Idelmo Rangel Garcia

Intraoral approach for surgical treatment of Eagle syndrome.

Eagle syndrome is symptomatic elongation of the styloid process, or calcification of the stylomandibular ligament. Difficulty with deglutition, phonation, cervical movement, and the sensation of a foreign body in the oropharynx are all symptoms of this syndrome. Its treatment consists of partial removal of the styloid process, leaving it within the range of normality. We describe the technique, report a case, and point out some of the advantages, such as the simplicity of the procedure, reduced operating time, and lack risks of operative complications.

Osteocalcin immunolabeling during the alveolar healing process in ovariectomized rats treated with estrogen or raloxifene

The influence of an estrogen-deficient state was evaluated in this study and also its treatments with estrogen (E(2)) or with raloxifene (RLX) on the expression of osteocalcin during the periods of the chronology of the alveolar bone healing process (7, 14, 21, 28 and 42 post-extraction days) by means of immunohistochemistry reactions and histomorphometric analysis. Rats (200-220 g) with oestrus cycles normal were either OVX or sham-operated and divided into four groups: sham, OVX control (OVX/O), estrogen (OVX/E(2); 17 beta-estradiol, 400 microg/mo) and raloxifene (OVX/RLX; 1 mg/kg bw/d) groups. Histomorphometric analysis showed the sham group presented the highest mean value of bone formation post-extraction. The reaction of immunohistochemistry for osteocalcin presented stronger expression of osteocalcin with predominance at 14 and 21 days on sham group. The OVX/RLX group presented better results than OVX/E(2), considering the expression of osteocalcin in osteoblastic lineage cells, but still inferior than the sham group. It was concluded that ovariectomy decreases the mineralization process and the osteocalcin expression during the chronology of the alveolar healing process that is not totally recovered with estrogen replacement or raloxifene treatment.

Evaluation of Immediate Bone-Cell Viability and of Drill Wear After Implant Osteotomies: Immunohistochemistry and Scanning Electron Microscopy Analysis

PURPOSE This study sought to evaluate the effect of repeated implant drilling on the immediate bone-cell viability, and to evaluate drill wear by scanning electron microscopy. MATERIALS AND METHODS The tibiae of 10 rabbits were used, divided into 5 groups (G): G1 corresponded to new drills, and G2, G3, G4, and G5 corresponded to drills used 10, 20, 30, and 40 times, respectively. The animals received 10 sequential osteotomies in each tibia. The animals were euthanized immediately after the osteotomies by perfusion with 4% formaldehyde. Samples then underwent immunohistochemistry processing for ordinal qualitative analysis of osteoprotegerin (OPG), the RANK ligant (RANKL; a tumor-related necrosis factor receptor family), and osteocalcin protein immunolabels, as detected by the immunoperoxidase method and revealed with 3,3-diaminobenzidine. Drill wear and plastic deformation were analyzed by scanning electron microscopy (SEM). RESULTS The proteins were expressed in osteocytes of the superior bone cortical during the 40 drillings. However, in G4 and G5, a discrete increase in the expression of RANKL was observed, when compared with OPG; this increase was statistically significant in G5 (P = .016). The SEM analysis revealed major plastic deformation and drill wear in G4 and G5. CONCLUSION Based on the present methodology, it may be concluded that cell viability is preserved if a less traumatic surgical protocol is used. However, the repeated use of drills alters the protein balance as of the thirtieth perforation.

Effect of unilateral misfit on preload of retention screws of implant-supported prostheses submitted to mechanical cycling

PURPOSE The aim of this study was to evaluate the effect of different levels of unilateral angular misfit on preload maintenance of retention screws of single implant-supported prostheses submitted to mechanical cycling. MATERIALS AND METHODS Premachined UCLA abutments were cast with cobalt-chromium alloy to obtain 48 crowns divided into four groups (n=12). The crowns presented no misfit in Group A (control group) and unilateral misfits of 50 μm, 100 μm and 200 μm in the groups B, C and D, respectively. The crowns were attached to external hexagon implants with a titanium retention screw with torque of 30 N/cm. Oblique loading of 130 N at 2 Hz was applied on each replica, totalizing 5×10⁴ and 1×10⁶ cycles. Detorque values were measured initially and after each cycling period. Data were evaluated by analysis of variance and Tukeys HSD test (p<0.05). RESULTS All groups presented reduced initial detorque values (p<0.05) in comparison to the insertion torque (30±0.5 N/cm) and Group A (25.18 N/cm) exhibited the lowest reduction. After mechanical cycling, all groups presented detorque values from 19.5 N/cm to 22.38 N/cm and the mechanical cycling did not statistically influence the detorque values regardless the misfit level of the replicas. CONCLUSION The unilateral misfit influenced the preload maintenance only before mechanical cycling. The mechanical cycling did not influence the torque reduction.

Comparative study of 2 software programs for predicting profile changes in Class III patients having double-jaw orthognathic surgery.

