Clipping de Literatura Científica de Janeiro-Fevereiro 2010

     Estas sugestões de leitura para o primeiro bimestre de 2010 vieram com bastantes informações interessantes concernentes aos tratamentos já realizados e que corroboram a segurança (muitas vezes acima dos 90%) dos mais variados tipos de tratamento em implantodontia, periodontia e reabilitação oral. Fica abaixo a sugestão.


Neste artigo, os autores tentam estabelecer um modelo para extração dental em pacientes periodontopatas.
Popelut A, Rousval B, Fromentin O, Feghali M, Mora F, Bouchard P. Tooth extraction decision model in periodontitis patients. Clin Oral Implants Res 2010;21(1):80-89.
A decision analysis was created based on a fictitious patient with adult chronic periodontitis with a single tooth with a periodontal defect that may affect the decision process. The decision tree evaluated options based on probabilities identified by a systematic literature analysis. The options, ranked by expected utilities were: no treatment (EU1), periodontal treatment (EU2), extraction followed by FPD (EU3), or extraction followed by implant-supported crown (EU4). It was not possible to calculate EU1 due to the lack of available probabilities. The probabilities indicate that the FPD option was the worst strategy, and it was not possible to differentiate between periodontal therapy or an implant-supported crown. 
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Foi feito um teste para avaliação da formação de biofilme em dois tipos de superfícies de implantes onde conclui-se que as partes dos implantes expostas à mucosa oral deveriam ter superfícies altamente polidas para se prevenir o acúmulo de placa
Bürgers R, Gerlach T, Hahnel S, Schwarz F, Handel G, Gosau M. In vivo and in vitro biofilm formation on two different titanium implant surfaces. Clin Oral Implants Res 2010;21(2):156-164.
Machined or sandblasted and acid-etched titanium specimens were mounted buccally and worn by six volunteers for 12 hours to evaluate in vivo biofilm formation. Bacterial adhesion in vitro was also evaluated. Surface roughness was significantly higher and surface free energy was significantly lower for the sandblasted/acid-etched specimens, and bacterial adhesion was significantly higher both in vitro and in vivo, but there was no significant difference in the percentage of dead cells among adhering bacteria between the two surfaces. Ectopic epithelial cells from the oral mucosa found on the sandblasted/acid-etched specimens but not on the machined specimens. Implant parts that are exposed to the oral mucosa should therefore be highly polished to prevent plaque accumulation.
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 Abaixo, um trabalho para checar se há relação entre a força máxima de mordida na perda óssea de implantes apoiando um tipo de prótese mandibular.
Jofré J, Hamada T, Mishimura M, Klattenhoff C. The effect of maximum bite force on marginal bone loss of mini-implants supporting a mandibular overdenture: a randomized controlled trial. Clin Oral Implants Res 2010;21(2):243-249.
Two mini-implants were placed in the anterior mandible of each of 45 patients; the implants were either ball-type (22 patients) or splinted with a prefabricated bar (23 patients). Maximum bite force and marginal bone loss were assessed at baseline and after 5, 7, 10 and 15 months. The results showed no relationship between maximum bite force and marginal bone loss, although both parameters were higher for the ball mini-implants after 15 months.
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Este, mostra um comparativo entre o uso de implantes curtos e enxerto em altura para regiões posteriores. Mostra, como esperado, que nesses casos há um maior número de complicações.
Felice P, Checci V, Pistilli R, Scarano A, Pellegrino G, Esposito M. Bone augmentation versus 5-mm dental implants in posterior atrophic jaws. Four-month post-loading results from a randomized controlled clinical trial. Eur J Oral Implantol 2009;2(4):267-281.
Patients with bilateral posterior edentulism and residual crest height 5-7 mm (15 patients) or 4-6 mm (15 patients) received either 5 mm long implants or bone augmentation with Bio-Oss and 10 mm long implants in a split-mouth design. In five of the 15 patients in the augmented group there was insufficient mandibular bone height to place 10 mm implants, so 7 and 8-5 mm implants were placed. One implant was found to be mobile in each group. Three complications occurred in the short implant group (maxillary sinus perforation) and two in the augmented group (one maxillary sinus perforation and one mandibular wound dehiscence) and paresthesia occurred in significantly more patients in the augmented group. There was no difference in patient preference between the two groups.
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Os autores fazem comparação do sucesso entre dois tipos diferentes de superfície de implantes e mostram que ambos são interessantes. Entretanto para um determinado grupo de implantes o comprimento menor que 10mm foi associado significantemente com maiores falhas.
Balshe AA, Assad DA, Eckert SE, Koka S, Weaver AL. A retrospective study of the survival of smooth- and rough-surface dental implants. Int J Oral Maxillofac Implants 2009;24(6):1113-1118.
A retrospective review was performed for smooth- and rough-surface implants from 1991-1996 and 2001-2005, respectively, with implants from the first and second periods followed through mid-1998 and mid-2007, respectively, to facilitate the comparison. A total of 2,182 smooth-surface implants were placed in 593 patients and 2,425 rough-surface implants were placed in 905 patients. Five-year survival rates were 94.0% for smooth implants and 94.5% for rough implants. Implant length ≤ 10 mm and anatomic location were significantly associated with implant failure for smooth implants but were not risk factors for rough implants.
