RESUMO

A maxillary sinus lift was performed without bone grafting in a 23-year-old female patient who required the placement of a dental implant in the edentulous area of tooth 16. The clinical and tomographic evaluation made it possible to plan and perform the maxillary sinus lift using the transcrestal approach and without the need for bone grafting. The residual ridge of 6mm allowed the placement of a simultaneous dental implant. After 6 months of tomographic follow-up, before prosthetic loading, a vertical bone height of 8.83 mm was achieved, resulting in a vertical bone gain of 2.83 mm. Additionally, an adequate integration of the dental implant was observed without postoperative complications. Transcrestal sinus lift without the use of bone graft is shown to be a viable, safe and effective technique for the simultaneous placement of dental implants in patients with bone atrophy in the maxillary area. This technique offers advantages such as reduced surgical time, less morbidity, lower cost and a faster healing process compared to conventional methods.

RESUMO

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.

Assuntos

Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Seios Transversos , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Tomografia Computadorizada de Feixe Cônico

RESUMO

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)

---

Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Implantação Dentária/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Assistência ao Convalescente , Custos e Análise de Custo

RESUMO

BACKGROUND: The development of techniques in biomaterials design and production added to advanced surgical procedures which enabled better and more predictable clinical outcomes. Maxillary sinus floor augmentation (MSFA) is among the more studied bone-guided regeneration procedure in the literature. The MSFA could be considered the gold standard procedure for bone-guided regeneration as it provides suitable functional and aesthetic solutions to alveolar ridge atrophy due to tooth loss. PURPOSE: This study aimed to conduct a detailed histomorphometric evaluation of collagen production in SFAs bone-guided regeneration, using nano-hydroxyapatite/ß-tricalcium phosphate (nano-HA/ß-TCP) composite. PATIENTS AND METHODS: A 52-year-old female had the left upper second premolar condemned due to periodontal disease, then a tooth implant replacement was planned. Due to maxillary sinus pneumatization, the MSFA had to be done before implant placement. Nano-HA/ß-TCP composite (2g) was used in the MSFA procedure. After nine months of the healing process, during the Cone Morse implant installation process, bone samples were collected for histologic analysis (sirius red, hematoxylin/eosin, polarized microscopy). Six months after implant installation, a ceramic crown was installed according to the patient's request. RESULTS: Proper masticatory function and aesthetics were re-established. The histomorphometric evaluation indicated that nano-HA/ß-TCP composite did not show any area devoid of cellular activity in sirius red or hematoxylin/eosin staining and the percentage (%) of new bone collagen fibers was achieved using polarization technique evaluation. CONCLUSION: According to these results, nano-HA/ß-TCP composite presented clinical and histomorphometric properties suit to be used as bone-guided regeneration biomaterial in MSFA. Furthermore, nano-HA/ß-TCP composite provided a favorable nano-environment to bone cells, enhancing bone matrix production.

RESUMO

RESUMEN: Proponer un plan de tratamiento con técnicas quirúrgicas y protocolos protésicos predecibles representa un gran desafío profesional, especialmente en pacientes con un maxilar atrófico. Entre las alternativas terapéuticas, la prótesis híbrida sobre cuatro implantes dentales correctamente distribuidos permite formar un área de distribución de carga, la cual guarda relación con las necesidades biomecánicas del elemento protésico.

---

ABSTRACT: Proposing a treatment plan with surgical techniques and predictable prosthetic protocols means a great professional challenge, especially in patients with an atrophic maxilla. Among the therapeutic alternatives, the hybrid prosthesis on four correctly distributed dental implants, allows to form a load distribution area, which is related to the biomechanical needs of the prosthetic element.

