RESUMO
The aim of this study was to compare the clinical, tomographic, and histological performance of collagenated xenogeneic bone blocks (CXBB) in horizontal bone augmentations for implant placement. Five patients with an absence of the 4 upper incisors and an HAC 3 horizontal bone defect, with a remaining of 3 to 5 mm, underwent a bone-grafting procedure with CXBB (test group [TG], n = 5) and autogenous graft (control group [CG], n = 5), with one type of graft used on the right side and other type on the left side. Changes in bone thickness and density (tomographic evaluation), levels of complications (clinically), and distribution pattern between mineralized and nonmineralized tissue (histomorphometrically) were analyzed. Tomographic analysis showed a horizontal bone increase of 4.25 ± 0.78 mm in the TG and 3.08 ± 0.8 mm in the CG between baseline and 8 months postoperatively (P < .05). The horizontal loss between the day of installation of the blocks and 8 months postoperatively was 1.02 ± 0.39 mm for the TG and 1.10 ± 0.71 mm for the CG (P > .05). With regard to bone density, the TG blocks right after installation had 440.2 ± 89.15 HU, and after 8 months, the region reached 730.7 ± 130.98 HU, representing an increase of 29.05%. For the CG blocks, bone density increased from 1052.2 ± 398.35 HU to 1222.5 ± 453.28 HU, representing an increase of 17.03%. The increase in bone density was significantly higher in the TG (P < .05). Clinically, no cases of exposure of the bone blocks and no failure of incorporation were observed. Histomorphometrically, the percentage of mineralized tissue was lower in the TG than in the CG (48.10% ± 2.88% and 53.53% ± 1.05%, respectively), and the opposite was verified for the levels of nonmineralized tissue (52.79% ± 2.88% and 46.47% ± 1.05%, respectively; P < .05). The use of CXBB achieved higher levels of horizontal gain, with lower bone density and lower levels of mineralized tissue when compared with the use of autogenous blocks.
Assuntos
Aumento do Rebordo Alveolar , Implantação Dentária Endóssea , Humanos , Implantação Dentária Endóssea/métodos , Projetos Piloto , Estudos Prospectivos , Aumento do Rebordo Alveolar/métodos , Boca , Transplante Ósseo/métodosRESUMO
The objective of this study was to assess the resorption index of particulate calvarial grafts in maxillary sinuses of patients undergoing total reconstruction of an atrophic maxilla with residual alveolar bone that was less than, or equal to, 3mm thick. Twenty-one maxillary sinus floor elevations were carried out using particulate calvarial grafts in 11 individuals with totally edentulous maxillas. All patients had computed tomography (CT) before (T0), and 48hours (T1) and six months after surgery (T2). For each CT scan, linear measurements were taken of sections of the anterior, medial, and posterior regions of the maxillary sinus. There was a significant increase in the height of the maxillary sinus floor when T0 was compared with T1 (p=0.001). There was a statistically significant reduction in all maxillary sinus measurements when T1 was compared with T2; the mean height reduction being 2.36mm (16.87%) in the anterior region, 3.53mm (22.47%) in the medial region, and 2.21mm (22.78%) in the posterior region (p=0.001). Mean resorption was 20.7%. Autogenous calvarial bone used alone is an option for graft material in pneumatised maxillary sinuses and in cases where there is limited alveolar bone.
Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Transplante Ósseo , Implantação Dentária Endóssea , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Estudos ProspectivosRESUMO
PURPOSE: This study evaluated the autogenous graft resorption rate in a calvarial block graft in the anterior region of an atrophic maxilla and compared it with the thickness of the remaining ridge. MATERIALS AND METHODS: Twelve patients were included in the study. They were submitted to cranial calotte graft surgery, and there were 40 blocks in total. The thicknesses of the ridges in the crest, middle and apical regions of the blocks were evaluated by computed tomography scan at the times: preoperative (T0), 48 hours (T1) and 6 months (T2) after the reconstructions. RESULTS: The resorption of the blocks from T1 to T2 was 13.4%. The greatest remodeling occurred in the alveolar bone crest (20.07%), followed by the middle portion (12.28%), and the apical region (9.5%), but the three regions did not significantly differ between times T1 and T2 (crest P = .07, middle P = .124, apical P = .131). Recipient site with the lowest thickness had the greatest resorption rates (up to 2 mm = 17.6%; from 2 to 4 mm = 17.52%) while than those with a thickness greater than 4 mm had a mean resorption of 8.81%. CONCLUSIONS: The resorption of the grafts in this study was 13.4%. Higher resorption rates were observed in the alveolar crest areas, where the ridges were less thick.
