Photobiomodulation and Inorganic Bovine Bone in Guided Bone Regeneration: Histomorphometric Analysis in Rats.

The objective of this study was to evaluate the efficacy of photobiomodulation in the bone regeneration of critical-sized defects (CSD) filled with inorganic bovine bone associated or not with collagen membranes. The study has been conducted on 40 critical defects in the calvaria of male rats, divided into four experimental groups (n = 10): (1) DBBM (deproteinized bovine bone mineral); (2) GBR (DBBM+collagen membrane); (3) DBBM+P (DBBM+photobiomodulation); and (4) GBR+P (GBR+photobiomodulation). At 30 days postoperative, the animals were euthanized, and after the tissue had been processed, histological, histometric, and statistical analyses were performed. The analyses have taken into account newly formed bone area (NBA), linear bone extension (LBE), and residual particle area (RPA) as variables. The Kruskal-Wallis test has been performed, followed by the Dwass-Steel-Critchlow-Fligner test for comparison between groups (p < 0.05). When the DBBM+P group was compared to the DBBM group, it was possible to observe significant statistical differences in all the variables analyzed (p < 0.05). The application of photobiomodulation in guided bone regeneration (GBR+P) has shown a decrease in the median value for the RPA variable (26.8) when compared to the GBR group (32.4), with a significant statistical difference; however, for NBA and LBE, the therapy has not provided significant results.

Evaluation of Different Photobiomodulation Therapy Protocols as Adjuncts in the Healing of Bone Defects Grafted with Inorganic Bovine Bone.

PURPOSE: This study evaluated the effect of two photobiomodulation therapy protocols on bone regeneration in criticalsize bone defects grafted with inorganic bovine bone. MATERIALS AND METHODS: A critical-size defect was created in 30 adult male rat calvaria, which were divided equally and randomly into three experimental groups (n = 10): (1) DBBM (deproteinized bovine bone mineral); (2) DBBM + PBMT 4 J (4 J; photobiomodulation therapy; GaAlAs, 730 nm, 100 mW, 140 J/cm2); and (3) DBBM + PBMT 6 J (6 J; GaAlAs, 730 nm, 100 mW, 210 J/cm2). Animals were euthanized after 30 days. The neoformed bone area (NBA), linear bone extension (LBE), and area of the remaining particles (ARP) were evaluated. The data were subjected to nonparametric Kolmogorov-Smirnov test and ANOVA, followed by Tukey post hoc test to identify differences between the groups (P < .05). RESULTS: The 6 J group showed the highest average NBA (48.57% ± 28.22%) and demonstrated a statistically significant difference in NBA and LBE. A higher mean ARP was found in the DBBM group (38.73 ± 6.95) than in the groups irradiated by photobiomodulation therapy, with statistically significant differences (P < .05). CONCLUSION: The 6 J protocol showed the best results, promoting greater bone formation with greater resorption of residual particles.

Relação entre reabsorções dentárias e enxerto alveolar em dentes adjacentes à área da fissura / Relationship between root resorption and alveolar graft in teeth adjacent to the cleft lip and palate area

Objetivo: avaliar, radiograficamente, a prevalência, extensão e severidade da reabsorção dentária em dentes adjacentes à área de fissura após enxerto ósseo alveolar. Métodos: radiografias de 200 indivíduos com fissura unilateral e bilateral, alveolar e palatina, foram analisadas para se investigar a presença de reabsorção dentária relacionada com o enxerto ósseo. No total, 1.315 radiografias foram analisadas (periapical, oclusal e radiografias panorâmicas), obtidas a partir de 200 indivíduos com fissura labiopalatina unilateral e bilateral completa ubmetidos a cirurgia de enxerto, disponíveis a partir dos arquivos da Seção de Radiologia do HRAC-USP. Resultados: entre os 200 indivíduos, 33 tinham reabsorções dentárias externas. Dessas, 15 estavam presentes nas radiografias pré-operatórias e 18 só depois do enxerto ósseo. No geral, 30 reabsorções localizaram- se no terço apical da raiz e 3 no terço cervical; o incisivo central esquerdo foi o mais afetado. Não foram observadas reabsorções dentárias no terço médio da raiz e nenhuma reabsorção afetou mais de um terço. Não existiu diferença estatisticamente significativa entre a idade do paciente durante a cirurgia de enxerto ósseo e a presença de reabsorção dentária externa. Conclusões: a prevalência da reabsorção dentária em dentes adjacentes à área da fissura em indivíduos submetidos a enxerto ósseo foi baixa (16,5%). O terço apical da raiz foi o local mais frequente de reabsorção radicular externa, e não houve reabsorções afetando mais de um terço da raiz. (AU)

Evaluation of photobiomodulation therapy associated with guided bone regeneration in critical size defects. In vivo study.