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Implantes Dentários , Maxila/cirurgia , Atrofia

RESUMO

OBJECTIVES: The objective of this cross-sectional study was to evaluate the vertical bone gain achieved after the sinus lift procedure with beta-tricalcium phosphate (ß-TCP) used as a bone substitute and simultaneous implant placement. METHODS: One hundred and twenty-eight sinus lift procedures (utilizing a synthetic ceramic containing 99.9% tricalcium phosphate as a bone substitute) and simultaneous implant placements were performed on 119 patients. The lateral window approach surgical protocol for maxillary sinus lift was performed on the patients. The implants were evaluated using cone-beam computed tomography (CBCT) at 6 months following placement. The vertical bone gain was considered a primary variable, while implant length, diameter, and location were considered secondary variables. RESULTS: The ANOVA results showed no statistical difference in vertical bone gain with implant parameters like implant length, width, and position. Pearsons correlation revealed a statistically significant positive correlation with vertical bone gain and implant length and diameter. A further multivariate linear regression analysis was performed and it observed statistically significant associations between the variables in the study after adjusting for confounding factors. CONCLUSIONS: This study concluded that there was vertical bone gain with the usage of ß-TCP in maxillary sinus lift surgical procedure with immediate implant placement and that implant variables like length and diameter had a significant influence on the average bone gain values. The implant position did not have a statistically significant influence but there was considerable variation in the bone gain between first, second premolar, and molar regions.

Assuntos

Substitutos Ósseos , Seio Maxilar , Fosfatos de Cálcio , Estudos Transversais , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia

RESUMO

La cirugía de elevación de seno maxilar se considera como la técnica de aumento óseo más predecible. Sin embargo, no está exenta de complicaciones las cuales deben ser manejadas adecuadamente. Se presenta un caso clínico rehabilitado, con un seguimiento de 3 años, en el cual se realizó un manejo multidisciplinario y resolutivo de complicaciones asociadas a la técnica quirúrgica de elevación de membrana sinusal vía ventana lateral. Frente a una infección postoperatoria, como la presentada en el caso, hay que considerar iniciar un tratamiento antibiótico en el momento adecuado para impedir el agravamiento del cuadro clínico o un cambio de esquema en caso de resistencia antimicrobiana.

---

Maxillary sinus lift surgery is considered the most predictable bone augmentation technique. However, this procedure is not without complications, which must be handled properly. We present a rehabilitated clinical case, with a 3-year follow-up, in which a multidisciplinary and resolutive management of complications associated with the surgical technique of sinus lift procedure, using lateral window approach, was performed. In case of postoperative infection, such as the one presented in this report, it is necessary to consider starting an antibiotic treatment at the adequate moment to prevent the aggravation of the illness or change the pharmacological treatment in case of antimicrobial resistance.

Assuntos

Humanos , Feminino , Adulto , Sinusite/terapia , Infecções Bacterianas/terapia , Rinite/terapia , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Complicações Pós-Operatórias/reabilitação , Sinusite/etiologia , Sinusite/microbiologia , Infecções Bacterianas/etiologia , Implantes Dentários , Rinite/etiologia , Rinite/microbiologia , Doença Aguda , Seguimentos , Resultado do Tratamento

RESUMO

OBJECTIVES: The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß-tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. MATERIALS AND METHODS: For this prospective case series, sinus augmentation was performed using a biphasic ß-tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. RESULTS: A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non-mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi-1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. CONCLUSION: Biphasic ß-tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone.

Assuntos

Substitutos Ósseos , Levantamento do Assoalho do Seio Maxilar , Materiais Biocompatíveis , Fosfatos de Cálcio , Durapatita , Humanos , Seio Maxilar , Estudos Prospectivos

RESUMO

The aim of this review was to test the hypothesis of no difference in the efficacy of bone regeneration when using stem cells in maxillary sinus floor augmentation surgery in comparison to other grafts. Nine randomized clinical trials and one follow-up study involving human subjects were identified through a search of the PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases, supplemented by a hand search. No significant difference between groups was found for the implant survival rate, increase in bone height, marginal bone loss following implant placement, or new bone formation. With regard to the residual bone graft, an effect favouring the graft group at 3-4months (P=0.001) and favouring the stem cell group at 6months (P=0.01) was found. Analyses of the subgroup in which the BMAC system extraction method was used in combination with Bio-Oss, revealed no difference in new bone formation; however, the results for residual bone graft at 3months favoured the control graft (Bio-Oss) (P=0.01), but at 6months favoured the stem cells (Bio-Oss+BMAC system) (P=0.01). Based on all findings, the use of stem cells does not contribute significantly to greater implant survival rates or the efficacy of bone regeneration following sinus lift procedures.