Assuntos
Aumento do Rebordo Alveolar , Transplante Ósseo , Maxila , Humanos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
The purpose of this article is to examine complications in patients who underwent bone grafting from the calcaneus between December 2001 and June 2010. This retrospective, single-practice study included 247 procedures in 242 patients, including 200 (82.64%) female and 42 (17.36%) male patients, ranging in age from 13 to 89 (median 49) years. Overall, the incidence of experiencing any form of complication was 2.43% (6 of 247); these included 5 (2.02%) feet that displayed donor site sural neuritis and 1 (0.41) that displayed a painful, hypertrophic scar at the donor site. The only statistically significant risk factor associated with the development of a calcaneal donor site complication was white race (being African American was protective). These findings indicate that procurement of autogenous bone graft from the calcaneus, as described in this report, is safe and dependable with a low incidence of complications, and irritation of the sural nerve is the most common complication associated with the procedure. Further clinical and long-term follow-up studies controlling for confounding variables need to be performed to fully determine the overall safety and efficacy of this procedure.
Assuntos
Transplante Ósseo/efeitos adversos , Calcâneo/transplante , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etnologia , Estudos Retrospectivos , Fatores de Risco , Coleta de Tecidos e Órgãos , Transplante Autólogo/efeitos adversos , População Branca , Adulto JovemRESUMO
AIM: The objective of this report was to present histological characteristics and gene expression profile of newly formed bone following horizontal augmentation of the atrophic anterior maxilla using recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier (rhBMP-2/ACS) versus an autogenous bone graft (ABG). METHODS: Bone core biopsies from 24 subjects participating in a randomized clinical trial were obtained at dental implant placement, 6 months following alveolar ridge augmentation using rhBMP-2/ACS (rhBMP-2 at 1.5 mg/ml; total dose 4.2 mg) or a particulate ABG harvested from the mandibular retro-molar region. A titanium mesh was used to provide wound stability and space for bone formation. Analysis included histological/histometric observations and gene expression profile of the newly formed bone. RESULTS: rhBMP-2/ACS yielded bone marrow rich in capillaries, undifferentiated cells and bone lining cells compared with the ABG (p = 0.002). Whereas no significant differences were observed in total bone fraction (p = 0.53), non-vital bone particles trapped in lamellar vital bone were observed in the ABG group (p < 0.001). Real-time PCR showed greater BMP-2 and RUNX2 expression for rhBMP-2/ACS over the ABG (p = 0.001 and 0.0021, respectively), while the ABG exhibited greater expression of RANKL:OPG, BSP and OPN over rhBMP-2/ACS (p = 0.01, 0.005 and 0.0009, respectively). CONCLUSIONS: Our observations suggest that formative biological processes explain bone formation following implantation of rhBMP-2/ACS, whereas remodelling, resorptive/formative processes, characterizes sites receiving ABGs.
Assuntos
Maxila , Aumento do Rebordo Alveolar , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas , Colágeno , Humanos , Proteínas Recombinantes , Transcriptoma , Fator de Crescimento Transformador betaRESUMO
As fenestrações das paredes alveolares são relativamente comuns durante o procedimento cirúrgico para instalação de implantes. O objetivo do presente trabalho foi relatar um caso clínico de reconstrução de fenestração peri-implantar imediatamente após a instalação de implante osseointegrável, através de enxerto ósseo autógeno em bloco obtido do ramo mandibular. Paciente do sexo masculino procurou o Departamento de Cirurgia e Clínica Integrada para trocar sua prótese parcial removível classe IV de Kennedy por prótese parcial fixa implantossuportada. Foram instalados dois implantes nos espaços protéticos correspondente aos dentes 12 e 21. Houve uma fenestração peri-implantar da parede vestibular durante a instalação do implante correspondente ao dente 12, que foi reconstruídapor meio de enxerto autógeno em bloco obtido do ramo mandibular e fixado por meio de parafuso bicortical. Após seis meses de concomitante período de incorporação do enxerto ósseo autógeno e osseointegração, iniciou-se o processamento para confecção da prótese parcial fixa implantossuportada. Diante da reabilitação protética alcançada, concluiu-se que o enxerto ósseo autógeno obtido da área doadora ramo mandibular constitui uma alternativa segura e eficaz para reconstrução de defeitos peri-implantares em forma de fenestração óssea...
Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types...
Assuntos
Humanos , Masculino , Adulto , Transplante Ósseo , Implantes Dentários , Reconstrução Mandibular , Reabilitação BucalRESUMO
PURPOSE: This multislice tomographic study evaluated the dimensional changes after maxillary sinus augmentation using autogenous bone or a mixture of hydroxyapatite and autogenous bone. MATERIALS AND METHODS: Ten selected patients, requiring a bilateral maxillary sinus augmentation, were divided, in a split mouth, design as follows: control group (CG n = 10 sinus grafted with autogenous bone) and test group (TG, n = 10 sinus grafted with a mixture of hydroxyapatite and autogenous bone at 80 : 20 w/w). Follow a healing period of 15 and 180 days, computed tomography (CT) measurements were taken by two blinded and calibrated examiners to verify the volumetric dimensional changes of the both groups. RESULTS: The interobserver agreement obtained ranged from good to excellent for both groups. Both groups presented significant dimensional changes after 180 days period healing (P < 0.05). The volumetric reduction in test group was lower (25.87%) when compared with the CG (42.30%) (P < 0.05). CONCLUSION: The both graft materials improved the bone volumetric ability to anchorage a dental implant. Moreover, the mixture of HA and autogenous bone graft showed lower degree of resorption and higher dimensional stability when compared with autogenous bone graft alone, at least at 180 days of healing. The CT exam protocol should be used as an important tool to measure bone grafts volumetric alterations.
Assuntos
Autoenxertos/transplante , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Durapatita/uso terapêutico , Levantamento do Assoalho do Seio Maxilar/métodos , Processo Alveolar/diagnóstico por imagem , Autoenxertos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Tamanho do Órgão , Radiografia PanorâmicaRESUMO
PURPOSE: This prospective, controlled split-mouth study evaluated the stability of dental implants placed in the augmented mandibular areas with alveolar segmental "sandwich" osteotomies using nonceramic hydroxyapatite (ncHA) or autogenous bone. MATERIAL AND METHODS: This study included 11 bilaterally partially edentulous mandibular patients in a split-mouth design. Alveolar augmentation osteotomies were performed bilaterally with interpositional ncHA graft (test group) or interpositional intraoral autogenous bone graft (control group). After 6 months of healing, four implants (two implants in each side) were placed in each patient. Forty-four implants were inserted and loaded after 6-month healing period. At 1-year follow-up, radiographic, prosthetic, and resonance frequency analysis parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, and implant mobility; absence of continuous peri-implant radiolucency; and distance between the implant shoulder and the first visible bone contact (DIB) < 2 mm. RESULTS: After a 1-year loading period, the overall implant survival rate was 95.45%, with two implant losses (one of each group). Among the surviving implants (42 out of 44), two did not fulfill the success criteria; therefore, the implant success was 90.90%. DIB was 0.71 ± 0.70 and 0.84 ± 0.72 mm for ncHA and autogenous bone grafts, respectively (p > .05). Implant stability measurements were similar between the groups during the 12-month follow-up (p > .05). CONCLUSION: Within the limits of this study, the implants placed either in sites augmented with ncHA or autogenous bone seem to represent a safe and successful procedure, at least, after 12-month follow-up.
