PURPOSE: The purpose of this study was to analyze anatomical spatial limitations of the existing bone for maxillary anterior implant placement in normal subjects. MATERIALS AND METHODS: Fifty Two (52) Cone Beam Computed Tomography (CBCT) scans were selected. A 3i Osteotite (6 x 15mm) implant was superimposed on tooth positions from the right first premolar to left first premolar on reformatted cross sectional mages of maxillary anterior teeth. For the first trial, the implant was positioned following the alveolar bone axis. Utilizing Invivo 5 Software (Anatomage), the proximal overlaps between superimposed implants were evaluated at successive vertical steps of 2.5 mm. The prospective crown angulation or PCA (defined as the angulation between the crown axis and alveolar bone axis) was measured. The inter-canine distance across the arch, the palatal plane length and the palatal bony angulation (defined as the angulation between the palatal surface and the alveolar bone axis) were also measured. For the second trial, implant positioning followed a prosthetic driven position; the crown axis. The crown axis was defined as a line drawn from the midpoint of a line between the mid buccal/lingual CEJ to the incisal edge. The crest height and the apical height at which the implant's 1mm sleeve penetrated the buccal wall were calculated. RESULTS: The implant position at the central incisor and lateral incisor presented the highest percentage of overlap in both the biologically and prosthetically driven positions. The prospective crown angulation was higher at the location of the lateral incisor compared to the central incisor and canine position. The association between the remaining anatomical parameters and the prevalence of overlap was analyzed with bi-serial correlation. There was no significant relationship among any of these parameters. When the implant was simulated in a prosthetically driven position, the lateral incisor implant position frequently showed perforation at 5mm apical to the buccal crest margin demonstrating this position as highly sensitive. SUMMARY: The data demonstrated that the constriction of the alveolar bony volume in the anterior maxilla could affect implant placement. Understanding this bone morphology suggests a major limitation in the central/lateral positions which might require bone grafting. A new unique reference plane was utilized for this study. / 2018-09-28T00:00:00Z

O tecido adiposo pode regular o metabolismo ósseo e estar envolvido na fisiopatologia da osteoporose, sendo este fator determinante no sucesso de tratamentos reabilitadores com implantes dentários osseointegrados. O presente estudo de coorte prospectivo teve como objetivo verificar o padrão ósseo alveolar por meio de índices radiomorfométricos da radiografia panorâmica e medidas lineares realizadas em radiografias periapicais, em pacientes eutróficas e obesas mórbidas antes e após a cirurgia bariátrica. A amostra foi constituída por 31 mulheres com idade de 20 a 35 anos, sendo divididas em 2 grupos: Grupo Experimental (GE-Obesas de Grau III, IMC >40 Kg/m2) e Grupo Controle (GC- Eutróficas, IMC 18,5 a 24,99 Kg/m2). Foram avaliadas 20 eutróficas e 11 obesas mórbidas no pré e pós-cirurgia bariátrica (6 meses). Índices radiomorfométricos e de placa dentária foram avaliados nos tempos T0 (baseline) e T1 (6 meses). Na análise radiográfica foram avaliados o padrão trabecular através da escada visual de Lindh e a perda óssea por meio do cálculo da distância da junção cemento-esmalte à crista óssea, em radiografias periapicais. Já as radiografias panorâmicas para mensurar Índice da Cortical Mandibular (ICM), Índice Mentoniano (IM) e Índice Panorâmico Mandibular (IPM), além do índice de Placa de Turesky. Houve perda óssea significativa em T1 nas pacientes submetidas à cirurgia bariátrica, quando comparada com as eutróficas (p<0,05). O padrão trabecular tornou-se mais esparso após a cirurgia apresentando uma diferença visual. No índice de placa foi observada uma ligeira melhora após a cirurgia e os eutroficos mantiveram valores similares ao longo do tempo. Pode-se concluir que pacientes obesas apresentam maior perda óssea, a qual piora após a cirurgia bariátrica, quando comparada com o de pacientes eutróficas. O mesmo acontecendo com o trabeculado ósseo que se torna mais esparso após a cirurgia bariátrica. / Adipose tissue can regulate bone metabolism and be involved in the pathophysiology of osteoporosis, being this determinant factor in the success of rehabilitative treatments with osseointegrated dental implants. The present prospective cohort study aimed to verify the alveolar bone pattern through radiomorphometric indices of panoramic radiography and linear measurements performed in periapical radiographs in eutrophic and morbidly obese patients before and after bariatric surgery. The sample consisted of 31 women aged 20-35 years old, divided into 2 groups: Experimental Group (GE-Obesas de Grade III, BMI> 40 Kg / m2) and Control Group (GC-Eutrophic, BMI 18.5 To 24.99 kg / m2). 