RESUMEN
BACKGROUND: Osseointegrated implant placement in the ideal prosthetic position necessitates a sufficient residual alveolar ridge. Tooth extraction and the subsequent healing process often lead to bony deformities, characterized by a reduction in alveolar ridge height and width, resulting in unfavorable ridge architecture for dental implant placement. Several materials, including allografts, alloplastics, xenografts, and autogenous bone, are commonly used to address these concerns. In this context, leucocyte- and platelet-rich fibrin (L-PRF) emerges as a promising solution. METHODS: This case report aims to compare the clinical and histological efficacy of bovine hydroxyapatite bone graft covered with polypropylene membrane (BHAG-PM) and leucocyte- and platelet-rich fibrin (L-PRF) in preserving dental alveoli following tooth extraction. Extraction, graft placement in the alveoli, and the anterior border between extracted elements were performed for both treatment groups. RESULTS: Up to 24 months of follow-up revealed satisfactory and comparable clinical and histological outcomes. These results suggest that both BHAG-PM and L-PRF effectively promote alveolar preservation, paving the way for ideal implant placement. CONCLUSIONS: In general, bone-substitute materials are effective in reducing alveolar changes after tooth extraction. Xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction. Both techniques effectively preserve the alveolar bone and facilitate the placement of osseointegrated implants in ideal positions, paving the way for successful oral rehabilitation.
Asunto(s)
Durapatita , Leucocitos , Fibrina Rica en Plaquetas , Polipropilenos , Extracción Dental , Fibrina Rica en Plaquetas/metabolismo , Animales , Polipropilenos/uso terapéutico , Polipropilenos/química , Bovinos , Durapatita/uso terapéutico , Durapatita/farmacología , Humanos , Leucocitos/patología , Trasplante Óseo/métodos , Membranas Artificiales , Sustitutos de Huesos/uso terapéutico , Sustitutos de Huesos/química , Sustitutos de Huesos/farmacología , Masculino , Femenino , Proceso Alveolar/cirugía , Proceso Alveolar/patología , Persona de Mediana EdadRESUMEN
AIM: This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS: Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS: Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.
Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Animales , Humanos , Proceso Alveolar/cirugía , Proceso Alveolar/patología , Atrofia/patología , Trasplante Óseo , Implantación Dental Endoósea , Estética Dental , Estudios de Seguimiento , Caballos , Resultado del TratamientoRESUMEN
AIM: The present systematic review aimed to identify and summarize the clinical, radiographic, and histological outcomes of alveolar ridge preservation using bone xenografts and absorbable sealing materials compared with spontaneous healing in the esthetic zone. MATERIALS AND METHODS: Randomized clinical trials (RCTs) fulfilling specific eligibility criteria were included. Two review authors independently searched for eligible studies, extracted data from the published reports and performed the risk of bias assessment (RoB 2 tool). Study results were summarized using random effects meta-analyses. RESULTS: Thirteen articles concerning 10 RCTs were included, involving a total of 357 participants. Most of studies were considered as "low" risk of bias. Meta-analyses indicated less horizontal (difference in means-MD = 1.88 mm; p < 0.001), vertical mid-buccal (MD = 1.84 mm; p < 0.001) and vertical mid-lingual (MD = 2.27 mm; p < 0.001) bone resorption in alveolar ridge preservation compared to spontaneous healing as assessed clinically. Bone changes assessed radiographically showed consistent results in terms of horizontal (at 1 mm: MD = 1.84 mm, p < 0.001), vertical mid-buccal (MD = 0.95 mm; p < 0.001) and mid-lingual (MD = 0.62 mm; p = 0.05) resorption. Part of the bone resorption in the spontaneous healing group was compensated by soft-tissues, since the observed differences between groups in linear ridge reduction evaluated through cast models superimposition were smaller (MD = 0.52 mm; p < 0.001). CONCLUSIONS: Alveolar ridge preservation with xenogeneic bone substitutes and non-autogenous resorbable socket sealing materials is efficacious in reducing post-extraction bone and ridge changes in the esthetic region.
Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Humanos , Proceso Alveolar/cirugía , Alveolo Dental/cirugía , Aumento de la Cresta Alveolar/métodos , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugía , Xenoinjertos , Remisión Espontánea , Extracción Dental/métodos , Estética DentalRESUMEN
PURPOSE: After extraction, dental alveolus filling aims to reduce bone loss and maintain the alveolus volume during patient rehabilitation. Boric acid (BA) is a boron-derived compound with osteogenic properties and an interesting candidate for alveoli filling. This study aims to investigate the osteogenic capacity of the local application of BA in dental socket preservation. METHODS: Thirty-two male Wistar rats were submitted to upper right incisor extraction and randomly divided into four groups (n = 8): control group (no intervention), BA (8 mg/kg) socket filling, bone graft (Cerabone®, Botiss, Germany), and BA + bone graft socket filling. Animals were euthanized 28 days after dental extraction. MicroCT and histological analysis were performed to evaluate the newly formed bone on the dental alveolus. RESULTS: MicroCT analysis demonstrated that bone volume fraction (BV/TV), bone surface (BS), bone surface/bone volume ratio (BS/BV), bone surface density (BS/TV), trabecular thickness (Tb.Th), total bone porosity (Po-tot), and total volume of pore space (Po.V(tot)) from BA and BA + bone graft rats were significantly different from the control group. Histological evaluation displayed a delayed bone repair in BA rats, with the presence of connective tissue and inflammatory infiltrate. However, the BA + bone graft group demonstrated histological aspects like the bone graft animals, with less organized osteoblasts, suggesting inferior bone repair. CONCLUSION: Osteogenic capacity did not depend on the BA local application after 28 days of dental extraction. The presence of inflammation in the BA group can represent toxicity induced by the substance dosage used.
Asunto(s)
Ácidos Bóricos , Extracción Dental , Alveolo Dental , Humanos , Ratas , Masculino , Animales , Alveolo Dental/cirugía , Alveolo Dental/patología , Ratas Wistar , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Proceso Alveolar/patologíaRESUMEN
AIM: To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS: Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS: CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.
Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Animales , Caballos , Implantación Dental Endoósea/métodos , Trasplante Óseo/métodos , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
AIM: This randomized controlled trial evaluated the impact of a partially exposed non-absorbable membrane (dPTFE) in Alveolar Ridge Preservation (ARP) procedures on clinical, tomographic, immunoenzymatic, implant-related, and patient-centered outcomes. MATERIALS AND METHODS: Patients with a hopeless maxillary single-rooted tooth demanding rehabilitation with implants were included. Patients were randomized into two groups: dPTFE (n = 22)-tooth extraction followed by ARP using a partially exposed dPTFE membrane; USH (n = 22)-unassisted socket healing. Clinical and tomographic analyses were performed at baseline and after 3 months. After 3 months, patients received one dental implant. Implant stability quotient was obtained following implant placement. Bone-related markers were analyzed in bone biopsies using an immunoenzymatic assay. RESULTS: Greater gain in Keratinized Mucosa Width (KMW) was observed in the dPTFE (1.33 ± 0.98 mm) compared to USH (0.59 ± 0.98 mm) (Mann-Whitney test, Z = 2,28, p < 0.05). USH showed a reduction of pain/discomfort, edema, and interference with daily life from the seventh day (Friedman/Wilcoxon test, maxT = 7.48, 8.00, and 5.92, respectively, p < 0.05). dPTFE presents a reduction of edema and interference with daily life from the 7th day and pain/discomfort from the 14th day (Friedman/Wilcoxon test, maxT = 5.40, 5.26, and 4.78, respectively, p < 0.05). The dPTFE group presented higher pain/discomfort in the 35 and 42 days and higher edema from 7 to 42 days postoperatively than USH group (Mann-Whitney test, p < 0.05). No differences between groups were observed in the tomographic measures, immunoenzymatic analysis, and implant stability (p > 0.05). CONCLUSION: dPTFE was superior to USH by increasing KMW gain. However, dPTFE without bone graft presented similar bone loss compared to USH. This clinical trial was not registered prior to participant recruitment and randomization (NCT04329351).
Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Humanos , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Alveolo Dental/cirugía , Aumento de la Cresta Alveolar/métodos , Extracción Dental/métodos , Atención Odontológica , Pérdida de Hueso Alveolar/cirugíaRESUMEN
AIM: To compare the efficacy of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone block (ABB) for lateral alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: Sixty-four patients with tooth gaps up to four teeth and atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. Lateral bone thickness (LBT) was measured 2 mm below the alveolar crest at augmentation surgery and 30 weeks later at implant placement. Implant-related outcomes, adverse events, surgery duration, pain sensation, analgesic consumption, and oral health-related quality of life were also assessed. Data were analysed using Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: At 30 weeks, the median change in LBT amounted to 2.90 (CXBB) and 3.00 (ABB), respectively. Secondary endpoints demonstrated similar results for CXBB and ABB in terms of possibility to place an implant, need to perform a secondary bone augmentation at implant placement and rate of complications. Early implant failure was 20% for CXBB and 10% for ABB, with no difference between the groups. Pain scores and post-operative consumption of analgesics were significantly lower in the CXBB group than in the ABB group, especially during the first days post-surgery. CONCLUSIONS: CXBB is non-inferior to ABB for horizontal alveolar ridge augmentation and two-stage implant placement.
Asunto(s)
Aumento de la Cresta Alveolar , Implantación Dental Endoósea , Proceso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Animales , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Caballos , Dolor/etiología , Calidad de VidaRESUMEN
BACKGROUND: Implant installation with conventional drilling can create buccal bone defects in areas of limited ridge thickness. Implant installation with osseodensification may aid in preventing buccal bone defects in these situations. This in vitro pilot study evaluated the impact of osseodensification on the increase in alveolar ridge thickness and the prevention of buccal peri-implant defects. METHODS: Ten fresh pig mandibles with limited bone thickness were selected for use in an experimental randomized split mouth pilot study. Two site-preparation protocols were used: conventional drilling with cutting burs (CTL, n = 10) and osseodensification with Densah® burs (OD, n = 10). After implant bed preparation, 20 implants (4.5 × 10 mm) were placed in the prepared sites and the insertion torque was recorded. Clinical and photographic analysis evaluated ridge thickness and the extent (height, width, and area) of bone defects in the buccal and lingual bone walls following implant placement. Three-dimensional measurements were performed using STL files to analyze the increase in buccal ridge thickness following site preparation and implant placement. The height of the buccal bone defect was considered as the primary outcome of this study. Defect width, area, implant insertion torque, and linear buccal ridge increase after implant site preparation and installation were also assessed. Non-parametric evaluations were carried out with the Mann-Whitney test to verify intergroup differences. RESULTS: There was no statistically significant difference between groups in the baseline ridge thickness. OD presented a significantly higher insertion torque, associated with reduced buccal and lingual bone defect width, in comparison to CTL. CONCLUSIONS: The increase in buccal ridge thickness after site preparation and implant placement was significantly higher in OD compared to CTL. Osseodensification increased the ridge thickness through expansion and reduced buccal bone defects after implant installation.
Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Proceso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Animales , Implantación Dental Endoósea/métodos , Humanos , Boca , Proyectos Piloto , PorcinosRESUMEN
AIM: To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption. MATERIALS AND METHODS: Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported. RESULTS: Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%). CONCLUSIONS: FA and OHB are efficacious techniques to seal the alveolus during ARP.
Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugía , Proceso Alveolar/cirugía , Aumento de la Cresta Alveolar/métodos , Humanos , Metaanálisis en Red , Extracción Dental , Alveolo Dental/cirugíaRESUMEN
AIM: To compare tissue changes at implant sites previously treated with two biomaterials for alveolar ridge preservation (ARP) in the aesthetic zone, 1 year after restoration. MATERIALS AND METHODS: Sixty-six participants were treated with ARP using demineralized bovine bone mineral (DBBM) or DBBM +10% of collagen (DBBM-C), both covered with a collagen matrix (CM). Dental implants were placed, and definitive crowns were installed. Silicon impressions were taken before tooth extraction (T0), 2 weeks after crown insertion (T1) and 1 year after restoration (T2). Mid-facial mucosal level change (MLC), soft tissue thickness changes (TT), and marginal bone loss (MBL) were analysed using inter-group comparisons. RESULTS: Fifty-four participants were included in the analysis. The mid-facial level change between T0-T1 and T1-T2 showed no statistical difference between DBBM and DBBM-C. Between T0 and T1 for soft tissue thickness, DBBM performed significantly better at 3 and 5 mm below the mucosal margin. From T1 to T2, no significant differences between groups were found at any level for soft tissue thickness and MBL. CONCLUSION: At the aesthetic zone, advanced recession from tooth extraction to crown placement can be expected at sites treated with ARP regardless of biomaterial used. However, after crown insertion, tissue stability can be predicted.
Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Pérdida de Hueso Alveolar/prevención & control , Proceso Alveolar/cirugía , Animales , Bovinos , Estética Dental , Estudios de Seguimiento , Humanos , Extracción Dental , Alveolo Dental/cirugíaRESUMEN
The present study investigated the healing response of 12 fresh post-extraction alveolous grafted with particulate autologous teeth to achieve preservation of the post-extraction alveolar ridge. The objective is to elucidate the osteoconductive and osteoinductive properties of the autologous dental graft used as a bone substitute in the alveolar ridge preservation technique. Five patients were included, with at least one hopeless tooth and in need of extraction and preservatio n of the ridge, to receive in the same place a dental implant in prosthetic replacement. In the first surgical stage, dental extractions and preservation of the alveolar ridge were performed, using the teeth extracted and processed with an automatic system as bone substitutes. In the second surgical stage, an incisional bone biopsy was performed in each grafted site, the bone beds were recapitulated in a drilling protocol that allowed the placement of the dental implant, and the harvested bone specimens were prepared for analysis. The histological results of the bone biopsies in all cases showed remnant particles of the dental graft, made up of dentin, partially resorbed, with irregular superficial edges and in close contact with newly forme d bone in transition to mature lamellar bone, in which well differentiated osteocytes were observed. The immunohistochemical results showed a moderate positive expression of osteopontin at the edges of the integrated teeth particles, inside the peritubular dentin space and at the osteodental contact interfaces. In conclusion, the evidence from the study shows that the autologous dental graft is a biocompatible bone substitute, that provides an osteoconductive scaffold that promotes bone cell adhesion and migration for local osteogenesis and that it is associated with moderate in situ expression of osteopontin, which showed a high affinity with mineralized dental tissue, suggesting osteoinductive properties in situ.
El presente estudio investigó el resultado cicatrizal de 12 alvéolos frescos postextracción injertados con dientes autólogos particulados para lograr la preservación del reborde alveolar postextracción. El objetivo es dilucidar las propiedades osteoconductivas y osteoinductivas del injerto dental autólogo utilizado como sustituto óseo en la técnica de preservación de reborde. Se incluyeron 5 pacientes, con al menos un diente sin esperanza y con necesidad de extracción y preservación del reborde, para recibir en el mismo sitio un implante dental en sustitución protésica. En la primera etapa quirúrgica, se realizaron las extracciones dentales y la preservación del reborde alveolar, utilizando como sustituto óseo los dientes extraídos y procesados con un sistema automático. En la segunda etapa quirúrgica, se realizó una biopsia ósea incisional en cada sitio injertado, los lechos óseos fueron recapitulados en un protocolo de fresado que permitió la colocación del implante dental y los especímenes óseos recolectados fueron preparados para su análisis. Los resultados histológicos de las biopsias óseas en todos los casos mostraron partículas remanentes del injerto dental, conformadas por dentina, parcialmente reabsorbidas, con margenes superficiales irregulares y en estrecho contacto con depósitos de hueso de reciente formación en transición hacia hueso laminar maduro, en el cual se observaron osteocitos bien diferenciados. Los resultados inmunohistoquímicos mostraron una expresión positiva moderada de osteopontina en los bordes de las partículas del injerto dental integrado, al interior del espacio peritubular dentinario y en las interfases de contacto osteodental. En conclusión, la evidencia del estudio muestra que el injerto dental autólogo es un sustituto óseo biocompatible, que provee un andamio osteoconductivo promotor de la adhesión y migración de las células óseas para la osteogénesis local y que está asociado a la expresión modera in situ de osteopontina, la cual mostro una alta afinidad con el tejido dental mineralizado, sugiriendo propiedades osteoinductivas in situ.