Assuntos
Aumento do Rebordo Alveolar/métodos , Transplante Ósseo , Implantes Dentários , Durapatita , Mandíbula/cirurgia , Osteotomia/métodos , Seguimentos , Humanos , Estudos Longitudinais , Estudos ProspectivosRESUMO
AIM: To compare the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge carrier (ACS) with autogenous bone graft for augmentation of the edentulous atrophic anterior maxilla. METHODS: Twenty-four subjects were enrolled in a randomized, controlled, parallel-group, open-label clinical trial. Subjects either received rhBMP-2/ACS (1.5 mg/ml) or particulated autogenous bone harvested from the mandibular retromolar region. A titanium-mesh was used to provide space and wound stability. A guide was used to standardize clinical recordings using an analogue caliper. Alveolar ridge width was also assessed using cone-beam computed tomography. RESULTS: rhBMP-2/ACS yielded significantly greater radiographic horizontal bone gain compared with autogenous bone graft at immediate subcrestal levels (1.5 ± 0.7 versus 0.5 ± 0.9 mm; p = 0.01); non-significant differences were observed at mid- (2.9 ± 0.8 versus 2.9 ± 0.9 mm; p = 0.98) and apical (1.7 ± 0.9 versus 1.8 ± 1.1 mm; p = 0.85) crestal levels. No significant differences in clinical horizontal bone gain were observed at 6 months between rhBMP-2/ACS and autogenous bone graft (3.2 ± 0.9 mm versus 3.7 ± 1.4 mm; p = 0.31). Sixty-two implants were placed after 6 month of healing with no significant differences between groups for number of implants, implant size, primary stability and survival. CONCLUSIONS: rhBMP-2/ACS appears a realistic alternative for augmentation of the edentulous atrophic anterior maxilla.
Assuntos
Aumento do Rebordo Alveolar/métodos , Autoenxertos/transplante , Proteína Morfogenética Óssea 2/uso terapêutico , Transplante Ósseo/métodos , Maxila/cirurgia , Fator de Crescimento Transformador beta/uso terapêutico , Implantes Absorvíveis , Adulto , Processo Alveolar/diagnóstico por imagem , Atrofia , Materiais Biocompatíveis/química , Colágeno , Tomografia Computadorizada de Feixe Cônico/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Portadores de Fármacos , Feminino , Seguimentos , Humanos , Arcada Parcialmente Edêntula/diagnóstico por imagem , Arcada Parcialmente Edêntula/cirurgia , Masculino , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Osteogênese/fisiologia , Proteínas Recombinantes/uso terapêutico , Telas Cirúrgicas , Titânio/químicaRESUMO
BACKGROUND: The presence of the inferior alveolar nerve within the body of the mandible could jeopardize the placement of dental implants. Previous studies have shown that the interpositional osteotomy for posterior mandible ridge augmentation could be a predictable procedure. Nevertheless, there are few prospective, controlled, and randomized studies that evaluated this technique using different bone graft materials. PURPOSE: This prospective, controlled split-mouth study evaluated, using tomographic and Resonance Frequency Analyses (RFA), implants placed in the augmented mandibular area. MATERIAL AND METHODS: Alveolar augmentation osteotomies were performed bilaterally in 12 partially edentulous mandibular patients in a split-mouth design. The alveolar segmental osteotomies were assigned in two groups: test group, interpositional non-ceramic hydroxylapatite bone graft, and control group, interpositional intra-oral autogenous bone graft. After 6 months healing, implants were placed. The tomographic measurements of bone gain were recorded at baseline and 6 months after surgery, when the implants were placed. At 12 months after osteotomy, RFA were performed for each implant. RESULTS: The mean of bone gain 6.5 ± 2.4 mm and 7.0 ± 1.76 mm to control and test group, respectively (P > 0.05). RFA values between groups were similar at baseline and 12 months follow-up (P > 0.05). CONCLUSION: Alveolar osteotomies associated with sandwich interpositional bone graft, independently of bone graft, resulted in bone formation over a period of 12 months.
Assuntos
Aumento do Rebordo Alveolar/métodos , Durapatita/uso terapêutico , Arcada Parcialmente Edêntula/reabilitação , Osteotomia/métodos , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Titânio , Resultado do TratamentoRESUMO
O Advento dos implantes integráveis promoveu uma modalidade de tratamento com alto grau de aplicabilidade em variadas situações clínicas. Entretanto, o planejamento de implantes depende,em última análise, de rebordos alveolares favoráveis para a colocação desses. Este artigo propôs relatar um caso clínico de aumento do volume osséo de uma maxila anterior por meio de osso bovino inorgânico e uma tela de titânio, com o objetivo de reter o material de preenchimento. Com base na literatura e no resultado obtido nesse trabalho, pode-se concluir que a combinação de técnicas para cirurgia óssea guiada é uma opção de tratamento para pacientes que possuem rebordo alveolar inadequado para a colocação de implantes.
