on the left side. She received appropriate treatment with acyclovir, vitamin B complex, and CMP nucleus. After 30 days after presentation, the patient did not show any signs or symptoms of the syndrome. At follow-up at 1 year, she showed no relapse of the syndrome.

Univ Estadual Paulista Julio de Mesquita Filho Ar, Aracatuba Dent Sch, Dept Surg, Sao Paulo, Brazil

Univ Estadual Paulista UNESP, Aracatuba Dent Sch, Oral & Maxillofacial Surg Post Graduat Course, Sao Paulo, Brazil

Moderate and controlled loading environments support or enhance osteogenesis, and, consequently, a high degree of bone-to-implant contact can be acquired. This is because when osteoprogenitor cells are exposed to limited physical deformation, their differentiation into osteoblasts is enhanced. Then, some range of microstrain is considered advantageous for bone ingrowth and osseointegration. The primary stability has been considered one of the main clinical means of controlling micromotion between the implant and the forming interfacial tissue, which helps to establish the proper mechanical environment for osteogenesis. Based on the biological aspects of immediate loading (IL), the objective of this study is to present a clinical case of maxillary arch rehabilitation using immediate loading with implant-supported fixed restoration after bone graft. Ten dental implants were placed in the maxilla 6 months after the autogenous bone graft, removed from the mandible (bilateral oblique line and chin), followed by the installation of an immediate-load fixed cross-arch implant-supported restoration because primary stability was reached for 8 implants. In addition, instructions about masticatory function and how it is related to interfacial micromotion were addressed and emphasized to the patient. The reasons for the IL were further avoidance of an interim healing phase, a potential reduction in the number of clinical interventions for the patient, and aesthetic reasons. After monitoring the rehabilitation for 8 years, the authors can conclude that maxillary IL can be performed followed by a well-established treatment planning based on computed tomography, providing immediate esthetics and function to the patient even when autogenous bone graft was previously performed in the maxilla.

Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual shape, starting on the palatal side and extending to the buccal side subgingivally. After 7 years, the attached coronal fragment remained in position with good esthetics, as well as clinical and radiographic signs of pulpal vitality, periodontal health, and root integrity, thus indicating success.

Purpose Hypertension is a major risk factor for cardiovascular diseases, which has been related to such changes as gradual bone loss and a decrease in bone mass index. The cellular and molecular mechanisms that involve hypertension and osteoporosis are not fully understood. Many patients have high blood pressure, controlled or uncontrolled, and may use at least 1 antihypertensive drug, and an understanding of the interference of hypertension with bone healing is very important when considering oral rehabilitation with implants and bone grafts. This study investigated the interference of hypertension in bone metabolism during the repair process of autogenous bone grafting and analyzed the influence of losartan, an antihypertensive drug and angiotensin II receptor antagonist, through histometric and immunohistochemical analyses by examining the protein expressions of osteocalcin, osteoprotegerin, receptor activator of nuclear factor-κB, receptor activator of nuclear factor-κB ligand, tartrate-resistant acid phosphatase, vascular endothelial growth factor, and platelet endothelial cell adhesion molecule. Materials and Methods The groups studied include 24 normotensive Wistar rats and 24 spontaneously hypertensive rats divided into groups treated and not treated with losartan. Rats were subjected to block bone graft surgery in the mandible and were sacrificed at 7, 14, and 28 days. Results Histometric analysis was performed to evaluate the amount of bone tissue formed at the interface of the recipient bed and bone graft. The total area of formed bone tissue was outlined and calculated. Immunohistochemical analysis was semi-quantitative and the significance of the differences between groups regarding the percentage of newly formed bone tissue interface and protein expression were determined by ANOVA analysis of variance and Kruskall-Wallis followed by Tukey test or Holm Sidak to detect differences between groups. The results were considered statistically significant when P Conclusion The untreated hypertensive rats showed a delay in the repair of autogenous bone block grafts compared with untreated Wistar rats. Furthermore, the use of losartan for lowering blood pressure in these animals was shown to improve the healing process, despite not showing important statistical differences.

