Andréa Cândido dos Reis

Mini vs. Standard Implants for Mandibular Overdentures A Randomized Trial

A mandibular implant-retained overdenture is considered a first-choice treatment for edentulism. However, some aspects limit the use of standard implants—for example, the width of edentulous ridges, chronic diseases, fear, or costs. This randomized trial compared mandibular overdentures retained by 2 or 4 mini-implants with standard implants, considering oral health–related quality of life (OHRQoL), patient satisfaction, and complications such as lost implant. In sum, 120 edentulous men and women (mean age, 59.5 ± 8.5 y) randomly received 4 mini-implants, 2 mini-implants, or 2 standard implants. Participants provided data regarding OHRQoL and satisfaction until 12 mo. Clinical parameters, including implant survival rate, were also recorded. Both 2 and 4 mini-implants led to better OHRQoL, compared with 2 standard implants. Treatment with 4 mini-implants was more satisfying than 2 standard implants, with 2 mini-implants presenting intermediate results. Implant survival rate was 89%, 82%, and 99% for 4 mini-implants, 2 mini-implants, or 2 standard implants, respectively. Overdentures retained by 4 or 2 mini-implants can achieve OHRQoL and satisfaction at least comparable with that of 2 standard implants. However, the survival rate of mini implants is not as high as that of standard implants (ClinicalTrials.gov NCT01411683).

Combination therapies in the treatment of temporomandibular disorders: a clinical report

Numerous implant systems exist that have the versatility to create a custom implant abutment with an anatomic shape. This clinical report describes the use of a digital scanner with CAD/CAM technology to create (copy mill) an anatomically shaped abutment.

Development of a novel resin with antimicrobial properties for dental application

The adhesion of biofilm on dental prostheses is a prerequisite for the occurrence of oral diseases. Objective To assess the antimicrobial activity and the mechanical properties of an acrylic resin embedded with nanostructured silver vanadate (β-AgVO3). Material and Methods The minimum inhibitory concentration (MIC) of β-AgVO3 was studied in relation to the species Staphylococcus aureus ATCC 25923, Streptococcus mutans ATCC 25175, Pseudomonas aeruginosa ATCC 27853, and Candida albicans ATCC 10231. The halo zone of inhibition method was performed in triplicate to determine the inhibitory effect of the modified self-curing acrylic resin Dencor Lay - Clássico®. The surface hardness and compressive strength were examined. The specimens were prepared according to the percentage of β-AgVO3 (0%-control, 0.5%, 1%, 2.5%, 5%, and 10%), with a sample size of 9x2 mm for surface hardness and antimicrobial activity tests, and 8x4 mm for the compression test. The values of the microbiologic analysis were compared and evaluated using the Kruskal-Wallis test (α=0.05); the mechanical analysis used the Shapiro-Wilks tests, Levenes test, ANOVA (one-way), and Tukeys test (α=0.05). Results The addition of 10% β-AgVO3 promoted antimicrobial activity against all strains. The antimicrobial effect was observed at a minimum concentration of 1% for P. aeruginosa, 2.5% for S. aureus, 5% for C. albicans, and 10% for S. mutans. Surface hardness and compressive strength increased significantly with the addition of 0.5% β-AgVO3 (p<0.05). Higher rates of the nanomaterial did not alter the mechanical properties of the resin in comparison with the control group (p>0.05). Conclusions The incorporation of β-AgVO3 has the potential to promote antimicrobial activity in the acrylic resin. At reduced rates, it improves the mechanical properties, and, at higher rates, it does not promote changes in the control.

