Do the New Protocols of Platelet-Rich Fibrin Centrifugation Allow Better Control of Postoperative Complications and Healing After Surgery of Impacted Lower Third Molar? A Systematic Review and Meta-Analysis.

PURPOSE: Platelet concentrate generation protocols have undergone several modifications in recent years; in light of these new developments, this study review aims to evaluate the effects of platelet-rich fibrin (PRF) and the new centrifugation protocols, advanced platelet-rich fibrin (A-PRF), and leukocyte platelet-rich fibrin (L-PRF), after extraction of impacted mandibular third molar. Specifically, we assessed pain control, edema, trismus, and soft tissue healing, and also measured the degree of periodontal regeneration adjacent to the second molar. METHODS: PubMed, MEDLINE, EMBASE, Web of Science, Virtual health library (BVS), and Cochrane Library were searched up to Julye 2021; randomized controlled studies were included. This report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and PICO (population, intervention, comparison, outcome) questions. This review has been registered at the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) under the number CRD42019136701. The risk of bias screening and data extraction was performed according to the guidelines recommended by Cochrane. The quantitative analysis was performed using RevMan version 5.4. RESULTS: Of 17 studies included in the systematic review, 11 were eligible for the meta-analysis. The use of L-PRF was not associated with better soft tissue healing at day 7. (standard mean difference = -0.70; 95% confidence interval, -3.50 to 2.10; Z = 0.49; P = .62; heterogeneity = 0.00001; I2 = 97%). With L-PRF, qualitative analysis revealed better pocket depth and insertion level, and also better pain control at 1 and 3 days. With A-PRF, a lower consumption of analgesics was observed than with L-PRF. With both A-PRF and L-PRF, better control of edema (but not trismus) was observed. CONCLUSIONS: The use of L-PRF and A-PRF allows better control of pain and edema compared with the use of standard PRF protocols, but neither has an effect on trismus. The PRF and L-PRF protocols improve soft tissue healing, although not to a statistically significant degree; however, they could improve probing depth at the third month after third molar surgery.

The efficacy of etodolac and ibuprofen, regarding gender, on pain, edema and trismus after impacted lower third molar surgery: A randomized prospective clinical split-mouth study / La eficacia del etodolaco y del ibuprofeno, según el sexo, sobre el dolor, el edema y trismo después de la cirugía del tercer molar inferior impactado: un estudio prospectivo aleatorizado estudio clínico de boca dividida

Background: This study aimed to conduct a randomized prospective study about the efficacy of etodolac andibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teethextraction.Material and Methods: Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of im-pacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac(300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during threedays. Patients were evaluated regarding pain, trismus and edema.Results: Sixteen men and fourteen women participated of the study. No statistical difference was establishedregarding gender according to the evaluated parameters. However, etodolac use showed better results regardingpain, trismus and edema.Conclusions: Pain, edema and trismus after impacted third molars extraction were not influenced by gender.(AU)

Bone Regeneration Assessment of Polycaprolactone Membrane on Critical-Size Defects in Rat Calvaria.

Biomaterials for use in guided bone regeneration (GBR) are constantly being investigated and developed to improve clinical outcomes. The present study aimed to comparatively evaluate the biological performance of different membranes during the bone healing process of 8 mm critical defects in rat calvaria in order to assess their influence on the quality of the newly formed bone. Seventy-two adult male rats were divided into three experimental groups (n = 24) based on the membranes used: the CG-membrane-free control group (only blood clot, negative control), BG-porcine collagen membrane group (Bio-Guide®, positive control), and the PCL-polycaprolactone (enriched with 5% hydroxyapatite) membrane group (experimental group). Histological and histometric analyses were performed at 7, 15, 30, and 60 days postoperatively. The quantitative data were analyzed by two-way ANOVA and Tukey's test (p < 0.05). At 7 and 15 days, the inflammatory responses in the BG and PCL groups were significantly different (p < 0.05). The PCL group, at 15 days, showed a large area of newly formed bone. At 30 and 60 days postoperatively, the PCL and BG groups exhibited similar bone healing, including some specimens showing complete closure of the critical defect (p = 0.799). Thus, the PCL membrane was biocompatible, and has the potential to help with GBR procedures.

Gene expression, immunohistochemical and microarchitectural evaluation of bone formation around two implant surfaces placed in bone defects filled or not with bone substitute material.