Asunto(s)
Humanos , Femenino , Embarazo , Persona de Mediana Edad , Pérdida de Hueso Alveolar/diagnóstico , Aumento de la Cresta Alveolar/métodos , Trasplante Autólogo , Biopsia , Demografía , Pérdida de Hueso Alveolar/cirugía , Trasplante Óseo/métodos , Alveolo Dental , Osteopontina/metabolismo , Proceso Alveolar/cirugía , HistologíaRESUMEN
La preservación de las dimensiones y contorno del reborde alveolar posterior a una extracción es de suma importancia para evitar problemas subsecuentes para la colocación de un implante dental. El objetivo de este estudio fue comparar los cambios dimensionales mediante el análisis en tomografía computarizada de haz cónico (CBCT) en sitios pre y post preservados con técnica Bartee y Bio-Col con xenoinjerto a los 6 meses de cicatrización. En un paciente de 62 años, se realizaron 6 preservaciones alveolares en órganos dentarios uniradiculares, con diagnóstico periodontal sin esperanza, grupo A la técnica de preservación alveolar Bartee (n= 3) y grupo B la técnica de preservación alveolar Bio-Col (n= 3). Se utilizó xenoinjerto (InterOss ® Anorganic Cancellous Bone Graft Granules 0,25- 1mm Sigma graft) en ambos grupos. En el grupo A se colocó injerto óseo en la totalidad del alveolo asistido por una membrana no reabsorbible de politetrafluoroetile no denso (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). En el grupo B se colocó el injerto óseo en 3⁄4 del alveolo y el último 1⁄4 del alveolo fue ocupado por apósito de colágeno reabsorbible (CollaPlug ® Zimmer biomet). Se registraron mediciones obtenidas mediante CBCT inicial previa a la realización de preservaciones alveolares y se tomó una segunda CBCT a los 6 meses de cicatrización obteniendo la medición en sentido vertical y horizontal, coincidiendo en el plano de corte. Se observó mediante el análisis dimensional en grupo A y Grupo B obteniendo en sentido vertical un 13,58 % y 20,76 % de reabsorción y en sentido horizontal 13,45 % y 15,72 % respectivamente a los 6 meses de cicatrización, utilizando xenoinjerto por lo que no existe diferencia estadísticamente significativa en cuanto a los cambios dimensionales entre ambas técnicas p>0,05. La preservación alveolar proporciona una estabilidad dimensional contrarrestando el proceso de reabsorción fisiológica, siendo una opción predecible.
Preserving the dimensions and contour of the alveolar ridge after the dental extraction, it´s of utmost importance to avoidsubsequent problems for the placement of a dental implant. The objective of this study was compare the dimensional changes through the analysis in Cone-beam computed tomography (CBCT), in pre and post sites preserved with the Bartee and Bio-Col technique with xenograft at 6 months of healing. In a 62-year-old patient, 6 alveolar preservations were performed in uniradicular dental organs, with a hopeless periodontal diagnosis, group A the Bartee alveolar ridge preservation technique (n = 3) and group B the Bio-Col alveolar ridge preservation technique (n = 3). Xenograft (InterOss ® Anorganic Cancellous Bone Graft Granules 0.25-1mm Sigma graft) was used in both groups. In the group A a bone graft was placed in the entire socket, assisted by a dense non-absorbable polytetrafluoroethylene membrane (Cytoplast ™ Regentex TXT-200 singles, Osteogenics Biomedical Inc, Lubbock, Texas). In the group B the bone graft was placed in 3⁄4 of the socket and the last 1⁄4 of the socket was occupied by an absorbable collagen dressing (CollaPlug ® Zimmer biomet). Measurements obtained by initial CBCT before recording alveolar ridge preservations were recorded, and the second CBCT was taken 6 months after healing obtaining the measurement vertically and horizontally, coinciding in the section plane. It was observed through dimensional analysis in group A and Group B, obtaining 13.58% and 20.76% of reabsorption vertically and 13.45% and 15.72% respectively at 6 months of healing, using xenograft, so there is no statistical difference significant in terms of dimensional changes between both techniques p> 0.05. Alveolar ridge preservation provides dimensional stability by counteracting the physiological resorption process, being a predictable option.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Pérdida de Hueso Alveolar/prevención & control , Aumento de la Cresta Alveolar , Extracción Dental , Materiales Biocompatibles , Remodelación Ósea/fisiología , Tomografía Computarizada de Haz Cónico , Proceso Alveolar/cirugía , XenoinjertosRESUMEN