The advent of integrated implants promoted a treatment modality with a highdegree of applicability to various clinical situations. However, the planning of implants depends, ultimately, on favorable alveolar ridges for itsplacement. This article purpose is to report a clinical case of anaugmentation in the bone volume of a anterior maxilla by means of inorganic bovine bone and a titanium membrane, in order to retain the filling material. Based on literature and the results obtained in this work, we can conclude that the combination of techniques for guided bone surgery is a treatment option for patients who have inadequate alveolar ridge for implant placement.
Assuntos
Humanos , Pessoa de Meia-Idade , Aumento do Rebordo Alveolar , Materiais Biocompatíveis , Regeneração Óssea , Transplante Ósseo , Brasil , Dentição Permanente , MaxilaRESUMO
Introdução: A nicotina, uma das drogas mais nocivas a saúde, causa, entre outros fatores, morbidade do enxerto ósseo e compromete a cicatrização óssea. Por outro lado, o tratamento com laser em baixa intensidade pode proporcionar efeitos bioestimulantes, aumentando a microcirculação sanguínea da área irradiada e estimulando fibroblastos, promovendo melhores condições de cicatrização. O objetivo do presente estudo foi analisar a influência do laser em baixa intensidade sobre o processo de reparo de enxertos ósseos autógenos em bloco instalados em animais modificados sistemicamente pelos efeitos indesejáveis da nicotina. Materiais e Métodos: Foram utilizados 72 ratos (Wistar) divididos em Grupo A (n=36), subgrupos GI e GII, submetidos à aplicação de nicotina e Grupo B (n=36), subgrupos GIII e GIV, submetidos à aplicação de solução fisiológica. Transcorridos 30 dias das aplicações, todos animais receberam enxerto ósseo autógeno na mandíbula, tendo como área doadora o osso parietal da calvária, sendo que os animais pertencentes aos subgrupos GII e GIV, receberam o tratamento com laser em baixaintensidade na interface enxerto-leito receptor. Os animais de cada grupo foram submetidos à eutanásia aos 7, 14 e 28 dias pós cirurgia de enxerto. Após o processamento laboratorial de rotina foi realizada a análise histomorfométrica, visando analisar qualitativamente e quantitativamente as etapas presentes nesse processo de reparo ósseo. Resultados: A análise histológica revelou que o grupo nicotina apresentou um atraso da atividade osteogênica na interface enxerto-leito receptor, como também menor organização do tecido de granulação em substituição ao coágulo sanguineo. Contudo, a irradiação do tecido com laser embaixa intensidade proporcionou melhor reparo ósseo. Histometricamente, os subgrupos submetidos à irradiação laser (GII e GIV) demonstraram maior formação óssea comparados aos seus respectivos subgrupos (GI e GIII), com os resultados considerados estatisticamente...