20 eutrophic and 11 obese morbidities were evaluated in the pre and postoperative bariatric surgery (6 months). Radiomorphometric and plaque indices were evaluated at T0 (baseline) and T1 (6 months) times. In the radiographic analysis the trabecular pattern through the Lindh visual ladder and the bone loss were evaluated by calculating the distance from the cemento-enamel junction to the bone crest in periapical radiographs. Panoramic radiographs were used to measure the Mandibular Cortical Index (ICM), Mentonian Index (IM) and Panoramic Mandibular Index (MPI), in addition to the Turesky Plate index. There was a significant loss of bone in T1 in patients submitted to bariatric surgery, when compared to eutrophic patients (p <0.05). The trabecular pattern became more sparse after surgery with a visual difference. The plate index showed a slight improvement after surgery and the eutrophic maintained similar values over time. It can be concluded that obese patients present greater bone loss, which worsens after bariatric surgery, when compared to that of eutrophic patients. The same happens with the trabecular bone that becomes more sparse after bariatric surgery.

There are many aspects that have direct effects on total hip replacement performance (THR), such as material properties, applied loads, surgical approach, femur size and quality, prosthesis design, bone-implant interface etc. Bone mechanics and traditional implant materials cause a frequent problem for patients of total hip arthroplasty (THA): the bone becomes shielded from the loading. Bone structure follows what is called "Wolff's Law", meaning it has an adaptive structure, which alters its geometry when experiencing forces over its life (Goldstein, 1987); (Pearson & Lieberman, 2004). The improved femoral stems act weakly in transferring stress onto the remnant bone and bone tissue atrophies at the interface, which will result in loosening of the implant, pain and thus, revision surgery will need to take place to correct the issue ( Feldt, 2011). For the current study, an innovative hollow spherical structure is developed for femoral hip stems. The aim is to extract volume in the spherical shape from the stainless steel hip implant stems, in order to focus solely on correlating with titanium behaviour. Internal geometry for the femoral stem is optimised in order to transfer more stress onto the bone. Moreover, the approach involves extracting volume in the spherical shape from internal structure to reduce stress shieling. New novel implant is proposed that demonstrated reduction in stress shielding. A new structure has been developed in this study for biomedical applications, such as implants, with the aid of the rule of mixtures and finite element analysis was applied to various models with different complex internal structures. Firstly, the rule of mixtures was used as finite element could not handle the simulation due to the large number of elements created, and also helped developing the designs analysed in this study. Secondly, computational analysis was applied to simplified finite elements containing hollow spheres in their outer shell. Moreover, a compression test was applied to a solid sample and the experimental case. This approach was adopted to investigate the effects of a hollow structure near the side surface and the bone-implant interface. The same method was applied to samples containing uniformly distributed hollow spheres. In the both scenarios, the specimens were designed differently based on the sphere size, their distance from wall and that from each other. Finally, finite element was applied to actual implant samples containing hollow spheres. The sphered models have a smaller Young's modulus and strength than the solid stainless steel sample. The spheres in hollowed structures reduce the stress shielding and they transfer more stress onto the bone when compared to the solid stainless steel models. This approach also involves restructuring a hard material, such as stainless steel, to enhance osseointegration. The reduction of the Young's modulus and stress directly depends on the volume of the hollow spheres in the models; however, there is certain volume that can be extracted from solid.

