A randomized controlled clinical trial to evaluate blood pressure changes in patients undergoing extraction under local anesthesia with vasopressor use.

The control of hypertensive patients' blood pressure and heart rate using vasoconstrictors during surgical procedures under anesthesia is still a major concern in everyday surgical practice. This clinical trial aimed to evaluate the variation of blood pressure and heart rate in nonhypertensive and controlled hypertensive voluntary subjects undergoing oral surgery under local anesthesia with lidocaine hydrochloride and epinephrine at 1:100,000 (Alphacaine; DFL, Brazil), performed in the Oral Surgery Department, Dentistry School, Fluminense Federal University. In total, 25 voluntary subjects were divided into 2 groups: nonhypertensive (n = 15) and controlled hypertensives (n = 10). Blood pressure and heart rate were measured at 4 different times: T0, in the waiting room; T1, after placement of the surgical drapes; T2, 10 minutes after anesthesia injection; and T3, at the end of the surgical procedure. A statistically significant difference (P < 0.05) between the groups was found at times T0 and T2 for the systolic pressure but only at time T0 for the diastolic pressure. The assessment of the heart rate of both groups showed a statistically significant difference (P < 0.05) at time T1. An analysis of the employed anesthetic volume indicated no statistically significant difference (P > 0.05) between the amount administered to nonhypertensive and hypertensive subjects. It was concluded that the local anesthetics studied could safely be used in controlled hypertensive and nonhypertensive patients in compliance with the maximum recommended doses.

In Vivo Evaluation of Permeable and Impermeable Membranes for Guided Bone Regeneration.

BACKGROUND: The degree of biodegradation and the inflammatory response of membranes employed for guided bone regeneration directly impact the outcome of this technique. This study aimed to evaluate four different experimental versions of Poly (L-lactate-co-Trimethylene Carbonate) (PTMC) + Poly (L-lactate-co-glycolate) (PLGA) membranes, implanted in mouse subcutaneous tissue, compared to a commercially available membrane and a Sham group. METHODS: Sixty Balb-C mice were randomly divided into six experimental groups and subdivided into 1, 3, 6 and 12 weeks (n = 5 groups/period). The membranes (1 cm2) were implanted in the subcutaneous back tissue of the animals. The samples were obtained for descriptive and semiquantitative histological evaluation (ISO 10993-6). RESULTS: G1 and G4 allowed tissue adhesion and the permeation of inflammatory cells over time and showed greater phagocytic activity and permeability. G2 and G3 detached from the tissue in one and three weeks; however, in the more extended periods, they presented a rectilinear and homogeneous aspect and were not absorbed. G2 had a major inflammatory reaction. G5 was almost completely absorbed after 12 weeks. CONCLUSIONS: The membranes are considered biocompatible. G5 showed a higher degree of biosorption, followed by G1 and G4. G2 and G3 are considered non-absorbable in the studied periods.

Osseodensification enables bone healing chambers with improved low-density bone site primary stability: an in vivo study.

Primary implant stability is a prerequisite for successful implant osseointegration. The osseodensification technique (OD) is a non-subtractive drilling technique that preserves the bone tissue, increases osteotomy wall density, and improves the primary stability. This study aimed to investigate the hypothesis that OD, through a wider osteotomy, produces healing chambers (HCs) at the implant-bone interface without impacting low-density bone primary stability. Twenty implants (3.5 × 10 mm) with a nanohydroxyapatite (nHA) surface were inserted in the ilium of ten sheep. Implant beds were prepared as follows: (i) 2.7-mm-wide using subtractive conventional drilling (SCD) technique (n = 10); (ii) 3.8-mm-wide using an OD bur system (n = 10). The sheep were randomized to two groups, with samples collected at either 14-(n = 5) or 28-days (n = 5) post-surgery and processed for histological and histomorphometric evaluation of bone-implant contact (BIC) and bone area fraction occupancy (BAFO). No significant group differences were found with respect to final insertion torque and implant stability quotient (p > 0.050). BIC values were higher for SCD after 14 and 28 days (p < 0.050); however, BAFO values were similar (p > 0.050). It was possible to conclude that the OD technique allowed a wider implant bed preparation without prejudice on primary stability and bone remodeling.

Effects of methods of hydration of a biphasic ceramic graft on bone regeneration of extraction socket defects.

