Análise comparativa entre técnicas cirúrgicas de enxertia óssea em reabilitação de maxila atrófica: transplante celular odontológico (TCO) e técnica convencional de enxertia óssea ­ relato de caso clínico / Comparative analysis between surgical techniques of bone grafting in rehabilitation of atrophic maxilla: dental cell transplantation (OCT) and conventional bone grafting technique - a case report

A reabilitação de maxila atrófica se apresenta ainda nos dias de hoje como um desafio anatômico/fisiológico para os profissionais da área odontológica que visam buscar a instalação de implantes para futuras reabilitações protéticas, tendo em vista o grau de dificuldade de reconstituição do rebordo alveolar perdido. Com o intuito de reabilitar essas maxilas frente às adversidades, diferentes técnicas são propostas tais como enxertos ósseos autógenos, homógenos, substitutos ósseos alógenos, xenógenos e aloplásticos e suas respectivas técnicas. O objetivo deste trabalho foi apresentar um relato de caso clínico, no qual duas técnicas de reconstituição de rebordo alveolar de hemi-arco foram realizadas na mesma maxila utilizando biomaterial em bloco, visando comparar os resultados histológicos e clínicos. Após 5 meses da realização da enxertia, foi coletado material dos enxertos alveolares bilateralmente utilizando-se brocas trefinas para estudo histológico. Através da metodologia empregada, pode-se observar maior formação de estrutura óssea no lado em que foi praticada a metodologia transplantes celular odontológico (TCO), que preconiza a associação de sangue medular mandibular ao biomaterial, em relação a técnica contralateral em que utilizou a metodologia convencional, que preconiza a associação ao biomaterial do sangue periférico. Pode-se observar através da metodologia empregada que a utilização de biomateriais potencializados com sangue medular mandibular apresentou maior crescimento de estrutura óssea, incrementando em torno de 35% a mais na neoformação.de osso vital.

The rehabilitation of atrophic maxilla is still presented today as an anatomical/physiological challenge for professionals in the dental field who aim to seek the installation of implants for future prosthetic rehabilitations, in view of the degree of difficulty in reconstituting the lost alveolar ridge. In order to rehabilitate these jaws in the face of adversity, different techniques are proposed such as autogenous, homogenous bone grafts, allogeneic, xenogenous and alloplastic bone substitutes and their respective techniques. The aim of this study was to present a clinical case report, in which two hemi-arch alveolar ridge reconstruction techniques were performed in the same maxilla using biomaterial en bloc, in order to compare the histological and clinical results. After 5 months of grafting, material was collected from the alveolar grafts bilaterally using trephine burs for histological study. Through the used methodology, it was possible to see greater bone formation of structure on the side in which the dental cell transplantation (TCO) methodology was practiced, which advocates the association of mandibular medullary blood to the biomaterial, in relation to the contralateral technique in which the methodology was used conventional method, which advocates the association with peripheral blood biomaterial. It can be observed through the used methodology that the use of biomaterials potentiated with mandibular medullary blood showed greater growth of bone structure, increasing around 35% more in the neoformation of vital bone.

Eficacia de la hidroxiapatita en la cicatrización de injertos oseos e implantes dentales: una revisión sistemática de la literatura / Hydroxyapatite effectiveness in the healing of bone and implants dental implants: a systematic review of the literature

La hidroxiapatita (HA) es un componente mineral del hueso. Se ha comercializado la HA sintética o aloplástica en forma porosa o no porosa, densa y reabsorbible o no reabsorbible. Se utiliza como injerto óseo dada sus propiedades osteoconductivas y estimuladoras de proliferación celular generando así condiciones favorables para la regeneración tisular. El objetivo de éste trabajo es evaluar la efectividad del tratamiento con HA en cirugías de implantes dentales e injertos óseos. Se realizó una revisión sistemática. Se revisó ensayos clínicos sobre cicatrización y los injertos de HA sintética en Pubmed, Cochrane Library, Google Académico, Blackwell y Ebsco. Los criterios de selección son pacientes candidatos a tratamientos de defectos periodontales o rehabilitación con implantes dentales, sin alteraciones sistémicas de importancia. La estrategia se resume en los siguientes puntos: Identificación del problema, Identificación de términos de búsqueda, Búsqueda sistemática, Selección de artículos mediante utilización de guías de análisis crítico, Incorporación de la información al REVMAN®, Análisis de sesgos y Meta análisis. Al evaluar el metaanálisis se observa que la HA es efectiva para la cicatrización de injerto óseo. Cuando se omiten los estudios de bajo peso, la medida de resumen se mantiene en la HA. El tratamiento con HA en la cicatrización ósea y de implantes dentales resulta positivo y con una alta tasa de éxito en el largo plazo aunque su rango de efectividad varía con los materiales a los cuales ésta se asocie.