OBJECTIVE To evaluate the bone regeneration of cervical defects produced around titanium implants filled with blood clot and filled with centrifuged bone marrow (CBM) by means of histomorphometric analysis. MATERIALS AND METHODS Twelve rabbits received 2 titanium implants in each right tibia, with the upper cortical prepared with a 5-mm drill and the lower cortex with a 3-mm-diameter drill. Euthanasia was performed to allow analysis at 7, 21, and 60 days after operation. The samples were embedded in light curing resin, cut and stained with alizarin red and Stevenel blue for a histomorphometric analysis of the bone-to-implant contact (BIC) and the bone area around implant (BA). The values obtained were statistically analyzed using the nonparametric Kruskal-Wallis test (P = 0.05). RESULTS At 60 days postoperation, the groups had their cervical defects completely filled by neoformed bone tissue. There was no statistically significant difference between the groups regarding BIC and BA during the analyzed periods. CONCLUSION There was no difference in the bone repair of periimplant cervical defects with or without the use of CBM.

Extensive bone defects in maxillofacial region can be corrected with autogenous grafts; otherwise, the disadvantages of the therapeutics modality take the research for new bone substitutes. The aim of the study was to evaluate and compare the osteoconductive properties of 3 commercial available biomaterials. A total of 30 calvarial defects (5-mm diameter) were randomly divided into 5 treatment groups, with a total of 6 defects per treatment group (n = 6). The treatment groups were as follows: 500 to 1000 μm β-tricalcium phosphate (β-TCP), polylactic and polyglycolic acid (PL/PG) gel, calcium phosphate cement, untreated control, and autograft control. The evaluations were based on histomorphometric analysis at 60 postoperative days. The results have shown that β-TCP and autograft control supported bone formation at 60 postoperative days. β-Tricalcium phosphate showed the highest amount of mineralized area per total area and statistically significant compared with PL/PG, calcium phosphate cement, and untreated control groups. The PL/PG gel does not have osteoconductive properties and performed similar to empty control. Calcium phosphate cement showed higher number of multinucleated giant cells around the sites of the biomaterial and showed newly formed bone only at the edges of the biomaterial, without bone formation within the biomaterial. The findings presented herein indicate that bone formation reached a maximum level when rat calvarial defects were filled with β-TCP at 60 postoperative days. Further studies should be conducted with β-TCP to understand the potential of this biomaterial in bone regeneration.

Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

The restoration and recovery of the alveolar healing process are a challenge to dental surgeons to achieve satisfactory results at the osseointegration of implants and implant rehabilitation. Different operative technique and biomaterials are being used to reconstruct the framework of the alveolar process. One of the biomaterials used for this purpose is the bioactive glass. The aim of this study was to report clinical and histologic final results of 7 clinical reports of alveolar ridge augmentation using bioactive glass. Clinically, bioglass was able to maintain bone architecture of the alveolar bone and repaired satisfactory. Biopsy was performed on the histologic samples and showed bone formation in intimate contact to the particles of the biomaterial.

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Computed tomographic scan is a precise complementary examination of diagnostic imaging and a noninvasive surveying technique that enables the professional to improve precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of mandible rehabilitation based on computed tomography of a patient; the cross sections were reformatted and used to construct a virtual planning of the implants and a guide template in Dental Slice. Immediate loading of 5 titanium implants were placed in the mandible using a Slice Guide System. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

OBJECTIVE Crohn's disease is a chronic inflammatory process that has recently been associated with a higher risk of early implant failure. Herein we provide information on the impact of colitis on peri-implant bone formation using preclinical models of chemically induced colitis. METHODS Colitis was induced by intrarectal instillation of 2,4,6-trinitro-benzene-sulfonic-acid (TNBS). Colitis was also induced by feeding rats dextran-sodium-sulfate (DSS) in drinking water. One week after disease induction, titanium miniscrews were inserted into the tibia. Four weeks after implantation, peri-implant bone volume per tissue volume (BV/TV) and bone-to-implant contacts (BIC) were determined by histomorphometric analysis. RESULTS Cortical histomorphometric parameters were similar in the control (n = 10), DSS (n = 10) and TNBS (n = 8) groups. Cortical BV/TV was 92.2 ± 3.7%, 92.0 ± 3.0% and 92.6 ± 2.7%. Cortical BIC was 81.3 ± 8.8%, 83.2 ± 8.4% and 84.0 ± 7.0%, respectively. No significant differences were observed when comparing the medullary BV/TV and BIC (19.5 ± 6.4%, 16.2 ± 5.6% and 15.4 ± 9.0%) and (48.8 ± 12.9%, 49.2 ± 6.2 and 41.9 ± 11.7%), respectively. Successful induction of colitis was confirmed by loss of body weight and colon morphology. CONCLUSIONS The results suggest bone regeneration around implants is not impaired in chemically induced colitis models. Considering that Crohn's disease can affect any part of the gastrointestinal tract including the mouth, our model only partially reflects the clinical situation.

