RESUMO
PURPOSE: The aim of this preclinical study was to evaluate the healing of critical-sized defects (CSDs) in the calvarial bone of rats grafted with deproteinized bovine bone graft (DBB) and with a combination of hydroxyapatite (HA) and ß-tricalcium phosphate (TCP) and bisphosphonate treatment. MATERIALS AND METHODS: Eighty-four animals were randomly divided into 2 groups according to the type of solution administered: the control group (CTR, saline solution) and the test group (alendronate [ALD]; sodium alendronate-50 µg/kg/day). Medications were administered via oral gavage starting 15 days before the surgical procedure until the end of the experiment. A CSD (5 mm in diameter) was made in the calvaria of each animal, and the rats were randomly allocated to 3 subgroups according to the biomaterial used to fill the defect: coagulum, DBB, and HA/TCP. The animals were sacrificed 15 and 60 days after the surgical procedure (n = 7 animals/period/subgroup). Microcomputed tomography was used to evaluate the percentage of mineralized tissues (volume). The amount of newly formed bone and remaining bone substitute material in the calvaria were analyzed by histomorphometry. RESULTS: There were no differences between the CTR and ALD groups with regard to the volume of mineralized tissues. The DBB and HA/TCP subgroups of CTR animals presented a significant increase in newly formed bone compared with these subgroups of ALD animals after 60 days of healing. CONCLUSIONS: Collectively, our findings indicate that the use of oral ALD reduced bone formation in CSD in the calvaria of rats grafted with DBB and HA/TCP.
Assuntos
Substitutos Ósseos , Transplantes , Alendronato/farmacologia , Animais , Regeneração Óssea , Substitutos Ósseos/uso terapêutico , Fosfatos de Cálcio , Bovinos , Ratos , Crânio/cirurgia , Microtomografia por Raio-XRESUMO
The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.
Assuntos
Alendronato , Conservadores da Densidade Óssea , Extração Dentária , Alvéolo Dental , Cicatrização , Alendronato/farmacologia , Alendronato/uso terapêutico , Extração Dentária/efeitos adversos , Animais , Cicatrização/efeitos dos fármacos , Alvéolo Dental/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêuticoRESUMO
OBJECTIVE: Studies have highlighted numerous benefits of ozone therapy in the field of medicine and dentistry, including its antimicrobial efficacy against various pathogenic microorganisms, its ability to modulate the immune system effectively, reduce inflammation, prevent hypoxia, and support tissue regeneration. However, its effects on dental extraction healing remain to be elucidated. .Therefore, this study aimed to evaluate the effects of systemically administered ozone (O3) at different doses in the healing of dental extraction sockets in rats. METHODOLOGY: To this end, 72 Wistar rats were randomly divided into four groups after extraction of the right upper central incisor: Group C - control, no systemic treatment; Group OZ0.3 - animals received a single dose of 0.3 mg/kg O3; Group OZ0.7 - a single dose of 0.7 mg/kg O3; and Group OZ1.0 - a single dose of 1.0 mg/kg O3, intraperitoneally. In total, six animals from each group were euthanized at 7, 14, and 21 days after the commencement of treatment. Bone samples were harvested and further analyzed by descriptive histology, histomorphometry, and immunohistochemistry for osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP) protein expression. RESULTS: All applied doses of O3 were shown to increase the percentage of bone tissue (PBT) after 21 days compared to group C. After 14 days, the OZ0.7 and OZ1.0 groups showed significantly higher PBT when compared to group C. The OZ1.0 group presented the most beneficial results regarding PBT among groups, which denotes a dose-dependent response. OCN immunostaining was higher in all groups at 21 days. However, after seven and 14 days, the OZ1.0 group showed a significant increase in OCN immunostaining compared to C group. No differences in TRAP+ osteoclasts were found between groups and time points. CONCLUSION: Therefore, O3 therapy at higher doses might be beneficial for bone repair of the alveolar socket following tooth extraction.