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Nesta pesquisa, mostra-se correçalação entre diabetes tipo 2 e periodontite crônica. Conclusão parece indicar que o tratamento desta auxilia na melhora de biomarcadores daquela patologia.
Correa FOB, Gonçalves D, Figueredo CMS, Bastos AS, Gustafsson A, Orrico SRP. Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes. J Clin Periodontol 2010;37(1):53-58.
Periodontal clinical parameters were evaluated in 23 patients with types 2 diabetes and chronic periodontitis, and plasma levels of high-sensitivity capsule reactive protein (hs-CRP), fibrinogen, TNF-α and IL-4, -6, -8 and -10 were analyzed, in addition to HbA1c and fasting plasma glucose. Evaluations were performed before and after 3 months of non-surgical periodontal therapy. A significant improvement in all parameters was observed after 3 months, with a tendency towards decreased levels of biomarkers, and a non-significant reduction of hs-CRP and HbA1c.
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 No artigo, houve comparação de uma técnica de recobrimento gengival (já utilizamos no nosso consultório) com e sem EMD (um tipo de matriz de esmalte). Os resultados não mostraram diferença, todavia mostraram que a técnica é bastante efetiva.
 Aroca S, Keglevich T, Nikolidakis D, Gera I, Nagy K, Azzi R, Etienne D. Treatment of class III multiple gingival recessions: a randomized clinical trial. J Clin Periodontol 2010;37(1):88-97.
In 20 patients, a modified tunnel/connective tissue graft technique was used to treat class III gingival recessions in one side of the mouth (control), while EMD was used in addition to the technique in the other side (test). Clinical parameters were evaluated at 28 days and 3, 6 and 12 months. Mean root coverage at 12 months was 82% and 83% for the test and control groups, respectively, with complete root coverage obtained in 38% of cases. The modified tunnel/connective tissue technique is therefore suitable in the treatment of recession defects, and is not enhanced by the addition of EMD.
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Nesta revisão, os autores fizeram comparação entre as taxas de sucessos de 3 sistemas de implantes associados aos seus comprimentos e diâmetros. Resultados mostram que implantes curtos (menores que 9mm) e de diâmetros menores apresentam maiores falhas.
Olate S, Lyrio MCN, de Moraes M, Mazzonetto R, Moreira RWF. Influence of diameter and length of implant in early implant failure. J Oral Maxillofac Surg 2010;68(2):414-419.
Three different implant systems and two surgical techniques were evaluated in a retrospective study of 1,649 implants in 650 patients. Implant lengths were classified as short (6-9 mm), medium (10-12 mm) or long (13-18 mm) and diameters were classified as wide, regular or narrow. Early overall survival rate was 96.2%; 50 implants were lost. In terms of implant diameter, narrow implants failed most (5.1%) followed by regular (3.8%) and wide (2.7%). A significantly higher failure rate was also observed in short implants (9.9%) versus medium (3.0%) or ling (3.4%) implants, and in implants placed in the anterior (4.3%) versus the posterior (2.8%).
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Aqui os autores mostram que o uso de enxertos xenógenos (osso anorgânico 100% bovino) para Levantamento de Seio Maxilar (para instalação de implantes) possui grande segurança.
Ferreira CEA, Novaes AB Jr, Haraszthy VI, Bittencourt M, Martinelli CB, Luczyszyn SM. A clinical study of 406 sinus augmentations with 100% anorganic bovine bone. J Periodontol 2009;80(12):1920-1927.
Sinus grafting with anorganic bovine bone was performed in 222 patients requiring unilateral sinus grafting and 92 patients requiring bilateral sinus grafting; a total of 1,025 implants were placed (118 simultaneous with grafting and 907 at second stage surgery after 6-12 months). After 3 years, the implant survival rate was 98.1% (19 implants were lost), with no significant differences in survival between implants with rough or machined surfaces, or between implants placed in various heights of native bone. Histomorphometry showed 39.0 ± 12% new bone formation and 52.9% ± 9.3% marrow space.
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Neste artigo, é feita comparação de abordagens atuais relacionando tipo de material para coroas (cerâmica pura, metalocerâmica) e posição do término do preparo. Conforme esperado, todas as abordagens são válidas, entretanto houve menor acúmulo de placa nas coroas de cerâmica pura e o término supra-gengival foi o mais vantajoso.
Kosyfaki P, Pinilla Martín MdelP, Strub JR. Relationship between crowns and the periodontium: a literature update. Quintessence Int 2010;41(2):109-122.
Electronic and manual literature searches were performed for information on crown margin, marginal fit, crown material and crown contour and their relationship to the periodontium. A total of 64 studies were identified. Results showed that the supragingival location is the most advantageous, but that an intracrevicular location in the anterior zone may be preferable for esthetics. Marginal fit is acceptable with both all-ceramic and metal-ceramic crowns, but plaque retention is lower with ceramic materials, and periodontal health and esthetics can be shown with normal crown contours. Current approaches were therefore confirmed.
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