The authors present a clinical case of bone atrophy at the level of premolars of the 2nd Q, regenerated with autograft in a block collected from the mandible body (oblique line), xenograft, PRGF and collagen membrane fixed with metal pins.
Discussion: Various types of bone substitutes are available for this type of surgery. For many authors, the autograft is considered the ideal graft. In this case, given the great bone atrophy in thickness and height and the demanding aesthetic component (high smile line), exactly this type of graft was chosen. It has the inconvenience of the need for another surgical site, which can translate into more comorbidity. In any case, it is a very predictable procedure with good clinical results.
Conclusions: In the absence of quantity and quality of bone for rehabilitation with dental implants, the surgeon has available surgical techniques and varied bone substitutes. One of these techniques is the autograft, considered by many to be the “Gold Standard” of bone grafting. In this case and in view of the need for a significant horizontal increase, as well as the desirable vertical increase and the availability of intraoral donors, this type of graft was obtained. The result obtained is predictable and with very satisfactory results.
Keywords: Autologous bone augmentation, Dental implants
Introduction and Aim: Larger periapical lesions are a challenging surgical procedure due to the greater amount of resorbed bone. L-PRF, a concept of naturally guided tissue regeneration, contains a dense fibrin network which releases various growth factors, cytokines and proteins. L-PRF improves the initial stages of healing, reducing the inflammatory process and risk of infection. Although L-PRF is popular among other dental fields, its regenerative potential in the apical region still seems to be unclear, therefore the aim of this review was to interpret the currently available literature and ascertain its effectiveness.
Method: Search was carried out in PUBMED’s and EBSCO’s databases, between 2010 and 2020, combinations of keywords were used to find appropriate clinical and in vitro studies. Only articles in English were considered and human studies were not limited to RCTs.
Results: In the 24 selected studies, L-PRF demonstrated to induce the proliferation of fibroblasts and stem cells, accelerate hemostasis, suppress osteoclastogenesis, increase osteoblastic expression and release growth factors, cytokines and proteins. In the apical region, complete regeneration was achieved in all studies and, a reduction of post-surgical pain, inflammation and administration of analgesics was also demonstrated. The centrifugation protocol and materials used demonstrated an influence over the viability of L-PRF.
Conclusions: L-PRF in endodontic microsurgery achieved total apical regeneration in all studies. Nevertheless, more research, preferably with a implemmented standardized protocol, is required.
Clinical Implications: L-PRF potentially accelerates hemostasis and tissue regeneration in the apical region, decreases inflammation, risk of infection and post-surgical pain.
Keywords: L-PRF, periapical lesions, healing process, bone recovery, tissue regeneration
Case report: A 12 years-old boy, with a preliminary radiographic diagnosis of pre-eruptive radiolucent lesion, made in 2016. In 2019, the diagnosis was confirmed through clinical observation after placing a separator orthodontic elastic in the interproximal space and radiographic exam. The treatment implemented was a full removal of the lesion, followed by dental bonding with total-etch (Prime&Bond®NT - DENTSPLY SIRONA) and restoration with composite resin (Synergy® Compact colour A2/B2 - Coltène Whaledent®). Follow-up after 6 months was performed.
Discussion: Pre-eruptive intracoronal radiolucency is characterized by a well-circumscribed radiolucent area, within the dentine of unerupted teeth and close to the amelodentinal junction. There is yet no consensus regarding the clinical management of this lesion, due to a low predictability of its clinical course. The difficulty to perform a differential diagnosis with other lesions is aggravated, in particular with dental caries, at least until the eruption of the affected tooth.
Conclusion: There are no reports of progression or reactivation of the lesion after dental restoration. Therefore, this seems to be the most appropriate therapeutic option, according to the particularities of each clinical situation. However, more prospective and retrospective studies are required in order to develop clinical guidelines for the treatment of this type of crown lesions.
Keywords: Pre-eruptive intracoronal radiolucency, Pre-eruptive intracoronal resorption, Radiolucent lesion, Unerupted teeth, Dentin, Clinical management
Endodontic treatment, in cases of traumatic teeth with immature apex, requires special care, due to anatomical particularities: Wide root canal, little thickness of dentine walls, absence of apical constriction and apical divergence.
Currently, there are several apexification techniques using calcium hydroxide, MTA or other materials based on calcium silicate, as well as regenerative endodontic treatments.
Female patient, 8 years old, attended the consultation with buccal fistula associated with tooth 11 and also discolored tooth. Parents reported a history of trauma a year and a half ago and dental phobia.
After clinical and radiographic evaluation, it was diagnosed pulp necrosis, chronic apical abscess and incomplete root formation.
Due patient's dental phobia, the suggested treatment was apexification with an MTA apical plug (MAP), in a surgery room.
MTA has a high potential on endodontic treatments due to its sealing capacity, resistance to microleakage and the fact that it can be used in a humid environment or in the presence of blood, making it suitable for use as an apical barrier in teeth with immature apex. Due to this fact, reducing the apexification time for a single session allows definitive restoration to be carried out briefly in order to achieve the coronary resistance, reducing the risk of fracture.