Hydroxyapatite (HA) is a mineral component of bone. Hydroxyapatite has been marketed as synthetic or alloplastic, porous or nonporous, dense and resorbable or non-resorbable form. It is used as bone graft due to its osteoconductive properties and stimulation of cell proliferation, generating favorable conditions for tissue regeneration. The aim of this study is to evaluate the effectiveness of treatment with HA in dental implant surgeries and bone grafts. We conducted a systematic review. Clinical trials on healing and graft of synthetic hydroxyapatite were reviewed in PubMed, Cochrane Library, Google Scholar, Blackwell and Ebsco. The selection criteria was: patient candidates for treatment of periodontal defects or rehabilitation with dental implants without significant systemic abnormalities. The strategy is summarized in the following: Identification of the problem, identifying search terms, systematic search and selection of articles by using critical analysis guides, Incorporating REVMAN ® information, unbiased analysis, and Meta-analysis. Assessing the meta-analysis shows that the HA is effective for healing bone graft. When omitting low weight studies, the summary measure remains in the HA. Treatment with HA in bone healing and dental implants, is positive with a high rate of success in the long term, although its effective range varies according to the materials to which it is associated.

Eficacia de la Hidroxiapatita en la Cicatrización de Injertos Óseos e Implantes Dentales: una Revisión Sistemática de la Literatura / Hydroxyapatite Effectiveness in Healing of Bone Grafts and Dental Implants: A Systematic Review of the Literature

La hidroxiapatita (HA) es un componente mineral del hueso. Se ha comercializado la HA sintética o aloplástica en forma porosa o no porosa, densa y reabsorbible o no reabsorbible. Se utiliza como injerto óseo dada sus propiedades osteoconductivas y estimuladoras de proliferación celular generando así condiciones favorables para la regeneración tisular. El objetivo fue evaluar la efectividad del tratamiento con HA en cirugías de implantes dentales e injertos óseos. Se realizó una revisión sistemática. Se revisó ensayos clínicos sobre cicatrización y los injertos de HA sintética en Pubmed, Cochrane Library, Google Académico, Blackwell y Ebsco. Los criterios de selección son pacientes candidatos a tratamientos de defectos periodontales o rehabilitación con implantes dentales, sin alteraciones sistémicas de importancia. La estrategia se resume en los siguientes puntos: Identificación del problema, Identificación de términos de búsqueda, Búsqueda sistemática, Selección de artículos mediante utilización de guías de análisis crítico, Incorporación de la información al REVMAN®, Análisis de sesgos y Metaanálisis. Al evaluar el metaanálisis se observa que la HA es efectiva para la cicatrización de injerto óseo. Cuando se omiten los estudios de bajo peso, la medida de resumen se mantiene en la HA. El tratamiento con HA en la cicatrización ósea y de implantes dentales resulta positivo y con una alta tasa de éxito en el largo plazo aunque su rango de efectividad varía con los materiales a los cuales ésta se asocie.

Hydroxyapatite (HA) is a mineral component of bone. The hydroxyapatite has been marketed: synthetic or alloplastic, as porous or nonporous, dense and resorbable or non-resorbable. These are used as bone graft due to their osteoconductive properties and stimulation of cell proliferation that generate favorable conditions for tissue regeneration. The objective of this study was to evaluate the effectiveness of treatment with HA in dental implant surgeries and bone grafts. We conducted a systematic review and studied clinical trials on healing and graft of synthetic hydroxyapatite in PubMed, Cochrane Library, Google Scholar, Blackwell and Ebsco. Selection criteria were: patient's candidate to treatment of periodontal defects or rehabilitation with dental implants without significant systemic abnormalities. The strategy is summarized in the following: Identification of the problem, identifying search terms, systematic search and selection of articles by using critical analysis guides, incorporating REVMAN® information, unbiased analysis, and Meta-analysis. Our results indicate that assessing the meta-analysis shows that the HA is effective for healing bone graft. When omitting low weight studies, the summary measure remains in the HA. In conclusion, treatment with HA in bone healing and dental implants is positive with a high success rate in the long term, although its effective range varies with the materials to which it is associated.

Otimização da regeneração óssea guiada em alvéolo pós-extração, por meio da técnica de Fugazzoto / Optimization of guided bone regeneration in post-extraction socket by means of the Fugazzoto technique

Introdução: durante o planejamento cirúrgico da reabilitação protética usando implantes osseointegráveis, é comum nos depararmos com limitações, como com seios maxilares pneumatizados. Nessas ocasiões, podemos lançar mão de procedimentos de regeneração alveolar e enxertia óssea. Métodos: entre as várias técnicas existentes, esse artigo discute e apresenta uma possibilidade de regeneração alveolar, por meio de um relato de caso. Resultados: foi obtido um ganho ósseo considerável, que possibilita a instalação do implante sem mais nenhum procedimento de enxertia. Conclusão: notou-se uma boa previsibilidade com a regeneração óssea guiada e a otimização do tratamento cirúrgico...

Introduction: During the surgical planning for prosthetic rehabilitation performed by means of osseointegrated implants, we often face some limitations such as pneumatized maxillary sinus, in which case we can make use of alveolar regeneration and bone grafting procedures. Objective: This article discusses and reports a case of alveolar regeneration. Results: Treatment resulted in bone gain that allows implant placement without further grafting procedures. Conclusion: Guided bone regeneration (GBR) provided predictability and optimization of surgical treatment...

