Polydioxanone Enhances Bone Regeneration After Resection and Reconstruction of Rat Femur with rhBMP2.

The aim of this study was to assess the bone regeneration potential of a polydioxanone (PDO) scaffold together with recombinant human bone morphogenetic protein-2 (rhBMP-2) for the reconstruction of large bone defect. In total, 24 male rats (6 months old) were subjected to bilateral femoral stabilization using titanium plates to create a 2 mm gap, and reconstruction using rhBMP-2 (Infuse®; 3.25 µg). The bone defects were covered with PDO (PDO group), or with titanium mesh (Ti group). Animals were euthanized on days 14 and 60. Simultaneously, 16 rats received PDO and Ti in their dorsum for the purpose of biocompatibility analysis at 3, 5, 7, and 10 days postoperatively. X-ray densitometry showed a higher density in the PDO group on day 14. On day 60, coverage of the bone defect with PDO showed a larger quantity of newly formed bone than that found for the Ti group, a lower inflammatory infiltrate value, and a more significant number of blood vessels on day 14. By immunohistochemical assessment, runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN) showed higher labeling on day 14 in the PDO group. On day 60, bone morphogenetic protein-2 (BMP-2) showed higher labeling in the PDO group, whereas Ti showed higher labeling for osteoprotegerin, nuclear factor kappa B ligand-activating receptor, RUNX2, and OCN. Furthermore, biocompatibility analysis showed a higher inflammatory response in the Ti group. The PDO scaffold enhanced bone regeneration when associated with rhBMP-2 in rat femur reconstruction. Impact statement Regeneration of segmental bone defects is a difficult task, and several techniques and materials have been used. Recent advances in the production of synthetic polymers, such as polydioxanone (PDO), produced by three-dimensional printing, have shown distinct characteristics that could improve tissue regeneration even in an important bone defect. The present preclinical study showed that PDO membranes used as scaffolds to carry recombinant human bone morphogenetic protein-2 (rhBMP-2) improved bone tissue regeneration by more than 8-fold when compared with titanium mesh, suggesting that PDO membranes could be a feasible and useful material for use in guided bone regeneration. (In English, viable is only used for living creatures capable of sustaining life.

Experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana / Clinical experience on the management of post-traumatic bone defects of long bones treated with the membrane induction technique

Resumen: Introducción: los defectos óseos alteran drásticamente la calidad de vida del paciente y pueden producir serias secuelas como acortamiento disfuncional, deformidad angular, rigidez articular y trastorno irreversible de la marcha. Objetivo: describir la experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana. Material y métodos: estudio observacional, retrospectivo, de pacientes con defectos óseos mayores de 3 cm con pseudoartrosis diafisaria de huesos largos, a los que se aplicó la técnica de Masquelet. En el período de Enero de 2019 a Enero de 2021. A todos los pacientes se les realizó desbridamiento enérgico y estabilización de la fractura, para posteriormente colocar el espaciador de cemento. El retiro del espaciador fue a las 4-6 semanas. Se valoró el grado de consolidación y la evolución del tratamiento. Resultados: se incluyeron 25 pacientes, la media de edad fue de 36.8 ± 8.9 años. El diámetro de las pérdidas óseas fue de 3 a 10 cm (84%) y > 10 cm (16%). La consolidación ósea se presentó en pacientes con un defecto < 10 cm (16%). Treinta y dos por ciento de los pacientes presentó alguna complicación. Conclusiones: la consolidación ósea se logró sólo en aquellos pacientes con defectos < 10 cm, requiriendo procedimientos alternativos a la técnica de inducción de membrana en la mayoría de los casos. Se requiere una selección adecuada de pacientes para lograr la consolidación ósea por medio de esta técnica.

Abstract: Introduction: bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder. Objective: to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique. Material and methods: retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment. Result: 25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication. Conclusions: bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

[Clinical experience on the management of post-traumatic bone defects of long bones treated with the membrane induction technique]. / Experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana.

