Gabriel Ramalho-Ferreira

Raloxifene enhances peri-implant bone healing in osteoporotic rats

The aim of this study was to evaluate bone healing at the bone-implant interface in rats with induced osteoporosis. The rats underwent a bilateral ovariectomy (OVX) and were fed a low calcium and phosphate diet. The OVX rats were divided into three groups: one was treated with raloxifene (OVX-RAL), one with alendronate (OVX-ALE), and one received no medication (OVX-NT). The control group rats (SHAM-DN) underwent sham surgery and were fed a normal diet. Each animal received one implant in each tibia: a machined surface implant in the right tibia and an implant with surface etching in the left tibia. All animals were euthanized after 42 days. Analysis of variance (ANOVA) and Tukey post hoc tests were applied to the biomechanics (reverse torque) and bone-implant contact (BIC) data (P<0.05). The RAL and ALE groups showed improved peri-implant bone healing. However, the ALE group showed no significant difference from the OVX-NT group. Surface treatment promoted higher corticalization at the bone-implant interface, but showed the same characteristics of mature bone and bone neoformation in concentric laminations as the machined implant. There were no statistically significant differences in reverse torque (P=0.861) or BIC (P=0.745) between the OVX-RAL and SHAM-DN groups. Therefore, the use of raloxifene resulted in good biomechanical, BIC, and histological findings in the treatment of induced osteoporosis in rats.

Effect of bleaching agents and soft drink on titanium surface topography

The effects of carbamide peroxide, hydrogen peroxide and cola soft drink on the topographic modifications of commercially-pure titanium (CP-Ti) and Ti-6Al-4V were investigated. Ti discs were divided into 18 groups (n = 4) based on the solution treatment and Ti type. Specimens were immersed in 3 mL of each solution for 4 h per day (for the remaining 20 h, discs were left dry or immersed in artificial saliva) for 15 days. For control, specimens were immersed in only artificial saliva. Ti surfaces were examined using scanning electron (SEM) and atomic force (AFM) microscopes and their surface roughness (in µm) and surface chemical modifications were investigated. Data were analyzed by ANOVA and Tukeys test (α = 0.05). Groups immersed in 35% hydrogen peroxide showed the highest roughness (Ra) (171.65 ± 4.04 for CP-Ti and 145.91 ± 14.71 for Ti-6Al-4V) (p < 0.05), followed by groups treated with carbamide peroxide 16% (110.91 ± 0.8 for CP-Ti and 49.28 ± 0.36 for Ti-6Al-4V) and 35% (65.67 ± 1.6 for CP-Ti and 53.87 ± 1.98 for Ti-6Al-4V); treatment with artificial saliva did not affect the results. These values were statistically superior to those observed prior to the treatment and to those of the control group (31.0 ± 0.99 for CP-Ti and 29.95 ± 0.58 for Ti-6Al-4V). Cola soft drink did not alter the surface roughness of either Ti type (p > 0.05). SEM and AFM revealed dramatic changes in the specimens surfaces immersed in the 35% hydrogen peroxide, mainly for CP-Ti. No detectable chemical modifications on the Ti surface were observed. Bleaching agents promoted significant changes in Ti topography, which could affect the longevity of implants treatments.

Mandibular movement restoration through bilateral coronoidectomy by intraoral approach.

The present study aimed at reporting a clinical and surgical case of bilateral coronoidectomy, using an intraoral approach. The patient is a 26-year-old man, who sought attendance complaining of a gradual reduction of his oral opening in the past 3 years; however, he had an aggravation in the last 2 months. After clinical examination and imaging evaluation, the diagnosis of coronoid process hyperplasia was confirmed, and the surgical treatment was proposed. Under general anesthesia, with nasotracheal intubation guided by a nasofiberendoscope, using an intraoral approach, the bilateral coronoidectomy was performed. In the immediate postoperative period, an increase of the buccal opening measured 29 mm, representing an enhancement of 11 mm, and in the 30th postoperative day, it measured 31.12 mm. During the clinical follow-up period, a reestablishment of the mandibular movements was observed. Therefore, coronoidectomy by an intraoral approach and the physiotherapy performed in the postoperative period were efficient procedures.

