Purpose: Hypertension is a major risk factor for cardiovascular diseases, which has been related ... more Purpose: Hypertension is a major risk factor for cardiovascular diseases, which has been related to such changes as gradual bone loss and a decrease in bone mass index. The cellular and molecular mechanisms that involve hypertension and osteoporosis are not fully understood. Many patients have high blood pressure, controlled or uncontrolled, and may use at least 1 antihypertensive drug, and an understanding of the interference of hypertension with bone healing is very important when considering oral rehabilitation with implants and bone grafts. This study investigated the interference of hypertension in bone metabolism during the repair process of autogenous bone grafting and analyzed the influence of losartan, an antihypertensive drug and angiotensin II receptor antagonist, through histometric and immunohistochemical analyses by examining the protein expressions of osteocalcin, osteoprotegerin, receptor activator of nuclear factor-kB, receptor activator of nuclear factor-kB ligand,...
The installation of implants has become a routine procedure in the clinic. However, it takes time... more The installation of implants has become a routine procedure in the clinic. However, it takes time and adequate bone thickness, and for that, tissue engineering has made efforts to develop substitutes for autografts, in view of certain disadvantages of this material. The decision to choose the most suitable graft material for each case is an important step in the success of bone reconstruction. This study was to verify, by means of immunohistochemical study, that the addition of bone morphogenetic protein had some influence on biomaterials commercially available, taking into account the formation of mineralized tissue, bone replacement, and the amount of degradation of biomaterials. The sample consisted of 72 rats that were divided into eight treatment groups, in which two defects of 5 mm were made in each animal calvaria. Euthanasia was performed at 5, 15, and 30 days postop. A histologic and histometric analysis was performed to quantitate the area of mineralized tissue formed, the...
Objectives Alendronate and raloxifene, a bisphosphonate and a selective estrogen modulator, respe... more Objectives Alendronate and raloxifene, a bisphosphonate and a selective estrogen modulator, respectively, are established osteoporosis therapies. Current evidence suggests that simultaneous application of osteoporosis therapies modulates osseointegration. However, alendronate shows inconsistent findings and raloxifene has not been studied comprehensively. This study aimed to evaluate the bone dynamics and molecular and microstructural features at the peri-implant bone interface in osteoporotic rats. Materials and methods Thirty female rats underwent ovariectomy and were fed a diet low in calcium and phosphate and treated with alendronate or raloxifene for 30 days or underwent fictional ovariectomy surgery (SHAM) prior to implant insertion in the tibia; osteoporosis therapies continued thereafter. After 42 days, peri-implant bone was evaluated by histometric and micro-CT analysis. Fluorochrome incorporation and gene expression was determined to evaluate bone turnover. Results We report here that alendronate had no impact on bone-to-implant contacts and the mineral apposition rate. The RANKL/OPG ratio and local bone volume, however, were increased compared to the untreated osteoporotic rats. Even though signaling to bone resorption activity through RANKL production was observed in the alendronate group, the blockade of bone resorption activity that occurs in decorrence to alendronate activity took place and resulted in an increase in bone volume. Raloxifene significantly increased osseointegration in osteoporotic rats, as indicated by bone-to-implant contacts, mineral apposition, and local bone volume. Raloxifene, however, had no considerable impact on the RANKL/ OPG ratio compared to untreated osteoporotic rats. As expected, the SH group showed higher bone-to-implant contacts and mineral apposition rates than the untreated osteoporotic rats. Conclusions These findings suggest that raloxifene but not alendronate can compensate for the impaired osseointegration in osteoporotic rats. Clinical relevance Regarding the superiority of raloxifene observed in the improvement of bone dynamics response, this statement suggests that raloxifene could be a good option for osteoporosis patients in oral rehabilitation procedures.
