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Aim: Stability measured by resonance frequency analysis (RFA) is an important factor to be considered in the success of dental implant treatments, which can be evaluated from the implant stability quotient (ISQ). The aim of the present case series was to map the RFA during healing of implants with nanostructured hydroxyapatite surface to describe the behavior of ISQ values related to individual factors. Materials and Methods: Twenty-three implants were placed in eight patients by conventional surgical protocol, and ISQ values were monitored from the day of implant placement until week 20. To obtain the ISQ values, an Osstell device was used and the placed implants were grouped in proportional amounts to describe the ISQ behavior considering the length (≤10 or >10 mm), the diameter (3.5 or 4.3 mm), the insertion torque (<40 N-cm or ≥40 N-cm), and the placement area (maxilla or mandible). Results: All the implants assessed decreased their values in the first 3 weeks after placement. Subsequently, the ISQ values increased by amounts similar to those obtained at the time of the placement and even more. Implants with length >10 mm, diameter 4.3 mm, and insertion torque ≥40 N-cm showed the highest ISQ values. Conclusions: A decrease in the ISQ values of dental implants with nanostructured hydroxyapatite surface was evidenced between weeks 2 and 3 considering length, diameter, insertion torque, and maxillary or mandibular placement site.

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AIM: Vertical marginal discrepancy (VMD) influences the success of implant-supported restorations. However, there is little literature that has investigated the influence of geometry and cementing agent on changes in VMD of metal copings on implant abutments. The objective was to evaluate the effect of the geometry of the abutment and cementing agents on VMD. METHODS: Cast copings were cemented on implant abutments customized cylindrical (4, 5.5, and 7 mm) and on hexagonal implant abutments (4 mm) cemented or uncemented molded copings were placed (n = 4, totally 64 samples) with different luting agents. The VMD of the copings were measured in the coping-abutment interface at three reference points using a stereomicroscope. The independent Student's t test was used for comparison between the two different abutment walls. The post hoc statistical analysis was performed by the Tukey test. RESULTS: There was a significant VMD increase between noncemented and cemented cast copings using different luting agents. Abutment geometry and luting agents significantly influenced the VMD (p ≤ 0.05). Cylindrical abutment at 7 mm in height cemented with different luting agent tested showed significantly higher VMD values than cylindrical abutments of 4 mm (p=0.019). Hexagonal abutments with a 4 mm height showed significantly higher VMD values than cylindrical 4 mm abutments using zinc oxide noneugenol and glass ionomer cements (p=0.032). CONCLUSIONS: Abutment geometry and luting agents influence the VMD of cast copings cemented on implant abutment. The higher the cylindrical abutment, the greater the VMD, and hexagonal wall abutments promote greater marginal gap.

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En los últimos años, se ha incrementado el porcentaje de colocación de implantes dentales y, con ello, también la mayor presencia de eventos adversos, por lo que las complicaciones no son infrecuentes. La gran mayoría de recomendaciones para la reducción de complicaciones asociadas con la colocación de implantes dentales están analizadas desde el punto de vista de sus causas directas, juzgando la técnica o al individuo, pero no al sistema en conjunto, cuando este constituye la etiología real de las complicaciones. Recientemente, se ha empezado a considerar más importante la inclusión de los factores humanos y la conciencia de la situación en la comprensión de las complicaciones en implantología oral. Esto ha permitido analizar de manera global tanto al individuo como a su entorno, y aportar soluciones basadas en la prevención. Sin embargo, el conocimiento y la utilización de estos aspectos en implantología oral están aún en vías de popularización, por lo que el objetivo del presente artículo es difundir el enfoque de los factores humanos y la conciencia de la situación en la prevención de complicaciones y en la reducción de riesgos en los procedimientos de colocación de implantes dentales. (AU)

In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures. (AU)

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OBJECTIVE: To review the historical and current periodontal phenotype classifications evaluating methods and characteristics. Moreover, to identify and classify the methods based on periodontal phenotype components. OVERVIEW: Several gingival morphology studies have been frequently associated with different terms used causing confusion among the readers. In 2017, the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions recommended to adopt the term "periodontal phenotype". This term comprises two terms, gingival phenotype (gingival thickness and keratinized tissue width) and bone morphotype (buccal bone plate thickness). Furthermore, gingival morphology has been categorized on "thin-scalloped", "thick-scalloped" and "thick-flat" considering the periodontal biotype. However, by definition, the term phenotype is preferred over biotype. Periodontal phenotype can be evaluated through clinical or radiographic assessments and may be divided into invasive/non-invasive (for gingival thickness), static/functional (for keratinized tissue width), and bi/tridimensional (for buccal bone plate thickness) methods. CONCLUSIONS: "Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal biotypes were identified. These three periodontal biotypes have been considered in the World Workshop but the term periodontal phenotype is recommended. Periodontal phenotype is the combination of the gingival phenotype and the bone morphotype. There are specific methods for periodontal phenotype evaluation. CLINICAL SIGNIFICANCE: The term periodontal phenotype is currently recommended for future investigations about gingival phenotype and bone morphotype. "Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal phenotypes can be evaluated through specific methods for gingival thickness, keratinized tissue width, and buccal bone plate thickness evaluation.