Elevación de seno maxilar y colocación simultánea de implantes utilizando plasma rico en factores de crecimiento (PRFC), hidroxiapatita y aloinjerto: Reporte de un caso de siete años / Maxillary sinus elevation and simultaneous implant placement using PRGF (plasma rich in growth factors), hydroxyapatite and allogenic graft: Seven year case report

La elevación de piso de seno maxilar es un procedimiento quirúrgico predecible que se realiza con la finalidad de aumentar verticalmente la cantidad de hueso en la región posterior del maxilar para poder realizar una rehabilitación protésica implantosoportada. El propósito de este trabajo es describir un caso clínico donde se realizó elevación de piso de seno maxilar utilizando plasma rico en factores de crecimiento, hidroxiapatita absorbible y aloinjerto óseo como materiales de injerto subantral y la colocación simultánea de dos implantes de superficie tratada (Osseotite, 3i) y reportar los resultados clínicos y radiográficos obtenidos siete días, seis meses y siete años después de la cirugía, observando una cicatrización adecuada tanto clínica como radiográficamente. El procedimiento quirúrgico utilizado en este caso clínico resultó una buena opción para poder colocar implantes en áreas maxilares posteriores atróficas.

Maxillary sinus floor elevation is a predictable surgical procedure meant to vertically increase the amount of bone in the posterior region of the upper jaw to enable placement of a prosthetic rehabilitation device supported by implants. The aim of the present article was to describe elevation of the maxillary sinus floor using plasma rich in growth factors, absorbable hydroxyapatite and bone allograft as sub-antral graft materials with simultaneous placement of two surface treated implants (Osseotite, 3i). The present article also reported clinical and radiographic results obtained at seven days, six months and seven years after the surgery. From the clinical and radiographic standpoint suitable healing was observed. The surgical procedure used in the present clinical case was considered a suitable option to place implants in atrophic maxillary areas.

Survival rate of implant placement in the maxilla treated with sinus elevation by the lateral approach: A retrospective study / 대한치주과학회지

PURPOSE: Osseointegration of implants in patients with pneumatized maxillary sinuses is difficult to achieve due to the deficiency of available bone in the posterior maxilla after loss of teeth. Maxillary sinus elevation is a method to overcome this problem. In this study, we evaluated the implant survival rate and the relationship between implant survival in patients with sinus elevation by the lateral approach. MATERIALS AND METHODS: A total of 48 patients were consecutively treated with sinus elevation by the lateral approach between February 2003 & August 2006 at the dental hospital of Chonbuk National university. A total of 113 implants were placed. The mean healing period was 7.1 months and implants were placed after a mean period of 5.6 months. The mean observation period was 21.8 months. RESULTS: Out of the 113 implants placed, fifteen failed, resulting in a survival rate of 86.7%, 18 cases of sinus membrane perforation were observed out of 65 sinuses treated. 33 implants were placed in a perforated site and 10 failed, representing a 60.7% implant survival. 80 implants were placed in a nonperforated site and 5 failed, representing a 92.6% implant survival. CONCLUSIONS: Implant placement with sinus elevation is an acceptable treatment for short term Results. Sinus membrane perforation and postoperative complications, however, may have an effect on implant failure.

Results of Maxillary Sinus Elevation for Endosseous Implant Placement / 영남의대학술지

BACKGROUND: Although dental implantation has become widespread and acceptable treatment for dental prosthodontics, maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus elevation procedure provides a way to increase the amount of available bone and to allow the placement of longer implants. MATERIALS & METHODS: We studied 11 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2003 in our clinic. Nine patients were males and two patients were females, aged from 39 to 72(mean=51.6). Four patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis. Patients didn't show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants, factors increasing the osseointegrating capacity of implants. RESULTS: The success rate of osseointegration of implants was 93%. At least 6 months after loading on implants, the survival rate of implants was 78.5%. Autogenous bone graft and adequate residual bone height(>6mm) increased survival rate of implants. CONCLUSION: Successful implant placement with maxillary sinus elevation mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.

Results of Maxillary Sinus Elevation for Endosseous Implant Placement / 영남의대학술지

BACKGROUND: Although dental implantation has become widespread and acceptable treatment for dental prosthodontics, maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus elevation procedure provides a way to increase the amount of available bone and to allow the placement of longer implants. MATERIALS & METHODS: We studied 11 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2003 in our clinic. Nine patients were males and two patients were females, aged from 39 to 72(mean=51.6). Four patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis. Patients didn't show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants, factors increasing the osseointegrating capacity of implants. RESULTS: The success rate of osseointegration of implants was 93%. At least 6 months after loading on implants, the survival rate of implants was 78.5%. Autogenous bone graft and adequate residual bone height(>6mm) increased survival rate of implants. CONCLUSION: Successful implant placement with maxillary sinus elevation mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.