BACKGROUND: Alveolar volumetric changes are inherent to the healing process after tooth extraction and filling of the extraction site with biomaterials can reduce these volumetric changes and provide a more favorable environment for the future prosthetic restoration with implants. Among the biomaterials available, biphasic ceramic compounds have shown promissing clinical results, however, histologic evaluation of bone tissue response to different hydration and incorporation methods are limited. The objective of this study was to comparatively evaluate in vivo the osteoconductive potential of the biphasic ceramic bone substitute (SBC) composed of beta-tricalcium phosphate and hydroxyapatite after different hydration methodologies in rat extraction sockets. METHODS: Wistar rats (n = 20) were randomly distributed in two subgroups (G1, G2) according to the hydration methods used. After extraction of the right upper central incisor the alveoli were filled with SBC hydrated by two different methods. Group 1: biomaterial hydrated in blood; Group 2: biomaterial hydrated in physiologic saline. The animals were euthanized after 1 and 6 weeks for removal of the bone blocks containing the biomaterial and were submitted to histologic processing. Five-µm-thick demineralized sections of the samples were stained with hematoxylin and eosin (HE) and subjected to histomorphometric analysis. RESULTS: Bone formation was limited 7 days after the extraction procedure and increased in both groups between 7 and 42 days from surgery, demonstrating a time dependent increase of bone volume throughtout the experimental period (p < 0.05). CONCLUSIONS: The hydration of SBC with saline significantly increased new bone formation and reduced connective tissue volume after 42 days demonstrating that hydration method may significantly influence bone healing in such defects, and, thus should be carefully performed.

In Vitro Physico-Chemical Characterization and Standardized In Vivo Evaluation of Biocompatibility of a New Synthetic Membrane for Guided Bone Regeneration.

This study's aim was to evaluate the biocompatibility and bioabsorption of a new membrane for guided bone regeneration (polylactic-co-glycolic acid associated with hydroxyapatite and ß-tricalcium phosphate) with three thicknesses (200, 500, and 700 µm) implanted in mice subcutaneously. Scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and the quantification of carbon, hydrogen and nitrogen were used to characterize the physico-chemical properties. One hundred Balb-C mice were divided into 5 experimental groups: Group 1-Sham (without implantation); Group 2-200 µm; Group 3-500 µm; Group 4-700 µm; and Group 5-Pratix®. Each group was subdivided into four experimental periods (7, 30, 60 and 90 days). Samples were collected and processed for histological and histomorphometrical evaluation. The membranes showed no moderate or severe tissue reactions during the experimental periods studied. The 500-µm membrane showed no tissue reaction during any experimental period. The 200-µm membrane began to exhibit fragmentation after 30 days, while the 500-µm and 700-µm membranes began fragmentation at 90 days. All membranes studied were biocompatible and the 500 µm membrane showed the best results for absorption and tissue reaction, indicating its potential for clinical guided bone regeneration.

In vitro and in vivo evaluations of nanocrystalline Zn-doped carbonated hydroxyapatite/alginate microspheres: zinc and calcium bioavailability and bone regeneration.

Background: Zinc-doped hydroxyapatite has been proposed as a graft biomaterial for bone regeneration. However, the effect of zinc on osteoconductivity is still controversial, since the release and resorption of calcium, phosphorus, and zinc in graft-implanted defects have rarely been studied. Methods: Microspheres containing alginate and either non-doped carbonated hydroxyapatite (cHA) or nanocrystalline 3.2 wt% zinc-doped cHA (Zn-cHA) were implanted in critical-sized calvarial defects in Wistar rats for 1, 3, and 6 months. Histological and histomorphometric analyses were performed to evaluate the volume density of newly formed bone, residual biomaterial, and connective tissue formation. Biomaterial degradation was characterized by transmission electron microscopy (TEM) and synchrotron radiation-based X-ray microfluorescence (SR-µXRF), which enabled the elemental mapping of calcium, phosphorus, and zinc on the microsphere-implanted defects at 6 months post-implantation. Results: The bone repair was limited to regions close to the preexistent bone, whereas connective tissue occupied the major part of the defect. Moreover, no significant difference in the amount of new bone formed was found between the two microsphere groups. TEM analysis revealed the degradation of the outer microsphere surface with detachment of the nanoparticle aggregates. According to SR-µXRF, both types of microspheres released high amounts of calcium, phosphorus, and zinc, distributed throughout the defective region. The cHA microsphere surface strongly adsorbed the zinc from organic constituents of the biological fluid, and phosphorus was resorbed more quickly than calcium. In the Zn-cHA group, zinc and calcium had similar release profiles, indicating a stoichiometric dissolution of these elements and non-preferential zinc resorption. Conclusions: The nanometric size of cHA and Zn-cHA was a decisive factor in accelerating the in vivo availability of calcium and zinc. The high calcium and zinc accumulation in the defect, which was not cleared by the biological medium, played a critical role in inhibiting osteoconduction and thus impairing bone repair.