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

The odontogenic keratocyst, also known as the keratocystic odontogenic tumor, is an aggressive, intraosseous lesion of odontogenic origin that presents a high rate of recurrence. Treatment modalities include aggressive surgical procedures and more conservative approaches that significantly influence the lesion's recurrence potential. The purpose of this case report was to demonstrate a conservative approach in the treatment of an extensive keratocystic odontogenic tumor, located in the mandible's posterior region, using decompression and enucleation.

The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine suture. There is controversy about its pathogenesis; however, its origin is generally attributed to the enclavement of epithelial remnants within the palatine suture between the 2 lateral maxillary processes during their fusion in the origin of the hard palate. The purpose of this report was to relate a case of a median palatine cyst, discussing the rarity of the lesion, its pathogenesis, and the different modalities that could be used for the correct treatment of this pathologic entity.

Bone formation in critical-sized calvaria defects is strongly dependent on the osteoconductive properties of grafts. It remains a matter of controversy whether biomaterials can replace autografts and whether the supplementation of biomaterials with Bone Morphogenetic Proteins (BMPs) is necessary to enhance bone formation. We examined rat calvaria critical-sized defects (5-mm-diameter) treated with β-tricalcium phosphate (TCP; Cerasorb® M), polylactic and polyglycolic acid gel (PLA/PGA; Fisiograft®) and calcium phosphate cement (CPC; Norian® CRS®), either alone or in the presence of 5 μg of BMP-2 after 45 days. Autografts and untreated defects served as controls. Bone formation was evaluated based on μCT analysis, histomorphometric analysis and fluorescence analysis. We report that TCP supported bone formation more efficiently than did autografts. Bone formation in the presence of TCP alone reached a maximal level, as BMP-2 supplementation failed to enhance bone formation. By contrast, no significant difference in bone formation was observed when PLA/PGA and CPC were compared to autografts. Moreover, the presence of BMP-2 did not substantially change the osteoconductive properties of PLA/PGA or CPC. We conclude that the osteoconductive properties of TCP are superior to those of autografts and that TCP does not require BMP-2 supplementation. Our findings also show that the decreased osteoconductive properties of PLA/PGA and CPC cannot be overcome by BMP-2 supplementation in rat calvaria defects.

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

To investigate the effects of bone-resorption inhibitors (oestrogen and raloxifene) on the RANKL/OPG balance during the chronology of the alveolar healing process in ovariectomized (OVX) rats by means of immunocolocalization and histomorphometric analysis.One hundred sixty female Wistar rats at 70 days of age were either OVX or sham-operated and divided into four groups: sham, OVX/Oil, OVX with E(2) replacement (17beta-estradiol, 400 microg/month), OVX with RLX treatment (1mg/kg bw/day). The 60-day treatment started 8 days after ovariectomy. The incisors were extracted to allow analysis of 7, 14, 21, 28 and 42 days of wound healing. After obtaining the histological samples, slides were stained with hematoxylin and eosin or subjected to immunocolocalization reaction for RANKL and OPG. Results were quantitatively evaluated.Histomorphometric analysis showed that the sham group presented the highest and OVX/Oil group the lowest mean bone formation value in the post-extraction period. The immunocolocalization analysis showed a larger increase in bone turnover at 7 postoperative days in OVX/Oil and sham groups and decreasing bone turnover in the other periods. The OVX/Oil group showed a large decrease in bone turnover at 14 postoperative days, a period demonstrated by mild cellular activity. OVX/E(2) and sham groups showed a decreased bone turnover at 28 postoperative days while OVX/RLX group showed a decreased bone turnover at 21 postoperative days. On the 42nd postoperative day, sham and OVX/RLX groups showed an established alveolar bone healing process.Ovariectomy delays the alveolar healing process and interferes with bone turnover through the balance between RANKL and OPG. Oestrogen replacement or raloxifene treatment did not totally recover the oestrogen-deficient state. However raloxifene treatment showed more satisfactory results than oestrogen replacement.

Root fractures are defined as those that involve cement, dentin and pulp, comprising from 0.5 to 7% of injuries in permanent dentition. Diagnosis is made through clinical and radiographic exams, the latter frequently being limited by the position of the fracture. Treatment varies according to the displacement and vitality of the fragments. The authors present a clinical case of recurrent trauma of tooth 21 causing a horizontal root fracture in the middle third. After several attempts at endodontic treatment, the option was to remove the apical fragment by surgery. The postoperative period of 4 years shows very satisfactory results with regard to wound repair and tooth mobility, or implantation of the coronal segment.