This study aimed to assess the biological response of BMP-2 (bone morphogenetic protein-2) in sup... more This study aimed to assess the biological response of BMP-2 (bone morphogenetic protein-2) in supplementation with β-tricalcium phosphate (TCP) as a carrier in the bone healing of surgical defects in rats' calvaria. A critical-size defect (5mm in diameter) was filled with β-TCP alone or added with that plus 5mg of BMP-2 at 5, 15, and 30 postoperative days. Histomorphometric and immunohistochemical (osteocalcin, collagen type I, and metalloproteinase-9) analysis was performed to assess the features of bone healing. Histological behavior and collagen type I labeling showed increased formation of the collagen matrix, leading to a higher percentage of newly formed bone and biomaterial for tissue and more total mineralization of pure TCP when compared to the other groups. The supplementation with BMP-2 promoted faster TCP remodeling; however, there was no statistically significant difference for the bone formed in both groups (P>0.05). Collagen-matrix formation and new bone format...
Supplementation of bone substitutes with recombinant platelet-derived growth factor-BB (PDGF-BB) ... more Supplementation of bone substitutes with recombinant platelet-derived growth factor-BB (PDGF-BB) can enhance bone regeneration. The aim of the study was to evaluate the effect of PDGF-BB on bone formation in the presence of β-tricalcium phosphate and bovine bone mineral matrix in a rat calvaria defect model. The authors examined 5 mm rat calvarial defects treated with β-tricalcium phosphate (TCP) or demineralized bovine bone mineral (DBBM) with and without 0.3 mg/ml recombinant PDGF-BB. Calvaria defects were randomly divided into the following treatment groups (n = 5); TCP; TCP plus PDGF-BB; DBBM; DBBM plus PDGF-BB; and untreated empty control. After 45 days, bone formation was evaluated by histomorphometry and fluorescence microscopy. The authors report that the area of newly formed bone was similar between the empty controls and the two bone substitutes, TCP and DBBM. Supplementation of TCP and DBBM with PDGF-BB had no significant impact on bone formation. Fluorochrome staining re...
The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following i... more The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and μCT analysis. Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Hi...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2015
The scientific and technological advancement of cosmetic dentistry has improved metal-free cerami... more The scientific and technological advancement of cosmetic dentistry has improved metal-free ceramic systems for fixed prosthodontics as well as porcelain veneers, making them an excellent treatment option for delivering superior cosmetic results. The authors present a clinical case of full-mouth rehabilitation using all-ceramic restorations with porcelain metal-free unit crowns in the maxilla, and porcelain veneers from the left inferior premolar to the right inferior premolar. Using this approach, they were able to achieve an excellent esthetic and functional result for the patient.
suture was performed with 4-0 nylon (Figs. 2D-F). One year postoperatively, complete bone regener... more suture was performed with 4-0 nylon (Figs. 2D-F). One year postoperatively, complete bone regeneration was verified, with great healing aspect and significant improvement in patient's occlusion, who is still under orthodontic treatment (Figs. 1E, F). The surgical procedure was performed in some stages because there were many teeth to be extracted. As bone defect created by the procedure was great, it was established to perform bone grafting with lyophilized bovine bone and guide bone regeneration. Therefore, despite considering the genetic theory of etiology, it is still quite unclear. It is known that genetics does not follow a simple Mendelian pattern, and environment can have such an important influence; therefore, cases have been reported in nonsyndromic patients with no family history of dental anomalies.
Department of Dentistry Materials and Prosthesis Faculty of Dentistry of Aracatuba University of ... more Department of Dentistry Materials and Prosthesis Faculty of Dentistry of Aracatuba University of the State of Sao Paulo
Department of Dental Materials and Prosthodontics Sao Jose dos Campos Dental School Sao Paulo Uni... more Department of Dental Materials and Prosthodontics Sao Jose dos Campos Dental School Sao Paulo University (UNESP), Sao Jose dos Campos
FIGURE 3. A, Removal of the fistula. B, Exposure of buccal fat pad. C and D, Closing the first la... more FIGURE 3. A, Removal of the fistula. B, Exposure of buccal fat pad. C and D, Closing the first layer. FIGURE 1. Initial clinical image. FIGURE 2. Preoperative panoramic radiograph.
