António Felino

IL1 gene polymorphisms and unsuccessful dental implants

OBJECTIVES This study aimed to analyse the association between polymorphisms in the IL1 gene cluster and failure of dental implants in a Portuguese population. MATERIAL AND METHODS A total of 155 Caucasian Portuguese subjects were divided into two groups: 100 with successful dental implants and 55 with unsuccessful dental implants. DNA was obtained through an oral mucosa scraping. PCR was used to identify the polymorphisms: single nucleotide changes in positions -889 of IL1A gene and +3953 of IL1B gene. RESULTS The prevalence of the polymorphisms -889IL1A gene and +3953IL1B gene, determined by the positive result of TGP (Genetic Test for Periodontitis; CGC, Genetics, Portugal), in the studied population rehabilitated with dental implants was of 33.50%. Allele 1 of the IL1B gene was the most prevalent (62.20%), followed by allele 1 of the IL1A gene (54.80%) and the least frequent was allele 2 of IL1B gene (37.40%). Success of dental implants was mainly associated with a negative TGP result, whereas no success was found to be related to a positive result. There were no statistically significant differences between the alleles 1 and 2 of the genes IL1A and IL1B and the tobacco and alcohol consumption for the success or no success of the dental implants. CONCLUSIONS The alleles 1 and 2 of IL1A gene and the alleles 1 and 2 of IL1B gene were statistically associated with the success or no success of the dental implants. Tobacco habit and alcohol consumption showed no statistically significant association with success or no success of the dental implants.

Relationship between invasion of the periodontium by periodontal pathogens and periodontal disease: a systematic review

Bacterial invasion of the periodontal tissues has been suggested as a relevant step in the etiopathogenesis of periodontal disease. However, its exact importance remains to be defined. The present systematic review assessed the scientific evidence concerning the relationship between the quality or quantity of periodontal microbiota in periodontal tissues and development of periodontal disease. The databases Medline-PubMed, Cochrane-CENTRAL, ISI Web of Knowledge and SCOPUS were searched, up to January 2014. Studies that reported evaluation of periodontal pathogens invasion on human tissues were selected. The screening of 440 title/abstracts elected 26 papers for full-text reading. Twenty three papers were subsequently excluded because of insufficient data or a study protocol not related to the objectives of this systematic review. All included studies were case-control studies that evaluated intracellular or adherent bacteria to epithelial cells from periodontal pockets versus healthy sulci. Study protocols presented heterogeneity regarding case and control definitions and methodological approaches for microbial identification. No consistent significant differences were found related to the presence/absence or proportion of specific periopathogens across the studies, as only one study found statistically significant differences regarding the presence of A. actinomycetemcomitans (p = 0.043), T. forsythia (P < 0.001), P. intermedia (P < 0.001), C. ochracea (P < 0.001) and C. rectus (P = 0.003) in epithelial cells from periodontal pockets vs. healthy sulci. All studies reported a larger unspecific bacterial load in or on the epithelial cells taken from a diseased site compared to a healthy sulcus. The current available data is of low to moderate quality and inconsistent mainly due to study design, poor reporting and methodological diversity. As so, there is insufficient evidence to support or exclude the invasion by periodontal pathogens as a key step in the etiopathogenesis of periodontal disease. Further research is needed.

CT maxillary sinus evaluation: a retrospective cohort study

Background Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population. Material and Methods Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature. Results 32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus. Conclusions Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus.

Periodontal inflammation in renal transplant recipients receiving Everolimus or Tacrolimus – preliminary results

OBJECTIVE To compare oral health status between renal transplant recipients (RTRs) receiving tacrolimus (Tac) or everolimus (ERL) as immunosuppressive therapy. DESIGN This study is a cross-sectional study. METHODS Thirty-six RTRs receiving Tac and 22 RTRs receiving ERL were included in the study. Age, gender, time since transplant and pharmacological data were recorded for both groups. Oral health status was assessed through the evaluation of teeth, periodontal parameters as well as saliva flow rate and pH. RESULTS RTRs receiving ERL were older than those receiving Tac. No differences were found between groups concerning oral hygiene habits, oral symptoms, smoking habits, unstimulated and stimulated saliva flow rate and pH, clinical attachment level or the number of decayed, missing and filled teeth. However, RTRs receiving ERL presented lower visible plaque index and lower values for bleeding on probing when compared to RTRs receiving Tac. In addition, RTRs receiving ERL presented a gingival index varying from normal to moderate inflammation whereas RTRs receiving Tac presented a gingival index varying from mild to severe inflammation. CONCLUSIONS RTRs receiving ERL have lower periodontal inflammation when compared to RTRs receiving Tac.