Assuntos
Imuno-Histoquímica , Osteocalcina , Ozônio , Distribuição Aleatória , Ratos Wistar , Fosfatase Ácida Resistente a Tartarato , Extração Dentária , Alvéolo Dental , Cicatrização , Animais , Ozônio/farmacologia , Alvéolo Dental/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Fosfatase Ácida Resistente a Tartarato/análise , Osteocalcina/análise , Fatores de Tempo , Masculino , Reprodutibilidade dos Testes , Resultado do Tratamento , Valores de ReferênciaRESUMO
In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.
Assuntos
Perda do Osso Alveolar , Defeitos da Furca , Perda do Osso Alveolar/cirurgia , Objetivos , Regeneração Tecidual Guiada Periodontal , Humanos , Periodontia , RegeneraçãoRESUMO
Abstract The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.
RESUMO
Abstract Studies have highlighted numerous benefits of ozone therapy in the field of medicine and dentistry, including its antimicrobial efficacy against various pathogenic microorganisms, its ability to modulate the immune system effectively, reduce inflammation, prevent hypoxia, and support tissue regeneration. However, its effects on dental extraction healing remain to be elucidated. Objective Therefore, this study aimed to evaluate the effects of systemically administered ozone (O3) at different doses in the healing of dental extraction sockets in rats. Methodology To this end, 72 Wistar rats were randomly divided into four groups after extraction of the right upper central incisor: Group C - control, no systemic treatment; Group OZ0.3 - animals received a single dose of 0.3 mg/kg O3; Group OZ0.7 - a single dose of 0.7 mg/kg O3; and Group OZ1.0 - a single dose of 1.0 mg/kg O3, intraperitoneally. In total, six animals from each group were euthanized at 7, 14, and 21 days after the commencement of treatment. Bone samples were harvested and further analyzed by descriptive histology, histomorphometry, and immunohistochemistry for osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP) protein expression. Results All applied doses of O3 were shown to increase the percentage of bone tissue (PBT) after 21 days compared to group C. After 14 days, the OZ0.7 and OZ1.0 groups showed significantly higher PBT when compared to group C. The OZ1.0 group presented the most beneficial results regarding PBT among groups, which denotes a dose-dependent response. OCN immunostaining was higher in all groups at 21 days. However, after seven and 14 days, the OZ1.0 group showed a significant increase in OCN immunostaining compared to C group. No differences in TRAP+ osteoclasts were found between groups and time points. Conclusion Therefore, O3 therapy at higher doses might be beneficial for bone repair of the alveolar socket following tooth extraction.
RESUMO
Abstract In the last decades, Periodontal Regeneration has been one of the most discussed topics in Periodontics, attracting the attention of researchers and clinicians. This can be justified by the evident and continuous progress observed in the field, characterized by a better understanding of the biological mechanisms involved, significant improvement of operative and technical principles, and the emergence of a wide range of biomaterials available for this purpose. Together, these aspects put the theme much in evidence in the search for functional and esthetic therapeutic solutions for periodontal tissue destruction. Despite the evident evolution, periodontal regeneration may be challenging and require the clinician to carefully evaluate each case before making a therapeutic decision. With a critical reassessment of the clinical and preclinical literature, the present study aimed to discuss the topic to answer whether Periodontal Regeneration is still a goal in clinical periodontology. The main aspects involved in the probability of success or failure of regenerative approaches were considered. A greater focus was given to intrabony and furcation defects, clinical conditions with greater therapeutic predictability. Aspects such as more appropriate materials/approaches, long-term benefits and their justification for a higher initial cost were discussed for each condition. In general, deep intrabony defects associated with residual pockets and buccal/lingual class II furcation lesions have predictable and clinically relevant results. Careful selection of the case (based on patient and defect characteristics) and excellent maintenance are essential conditions to ensure initial and long-term success.
RESUMO
Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12% of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60% of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50% of hemangiomas have complete resolution, and 90% of them are resolved up to the age of 9. Complications occur in only 20% of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.
Assuntos
Hemangioma Cavernoso/terapia , Neoplasias Labiais/terapia , Soluções Esclerosantes/uso terapêutico , Pré-Escolar , Terapia Combinada , Hemangioma Cavernoso/patologia , Humanos , Neoplasias Labiais/patologia , Masculino , Resultado do TratamentoRESUMO
The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a=0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75%±17.16% and 37.25±17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p=0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.