The aim of this study was to evaluate the dental socket bone healing process by histomorphometric... more The aim of this study was to evaluate the dental socket bone healing process by histomorphometric and immunohistochemical analysis of osteoprotegerin (OPG), receptor activator of nuclear factor-κβ (RANK), and receptor activator of nuclear factor-κβ ligand (RANKL) proteins in spontaneously hypertensive rats (SHR). Under general anesthesia, 25 Wistar rats and 25 SHRs underwent upper right incisor extraction. Rats were euthanized after 7, 14, 21, 28, or 42 days of dental extractions. Histomorphometric and immunohistochemical analyses of OPG, RANK, and RANKL proteins were performed. Histomorphometric results showed decreased bone healing and reduced bone trabecular thickness in SHRs. Immunohistochemical reactions showed intense RANKL and RANK immunolabeling at 14 and 28 postoperative days and mild OPG immunolabeling at 7, 14, and 21 days after surgery in SHRs. The results of this study show that RANK, RANKL, and OPG immunolabeling was altered in SHRs, and these results are associated wi...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
The prevalence of dental trauma and its consequences are challenging. This article presents a cli... more The prevalence of dental trauma and its consequences are challenging. This article presents a clinical case of a 9-year-old female who was in a bicycling accident and had a dental intrusion of the left maxillary lateral incisor with extensive dislocation. In the emergency department, surgical repositioning of the intruded tooth and a splinting with steel wire and composite resin was performed and the soft-tissue lesions were sutured. Two weeks after the first visit, pulp necrosis was found and endodontic treatment of the intruded tooth was started with a calcium hydroxide dressing. Despite the traumatic nature of the dental injury, the result of treatment was favorable. After 3 years of follow-up, repair of the resorptions and no signs of ankylosis of the teeth involved were evident. Considering the patient's age and the extent of intrusion, it was concluded that surgical repositioning associated with adequate endodontic therapy was an effective alternative treatment for this case.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, d... more Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual s...
The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine ... more The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine suture. There is controversy about its pathogenesis; however, its origin is generally attributed to the enclavement of epithelial remnants within the palatine suture between the 2 lateral maxillary processes during their fusion in the origin of the hard palate. The purpose of this report was to relate a case of a median palatine cyst, discussing the rarity of the lesion, its pathogenesis, and the different modalities that could be used for the correct treatment of this pathologic entity.
Factors associated with the success rate of orthodontic mini-screws placed in the upper and lower... more Factors associated with the success rate of orthodontic mini-screws placed in the upper and lower posterior buccal region.
Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible... more Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis.
Purpose: Hypertension is a major risk factor for cardiovascular diseases, which has been related ... more Purpose: Hypertension is a major risk factor for cardiovascular diseases, which has been related to such changes as gradual bone loss and a decrease in bone mass index. The cellular and molecular mechanisms that involve hypertension and osteoporosis are not fully understood. Many patients have high blood pressure, controlled or uncontrolled, and may use at least 1 antihypertensive drug, and an understanding of the interference of hypertension with bone healing is very important when considering oral rehabilitation with implants and bone grafts. This study investigated the interference of hypertension in bone metabolism during the repair process of autogenous bone grafting and analyzed the influence of losartan, an antihypertensive drug and angiotensin II receptor antagonist, through histometric and immunohistochemical analyses by examining the protein expressions of osteocalcin, osteoprotegerin, receptor activator of nuclear factor-kB, receptor activator of nuclear factor-kB ligand,...
The installation of implants has become a routine procedure in the clinic. However, it takes time... more The installation of implants has become a routine procedure in the clinic. However, it takes time and adequate bone thickness, and for that, tissue engineering has made efforts to develop substitutes for autografts, in view of certain disadvantages of this material. The decision to choose the most suitable graft material for each case is an important step in the success of bone reconstruction. This study was to verify, by means of immunohistochemical study, that the addition of bone morphogenetic protein had some influence on biomaterials commercially available, taking into account the formation of mineralized tissue, bone replacement, and the amount of degradation of biomaterials. The sample consisted of 72 rats that were divided into eight treatment groups, in which two defects of 5 mm were made in each animal calvaria. Euthanasia was performed at 5, 15, and 30 days postop. A histologic and histometric analysis was performed to quantitate the area of mineralized tissue formed, the...