INTRODUCTION: bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder. OBJECTIVE: to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique. MATERIAL AND METHODS: retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment. RESULT: 25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication. CONCLUSIONS: bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

INTRODUCCIÓN: los defectos óseos alteran drásticamente la calidad de vida del paciente y pueden producir serias secuelas como acortamiento disfuncional, deformidad angular, rigidez articular y trastorno irreversible de la marcha. OBJETIVO: describir la experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo, de pacientes con defectos óseos mayores de 3 cm con pseudoartrosis diafisaria de huesos largos, a los que se aplicó la técnica de Masquelet. En el período de Enero de 2019 a Enero de 2021. A todos los pacientes se les realizó desbridamiento enérgico y estabilización de la fractura, para posteriormente colocar el espaciador de cemento. El retiro del espaciador fue a las 4-6 semanas. Se valoró el grado de consolidación y la evolución del tratamiento. RESULTADOS: se incluyeron 25 pacientes, la media de edad fue de 36.8 ± 8.9 años. El diámetro de las pérdidas óseas fue de 3 a 10 cm (84%) y > 10 cm (16%). La consolidación ósea se presentó en pacientes con un defecto < 10 cm (16%). Treinta y dos por ciento de los pacientes presentó alguna complicación. CONCLUSIONES: la consolidación ósea se logró sólo en aquellos pacientes con defectos < 10 cm, requiriendo procedimientos alternativos a la técnica de inducción de membrana en la mayoría de los casos. Se requiere una selección adecuada de pacientes para lograr la consolidación ósea por medio de esta técnica.

Análise do potencial do reparo ósseo através da reconstrução de ressecções segmentares por meio da associação de scaffolds de Polidioxanona ou malha de titânio e rhBMP-2: estudo in vivo / Bone potential analysis through segmental resection reconstruction using Polydioxanone or Titanium Mesh scaffolds and rhBMP-2: in vivo study

O objetivo deste trabalho foi analisar o potencial bioativo de um "scaffold" de Polidioxanona (PDO) com associação da rhBMP-2, nas reconstruções após simulação de ressecção óssea em fêmures de ratos. Para tanto, 24 ratos, machos, adultos, com 6 meses de idade, foram submetidos a ressecção e reconstrução dos fêmures bilateralmente. Inicialmente foi realizada a estabilização com fixação de placas e parafusos de titânio do sistema 1.5mm e em seguida a confecção de um "gap" de 2mm. A reconstrução foi realizada com rhBMP-2 (Infuse) carreada em esponja de colágeno (3,25 µg), tendo uma malha de titânio, para o grupo Titânio (n=24 fêmures) (grupo controle), atuando como um arcabouço. E para o grupo PDO (n=24 fêmures) (grupo teste), a reconstrução foi realizada também com a rhBMP-2 carreada em uma esponja de colágeno (3,25 µg), envolvido por um "scaffold" de PDO. Desses animais, 16 (2 por tempo) receberam em seu dorso, no plano subcutâneo, um fragmento do mesmo material testado em seu fêmur, para análise de biocompatibilidade, que foram removidos sob anestesia local, junto de fragmento do tecido subcutâneo adjacente, aos 3, 5, 7 e 10 dias para análise. Os animais foram submetidos à eutanásia (n=6 por grupo) nos períodos de 14 e 60 dias após a cirurgia de reconstrução tiveram seus órgãos de metabolização (cérebro, rim, fígado e músculo) removidos para análise anatomopatológica e seus fêmures também foram removidos, reduzidos, radiografados para análise da densitometria radiográfica posteriormente os fêmures passaram por descalcificação e em seguida todas as peças foram submetidas ao processamento para obtenção de lâminas com cortes de 5 µm de espessura, para avaliação histológica, com avaliação da área óssea neoformada e perfil inflamatório e para análise imunohistoquimica através das proteínas Runx2, OPG, RANKL, OCN e BMP2. Todos os dados quantitativos foram submetidos ao teste ANOVA-2 fatores e quando p< 0,05, o pós-teste Tukey foi realizado. Os resultados da densitometria radiográfica demonstraram maior densidade para o grupo PDO, especialmente no período de 14 dias (p< 0,05). Na análise histológica observou-se reparo mais favorável para o grupo PDO, especialmente aos 60 dias quando comparado ao Titânio, com diferença estatística significativa (p = 0.002) bem como menor infiltrado inflamatório e maior número de vasos sanguíneos aos 14 dias. Com relação as imunomarcações, BMP-2 não apresentou marcações para Titânio e dados expressivos para PDO, com diferença significativamente estatística aos 60 dias (p< 0.05). OPG e RANKL mostraram maior marcação para titânio, principalmente aos 60 dias (p< 0.05). Já Runx2 e OCN apresentaram resultados superiores para PDO aos 14 dias, entretanto, aos 60 dias titânio demonstrou maior expressão. A análise de biocompatibilidade mostrou maior processo inflamatório para o grupo titânio. Os órgãos de metabolização apresentaram aspectos de higidez dentro da normalidade para ambos grupos. Os resultados deste trabalho demonstram um padrão reparacional mais favorável à associação do "Scaffold" de PDO com a rhBMP-2, quando comparado a reconstrução com malha de titânio(AU)