In vitro analysis of the influence of surface treatment of dental implants on primary stability

Surface treatment interferes with the primary stability of dental implants because it promotes a chemical and micromorphological change on the surface and thus stimulates osseointegration. This study aimed to evaluate the effects of different surface treatments on primary stability by analyzing insertion torque (IT) and pullout force (PF). Eight samples of implants with different surface treatments (TS - external hexagon with acid surface treatment; and MS - external hexagon, machined surface), all 3.75 mm in diameter X 11.5 mm in length, were inserted into segments of artificial bones. The IT of each sample was measured by an electronic torquemeter, and then the pullout test was done with a universal testing machine. The results were subjected to ANOVA (p < 0.05), followed by Tukeys test (p < 0.05). The IT results showed no statistically significant difference, since the sizes of the implants used were very similar, and the bone used was not highly resistant. The PF values (N) were, respectively, TS = 403.75 ± 189.80 and MS = 276.38 ± 110.05. The implants were shown to be different in terms of the variables of maximum force (F = 4.401, p = 0.0120), elasticity in maximum flexion (F = 3.672, p = 0.024), and relative stiffness (F = 4.60, p = 0.01). In this study, external hexagonal implants with acid surface treatment showed the highest values of pullout strength and better stability, which provide greater indication for their use.

Color change of composite resins subjected to accelerated artificial aging

AIM The aim of this study was to evaluate the influence of accelerated artificial aging (AAA) on the color change of composite resins used in dentistry. MATERIALS AND METHODS Three composite resins were evaluated: Two microhybrids and one hybrid of higher viscosity, with different amounts and sizes of filler particles, shades C2 and B2. A total of 54 specimens were obtained (18 for each composite resin), made of a Teflon matrix (15 mm in diameter and 2 mm in height). The color measurements were obtained with a Spectrophotometer, (PCB 6807 BYK Gardner) before and after AAA. Data were submitted to the Kolmogorov-Smirnov test (α >0.05), ANOVA and Tukey test (α <0.05). After statistical analysis, the color difference among composite resins with the same shades was analyzed. RESULTS All composite resins showed unacceptable color changes after AAA (ΔE > 3). Considering the variable ∆E, it was observed that the color tone C2 was already statistically different for the microhybrid composite resin prior to AAA (P < 0.05) and in shade B2 for hybrid of higher viscosity and microhybrid with barium glass fluoride aluminum and silica dioxide (P < 0.01). After this process, a statistically significant difference was observed only for shade B2 between microhybrid composite resins (P < 0.01) and for hybrid of higher viscosity and microhybrid with barium glass fluoride aluminum and silica dioxide (P < 0.05). Regarding the color difference within a same composite resin group, before aging the composite resin hybrid of higher viscosity B2 showed the highest color variation rate and microhybrid with zirconium/silica C2 showed the lowest. CONCLUSIONS All composite resins presented unacceptable color changes after 382 h of aging and different composite resins with same hue, presented different colors before being subjected to the aging process (B2 and C2) and after (B2). It was also observed color difference within a group of the same composite resin and same hue.

Microstructural characterization and evaluation of the properties of polymeric materials for maxillofacial prosthetics.

Abstract This study evaluated the Shore A hardness, colour and microstructural alterations of an experimental silicone for maxillofacial prostheses. As a control, the MDX 4-4210 silicone was used. Eighty specimens of each material were randomly divided into groups of pigmentation and ageing. For microstructural analysis by Thermogravimetry, Fourier Transform Infrared Spectroscopy and Differential Scanning Calorimetry, three specimens of each group were used. Anova and Tukey test (p < 0.05) was used in statistical analysis. There was significant difference in hardness depending on the materials, pigmentation and ageing and interaction between all the factors evaluated (p = 0.00). The colour change was significant due to ageing ( p = 0.00) and the interaction between the factors evaluated (p = 0.00). The microstructural analyses have shown that ageing methods and pigmentations did not cause structural alterations. The results suggest that the alterations in hardness and colour do not represent important structural changes.

Analyzing the Influence of a New Dental Implant Design on Primary Stability.

BACKGROUND The macrogeometry of dental implants strongly influences the primary stability and hence the osseointegration process. PURPOSE Compare the performance of conventional and modified implant models in terms of primary stability. MATERIALS AND METHODS A total of 36 implants (Neodent®) with two different formats (n = 18): Alvim CM (Conical CM, Ø 4.3 mm × 10 mm in length) and Titamax Ti (Cylindrical HE, Ø 4.0 mm × 11 mm in length) were inserted into artificial bone blocks. Nine implants from each set were selected to undergo external geometry changes. The primary stability was quantified by insertion torque and resonance frequency using an Osstell device and the pullout test. One-way analysis of variance and Tukeys test were used for statistical evaluation. RESULTS The comparative analysis of the implants showed a significant increase of the insertion torque for the modified Conical CM implants (p = 0.000) and Cylindrical HE (p = 0.043); for the resonance frequency the modified Cylindrical HE showed a lower statistical mean (p = 0.002) when compared to the conventional model, and in the pullout test both modified implants showed significant reduction (p = 0.000). CONCLUSIONS Within the limitations of this study, the proposed modification showed good stability levels and advantages when compared to the conventional implants.