Objectives Alendronate and raloxifene, a bisphosphonate and a selective estrogen modulator, respe... more Objectives Alendronate and raloxifene, a bisphosphonate and a selective estrogen modulator, respectively, are established osteoporosis therapies. Current evidence suggests that simultaneous application of osteoporosis therapies modulates osseointegration. However, alendronate shows inconsistent findings and raloxifene has not been studied comprehensively. This study aimed to evaluate the bone dynamics and molecular and microstructural features at the peri-implant bone interface in osteoporotic rats. Materials and methods Thirty female rats underwent ovariectomy and were fed a diet low in calcium and phosphate and treated with alendronate or raloxifene for 30 days or underwent fictional ovariectomy surgery (SHAM) prior to implant insertion in the tibia; osteoporosis therapies continued thereafter. After 42 days, peri-implant bone was evaluated by histometric and micro-CT analysis. Fluorochrome incorporation and gene expression was determined to evaluate bone turnover. Results We report here that alendronate had no impact on bone-to-implant contacts and the mineral apposition rate. The RANKL/OPG ratio and local bone volume, however, were increased compared to the untreated osteoporotic rats. Even though signaling to bone resorption activity through RANKL production was observed in the alendronate group, the blockade of bone resorption activity that occurs in decorrence to alendronate activity took place and resulted in an increase in bone volume. Raloxifene significantly increased osseointegration in osteoporotic rats, as indicated by bone-to-implant contacts, mineral apposition, and local bone volume. Raloxifene, however, had no considerable impact on the RANKL/ OPG ratio compared to untreated osteoporotic rats. As expected, the SH group showed higher bone-to-implant contacts and mineral apposition rates than the untreated osteoporotic rats. Conclusions These findings suggest that raloxifene but not alendronate can compensate for the impaired osseointegration in osteoporotic rats. Clinical relevance Regarding the superiority of raloxifene observed in the improvement of bone dynamics response, this statement suggests that raloxifene could be a good option for osteoporosis patients in oral rehabilitation procedures.
This study aimed to assess the biological response of BMP-2 (bone morphogenetic protein-2) in sup... more This study aimed to assess the biological response of BMP-2 (bone morphogenetic protein-2) in supplementation with β-tricalcium phosphate (TCP) as a carrier in the bone healing of surgical defects in rats' calvaria. A critical-size defect (5mm in diameter) was filled with β-TCP alone or added with that plus 5mg of BMP-2 at 5, 15, and 30 postoperative days. Histomorphometric and immunohistochemical (osteocalcin, collagen type I, and metalloproteinase-9) analysis was performed to assess the features of bone healing. Histological behavior and collagen type I labeling showed increased formation of the collagen matrix, leading to a higher percentage of newly formed bone and biomaterial for tissue and more total mineralization of pure TCP when compared to the other groups. The supplementation with BMP-2 promoted faster TCP remodeling; however, there was no statistically significant difference for the bone formed in both groups (P>0.05). Collagen-matrix formation and new bone format...
Supplementation of bone substitutes with recombinant platelet-derived growth factor-BB (PDGF-BB) ... more Supplementation of bone substitutes with recombinant platelet-derived growth factor-BB (PDGF-BB) can enhance bone regeneration. The aim of the study was to evaluate the effect of PDGF-BB on bone formation in the presence of β-tricalcium phosphate and bovine bone mineral matrix in a rat calvaria defect model. The authors examined 5 mm rat calvarial defects treated with β-tricalcium phosphate (TCP) or demineralized bovine bone mineral (DBBM) with and without 0.3 mg/ml recombinant PDGF-BB. Calvaria defects were randomly divided into the following treatment groups (n = 5); TCP; TCP plus PDGF-BB; DBBM; DBBM plus PDGF-BB; and untreated empty control. After 45 days, bone formation was evaluated by histomorphometry and fluorescence microscopy. The authors report that the area of newly formed bone was similar between the empty controls and the two bone substitutes, TCP and DBBM. Supplementation of TCP and DBBM with PDGF-BB had no significant impact on bone formation. Fluorochrome staining re...