OBJECTIVE: The aim of this study is to evaluate through gene expression, immunohistochemical and microtomographic (micro-CT) analysis the response of peri-implant bone tissue around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute materials. In addition, to investigate the hypothesis that porous-hydrophilic surface induces a faster bone formation. MATERIALS AND METHODS: Twenty-six animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: bone defect filled with blood clot and porous surface titanium implant installed; BC-A: bone defect filled with blood clot and porous-hydrophilic surface titanium implant installed; HA/TCP-N: bone defect filled with bone substitute material and porous surface titanium implant installed; and HA/TCP-A: bone defect filled with bone substitute material and porous-hydrophilic surface titanium implant installed. The animals were submitted to euthanasia at 15, 30, and 60 days after implant installation. The expression of two genes was evaluated: RUNX2 and BSP. Immunohistochemical analyses were performed for detection of RUNX2, OPN, OCN, OPG, and RANKL antibodies and bone matrix proteins. Finally, four parameters were chosen for micro-CT analysis: trabecular number, separation and thickness, and connectivity density. RESULTS: Descriptive analysis showed similar findings among the experimental groups. Moreover, porous-hydrophilic surfaces presented a higher expression of RUNX2, which is probably an indicative of better osteogenesis; although the data from this study may be considered an insufficient support for a concrete statement. CONCLUSION: Porous hydrophilic surface can improve and accelerate protein expression and bone formation.

Is the Bacterial Cellulose Membrane Feasible for Osteopromotive Property?

Guided bone regeneration was studied to establish protocols and develop new biomaterials that revealed satisfactory results. The present study aimed to comparatively evaluate the efficiency of the bacterial cellulose membrane (Nanoskin®) and collagen membrane Bio-Gide® in the bone repair of 8-mm critical size defects in rat calvaria. Seventy-two adult male rats were divided into three experimental groups (n = 24): the CG-membrane-free control group (only blood clot, negative control), BG-porcine collagen membrane group (Bio-Guide®, positive control), and BC-bacterial cellulose membrane group (experimental group). The comparison periods were 7, 15, 30, and 60 days postoperatively. Histological, histometric, and immunohistochemical analyses were performed. The quantitative data were subjected to 2-way ANOVA and Tukey's post-test, and p < 0.05 was considered significant. At 30 and 60 days postoperatively, the BG group showed more healing of the surgical wound than the other groups, with a high amount of newly formed bone (p < 0.001), while the BC group showed mature connective tissue filling the defect. The inflammatory cell count at postoperative days 7 and 15 was higher in the BC group than in the BG group (Tukey's test, p = 0.006). At postoperative days 30 and 60, the area of new bone formed was greater in the BG group than in the other groups (p < 0.001). Immunohistochemical analysis showed moderate and intense immunolabeling of osteocalcin and osteopontin at postoperative day 60 in the BG and BC groups. Thus, despite the promising application of the BC membrane in soft-tissue repair, it did not induce bone repair in rat calvaria.

Bone Healing Evaluation in Critical-Size Defects Treated With Xenogenous Bone Plus Porcine Collagen.

PURPOSE: This study aimed to evaluate the osteoconductive features of Bio-Oss Collagen in large critical-size defects (8 mm). MATERIALS AND METHODS: Thirty-six adult Wistar Albinus male adult rats were carried out a critical-size defect with a trephine bur of 8 mm in the calvaria. Groups were divided depending on the filling biomaterial as follows: group BO: Bio-Oss (n = 18); group BOC: Bio-Oss Collagen (n = 18). After 7, 30, and 60 days, 6 rats of each group were euthanized with anesthetic overdose. Specimens were laboratory processed for histomorphometric analysis. Histomorphometric data were statistically analyzed by analysis of variance and post-Tukey test (P < 0.05). RESULTS: Statistical differences were found in new bone formation just in the intragroup comparison among periods after 7 and 60 postoperative days, indicating more new bone formation after 60 days (Tukey test, P = 0.029). CONCLUSION: Under the limitation of this research, it could be concluded that Bio-Oss and Bio-Oss Collagen in this experimental model did not show osteoconductive features.

Raiz dentária impelida para o seio maxilar após exodontia: uma opção de tratamento / Dental root displaced to maxillary sinus after tooth extraction: a treatment option

Introdução: A íntima relação anatômica entre raízes dentáriase o assoalho do seio maxilar, principalmente na região depré-molares e primeiro molar superiores, podem levar aodeslocamento acidental de raízes para o interior do seio maxilarnos procedimentos de exodontia. Objetivo: Descrição dotratamento realizado para a remoção de uma raiz dentária nointerior do seio maxilar, deslocada durante um procedimento deexodontia. Relato de Caso: Paciente do sexo feminino, 39 anosde idade, que relatou ter sido submetida à extração do elemento26 para cerca de dois meses. O paciente foi informado peloprofissional que realizou a extração de uma raiz que foi impelidopara o interior do seio maxilar. O plano de tratamento incluiu acirurgia para remover a raiz no seio maxilar. Comentários Finais:Os profissionais devem ser criteriosos durante as extraçõesdentárias, para evitar estes acidentes. Entretanto, caso ocorraesta intercorrência, o acesso ao seio maxilar é a melhor opçãoterapêutica.