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1.
J Periodontol ; 2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33152103

RESUMEN

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted in this review may have the potential especially in combination approaches to repair challenging interproximal soft and hard tissue deficiencies.

2.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
3.
Materials (Basel) ; 12(13)2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31288437

RESUMEN

Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. Periodontal therapy aims at maintaining patient's teeth through infection control and correction of non-maintainable anatomies including-when possible-regeneration of lost periodontal tissues. The biological regenerative potential of the periodontium is high, and several biomaterials can be utilized to improve the outcome of periodontal therapy. Use of different natural and synthetic materials in the periodontal field has been studied for many years. The main materials used today in periodontology analyzed in this review are: Resorbable and non-resorbable barrier membranes; autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes; biological agents, such as amelogenins; platelet-derived growth factor; bone morphogenic proteins; rh fibroblast growth factor 2; teriparatide hormone; platelet concentrates; and 3D scaffolds. With the development of new surgical techniques some concepts on periodontal regeneration that were strictly applied in the past seem to be not so critical today. This can have an impact on the materials that are needed when attempting to regenerate lost periodontal structures. This review aims at presenting a rationale behind the use of biomaterials in modern periodontal regeneration.

4.
Mediators Inflamm ; 2019: 1737306, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30918466

RESUMEN

Objectives: Cementogenesis seems to be significantly compromised during tissue inflammation. In dental practice, surgical procedures are performed with the aim to regenerate periodontium including cementum. However, inflammation that occurs during the initial healing phases after surgery may impair regeneration of this tissues. The aim of the present study was to assess if surgical procedures designed to regenerate periodontium might affect levels of cementum protein-1 (CEMP-1) in periodontal wound fluid during early phase of healing. Materials and Methods: In 36 patients, 18 intrabony periodontal defects were treated with regenerative therapy (REG group) and 18 suprabony periodontal defects were treated with open flap debridement (OFD group). In the experimental sites, gingival crevicular fluid was collected immediately before surgery, and periodontal wound fluid was collected 4, 7, 14, and 21 days after surgery. CEMP-1 levels were detected by indirect enzyme-linked immunosorbent assay technique. Results: At the analysis, it resulted that there was a significant average difference in CEMP-1 values between the REG and OFD groups at baseline (p = 0.041), the CEMP-1-modeled average in the OFD group was lower by 0.45 ng/ml. There was a significant trend in CEMP-1 over time, and this trend was different among the 2 groups: the REG group showed a statistically significant rising CEMP-1 trend (0.18 ng/ml a week p = 0.012), while the OFD had a trend that was significantly lower (-0.22 ng/ml a week compared to the REG group trend p = 0.023), the OFD group lost on average 0.05 ng/ml a week. In REG sites, GCF protein levels resulted also related to clinical parameters. Conclusions: During the initial inflammatory phase of periodontal healing, CEMP-1 levels decrease regardless of the surgical protocol applied. The surgical procedures used to regenerate periodontal tissue are able to reverse this trend and to induce significant increase of CEMP-1 in periodontal wound fluid after the first week postop.


Asunto(s)
Líquido del Surco Gingival/metabolismo , Periodoncio/metabolismo , Proteínas/metabolismo , Cicatrización de Heridas/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inflamación/metabolismo , Masculino , Persona de Mediana Edad
5.
Int J Periodontics Restorative Dent ; 38(6): e127-e134, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30304077

RESUMEN

This clinical study was conducted to evaluate the impact of different hemostatic treatments following palatal gingival harvesting on patient discomfort. Fifty patients who needed a mucogingival surgery requiring gingival graft harvesting were enrolled and randomly assigned to one of five groups: (1) a control group in which only sutures were applied; (2) a cyanoacrylate group; (3) a periodontal dressing material group; (4) a hemostatic gelatin sponge group; and (5) a group in which the gelatin sponge and cyanoacrylate were combined. In the 2 weeks following the procedures, perception of pain, healing, consumption of drugs, and willingness to repeat the procedure were recorded through visual analog scale (VAS) by patients. Over the 2 weeks, lower pain (VAS) was found in all test groups compared to the control group (P < .01, value for time-group interaction). Notably, the gelatin sponge combined with cyanoacrylate group had very low pain (VAS ≤ 0.5 points) throughout the 14 days. The lowest healing scores at day 10 were associated with the control group (6.8 VAS points) in contrast to the four test groups (8.2 to 9.0 VAS points, P = .0001). Pain was inversely correlated with age (P < .05). Pain also depended on the apicocoronal dimension of the graft: the higher the graft, the more pain was experienced by the participants (0.4 VAS points per 1 mm, P < .05). Within the limitations of this study, palatal coverage appears to result in better outcomes when compared to suture alone. In particular, a double-layered protection of the palatal wound with a gelatin sponge combined with cyanoacrylate appeared to be the best option in reducing pain and postoperative discomfort.