Background: The nicotine is one of the mostly drugs more harmful to the health cause, among other factors, morbidity of bone graft and compromises bone healing. Furthermore, treatment with low level laser can provide biostimulation effects, increasing the blood microcirculation in the irradiated area and stimulating fibroblasts promoting better healing. The aim of this study was to evaluate the influence of low level laser therapy on the healing process of autogenous bone grafts installed in block in systemic modificated animals by undesirable effects of nicotine. Methods: Were used 72 rats (Wistar) divided into Group A (n = 36) subgroups GI and GII, submitted to the application of nicotine and Group B (n = 36) subgroups GIII and GIV, submitted to the application of saline solution. After 30 days of applications, all animals received autogenous bone block graft stabilized on mandible, with the parietal bone donor area of the skull, and the animals belonging to subgroups GII and GIV received treatment with low level laser in the bed-graft interface. The animals in each group were euthanized at 7, 14 and 28 days after bone graft surgery. After routine processing was performed histomorphometric analysis in order to analyze qualitatively and quantitatively the timing sequence of bone repair. Results: The histological analysis revealed that the nicotine group showed a delay of osteogenic activity in the bed-graft interface, as well as decreased organization of granulation tissue replacing the blood clot. However, the low level laser irradiation showed better bone healing. Histometrically, the laser subgroups (GII and GIV) demonstrated greater bone formation compared with the respective subgroups (GI and GIII), with significantly statistically results (P˂0) at 14 days (GI 14,27% ± 2,22% versus GII 24,37% ± 11,93% and GIII 24,94% ± 13,06% versus GIV 27,53% ± 19,07%) and 28 days (GI 36,89% ± 8,40% versus GII 45,81% ± 6,03% and GIII 50,31% ± 2,69% versus GIV 58,19%
Assuntos
Animais , Ratos , Transplante Ósseo , Nicotina , Terapia com Luz de Baixa IntensidadeRESUMO
O presente estudo avaliou a influência do plasma autógeno rico em plaquetas (PRP), associado ou não ao autoenxerto esponjoso (EOE), na reparação de falhas ósseas criadas no crânio de coelhos. A falha I foi preenchida com o PRP; a falha II com 3mg de EOE; a falha III com EOE associado ao PRP e a falha IV não foi preenchida, servindo como controle. Após as cirurgias, os animais foram separados em três grupos e eutanasiados aos 30, 60 e 90 dias. Na avaliação mesoscópica, independentemente do período de observação, o preenchimento ósseo, na falha controle e naquelas tratadas com PRP, iniciou-se a partir das bordas para o centro e do fundo para a superfície das falhas. Já nas falhas tratadas com EOE e com enxerto associado ao PRP, foi notado também crescimento ósseo na porção central das falhas. Na análise radiográfica, foi observada maior radiopacidade no interior das falhas tratadas com EOE e com enxerto associado ao PRP, em todos os tempos. Microscopicamente, aos 30 dias, na falha tratada com EOE associado ao PRP, os fragmentos ósseos do enxerto estavam indistintos do tecido ósseo neoformado, presente em toda a borda do defeito, associado à moderada quantidade de tecido conjuntivo fibroso muito vascularizado e celularizado. Esse tecido apresentou material amorfo, eosinofílico e extracelular, junto a um processo inflamatório, constituído por linfócitos e, em menor número, por macrófagos e células gigantes multinucleadas, que podem ter influenciado negativamente a formação óssea precoce. Aos 60 e 90 dias, apenas focos ocasionais de inflamação linfocitária foram observados. O comportamento dos dois tratamentos, PRP associado ou não ao EOE, em relação a preenchimento ósseo, foi semelhante ao final do período de observação; o enxerto, utilizado de forma isolada, determinou precocidade de reparação óssea e a tromboplastina, utilizada para formação do gel de plaquetas, incitou uma reação semelhante a do tipo corpo estranho, que atuou negativamente...(AU)
The present study evaluated autogenous platelet rich plasma's (PRP) influence on the reparation process of four bone defects made on rabbit's skull, associated or not to autogenous bone graft (EOE). Defect I received PRP only; defect II received 3mg of EOE only; defect III received EOE associated to PRP; defect IV was left to heal naturally, serving as control. After each surgery the animals were randomly divided into three groups that were euthanized at 30, 60 and 90 days. In the mesoscopic evaluation bone ingrowth started from the defect's borders to the center and from the bottom to the surface for all observation times on the control (VI) and PRP only (I) groups. In the groups treated with EOE only (II) and EOE associated to PRP (III) new bone was observed in the center of the defects. Radiographic analysis showed greater central radiopacity for groups treated with EOE only (II) and