O objetivo deste estudo foi determinar o padrão de remodelação óssea após levantamento de seio maxilar in humanos por meio de analise de dimensão fractal (FD) e histomorfometria. Além disso, a correlação entre FD e histomorfometria foi avaliada. Dezesseis pacientes com edentulismo na região posterior da maxila foram relacionados para este estudo. Levantamento de seio maxilar foi realizado utilizando-se enxerto de osso autógeno coletado da região retro molar da mandíbula. Três radiografias panorâmicas digitais foram obtidas: antes da cirurgia (Grupo 1), imediatamente após o levantamento de seio (Grupo 2) e após 6 meses de cicatrização (Grupo 3) para analise de FD. Biopsias foram coletadas após 6 meses, processadas e submetidas para analise histológica e histomorfométrica. Os dados foram analisados utilizando-se o teste Shapiro-Wilk e ANOVA seguido pelo pós teste de Tukey (a=0.05). A fração de volume de ósseo neoformado para o osso trabecular (TB) e para a área medular (MA) foi mensurado como 65,75%±17,16% and 37,25±17,16%, respectivamente. Diferença significante na analise FD foi observada entre os grupos 1 e 3. Nenhuma diferença estatística foi encontrada para correlação entre FD e histomorfometria para TB e MA (p=0,84). Em conclusão, todas as análises realizadas foram efetivas em acessar o padrão de remodelação ósseo no seio maxilar, oferecendo informações complementares sobre cicatrização e previsibilidade de resultados. Não houve correlação entre FD e histomorfometria.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Transplante Ósseo/métodos , Mandíbula/transplante , Seio Maxilar/cirurgia , Maxila/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Biópsia , Remodelação Óssea , Implantação Dentária Endóssea , Fractais , Arcada Parcialmente Edêntula/patologia , Arcada Parcialmente Edêntula/cirurgia , Seio Maxilar/patologia , Maxila/patologia , Radiografia Panorâmica , Transplante Autólogo , Resultado do Tratamento , CicatrizaçãoRESUMO
One of the main purposes of mucogingival therapy is to obtain full root coverage. Several treatment modalities have been developed, but few techniques can provide complete root coverage in a class III Miller recession. Thus, the aim of this case report is to present a successful clinical case of a Miller class III gingival recession in which complete root coverage was obtained by means of a multidisciplinary approach. A 17-year-old Caucasian female was referred for treatment of a gingival recession on the mandibular left central incisor. The following procedures were planned for root coverage in this case: free gingival graft, orthodontic movement by means of alignment and leveling and coronally advanced flap (CAF). The case has been followed up for 12 years and the patient presents no recession, no abnormal probing depth and no bleeding on probing, with a wide attached gingiva band. A compromised tooth with poor prognosis, which would be indicated for extraction, can be treated by orthodontic movement and periodontal therapy, with possibility of 100% root coverage in some class III recessions.
Um dos principais objetivos da terapia mucogengival é atingir a cobertura completa da raiz. Diversas modalidades de tratamento têm sido desenvolvidas, mas poucas técnicas podem obter a cobertura total da raiz em uma recessão gengival classe III de Miller. Assim, o objetivo deste relato é apresentar um caso de sucesso clínico de uma recessão gengival classe III de Miller na qual foi obtida a cobertura completa da raiz por meio de uma abordagem multidisciplinar. Uma jovem de 17 anos sexo feminino, leucoderma, foi encaminhada para tratamento de uma recessão gengival no incisivo central inferior esquerdo. Para a cobertura radicular foi planejado: enxerto gengival livre, movimento ortodôntico por meio de alinhamento e nivelamento e retalho reposicionado coronariamente (CAF). Este caso tem sido acompanhado por 12 anos e o paciente apresenta ausência de recessão, sem profundidade de sondagem anormal e sem sangramento à sondagem com ampla faixa de gengiva inserida. Dentes comprometidos e com mau prognóstico, que seriam extraídos em muitos casos, podem ser tratados por meio de movimento ortodôntico e terapia periodontal. 100% de cobertura da raiz é possível e pode ser conseguida em alguns casos de recessão gengival classe III.