Alveolar bone dynamics in osteoporotic rats treated with raloxifene or alendronate: confocal microscopy analysis

Abstract. In this study, the characteristics of the alveolar bone of rats with induced osteoporosis were examined. Thirty-two rats were divided into four groups according to the induction of osteoporosis and drugs administered: OG, osteoporotic rats without treatment (negative control); SG, rats which underwent sham surgery ovariectomy (SHAM); alendronate (AG), osteoporotic rats treated with alendronate; and RG, osteoporotic rats treated with raloxifene (RG). On the 8th day after ovariectomy and SHAM surgeries, drug therapy was started with AG or RG. On the 52nd day, 20  mg/kg calcein was administered to all of the rats, and on the 80th day, 20  mg/kg alizarin red was administered. Euthanasia was performed on the 98th day. The bone area marked by fluorochromes was calculated and data were subjected to two-way ANOVA test and Tukey’s post-hoc test (p<0.05). The comparison of the induced osteoporosis groups showed no statistically significant differences in bone turnover only between RG and SG (p=0.074) and AG and OG (p=0.138). All other comparisons showed significant differences (p<0.001). The largest bone turnover was observed in RG and SG groups. RG was the medication that improved the dynamics of the alveolar bone of rats with induced osteoporosis, resembling that of healthy rats.

The influence of bone quality on the biomechanical behavior of full-arch implant-supported fixed prostheses.

We evaluated the influence of bone tissue type on stress distribution in full-arch implant-supported fixed prostheses using a three-dimensional finite element analysis. Stresses in cortical and trabecular bones were also investigated. Edentulous mandible models with four implants inserted into the interforaminal region were constructed from different bone types: type 1 - compact bone; type 2 - compact bone surrounding dense trabecular bone; type 3 - a thin layer of compact bone surrounding trabecular bone; and type 4 - low-quality trabecular bone. The mandible was restored with a full-arch implant-supported fixed prosthesis. A 100-N oblique load was applied to the left lower first molar of the prosthesis. The maximum (σmax) and minimum (σmin) principal stress values were determined. The σmax in the type 4 cortical bone was 22.56% higher than that in the type 1 bone. The σmin values in the cortical bone were similar among all the bone types. For the superstructure, increases of 9.04% in the σmax and 11.74% in the σmin in G4 (type 4 bone) compared with G1 (type 1 bone) were observed. For the implants, the highest stress values were located in G4, and the lowest values were observed in G1. In the trabecular bone, the highest stress was generated in G1 and G2. In conclusion, the more compact bones (types 1 and 2) are the most suitable for supporting full-arch implant-supported fixed prostheses, and poor bone quality may increase the risk of biological and mechanical failure.

Reconstruction of extensive frontal fracture with titanium mesh.

When local flap options are not available or suitable, the best choice of regional reconstruction method is the forehead flap. The skin of the forehead has perfect color and tissue match with the nose, lips, as well as the medial canthal and malar regions. Paramedian forehead flap is widely accepted as the workhorse flap for nasal reconstruction. The paramedian forehead flap is an axial flap that is perfused by the supratrochlear artery as major and the supraorbital artery as minor pedicle. Vertical paramedian flap length is limited with hairline. Obliquely oriented flap can be used to increase the length. In our case, local flaps from the malar region were not reliable because of a previously performed surgery. We preferred deepithelialized modification of paramedian forehead flap instead of standard fashion because of the thickness heterogeneity of the cavity. The distal portion of the flap was folded to fill the deeper caudal part of the defect. The fullthickness skin graft obtained from the flap was used to cover the defect. Thus, the cavitary defect was filled and no additional morbidity was formed for skin graft harvesting. Being a 2-stage procedure is the most important disadvantage of forehead flap. The perfect color and tissue match with the infraorbital region makes this disadvantage negligible. With our modification, a cavitary infraorbital defect could be reconstructed, preserving the contour of the cheek and also achieving color and tissue match. Cemil Ozerk Demiralp, MD Department of Plastic Reconstructive and Aesthetic Surgery Ataturk Training and Research Hospital Ankara, Turkey

Short dental implants in posterior mandible.

The rehabilitation with oral implants is, without any doubt, a consecrated technique. But often we face situations of high bone atrophy where the conventional installation of dental implants is not possible. The posterior mandible, when severely resorbed, generally requires complex techniques to be rehabilitated with implants, such as the lateralization of the inferior alveolar nerve. As an option for these cases, this paper proposes the use of short implants for the rehabilitation of severely resorbed posterior mandible.

Compound Odontoma in a Pediatric Patient With Aspects Similar to Complex Odontoma.

Division of Oral and Maxillofacial Surgery Department of Surgery and Integrated Clinic Aracatuba Dental School Univ. Estadual Paulista Julio de Mesquita Filho (UNESP)

Surgical techniques for maxillary bone grafting - literature review

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.

Unerupted lower third molar extractions and their risks for mandibular fracture.

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.