Microspheres of alginate encapsulated minocycline-loaded nanocrystalline carbonated hydroxyapatite: therapeutic potential and effects on bone regeneration.

Background and objective: Tetracycline and its derivatives, combined with calcium phosphates, have been proposed as a delivery system to control inflammatory processes and chronic infections. The objective of this study was to evaluate the microspheres of alginate encapsulated minocycline-loaded nanocrystalline carbonated hydroxyapatite (CHAMINO) as a biomimetic device to carry out target-controlled drug delivery for alveolar bone repair. Methods: CHAMINO microspheres were implanted in a rat central incisor socket after 7 and 42 days. New bone was formed in both groups between 7 and 42 days of implantation. However, the bone growth was significantly higher for the CHAMINO microspheres. Results: The minocycline (MINO) loading capacity of the nanocrystaline carbonated hydroxyapatite (CHA) nanoparticles was 25.1±2.2 µg MINO/mg CHA for adsorption over 24 hrs. The alginate microspheres containing minocycline-loaded CHA were biologically active and inhibited the Enterococcus faecalis culture growth for up to seven days of the MINO release. An osteoblastic cell viability assay based on the resazurin reduction was conducted after the cells were exposed to the CHAMINO powder and CHAMINO microspheres. Thus, it was found that the alginate extracts encapsulated the minocycline-loaded CHA microspheres and did not affect the osteoblastic cell viability, while the minocycline-doped CHA powder reduced the cell viability by 90%. Conclusion: This study concluded that the alginate microspheres encapsulating the minocycline-loaded nanocrystalline carbonated hydroxyapatite exhibited combined antibacterial activity against Enterococcus faecalis with cytocompatibility and osteoconduction properties. The significant improvement in the new bone formation after 42 days of implantation suggests that the CHAMINO microsphere has potential in clinical applications of bone regeneration.

Estabilidade de cor de diferentes sistemas cerâmicos fresados no CAD/CAM e polidos com diferentes métodos / Color stability of different ceramic systems milled in CAD/CAM and polished with different methods

A descoloração ou perda de translucidez dos materiais cerâmicos usados em odontologia ainda hoje é um problema, especialmente pelo comprometimento estético. Com o objetivo de comparar a estabilidade de cor, blocos de dissilicato de lítio (IPS e.max CAD HT) e de silicato de lítio reforçado com zircônia (Vita Suprinity HT) fresados no desenho de um disco com dimensões de 1,5 × 7 × 12 mm3 (n = 120) foram preparados usando 3 procedimentos de acabamento de superfície: glaze, polimento mecânico e coloração externa e glaze. Em seguida, cada grupo foi dividido em 2 subgrupos de armazenamento, chá preto e café (n = 10/grupo). As mensurações de cor foram medidas com espectrofotômetro (VITA Easyshade) no estágio inicial e após 1 semana, 2 semanas, 1 mês, 2 meses de armazenamento. As alterações de cor (ΔE) foram calculadas e analisadas estatisticamente usando ANOVA (α < 0,05). Observamos que, para ambos os materiais cerâmicos, o procedimento de glaze apresentou valores de mudança de cor estatisticamente menores do que os outros grupos (p < 0,05) após o armazenamento em ambas as bebidas. Os grupos de dissilicato de lítio apresentaram valores de alteração de cor estatisticamente menores em relação aos grupos de silicato de lítio reforçados com zircônia. Conclui-se que, o glaze sozinho levou a uma maior estabilidade de cor em relação ao polimento mecânico e coloração externa o dissilicato de lítio apresentou maior estabilidade de cor em comparação com o silicato de lítio reforçada com zircônia.

