Purpose: To determine the characteristics influencing periodontal practices in Virginia and report on the anticipated changes in practice. Methods: A REDCap survey was emailed to Virginia based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in dental treatment and practice models, and how periodontists will adjust to account for these trends. Results: The response rate was 31% (n=46). Respondents report greater referrals from more experienced general practitioners (GPs). Student debt was associated with age. Respondents ranked biologic advances, treatment of peri-implantitis, digital dentistry, development of corporate and group practice models, and GPs incorporating more periodontal services in their practices as most likely to impact periodontal practices. The most reported periodontal practice adjustments included expansion of existing services, increasing the number of periodontists in the practice, and joining with other specialists or GPs to create group practices. Conclusions: Periodontists perceive the need to expand services, increase number of providers in their practices or create group practice models as future practice adjustments.

Orientador: Lafayette Nogueira Junior / Banca: Tarcísio José de Arruda Paes Junior / Banca: Fernanda de Cassia Papaiz Gonçalves / Banca: Rodrigo Máximo de Araújo / Banca: Jean Soares Miranda / Resumo: A sobrecarga do hexágono durante a inserção dos implantes dentários de hexágono externo pode gerar danos irreversíveis ao mesmo ocasionando problemas futuros na reabilitação. Sendo assim, esse trabalho teve por objetivo avaliar a deformação e resistência ao contra-torque dos hexágonos com o uso de um montador modificado proposto pelo autor para inserção dos implantes tipo hexágono externo (HE) tendo como hipótese de que o montador modificado apresente resultados diferentes do montador padrão. Para isso, 44 implantes foram divididos em dois grupos, controle (montador normal MN; n=12) e o teste (montador modificado MM; n=12), e foram submetidos ao teste de torção seguindo os parâmetros da norma ISO 13498:2013. Em seguida, a deformação dos hexágonos e possíveis deformações causadas às roscas internas dos implantes foram analisadas, respectivamente, de forma qualitativa por meio de microscopia eletrônica de varredura. Já para o teste de fadiga, controle (MN; n=10) e teste (MM; n=10), os parâmetros utilizados foram da norma ISO 14801:2007. Ao final de 1,2 x 106 (4Hz) ciclos, o valor de destorque dos pilares foi registrado. A desadaptação da junta pilar/implante foi avaliada qualitativamente por meio da microscopia MEV. Como resultados pudemos observar maior manutenção da estrutura da conexão pelo grupo MM comparado ao grupo MN, sugerindo-se que o grupo MM apresentaram comportamento mais seguro e previsível quando comparado ao grupo MN / Abstract: Hexagon overload during the insertion of external hexagon dental implants can lead to irreversible damage, leading to future problems in rehabilitation. Thus, this study aimed to evaluate the deformation and reverse torque resistance of hexagons with the use of a modified mount proposed by the author for insertion of external hexagon (HE) implants with the hypothesis that the modified mount presents different results compared to the default assembler. For this, 44 implants were divided into two groups, control (normal mount MN; n = 12) and the test (modified mount MM; n = 12), and were submitted to torsion testing following the parameters of ISO 13498: 2013. Then, the deformation of the hexagons and possible deformations caused to the internal threads of the implants were analyzed qualitatively, respectively by scanning electron microscopy. For the fatigue test, control (MN; n = 10) and test (MM; n = 10), the parameters used were from ISO 14801: 2007. At the end of 1.2 x 106 (4Hz) cycles, the abutment value of the abutments was recorded. Abutment of the abutment / implant joint was qualitatively evaluated by SEM microscopy. As a result we could observe a better maintenance of the connection structure by the MM group compared to the MN group, suggesting that the MM group presented a safer and more predictable behavior when compared to the MN group / Doutor