With the presentation of this clinical case, we pretend to highlight the importance of using MTA in apexification due to its high predictability in relation to apical sealing because it allows a reduction in the number of sessions and less dependence on patient compliance.
Keywords: MTA, Apexification, Surgery Room
Introduction: Attractiveness plays an important role in personal self-esteem and social relationships, influencing our daily life. Therefore, it is essential to know the characteristics of a beautiful face.
Objectives: The objective of this investigation was to evaluate the relationship between facial attractiveness and several hard and soft tissue cephalometric variables, in individuals with Class I and III.
Material and methods: Facial attractiveness of 40 individuals with skeletal Class I and III was determined by 14 laymen using a Visual Analog Scale, in the frontal, frontal smiling, profile, and the triplet photographs. Facial attractiveness scores were correlated with the cephalometric analysis, through a non-linear regression.
Results: A quadratic correlation described by a U-shaped curve was verified, between the distance LLip-SnPog' line and the attractiveness of the frontal (r=0,52, p=0,003) and profile photographs (r=0,42, p=0,003); and between the SNA angle and the triplet attractiveness (r=0,49, p=0,006). Maximum attractivity scores were found with LLip-SnPog'=3,8mm/3,7mm and SNA=83,8 degrees. Discussion and
Conclusions: The correlation between cephalometric variables and facial attractiveness may assume a non-linear relationship, represented by a parabola of lower concavity, where the turning point corresponds to the maximum attractiveness. Few studies have investigated this type of correlation. Facial attractiveness assessed from the frontal and profile photographs showed a non-linear correlation with a soft tissue cephalometric variable assessing lip protrusion, and the facial attractiveness of the triplet with a skeletal measurement, the SNA angle.
Keywords: Attractiveness, Face, Class III, Cephalometrics, Photographs
Introduction: Temporomandibular disorder (TMD) is the most common cause of orofacial pain with non-dental origin, being pain the most frequent symptom. Bruxism is a movement disorder characterized by the clenching or grinding of teeth, often associated with TMD. The numerical scale has been widely used to record pain intensity.
Objective: To evaluate the evolution of pain intensity in patients diagnosed with TMD and / or Bruxism before and after treatment, using the numerical scale.
Materials and Methods: Longitudinal retrospective study to 5 years, carried out by consulting clinical processes in a university clinic (2015-2020).
Results: For all groups, there was a reduction in pain intensity. The evolution of pain intensity was more significant for patients with TMD II, this reduction being 63.3% at peak, 80% in latency and 85.7% in current pain. Likewise, there was a more notable evolution for patients with Mixed Bruxism, with a decrease of 58.2% at peak, 86.5% in latency and 74% in current pain.
Discussion: The population of this study is characterized by 80.2% of female patients and the average age is 42.2 years. Conservative therapy appears to be associated with symptom relief in both TMD and Bruxism cases. These results are according to previous studies.
Conclusion: Pain intensity decreased in most diagnoses studied after conservative treatments. Clinical Implications: The pain scale has shown good clinical applicability for monitoring patients with TMD and/or Bruxism. Conservative treatments seem to have a positive effect on painful symptoms.
Keywords: Temporomandibular disorder, pain intensity, numerical scale, Bruxism
The extraction of a tooth is always accompanied by the resorption of the surrounding support tissues, a problem with which the dentist is inevitably challenged as the loss of soft tissues limits the aesthetic and functional prognosis of rehabilitation.
The socket-shield (SST) technique is a promising complement to the treatment of patients with fixed rehabilitation, preserving the supporting tissues of the periodontal bone-ligament complex, especially in aesthetically challenging cases such as total rehabilitation.
The use of digital implant placement planning tools and surgical guides provides greater accuracy and precision in implant placement.
In this poster, we present the digital planning performed, the surgical technique of implant placement and total fixed upper rehabilitation of partially edentulous patient.
Keywords: rehabilitation, implants, socket shield, fixed rehabilitation
A big challenge in oral surgery includes the bioengineering of biomaterials that simultaneously promote soft and hard tissue regeneration while stimulating a pro-regenerative immune phenotype to support tissue remodeling. A strontium-rich hybrid system was developed, composed of Sr-doped HAp microspheres, delivered in an alginate vehicle. Herein a bilayer system based on the latter was developed, aiming to promote both gingival and bone tissue regeneration. This system was further enriched with decellularized human fetal membranes (dh-FMs). The objective of this work was to evaluate the immunomodulatory potential of a bilayer strontium-hybrid system doped with dh-FMs.
A triton-X-based decellularization was performed. The physicochemical integrity and absence of nuclei was analyzed by histology, electronic microscopy, atomic force microscopy, and Fourier transform infrared spectroscopy analysis. Macrophage inflammatory response was evaluated by flow cytometry and ELISA assays. Statistically analysis was performed using Kruskal-wallis test.