Assuntos
Adolescente , Feminino , Humanos , Retalhos de Tecido Biológico/transplante , Gengiva/transplante , Retração Gengival/cirurgia , Técnicas de Movimentação Dentária/métodos , Autoenxertos , Perda do Osso Alveolar/cirurgia , Terapia Combinada , Estética Dentária , Seguimentos , Gengiva/patologia , Retração Gengival/classificação , Gengivite/cirurgia , Incisivo/cirurgia , Má Oclusão/terapia , Retalhos Cirúrgicos/transplante , Resultado do Tratamento , Raiz Dentária/cirurgiaRESUMO
Objetivo: O objetivo deste estudo foi avaliar histologicamente os efeitos do plasma rico em plaquetas (PRP), quando usado em combinação com enxerto ósseo autógeno e membrana bioabsorvível (Resolut®) no tratamento de defeitos de furca Classe III em cães. Material e método: Cinco cães foram usados neste estudo. Defeitos de furca classe III (5 mm de altura e de profundidade) foram criados cirurgicamente no terceiro pré-molar inferior de ambos os lados. Nove semanas após a primeira cirurgia, os terceiros pré-molares foram tratados com raspagem e alisamento radicular e cada defeito recebeu um dos seguintes tratamentos: Enxerto ósseo autógeno + membrana (grupo C) ou PRP + enxerto ósseo autógeno + membrana (grupo T). Após um período de cicatrização de 90 dias, os animais foram sacrificados. Processamento histológico de rotina e coloração com hematoxilina e eosina e tricrômico de Masson foram realizados para determinar o efeito dos tratamentos na regeneração dos tecidos periodontais. Os dados foram analisados pelo teste T2 de Hotelling (p < 0,05). Resultado: A análise histomorfométrica da área de furca não mostrou nenhuma diferença estatisticamente significativa entre os grupos C e T. Os dois grupos de tratamento demonstraram resultados regenerativos semelhantes, com os defeitos de furca parcialmente preenchidos e a regeneração periodontal foi limitada à marca experimental apical das lesões. (p > 0,05). Conclusão: Dentro dos limites deste estudo, concluiu-se que o uso de PRP não melhorou a regeneração periodontal em defeitos de furca classe III tratados com enxerto ósseo autógeno e membrana bioabsorvível.
Objective: The purpose of this study was to evaluate the effects of the platelet-rich plasma (PRP) when used in combination with autogenous bone graft and bioabsorbable membrane (Resolut®) in the treatment of Class III furcation defects in dogs. Material and method: Class III furcation defects (5 mm in height and in depth) were surgically created in the mandibular third premolars of five mongrel dogs. After nine weeks, the lesions were treated with scaling and root planning and each defect received one of the following treatments: autogenous bone graft + membrane (group C) or PRP + autogenous bone graft + membrane (group T). After a healing period of 90 days, the animals were sacrificed. Routine histological processing and staining with hematoxilyn and eosin and Masson trichrome were performed and a histomorphometric analysis determined the effect of the treatments on periodontal tissue regereneration. Data were analyzed by Hotelling's T-squared (p < 0.05). Result: No statistically significant difference between C and T groups was observed by the histomorphometric analysis of the furcation area. Both treatment groups demonstrated similar regenerative results with the furcation defects partially filled and periodontal regeneration limited to the experimental notches of the lesions. (p > 0.05). Conclusion: According to the present results, PRP does not enhance the periodontal regeneration in class III furcation defects treated with autogenous bone graft and bioabsorbable membrane.
Assuntos
Animais , Cães , Transplante Ósseo , Defeitos da Furca , Regeneração Tecidual Guiada , Plasma Rico em PlaquetasRESUMO
Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12 percent of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60 percent of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50 percent of hemangiomas have complete resolution, and 90 percent of them are resolved up to the age of 9. Complications occur in only 20 percent of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.