Introdução:Técnicas para extração dentária vêm sendo aperfeiçoadas objetivando um procedimento que diminua o esforço profissional, o tempo cirúrgicoeamenize as dores e os processos inflamatórios. Neste sentido os extratores minimamente traumáticos,com a exodontia vertical, propõem-se a preservar o osso alveolar e proporcionar uma recuperação mais rápida e confortável para o paciente. Objetivo:Avaliar a efetividade do kit para extração minimamente traumática da Maximus® (Contagem, Minas Gerais, Brasil) na exodontia de raízes residuais de incisivos, caninos e pré-molares unirradiculares. Metodologia:Trata-se de um ensaio clínico, prospectivo e analítico. Os pacientes foram operados utilizando o dispositivo, sendo avaliados os dados demográficos, tempo cirúrgico, dor e conforto após a cirurgia, bem como o grau de satisfação profissional com o uso do dispositivo. Para verificar diferenças significativas foi utilizado o teste de Mann-Whitney e a busca de associações foi realizada com o Exato de Fisher. Para todos os testes foi estabelecida uma significância com p<0,05.Resultados:Quarenta elementos foram removidos, o tempo cirúrgico foi em média 16,28 minutos, níveis de dor e conforto imediatamente após a cirurgia se mantiveram baixos (p<0,0001), e o grau de satisfação profissional se manteve alto (p<0,0001). A taxa de sucesso do dispositivo foi de 93,3% para os elementosincisivos e 20% para os elementos caninos e pré-molares (p<0,0001).Conclusões:A eficácia do extrator é determinada pelo tamanho da superfície radicular cobertas com fibras periodontais e a localização do dente. No entanto pode ser bem indicada no planejamento de reabilitações implantosuportadas em região anterior de maxila e mandíbula (AU).
Introduction:Techniques for tooth extraction have been improvedaiming at a procedure that reduces professional effort, surgical time, pain and inflammatory processes. In this sense, minimally traumatic extractors with vertical extraction, propose to preserve the alveolar bone and provide a faster and more comfortablerecovery for the patient. Objective:To evaluate the effectiveness of the Maximus® Minimally Traumatic Extraction Kit (Contagem, Minas Gerais, Brasil) in the extraction of uniradicular residual roots from incisors, canines and premolars.Methodology:Thisis a clinical, prospective and analytical trial. Patients were operated on using the device, and demographic data, surgical time, pain and comfort after surgery were evaluated, as well as the degree of professional satisfaction with the use of the device.To verify significant differences, the Mann-Whitney test was used and the search for associations was performed with Fisher's exact test. For all tests, significance was set at p<0.05.Results:Forty elements were removed, surgical time averaged 16.28 minutes, levels of pain and comfort immediately after surgery remained low (p<0.0001), and the degree of job satisfaction remained high (p<0.0001). The success rate of the device was 93.3% for the incisor elements and 20% for the canine and premolar elements (p<0.0001).Conclusions:The effectiveness of the extractor is determined by the size of the root surface covered with periodontal fibers and the location of the tooth. However, can be well indicated in planning implanted rehabilitation in the anterior region of the maxilla and mandible (AU).
Introducción: Se han mejorado las técnicas de extracciónde dientescon el objetivo de un procedimiento que reduzca el esfuerzo profesional, el tiempo quirúrgico, el dolor y los procesos inflamatorios. En este sentido, los extractores mínimamente traumáticos con extracción vertical tienen como objetivo preservar el hueso alveolar y proporcionar una recuperación más rápida y cómoda para el paciente. Objetivo: Evaluar la efectividad del Kit de Extracción Mínimamente Traumática Maximus® (Contagem, Minas Gerais, Brasil) en la extracción de raíces residuales de incisivos, caninos y premolares uniradiculares. Metodología: Es un ensayo clínico, prospectivo y analítico. Los pacientes fueron intervenidos con el dispositivo y se evaluaron datos demográficos, tiempo quirúrgico, dolor y comodidad después de la cirugía, así como el grado de satisfacción laboral con el uso del dispositivo. Para verificar diferencias significativas se utilizó la prueba de Mann-Whitney y la búsqueda de asociaciones se realizó mediante la prueba exacta de Fisher. Para todas las pruebas, la significancia se estableció en p <0,05. Resultados:Se retiraron cuarenta ítems, el tiempo quirúrgico promedió 16,28 minutos, los niveles de dolor y comodidad inmediatamente después de la cirugía permanecieron bajos (p<0,0001) y el grado de satisfacción laboral se mantuvo alto (p<0,0001). La tasa de éxito del dispositivo fue del 93,3% para los elementos incisivos y del 20% para los elementos caninos y premolares (p<0,0001).Conclusiones: La efectividad del extractor está determinada por el tamaño de la superficie radicular cubierta por fibras periodontales y la ubicación del diente. Sin embargo, puede resultar muy adecuado para planificar la rehabilitación con implantes en la región anterior del maxilar y la mandíbula (AU).