The objective of this work was to analyze the bioactive potential of a Polydioxanone (PDO) scaffold with rhBMP-2 association, in reconstructions after simulating bone resection in rat femurs. Therefore, 24 male, adult rats, aged 6 months, underwent resection and reconstruction of the femurs bilaterally. Initially, stabilization was performed with fixation of titanium plates and screws of the 1.5mm system and then a 2mm gap was created. The reconstruction was performed with rhBMP-2 (Infuse) loaded in a collagen sponge (3.25 µg), with a titanium mesh, for the Titanium group (n=24 femurs) (control group), acting as a scaffold. And for the PDO group (n=24 femurs) (test group), the reconstruction was also performed with rhBMP-2 carried in a collagen sponge (3.25 µg), surrounded by a PDO scaffold. Of these animals, 16 (2 per time) received on their back, in the subcutaneous plane, a fragment of the same material tested in their femur, for biocompatibility analysis, which was removed under local anesthesia, together with a fragment of the adjacent subcutaneous tissue, at 3, 5, 7 and 10 days for analysis. The animals were euthanized (n=6 per group) in the periods of 14 and 60 days after the reconstruction surgery, had their metabolizing organs (brain, kidney, liver, and muscle) removed for anatomopathological analysis and their femurs were also removed, reduced, radiographed for analysis of radiographic densitometry later the femurs underwent decalcification and then all the pieces were submitted to processing to obtain 5 µm thick slices for histological evaluation, with the evaluation of the newly formed bone area and inflammatory profile and for immunohistochemical analysis through Runx2, OPG, RANKL, OCN, and BMP2 proteins. All quantitative data were submitted to the 2-way ANOVA test and when p< 0.05, the Tukey post-test was performed. The results of radiographic densitometry showed higher density for the PDO group, especially in the 14-day period (p< 0.05). In the histological analysis, a more favorable repair was observed for the PDO group, especially at 60 days when compared to Titanium, with a statistically significant difference (p = 0.002), as well as a lower inflammatory, infiltrate and a greater number of blood vessels at 14 days. Regarding immunostaining, BMP-2 did not show staining for Titanium and expressive data for PDO, with a statistically significant difference at 60 days (p< 0.05). OPG and RANKL showed higher staining for titanium, mainly at 60 days (p< 0.05). On the other hand, Runx2 and OCN showed superior results for PDO at 14 days, however, at 60 days titanium showed greater expression. The biocompatibility analysis showed a greater inflammatory process for the titanium group. The metabolizing organs presented aspects of health within the normal range for both groups. The results of this work demonstrate a more favorable repair pattern for the association of the PDO scaffold with rhBMP-2, when compared to reconstruction with titanium mesh(AU)

Human levator veli palatini muscle: a novel source of mesenchymal stromal cells for use in the rehabilitation of patients with congenital craniofacial malformations.