The Influence of Crown-to-Implant Ratio on Short Implant Marginal Bone Loss

PURPOSE There is a need for more studies evaluating the marginal bone loss (MBL) of rehabilitations in the posterior regions of extremely resorbed maxillae and mandibles supported by short-length dental implants with a high crown/implant ratio (C/I-R). The aim of this study was to evaluate the influence of the C/I-R in implants on MBL considering dental implants with 4 mm of width and 7 mm of length. MATERIALS AND METHODS This retrospective cohort study included 59 patients (mean age of 52.8 years) rehabilitated with at least one implant 4 mm in width and 7 mm in length, with an anodically oxidized surface and external connection on the premolar or molar positions, supporting a fixed prosthesis, and in function for a period of 36 months. Periapical radiographs at 36 months were used to calculate the C/I-R and MBL. The Spearman correlation coefficient was used to test the correlation between C/I-R and MBL. The level of significance was set at 5%. RESULTS One hundred eighteen implants from 59 patients were evaluated. The mean ± SD MBL was 0.67 ± 0.63 mm. The C/I-R mean ± SD was 2.53 ± 0.79 mm. Thirty implants presented a C/I-R ≤ 2, while 88 implants had a C/I-R > 2. A weak nonsignificant inverse correlation (r = -0.081; P = .383, Spearman) was registered between C/I-R and MBL. CONCLUSION Within the limitations of this study, it is possible to conclude that implant-supported fixed prostheses with C/I-R > 2 do not correlate positively with MBL.

Partial Rehabilitation with Distally Tilted and Straight Implants in the Posterior Maxilla with Immediate Loading Protocol: A Retrospective Cohort Study with 5-Year Follow-up.

PURPOSE The purpose of this study was to compare the outcome of fixed partial prostheses in the posterior maxilla with two axially placed implants or one implant placed distally tilted and one axially placed implant following an immediate loading protocol. MATERIALS AND METHODS A sample of 60 patients was divided into two groups-group 1: 30 patients rehabilitated with one axially placed implant and one implant placed distally tilted in the posterior maxilla; group 2: 30 patients rehabilitated with two axially placed implants in the posterior maxilla. Outcome measures were implant survival based on function, marginal bone resorption, and the incidence of mechanical and biologic complications at 5 years; inferential statistics were used to analyze the intergroup and intragroup differences. The level of significance was set at 5%. RESULTS No significant differences were found between both groups in survival, complications, or marginal bone resorption. One axially placed implant was lost at 58 months in group 1, rendering a cumulative survival estimate at 5 years of 96.7% and 98.3% in group 1 and the total sample, respectively (P = .317). Mechanical complications occurred in 16 patients (26.7%; n = 8 patients in each group; [P > .999]), consisting of fractures in the provisional prosthesis (n = 8 patients), chipped ceramics of the definitive prosthesis (n = 2 patients), loosening of prosthetic components (n = 5 patients), and fracture of an attachment screw (n = 1 patient). Biologic complications occurred in 5 patients (8.3%; group 1 = 4 patients; group 2 = 1 patient; [P = .161]), consisting of peri-implant pathology. The mean ± SD marginal bone loss was 2.02 ± 0.36 mm and 1.90 ± 0.69 mm for groups 1 and 2, respectively (P = .235). In group 1, the mean ± SD marginal bone loss was 1.92 ± 0.48 mm and 2.11 ± 0.44 mm for the implant placed distally tilted and axially placed implant, respectively; the difference was significant (P < .001). CONCLUSION Within the limitations of this study, the use of implants placed distally tilted together with axially placed implants or two axially placed implants in the fixed partial rehabilitation of the posterior maxilla are viable treatment alternatives.

Decision model to predict the implant success

In this work we propose to build a set of binary logistic models that could assess the probability of success or no success in oral rehabilitation process taking into account some genetic factors, individual habits clinical and non-clinical factors. The study was conducted in a retrospective evaluation and consisted of 155 subjects undergoing oral rehabilitation in the Northern region of Portugal. We evaluated multiple factors in the construction of binary logistic regression models. We have chosen the model that gave statistically better discriminating power between success and failure, through the value of area under the ROC curve. The model that reveals better performance was Model 4, with AUC=0.789 and a 95% confidence interval [0.715;0.863].

