Aristides da Rosa Pinheiro

MMP13, TIMP2 and TGFB3 Gene Polymorphisms in Brazilian Chronic Periodontitis and Periimplantitis Subjects

Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of periimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of periimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

Chronic Periodontitis and RANKL/OPG Ratio in Peri-Implant Mucosae Inflammation

tHistory of chronic periodontitis (CP) is a risk factor for oseointegration failure. The osteoclastogenesis system (RANK, RANKL and OPG) is critical for bone homeostatic control. We investigated the levels of OPG and RANKL in peri-implant tissues from volunteers with and without a history of CP and their association with mucosae inflammation. This is a single-blind case-contro study. Diagnosis of a history of CP and peri-implant examination was performed on 46 volunteers, divided into control (without history of CP, n=26) and CP group (with history of CP, n=20). Gingival biopsies were harvested during implant exposure. Quantitative PCR evaluated OPG/RANKL mRNA expressions. OPG and RANKL proteins were analyzed by western blot and immunohistochemistry assay. The chi-square test analyzed the significance of nominal variables between groups while continuous variables were analyzed by T-test or Mann-Whitney test, after Shapiro-Wilk test evaluation. The 2-ΔΔCT Livak method calculation evaluated the gene expression. Values of p<0.05 were considered statistically significant. Volunteers with CP history had 23 times higher chance of developing mucosae inflammation. High mucosae levels of RANKL (p=0.04) and RANKL/OPG (p=0.001) mRNA expressions were observed in CP group. CP volunteers showed increased RANKL protein levels in opposition to decreased OPG expression. Even without active periodontitis, volunteers with a history of CP had elevated gingival levels of RANKL/OPG and higher correlation with peri-implant mucosae inflammation and implant loss.

Haplotypes in BMP4 and FGF Genes Increase the Risk of Peri-Implantitis

Despite the success of osseointegrated implants, failures have increased significantly, associated with development of peri-implantitis. Multiple factors influence the peri-implant bone loss, including environmental and genetic causes. BMPs (Bone morphogenetic proteins) are growth factors that induce bone formation. FGF (fibroblast growth factors) and their receptors (FGFRs) play important roles by controlling the levels of cell proliferation, differentiation and migration. BMP/FGF relationship is responsible for promoting bone regeneration and bone loss. The aim of this study was to analyze the correlation between BMP4, FGF3, FGF10 and FGFR1 genes and peri-implant bone loss. Two hundred and fifteen volunteers, with 754 dental implants, were submitted to oral examination and divided in healthy group (n=129) and peri-implantitis group (n=86). Thirteen polymorphisms in BMP4, FGF3, FGF10 and FGFR1 genes were analyzed individually and in haplotype. The chi-square test correlated genotypes, allelic and haplotype frequencies. Values of p<0.05 were considered significant. Volunteers with peri-implantitis demonstrated high incidence of total edentulism (p<0.0001) and thin peri-implant phenotype (p<0.04). Higher incidence of spontaneous bleeding, plaque and implant mobility was observed in peri-implantitis group (p<0.0001 for all). The TT polymorphic genotype for BMP4 rs2761884 was associated with healthy peri-implant (p=0.01). FGF3 rs4631909 (TT+CT genotype) also showed association with the control group (p=0.04). The frequency of C allele for FGF3 rs4631909 showed a tendency for association with peri-implantitis (p=0.08). FGF10 CCTG (p=0.03), BMP4 GAAA (p=0.05) and GGGA (p=0.02) haplotypes were associated with peri-implantitis (p=0.03). Therefore, it may be concluded that BMP4 and FGF10 haplotypes are associated with peri-implantitis.

Prevalência de Anomalia Dentária de Número em Pacientes Submetidos a Tratamento Ortodôntico: um Estudo Radiográfico

Resumen pt: Objetivo: Avaliar a prevalencia das anomalias dentarias de numero em pacientes de 6 a 16 anos de idade, atendidos no servico de Ortodontia do Hospital da...

Peri-implant mucosae inflammation during osseointegration is correlated with low levels of epidermal growth factor/epidermal growth factor receptor in the peri-implant mucosae