Hemangiomas são tumores benignos da infância que se caracterizam por uma fase de crescimento rápido com proliferação de células endoteliais, ocorrendo em 10 a 12 por cento das crianças com 1 ano de idade. Sua localização mais comum é nos lábios, na língua, mucosa jugal e no palato. Aproximadamente 50 por cento dos casos de hemangioma mostram completa resolução e 90 por cento deles resolvem-se até os 9 anos de idade. As complicações ocorrem em apenas 20 por cento dos casos e o problema mais comum é a ulceração com ou sem infecção. O tratamento depende da localização, do tamanho e do estágio evolutivo da lesão, bem como da idade do paciente. A cirurgia geralmente é indicada quando não há resposta aos tratamentos sistêmicos ou por razões estéticas, podendo ser empregada sob forma de exérese simples com ou sem plástica. Este artigo apresenta um caso de hemangioma cavernoso labial em uma criança de 4 anos de idade, a qual, devido ao tamanho da lesão, foi submetida a 3 sessões de esclerose vascular seguido de exérese simples da lesão, com acompanhamento clínico de 2 anos de pós-operatório.
Assuntos
Pré-Escolar , Humanos , Masculino , Hemangioma Cavernoso/terapia , Neoplasias Labiais/terapia , Soluções Esclerosantes/uso terapêutico , Terapia Combinada , Hemangioma Cavernoso/patologia , Neoplasias Labiais/patologia , Resultado do TratamentoRESUMO
A reabilitação protética de maxila atrófica representa um grande desafio para o cirurgião-dentista, mesmo após o advento dos implantes osseointegrados. Isso se deve ao fato de a maxila apresentar características anatômicas que dificultam o procedimento, tais como: osso predominantemente do tipo esponjoso (classe III e IV), proximidade da fossa nasal, seio maxilar e forame incisivo. Os pacientes portadores de reabsorção do processo alveolar, pneumatização exacerbada do seio maxilar para anterior e aqueles que sofreram grandes ressecções tumorais não são bons candidatos à instalação de implantes convencionais. Nesses casos, o tratamento seria baseado em grandes reconstruções ósseas, o que resultaria em alto grau de morbidade, aumento dos custos, diminuição da previsibilidade e necessidade de internação. A fim de solucionar os casos mais rapidamente e possibilitar a reabilitação de pacientes com defeitos maxilares, a ancoragem zigomática surge como alternativa cirúrgica com índices de sucesso próximo dos obtidos pelos implantes convencionais. O objetivo deste estudo é o de relatar um caso clínico de reabilitação de maxila atrófica, utilizando implantes zigomáticos bilaterais e implantes convencionais.
The prosthetic rehabilitation of atrophic maxilla represents a great challenge for the surgeon dentist, exactly after the advent of the osseointegrated implants. This if must to the fact of the jaw present anatomical characteristics that make it difficult the procedure such as: bone, predominantly, of the spongy type (classroom III and IV), proximity of nasal cavity, the sinus to maxillaries and the incisive foramen. The carrying patients of resorption of the alveolar process, exacerbate pneumatization of the sinus to maxillaries for previous and those that had suffered great tumor resection are not good candidates to the installation of conventional implantations. On these cases, the treatment would be based on great bones reconstructions what it would result in high degree of morbidity, increase of the costs, reduction of the previsibility and necessity of internment. In the intention of solve the case more quickly and make possible the reconstruction of defect maxillaries the zygomatic anchorage appear as alternative surgical for this patient present index of success next of the 97%, approach of the get for the implantation conventional. The aim of this study was to tell a clinical case of rehabilitation of atrophic jaw by using of zygomatic anchorage bilateral and conventional implants.