Asunto(s)
Humanos , Cirugía Bucal , Conservación de Tejido , Extracción Dental/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Proceso Alveolar/cirugía , Diente Premolar , Efectividad , Brasil , Eficacia , Estudios Prospectivos , Estadísticas no Paramétricas , Diente Canino , IncisivoRESUMEN
Host inflammatory immune response comprises an essential element of the bone healing process, where M2 polarization allegedly contributes to a favorable healing outcome. In this context, immunoregulatory molecules that modulate host response, including macrophage polarization, are considered potential targets for improving bone healing. This study aims to evaluate the role of the immunoregulatory molecules VIP (Vasoactive intestinal peptide) and PACAP (Pituitary adenylate cyclase activating polypeptide), which was previously described to favor the development of the M2 phenotype, in the process of alveolar bone healing in C57Bl/6 (WT) mice. Experimental groups were submitted to tooth extraction and maintained under control conditions or treated with VIP or PACAP were evaluated by microtomographic (µCT), histomorphometric, immunohistochemical, and molecular analysis at 0, 3, 7, and 14 days to quantify tissue healing and host response indicators at the healing site. Gene expression analysis demonstrates the effectiveness of VIP or PACAP in modulating host response, evidenced by the early dominance of an M2-type response, which was paralleled by a significant increase in M2 (CD206+) in treated groups. However, despite the marked effect of M1/M2 balance in the healing sites, the histomorphometric analysis does not reveal an equivalent/corresponding modulation of the healing process. µCT reveals a slight increase in bone matrix volume and the trabecular thickness number in the PACAP group, while histomorphometric analyzes reveal a slight increase in the VIP group, both at a 14-d time-point; despite the increased expression of osteogenic factors, osteoblastic differentiation, activity, and maturation markers in both VIP and PACAP groups. Interestingly, a lower number of VIP and PACAP immunolabeled cells were observed in the treated groups, suggesting a reduction in endogenous production. In conclusion, while both VIP and PACAP treatments presented a significant immunomodulatory effect with potential for increased healing, no major changes were observed in bone healing outcome, suggesting that the signals required for bone healing under homeostatic conditions are already optimal, and additional signals do not improve an already optimal process. Further studies are required to elucidate the role of macrophage polarization in the bone healing process.
Asunto(s)
Proceso Alveolar/lesiones , Activación de Macrófagos/efectos de los fármacos , Polipéptido Hipofisario Activador de la Adenilato-Ciclasa/administración & dosificación , Péptido Intestinal Vasoactivo/administración & dosificación , Cicatrización de Heridas/inmunología , Proceso Alveolar/efectos de los fármacos , Proceso Alveolar/inmunología , Proceso Alveolar/cirugía , Animales , Diferenciación Celular/efectos de los fármacos , Diferenciación Celular/inmunología , Modelos Animales de Enfermedad , Femenino , Inmunomodulación/efectos de los fármacos , Masculino , Ratones , Osteoblastos/fisiología , Osteogénesis/efectos de los fármacos , Osteogénesis/inmunología , Extracción Dental/efectos adversos , Cicatrización de Heridas/efectos de los fármacos , Microtomografía por Rayos XAsunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugía , Proceso Alveolar/cirugía , Animales , Trasplante Óseo , Implantación Dental Endoósea , Caballos , Extracción Dental , Alveolo Dental/cirugía , Flujo de TrabajoRESUMEN
This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.