A perda do osso alveolar como resultado de doença periodontal ou secundariamente à cirurgia são fontes de inúmeras complicações para os cirurgiões dentistas, e a solução para tal problema se baseiam em procedimentos regenerativos, que é realizada através de enxertos ósseos que estabelecem um arcabouço para a reparação tecidual, aumentando os tecidos ósseos nos defeitos resultantes de trauma ou cirurgias, preenchendo os alvéolos após extração para preservar a altura e espessura do rebordo alveolar e aumentando e/ou reconstruindo o rebordo alveolar. Este projeto tem como objetivo determinar a resistência à tração do osso neoformado com a utilização de diferentes biomateriais. Foram utilizados 60 animais divididos em 3 grupos. O grupo 1A (n=10): GenO; Grupo 1B (n=10): GenMix; Grupo1C (n=10): Bio-Oss; Grupo 2a (n=10): PerioGlas; Grupo 2b (n=10): Polímero de mamona e Grupo 3 (n=10): coágulo. Após 3 meses de nascimento os animais foram submetidos a anestesia intraperitonial e confecção de defeito não critico (3mm de diâmetro) na calvária dos animais, que foram preenchidos com os biomateriais correspondentes a cada grupo. Após 6 meses da cirurgia foi realizada a morte dos animais, os espécimes foram coletados e submetidos ao teste em uma máquina de teste universal. Observa-se que o grupo que obteve maior média de resistência à tração foi o grupo de polímero de mamona (10,932±4,529MPa). Consequentemente, obteve-se uma comparação descrescente na seguinte ordem: Coágulo (9,563±3,74MPa), Bio-Oss (8,706±4,087MPa), GenMix (8,587±3,602MPa), GenOx (7,709±2,416MPa), PerioGlas (7,185±6,837MPa), não notando-se diferença estatisticamente significante entre os grupos. Nas microscopias eletrônicas de varredura na maioria dos grupos observou-se presença de fibras colágenas ao redor do tecido ósseo neoformado e dos remanescentes de enxerto. Conclui-se que o material foi indiferente para o resultado final da resistência à tração, demonstrando uma boa qualidade dos materiais utilizados, tanto quando comparamos os produtos quanto a sua origem (xenogênica, polimérica ou coágulo), ou a sua procedência de fabricação (nacional ou importado). / The loss of alveolar bone as a result of periodontal disease or secondary to surgery are numerous sources of complications for the dentists, and the solution to this problem are based on regenerative procedures, which is conducted through bone grafts that provide a scaffold for tissue repair by increasing the bone tissues in the defects resulting from trauma or surgery, filling the alveoli after extraction to preserve the height and thickness and increasing the alveolar ridge and/or reconstructing the alveolar ridge. This project aims to determine the tensile strength of newly formed bone with the use of different biomaterials. We used 60 animals divided into three groups. Group 1A (n = 10): GenOx; Group 1B (n = 10): GenMix; Group 1C (n = 10): Bio-Oss; Groups 2a (n = 10): PerioGlas; Group 2b (n = 10): castor bean polymer; Group 3 (n = 10): clot. After 3 months of birth the animals were anesthetized intraperitoneally and making non critical defect (3mm diameter) in the calvaria of the animals, which were filled with biomaterials for each group. After 6 months of surgery was performed the animals\' death, the specimens were collected and tested in a universal testing machine. It is observed that the group had a higher average tensile strength was the castor oil polymer group (10.932 ± 4.529 MPa). Consequently, we obtained a comparison descended in the following order: Clot (9.563 ± 3.74 MPa), Bio-Oss (8.706 ± 4.087 MPa), GenMix (8.587 ± 3.602 MPa), GenOx (7.709 ± 2.416 MPa), PerioGlas (7.185 ± 6.837 MPa), not noticing a significant difference between the groups. In scanning electron microscopies in most groups there was presence of collagen fibers around the newly formed bone and remaining graft. It is concluded that the material was irrelevant to the final result of the tensile strength, showing a good quality of materials used, both when comparing products as their source (xenogenic, polymeric or clot), or its origin of manufacture (national or imported).