The repair of bone defects raises the interest of investigators in several health specialties. Grafting techniques with bone substitutes and laser therapies have been investigated to replace autogenous bone and accelerate the bone healing process. Objective To evaluate the effect of photobiomodulation therapy (PBMT) associated with guided bone regeneration (GBR) in critical size defects. Material and Methods The study was conducted on 80 male rats (Rattus norvegicus albinus, Wistar) submitted to surgical creation of a critical size defect on the calvaria, divided into eight study groups: group C (control - only blood clot); group M (collagen membrane); group PBMT (photobiomodulation therapy); group AB (autogenous bone); group AB+PBMT; group AB+M; group PBMT+M; group AB+PBMT+M. The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric analysis and statistical analyses were performed (Tukey test, p<0.05). Results All groups had greater area of newly formed bone compared to group C (9.96±4.49%). The group PBMT+M (achieved the greater quantity of new bone (64.09±7.62%), followed by groups PBMT (47.67±8.66%), M (47.43±15.73%), AB+PBMT (39.15±16.72%) and AB+PBMT+M (35.82±7.68%). After group C, the groups AB (25.10±16.59%) and AB+M (22.72±13.83%) had the smallest quantities of newly formed bone. The area of remaining particles did not have statistically significant difference between groups AB+M (14.93±8.92%) and AB+PBMT+M (14.76±6.58%). Conclusion The PBMT utilization may be effective for bone repair, when associated with bone regeneration techniques.

Effect of Low-Level Laser on the Healing of Bone Defects Filled with Autogenous Bone or Bioactive Glass: In Vivo Study.

PURPOSE: This study evaluated the effect of low-level laser therapy (LLLT) on the healing of bone defects filled with autogenous bone or bioactive glass. MATERIALS AND METHODS: A critical size defect with 5-mm diameter was created on the calvaria of 60 adult male rats divided into 6 groups (n = 10): group C (control), group LLLT (LLLT - GaAlAs, wavelength of 780 nm, power of 100 mW, energy density of 210 J/cm2 per point during 60 seconds/point, in five points, only once, after creation of the surgical defect), group AB (autogenous bone), group AB+LLLT (autogenous bone + LLLT), group BG (bioactive glass), group BG+LLLT (bioactive glass + LLLT). All animals were sacrificed at 30 days after surgery. The areas of newly formed bone (ANFB) and areas of remaining particles (ARP) were calculated in relation to the total area (TA). RESULTS: The highest mean ± SD ANFB was observed for group LLLT (47.67% ± 8.66%), followed by groups AB+LLLT (30.98% ± 16.59%) and BG+LLLT (31.13% ± 16.98%). There was a statistically significant difference in relation to ANFB between group C and the other groups, except for comparison with group BG (Tukey test, P > .05). There was no statistically significant difference in ANFB values between group AB and the other study groups (Tukey test, P > .05), group AB+LLLT and groups BG and BG+LLLT (Tukey test, P > .05), and between groups BG and BG+LLLT (Tukey test, P > .05). The highest mean ± SD ARP was found for group BG (25.15% ± 4.82%), followed by group BG+LLLT (17.06% ± 9.01%), and there was no significant difference between groups (t test, P > .05). CONCLUSION: The LLLT, in the present application protocol, did not increase the area of new bone formation when associated with autogenous bone or bioactive glass.