Assuntos

Substitutos Ósseos , Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Transplante Ósseo , Implantação Dentária Endóssea , Seguimentos , Humanos , Seio Maxilar , Ensaios Clínicos Controlados Aleatórios como Assunto , Células-Tronco

RESUMO

A elevação de seio via crista do rebordo maxilar é uma técnica bastante utilizada no aumento ósseo da maxila posterior, e a utilização de osteótomos de Summers com martelo é a modalidade mais conhecida. Esta técnica é denominada "técnica de elevação de seio atraumática", o que se trata de uma designação equivocada, uma vez que as marteladas utilizadas para elevar o assoalho do seio maxilar, dependendo do nível de densidade óssea, são bastante incômodas aos pacientes e não são raras as manifestações de desconforto pelos mesmos. Além do desconforto, devido às marteladas sobre os osteótomos, pode ocorrer a vertigem posicional paroxicística benigna (VPPB). Nos últimos anos, a Implantodontia vem buscando técnicas menos traumáticas para a elevação de seio maxilar, destacando-se aquelas que se utilizam de instrumentos rotatórios. Neste trabalho, foi apresentada uma técnica de elevação de seio via crista, que se caracteriza por ser minimamente invasiva e pouco traumática, utilizando instrumentos rotatórios (kit SCA ­ Neobiotech, Coreia), associada à técnica hidrodinâmica (Aqua Lift System, IM3 ­ Neobiotech, Coreia) para descolamento e elevação da membrana, enxertia com Cerasorb (Curasan, Alemanha) e instalação de implante concomitantemente (SW ­ SIN, Brasil).

---

The transcrestal maxillary sinus lift is a technique widely used in bone enhancement of the posterior maxilla and the use of Summers osteotomes with hammer is the best known modality. This technique is termed an atraumatic sinus elevation technique, which is probably a misnomer, since hammers used to raise the floor of the maxillary sinus, depending on the level of bone density, are very uncomfortable for patients and manifestations of discomfort are not uncommon. In addition to discomfort, due to the hammering of the osteotomes, benign paroxysmal positional vertigo (BPPV) can occur as a complication. In recent years, Implantology has been seeking less traumatic techniques for maxillary sinus elevation. Among them, stand out those that use rotary instruments. In this work, a technique of sinus elevation via crest is presented, which is characterized by being minimally invasive and not very traumatic, using rotary instruments (kit SCA ­ Neobiotech, Korea), associated to the hydrodynamic technique (Aqua Lift System, IM3 ­ Neobiotech, Korea) for membrane detachment and elevation, grafting with Cerasorb (Curasan, Germany) and concomitant implant installation (SW ­ SIN, Brazil).

Assuntos

Humanos , Masculino , Pessoa de Meia-Idade , Materiais Biocompatíveis , Substitutos Ósseos , Implantes Dentários para Um Único Dente , Levantamento do Assoalho do Seio Maxilar/métodos , Transplante de Tecidos , Transplante Autólogo

RESUMO

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

---

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Assuntos

Humanos , Masculino , Feminino , Artéria Maxilar/anatomia & histologia , Levantamento do Assoalho do Seio Maxilar/métodos , Artéria Maxilar , Tomografia Computadorizada de Feixe Cônico/métodos , Anastomose Arteriovenosa/anatomia & histologia , Estudos Transversais , Epidemiologia Descritiva , Levantamento do Assoalho do Seio Maxilar/estatística & dados numéricos , México , Estudo Observacional , Interpretação Estatística de Dados