Asunto(s)
Encía/cirugía , Técnicas Hemostáticas , Hemorragia Posoperatoria/prevención & control , Humanos , Dolor Postoperatorio/prevención & control , Tapones Quirúrgicos de Gaza
6.
J Clin Periodontol ; 45(9): 1107-1117, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29777632

RESUMEN

AIM: To assess the clinical outcomes 9 years after the surgical treatment of single maxillary gingival recessions and identify predictors for long-term gingival margin stability. MATERIALS AND METHODS: Twenty-five gingival recessions (Miller Class I and II) were randomly treated with Coronally Advanced Flap (CAF) plus Connective Tissue Graft (CTG) or CAF alone. Outcomes included complete root coverage (CRC), recession reduction (REC), keratinized tissue (KT) gain and dentin hypersensitivity, and were evaluated at 6 months, 1 and 9 years. Multilevel analysis was performed to identify predictors for long-term gingival margin stability. RESULTS: Baseline gingival recession was 2.4 ± 0.8 mm and 2.4 ± 1.0 mm in the CAF + CTG and in the CAF-treated sites, respectively (p = 0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF + CTG group (Relative Risk [RR] = 1.70, 95% CI [0.84-3.45]; adjusted RR = 1.48, 95% CI [0.61-3.62]). Using the CTG, an increase in KT was recorded 9 years after the surgery (p = 0.019). An OR of 0.12 (p = 0.022) of not achieving CRC was observed in cases with non-carious cervical lesions (NCCL) compared to cases without NCCL. CONCLUSION: Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT. The presence of NCCL negatively affected CRC and REC.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Estudios de Seguimiento , Encía , Humanos , Pérdida de la Inserción Periodontal , Raíz del Diente , Resultado del Tratamiento
7.
Artículo en Inglés | MEDLINE | ID: mdl-29240214

RESUMEN

The success of dental implants depends mainly on osseointegration and gingival sealing. Therefore, early attachment and spreading of epithelial cells might be critical for a positive outcome. Research in dental implant materials has primarily focused on surface roughness, defined by the average roughness (Ra) index, as it promotes the process of osseointegration. This study explored its influence on soft tissue attachment by looking mainly at adhesion, proliferation, and spreading of primary human cells belonging to the epithelial lineage. Characterized human gingival keratinocytes, gingival and epithelial progenitor cells were seeded on machined (S1; Ra = 0.3 to 0.6 µm), Ti-Unite (S2; Ra = 1.2 µm), and SLA (S3; Ra = 2 µm) implants. Cell adhesion with early proliferation and spreading were evaluated by combining a biochemical vitality test with imaging analyses. Findings showed that adhesion was significantly higher on S1 (36% ± 2%) and S2 (44% ± 7%) than on S3 (23% ± 6%), while early proliferation was slightly improved on S1. The resulting data, obtained through an innovative and easily reproducible in vitro method, suggest that implant surface roughness affects epithelial cell adhesion and proliferation.


Asunto(s)
Adhesión Celular , Proliferación Celular , Implantes Dentales , Encía/citología , Queratinocitos/fisiología , Células Madre/fisiología , Células Cultivadas , Humanos , Propiedades de Superficie
8.
Artículo en Inglés | MEDLINE | ID: mdl-28817135

RESUMEN

The purpose of this study was to compare microcomputed tomography (microCT) and histologic analysis outcomes of a periodontal regeneration of a human defect treated with a polylactic- and polyglycolic-acid copolymer. At 11 months following the grafting procedure, the root with the surrounding periodontal tissues was removed and analyzed using microCT and histologic techniques. The results suggest that microCT three-dimensional analysis may be used in synergy with two-dimensional histologic sections to provide additional information for studying the regeneration outcomes normally reported by histologic biopsies in humans. Additional data is needed to validate these findings.