Evaluation of photobiomodulation therapy associated with guided bone regeneration in critical size defects. In vivo study

Abstract The repair of bone defects raises the interest of investigators in several health specialties. Grafting techniques with bone substitutes and laser therapies have been investigated to replace autogenous bone and accelerate the bone healing process. Objective To evaluate the effect of photobiomodulation therapy (PBMT) associated with guided bone regeneration (GBR) in critical size defects. Material and Methods The study was conducted on 80 male rats (Rattus norvegicus albinus, Wistar) submitted to surgical creation of a critical size defect on the calvaria, divided into eight study groups: group C (control - only blood clot); group M (collagen membrane); group PBMT (photobiomodulation therapy); group AB (autogenous bone); group AB+PBMT; group AB+M; group PBMT+M; group AB+PBMT+M. The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric analysis and statistical analyses were performed (Tukey test, p<0.05). Results All groups had greater area of newly formed bone compared to group C (9.96±4.49%). The group PBMT+M (achieved the greater quantity of new bone (64.09±7.62%), followed by groups PBMT (47.67±8.66%), M (47.43±15.73%), AB+PBMT (39.15±16.72%) and AB+PBMT+M (35.82±7.68%). After group C, the groups AB (25.10±16.59%) and AB+M (22.72±13.83%) had the smallest quantities of newly formed bone. The area of remaining particles did not have statistically significant difference between groups AB+M (14.93±8.92%) and AB+PBMT+M (14.76±6.58%). Conclusion The PBMT utilization may be effective for bone repair, when associated with bone regeneration techniques.

Evaluation of the effectiveness of diode laser on pain and edema in individuals with cleft lip and palate submitted to secondary bone graft.

OBJECTIVE : To clinically evaluate the effects of diode laser, Gallium-Aluminum-Arsenide laser (GaAlAs), on the pain and edema after secondary alveolar bone graft. DESIGN : Case-control, double-blind study. Setting : Institutional tertiary referral hospital. Participants : The sample was composed of 60 individuals with complete unilateral cleft lip and palate, of both genders, aged 9 to 15 years, submitted to secondary alveolar bone graft. MAIN OUTCOME MEASURES : The individuals were divided into an experimental group (patients irradiated with diode laser GaAlAs, energy density of 4 J/cm(2), power of 100 mW, and wavelength in the infrared spectrum, for 10 seconds per point on 10 points, adding up to a dose of 40 J/cm(2)) and a placebo group (simulated laser application for 60 seconds per point, also on 10 points). Applications were made on the receptor site immediately postoperatively and after 24 and 48 hours. The pain and edema were assessed preoperatively and at each application. RESULTS : The two groups presented increase in pain and edema in 24 and 48 hours. No statistically significant difference was found between groups. CONCLUSIONS : According to the present methodology, the use of low-level laser to control the pain and edema in the postoperative period of secondary alveolar bone graft was not effective.

Esthetic composition of smile in individuals with cleft lip, alveolus, and palate: visibility of the periodontium and the esthetics of smile.

Objective. To evaluate characteristics of smile related to visibility in individuals with cleft lip, alveolus, and palate. Design. Cross-sectional. Setting. HRAC/USP, Brazil. Patients. Individuals with repaired complete unilateral cleft lip and palate (n = 45), aged 15-30 years. Interventions. Frontal facial photographs were obtained in natural and forced smiles (n = 135). Six specialists in periodontics evaluated the photographs as to the smile line, thickness, and curve of the upper lip. Main Outcome Measures. The cleft area was compared with the contralateral region. Results were expressed as percentages and means. The findings were compared between groups of periodontists. Results. Statistically significant relationship was observed in the smile line between examiners and between natural and forced smiles, regardless of the association with the cleft side. The lip was thicker at rest and thinner in the forced smile, as also evaluated by the group not experienced with cleft care. The curve of the upper lip in natural and forced smiles was considered as close to straight by both groups, regardless of the cleft. Conclusion. The smile in individuals with clefts was regarded as average for both cleft and noncleft sides. The thickness was characterized as average to thin, being thinner in forced smile and when analyzed by the group not experienced with cleft care. In the average, the curve of the upper lip was considered as straight. The present study elucidates some characteristics related to the smile in individuals with repaired unilateral cleft lip, alveolus, and palate.