O implante coclear tem como objetivo promover a percepção auditiva de indivíduos com deficiência auditiva de grau severo e profundo. Seu uso resulta na otimização do desenvolvimento da linguagem, da fala e da produção vocal de seus usuários. Esse dispositivo tem se mostrado uma das tecnologias mais efetivas e promissoras para remediar a perda auditiva, sendo que seus resultados são altamente dependentes da estratégia de codificação selecionada no processador de fala. O objetivo deste trabalho foi comparar as características perceptivas e acústicas da voz de crianças deficientes auditivas usuárias de implante coclear que utilizam as estratégias de codificação de fala Advanced Combination Encoder (ACE) e Fine Structure Processing (FSP), bem como investigar se as vozes dessas crianças se diferenciam das de crianças ouvintes. Crianças de 3 anos a 5 anos e 11 meses de idade foram selecionadas. Foi realizada análise acústica da vogal /a/ por meio do Multi Dimentional Voice Program (MDVP), da fala encadeada e da conversa espontânea por meio do Real Time Pitch (RTP), e análise perceptiva das mesmas emissões por meio de escalas visuais analógicas de parâmetros pré-selecionados. Em comparação com os usuários da estratégia ACE, os usuários da estratégia FSP apresentaram maior valor da frequência fundamental (F0) na vogal sustentada (p=0,004), maior desvio padrão da F0 na vogal sustentada (p=0,008), maior coeficiente de variação da amplitude também na vogal sustentada (p= 0,019), e maior desvio do pitch para o agudo na conversa espontânea (0,011). Em relação ao grupo controle os usuários da estratégia FSP apresentaram, na vogal sustentada, maior valor da F0 (p=0,012), maior desvio padrão da F0 (p=0,000), maior coeficiente de variação da frequência (p=0,039), maior coeficiente de variação da amplitude (p= 0,039), maior desvio de ressonância (p=0,027), maior instabilidade (p=0,001) e maior desvio da loudness para o forte (p=0,029). Apresentaram também na fala encadeada maior média da F0 (p=0,002), maior frequência máxima (p=0,009), maior grau geral do impacto negativo da voz (p=0,003) e maior tensão (p=0,001). Na conversa espontânea apresentaram maior grau geral do impacto negativo da voz (p=0,001), maior tensão (p=0,012), maior desvio do pitch para o agudo (0,000) e maior desvio de ressonância (p=0,010). Em comparação com os usuários da estratégia FSP, os usuários da estratégia ACE apresentaram maior valor do índice de fonação suave (SPI) na vogal sustentada (p=0,013). Em relação ao grupo controle os usuários da estratégia ACE apresentaram maior instabilidade na vogal sustentada (p=0,001), maior extensão da frequência em Hertz (p=0,004) e em semitons (p=0,048) na fala encadeada, maior frequência máxima (p=0,011) também na fala encadeada, maior grau geral do impacto negativo da voz na conversa espontânea (p=0,009) e maior desvio da ressonância na conversa espontânea (p=0,021). A partir dos dados concluiu-se que os usuários da estratégia FSP apresentaram vozes mais agudas e instáveis do que os usuários da estratégia ACE, que apresentaram produção vocal mais suave. Em relação ao grupo controle, os usuários da estratégia ACE apresentaram valor mais elevado do grau geral do impacto negativo da voz, maior grau de desvio da ressonância e maior extensão vocal para o agudo. Os usuários da estratégia FSP apresentaram vozes com maior valor do desvio global do impacto da voz, voz mais aguda, com maior desvio de ressonância, maior grau de tensão, maior desvio da loudness e maior extensão vocal. / The cochlear implant has the pupose of providing hearing perception for individuals with severe and profound hearing loss. The implants use result on optimization of development of language, speech and voice production of its users. This device is one of the most promissing and effective technologies to remedy hearing loss, and its results depend highly on the speech coding strategy selected in the speech processor. The pupose of this study was to compare perceptual and acoustic characteristics of the voices of children who use the Advanced Combination Encoder (ACE) or Fine Structure Processing (FSP) speech coding strategies, and to investigate whether these characteristics differ from children with normal hearing. Children between 3 and 5 years and 11 months of age participated. Acoustic analysis of the sustained vowel /a/ was performed using the Multi Dimentional Voice Program. Analysis of sequential speech and spontaneous speech were performed using the Real Time Pitch. Perceptual analysis of these speech samples were performed using visual-analogic scales of pre-selected parameters. In comparison with the users of the ACE strategy, the users of the FSP strategy presented greater value of fundamental frequency (F0) for the sustained vowel (p=0,004), greater standard deviation of the F0 for the