The effectiveness of the decellularization process was confirmed by the absence of nuclei and maintenance of its chemical structural integrity. The preliminary results indicated a low macrophage activation and a decrease of TNF-alpha, IL-4, and IL-6 secretion upon dFMs integration. Regarding the innovative biomaterial design, the understanding of biological approaches to mitigate the foreign body response and drive the tissue inflammation into a pro-regenerative phenotype is essential. Therefore the incorporation of dh-FMs into a biomaterial showed to be an interesting strategy for tissue regeneration. The preliminary results concerning immunomodulatory properties indicated low macrophage activation. We concluded that the dh-FMs incorporation into a biomaterial showed to be a promising multifunctional tissue approach. Further tests should be performed to explore the immunomodulation capacity of the biomaterial.
Keywords: Decellularization, fetal membranes, alginate, strontium, nano-hydroxyapatite, inflammation, macrophages
Gingival Recession is defined as the apical location of the gingival margin in relation to the cementoenamel junction (JEC) of a tooth which causes root exposure in the oral cavity. Several surgical techniques have been proposed for the treatment of this pathology. Laterally Positioned Flap is the method of choice whenever the keratinized gingiva adjacent to the defect is adequate in length and thickness and there is not enough keratinized gingiva apical to the recession to be coronal repositioned. This poster reports a clinical case of a 23-year-old female presented two Miller's class III gingival recessions in teeth 31 and 41. According to the clinical picture, and in order to resolve the aforementioned situation in a single surgical time, the following treatment plan was established: Double laterally positioned flap + Enamel matrix proteins derivatives + Connective tissue graft.
Different degrees of complexity are emerging in the treatment of gingival recessions. The dentist must be able to interconnect techniques and modifications in order to establish the most appropriate treatment plan for each situation. The double laterally positioned flap was effective in the treatment of two contiguous gingival recessions in a single surgical procedure.
Keywords: Gingival recession, pedicle gingival graft, laterally positioned flap, connective tissue graft
Introduction: Peri-implantitis results from a process that involves bacterial interactions and an excessive inflammatory response. The purpose of the modifications present on implant surfaces is to positively affect the tissue response to osteointegration. Goals: Pilot study: Characterization of the microbiome formed on titanium implant surfaces placed in devices present in the oral cavity of human volunteers and to investigate the impact of microorganisms on the implants structure.
Materials and methods: 22 volunteers used intraoral devices containing a laterally machined titanium implant and another implant with Vellox® surface treatment (double acid etching + blasting with Al2O3) for a period of 48 hours. The adhered microbiome was characterized using gene sequencing. Additionally, the studied implants were observed by MEV and their wettability was analyzed.
Results: The Vellox® surface showed a higher contact angle in comparison with the machined surface, characterizing them as hydrophobic. The machined surface and the Vellox® surface differ microscopically in terms of their nanostructure. Bacterial adhesion to both surfaces occurs qualitatively in a similar way.
Discussion: The superficial microscopic aspects determined in the studied implants are in agreement with those described in the literature. It was possible to verify that the bacterial composition on both studied surfaces was the same. These results contrast with those described in the literature in which there appears to be a greater bacterial adhesion to irregular surfaces. Clinical implications: Understanding peri-implantitis by its microbiological etiology and the mechanisms that manufacturers can adopt to reduce its incidence.
Conclusion: Wettability and the surfaces microtopographic characteristics do not promote the initial biofilms adhesion to the surfaces with different treatments, in the studied implants.
Keywords: Bacterial adhesion, titanium, implant, implant surface, wettability, surface properties
Introduction: Dental erosion is considered a challenge in oral rehabilitation. Adhesion to eroded substrates, especially dentin, is complex and defiant. Therefore, it is important to find out which adhesive protocols are evidence-based and what has been researched up to this date.
Objectives: To report and summarize in vitro research that tested bond strength in eroded enamel/dentin. This will identify current knowledge gaps and guide future research.
Methods: The review was conducted following PRISMA-ScR guidelines. PubMed/Medline, Scopus and EMBASE databases were searched to identify peer-reviewed articles published in the last 10 years. Laboratory studies which tested bond strength in human/bovine samples were included. Three reviewers independently performed data charting and quality assessment of papers.
Results: The search retrieved 29 studies. The studies included comparison of restorative materials and application modes, enzymatic inhibitors, surface pre-treatments and remineralization techniques. Dentin (76%) was the preferred substrate, whereas 17% tested enamel and 7% evaluated both. 83% of studies document an effective intervention. The majority of studies tested an etch-and-rinse adhesive strategy.
Conclusion: It is well established that eroded enamel seems to be beneficial as a substrate for adhesion, while the contrary happens in dentin. Adhesive type and composition seem significant in bonding to the latter. 10-MDP-containing adhesives demonstrated better bond strength results. Remineralising agents also represent a promising method to increase bond in dentin and should be further studied.
Clinical implications: Establishing clear protocols based on current in vitro evidence is key to impact clinical outcomes regarding adhesion to an eroded substrate. Adhesive choice in dentin and remineralising formulations should be considered.
Keywords: dentin, erosion, adhesion, enamel, eroded, in vitro