Assuntos
Implantação Dentária Endóssea , Implantes Dentários , ZigomaRESUMO
A reabilitação oral de pacientes portadores de maxila atrófica tem sido bastante discutida na literatura. Técnicas e materiais vêm sendo desenvolvidos, visando à recuperação do tecido ósseo para a instalação de implantes. O enxerto autógeno é o material de escolha para a grande maioria dos casos, no entanto o aumento no tempo operatório, a morbidade cirúrgica e as possíveis complicações inerentes à abordagem da área doadora nem sempre o tornam viável. Já os enxertos ósseos homógenos oferecem como principais vantagens a eliminação da abordagem de um segundo sítio cirúrgico e quantidade suficiente de osso, o que reduz o tempo e a morbidade. Portanto, o enxerto homógeno fresco congelado é uma alternativa para as reconstruções dos rebordos atróficos devido a sua capacidade de remodelação, incorporação e qualidade que permitem resistir às cargas funcionais quando da instalação de implantes osseointegráveis. O presente estudo pretende relatar um caso clínico de reconstrução óssea de rebordo alveolar, utilizando enxerto homógeno.
Oral rehabilitation of patients with maxilla atrophic has been sufficiently argued in literature. Techniques and materials come being developed aiming at to the recovery of the tissue bone for the installation of implants. Autogenous bone grafts are the material of choice for the great majority of the cases due to the potential of osteogenesis and osteoinduction. However, the increase in the operatory neither time, the surgical morbity and the possible inherent complications to the boarding of the area giver nor makes always it viable. Already the homogenous bone grafts offer as to main advantages to the elimination of the boarding of as a surgical small farm and enough amount of bone, what it reduces the time and the morbity. Therefore, homogenous grafts is a viable alternative for the reconstructions of the atrophic rims of form that presents capacity of remodeling, incorporation and quality that allow to resist functional loads when of the installation of osseointegrated implants. The present study it intends to present a case of bone reconstruction of alveolar rim being used homogenous bone grafts.
Assuntos
Regeneração Óssea , Transplante Ósseo , Transplante AutólogoRESUMO
A sialolitíase é responsável por metade das patologias que acometem as glândulas salivares e, em função disso, vem sendo tratada e estudada há décadas. Nos últimos anos, com o advento de novos recursos de diagnóstico e métodos de tratamento, propostas terapêuticas vêm sendo continuamente sugeridas para abordagem dos cálculos salivares. Este trabalho apresenta o caso clínico de um paciente de gênero masculino, de trinta e sete anos que procurou atendimento profissional devido aumento volumétrico e dor em região submandibular esquerda com seis meses de evolução. A avaliação clínica associada aos exames de imagem levaram à confirmação diagnóstica de sialolitíase, com o cálculo salivar localizado no ducto da glândula submandibular esquerda. Foi planejada e realizada a remoção cirúrgica por acesso intrabucal do sialolito, de forma que num pós-operatório imediato já se observa funcionamento normal da glândula e de seu sistema secretor. Com base no caso apresentado, este trabalho ainda discute os mais recentes métodos de diagnóstico e tratamento de sialolitíase.
Considering that sialolithiasis is responsible for half of disorders that affect the salivary glands, and therefore it has been studied and treated during decades. Therapeutic alternatives have been suggested to treat salivary calculi over the last years due to development of diagnostic and treatment resources. The aim of this study is to report the case of a male patient, 37 years old, who reported pain and volume expansion in left submandibular region during 6 months. Clinical evaluation combined with radiographic exams confirmed the diagnosis of sialolithiasis with salivary calculus in the duct of left submandibular gland. After definitive diagnostic of sialolithiasis, surgical removal of calculus was planned and performed through intraoral approach of calculus in left submandibular duct. Normal function and drainage recovery was achieved in an immediate postoperative period. According to the present report, this study still discusses the current methods for diagnosis and treatment of sialolithiasis.