sustained vowel (p=0,008), greater amplitude variation coheficient, also for the sustaned vowel (p= 0,019), and greater pitch deviation for the spontaneous speech (p=0,011). In relation to the control group, the users of the FSP strategy presented, for the sustained vowel, greater F0 value (p=0,012), greater standard deviation of the F0 (p=0,000), greater frequency variation coheficient (p=0,039), grater amplitude variation coheficient (p= 0,039), greater ressonance deviation (p=0,027), greater instability (p=0,001) and greater loudness deviation (p=0,029). They also presented, for the sequential speech, greater F0 average (p=0,002), greater maximum frequency (p=0,009), greater overall severity of the voice (p=0,003) and greater strain (p=0,001). For the spontaneous speech, they presented greater overall severity (p=0,001), greater strain (p=0,012), greater pitch deviation (0,000) and greater ressonance deviation (p=0,010). In comparison the users of the FSP strategy, the users of the ACE strategy presented greater value of the Soft Phonation Index (SPI) for the sustained vowel (p=0,013). In relation to the control group, the users of the ACE strategy presented greater instability for the sustained vowel (p=0,001), greater frequency range in Hertz (p=0,004) and in semitones (p=0,048) for the sequential speech, greater maximum frequency (p=0,011) also for the sequential speech, greater overall severity for the spontaneous speech (p=0,009) and greater ressonance deviation for the spontaneous speech. (p=0,021). The study concluded that the users of the FSP strategy presented more high pitched and unstable voices than the users of the ACE strategy, who presented softer phonation. In relation to the control group, the users of the ACE strategy presented greater value of overall severity, greater ressonance deviation and greater frequency range. The users of the FSP strategy presented greater value of overall severity, more high pitched voices, greater ressonance deviation, greater vocal strain e and greater frequency range.

Diversos estudos têm demonstrado que os implantes de titânio são altamente biocompatíveis e passíveis de osseointegrar, contudo os mecanismos moleculares que atuam por trás da osseointegração permanecem largamente inexplorados. Uma das possibilidades é que o implante exposto ao sangue do paciente durante a cirurgia absorve proteínas relacionadas com a adesão celular, como a fibronectina e vitronectina presentes no plasma. Células como osteoblastos podem então aderir a estas proteínas através dos mecanismos mediadas pelas integrinas. No presente estudo, utilizamos a imunofluorescência para marcação dos anticorpos contra integrinas &#945;2, &#945;3, &#945;5, &#945;6, &#945;v e &#946;1 em células OsA-CL cultivadas sobre lamínulas de vidro e superfície de titânio modificada por radiação à laser no período de 1h à 24 horas. As células aderidas na superfície lisa das lamínulas de vidro tiveram um maior espalhamento durante as primeiras 3 horas, porém nos outros períodos estudados o espalhamento ocorreu de maneira similar em ambas as superfícies. A expressão de integrinas na superfície rugosa dos implantes manteve-se uniforme em todos os períodos estudados, contudo no grupo controle a expressão de integrinas diminuiu na avaliação de 24 horas. Concluiu-se que as características de superfície dos diferentes biomateriais podem afetar o comportamento celular durante a interação inicial das células com a superfície de material utilizado como substrato. / Many studies have been demonstrate that titanium implants are highly biocompatible, however the molecular mechanisms that are behind of the osseointegration process are still largely unexplored. One of the possibilities is that the implant exposed to the patient blood during the surgery, adsorb proteins related to the cellular adhesion. Cells like the osteoblasts can adhere to these proteins trough the mechanisms mediated by integrins. In the present study, we used the immunofluorescence for marking antibodies against &#945;2, &#945;3, &#945;5, &#945;6,, &#945;v and &#946;1 integrins on culture of OsA-CL cells on laminulas of glass and modified titanium surface modified by laser radiation in the period of 1h to 24 hs. Cells adhered in the smooth surface of laminulas of glass had a bigger spreading during the first 3 hours, however in the other studied periods the spreading occurred in a similar way in both surfaces. The expression of integrins in the roughness surface of the implants remained uniform in all the studied periods, but on the control group the integrins expression decreased in the 24-hours evaluation. We concluded that the characteristics of surface of the different biomaterials can affect the cellular behavior during the initial interaction of the cells with the surface of the used material as substratum.