Comparative analysis of stress in a new proposal of dental implants

The purpose of this study was to compare, through photoelastic analysis, the stress distribution around conventional and modified external hexagon (EH) and morse taper (MT) dental implant connections. Four photoelastic models were prepared (n=1): Model 1 - conventional EH cylindrical implant (Ø 4.0mm×11mm - Neodent®), Model 2 - modified EH cylindrical implant, Model 3 - conventional MT Conical implant (Ø 4.3mm×10mm - Neodent®) and Model 4 - modified MT conical implant. 100 and 150N axial and oblique loads (30° tilt) were applied in the devices coupled to the implants. A plane transmission polariscope was used in the analysis of fringes and each position of interest was recorded by a digital camera. The Tardy method was used to quantify the fringe order (n), that calculates the maximum shear stress (τ) value in each selected point. The results showed lower stress concentration in the modified cylindrical implant (EH) compared to the conventional model, with application of 150N axial and 100N oblique loads. Lower stress was observed for the modified conical (MT) implant with the application of 100 and 150N oblique loads, which was not observed for the conventional implant model. The comparative analysis of the models showed that the new design proposal generates good stress distribution, especially in the cervical third, suggesting the preservation of bone tissue in the bone crest region.

Analysis of the surface deformation of dental implants submitted to pullout and insertion test.

OBJECTIVE The aim of the present study was to evaluate the possible deformations in the surface of dental implants submitted to pullout and insertion test in polyurethane synthetic bone, using scanning electron microscopy. MATERIAL AND METHODS Four different types of implants were used: Master Screw, Master Porous, Master Conect AR and Master Conect Conical (n = 8). These implants were into the femoral head synthetic bone (Synbone) and removed through the pullout test, performed with a universal testing machine (EMIC MEM 2000). All the screws, before and after the mechanical tests, were micro structurally analyzed in a Scanning Electron Microscope (SEM - Zeiss EVO50), utilizing a magnification of 35 times. The results were subjected to ANOVA and Tukey tests (α =0.05). RESULTS Only the Master Conect Conical and Master Porous implants presented statistically significant difference to pullout and maximum deformation (P = 0.014 and P = 0.009, respectively). The SEM images did not show morphological changes of the implants when compared before and after the mechanical tests. CONCLUSION We concluded that Master Porous presented higher pullout resistance, suggesting a greater primary stability.

Mini-Implants for Mandibular Overdentures: Cost-Effectiveness Analysis alongside a Randomized Trial

Mandibular overdentures retained by 2 conventional implants have been considered the standard of care for complete edentulism, according to the McGill and York consensuses. However, many patients refuse this treatment modality due to the associated costs and postsurgical discomfort. Mini-implants have the chance to overcome these limitations due to their potentially lower costs and a relatively uncomplicated surgical technique. This study compared treatment costs and incremental cost-effectiveness following the insertion of mini-implants (2 or 4) or 2 standard-size implants for the retention of mandibular overdentures, by means of a randomized clinical trial. In total, 120 edentulous participants (mean age 59.5 ± 8.5 y) were randomly allocated into 3 groups according to treatment received: 4 mini-implants (group 1), 2 mini-implants (group 2), or 2 standard implants (group 3). Treatment costs and outcomes (Oral Health Impact Profile for Edentulous [OHIP-EDENT] and satisfaction with the dentures) were evaluated after 6 mo. Incremental cost-effectiveness ratios (ICERs) were calculated for each intervention in terms of cost per 1-point change in patient outcomes. A 1-way sensitivity analysis was performed considering a 95% confidence interval variation in cost and outcome parameters, represented in tornado diagrams. Overall treatment cost was the lowest for group 2 (average cost: US