RESUMO

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

RESUMO

OBJECTIVE: 1) To describe implant success in the posterior maxillary when a sinus augmentation procedure was performed simultaneously with implant placement and then compare differences in success when sinus augmentation was delayed in patients attending the maxillofacial surgery clinic of the University of Puerto Rico, 2008 through 2011. 2) To determine sociodemographic characteristics, ASA classification, graft material, and final restoration and, using a questionnaire, determine as well patient satisfaction. METHODS: A retrospective cohort study was conducted (approved by IRB) with 172 patients, using medical records. A total of 102 implants were placed in grafted maxillary areas, 55 placed simultaneously and 47 delayed. Patients were contacted, invited to participate, and, upon agreement, instructed to sign an informed consent. RESULTS: A total of 45 implants were evaluated clinically (22 immediate and 23 delayed), all with 100% success (according to Buser and Weber criteria). In the sample group, 72.5% of the participants were women and 26.8% were men; their ages ranged from 42 to 87 years, with a mean age of 57 years. Patient participation was low (44%). The categories of appearance and esthetics and function were both rated at 86.2%; cost of restoration came in at 86.1%, and maintenance was rated at 71.2%. CONCLUSION: Implant placement with simultaneous sinus augmentation was successful, and no differences were found between implants that were placed immediately and those that were delayed, which is similar to what has been found by previous studies. Patients reported being satisfied with the final cost of the implant restoration.

Assuntos

Implantação Dentária Endóssea , Levantamento do Assoalho do Seio Maxilar , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Fatores de Tempo

RESUMO

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

---

El objetivo de este estudio es comparar la formación ósea en técnicas de elevación de seno maxilar utilizando injerto óseo autógeno en evaluaciónhistológica a las 2 y 6 meses. Un estudio comparativo fue diseñado donde 10 pacientes con dientes perdidos de forma bilateral en el sector posterior de maxila fueron incluidos. Los pacientes recibieron injerto óseo particulado bajo las mismas condiciones quirúrgicas, seleccionando el sitio para tomar la biopsia y el análisis histológico respectivo a los 2 meses en un lado y 6 meses en el lado contralateral. La histomorfometría se realizó y fueron utilizadas la prueba de Kolmogorov-Smirnov, la prueba t de student y la prueba de Spearman, considerando un valor de p<0,05. Fueron observadas diferencias en infiltrado inflamatorio y características de vascularización; sin embargo, los grupos analizados a los dos meses presentaron 38.12% ± 6.64% de tejido mineralizado, mientras que los grupos de estudio a los 6 meses presentaron en promedio 38.45 ± 9.27%. No se observo diferencias significativas entre los grupos. Se concluye que la formación ósea puede ser similar en elevaciones de seno maxila realizada con hueso autógeno particulado a los dos o seis meses; en estas condiciones, la instalación temprana de implantes puede ser viable.

Assuntos

Humanos , Autoenxertos , Regeneração Óssea/fisiologia , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Seio Maxilar/patologia , Seio Maxilar/fisiologia , Fatores de Tempo

RESUMO

El uso de biomateriales para elevar el piso del seno maxilar permite la instalación de implantes de metal y la rehabilitación estética y funcional de los pacientes con pérdida de dientes en sus maxilares. Actualmente existen diferentes biomateriales que pueden utilizarse en estos procedimientos con diferentes propiedades osteoinductivas y osteoconductivas. Es fundamental para el odontólogo conocer profundamente cada uno de los biomateriales para precisar correctamente el tratamiento. El objetivo de este estudio fue realizar una revisión de la literatura que describe la mayoría de los tipos de biomateriales utilizados en Odontología.

---

The use of biomaterials for the elevation of the maxillary sinus floor allows the installation of metallic implants and enables the aesthetic and functional rehabilitation of patients with maxillary tooth loss. Currently there are different biomaterials that can be used in these procedures with different osteoinductive and osteoconductive properties. It is fundamental to the dentist thoroughly knowledge of each of these biomaterials in order to properly indicate treatment. Thus, the aim of this study was to conduct a literature review describing the types most commonly used biomaterials in dentistry.