Asunto(s)
Pérdida de Hueso Alveolar , Alveolo Dental , Pérdida de Hueso Alveolar/diagnóstico por imagen , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Tomografía Computarizada de Haz Cónico , Humanos , Maxilar , Estudios Retrospectivos , Extracción DentalRESUMEN
Una de las causas de la evolución de la periodontitis es la formación de defectos óseos y pérdida de inserción clínica. Una manera de eliminar el defecto intraóseo y su bolsa periodontal es eliminar las paredes de hueso que componen el defecto para colocar el complejo dentogingival en una posición más apical. La cirugía ósea es un procedimiento periodontal resectivo que involucra la modificación del tejido óseo del soporte dental, la cual es una modalidad del tratamiento periodontal quirúrgico que puede utilizarse para eliminar eficazmente los defectos óseos periodontales para estabilizar la inserción periodontal. El objetivo del presente estudio es realizar una revisión de la literatura sobre las consideraciones actuales, técnicas y principios de la cirugía ósea resectiva en el paciente periodontalmente comprometido (AU)
One of the causes of the evolution of periodontitis is the formation of bone defects and loss of clinical attachment, where one way to eliminate the intraosseous defect and its periodontal pocket is to eliminate the bone walls that make up the defect to place the dentogingival complex in a more apical position. Bone surgery is periodontal surgery that involves the modification of the supporting bone tissue of the teeth, which is a modality of surgical treatment that can be used to effectively eliminate periodontal defects and stabilize the periodontal insertion. The aim of the present study is to conduct a literature review about the considerations, techniques and principles of resective bone surgery in the periodontally compromised patient (AU)
Asunto(s)
Humanos , Periodontitis/cirugía , Pérdida de Hueso Alveolar/cirugía , Proceso Alveolar/cirugía , Osteotomía/métodos , Bolsa Periodontal/cirugía , Colgajos Quirúrgicos , Alargamiento de Corona/métodosRESUMEN
Abstract This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.
Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.
Asunto(s)
Humanos , Pérdida de Hueso Alveolar/diagnóstico por imagen , Alveolo Dental , Extracción Dental , Estudios Retrospectivos , Tomografía Computarizada de Haz Cónico , Proceso Alveolar/cirugía , Proceso Alveolar/diagnóstico por imagen , MaxilarRESUMEN
RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).
ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).
Asunto(s)
Humanos , Técnicas de Movimiento Dental/instrumentación , Tornillos Óseos/efectos adversos , Implantes Dentales , Métodos de Anclaje en Ortodoncia/instrumentación , Maloclusión Clase II de Angle/cirugía , Maloclusión de Angle Clase III/cirugía , Placas Óseas , Cefalometría , Técnicas de Sutura , Anclas para Sutura , Proceso Alveolar/cirugía , Técnicas de Retracción Gingival , Diente MolarRESUMEN
Abstract Objective: To evaluate the efficacy of the technique for ridge augmentation prior to implant placement. Material and Methods: Six patients with nine sites presenting an initial ridge width of smaller than 4 mm were included in this study. The tent-pole technique (combination of osteosynthesis screws measuring 1.5 mm in diameter, ABBM, and resorbable collagen membrane) was applied at defect sites. After eight months of healing time, implants were placed in the treated sites. The primary outcomes (radiographic initial ridge width, re-entry ridge width, ridge width gain) were measured by cone-beam computed tomography in reference buccopalatal cross-sections and the secondary outcomes (clinical parameters) were recorded by a digital caliper at the first and second stages. Results: After grafting, the radiographic ridge width increased by 3.02 ± 1.11 mm (1.57-4.75 mm) at 2 mm below the crest and 3.32 ± 1.70 mm (0.23-5.66 mm) at 6 mm below the crest significantly (p< 0.05). For clinical results, the mean horizontal dimension gain was 3.21 ± 1.04 mm (1.83-4.57 mm), while the mean reduction in dimension was 0.38 ± 0.33 mm. These results were statistically significant (p<0.05). Uneventful healing and no infections or membrane exposure were recorded at all sites during the study process. Three of nine (33.33%) defect sites required additional bone grafting. Conclusion: The tent-pole technique is an effective method for increasing the horizontal ridge dimension, minimizing postoperative complications, and facilitating subsequent implant placement.