EOE associated to PRP (III) at all observation times. Microscopically in the group treated with EOE associated to PRP (III) at 30 days the graft was indistinguishable from new bone present on the border of the defect, associated to a moderate quantity of a very vascularized and cellular fibrous connective tissue. This tissue showed an extracelular eosinophilic amorphous foamy material, associated to an inflammatory process constituted by lymphocytes and in less number by macrophages and multinucleated giant cells that may have negatively influenced early bone formation. At 60 and 90 days occasional spots of lymphocytic inflammation were observed. Both treatments, PRP associated or not to EOE, were similar for the bone ingrowth at the final time of observation; the graft used alone determined early bone reparation and thromboplastine used for the platelet gel formation incited a foreign body-like reaction that acted negatively on the initial reparation.(AU)
Assuntos
Animais , Coelhos/cirurgia , Osso Parietal/lesões , Transplante Ósseo/veterinária , Plasma Rico em Plaquetas , Regeneração Óssea/fisiologiaRESUMO
O presente estudo avaliou a influência do plasma autógeno rico em plaquetas (PRP), associado ou não ao autoenxerto esponjoso (EOE), na reparação de falhas ósseas criadas no crânio de coelhos. A falha I foi preenchida com o PRP; a falha II com 3mg de EOE; a falha III com EOE associado ao PRP e a falha IV não foi preenchida, servindo como controle. Após as cirurgias, os animais foram separados em três grupos e eutanasiados aos 30, 60 e 90 dias. Na avaliação mesoscópica, independentemente do período de observação, o preenchimento ósseo, na falha controle e naquelas tratadas com PRP, iniciou-se a partir das bordas para o centro e do fundo para a superfície das falhas. Já nas falhas tratadas com EOE e com enxerto associado ao PRP, foi notado também crescimento ósseo na porção central das falhas. Na análise radiográfica, foi observada maior radiopacidade no interior das falhas tratadas com EOE e com enxerto associado ao PRP, em todos os tempos. Microscopicamente, aos 30 dias, na falha tratada com EOE associado ao PRP, os fragmentos ósseos do enxerto estavam indistintos do tecido ósseo neoformado, presente em toda a borda do defeito, associado à moderada quantidade de tecido conjuntivo fibroso muito vascularizado e celularizado. Esse tecido apresentou material amorfo, eosinofílico e extracelular, junto a um processo inflamatório, constituído por linfócitos e, em menor número, por macrófagos e células gigantes multinucleadas, que podem ter influenciado negativamente a formação óssea precoce. Aos 60 e 90 dias, apenas focos ocasionais de inflamação linfocitária foram observados. O comportamento dos dois tratamentos, PRP associado ou não ao EOE, em relação a preenchimento ósseo, foi semelhante ao final do período de observação; o enxerto, utilizado de forma isolada, determinou precocidade de reparação óssea e a tromboplastina, utilizada para formação do gel de plaquetas, incitou uma reação semelhante a do tipo corpo estranho, que atuou negativamente...
The present study evaluated autogenous platelet rich plasma's (PRP) influence on the reparation process of four bone defects made on rabbit's skull, associated or not to autogenous bone graft (EOE). Defect I received PRP only; defect II received 3mg of EOE only; defect III received EOE associated to PRP; defect IV was left to heal naturally, serving as control. After each surgery the animals were randomly divided into three groups that were euthanized at 30, 60 and 90 days. In the mesoscopic evaluation bone ingrowth started from the defect's borders to the center and from the bottom to the surface for all observation times on the control (VI) and PRP only (I) groups. In the groups treated with EOE only (II) and EOE associated to PRP (III) new bone was observed in the center of the defects. Radiographic analysis showed greater central radiopacity for groups treated with EOE only (II) and EOE associated to PRP (III) at all observation times. Microscopically in the group treated with EOE associated to PRP (III) at 30 days the graft was indistinguishable from new bone present on the border of the defect, associated to a moderate quantity of a very vascularized and cellular fibrous connective tissue. This tissue showed an extracelular eosinophilic amorphous foamy material, associated to an inflammatory process constituted by lymphocytes and in less number by macrophages and multinucleated giant cells that may have negatively influenced early bone formation. At 60 and 90 days occasional spots of lymphocytic inflammation were observed. Both treatments, PRP associated or not to EOE, were similar for the bone ingrowth at the final time of observation; the graft used alone determined early bone reparation and thromboplastine used for the platelet gel formation incited a foreign body-like reaction that acted negatively on the initial reparation.