RESUMO

Various synthetic bone substitutes have been developed to reconstruct bone defects. One of the most prevalent ceramics in bone treatment is hydroxyapatite (HA) that is a useful material as bone substitute, however, with a low rate of biodegradation. Its structure allows isomorphic cationic and anionic substitutions to be easily introduced, which can alter the crystallinity, morphology, biocompatibility, and osteoconductivity. The objective of this study was to investigate the in vitro and in vivo biological responses to strontium-containing nanostructured carbonated HA/sodium alginate (SrCHA) spheres (425<ϕ <600 µm) that were used for sinus lifts in rabbits using nanostructured carbonated HA/sodium alginate (CHA) as a reference. Cytocompatibility was determined using a multiparametric assay after exposing murine preosteoblasts to the extracts of these materials. Twelve male and female rabbits underwent bilateral sinus lift procedures and were divided into two groups (CHA or SrCHA) and in two experimental periods (4 and 12 weeks), for microscopic and histomorphometric analyses. The in vitro test revealed the overall viability of the cells exposed to the CHA and SrCHA extracts; thus, these extracts were considered cytocompatible, which was confirmed by three different parameters in the in vitro tests. The histological analysis showed chronic inflammation with a prevalence of macrophages around the CHA spheres after 4 weeks, and this inflammation decreased after 12 weeks. Bone formation was observed in both groups, and smaller quantities of SrCHA spheres were observed after 12 weeks, indicating greater bioresorption of SrCHA than CHA. SrCHA spheres are biocompatible and osteoconductive and undergo bioresorption earlier than CHA spheres.

Assuntos

Alginatos , Substitutos Ósseos , Cavidades Cranianas/cirurgia , Durapatita , Nanoestruturas/química , Estrôncio , Alginatos/química , Alginatos/farmacologia , Animais , Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos/química , Substitutos Ósseos/farmacologia , Linhagem Celular , Cavidades Cranianas/lesões , Cavidades Cranianas/metabolismo , Avaliação Pré-Clínica de Medicamentos , Durapatita/química , Durapatita/farmacologia , Feminino , Ácido Glucurônico/química , Ácido Glucurônico/farmacologia , Ácidos Hexurônicos/química , Ácidos Hexurônicos/farmacologia , Masculino , Teste de Materiais/métodos , Camundongos , Coelhos , Estrôncio/química , Estrôncio/farmacologia

RESUMO

A restauração implantossuportada bem-sucedida passa por um planejamento prévio, abordando as variáveis clínicas específicas para cada caso. Maxilas severamente atróficas representam um desafio para reabilitação com próteses fixas, haja vista que o paciente não possui a quantidade mínima necessária de altura óssea na região posterior para a instalação de implantes no local preconizado pelo enceramento diagnóstico. Objetivo: o presente estudo tem como objetivo relatar um caso de reabilitação bucal com prótese total implantossuportada por meio de elevação bilateral de seio maxilar, utilizando 100% de biomaterial aloplástico para posterior instalação de implantes dentários, com cinco anos de follow-up clínico e tomográfico. Métodos: a utilização de um substituto ósseo sintético (fosfato de cálcio bifásico) elimina qualquer risco potencial de transmissão de microrganismos e reduz o número de sítios cirúrgicos, haja vista que dispensa a coleta de osso autógeno para enxertia. Como a altura óssea subantral residual chegava a ser inferior a 1mm, um procedimento de elevação de seio maxilar bilateral, por meio da técnica da janela lateral, foi planejado para oito meses antes da instalação de oito implantes, que serviriam de retenção para uma prótese total implantossuportada, a ser instalada 60 dias após a cirurgia de colocação dos implantes. Conclusão: há evidências, tanto na literatura científica quanto no caso relatado,que de que a utilização de 100% biomaterial aloplástico para aumento vertical de maxila atrófica por meio de levantamento do assoalho do seio maxilar consiste em uma alternativa ao uso do enxerto autógeno, tornando-se uma solução eficiente e de menor morbidade...

---

Successful implant rehabilitation relies on previous planning that addresses thespecific clinical variables of each case. Fixed-prosthesis rehabilitation of severely atrophic maxilla is a challenge, given that patients do not present with minimal posterior bone height required for implant placement at the site recommended by diagnostic wax-up. Objective: The present study aims at reporting a case of implant-supported complete denture oral rehabilitation performed by means of bilateral maxillary sinus lift with 100% alloplastic biomaterial for subsequent implant placement, with a 5-year clinicaland tomographic follow-up. Methods: The use of synthetic bone substitutes (biphasic calcium phosphate) not only eliminates potential risks of contamination, but also reduces the number of surgical sites, given that it does not require autogenous bone to be harvested for grafting. Subantral residual bone height was less than 1 mm, therefore, bilateral maxillary sinus lift carried out by means of the lateral window approach was planned to be performed eight months before placement of eight implants. These implants would give support to a complete denture installed 60 days after implant placement surgery. Conclusion:Both scientific literature and the case reported herein evince that the use of 100% alloplastic biomaterialfor vertical augmentation of atrophic maxilla by means of maxillary sinus lift is an efficient alternative to replace autograft due to presenting lower morbidity rates...