Peri-implant mucosae inflammation during osseointegration period can promote host response imbalance and bone resorption by bacteria infiltration. Aim: To evaluate the association between EGF and EGFR gene expressions in the peri-implant tissue with mucosae inflammation during osseointegration period. Material and Methods: Forty-nine participants, with 59 endosseos implants, were recruited for this study. All participants included were rehabilitated with implants in two stages surgical protocol, presenting favorable bone quality and quantity. Osseointegration was evaluated one month after exposure surgery, wich was performed three months (mandible) and 6 months (maxillary) after implant placement. The criteria to consider the proper osseointegration were: Implant immobility; absence of peri-implant radiolucency; and no clinical signs of inflammation. Based on clinical and radiographic characteristics of peri-implant sites, participants were characterized as (i) having healing without complications (with proper osseointegration without mobility of the implant, and without clinical signs of mucosal inflammation) (control group) or (ii) failure peri-implant healing (with inadequate osseointegration characterized by signs of mucosae inflammation and/or implant mobility) (test group). Gingival biopsies were collected from 49 participants after osseointegration period, during the exposure procedure. Total RNA from gingival samples was isolated using the Trizol® reagent. The reaction of reverse transcription of PCR was performed for the synthesis of complementary DNA from 300ng RNA using Improm-II Reverse Transcription System™. Specific primers for EGF (NM_001963.4) and EGFR (NM_005228.3) were based on the BLAST data. The Livak method (2-ΔΔCT) was used to determine the relative quantification of the expression of EGF and EGFR. The values were normalized by relative expression of β-actin. Results: There was no difference between control and test groups to race, sex, age, alcohol consumption, general medical conditions, current medications, edentulism and periodontal phenotype. All RNA samples revealed proportions A260 nm/A280 nm more than 1.9. EGF and EGFR showed significant lower expression in gingival tissues removed from regions with failure healing (test group). EGF showed mRNA expression with an average of 44.53 ± 79.16 and 01.02 ± 1:33 in the control groups and test, respectively (P = 0.008). Similarly EGFR expression was significantly higher in the control group (102.03 ± 329.57) compared to the test group (7.85 ± 4.16) (P = 0:04). Conclusion: Low levels of EGF and EGFR are associated with inadequate healing of mucosal peri-implant during the osseointegration period.

Protocolo de atendimento clínico do curso de especialização em Implantodontia da FO/UFF

Na Faculdade de Odontologia da Universidade Federal Fluminense, o ensino da Implantodontia com atendimento clinico e ministrado no Curso de Especializacao. O futuro paciente e chamado para a consulta pre-clinica apos ter assistido a uma palestra, na qual e informado, orientado e conscientizado sobre os procedimentos que podem ser realizados na clinica de Implantodontia. Aqueles que se encontram em condicoes clinicas favoraveis sao encaminhados para o tratamento, que so e iniciado depois que o paciente leu e assinou o termo de consentimento entregue ao mesmo. O presente artigo tem como proposito apresentar o protocolo de atendimento clinico empregado nos cursos de Implantodontia da FO/UFF (Niteroi).

Satisfação de Pacientes Portadores de Sobredentaduras Mandibulares Implanto-Retidas e Muco-Suportadas

3Especialista em Odontologia do Trabalho. 4 Especialista em Implantodonti a pela Odontoclinica Central do Exercito (OCEX), Rio de Janeiro/RJ, Brasil. 5

Satisfaction of Patients Wearing Implant-retained and Tissue-supported Mandibular Overdentures

Objetivo: Avaliar a satisfacao de individuos portadores de sobredentaduras mandibulares implanto-retidas e muco-suportadas relacionando numero de implantes e tipos de retentores. Metodo: Foram avaliados pacientes oriundos das clinicas dos Cursos de Pos-Graduacao em Implantodontia da Faculdade de Odontologia da Universidade Federal Fluminense, por meio de entrevistas e avaliacao de seus prontuarios, nos quais haviam sido instalados 140 implantes osseointegraveis e 40 sobredentaduras implanto-retidas e muco-suportadas. Cerca de 70% destes pacientes estavam no grupo etario acima de 60 anos e a maioria portava protese total convencional no arco antagonista. Foi feito o levantamento da quantidade de implantes e tipos de retentores utilizados nas reabilitacoes bucais destes pacientes, e avaliadas as relacoes entre estas situacoes e a satisfacao dos pacientes quanto a: funcao, retencao e satisfacao geral. As respostas possiveis variavam de muito insatisfeito a muito satisfeito. Resultados: Observou-se que, em todas as situacoes avaliadas, mais de 87% das respostas fornecidas pelos pacientes quanto a satisfacao era de muito satisfeitos a satisfeitos. Sendo o item retencao o de menor valor e a satisfacao geral o de maior valor. Conclusao: Independente da quantidade de implantes (2, 3 ou 4) e dos diferentes tipos de retentores utilizados (bola encaixe ou barra encaixe), nao houve variacao consideravel na satisfacao dos pacientes portadores de sobredentaduras mandibulares implanto-retidas e muco-suportadas, visto que a maioria deles se declarou satisfeitos ou muito satisfeitos com as categorias incluidas neste estudo.

Prótese inferior implanto-suportada com carga imediata: relato de caso clínico com acompanhamento de dois anos

Rehabilitation using full lower fixed implant-supported prosthesis with immediate loading has been carried out as a viable alternative, with excellent prognosis and comfort for the patient, since it can be completed in a short period of time, thus modifying the twostage surgical protocol for installing implants and subsequently the prosthesis. This procedure becomes viable given the highly successful technique employed, which produces quite satisfactory results. The purpose of this paper is to report a clinical case of immediate loading of osseointegrable implants, using full lower fixed prosthesis, followed up for two years.