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In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures.

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Resumen: El bruxismo se define como una actividad repetitiva de los músculos masticatorios caracterizada por apretar o rechinar los dientes y/o por golpear y balancear la mandíbula. Es de etiología multifactorial y se considera que existe un bruxismo fisiológico necesario para el desarrollo de la cara de los niños. Estos dos aspectos hacen complicado el diagnóstico que se basa fundamentalmente en un cuestionario a los padres y en el examen clínico del niño. Cuando el desgaste fisiológico no se diferencia a tiempo del desgaste parafuncional, trae consecuencias negativas en el niño que alteran su calidad de vida, necesitando un manejo multidisciplinario adecuado. Considerando que es necesario conocer características fundamentales del bruxismo infantil, el objetivo del presente artículo de revisión es realizar una actualización sobre sus manifestaciones circadianas, clasificaciones, prevalencia, etiología, factores de riesgo, diagnóstico y tratamiento que servirá al odontólogo para una temprana identificación y tratamiento.

Abstract: Bruxism is defined as a repetitive activity of the chewing muscles characterized by clenching or grinding of the teeth and/or by striking and swinging the jaw. It is of multifactorial etiology and it is considered that there is a physiological bruxism necessary for the development of the face of children. These two aspects complicate the diagnosis that is fundamentally based on a questionnaire to the parents and on the clinical examination of the child. When the physiological wear does not differentiate in time from the parafunctional wear, it has negative consequences in the child that alter their quality of life, requiring an adequate multidisciplinary management. Considering that it is necessary to know the fundamental characteristics of bruxism in children and adolescents, the objective of this review article is to update its circadian manifestations, classifications, prevalence, etiology, risk factors, diagnosis and treatment that will serve the dentist for the early identification and treatment.

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OBJECTIVE: Cone beam computed tomography (CBCT) images can be useful for estimating cervical vertebrae maturity (CVM). The aim of this study was to evaluate the reliability of cephalograms derived from CBCT versus lateral cephalograms (LC) to estimate the CVM in a Peruvian population. MATERIAL AND METHODS: The sample evaluated consisted of 40 cephalograms derived from CBCT and 40 LC images from individuals aged 10-19 years. One trained and calibrated observer (Kappa scores≥0.90) interpreted the CBCT and LC images twice. Intra-observer reliability of each maturation stage on CBCT sagittal slices and LC images were analysed using the weighted kappa statistics (α=0.05). Comparison of CVM stages between CBCT slices and LC images were analysed by the Spearman rank correlation coefficient, p<0.05. RESULTS: The weighted kappa test showed almost perfect intra-observer agreement for the CVM stages using the CBCT sagittal slices (0.873). Considering the LC images, the weighted kappa test showed almost perfect intra-observer agreement too (0.937). In both intra-observer agreement, the difference was limited to one maturation stage of the CVM method. The first and second intra-observer agreement for the CVM stages between the CBCT sagittal slices and LC images were almost perfect (0.937 and 0.874). High correlation values at the first (0.975) and second (0.976) intra-observer agreement for the CVM stages between CBCT sagittal slices and LC images were also found. CONCLUSION: CBCT is a reliable method for CVM assessment and can be used as an alternative method for this purpose. The orthodontists might use the CBCT scans as a valuable tool for CVM method estimation.

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BACKGROUND: The aim of this study was to evaluate the midpalatal suture maturation stages in adolescents and young adults using cone-beam computed tomography (CBCT). METHODS: The sample comprised 200 CBCT scans of individuals aged 10 to 25 years old (95 males and 105 females) divided into three groups, adolescents (n = 48), post-adolescents (n = 52), and young adults (n = 100). The Planmeca ProMax 3D software was used for the midpalatal suture maturation stage evaluation according to Angieleri's method, using cross-sectional axial slice. Two previously calibrated examiners analyzed the images and classified according to five different maturation stages. A, B, and C stages were considered with open midpalatal suture, and D and E were considered without open midpalatal suture. Association tests were performed using chi-square test also, and a binary logistic regression was evaluated (P < 0.05). RESULTS: The possibility to find open midpalatal suture in individuals of 10 to 15 years old was 70.8%, in subject aged 16 to 20 and 21 to 25 years old was 21.2% and 17%, respectively. Furthermore, this possibility in individuals older than 16 years was greater in males than in females. CONCLUSIONS: The possibility to find open midpalatal suture in post-adolescents and young adults is greater than the orthodontists considered years ago. Furthermore, men are more likely to find midpalatal suture opening. These implications might be considered by the orthodontists when maxillary expansion is required. Besides, the ossification of the middle palatal suture is very variable, and therefore, the use of CBCT might be recommended to clarify this possibility.