BACKGROUND: Bone reconstruction in congenital craniofacial differences, which affect about 2-3% of newborns, has long been the focus of intensive research in the field of bone tissue engineering. The possibility of using mesenchymal stromal cells in regenerative medicine protocols has opened a new field of investigation aimed at finding optimal sources of multipotent cells that can be isolated via non-invasive procedures. In this study, we analyzed whether levator veli palatini muscle fragments, which can be readily obtained in non-invasive manner during palatoplasty in cleft palate patients, represent a novel source of MSCs with osteogenic potential. METHODS: We obtained levator veli palatini muscle fragments (3-5 mm3), during surgical repair of cleft palate in 5 unrelated patients. Mesenchymal stromal cells were isolated from the muscle using a pre-plating technique and other standard practices. The multipotent nature of the isolated stromal cells was demonstrated via flow cytometry analysis and by induction along osteogenic, adipogenic, and chondrogenic differentiation pathways. To demonstrate the osteogenic potential of these cells in vivo, they were used to reconstruct a critical-sized full-thickness calvarial defect model in immunocompetent rats. RESULTS: Flow cytometry analysis showed that the isolated stromal cells were positive for mesenchymal stem cell antigens (CD29, CD44, CD73, CD90, and CD105) and negative for hematopoietic (CD34 and CD45) or endothelial cell markers (CD31). The cells successfully underwent osteogenic, chondrogenic, and adipogenic cell differentiation under appropriate cell culture conditions. Calvarial defects treated with CellCeram™ scaffolds seeded with the isolated levator veli palatini muscle cells showed greater bone healing compared to defects treated with acellular scaffolds. CONCLUSION: Cells derived from levator veli palatini muscle have phenotypic characteristics similar to other mesenchymal stromal cells, both in vitro and in vivo. Our findings suggest that these cells may have clinical relevance in the surgical rehabilitation of patients with cleft palate and other craniofacial anomalies characterized by significant bone deficit.

Talar Body Reconstruction for Nonunions and Malunions.

BACKGROUND: Talar body and neck nonunions and malunions may undergo a reconstructive surgery when joint cartilage is still viable, and no talar collapse or infection has occurred. This is a rare condition and the studies supporting the procedure have small number of cases. The objective of the present study is to report a case series of six patients who underwent talar reconstructions. MATERIALS AND METHODS: Six patients with talar malunions or nonunions who underwent surgical treatment were reviewed in this retrospective study. There were three nonunions and two malunions of the talar body and one malunion of the talar neck. Clinical evaluation included all the parameters used in the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale. Arthritic degeneration of the ankle joint was assessed according to a modified Bargon scale. RESULTS: The mean followup was 86 months (range 24-282 months). There were no cases of postoperative avascular necrosis of the talus. Four of the six patients in our series required a subtalar fusion as part of the reconstruction procedure. The average preoperative AOFAS hindfoot score was 34, and at the time of the last evaluation, it was 74. The mean preoperative score on the modified Bargon scale for the tibiotalar joint was 1.17. At the last followup, it rose to 1.33. Three different deformities of the talus were identified (a) flattening of the talus (b) extra-articular step and (c) intraarticular step. CONCLUSION: Reconstruction of talar nonunions and malunions improved function in selected patients with a low risk of complications. Three different anatomical patterns of talar nonunions and malunions were identified.

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis.

BACKGROUND: This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques. METHODS: The PubMed and the Cochrane Library databases were searched using the terms: 'fracture' AND ('bone loss' OR 'defect' OR 'defects') AND 'bone graft', restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates. RESULTS: Out of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87-95 %) while union rate after additional procedures raised to 98 % (95 % CI 96-99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001). CONCLUSION: The results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.