Os objetivos deste trabalho foram: avaliar os efeitos das diferentes relações sinal/ruído, no reconhecimento da fala com o implante coclear; comparar o reconhecimento da fala no ruído, com diferentes tipos de implantes cocleares multicanais; avaliar a influência do tempo de surdez, tempo de uso do implante coclear e progressão da surdez, no reconhecimento da fala com o implante coclear e avaliar o grau de dificuldade dos usuários de implante coclear, em situações com ruído competitivo no dia-a-dia. Foram selecionados 40 adultos com deficiência auditiva pós-lingual, com os implantes cocleares Nucleus 22 (N=13, estratégia SPEAK), Nucleus 24 (N=7, estratégia ACE), Combi 40 (N=6), Combi 40+ (N=7) e Clarion (N=7) com a estratégia CIS, com experiência de mais 6 meses de uso do implante coclear e reconhecimento de fala em conjunto aberto. Foi avaliado o reconhecimento das sentenças CPA (Valente 1998), no silêncio e nas relações S/R de +15 dB, +10 dB, +5 dB e aplicado o questionário Social Hearing Handicap Index - SHHI (Wedel e Tegtmeier 1979, Wedel 1983), para a auto-avaliação do desempenho com o implante coclear, em situações de silêncio (componente da deficiência auditiva) e ruído (componente da seletividade), no dia-a-dia. Os usuários de todos os tipos de implante coclear apresentaram redução significativa dos índices de reconhecimento de sentenças CPA, em função da diminuição da relação S/R, com a curva das medianas de reconhecimento das sentenças CPA alcançando 50% na relação S/R de +10 dB. Não houve diferença estatisticamente significante nos índices de reconhecimento das sentenças CPA e escores de dificuldade do Social Hearing Handicap Index (SHHI), obtidos com os diferentes tipos de implantes cocleares e estratégias de codificação da fala. As dificuldades dos usuários de implante coclear foram raras nas situações de silêncio (componente da deficiência auditiva) e ocasionais nas situações com ruído competitivo (componente da seletividade), no questionário SHHI. Observou-se, também, a influência das características dos sujeitos (tempo de surdez, tempo de uso do implante coclear e progressão da surdez) nos índices de reconhecimento das sentenças CPA. O presente estudo permitiu concluir que os usuários de todos o tipos de implante coclear multicanais apresentaram redução dos índices de reconhecimento da fala, em função da diminuição da relação S/R e maior dificuldade, no dia-a-dia, em ambientes com ruído competitivo, do que no silêncio. / The aims of this study were: to evaluate the effects of different signal to noise ratios on speech recognition obtained by the use of the cochlear implant; to compare the speech recognition in noise with different types of multichannel cochlear implants; to evaluate the influence of duration of deafness, time of implant use and hearing loss progression in the speech recognition with cochlear implant and to evaluate the degree of difficulty for speech understanding in noise in daily life situations as well. Forty adults with post lingual hearing loss implanted with Nucleus 22 (n=13, SPEAK strategy), Nucleus 24 (n=7, ACE strategy), Combi 40 (n=6, CIS strategy), Combi 40+ (n=7, CIS strategy) and Clarion (n=7, CIS strategy). The minimum time of implant use was 6 months. All subjects enjoyed some degree of open set recognition. It was evaluated the recognition for CPA sentences (Valente 1998), in silence and in S/N +15, +10 and +5 dB. It was also applied the Social Hearing Handicap Index - SHHI questionnaire (Wedel e Tegtmeier 1979, Wedel 1983) for self assessment in daily life in silence (hearing loss component) and noise (selectivity component). All the implanted adults presented a significant reduction in the scores for sentences recognition as the S/N decreased. The medians´ curve for sentence recognition reached 50% in the signal to noise ratio of +10 dB. There was no difference statistically significant in sentences recognition scores and difficulty scores obtained with the Social Hearing Handicap Index (SHHI), for all types of implants and different speech strategy. The difficulties of implanted adults were rare in silence (hearing loss component) and occasional in noisy situations (selectivity component) in the SHHI questionnaire. It was also observed the influence of duration of deafness, time of implant use and hearing loss progression in the sentences recognition scores. In this study it was concluded that all subjects presented a significant reduction in sentences recognition scores as the S/N decreased and all subjects showed more difficulty for speech understanding in noisy environments independently of the type of multichannel cochlear implants used.