RESUMO
Frente a crescente utilização de implantes osseointegrados nas reabilitações orais, as dificuldades foram surgindo junto a necessidade de reabilitar arcos dentários com níveis avançados de comprometimento dos rebordos alveolares remanescentes. Assim, os enxertos ósseos passaram a ser uma opção no sentido de possibilitar e/ou até mesmo melhorar os resultados finais da prótese sobre implante sobre tudo em maxila. Os autores relatam o caso clínico de uma paciente de 40 anos de idade, portadora de prótese total superior que desejava substituí-la por implantes. Detectado a avançada reabsorção óssea da maxila planejou-se cirurgia de enxerto autógeno da crista ilíaca. A técnica usada foi do tipo onlay, e simultâneo levantamento e preenchimento bilateral do seio maxilar. Conclui-se que a reconstrução de maxilas extremamente atróficas com o uso de protocolos de enxertos de osso autógeno oriundo da crista ilíaca podem devolver o volume em espessura do osso maxilar viabilizando a fixação futura de implantes e facilitando o sucesso das próteses
Due to the increasing use of osseointegrated implants in oral rehabilitations, difficulties have been arisen with the need of rehabilitating dental arches with advanced levels of remaining alveolar ridge involvement. Thus, bone grafts have become an option in the sense of both making possible and improving the results of prostheses over implants mainly in the maxilla. The authors report a clinical case of a 40-year-old patient who desired to substitute an upper total prosthesis for implants. The autogenous iliac crest graft has been chosen due to the advanced bone resorption the maxilla. The onlay technique has been used with simultaneous lifting and bilateral filling of the maxillary sinus. It has been concluded the reconstruction of extremely atrophic maxillas with autogenous iliac crest grafts may restore the maxillary bone thickness making possible the future placement of implants for better prosthetic results
Assuntos
Humanos , Feminino , Adulto , Transplante Ósseo , Seio Maxilar , Reabilitação BucalRESUMO
O autor apresenta e elucida com dois casos clínicos, uma técnica de reconstrução óssea dos maxilares para aumentar a previsibilidade de reparação de defeitos extensos com envolvimento de pelo menos uma parede óssea inteira. A técnica consiste na formatação da parede perdida através da extração de uma mini-placa de osso autógeno cortical das regiões posteriores dos maxilares e conseqüente redimensionamento para fixação imediata, reconfigurando a anatomia perdida e evitando-se o uso de barreiras de ROG. Aspectos complementares para otimizar os resultados são discutidos, como os parâmetros para posicionamento ideal dos implantes, manipulação de tecidos moles, tempos de espera e cuidados especiais com as primeiras próteses. Os resultados clínicos e a experiência apresentada pelo autor permite concluir que a técnica é factível por todos porém um treinamento específico torna-se fundamental para a garantia de sucesso
The author presents and clarify with two clinical cases, a new bone reconstruction technique for enhancing the previsibility for extense bone defects that lost at least one entire wall. The technique includes the lost wall reconstruction by the extraction of a little cortial bone plate from the posteriors areas of both maxillaries and formatting it for immediate fixation looking for reshaping the lost anatomy as well as avoiding the use of GBR barriers. Other complementary aspects for enhancing the final results are discussed, like three-dimensional space parameters for ideal implant installation, soft tissues manipulation, healing time, and special cares with the first prostheses. The clinical results as well as the author experience presented, makes possible the conclusion that the technique can be routinely used but a specific training is crucial for a guarantee success
Assuntos
Humanos , Transplante Ósseo , Cirurgia Bucal , Placas Ósseas , Regeneração ÓsseaRESUMO
Os pacientes que possuem reabsorções ósseas severas na região maxilar anterior, enfrentam problemas funcionais e estéticos. A reabilitação protética de um paciente desdentado, com atrofia severa, é, muitas vezes, difícil e desafiadora. Os autores realizaram um caso clínico de enxerto ósseo autógeno, coletado da sínfise mandibular através do aparelho Autogenous®, com fixação imediata de implantes osseointegráveis (Implus®)
The edentulous patients that have extremely diminished alveolar height, also including the cases of severe atrophic maxilla, confront with functional and esthetic problems. The autors presents a clinic case of autogenous bone graft, harvested from the synphysis through one Autogenous®, with immediate implant placement (Implus®)