Aumento da espessura do rebordo ósseo com um novo enxerto sintético particulado. Caso clínico com avaliação microtomográfica / Horizontal alveolar ridge augmentation with a new particulate bone substitute: a case report with micro-CT evaluation

As limitações anatômicas do rebordo alveolar residual podem impedir a instalação de um implante osseointegrado. Nesses casos, procedimentos de regeneração óssea guiada são necessários para proporcionar osso alveolar suficiente em altura e/ou espessura para a inserção de implantes dentais. Este relato piloto de caso clínico apresenta um procedimento de aumento horizontal do rebordo ósseo usando um novo substituto ósseo aloplástico para proporcionar volume ósseo necessário para a colocação de um implante, avaliando também por meio de microtomografia o osso neoformado. O paciente do sexo masculino, 58 anos, não fumante, sem condições sistêmicas que pudessem afetar o procedimento cirúrgico, apresentava a ausência de um dente (primeiro pré-molar superior direito) e optou por instalar um implante para a reabilitação cirúrgico-protética desta área. A tomografia computadorizada pré-operatória mostrou que o osso residual tinha espessura insuficiente para a instalação de um implante, sendo necessária a realização de um procedimento cirúrgico para aumento ósseo horizontal. O paciente assinou um consentimento informado autorizando a realização dos procedimentos bem como a documentação científica do caso. Foi realizada cirurgia de regeneração óssea guiada (ROG) utilizando substituto ósseo particulado (Reprobone®) e uma membrana colágena (Biomend), para aumentar a espessura óssea vestíbulo-palatal. O paciente foi apropriadamente medicado e a cicatrização ocorreu sem intercorrências. Após 6 meses, a área foi reaberta e antes da instalação do implante uma biópsia óssea foi coletada para análise microtomográfica. A técnica de ROG proporcionou volume ósseo adequado para a colocação do implante. A análise microtomográfica da biópsia óssea resultou em 40,85% de volume ósseo cortical e 17,08% de biomaterial residual...

Anatomic limitations of the residual alveolar bone may impair implant placement. Alveolar ridge augmentation procedures are required in such cases to provide alveolar bone width and/or height for dental implant placement. This case report presents a horizontal ridge augmentation procedure using a new alloplastic bone substitute providing bone volume for implant placement, with micro-CT analysis of the newly formed bone. The patient was a 58-year-old male, non-smoker, with no systemic health conditions that could affect the surgical procedure, and reported the willingness of rehabilitating the edentulous area corresponding to the tooth 14 with an osseointegrated implant. The CBCT analysis revealed that residual alveolar bone width was too narrow for implant insertion, and therefore a bone augmentation procedure was necessary. The patient signed an informed consent form authorizing all procedures and scientific documentation. Guided bone regeneration was performed using ReproBone® granules and a collagen membrane (BioMend®) to increase the buccal-palatal bone width. The patient was properly medicated and healing was uneventful. After 6 months, the area was reopened and before placing an implant a bone biopsy was collected for micro-CT analysis. The bone augmentation procedure provided adequate bone volume for implant placement. The micro-CT results of the bone biopsy showed 40% of bone volume and 17% of remnant particles of the biomaterial after 6 months. It was concluded that this biomaterial may be used in such clinical situations as an alternative to autogenous bone blocks and still avoiding patient morbidity...

Estudio morfométrico del seno maxilar mediante tomografías computadorizadas: evaluación de la reconstrucción total de piso sinusal / Morphometric study of maxillary sinus by computed tomography: assessment of sinus floor bone reconstruction