INTRODUCTION Computer software can be used to predict orthognathic surgery outcomes. The aim of this study was to subjectively compare the soft-tissue surgical simulations of 2 software programs. METHODS Standard profile pictures were taken of 10 patients with a Class III malocclusion and a concave facial profile who were scheduled for double-jaw orthognathic surgery. The patients had horizontal maxillary deficiency or horizontal mandibular excess. Two software programs (Dentofacial Planner Plus [Dentofacial Software, Toronto, Ontario, Canada] and Dolphin Imaging [version 9.0, Dolphin Imaging Software, Canoga Park, Calif]) were used to predict the postsurgical profiles. The predictive images were compared with the actual final photographs. One hundred one orthodontists, oral-maxillofacial surgeons, and general dentists evaluated the images and were asked whether they would use either software program to plan treatment for, or to educate, their patients. RESULTS Statistical analyses showed differences between the groups when each point was judged. Dolphin Imaging software had better prediction of nasal tip, chin, and submandibular area. Dentofacial Planner Plus software was better in predicting nasolabial angle, and upper and lower lips. The total profile comparison showed no statistical difference between the softwares. CONCLUSIONS The 2 types of software are similar for obtaining 2-dimensional predictive profile images of patients with Class III malocclusion treated with orthognathic surgery.

Evaluation of Bone Heating, Drill Deformation, and Drill Roughness After Implant Osteotomy: Guided Surgery and Classic Drilling Procedure

PURPOSE This study evaluated and compared bone heating, drill deformation, and drill roughness after several implant osteotomies in the guided surgery technique and the classic drilling procedure. MATERIALS AND METHODS The tibias of 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG); subgroups were then designated (G0, G1, G2, G3, and G4, corresponding to drills used 0, 10, 20, 30 and 40 times, respectively). Each animal received 10 sequential osteotomies (5 in each tibia) with each technique. Thermal changes were quantified, drill roughness was measured, and the drills were subjected to scanning electron microscopy. RESULTS Bone temperature generated by drilling was significantly higher in the GG than in the CG. Drill deformation in the GG and CG increased with drill use, and in the CG a significant difference between G0 and groups G3 and G4 was observed. In the GG, a significant difference between G0 and all other groups was found. For GG versus CG, a significant difference was found in the 40th osteotomy. Drill roughness in both groups was progressive in accordance with increased use, but there was no statistically significant difference between subgroups or between GG and CG overall. CONCLUSION During preparation of implant osteotomies, the guided surgery technique generated a higher bone temperature and deformed drills more than the classic drilling procedure. The increase in tissue temperature was directly proportional to the number of times drills were used, but neither technique generated critical necrosis-inducing temperatures. Drill deformation was directly proportional to the number of times the drills were used. The roughness of the drills was directly proportional to the number of reuses in both groups but tended to be higher in the GG group.

Preload evaluation of different screws in external hexagon joint.

Purpose: This study compared the maintenance of tightening torque in different retention screw types of implant-supported crowns. Materials and Methods: Twelve metallic crowns in UCLA abutments cast with cobalt-chromium alloy were attached to external hexagon osseointegrated implants with different retention screws: group A: titanium alloy retention screw; group B: gold alloy retention screw with gold coating; group C: titanium alloy retention screw with diamond-like carbon film coating; and group D: titanium alloy retention screw with aluminum titanium nitride coating. Three detorque measurements were obtained after torque insertion in each replica. Data were evaluated by analysis of variance (ANOVA), Tukeys test (P < 0.05), and t test (P < 0.05). Results: Detorque value reduced in all groups (P < 0.05). Group A retained the highest percentage of torque in comparison with the other groups (P < 0.05). Groups B and D retained the lowest percentage of torque without statistically significant difference between them (P > 0.05). Conclusions: All screw types exhibited reduction in the detorque value. The titanium screw maintained the highest percentage of torque whereas the gold-coated screw and the titanium screw with aluminum titanium nitride coating retained the lowest percentage.

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.

Clinical viability of immediate loading of dental implants: part I--factors for success.

Two-stage procedure for dental implants presents corroborated clinical success over 40 years. The evolution of surgical techniques, development of diagnostic methods, knowledge about tissue biology, and quality of implants regarding design and surface supported studies with 1 surgical stage followed by immediate prosthesis placement. However, several factors influence the treatment success with immediate loading. So, this study aimed to evaluate some factors regarding the success and characteristics of implants and patients.

Prosthetic Platforms in Implant Dentistry

AbstractThe use of implant-supported prosthesis to replace missing teeth became a predictable treatment. Although high success rate has been reported, implant treatment is suitable to complications, failures, and limitations such as peri-implant bone loss after implant loading. Stress evaluation on the bone-abutment-implant interface has been carried out to develop new designs of prosthetic platform and to understand the stress distribution in this interface. Several types of prosthetic platforms are available such as external and internal hexagon, Morse cone connection, and the concept of platform switching. Therefore, this study aimed to critically describe the different options of prosthetic platforms in implant dentistry, by discussing their biomechanical concepts, clinical use, and advantages and disadvantages. It was observed that all types of prosthetic platforms provided high success rate of the implant treatment by following a strict criteria of indication and limitation. In conclusion, a reverse planning of implant treatment is strongly indicated to reduce implant overload, and the use of advanced surgical-prosthetic techniques is required to obtain a long-term success of oral rehabilitations.