Asunto(s)
Regeneración Tisular Guiada Periodontal , Periodoncio/patología , Periodontitis Crónica/cirugía , Femenino , Regeneración Tisular Guiada Periodontal/métodos , Humanos , Persona de Mediana Edad , Periodoncio/diagnóstico por imagen , Radiografía Dental , Resultado del Tratamiento , Microtomografía por Rayos X
9.
J Clin Periodontol ; 44(9): 905-914, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28736819

RESUMEN

OBJECTIVE: To evaluate the influence of periodontal therapy on DNA methylation in patients with chronic periodontitis as compared to healthy individuals. MATERIAL AND METHODS: Twenty patients were enrolled into two groups: (i) 10 diagnosed as clinically healthy; and (ii) 10 diagnosed with chronic periodontitis. Clinical measures were recorded and gingival biopsies were harvested at baseline (both patient groups) and at 2 and 8 weeks post-baseline for diseased individuals. Molecular DNA methylation analysis was performed by pyrosequencing for the putative inflammation-associated genes LINE-1, COX-2, IFN-γ and TNF-α. Random-intercept linear regression models were applied to evaluate methylation levels across groups at baseline and the methylation changes over time in the diseased and normal tissues. RESULTS: Periodontal therapy did not influence gene expression methylation of TNF-α, IFN-γ and LINE-1 levels at normal and periodontitis sites over time. However, it significantly reduced COX-2 methylation levels comparable to healthy individuals at both 2 and 8 weeks post-treatment (p < .05). CONCLUSIONS: Periodontal therapy resets the DNA methylation status of inflammatory gene for COX-2 in patients with periodontal disease. DNA methylation levels of TNF-α, IFN-γ and LINE-1 were sustained in periodontitis sites despite therapy. Future studies should consider an expanded panel of inflammatory genes over time. (ClinicalTrials.gov NCT02835898).


Asunto(s)
Periodontitis Crónica/genética , Periodontitis Crónica/terapia , Metilación de ADN , Adulto , Anciano , Estudios de Casos y Controles , Ciclooxigenasa 2/genética , Femenino , Perfilación de la Expresión Génica , Humanos , Interferón gamma/genética , Elementos de Nucleótido Esparcido Largo/genética , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Factor de Necrosis Tumoral alfa/genética
10.
J Periodontol ; 87(10): 1186-94, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27677810

RESUMEN

BACKGROUND: Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush. METHODS: Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test. RESULTS: Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002). CONCLUSION: Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.


Asunto(s)
Índice de Placa Dental , Gingivitis/cirugía , Mucosa Bucal/cirugía , Cirugía Plástica , Cepillado Dental , Placa Dental , Diseño de Equipo , Humanos , Método Simple Ciego
11.
Int J Dent ; 2016: 1239842, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27366149

RESUMEN

To ensure a successful dental implant therapy, the presence of adequate vertical and horizontal alveolar bone is fundamental. However, an insufficient amount of alveolar ridge in both dimensions is often encountered in dental practice due to the consequences of oral diseases and tooth loss. Although postextraction socket preservation has been adopted to lessen the need for such invasive approaches, it utilizes bone grafting materials, which have limitations that could negatively affect the quality of bone formation. To overcome the drawbacks of routinely employed grafting materials, bone graft substitutes such as 3D scaffolds have been recently investigated in the dental field. In this review, we highlight different biomaterials suitable for 3D scaffold fabrication, with a focus on "3D-printed" ones as bone graft substitutes that might be convenient for various applications related to implant therapy. We also briefly discuss their possible adoption for periodontal regeneration.