Orientador: Fellippo Ramos Verri / Resumo: O objetivo deste estudo foi avaliar a distribuição de tensão e deslocamento em implantes de diâmetro reduzido em reabilitações unitárias em região maxilar anterior, variando o posicionamento do implante (ao nível ósseo e 1,5 mm infra-ósseo), através do método de elementos finitos tridimensionais (MEF-3D). Quatro modelos 3D representando uma hemisecção do lado direito da região anterior da maxila foram simulados com a presença de coroa cimentada sobre implante (cone morse) de 10mm de comprimento, variando-se o diâmetro do implante (2,9 mm e 3,5 mm) e a instalação dos implantes no tecido ósseo em rebordo alveolar de 4,5 mm de espessura. O modelo ósseo tridimensional foi construído por recomposição tomográfica com uso dos softwares Invesalius e Rhinoceros 3D. O implante e os componentes foram modelados a partir de modificações do formato original no programa SolidWorks e finalizados no Rhinoceros, bem como o desenho da coroa simulada. A discretização dos modelos foi feita no software ANSYS 19.2, incluindo caracterização dos materiais, contatos, elaboração das malhas, condições de carregamento (178N em direção de 0, 30 e 60 graus em relação ao longo eixo do implante) e de contorno (com restrição em direção x, y, z nas secções laterais dos modelos). Os resultados mostraram comportamento biomecânico similar, com diminuição dos níveis de deslocamento e estresse para implantes de 3,5 mm e implantes infra-ósseos, muito embora os valores obtidos estiveram dentro de valores fisiológicos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Abstract: The Aim of this study was to evaluate the distribution of stress on implants of narrow diameter, in single unit cemented crowns in the anterior maxillary region, varying the position of the implant (at the bone level and 1.5 mm infra-osseous), through the 3D finite element analysis (3D-FEA). Four 3D models representing a right hemisection of the anterior maxillary region were simulated with the presence of a cemented crown over a 10mm long implant (morse cone), with the implant diameter varying among 2.9 mm and 3.5 mm in an simulated alveolar ridge of 4,5mm thickness. The bone of 3D models was simulated by tomographic recomposition using the software Invesalius and Rhinoceros 3D. The implant and components were modeled from modifications of the original design in the SolidWorks software and modeled in the Rhinoceros, as well as the design of the simulated crown. The discretization of the models was done in the ANSYS 19,2 software, including characterization of materials, contacts, meshes, loading conditions (178N towards 0, 30 and 60 degrees in relation to the implant long axis) and boundary conditions in the x, y, z direction in the lateral sections of the models). The results of dislodgment and von Mises showed similar maps distribution, decreasing dislodgment and stress in implants of 3,5mm diameter and in infra-osseous position, besides these results were inside physiologic values. It was possible to conclude that 2.9mm implants were no more biomechanically favo... (Complete abstract click electronic access below) / Mestre

De nombreux traitements de surface (sablage, attaques acides…) ont été mis au point sur les implants dentaires afin de favoriser leur ostéointégration. Par ailleurs, depuis plusieurs années des revêtements à base de phosphates de calcium sont également développés dans le même but.L’objectif principal de la thèse est de mettre au point un procédé de revêtement à basse température afin de déposer à la surface de l’implant en titane une couche mince de phosphate de calcium, de structure et de composition analogue au minéral osseux en vue de favoriser l’ostéointégration. Il est aussi souhaité que ce revêtement présente des propriétés antibactériennes afin de lutter contre les infections post-opératoires. Dans un premier temps, un traitement de surface de l’implant en titane composé d’une étape de sablage et d’une attaque acide a été développé. Il permet d’obtenir une rugosité moyenne de surface comprise entre 1,4 et1,8 µm ainsi qu’une texture microporeuse et une mouillabilité de surface améliorée. Puis, les procédés de revêtement d’électrodéposition et d’immersions successives ont été étudiés. L’étapede centrifugation implémentée dans le procédé d’immersions successives s’est révélée cruciale et un revêtement d’environ 2 µm d’épaisseur composé d’apatite biomimétique a été obtenu. La composition et l’épaisseur du revêtement élaboré par électrodéposition est fortement influencée par la durée du dépôt. Ainsi une durée d’électrodéposition de 1 mn menée à un potentiel de -1,6V/ECS permet d’obtenir un revêtement d’environ 1,5 µm d’épaisseur composé d’une couche de phosphate octocalcique et de cristaux de brushite. Un test de vissage/dévissage dans une mâchoire artificielle a démontré la tenue mécanique des revêtements obtenus selon les deux procédés. Enfin, des ions antibactériens tels que l’argent, le cuivre ou le zinc ont été incorporésaux revêtements. Il a été démontré que des taux importants d’incorporation allant jusqu’à 40 %molaire par rapport au calcium peuvent être atteints pour le cuivre et le zinc. Des tests biologiques permettant d’évaluer l’effet de ces revêtements sur l’activité biologique de cellules mésenchymateuses humaines ainsi que sur la formation d’un biofilm (modèle de péri-implantite)en vue de la prévention des infections post-opératoires ont conduit à des résultats prometteurs pour le développement de tels revêtements bioactifs. Ces travaux de thèse s’inscrivent dans le cadre du projet BIOACTISURF, soutenu par la Région Midi-Pyrénées, et réalisé en collaboration avec le Laboratoire de Génie Chimique (LGC) ainsi qu’un partenaire industriel