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Prótese Dentária Fixada por Implante , Maxila/anormalidades , Seio Maxilar/cirurgia , Prótese Total Superior , Radiografia Panorâmica

RESUMO

PURPOSE: To assess the influence of complete maxillary sinus volume on the dimensional changes of different grafts used in maxillary sinus lift. MATERIALS AND METHODS: Analysis of 50 surgical procedures of maxillary sinus lift performed on 43 subjects using different grafting materials: fresh frozen allogenic particulated bone (11), hydroxyapatite (Endobon(®)) (17), 60% hydroxyapatite + 40% beta-tricalcium phosphate (Bone Ceramic(®)) (12) and Bone Ceramic(®) + Emdogain(®) (10). One hundred and fifty multislice tomographic images of the maxillary sinus were obtained using the software Syngo CT 2011 A VOLUME, measuring complete maxillary sinus volume (T0) and dimensional changes of different graft materials during periods of 15 days (T1) and 180 days (T2). The factor studied was the influence of maxillary sinus volume on the dimensional changes of different graft materials used in maxillary sinus lift in patients with posterior edentulism. Data obtained were assessed using the Student's t-test and Pearson's correlation coefficient. RESULTS: No correlation (r 0.112) between the total maxillary sinus volume and the dimensional changes of the different graft materials used in this study was observed (P > 0.05). CONCLUSION: This study demonstrated that there is no sufficient evidence to support the thesis that the volume of the maxillary sinus influences the contraction of the grafts, at least on sample or the biomaterials evaluated in this cohort study.

Assuntos

Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/instrumentação , Tomografia Computadorizada por Raios X , Transplante Ósseo , Fosfatos de Cálcio/uso terapêutico , Durapatita/uso terapêutico , Feminino , Humanos , Masculino

RESUMO

BACKGROUND: The installation of dental implants in the posterior maxilla is often faced with resorbed alveolar processes, resulting from a combination of pneumatization of the maxillary sinus, the effects of periodontal disease, and physiological bone resorption. The sinus lift surgery has been practiced since 1980 with the aim to increase bone height in this region for an implant supported prosthetic rehabilitation, and various filling materials have been used for such. OBJECTIVES: This study aimed to clinically, radiographically, and histologically evaluate a preparation of calcium phosphate cement (Bone Source(®), BS) used as filling material in maxillary sinus elevation surgery. METHODS: Ten patients were operated requiring maxillary sinus graft for future placement of osseointegrated implants. After a period ranging from 9 to 16 months, a clinical evaluation and biopsy of the grafted area in the region adjacent to the axis of the implant to be inserted were performed. RESULTS: Clinically and radiographically, no evidence of resorption/substitution of BS was noticed. Although no patients have had postoperative complications and the material presented fully biocompatible characteristics with woven bone in intimate contact with BS, it was not possible to place any implants due to minimal bone formation and friability of the material. CONCLUSION: It was concluded that despite the osteoconductive capacity of BS, this conventional calcium phosphate preparation does not support sufficient amount of new bone formation that could allow its use as filling material for maxillary sinus floor lift and subsequent dental implant placement.

Assuntos

Aumento do Rebordo Alveolar/métodos , Cimentos Ósseos/uso terapêutico , Substitutos Ósseos/uso terapêutico , Fosfatos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Osseointegração/fisiologia , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Materiais Biocompatíveis/uso terapêutico , Regeneração Óssea/efeitos dos fármacos , Implantação Dentária Endóssea/métodos , Feminino , Humanos , Masculino , Maxila/cirurgia , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Osteogênese/efeitos dos fármacos

RESUMO

OBJECTIVES: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. MATERIALS AND METHODS: A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). RESULTS: A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). CONCLUSIONS: Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm).