Murillo Sucena Pita

Reconstruction of skull defects: currently available materials.

The restoration and recovery of a compromised skull continues to be a challenge to craniofacial surgeons and neurosurgeons. Different operative techniques and implant materials are being used to reconstruct the rigid framework of the skull. However, no currently available materials satisfy all of these criteria. According to this premise, the aim of this study was to report on the currently available materials for the reconstruction of the cranial vault and to describe their main characteristics, advantages, and disadvantages. Although the use of the materials discussed in this study is clearly positive for the reconstruction of skull defects and cranioplasties, there is a need for more complex studies and research into developing these materials to achieve all the ideal prerequisites stipulated by the scientific community and to evaluate their properties and aesthetic and functional results in the long term.

Microbiome of titanium and zirconia dental implants abutments

OBJECTIVES This study employed culture-independent molecular techniques to extend the characterization of the microbial diversity of biofilm associated with either titanium or zirconia implant-abutments, including not-yet-cultivated bacteria species, and to identify and quantify species recovered from peri-implantar/periodontal sulci, supragingival biofilm and the internal parts of implants. Probing depth, clinical attachment level, bleeding on probing, and marginal bone level were also evaluated over time and correlated with biofilm formation. METHODS Twenty healthy participants were analyzed. DNA-Checkerboard and 16S-rDNA-Pyrosequencing were used to quantify and determine species identity. RESULTS 161 bacterial taxa representing 12 different phylotypes were found, of which 25% were non-cultivable. Species common to all sites belonged to genera Fusobacterium, Prevotella, Actinomyces, Porphyromonas, Veillonella and Streptococcus. While some species were subject-specific and detected in most sites, other species were site-specific. Moderate to higher levels of unclassified species were found colonizing titanium-related sites. Pathogenic and non-pathogenic species were detected colonizing oral sites in both materials. Titanium-related sites presented the highest total microbial count and higher counts of pathogenic species. CONCLUSIONS Our results revealed differences regarding microbial diversity and microorganisms counts in oral biofilm associated with titanium or zirconia. The obtained data suggests a possible relation between microbiological findings and clinical outcomes. SIGNIFICANCE Next-generation methods of detection have provided new insights on complex microbiota colonizing different sites of oral cavity. The present study demonstrates relevant differences in the communities and microbial counts colonizing different tested substrates with consequent significant differences in the clinical-outcomes, suggesting a probably different mechanism for specific bacterial adhesion.

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.

Oral biofilm formation on the titanium and zirconia substrates

OBJECTIVE: The aim of this randomized crossover investigation was to assess the biofilm formation on two titanium and one zirconia substrates in relation to the topography and surface roughness of the materials. METHODS: Twenty‐four discs specimens for each evaluated material (Machined pure titanium, Cast pure titanium, or Zirconia) were evaluated after oral cavity exposure in six healthy subjects. The study was conducted in 3 phases according to the material evaluated. Each subject was asked to use a removable splint containing 4 disks of the same tested substrate, 2 located in the anterior, and 2 in the posterior region. Participants were asked to use the intraoral splint during 24 h. The total biofilm covering on the discs was evaluated by 1% of neutral red staining. EMV and surface roughness was carried out to correlate with the biofilm found between different substrates. RESULTS: Data showed higher mean roughness values for zirconia (Zc) when compared with titanium specimens (MPT and CPT; P < 0.001). MPT and CPT presented no differences between them (P > 0.05). The mean percentage (%) of covering biofilm on substrates was 84.14 for MPT, 86.22 for CPT and 90.90 for Zc. CONCLUSION: There were no significant differences in the total area of formed biofilm among the tested groups. No correlation was found between surface roughness and the total amount of formed biofilm in the groups. Microsc. Res. Tech., 2013.

In vivo evaluation of Candida spp. adhesion on titanium or zirconia abutment surfaces

OBJECTIVE Candida spp. have been found colonising implant sites in healthy or diseased subjects. The aim of this in vivo study was to evaluate the Candida spp. adhesion on machined or cast titanium and zirconia (Zc) abutment substrates. DESIGN Six healthy subjects were enrolled in this randomised crossover clinical investigation. The study was conducted in three phases according to evaluated substratum. Participants were advised to use an intraoral splint containing four discs of the same tested substrate for 24h. Two discs were located in the anterior region and two in the posterior region. DNA checkerboard hybridisation method was used to detect and quantify five different Candida species. Data on the surface roughness and the total area of discs covered by formed biofilm were also provided to correlate the species and biofilm found between different substrates. RESULTS Zc presented the highest means of surface roughness. Total area of the biofilm covering was not different in the tested groups. Moderate to high levels of target microorganisms were recorded for all the tested substrates. Zc showed the lowest indices, followed by machined pure titanium (MPT) and cast and polished titanium (CPT). Candida albicans and Candida krusei were not detected in the Zc group. The region of disc placement did not show differences in relation to Candida adhesion. CONCLUSIONS There was a significant difference in the total cell count between the three groups. CPT presented the higher mean counts, followed by MPT and Zc. There was no positive correlation between the cell counts recorded and the surface roughness or total area of formed biofilm.

Marginal fit and microbial leakage along the implant-abutment interface of fixed partial prostheses: An in vitro analysis using Checkerboard DNA-DNA hybridization

STATEMENT OF PROBLEM Bidirectional leakage through the implant-abutment interface still constitutes a major concern in implant-supported restorations. PURPOSE The purpose of this in vitro study was to evaluate the marginal fit, before and after loading simulation, of 3-unit fixed partial prostheses supported by external hexagon or Morse cone implants and to identify and quantify up to 43 microbial species penetrating through the implant-abutment interface after loading. MATERIAL AND METHODS Forty-eight dental implants with external hexagon (EH; n=24) or Morse cone (MC; n=24) connections were investigated. Experimental specimens were made from 2 implants restored with a 3-unit fixed partial prosthesis and divided into 2 groups (n=12) according to platform connection EH or MC. Vertical misfit at the implant-abutment interface was measured before and after loading (150 Ncm during 500,000 cycles at 1.8 Hz). checkerboard DNA-DNA hybridization was used to identify and quantify up to 38 bacterial and 5 Candida species colonizing the internal parts of the implants after loading. Generalized estimating equations were used for statistical analysis (α=.05). RESULTS The mean values (mm, ±SD) of vertical misfit for EH were 0.0131 ±0.002 before loading and 0.0138 ±0.002 after loading and for MC were 0.0132 ±0.003 before loading and 0.0137 ±0.001 after loading. Twenty-one bacterial species, including periodontal pathogens and C. albicans, were found colonizing the inner surfaces of EH implants after loading. None of the target species were detected in the internal parts of MC implants. CONCLUSIONS EH implants showed higher microbial counts than MC implants, in which microbial colonization was not found after loading. Detected species included nonpathogens and microorganisms related to periodontal/periimplant diseases. Further studies are needed to evaluate the effect of loading simulation on the marginal misfit of 3-unit fixed partial prostheses supported by EH or MC implants, because no significant differences could be found either before or after loading.

Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching

The extent of separation between the maxillary and mandibular teeth in the fabrication of interocclusal splints designed to achieve efficiency and muscle relaxation is controversial and undefined in the literature. Based on this premise, the aim of this study was to evaluate the effect of interocclusal splint thicknesses of 3 and 6 millimeters on the electrical activity of the anterior temporal and masseter muscles during rest and dental clenching. Twenty asymptomatic individuals (10 males and 10 females) were selected using the Research Diagnostic Criteria (RDC). Electromyography (EMG) was performed both with and without the 3- and 6-mm splints using the Bio EMG software package, which recorded values given in microvolts (µV). The results, which were assessed using analysis of variance (ANOVA) to a 5% significance level (p < 0.05), showed increased electrical activity of the masticatory muscles during dental clenching compared with at rest, with greater activity in the masseter muscle. The electrical activity did not differ according to the thickness of the splints or between males and females. We can conclude that both splint thicknesses are effective in treating muscle hyperactivity given their similar clinical behavior for asymptomatic individuals.

Effectiveness of three antimicrobial mouthrinses on the disinfection of toothbrushes stored in closed containers: a randomized clinical investigation by DNA Checkerboard and Culture.

OBJECTIVES The aim of this in vivo study was to evaluate the efficacy of three antimicrobial solutions on the disinfection of toothbrushes after storage in closed containers. MATERIALS AND METHODS Sixteen healthy subjects were enrolled in this randomized cross-over clinical investigation. The study was conducted in four phases, in which mouthrinses (chlorhexidine gluconate-based or cetilpiridinium-based) and sterile tap water (control group) were used to individually store used toothbrushes in closed containers during 7 days of toothbrushing. Five toothbrushes were used as negative control for bacterial colonisation before contact with oral cavity. Conventional culture and DNA Checkerboard hybridization were used to detect bacterial contamination on the toothbrushes. Subsequently, the number of bacterial species on the bristles was estimated by the DNA Checkerboard method. RESULTS One toothbrush presented bacterial contamination in the negative control test. Both culture and DNA Checkerboard showed positive signals of bacterial contamination in the toothbrushes with no differences in the frequency of detection. The control group showed higher total bacterial counts when compared with the mouthrinse groups. Porphyromonas gingivalis had the highest bacterial count followed by Parvimonas micra. CONCLUSION Culture and DNA Checkerboard showed positive signals of bacterial contamination. Mouthrinses that contains 0.12% of chlorhexidine gluconate were more effective in reducing bacterial colonisation on the toothbrushes.

Impact of temperature and time storage on the microbial detection of oral samples by Checkerboard DNA–DNA hybridization method

PURPOSE Molecular diagnosis methods have been largely used in epidemiological or clinical studies to detect and quantify microbial species that may colonize the oral cavity in healthy or disease. The preservation of genetic material from samples remains the major challenge to ensure the feasibility of these methodologies. Long-term storage may compromise the final result. The aim of this study was to evaluate the effect of temperature and time storage on the microbial detection of oral samples by Checkerboard DNA-DNA hybridization. METHODS Saliva and supragingival biofilm were taken from 10 healthy subjects, aliquoted (n=364) and processed according to proposed protocols: immediate processing and processed after 2 or 4 weeks, and 6 or 12 months of storage at 4°C, -20°C and -80°C. RESULTS Either total or individual microbial counts were recorded in lower values for samples processed after 12 months of storage, irrespective of temperatures tested. Samples stored up to 6 months at cold temperatures showed similar counts to those immediately processed. The microbial incidence was also significantly reduced in samples stored during 12 months in all temperatures. CONCLUSIONS Temperature and time of oral samples storage have relevant impact in the detection and quantification of bacterial and fungal species by Checkerboard DNA-DNA hybridization method. Samples should be processed immediately after collection or up to 6 months if conserved at cold temperatures to avoid false-negative results.

Genomic identification and quantification of microbial species adhering to toothbrush bristles after disinfection: A cross-over study

PURPOSE The aim of this clinical investigation was to identify and quantify the microbial species adhering to toothbrush bristles after controlled brushing and storage in different antimicrobial agents. METHODS Sixteen healthy participants were enrolled in this study and randomly submitted to 4 interventions in a cross-over design: brushing and toothbrush storage in (I) Periogard/(II) Periobio (Chlorhexidine gluconate 0.12%), (III) Cepacol (cetylpyridinium chloride 0.05%) and (IV) distilled water (positive control). Thirty-eight bacterial species including putative pathogens and 5 Candida spp. were assessed by Checkerboard DNA-DNA hybridization. RESULTS The results of the study have shown a striking reduction of the total microbial counts, including bacteria and Candida spp., on the toothbrush bristles after storage in cetylpyridinium chloride 0.05% (p < 0.0001). Chlorhexidine gluconate 0.12% showed no differences on the total bacterial count when compared to distilled water (p > 0.05). Cetylpyridinium chloride solution also presented the lowest genome counts and frequency of detection for individual target species; distilled water showed the highest individual genome counts (p < 0.05). Potential pathogenic species were recorded in moderate to high levels for chlorhexidine gluconate and distilled water. CONCLUSION Cetylpyridinium chloride 0.05% was the most effective storage solution in the reduction of total and individual microbial counts, including pathogenic species.