The discoloration or loss of translucency of ceramic materials used in dentistry is still a problem today, especially due to aesthetic compromise. In order to compare color stability, lithium disilicate (IPS e.max CAD HT) and zirconia-reinforced lithium silicate (Vita Suprinity HT) blocks were milled into a disc design with dimensions of 1.5 × 7 × 12 mm3 (n = 120). The specimens were prepared using 3 surface finishing procedures: glaze, mechanical polishing and external staining and glaze. Then, each group was divided into 2 storage subgroups, black tea and coffee (n = 10/group). Color measurements were measured with a spectrophotometer (VITA Easyshade) at the initial stage and after 1 week, 2 weeks, 1 month, 2 months of storage. Color changes (ΔE) were calculated and statistically analyzed using ANOVA (α < 0.05). We observed that, for both ceramic materials, the glaze procedure presented statistically lower color change values ​​than the other groups (p < 0.05) after storage in both beverages. The lithium disilicate groups showed statistically lower color change values ​​than the zirconia-reinforced lithium silicate groups. It is concluded that, glaze alone led to greater color stability compared to mechanical polishing and external staining, lithium disilicate showed greater color stability compared to zirconia-reinforced lithium silicate.

Saúde bucal e condições sistêmicas em idosos da Baixada Fluminense: coorte retrospectivo / Oral health and systemic conditions in elderly people from Baixada Fluminense: retrospective cohort

O equilíbrio sistêmico e a saúde bucal são condições clínicas que estabelecem entre si uma relação multidimensional capaz de exercer grande impacto sobre o bem-estar cotidiano do indivíduo. As disfunções metabólicas associadas ao estado nutricional e a perda da capacidade muscular geram uma maior necessidade de cuidados em pessoas idosas. Sob o ponto de vista odontológico a presença de dentes naturais bem como o grau de doença periodontal, estão associados a competência mastigatória e, desta forma, são fatores determinantes na saúde da população acima dos 60 anos de idade. O presente estudo teve como objetivo avaliar, através da análise retrospectiva dos últimos 05 anos, a relação entre a saúde bucal e as condições sistêmicas de indivíduos acima de 60 anos residentes na Baixada Fluminense (Rio de Janeiro/Brasil) com evidente crescimento demográfico populacional. Para isso foram analisados 11.390 prontuários de pacientes usuários da Clínica Odontológica da Universidade Iguaçu/RJ sendo selecionados 1.125 que atendiam aos critérios de inclusão. Os resultados destacam a presença de doença periodontal em cerca de 56% dos indivíduos diabéticos, além de 43% com quadro hipertensivo no momento do atendimento apontando para uma importante relação entre a atenção com a saúde bucal da população assistida nessa região e suas condições sistêmicas.

Systemic balance and oral health are clinical conditions that establish a multidimensional relationship capable of having a great impact on the individual's daily well-being. Metabolic dysfunctions associated with nutritional status and loss of muscle capacity generate a greater need for care in the elderly. From the dental point of view, the presence of natural teeth, as well as the degree of periodontal disease, are associated with masticatory competence and, thus, are determining factors in the health of the population over 60 years of age. The present study aimed to describe descriptively, through the retrospective analysis of the last 05 years, the relationship between oral health and the systemic conditions of individuals over 60 years old living in the Baixada Fluminense (Rio de Janeiro / Brazil) with evident population demographic growth. For that purpose, 11,390 medical records of patients who were users of the Clínica Odontológica of Universidade Iguaçu / RJ were analyzed, 1,125 who met the inclusion criteria were selected. The results highlight the presence of periodontal disease in about 56% of diabetic individuals, in addition to 43% with the hypertensive condition at the time of care, pointing to an important relationship between the attention to the oral health of the assisted population in this region and their systemic conditions.

Advances in surface treatment of dental implants: a literature review

Amplamente utilizados para substituir dentes perdidos, os implantes dentários nos últimos anos vêm apresentando tecnologias como superfícies com micro e nanotopografia e ajustes nas composições químicas, dentre outros, para melhorar a osseointegração e reduzir o prazo de tratamento, permitindo, assim, carga funcional imediata ou precoce em pacientes com densidade óssea reduzida. Vários métodos são aplicados com intuito de modificar a superfície do implante, como jateamento com areia, corrosão ácida, oxidação anódica, tratamento com flúor, usinagem, pulverização de plasma de titânio e revestimento de fosfato de cálcio; esses métodos podem aumentar notavelmente a área de superfície quando operada a técnica adequadada de modificação, quer por procedimento de adição ou subtração. Tais modificações promovem superfícies rugosas, as quais aumentam a porcentagem de contato osso-implante (BIC) durante o processo de cicatrização óssea inicial. Os principais benefícios da modificação da superfície são melhorar a molhabilidade (hidrofilicidade), adesão e fixação de células a implantes e proliferação celular. Dentre os tratamentos de superfície de implantes dentários destaca-se o jateamento de areia com granulação grossa e ataque-ácido com HCL/H2SO4 (SLA) em altas temperaturas, o revestimento de superfície do implante com hidroxiapatita, oxidação anódica e o duplo ataque ácido. O objetivo deste trabalho é realizar uma revisão de literatura discutindo a importância e eficácia desses métodos para a osseointegração e, por conseguinte, para a redução do período de tratamento.

Widely used to replace lost teeth, dental implants have been presenting technologies such as surfaces with micro and nano topography and adjustments in chemical compositions, among others, to improve osseointegration and reduce treatment time, thus allowing immediate or early functional load in patients with reduced bone density. Several methods are applied to modify the implant surface, such as sandblasting, acid corrosion, anodic oxidation, fluoride treatment, machining, titanium plasma spraying, and calcium phosphate coating; these methods can notably increase the surface area when the appropriate modification technique is operated, either by the addition or subtraction procedure. Such modifications promote rough surfaces, which increase the percentage of bone-implant contact (BIC) during the initial bone healing process. The main benefits of surface modification are to improve wettability (hydrophilicity), adhesion and attachment of cells to implants, and cell proliferation. Among the surface treatments for dental implants, sandblasting with large grit and acid-etching with HCL/H2SO4 (SLA) stands out at high temperatures. The surface coating of the implant with hydroxyapatite, anodic oxidation, and double acid-etching. This work aims to conduct a literature review discussing the importance and effectiveness of these methods for osseointegration and, therefore, for reducing the treatment period.

Randomized clinical trial for the biological evaluation of two nanostructured biphasic calcium phosphate biomaterials as a bone substitute.

BACKGROUND: The presence of nonresorbable residual granules of hydroxyapatite (HA) may decrease the bone/implant interface. To balance resorption and bone formation biphasic calcium phosphate ceramics compounds applied at different rates have been studied. PURPOSE: The aim of this trial was to compare the clinical, histological, and histomorphometric responses of two new biphasic calcium phosphate biomaterials in fresh dental sockets after 3 and 6 months. MATERIALS AND METHODS: Forty-eight volunteers were divided randomly and double-blindly into 4 groups of 12 individuals: Clot (C), BoneCeramic (BC), Biomaterial 1 (B1), and Biomaterial 2 (B2) groups. Three and six months later, samples were obtained, and histological and histomorphometric sections were evaluated, focusing on the presence of fibrous connective tissue (CT) and newly formed bone. Statistical analysis was performed (P < .05%). RESULTS: The quantification of crystalline phases showed B1 composed of HA (60.28%) and ß-TCP (39.72%); B2 composed of HA (78.21%) and ß-TCP (21.79%); and BC composed of HA (61%) and ß-TCP (39%). The B1 group showed the most newly formed bone (69.3% ± 6.03%), followed by the BC (51.6 ± 12.34%), B2 (46.6 ± 7.66%), and C groups (45.4 ± 7.98%), and less connective tissue and biomaterial remained in the B1 group after 6 months. CONCLUSION: B1 group showed the greatest amount of newly formed bone after 6 months.

Como realizar o manejo do paciente anticoagulado com Varfarina no pré, trans e pós-operatório / How to manage the anticoagulated patient with Warfarin in the pre, trans and postoperative period

A Varfarina é um anticoagulante da classe dos antagonistas da vitamina K que atua prevenindo a formação e a expansão do coágulo sanguíneo. É indicada para indivíduos com risco de trombose, pacientes pós-acidentes vasculares isquêmicos e portadores de trombofilias, dentre outros. O manejo do paciente anticoagulado pode gerar dúvidas, devido ao risco de complicações hemorrágicas ou da ocorrência de eventos tromboembólicos. Este trabalho visa orientar, de forma direta, o acadêmico e profissional de odontologia, diante de pacientes em uso de Varfarina.