The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following i... more The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and μCT analysis. Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Hi...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2015
The scientific and technological advancement of cosmetic dentistry has improved metal-free cerami... more The scientific and technological advancement of cosmetic dentistry has improved metal-free ceramic systems for fixed prosthodontics as well as porcelain veneers, making them an excellent treatment option for delivering superior cosmetic results. The authors present a clinical case of full-mouth rehabilitation using all-ceramic restorations with porcelain metal-free unit crowns in the maxilla, and porcelain veneers from the left inferior premolar to the right inferior premolar. Using this approach, they were able to achieve an excellent esthetic and functional result for the patient.
suture was performed with 4-0 nylon (Figs. 2D-F). One year postoperatively, complete bone regener... more suture was performed with 4-0 nylon (Figs. 2D-F). One year postoperatively, complete bone regeneration was verified, with great healing aspect and significant improvement in patient's occlusion, who is still under orthodontic treatment (Figs. 1E, F). The surgical procedure was performed in some stages because there were many teeth to be extracted. As bone defect created by the procedure was great, it was established to perform bone grafting with lyophilized bovine bone and guide bone regeneration. Therefore, despite considering the genetic theory of etiology, it is still quite unclear. It is known that genetics does not follow a simple Mendelian pattern, and environment can have such an important influence; therefore, cases have been reported in nonsyndromic patients with no family history of dental anomalies.
Department of Dentistry Materials and Prosthesis Faculty of Dentistry of Aracatuba University of ... more Department of Dentistry Materials and Prosthesis Faculty of Dentistry of Aracatuba University of the State of Sao Paulo
Department of Dental Materials and Prosthodontics Sao Jose dos Campos Dental School Sao Paulo Uni... more Department of Dental Materials and Prosthodontics Sao Jose dos Campos Dental School Sao Paulo University (UNESP), Sao Jose dos Campos
FIGURE 3. A, Removal of the fistula. B, Exposure of buccal fat pad. C and D, Closing the first la... more FIGURE 3. A, Removal of the fistula. B, Exposure of buccal fat pad. C and D, Closing the first layer. FIGURE 1. Initial clinical image. FIGURE 2. Preoperative panoramic radiograph.
The aim of this study was to evaluate the dental socket bone healing process by histomorphometric... more The aim of this study was to evaluate the dental socket bone healing process by histomorphometric and immunohistochemical analysis of osteoprotegerin (OPG), receptor activator of nuclear factor-κβ (RANK), and receptor activator of nuclear factor-κβ ligand (RANKL) proteins in spontaneously hypertensive rats (SHR). Under general anesthesia, 25 Wistar rats and 25 SHRs underwent upper right incisor extraction. Rats were euthanized after 7, 14, 21, 28, or 42 days of dental extractions. Histomorphometric and immunohistochemical analyses of OPG, RANK, and RANKL proteins were performed. Histomorphometric results showed decreased bone healing and reduced bone trabecular thickness in SHRs. Immunohistochemical reactions showed intense RANKL and RANK immunolabeling at 14 and 28 postoperative days and mild OPG immunolabeling at 7, 14, and 21 days after surgery in SHRs. The results of this study show that RANK, RANKL, and OPG immunolabeling was altered in SHRs, and these results are associated wi...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
The prevalence of dental trauma and its consequences are challenging. This article presents a cli... more The prevalence of dental trauma and its consequences are challenging. This article presents a clinical case of a 9-year-old female who was in a bicycling accident and had a dental intrusion of the left maxillary lateral incisor with extensive dislocation. In the emergency department, surgical repositioning of the intruded tooth and a splinting with steel wire and composite resin was performed and the soft-tissue lesions were sutured. Two weeks after the first visit, pulp necrosis was found and endodontic treatment of the intruded tooth was started with a calcium hydroxide dressing. Despite the traumatic nature of the dental injury, the result of treatment was favorable. After 3 years of follow-up, repair of the resorptions and no signs of ankylosis of the teeth involved were evident. Considering the patient's age and the extent of intrusion, it was concluded that surgical repositioning associated with adequate endodontic therapy was an effective alternative treatment for this case.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)
Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, d... more Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual s...
The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine ... more The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine suture. There is controversy about its pathogenesis; however, its origin is generally attributed to the enclavement of epithelial remnants within the palatine suture between the 2 lateral maxillary processes during their fusion in the origin of the hard palate. The purpose of this report was to relate a case of a median palatine cyst, discussing the rarity of the lesion, its pathogenesis, and the different modalities that could be used for the correct treatment of this pathologic entity.
Factors associated with the success rate of orthodontic mini-screws placed in the upper and lower... more Factors associated with the success rate of orthodontic mini-screws placed in the upper and lower posterior buccal region.
Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible... more Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis.
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