12.
Int J Dent ; 2016: 4723589, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26904120

RESUMEN

The aim of this review is to describe the most commonly observed changes in periodontium caused by orthodontic treatment in order to facilitate specialists' collaboration and communication. An electronic database search was carried out using PubMed abstract and citation database and bibliographic material was then used in order to find other appropriate sources. Soft and hard periodontal tissues changes during orthodontic treatment and maintenance of the patients are discussed in order to provide an exhaustive picture of the possible interactions between these two interwoven disciplines.

13.
Clin Oral Implants Res ; 27(5): 505-22, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26037472

RESUMEN

OBJECTIVES: The aim of this study was to explore the development of soft tissue expanders, their different types and their potential applications prior to bone augmentation and implant placement. MATERIAL AND METHODS: A review of pertinent literature was performed using PubMed to comprehend the dynamics of soft tissue expanders and determine the current position of their pre-augmentation applications. RESULTS: There is promising, albeit preliminary information regarding the benefits of pre-augmentation soft tissue expansion. Findings cannot be generalised due to relatively small sample size. CONCLUSIONS: Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice.


Asunto(s)
Dispositivos de Expansión Tisular , Expansión de Tejido , Humanos
14.
Int J Esthet Dent ; 10(2): 258-68, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25874273

RESUMEN

AIM: There have been no modifications made to the original double papillae flap surgical technique introduced by Cohen and Ross in 1968. The aim of the present case series is to evaluate the effectiveness of a modified surgical approach to the double papillae flap design in the treatment of isolated gingival recession. MATERIALS AND METHODS: A total of 12 healthy, young patients (age range 20 to 28 years) with isolated gingival recession were enrolled in this study. The gingival recession had the following characteristics: isolated defect, Miller Class I or II defect, visible cementoenamel junction (CEJ), and well represented interdental papillae. The following clinical measurements were taken before the surgery and at the 1-year follow-up examination: probing depth (PD) at the treated tooth, clinical attachment level (CAL), amount of keratinized tissue (KT) at the treated site, and recession depth (RD). All measurements were taken at baseline and after 12 months by means of a manual probe and were rounded up to the nearest millimeter. RESULTS: At the 1-year follow-up examination, the same clinical parameters taken at baseline were rerecorded. No statistical differences were noted for the PD (P=0.54). The mean increase for the CAL was statistically significant (P=0.04). Furthermore, the mean amount of KT increased by 2.5±0.4 mm (P<0.001). Finally, the mean RD decreased to 0.5±0.6 mm, corresponding to a root coverage of 3.8±0.8 mm (P<0.001). In terms of mean root coverage (MRC), 88.4% of exposed root surface was covered with soft tissue, and 9 of the 12 treated teeth (75%) showed complete coverage of the root surface. CONCLUSION: The results of the present case series show that the modified double papillae flap technique is effective in obtaining root coverage of isolated gingival recession defects. These rootcoverage outcomes were associated with clinically and statistically highly significant clinical attachment gain, with no noticeable change in either the PD values or the height of KT on the buccal aspect of the treated teeth.


Asunto(s)
Encía/cirugía , Recesión Gingival/cirugía , Cirugía Bucal/métodos , Colgajos Quirúrgicos , Adulto , Femenino , Humanos , Masculino , Adulto Joven
15.
Int J Dent ; 2013: 521547, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23843792

RESUMEN

Guided tissue regenerative (GTR) therapies are performed to regenerate the previously lost tooth supporting structure, thus maintaining the aesthetics and masticatory function of the available dentition. Alveolar ridge augmentation procedures (GBR) intend to regain the alveolar bone lost following tooth extraction and/or periodontal disease. Several biomaterials and surgical approaches have been proposed. In this paper we report biomaterials and surgical techniques used for periodontal and bone regenerative procedures. Particular attention will be adopted to highlight the biological basis for the different therapeutic approaches.