Warfarin is an anticoagulant in the class of vitamin K antagonists that works by preventing the formation and expansion of the blood clot. It is indicated for individuals at risk of thrombosis, ischemic post-stroke patients and patients with thrombophilia, among others. The management of anticoagulated patients may raise doubts, due to the risk of hemorrhagic complications or the occurrence of thromboembolic events. This work aims to direct, directly, the academic and professional of dentistry, before patients using Warfarin.

Cuidados que o cirurgião-dentista deve tomar no momento de tratar cirurgicamente um paciente em uso de anticoagulantes ou antiagregantes plaquetários / Care that the dental surgeon must take when treating surgically a patient using anticoagulants or antiplatelet agents

Os anticoagulantes e antiagregantes plaquetários são medicamentos utilizados por uma grande parcela da população mundial. Eles são utilizados para prevenir que pacientes de risco desenvolvam doenças cardiovasculares, como o infarto agudo do miocárdio (IAM) ou o acidente vascular cerebral (AVC). Por serem muito utilizados, constantemente o cirurgião-dentista poderá se deparar em sua rotina clínica, com pacientes usuários de anticoagulantes ou antiagregantes. Neste caso, o profissional precisará estar ciente das normas mais atuais de manejo com cada um dos tipos de medicamentos, para que o tratamento seja realizado com sucesso. No presente trabalho, é proposto um Protocolo Operacional Padrão (POP), que pode ser seguido no momento de realizar cirurgias orais em pacientes em uso de Varfarina, Ácido Acetil Salicílico, Heparina de Baixo Peso Molecular, Heparina Não Fracionada, Rivaroxabana e Clopidogrel.

Anticoagulants and antiplatelet agents are drugs used by a large portion of the world population. They are used to prevent at-risk patients from developing cardiovascular diseases, such as acute myocardial infarction (AMI) or stroke (stroke). Because they are widely used, the dental surgeon may constantly encounter patients using anticoagulants or anti-aggregating agents in their clinical routine. In this case, the professional will need to be aware of the most current management standards with each type of medication, so that the treatment is carried out successfully. In the present work, a Standard Operational Protocol (POP) is proposed, which can be followed when performing oral surgeries on patients using Warfarin, Acetyl Salicylic Acid, Low Molecular Weight Heparin, Unfractionated Heparin, Rivaroxaban and Clopidogrel.

Superior labial frenectomy by double clamping techniche: clinical case report

The lip brake is a fold in the oral mucosa, originating in the upper lip and insertion in the alveolar mucosa. At birth, the labial frenum may be inserted in the palatal papilla. As the individual grows, he can migrate to a more upper region, featuring a normal lip curl. However, when it remains inserted in the papilla, it is a case of hypertrophic lip curl. When pathological, this structure can promote the formation of interincisal diastema, periodontal pocket, gingival retraction, aesthetic problems, difficulties in phonation and brushing. The objective of this article is to report a clinical case of upper lip frenectomy using the double clamping technique or Archer technique, performed at the Oral Minor Surgery clinic of the Dentistry School of the Federal Fluminense University, in a male patient, leucoderma, 23 years old, indicated by his orthodontist after recurrence of interincisal diastema. From the procedure performed, it can be concluded that the surgical intervention and the applied technique were effective in solving the reported clinical case.

Guia prático de coleta de sangue venoso para obtenção da fibrina rica em plaquetas / Practical guide for collecting venous blood for obtaining platelet rich fibrin

A Fibrina Rica em Plaquetas (PRF) é caracterizada por sua abrangente aplicabilidade na Odontologia. Neste sentido, a venopunção é uma etapa fundamental para sua obtenção. Tal procedimento consiste na identificação das veias superficiais, localizadas na região da fossa antecubital dos membros superiores, para que através da utilização do sistema a vácuo de coleta seja obtido o sangue venoso do paciente. O objetivo deste trabalho é realizar um guia prático abordando cada etapa que compreende a coleta sanguínea para produção do PRF permitindo sua reprodutibilidade de forma segura e eficiente.

Platelet Rich Fibrin (PRF) is characterized by its wide applicability in Dentistry. In this sense, venipuncture is a fundamental step towards obtaining it. Such procedure consists of the identification of superficial veins, located in the region of the antecubital fossa of the upper limbs, so that through the use of the vacuum collection system, the patient's venous blood is obtained. The objective of this work is to carry out a practical guide covering each step that comprises the blood collection for the production of the PRF allowing its reproducibility in a safe and efficient way.