Avaliação periodontal de indivíduos com Síndrome de Apert: análise transversal / Periodontal status in patients with Apert Syndrome: cross-sectional study

A Síndrome de Apert é uma anomalia genética que afeta cerca de 1:160.000 nascimentos. As características clínicas frequentemente encontradas na cavidade bucal de indivíduos com Síndrome de Apert são anomalias dentárias como erupção ectópica, hipodontia e dentes supranumerários, dentes não irrompidos, bem como a gengiva espessa. Este estudo avaliou as condições periodontais de indivíduos com Síndrome de Apert. O exame clínico foi realizado em 20 pacientes com idade entre dez e 30 anos. Todos os dentes na arcada dentária foram examinados e os parâmetros clínicos avaliados foram: profundidade de sondagem, nível de inserção, índice de placa e índice gengival. Foram realizadas comparações descritivas entre os valores médios destes parâmetros. Quanto a profundidade de sondagem e o nível clínico de inserção, os locais com menores medidas inferiores ou iguais a 3 mm foram as mais prevalentes, seguido por sítios com 4-5 mm, tanto em dentes superiores como em inferiores. A média do índice gengival em sítios vestibulares dos dentes superiores foi de 1,4 e 1,5 em sítios linguais. De acordo com os resultados apresentados, os sítios palatinos de indivíduos com Síndrome de Apert não apresentam maior prevalência de doença periodontal em relação aos outros locais, apesar do aumento volumétrico.

Survival of dental implants in the cleft area--a retrospective study.

OBJECTIVE: To evaluate the survival rate of dental implants placed in the cleft area. DESIGN: Retrospective study. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Institutional Tertiary Healthcare Center. PATIENTS: 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005. INTERVENTIONS: Clinical data were evaluated from the records of 120 patients according to the following criteria: placement grafted, cleft area, and age at surgery; age at placement of dental implants; site and dimension of implants; interval between placement of implants and the last clinical follow-up; and interval between placement and removal or indication for removal of implants. MAIN OUTCOME MEASURES: Percentage of survival rate of implants. RESULTS: Mean age at placement of the bone graft was 17.6 years and 21 years at placement of implants. A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft). The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis. Seven dental implants were removed. The survival rate since placement to the last clinical follow-up was 94.3%. CONCLUSION: Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosis.

Gingival recession in maxillary canines and central incisors of individuals with clefts.

BACKGROUND: Mucogingival alterations are inherent to clefts and may be worsened by the several plastic surgeries required in these individuals. OBJECTIVE: The aim of this study was to evaluate the prevalence, severity, and some possible etiologic factors of gingival recessions in teeth adjacent to the cleft. STUDY DESIGN: A total of 641 teeth (maxillary canines and central incisors) of 193 individuals with cleft lip and/or palate were examined. A generalized linear model was used, and the Wilcoxon test was used to compare the recession with cleft types. RESULTS: Comparison among cleft types as to the presence of recession revealed a statistically significant positive relationship for the maxillary right and left central incisors only in the group with left cleft lip, alveolus, and palate (P = .034). The most frequently affected tooth was the right maxillary canine (26.16%). CONCLUSION: The prevalence of recession in teeth close to the cleft was higher, although it was not very severe.

Planejamento periodontal visando o recobrimento radicular em indivíduo portador de fissura labiopalatina: relato de caso / Periodontal planning for root coverage in a subject with cleft lip and palate: case report

Em cada caso clínico, o planejamento periodontal bem realizado é fundamental para o sucesso da terapia. Este trabalho descreve um caso clínico no qual estava indicada a remoção tecidual em espessura na palatina dos dentes superiores e havia necessidade de enxerto de conjuntivo no dente 23. Após adequado planejamento do caso, foi realizado o enxerto com o tecido conjuntivo proveniente da gengivectomia interna, evitando outro procedimento cirúrgico.

Careful periodontal planning allows good outcomes and is fundamental for the esthetic and functional success of therapy. This paper describes the case report of a patient with indication for reduction of tissue thickness at the palatal region of maxillary teeth and connective tissue graft at the region of the left maxillary canine. After proper planning of the case, the graft was performed with connective tissue obtained from the internal gingivectomy, avoiding the need of a second surgery.

Estética periodontal em indivíduos fissurados: relato de casos clínicos / Periodontal esthetic in cleft individuals: a case report

As recessões gengivais são as alterações mucogengivais observadas com maior frequência em indivíduos portadores de fissuras labiopalatinas atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Este trabalho relata dois casos clínicos de recobrimento radicular com enxerto gengival subepitelial em que parte do enxerto permaneceu exposta, e os resultados estéticos e funcionais foram satisfatórios apresentando recobrimento total das raízes desnudas e um aumento da faixa de mucosa queratinizada em ambos os casos, sendo que as técnicas empregadas em nada diferem daquelas utilizadas no tratamento das alterações mucogengivais em indivíduos não portadores de fissura