RESUMO
PURPOSE: To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis. METHODS: A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery. RESULTS: A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved. CONCLUSION: Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement. LEVEL OF EVIDENCE: Level 1. Treatment. REGISTER: NCT03265561.
Assuntos
Discite , Fusão Vertebral , Adulto , Aloenxertos , Autoenxertos , Discite/diagnóstico por imagem , Discite/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
ABSTRACT. Introduction: autologous bone grafts for maxillary sinus floor lifting are widely accepted to reconstruct alveolar ridge defects; however, there are donor sites that have not been fully explored and can be valid alternatives for this type of procedures. The objective of this study was to evaluate the behavior of tibia autologous grafts compared with freeze-dried homologous bone in maxillary sinus floor lifting. Methods: prospective, controlled, randomized study in 11 patients requiring maxillary sinus elevation. Panoramic radiographs were taken in three different moments (pre-surgery, immediately after surgery, and 6 months post-surgery) in the two groups (tibia and freeze-dried), measuring the alveolar ridge height in the posterior maxilla. Bone biopsies were taken in the grafted area 6 months after the procedure. Results: A significant reduction in bone height was found in the group grafted with freeze-dried bone. The group grafted with tibia autologous bone showed greater stability between baseline and 6 months after surgery. The histological sections showed equal conditions between the two groups. Conclusion: tibia bone shows greater stability in the evaluated period in terms of the height obtained in maxillary sinus floor lifting procedures, with clinical and histological characteristics suitable for the placement of implants. This study should be complemented with a larger sample to provide more representative results that can be applied to the general population.
RESUMEN. Introducción: los injertos de hueso autólogo para elevación del piso del seno maxilar son ampliamente aceptados para la reconstrucción de defectos en el reborde alveolar; sin embargo, existen sitios donantes que no han sido debidamente explorados y que pueden representar opciones válidas para este tipo de procedimientos. El objetivo de este estudio consistió en evaluar el comportamiento de los injertos autólogos de tibia, comparados con injertos homólogos de hueso liofilizado en la elevación de seno maxilar. Métodos: estudio prospectivo, controlado, aleatorio, que incluyó a 11 pacientes que requerían elevación del seno maxilar. Se tomaron radiografías panorámicas en tres momentos (prequirúrgico, posquirúrgico inmediato y posquirúrgico a 6 meses) en los dos grupos (tibia y liofilizado). En estas se midió la altura del reborde alveolar en el maxilar posterior. Se tomaron biopsias de hueso en la zona injertada 6 meses después del procedimiento. Resultados: Se encontró una disminución significativa de la altura ósea en el grupo injertado con hueso liofilizado. El grupo injertado con hueso autólogo de tibia presentó mayor estabilidad entre el periodo de la cirugía y 6 meses después. En los cortes histológicos se evidenció igualdad de condiciones entre ambos grupos. Conclusión: el hueso de tibia muestra mayor estabilidad en el periodo investigado, en términos de altura obtenida en procedimientos de elevación de piso del seno maxilar, con características clínicas e histológicas adecuadas para la colocación de implantes. Este estudio debe complementarse con una muestra mayor para aportar resultados más representativos aplicables a la población.
Assuntos
Materiais Dentários , Radiografia Dentária , Histologia , Seio MaxilarRESUMO
In recent years there has been increasing interest in the choice of the best material for bone substitutes. Experimental models enable estimation of biological potential, efficacy and safety of a biomaterial before its clinical application. The aim of this study was to evaluate the response of a bone substitute, UNC bone matrix powder (MOeP-UNC), for repairing the postextraction alveolus in Wistar rats. Rats' first lower molars were extracted. The right alveoli were filled with MOeP-UNC hydrated with physiological saline (Experimental Group, EG), and the left alveoli were used as Control Group (CG). Thirty days after extraction, the animals were killed and the samples processed. Histological sections were made in vestibular- lingual direction at the level of the mesial alveolus of the first inferior molar (Guglielmotti et al. J. Oral Maxillofac. Surg. 1985;43(5):359-364). Repair of the alveoli at 30 days after extraction was evaluated histologically. Repair of the alveolus was optimum in the control group at 30 days, and the EG showed presence of MOeP-UNC particles in close contact with newly formed bone tissue (osseointegration). In the experimental model used, at 30 days post-surgery, the MOeP-UNC particles integrate compatibly with newly formed bone tissue.
En los ultimos anos se ha incrementado el interes por la eleccion del material mas adecuado como sustituto oseo. Los modelos experimentales permiten estimar el potencial biologico, la eficacia y seguridad de un biomaterial, previo a su aplicacion clinica. El objetivo del presente estudio fue evaluar la respuesta de un sustituto oseo, matriz osea-UNC en polvo (MOeP-UNC), en la reparacion alveolar post-exodoncia en ratas Wistar. Se realizo la exodoncia de los primeros molares inferiores. En los alveolos derechos se coloco MOeP-UNC hidratada con solucion fisiologica (Grupo Experimental, GE). Los alveolos izquierdos, fueron utilizados como Grupo Control (GC). A los 30 dias post-exodoncia los animales fueron sacrificados y las muestras obtenidas se procesaron, se realizaron cortes histologicos en sentido vestibulo-lingual a la altura del alveolo mesial del primer molar inferior (Guglielmotti et al. J Oral Maxillofac Surg. 1985;43(5):359-364). Se realizo la evaluacion histologica de la reparacion de los alveolos a los 30 dias post cirugia. El grupo control presento una optima reparacion alveolar a los 30 dias y en el GE se evidencio la presencia de las particulas de MOeP-UNC en intimo contacto con el tejido oseo neoformado (oseointegracion). En el modelo experimental utilizado, a los 30 dias post-cirugia las particulas MOePUNC se integran de manera compatible con el tejido oseo neoformado.