La rehabilitación con implantes dentales en maxila posterior es compleja debido a la presencia del seno maxilar con sus diferentes variaciones anatómicas; el objetivo de este trabajo fue determinar el volumen óseo intrasinusal necesario para realizar la instalación de uno o mas implantes dentarios sin invadir la membrana sinusal. En 22 cráneos fueron evaluados 40 senos maxilares mediante tomografías computadorizadas (TC) realizando mediciones en los cortes axiales, coronales y sagitales. Se clasificaron los senos maxilares según el remanente de hueso alveolar y se instalo un implante de forma virtual en el lugar del primer molar superior, mediante el software implant view. Con estas medidas volumétricas finales se estableció las indicaciones reconstructivas intra sinusales a partir de los sitios donantes intrabucales mas frecuentemente evaluados en la literatura mundial. El grupo I (1mm a 4mm de reborde alveolar remanente) presentaba déficit óseo de hasta 1,98 cm3, el grupo II (4mm a 7mm) presentaba déficit de 1,06cm3; el grupo III (7mm a 10mm) presentaba un déficit de 0,67 cm3; a partir de estos resultados podemos concluir que los sitios intrabucales pueden ser utilizados en la mayoría de los grupo estudiados, incluyendo las reconstrucciones bilaterales.

Rehabilitation with dental implants in posterior maxilla is difficult because of the presence of maxillary sinus with anatomical variations. The aim of this research was to evaluate the sinus volume to install one or more implants without invading the sinus membrane. Forty (40) maxillary sinuses were evaluated in 22 skulls by computed tomography measuring in the axial, coronal and sagittal slice. The sinus were classified according to the remaining alveolar bone and a dental implant in the place of the upper first molar was virtually installed by implant view software. With this final volumetric measurement the surgical indications were established for inlay reconstruction from intra oral donor sites frequently evaluated in world literature. Group I (1mm to 4mm of alveolar ridge) showed a bone deficit of 1.98 cm3, group II (4mm to 7mm) showed a deficit of 1.06 cm3; group III (7mm to 10mm) showed a 0.67 cm3 deficit. In view of these results we concluded that intra oral donor site can be used for the three study groups and in some cases in bilateral reconstruction.

Análise das intercorrências e complicações em instalação de implantes dentais: um estudo retrospectivo / Analysis of intercurrences and complications in the placement of dental implants: a retrospective study

Intrinsecamente, todo procedimento cirúrgico apresenta um certo índice de intercorrências e/ou complicações associadas. Hemorragias, infecções, parestesias ou disestesias e perda primária dos implantes são algumas das intercorrências e complicações mais comuns relacionadas a procedimentos cirúrgicos para implantodontia. Este estudo avaliou retrospectivamente o índice de intercorrências e complicações após cirurgia para a instalação de implantes dentais osteointegráveis. Foram avaliados, retrospectivamente, 660 prontuários clínicos de pacientes submetidos à instalação de implantes osteointegráveis no período de 8 anos, atendidos na Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. Os resultados demonstraram que houve um maior índice de intercorrências e complicações quando os pacientes eram atendidos por alunos de especialização (p= 0,015) e quando o exame por imagem realizado era somente a radiografia panorâmica convencional (p= 0,011). Os resultados demonstraram também um maior índice de intercorrências e complicações nos pacientes quando estes eram submetidos a procedimentos cirúrgicos de reconstrução óssea alveolar (p< 0,0001). A presença de infecção pós-operatória influenciou significativamente para o aumento no índice de perda primária de implantes (p< 0,0001).

Intrinsically, every surgical procedure presents a certain rate of associated intercurrences and/or complications. Hemorrhages, infections, paresthesias or dysesthesias and primary loss of implants are some of the most common intercurrences and complications related to surgical procedures in implant dentistry. This study conducted a retrospective evaluation of the rate of intercurrences and complications related to patients submitted to osseointegratable dental implant placement. A retrospective evaluation was made of 660 clinical record charts of patients submitted to osseointegratable dental implants in the period of 8 years, attended in the Oral and Maxillofacial Surgery Department of Piracicaba Dental School - Unicamp. The results showed that there was a higher rate of intercurrences and complications when patients were attended by residents (p= 0.015) and when the panoramic radiograph was the only preoperative image exam requested (p= 0.011). The results also showed a higher rate of intercurrences and complications in patients when they were submitted to surgical procedures of alveolar bone reconstruction (p< 0.0001). The presence of post-operative infection had a significant influence on the increase in the primary loss of implants (p< 0.0001).