Survival Rate of Dental Implants in Patients with History of Periodontal Disease: A Retrospective Cohort Study

PURPOSE To evaluate the differences between the survival rates of implants placed in patients with no history of periodontal disease (NP) and in patients with a history of chronic periodontal disease (CP). MATERIALS AND METHODS A retrospective cohort study was conducted in which all consenting patients treated with dental implants in a private clinic in Oporto, Portugal, from November 2, 2002 through February 11, 2011 were included. All patients were treated consecutively by the same experimental operator. This study aimed to analyze how the primary outcomes (presence of disease, time of placement, and time of loading) and the secondary outcomes (severity-generalized periodontitis, brand, implant length, prosthesis type, prosthesis metal-ceramic extension) influence the survival rate of dental implants. The survival analysis was performed through the Kaplan-Meier method, and the equality of survival distributions for all groups was tested with the log-rank test with a significance level of .05 for all comparisons. RESULTS The sample consisted of 202 patients (47% NP and 53% CP) and 689 implants (31% NP and 69% CP). The survival rate in the NP and CP groups showed no statistically significant differences (95.8% versus 93.1%; P ≥ .05). Implants were lost before loading in 54.9% of the cases. The majority of the implants were lost in the first year and stabilized after the second year. Survival rates in the NP and CP patients showed no statistically significant differences when comparing the following factors: subclassification of the disease, implant brands, implant length (short/standard), type of prosthesis, extension of the prosthesis metal-ceramic, and time of placement and loading (P ≥ .05). CONCLUSION This work disclosed no statistically significant differences in terms of survival rates when compared with the control group. Placing implants in patients with a history of periodontal disease appears to be viable and safe.

The applications of regenerative medicine in sinus lift procedures: A systematic review

BACKGROUND Findings in regenerative medicine applied to the sinus lift procedures. PURPOSE Evaluate the effectiveness of regenerative medicine in sinus lift. MATERIALS AND METHODS An extensive search for manuscripts were performed by using different combinations of keywords and MeSH terms (Pub-med; Embase; Scopus; Web of Science Core Collection; Medline; Current Contents Connect; Derwent Innovations Index; Scielo Citation Index; Cochrane library). The full text selected articles are written in English, Portuguese, Spanish, Italian, German, or French, and published until 28 of November 2016. Inclusion criteria were: implant osteointegration, radiographic, histologic, and/or histomorphometric analysis, clinical studies in humans using of regenerative medicine. This systematic review was performed by selecting only randomized controlled clinical trials and controlled clinical trials. RESULTS Eighteen published studies (11 CT and 7 RCT) were considered eligible for inclusion in the present systematic review. These studies demonstrated considerable variation of biomaterial and cell technics used, study design, sinus lift technic, outcomes, follow-up, and results. CONCLUSION Only few studies have demonstrated potential of regenerative medicine in sinus lift; further randomized clinical trials are needed to achieve more accurate results.

Two-Dimensional Identification of Fetal Tooth Germs.

Objective To demonstrate the efficiency and applicability of two-dimensional ultrasonography in the identification of tooth germs and in the assessment of potential pathology. Design Observational, descriptive, cross-sectional study. Setting Prenatal Diagnosis Unit of Centro Hospitalar de Vila Nova de Gaia / Espinho–Empresa Pública in Portugal. Patients A total of 157 white pregnant women (median age, 32 years; range, 14 to 47 years) undergoing routine ultrasound exams. Main Outcome Measure(s) Description of the fetal tooth germs, as visualized by two-dimensional ultrasonography, including results from prior fetal biometry and detailed screening for malformations. Results In the first trimester group, ultrasonography identified 10 tooth germs in the maxilla and 10 tooth germs in the mandible in all fetuses except for one who presented eight maxillary tooth germs. This case was associated with a chromosomal abnormality (trisomy 13) with a bilateral cleft palate. In the second and third trimesters group, ultrasonography identified a larger range of tooth germs: 81.2% of fetuses showed 10 tooth germs in the maxilla and 85.0% of fetuses had 10 tooth germs in the mandible. Hypodontia was more prevalent in the maxilla than in the mandible, which led us to use qualitative two-dimensional ultrasonography to analyze the possible association between hypodontia and other variables such as fetal pathology, markers, head, nuchal, face, and spine. Conclusions We recommend using this method as the first exam to evaluate fetal morphology and also to help establish accurate diagnosis of abnormalities in pregnancy.