Objective. As a result of newborn hearing screenings, an increasing number of infants are being identified with a hearing loss at birth or within a few months of life. The literature supports that early identification in conjunction with early intervention services have led to drastic improvements in speech and language outcomes for children who have a received a cochlear implant (CI). The purpose of this study was to investigate the amount, type, and quality of services that young children with CI(s) are receiving. Methods. Participants in this study included 22 teachers of the deaf/hard of hearing (TD/HH), 7 speech-language pathologists (SLP), and 4 early childhood interventionists (ECI). All of the service providers were serving at least one child with a CI(s) at the time of the study. Three on-line service provider surveys were modified from the National Early Intervention Longitudinal Study (NEILS) in order to specifically address the concerns and interests of service provision for children with CIs. The three surveys addressed the birth-3, preschool, and school-age populations. Results. Results from the birth-3 and preschool populations with CIs were analyzed. The school-age population was not analyzed due to the low response rate from that age group. Findings from this study revealed that the TD/HH is the primary service provider for the birth-5 population with CIs. In addition, other service providers (i.e. SLP, ECI) reported that they do not feel completely comfortable working with the CI device (i.e. troubleshooting, utilizing the Ling Six Sound test). Another area of concern was the child's compliance in wearing the CI on a full-time, daily basis. Collaboration and education among professionals and the families of children with CIs must be stressed in order for early intervention services to effectively facilitate the child's speech, language, and educational development. Conclusion. The results revealed characteristics specific to both the child (i.e. services the child has received in the past 6 months as part of his/her intervention program) and the service provider (i.e. amount of professional education concerning children with CIs). More research is needed to assess the relationship between the amount and quality of service provision and the child's speech and language performance to ensure that this population is receiving appropriate early intervention services.

This study aimed to answer whether current research addressing executive function abilities in cochlear implant users was accurately depicting their impairments. Secondly, this study aimed to identify differences in identification of executive function impairments when measured using parent report versus behavioral measures of executive function. Results suggest that children do have executive function impairments in areas of measure nonverbal planning, problem-solving, monitoring, and self-regulation abilities as well as attention to a visually presented array of pictures which has been documented in previous research. However, it is likely that these abilities are modulated by children with cochlear implants' poorer language ability as demonstrated on the PPVT, which seems not to be related to their age of implantation. The behavioral measures and parent report measures identified impairments in the subsets which required a greater language demand and subsequently subsets that were significantly more difficult for CI children.

Orientador: Juliano Milanezi de Almeida / Resumo: O propósito do presente estudo foi avaliar a remodelação óssea de implantes ósseointegrados instalados em tíbias de ratos modificados ou não sistemicamente pelo tamoxifeno. Foram utilizadas 72 ratas, os animais receberam ovariectomia bilateral, instalação dos implantes em tíbia bilateralmente e após 6 semanas,foram aleatoriamente distribuídas em dois grupos experimentais(n=36), Grupo SS: administração de solução salina e Grupo TAM: administração de citrato de tamoxifeno, via gavagem por todo o período experimenta. Doze animais de cada grupo foram eutanasiados aos 30, 60 e 90 dias após a administração da primeira dose das soluções, as tíbias direita e esquerda foram coletadas, e aleatóriamente processadas com desmineralização para as análises histológicas, imunoistoquímicas e para a análise de porcentagem de tecido ósseo neoformado(PTON) e sem desmineralização para análise do contato osso/implante(BIC) e para as análises de Microscopia Eletrônica de Varredura (MEV) e de Espectroscopia Dispersiva de Raio-x (EDS). Os dados obtidos foram submetidos à análise estatística (p<0,05) em programa computacional especializado. Com relação ao contato osso implante, o grupo TAM, apresentou maior BIC em todos os períodos experimentais quando comparado com o grupo SS. O grupo TAM apresentou também maior PTON em todos os períodos experimentais quando comparado com o grupo SS. A análise histológica dos tecidos periimplantares mostrou que o grupo TAM apresentou características histológicas que ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The purpose of the present study was to evaluate the bone remodeling of osseointegrated implants installed in tibias of rats modified or not systemically modified by tamoxifen. Seventy-two female rats were used, the animals received bilateral ovariectomy, tibial implant placement bilaterally and after 6 weeks were randomly assigned to two experimental groups (n = 36). Group SS: received saline administration and Group TAM: received administration of tamoxifen citrate via gavage throughout the experimental period. Twelve animals from each group were euthanized at 30, 60 and 90 days after administration of the first dose of the solutions. The right and left tibias were collected, processed with demineralization for histológical, immunohistochemical and percentage analysis of neoformed bone tissue. (PTON) and without demineralization for bone / implant contact analysis (BIC) and for Scanning Electron Microscopy (SEM) and Xray Dispersive Spectroscopy (EDS). The data obtained were submitted to statistical analysis (p <0.05) in a specialized computer program. With regard to implant bone contact, the TAM group presented higher BIC in all experimental periods when compared to the SS group. The TAM group also presented higher PTON in all experimental periods when compared to the SS group. Histológical analysis of periimplant tissues showed that the TAM group presented histológical characteristics that were similar to the control group, however, with a larger amount of peri-implant bon... (Complete abstract click electronic access below) / Mestre

No description available.