Os fatores que possam promover e incrementar a osseointegração, ou prejudicar o processo biológico, aumentando o índice de falhas, têm sido cada vez mais investigados com o objetivo de ampliar indicações e as taxas de sobrevivência dos implantes dentais assim como controlar fatores adversos. O objetivo desta tese foi identificar, analisar e sintetizar as evidências científicas quanto a influência das estatinas, do envelhecimento e da experiência do cirurgião no processo osseointegração e na sobrevivência de implantes dentais. Este volume apresenta um compilado de três revisões sistemáticas orientadas pelas recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). O processo de revisão foi realizado por meio de uma busca sistemática em cinco bases de dados eletrônicas (PubMed, Scopus, Web of Science, Embase e Cochrane Library), além de busca manual nas referências bibliográficas dos estudos incluídos. A meta-análise, quando cabível, foi realizada com o auxílio do software Review Manager (RevMan, Versão 5.3). O grau de heterogeneidade entre os estudos foi verificado por meio do teste Q de Cochran e I2. O viés das publicações foi avaliado com o auxílio das escalas Newcasttle-Ottawa e Cochrane Collaboration\'s Tool. A síntese dos dados permitiu a publicação de três artigos científicos dispostos nesta tese. / Factors that may promote and enhance osseointegration, or impair the biological process, have been increasingly investigated in order to expand the indications and survival rates of dental implants and control the adverse factors. The aim of this thesis is to identify and summarize the scientific evidence of statins, ageing and surgeon related factors that can influence osseointegration and survival of dental implants. This volume presents a compilation of three systematic reviews structured by PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review process was carried out through a systematic search in five electronic databases (PubMed, Scopus, Web of Science, Embase and Cochrane Library) and bibliographical references of the included studies. Meta-analyses, when appropriate, were performed using the software Review Manager (RevMan version 5.3). The degree of heterogeneity in the studies was verified by Q Cochran test and I2. The bias of the publications was assessed with the assistance of Newcastle-Ottawa Scale and Cochrane Collaboration Tool\'s. The synthesis of the data was included in three papers prepared for this thesis.

Três dos principais tipos de implantes disponíveis no mercado são: o hexágono externo, o hexágono interno e o cone morse. Um microespaço, presente entre o implante e o intermediário protético, permite a penetração bacteriana e colonização do interior do implante. Esse microespaço, juntamente com a colonização bacteriana, tem sido associado com a perda óssea ao redor dos implantes, característica da periimplantite. O objetivo desse trabalho foi comparar a possível contaminação bacteriana nesses três tipos de implantes, em um período de 24 horas, semelhante ao que acontece na condição de carga imediata. Para tal, foram utilizados 10 implantes de cada tipo, com seus respectivos intermediários protéticos, sendo o Grupo 1 de implantes Hexágono Externo (HE), Grupo 2 de Hexágono Interno (HI) e Grupo 3 de Cone Morse (CM). No interior de cada implante foram inoculados 2L de meio de cultura (BHI). Os espécimes foram depositados individualmente em tubos de ensaio contendo 4 mL de BHI estéril. Após um teste de esterilidade, 100L de BHI contendo Enterococcus faecalis foram inoculados em cada tubo. Após 24 horas em meio contendo bactérias, os espécimes foram removidos, desinfectados e reabertos. Com um cone de papel estéril, o material do interior dos implantes foi coletado e colocado em meio de cultura para avaliar a possível passagem de bactérias do meio externo para o interno dos implantes. O teste foi repetido por mais duas vezes (Teste I, II e III), com o cuidado de se lavar e esterilizar em autoclave os espécimes. Os resultados foram tabulados e o teste exato de Fisher foi aplicado com o nível de significância de 5%. Os resultados do teste I mostraram a contaminação de 8 implantes HE, 4 implantes HI e 2 implantes CM, sendo a contaminação no grupo HE estatisticamente significante maior que nos grupos HI e CM; o teste II mostrou a contaminação de 7 implantes HE, 4 implantes HI e 4 implantes CM, não havendo diferenças estatisticamente significantes; o teste III mostrou a contaminação de 10 implantes HE, 7 implantes HI e 3 implantes CM, revelando diferenças estatisticamente significantes entre o grupo HE e CM. Concluise, portanto, que após um período de 24 horas, houve contaminação bacteriana em todos os grupos avaliados, sendo estatisticamente maior no grupo 1. / Three main types of implants available in the market are: external hexagonal, internal hexagonal and morse-taper. A microgap, present between the implant and the abutment, enables bacterial penetration and colonization of the interior of the implant. This microgap, associated with bacterial colonization, has been related with bone loss around the implants, present in periimplantitis . The aim of this study was to compare the possible bacterial contamination in these three types of implants in a 24 hour period, similarly with immediate loading. 