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RESUMEN Objetivo: Evaluar la influencia de las perforaciones corticales en regeneración ósea guiada (ROG) mediante resultados de histomorfometría obtenidos de estudios humanos y animales. Revisión de la literatura actual: Se realizó una búsqueda electrónica de estudios en humanos y animales en bases de datos PubMed, Cochrane Library, SciELO y Google Scholar desde 1980 hasta mayo del 2017. Se utilizó la siguiente estrategia de búsqueda: ((decortication of bone) OR (bone decortication) OR (alveolar decortication) OR (decortication) OR (decortications) OR (cortical perforation of bone) OR (cortical bone perforation) OR (cortical perforation) OR (cortical perforations) OR (intramarrow penetration) OR (marrow penetration)) AND ((guided bone regeneration) OR (guided bone augmentation) OR (bone augmentation) OR (osseous repair) OR (graft integration)). Discusión y conclusión: Se identificaron 65 artículos y sólo se seleccionaron 8. Cuatro estudios en animales mostraron influencia estadísticamente significativa al realizar perforaciones corticales. En 3 estudios en animales y en un estudio en humanos esta diferencia no fue estadísticamente significativa. Sin embargo, al realizar perforaciones existió mayor número de vasos sanguíneos y mayor formación ósea sin reacciones inflamatorias resaltantes ni impactos negativos. Las perforaciones corticales muestran beneficios en etapas tempranas de cicatrización influyendo significativamente en la angiogénesis incrementando la cantidad de hueso neoformado.

ABSTRACT Objective: To evaluate the influence of cortical perforations on guided bone regeneration (ROG) by histomorphometry results obtained from human and animal studies. Review of current literature: An electronic search of trials in humans and animals with histomorphometric evaluations was carried out in the PubMed, Cochrane Library, SciELO and Google Scholar databases from 1980 to May 2017. The following search strategy was used: ((decortication of bone) OR (bone decortication) OR (alveolar decortication) OR (decortication) OR (decortications) OR (cortical perforation of bone) OR (cortical bone perforation) OR (cortical perforation) OR (cortical perforations) OR (intramarrow penetration) OR (marrow penetration)) AND ((guided bone regeneration) OR (guided bone augmentation) OR (bone augmentation) OR (osseous repair) OR (graft integration)). Discussion and conclusion: Sixty five articles were identified and only 8 were selected. Four studies in animals showed statistically significant influence when performing cortical perforations. In 3 studies in animals and in 1 human study this difference was not statistically significant. However, when drilling, a greater number of blood vessels and a greater bone formation without inflammatory reactions or negative impacts were recorded. Cortical perforations show benefits in early stages of healing, influencing significantly in the angiogenesis, increasing the amount of neoformed bone.

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Las perforaciones corticales, penetraciones intramedulares o decorticaciones se realizan a menudo como parte del procedimiento de regeneración ósea guiada (ROG). Su sustento biológico se basa en que mejorarían la angiogénesis y proporcionarían una vía hacia el hueso esponjoso rico en vasos sanguíneos. También se consideran como un "noxious stimuli" (estímulo nocivo) que iniciaría el fenómeno regional acelerado con una respuesta local exuberante facilitando la cicatrización ósea normal. Además, mejorarían la unión o enlace físico entre el injerto óseo y el lecho receptor asegurando estabilidad y fusión de los bloques óseos. Sin embargo, se nos presentan algunas interrogantes relacionadas a su fundamento, a los términos que las describen, a los tamaños, a su cantidad y disposición, al instrumental adecuado para realizarlas y al confort del paciente. (AU)

Cortical perforations, intramedullary penetrations or decortications are often performed as part of the guided bone regeneration (GBR) procedure. Their biological basis is that they would improve angiogenesis, providing a pathway to the medullar bone rich of blood vessels. In addition, cortical perforations would be consider as a "noxious stimuli" that initiate the accelerated regional phenomenon with an exuberant local response facilitating normal bone healing. Moreover, they would improve the physical bonding between the bone graft and the recipient bed ensuring stability and fusion of the bone blocks. However, there are some questions related to its foundation, terms to describe them, their sizes, quantity and disposition, the appropriate instruments to perform them and the comfort of the patient. (AU)

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