Objective: The aim of the study was to evaluate the clinical outcomes of oral implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005. Methods: Oral implant patients (n=320) with 586 implants were identified and invited to attend for a clinical examination. Implant demographics of all the patients were extracted from the files. Implant demographics of the examined and unexamined patients were compared to assess if the examined patients were representative of the total group. One hundred and three patients with 214 implants agreed to attend for an examination. In the clinical examination full mouth plaque scores, probing depths, bleeding on probing and suppuration were measured. In addition, around implants recession and width of keratinized gingiva were also recorded. For the radiographic examination, baseline radiographs and radiographs taken at the time of examination were digitized and compared to measure the amount of bone lost or gained around implants using NIH Image J software. Results: There were equal numbers of males and females with a mean age of 46.3 � 15 years at the time of implant placement. The smoking history at the time of examination was recorded, 56% of the patients were non-smokers, 37% former smokers, and 7% were current smokers. More than half of the implants (56%) were placed in the anterior region. Based on the type of implant system, 79% were Branemark implants, 10% Straumann, 6% Southern implants and 4% were unknown. Most of the patients (64%) had implant-supported crowns, 19% had fixed denture prostheses, and 17% had implant-supported overdentures. The overall implant survival rate was 97.7% with five implants lost (2.3%) and 8 implants treated for peri-implantitis (3.8%). The mean PD around implants was 2.3mm (SD 0.6mm), mean recession was 0.5mm (SD 0.8mm) and mean attachment level of 2.8mm (SD 0.9mm). Probing depths [greater than or equal to] 4mm with BOP were recorded around implants in 8.9% of patients. The mean full mouth plaque score was 30% while mean plaque score around implants was 15.9%. The average bone loss around implants was 0.3mm (SD 0.8). Maximum bone loss observed was 2.9 mm. Conclusion: The prevalence of peri-implant inflammation and implant survival rates in this group of patients appeared comparable to that reported in the literature. The prevalence of peri-implant lesions was low in the group of patients examined.

Doctor of Philosophy (PhD) / An in-depth, longitudinal study of the speech and oral language development of eight infants with a profound hearing loss who receive early interventions focused on developing their auditory, speech and oral language capacity is presented in this thesis. Infants were tracked for two years, during the period when they are changed from a hearing aid to a cochlear implant. All infants in this study had their hearing loss identified early and were fitted with hearing aids between 1 and 7 months of age and received their cochlear implant between 8 and 16 months of age. They attended a number of different auditory-verbal early intervention programs (depending on where they lived) all of which focused on developing speech and language skills through listening. Attendance at their particular early intervention program at least once a week was in addition to weekly attendance the Sydney Cochlear Implant Centre for therapy and audiological services. A broad range of measures has been used to track the infants’ acquisition of oral language skills, including measures of communicative intention, pre-speech and speech development, and oral language development. Despite a wide range of individual differences across the group of infants, the results suggest some general trends. In the area of communicative intent most infants followed typical development patterns in terms of both the types (e.g. requesting, answering etc) and forms (gestural, vocal, verbal) used, but they showed delays in their frequency of usage of these types and forms. For speech development the infants demonstrated typical speech skills by 18-months post-cochlear implantation in the areas of consonant inventories, severity of phonological involvement (speech intelligibility) and phonological process development, but they showed delays in vowel and consonant acquisition. Finally, for language development the infants were delayed relative to typical development at 18 months post-implantation. The findings support and extend previous studies which have demonstrated the benefits of early intervention for communication development in infants with hearing loss (Calderon & Naidu, 2000; Mayne, Yoshinaga-Itano & Sedey, 2000; Moeller, 2000; Yoshinaga-Itano & Apuzzo, 1998). However, the delays in the oral communication skills of the infants in the current study suggest that more intensive long-term intervention is required if the infants are to attain typical oral speech and language development. The findings capture the complexity of early oral language development, which has been lacking in previous studies of infants with significant hearing loss, receiving a cochlear implant (Dettman, Briggs, & Dowell, 2005; Houston, Ying, Pisoni, & Iler Kirk, 2003; Schauwers, Gillis, Daemers, De Beukelaer, & Govaerts, 2004). The present data also provide some limited support for earlier implantation, that is, before 12 months of age, as the infants made little progress in oral language development while using hearing aids. The reduced amount of auditory signal available to them prior to implantation may be the determining factor in their inability to follow typical rates and patterns of development. However, rates of development with the implant were not straightforward and further research on this population is needed. Universal neonatal screening programs for hearing loss will potentially provide a larger population of early identified infant for future research. This will create the opportunity for large scale, prospective, longitudinal, studies examining the acquisition of speech and oral language development. Limitations of this study, tracking the early stages of speech and language development over a two year period are identified. Future studies are needed to follow the infants for a longer time to determine if their rate of development is sufficient for them to catch up in areas of delay and maintain their performance in areas where they match their typically developing peers.