16.
Artículo en Inglés | MEDLINE | ID: mdl-23593632

RESUMEN

The ability to stabilize the blood clot is crucial in achieving predictable periodontal regeneration in infrabony defects. Unfortunately, micromovements may cause degradation of the clot-root interface and result in suboptimal wound healing. Current surgical and suturing techniques are aimed at reducing flap micromovement because flap management is one of the main factors influencing the stability of the clot. The aim of this paper is to describe the use of the soft tissue wall technique to enhance periodontal tissue regeneration outcomes of challenging non-contained infrabony defects. Nine one-wall infrabony defects were treated with a combination of a papilla preservation technique and a coronally advanced flap. Enamel matrix derivative was delivered to the defect, but no bone grafting materials or membranes were employed. Mean 1-year probing depth reduction was 6.3 ± 2.0 mm (P < .001) and mean clinical attachment gain was 7.1 ± 1.0 mm (P < .001). All treated sites showed a mean reduction of exposed root surface equal to 1.0 ± 0.4 mm (P = .05). The results suggest the possibility of improving the regenerative potential of a one-wall infrabony defect by the creation of a stable soft tissue wall while also enhancing the esthetic outcome of the surgical procedure. Further studies with a larger number of patients are needed to support these preliminary data.


Asunto(s)
Pérdida de Hueso Alveolar/cirugía , Regeneración Tisular Guiada Periodontal/métodos , Adulto , Coagulación Sanguínea/fisiología , Periodontitis Crónica/cirugía , Proteínas del Esmalte Dental/uso terapéutico , Índice de Placa Dental , Estética Dental , Femenino , Estudios de Seguimiento , Recesión Gingival/cirugía , Gingivoplastia/métodos , Humanos , Masculino , Pérdida de la Inserción Periodontal/cirugía , Índice Periodontal , Bolsa Periodontal/cirugía , Colgajos Quirúrgicos/cirugía , Raíz del Diente/cirugía , Resultado del Tratamiento
17.
Cell Transplant ; 22(5): 767-77, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-22776413

RESUMEN

Stem cell therapy offers potential in the regeneration of craniofacial bone defects; however, it has not been studied clinically. Tissue repair cells (TRCs) isolated from bone marrow represent a mixed stem and progenitor population enriched in CD90- and CD14-positive cells. In this phase I/II, randomized, controlled feasibility trial, we investigated TRC cell therapy to reconstruct localized craniofacial bone defects. Twenty-four patients requiring localized reconstruction of jawbone defects participated in this longitudinal trial. For regenerative therapy, patients were randomized to receive either guided bone regeneration (GBR) or TRC transplantation. At 6 or 12 weeks following treatment, clinical and radiographic assessments of bone repair were performed. Bone biopsies were harvested and underwent quantitative micro-computed tomographic (µCT) and bone histomorphometric analyses. Oral implants were installed, subsequently restored, and functionally loaded with tooth restorations. Reconstructed sites were assessed for 1 year following therapy. No study-related, serious adverse events were reported. Following therapy, clinical, radiographic, tomographic, and histological measures demonstrated that TRC therapy accelerated alveolar bone regeneration compared to GBR therapy. Additionally, TRC treatment significantly reduced the need for secondary bone grafting at the time of oral implant placement with a five fold decrease in implant bony dehiscence exposure (residual bone defects) as compared to GBR-treated sites(p < 0.01). Transplantation of TRCs for treatment of alveolar bone defects appears safe and accelerates bone regeneration, enabling jawbone reconstruction with oral implants. The results from this trial support expanded studies of TRC therapy in the treatment of craniofacial deformities (ClinicalTrials.gov number CT00755911).


Asunto(s)
Regeneración Ósea , Células Madre Mesenquimatosas/citología , Trasplante de Células Madre , Adulto , Anciano , Densidad Ósea , Células de la Médula Ósea/citología , Femenino , Regeneración Tisular Guiada Periodontal , Histocompatibilidad , Humanos , Maxilares/diagnóstico por imagen , Maxilares/patología , Receptores de Lipopolisacáridos/metabolismo , Estudios Longitudinales , Masculino , Células Madre Mesenquimatosas/metabolismo , Persona de Mediana Edad , Antígenos Thy-1/metabolismo , Tomografía Computarizada por Rayos X
18.
Int J Dent ; 2012: 151030, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22737169

RESUMEN

Following tooth extraction, the alveolar ridge undergoes an inevitable remodeling process that influences implant therapy of the edentulous area. Socket grafting is a commonly adopted therapy for the preservation of alveolar bone structures in combination or not with immediate implant placement although the biological bases lying behind this treatment modality are not fully understood and often misinterpreted. This review is intended to clarify the literature support to socket grafting in order to provide practitioners with valid tools to make a conscious decision of when and why to recommend this therapy.