Guia prático de uso da centrífuga IntraSpin® para a obtenção de fibrina rica em plaquetas / Practical guide for using the IntraSpin® centrifuge to obtain platelet-rich fibrin

Obter corretamente a Fibrina Rica em Plaquetas (PRF) depende da execução de cada etapa de maneira protocolada. Nesse sentido, no Laboratório Associado de Pesquisa Clínica (LPCO), da Faculdade de Odontologia da Universidade Federal Fluminense (FO-UFF) é utilizado o sistema IntraSpin® de centrifugação do sangue coletado, que caracteriza o segundo passo para preparo deste material autólogo. O objetivo do presente trabalho é realizar uma descrição prática do correto manuseio da Centrífuga IntraSpin para garantir a obtenção do PRF e sua efetiva aplicabilidade clínica.

Obtaining Platelet Rich Fibrin (PRF) correctly depends on the execution of each step in a protocol manner. In this sense, at the Associated Clinical Research Laboratory (LPCO), of the Faculty of Dentistry in the Federal Fluminense University (FO-UFF) the IntraSpin® centrifugation system is used in the collected blood, that characterizes the second step to prepare this autologous material. The objective of this present work is to make a practical description of the correct handling of the IntraSpin Centrifuge to guarantee the PRF's biocompatibility and its effective clinical applicability.

Passo-a-passo para utilização de fibrina rica em plaquetas como agente hemostático após exodontia: descrição da técnica / Step-by-step for use of platelet-rich fibrin as a hemostatic agent after exodontic: description of the technique

A extração dentária é um dos procedimentos mais frequentes em cirurgia oral e maxilofacial e está relacionada a mudanças fisiológicas no processo alveolar. Neste sentido, entre as principais complicações transoperatórias está a hemorragia, que ocorre geralmente devido a lesões de vasos sanguíneos presentes no alvéolo dentário onde se realizou a exodontia. Uma alternativa para se obter a hemostasia é a utilização da Fibrina Rica em Plaquetas (PRF), um concentrado leucoplaquetário, obtido através do sangue do paciente. A membrana obtida é rica em leucócitos, plaquetas e fatores de crescimento que promovem a modulação de células envolvidas no processo de cicatrização, favorecendo um melhor e mais rápido reparo das lesões cirúrgicas. Esta matriz de fibrina apresenta diversas utilidades para a odontologia, demonstrando bons resultados, além do baixo custo e fácil obtenção. O objetivo deste artigo é descrever a técnica de obtenção da PRF usada como agente hemostático após exodontia, orientando assim, sua reprodutibilidade e utilização.

Tooth extraction is one of the most frequent procedures in oral and maxillofacial surgery and is related to physiological changes in the alveolar process. In this sense, among the main transoperative complications is hemorrhage, which usually occurs through the dental alveolus, due to damage to the blood vessels where the extraction was performed. An alternative to obtain hemostasis is the use of Fibrin Rich in Platelets (PRF), which is a white platelet concentrate obtained from the patient's blood that undergoes a centrifugation step. The membrane obtained after this process is rich in leukocytes, platelets and growth factors that promote modulation of cells involved in the healing process, favoring a better and faster repair of surgical lesions. This fibrin matrix has several uses for dentistry, showing good results, in addition to being low cost and easy to obtain. The aim of this article is to describe the technique for obtaining Platelet-Rich Fibrin (PRF) used as a hemostatic after tooth socket extraction, thus allowing its reproducibility and use.

SHEEP AS AN EXPERIMENTAL MODEL FOR BIOMATERIAL IMPLANT EVALUATION.

OBJECTIVE: Based on a literature review and on our own experience, this study proposes sheep as an experimental model to evaluate the bioactive capacity of bone substitute biomaterials, dental implant systems and orthopedics devices. The literature review covered relevant databases available on the Internet from 1990 until to date, and was supplemented by our own experience. METHODS: For its resemblance in size and weight to humans, sheep are quite suitable for use as an experimental model. However, information about their utility as an experimental model is limited. The different stages involving sheep experiments were discussed, including the care during breeding and maintenance of the animals obtaining specimens for laboratory processing, and highlighting the unnecessary euthanasia of animals at the end of study, in accordance to the guidelines of the 3Rs Program. RESULTS: All experiments have been completed without any complications regarding the animals and allowed us to evaluate hypotheses and explain their mechanisms. CONCLUSION: The sheep is an excellent animal model for evaluation of biomaterial for bone regeneration and dental implant osseointegration. From an ethical point of view, one sheep allows for up to 12 implants per animal, permitting to keep them alive at the end of the experiments. Level of Evidence II, Retrospective Study.

