RESUMO
Esse estudo teve como objetivo avaliar as alterações hemodinâmicas e do nível de glicemia decorrentes do uso do anestésico local articaína a 4% com epinefrina nas concentrações 1:100.000 (A100) e 1:200.000 (A200) em cirurgias periodontais na maxila, realizadas em diabéticos. Em relação aos anestésicos, foram avaliados: tempo de início de ação, duração da anestesia sobre os tecidos mole, analgesia pós-operatória, sangramento trans-operatório, qualidade da cicatrização, parâmetros hemodinâmicos e glicemia medidos durante as cirurgias. Para isso, 18 voluntários com idades entre 40 e 65 anos foram selecionados. Destes, 10 não apresentavam alterações sistêmicas (não diabéticos-não DM), enquanto 8 eram portadores de diabetes mellitus não insulinodependentes (DM), todos com condições periodontais semelhantes. Foram submetidos a cirurgias periodontais bilateralmente na região da maxila sob anestesia local com A100 e A200, de forma duplo-cega, randomizada e cruzada. O tempo cirúrgico foi semelhante para todos os grupos, e A100 e A200 mostraram-se igualmente eficazes para cirurgias periodontais. Foi utilizada quantidade idêntica de ambos anestésicos em todas as cirurgias (1 tubete; 1,8ml), o tempo cirúrgico foi semelhante em todos os procedimentos. O tempo de inicio de ação foi similar para todos, independentemente da concentração de epinefrina ou presença de diabetes. O tempo de duração da anestesia foi significativamente maior para os DM, sem haver correlação com a concentração de epinefrina. O sangramento trans-operatório foi significativamente maior nos pacientes diabéticos apenas na fase de incisão com A200. Nas demais fases, o sangramento foi muito semelhante entre DM e Não DM. A analgesia pós-operatória foi considerada excelente, refletindo na baixa ingestão de analgésicos (paracetamol), especialmente pelo grupo DM, independentemente da concentração de epinefrina. Quanto à cicatrização, não houve diferença entre os grupos. As mudanças transitórias nos parâmetros...
The present study compared the effect of articaine 4% associated with epinephrine in two different concentrations, 1:100.000(A100) and 1:200.000(A200), in periodontal surgeries performed in diabetic patients. We analyze hemodynamic parameters, blood glucose concentration, onset and duration of anesthetic action on soft tissues, intraoperative bleeding and wound healing. Eighteen volunteers, age range 40 to 65 years, with similar periodontal disease and conditions, were separate in two groups, type 2 diabetes mellitus (DM, 8 volunteers) or with no diabetes mellitus (Non DM, 10 volunteers). They´re submitted to a matched bilateral periodontal surgery in maxilla, under local anesthesia with either A100 or A200, in a double blind, randomized, crossed manner. The duration of surgery was the same for all groups, with A100 and A200 being equally effective for periodontal surgeries. Identical volumes of both anesthetic solutions were used (1 cartridge:1,8ml) in all surgeries. The anesthetic latency was similar in diabetics or non-diabetics for both epinephrine concentration. In diabetic patients the anesthetic duration was increased regardless the epinephrine concentration. Intraoperative bleeding only increased in diabetic patients with A200 during incision phase. The duration of postoperative analgesia was excellent, reflecting by a low intake of postoperative medications (paracetamol). Wound healing was relatively normal for all volunteers regardless the local anesthetic employed or presence of diabetes. The transient changes in blood pressure or hart hate were not clinically significant but the diabetic patients have some tendency to increase their blood pressure in some surgical phases. In diabetic subjects, blood glucose have no increase throughout surgical phases, regardless the epinephrine concentration present in the anesthetic solution, but the Non DM presents a prolonged time for normalize their blood glucose after A100...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Agonistas alfa-Adrenérgicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Diabetes Mellitus/sangue , Epinefrina/administração & dosagem , Hemodinâmica , Índice Glicêmico , Cirurgia Bucal/métodos , Doenças Periodontais/cirurgia , Dor Pós-Operatória , Hemorragia Pós-Operatória , Pressão Arterial , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years) that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.
RESUMO
OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years) that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28+/-0.87 mm at mesial and 2.81+/-0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.