19.
Artículo en Inglés | MEDLINE | ID: mdl-21845241

RESUMEN

The aims of this article were to perform a detailed evaluation of the healing of extraction sockets covered with a resorbable collagen membrane 12 weeks following exodontia and to determine if this device had ossifying properties. Ten consecutive subjects in need of extraction of maxillary premolars were recruited. Each subject had a hopeless maxillary premolar extracted with minimal trauma. Sockets were then covered with a collagen barrier membrane alone. At 12 weeks, reentry surgery was performed, clinical measurements were repeated, and bone core biopsies were obtained prior to dental implant placement for histologic and microcomputed tomography (micro-CT) analysis. Study sites showed mean bone regeneration horizontally of 7.7 mm (buccopalatally) and 4.6 mm (mesiodistally). Vertical bone repair showed a mean gain of 10.9 mm. Subtraction radiography showed a mean apical shift of the crestal bone at the center of the socket of 2.1 mm (range, 0.7 to 4.3 mm). Micro-CT and histology revealed formation of well-mineralized tissue at 12 weeks, with a mean percentage of vital bone of 45.87% ± 12.35%. No signs of membrane ossification were observed. A detailed analysis of tissue neogenesis in extraction sites protected by this barrier membrane has demonstrated that adequate bone formation for implant placement occurs as early as 12 weeks following exodontia, with minimal changes in alveolar ridge dimensions. No evidence of membrane ossification was observed.


Asunto(s)
Regeneración Ósea/fisiología , Regeneración Tisular Guiada Periodontal/métodos , Extracción Dental , Alveolo Dental/patología , Microtomografía por Rayos X/métodos , Implantes Absorbibles , Adulto , Proceso Alveolar/patología , Proceso Alveolar/cirugía , Diente Premolar/cirugía , Biopsia , Calcificación Fisiológica/fisiología , Colágeno , Implantación Dental Endoósea , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Osteogénesis/fisiología , Radiografía de Mordida Lateral , Técnica de Sustracción , Colgajos Quirúrgicos , Alveolo Dental/cirugía , Resultado del Tratamiento , Cicatrización de Heridas/fisiología
20.
Tissue Eng Part A ; 16(9): 2809-20, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20412009

RESUMEN

There has been increased interest in the therapeutic potential of bone marrow derived cells for tissue engineering applications. Bone repair cells (BRCs) represent a unique cell population generated via an ex vivo, closed-system, automated cell expansion process, to drive the propagation of highly osteogenic and angiogenic cells for bone engineering applications. The aims of this study were (1) to evaluate the in vitro osteogenic and angiogenic potential of BRCs, and (2) to evaluate the bone and vascular regenerative potential of BRCs in a craniofacial clinical application. BRCs were produced from bone marrow aspirates and their phenotypes and multipotent potential characterized. Flow cytometry demonstrated that BRCs were enriched for mesenchymal and vascular phenotypes. Alkaline phosphatase and von Kossa staining were performed to assess osteogenic differentiation, and reverse transcriptase-polymerase chain reaction was used to determine the expression levels of bone specific factors. Angiogenic differentiation was determined through in vitro formation of tube-like structures and fluorescent labeling of endothelial cells. Finally, 6 weeks after BRC transplantation into a human jawbone defect, a biopsy of the regenerated site revealed highly vascularized, mineralized bone tissue formation. Taken together, these data provide evidence for the multilineage and clinical potential of BRCs for craniofacial regeneration.


Asunto(s)
Células de la Médula Ósea/citología , Huesos Faciales/cirugía , Neovascularización Fisiológica/fisiología , Osteogénesis/fisiología , Ingeniería de Tejidos/métodos , Fosfatasa Alcalina/metabolismo , Células de la Médula Ósea/metabolismo , Diferenciación Celular/fisiología , Células Cultivadas , Huesos Faciales/metabolismo , Huesos Faciales/patología , Citometría de Flujo , Humanos , Maxilares/patología , Procedimientos Quirúrgicos Ortognáticos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
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