Cirurgia ortognática no tratamento da Síndrome da Apneia Obstrutiva do Sono / Orthognathic Surgery in the Treatment of Obstructive Sleep Apnea Syndrome

Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é considerada um problema de saúde pública associada a diversas comorbidades que afetam a qualidade e a expectativa de vida. Atualmente, o uso de dispositivos que controlam a pressão do ar durante o sono é considerado uma das melhores terapias para diminuir os sintomas da apneia, entretanto, apresentam difícil adesão dos pacientes. Assim, o tratamento cirúrgico para este distúrbio, cuja cirurgia ortognática se destaca, apresenta alta previsibilidade e bons resultados. Relato de caso: O presente trabalho tem como objetivo relatar o caso clínico de uma paciente do sexo feminino de 40 anos, portadora da SAOS severa e com alto índice de apneia-hipopneia (IAH). Ao exame físico foi observada respiração bucal, deformidade dentofacial do tipo classe II, plano oclusal acentuado e disfunção bilateral da articulação temporomandibular. O tratamento utilizado foi avanço maxilomandibular com rotação anti-horária do plano oclusal associado à mentoplastia. O acompanhamento foi realizado por um período de dois anos, no qual observou uma diminuição no IAH após oito meses da cirurgia e um aumento significativo no volume axial das vias aéreas superiores. Considerações finais: A cirurgia ortognática proposta para este caso demonstrou ser o tratamento adequado, apresentando ótimos resultados e eficácia a longo prazo... (AU)

Introduction: Obstructive sleep apnea syndrome (OSAS) is considered a public health problem associated with several comorbidities that affect quality and life expectancy. Currently, the use of devices that control air pressure during sleep is considered to be one of the best therapies to reduce apnea symptoms, however, it is difficult for patients to adhere. Thus, surgical treatment for this disorder, whose orthognathic surgery stands out, has high predictability and good results. Case report: The present study aims to report the clinical case of a 40-year-old female patient with severe OSAS and a high rate of apnea-hypopnea (AHI). On physical examination, mouth breathing, class II type dental-facial deformity, accentuated occlusal plane and bilateral temporomandibular joint dysfunction were observed. The treatment used was maxillomandibular advancement with counterclockwise rotation of the occlusal plane associated with chin repair. Follow-up was carried out for a period of two years, in which were observed a decrease in AHI eight months after surgery and a significant increase in the axial volume of the upper airways. Final considerations: The orthognathic surgery proposed for this case proved to be the appropriate treatment, presenting excellent results and long-term efficacy... (AU)

Maxillary Sinus Augmentation with a New Xenograft: A Randomized Controlled Clinical Trial.

BACKGROUND: Insufficient residual alveolar bone height is a common deterrent in the placement of dental implants in the posterior maxilla. The use of autografts, xenografts, allografts and alloplasts or a combination between them has been demonstrated to be effective for increasing bone height and bone volume in the deficient posterior maxilla. PURPOSE: The aim of this clinical trial is to comparatively determine the density of newly formed in sinus floor augmentation bone after a 24-week healing period treatment with a new bovine xenograft. MATERIALS AND METHODS: The sinus floor was grafted with Bio-Oss® (n = 10) and Osseous® (n = 10). Histological sections were examined with a focus on the presence of connective tissue (CT) and newly formed bone (NFB). The sections were histomorphometrically evaluated and the definitive crown was inserted after 3 months. RESULTS: After 6 months, the mean value of new bone formation was 24.60 (±2.503), the CT was 42.60 (±4.006) and the remaining biomaterial was 25.40 (±2.547) in Bio-Oss group. In Osseous group, the mean value of new bone formation was 24.90 (±3.542), the CT was 45.70 (±7.040) and the remaining biomaterial was 22.90 (±3.247). CONCLUSIONS: Both biomaterials afforded a favorable implant position and the prosthetic rehabilitation.