10 implants of each type, with their abutments, were used. The implants of Group 1 were external hexagonal (HE) type, Group 2 were Internal Hexagonal (HI) type and Group 3, morse-taper type(MC). 2 µL of brain-heart infusion (BHI) broth were added into each implant. The specimens were placed individually in glass culture tubes containing 4 mL of sterile BHI broth. After a test to assure sterility, 100 µL of BHI broth containing Enterococcus faecalis were inoculated in each tube. After 24 hours, the specimens were removed, disinfected and reopened. With a sterile paper cone, the material inside the implants were collected and placed in BHI to evaluate the possible passage of bacteria from the outside to the internal side of the implant. The test was repeated two times more (Test I, II and III). The Fisher exact test was used to compare the number of contaminated implants in each group, at a significance level of 5%. The results of test I showed contamination of 8 HE implants, 4 HI implants and 2 CM implants. The contamination in the HE group was statistically higher than CM and HI groups. Test II revealed contamination of 7 HE implants, 4 HI implants and 4 CM implants. No statistically significant differences were observed. Test III showed contamination of 10 HE implants, 7 HI implants and 3 CM implants, revealing statistically significant differences between HE and CM groups. It can be concluded that after a period of 24 hours, there was bacterial leakage in all groups studied, with statistically higher contamination in group 1.

Neural prosthetics are used to replace or substantially augment remaining motor and sensory functions of neural pathways that were lost or damaged due to physical trauma, disease, or genetics. However, due to poor spatial signal resolution, neural prostheses fail to recapitulate the intimate, precise interactions inherent to neural networks. Designing materials and interfaces that direct de novo nerve growth to spatially specific stimulating elements is, therefore, a promising method to enhance signal specificity and performance of prostheses such as the successful cochlear implant (CI) and the developing retinal implant. In this work, the spatial and temporal reaction control inherent to photopolymerization was used to develop methods to generate micro and nanopatterned materials that direct neurite growth from prosthesis relevant neurons. In particular, neurite growth and directionality has been investigated in response to physical, mechanical, and chemical cues on photopolymerized surfaces. Spiral ganglion neurons (SGNs) serve as the primary neuronal model as they are the principal target for CI stimulation. The objective of the research is to rationally design materials that spatially direct neurite growth and to translate fundamental understanding of nerve cell-material interactions into methods of nerve regeneration that improve neural prosthetic performance. A rapid, single-step photopolymerization method was developed to fabricate micro and nanopatterned physical cues on methacrylate surfaces by selectively blocking light with photomasks. Feature height is readily tuned by modulating parameters of the photopolymerizaiton including initiator concentration and species, light intensity, separation distance from the photomask, and radiation exposure time. Alignment of neural elements increases significantly with increasing feature amplitude and constant periodicity, as well as with decreasing periodicity and constant amplitude. SGN neurite alignment strongly correlates with the maximum feature slope. Neurite alignment is compared on unpatterned, unidirectional, and multidirectional photopolymerized micropatterns. The effect of substrate rigidity on neurite alignment to physical cues was determined by maintaining equivalent pattern microfeatures, afforded by the reaction control of photopolymerization, while concomitantly altering the composition of several copolymer platforms to tune matrix stiffness. For each platform, neurite alignment to unidirectional patterns increases with increasing substrate rigidity. Interestingly, SGN neurites respond to material stiffness cues that are orders of magnitude higher (GPa) than what is typically ascribed to neural environments (kPa). Finally, neurite behavior at bioactive borders of various adhesion modulating molecules was evaluated on micropatterned materials to determine which cues took precedence in establishing neurite directionality. At low microfeatures aspect ratios, neurites align to the pattern direction but are then caused to turn and repel from or turn and align to bioactive borders. Conversely, physical cues dominate neurite path-finding as pattern feature slope increases, i.e. aspect ratio of sloping photopolymerized features increases, causing neurites to readily cross bioactive borders. The photopolymerization method developed in this work to generate micro and nanopatterned materials serves as an additional surface engineering tool that enables investigation of cell-material interactions including directed de novo neurite growth. The results of this interdisciplinary effort contribute substantially to polymer neural regeneration technology and will lead to development of advanced biomaterials that improve neural prosthetic tissue integration and performance by spatially directing nerve growth.