Assuntos
Humanos , Masculino , Adulto , Cálculos das Glândulas Salivares/patologia , Cirurgia Bucal , Glândula Submandibular/patologia , Litotripsia/métodos , Litotripsia , Radiografia Dentária/métodos , Radiografia Dentária , Sialadenite/patologiaRESUMO
A periodontite é uma doença infecciosa caracterizada pela destruição do tecido ósseo alveolar, mediada e modulada pelo hospedeiro frente aos microrganismos provenientes do biofilme dental. Compreender a origem e a evolução da reabsorção de osso alveolar é uma das metas primordiais da pesquisa periodontal, sobretudo visando o estabelecimento de novas modalidades terapêuticas. O desenvolvimento de modelos experimentais torna-se importante e é um passo necessário antes de ingressar em experimentações clínicas com novas terapias de tratamentos. Sendo assim, o presente estudo apresenta como objetivos caracterizar e avaliar as alterações teciduais provocadas por diferentes modelos de doença periodontal experimental em camundongos. Para isto, foram utilizados camundongos C57/BL6 wild type (WT), fêmeas distribuídas em 5 grupos experimentais seguindo os períodos de sacrifício: 7, 15 e 30 dias após o início da indução da doença (n=6 animais/período/grupo). O Grupo C correspondeu ao grupo controle; no Grupo L a doença periodontal foi induzida por meio de ligaduras; nos Grupos G-Pg e G-PgFn foram realizadas gavagem com Porphyromonas gingivalis e Porphyromonas gingivalis + Fusobacterium nucleatum respectivamente; no Grupo I-Pg foi injetado Porphyromonas gingivalis inativada por calor na mucosa palatina entre os molares. As amostras obtidas foram utilizadas para avaliação do processo imuno-inflamatório presente no tecido gengival, por meio de análise histológica descritiva, e RT-PCR em tempo real. A avaliação da perda óssea alveolar foi avaliada por microtomografia comutadorizada (µCT). Apenas os modelos de ligadura e de injeção de Porphyromonas gingivalis inativada por calor apresentaram significante perda óssea alveolar, no período de 30 dias, comparado ao grupo controle e os demais grupos. Houve aumento significante (p<0.05) na expressão gênica do mediador inflamatório IL-6 e na proteína RANKL envolvida no processo de osteoclastogenese no grupo ligadura em relação ao grupo controle. Os modelos de ligadura e de injeção de Porphyromonas gingivalis inativada por calor foram os mais representativos da doença periodontal em humanos, enquanto que os modelos de gavagem não foram efetivos em induzir doença, nas condições estudadas
Periodontitis is an infectious disease characterized by the destruction of alveolar bone tissue, mediated and modulated by the host response against the microorganisms from the biofilm. Understanding the origin and evolution of the alveolar bone resorption is one of the primary goals of periodontal research, especially to stop the disease progression and improve future treatments. For this, the development of experimental models is important and a necessary step before entering into clinical trials with new treatment therapies. Therefore, the aim of this study was to characterize and evaluate tissue changes caused by different experimental models of periodontal disease in mice. We used C57/BL6 wild type mice (WT), females, distributed into 5 experimental groups and sacrificed at 7, 15 and 30 days after periodontal disease induction (n=6 animals/period/group). Group C was the control group; Group L periodontal disease was induced by ligature; in Groups G-Pg and G-PgFn oral gavage with Porphyromonas gingivalis and Fusobacterium nucleatum + Porphyromonas gingivalis were performed, respectively; in Group I-Pg heat killed Porphyromonas gingivalis was injected in the palatal mucosa between the molars. The samples were used for analysis of the immune-inflammatory process in the gingival tissue by histological descriptive analysis and real time RT-PCR analyses. The alveolar bone loss was evaluated by micro-computerized tomography (µCT). Only ligature and injection of Porphyromonas gingivalis heat-killed models showed significant alveolar bone loss in 30 day period compared to the control and the others groups. There were a significant increase (p <0.05) in gene expression of inflammatory mediator IL-6 and proteins involved in osteoclastogenesis RANKL in ligature group compared with the control group. The ligature and injection of heat-killed Porphyromonas gingivalis models were the most representative of periodontal disease in humans, while oral gavage models were not effective to induce the disease, in the studied conditions
Assuntos
Animais , Camundongos , Citocinas , Doenças Periodontais , Porphyromonas gingivalis , Reabsorção ÓsseaRESUMO
Introdução: a periodontite constitui um foco inflamatório crônico em resposta ao biofilme dental que pode estar envolvida no desenvolvimento de câncer bucal. Objetivo: o objetivo desta revisão narrativa da literatura foi compreender e verificar as evidências de associação entre periodontite e câncer bucal. Revisão da literatura: foram buscados artigos que avaliassem a relação entre periodontite - e seus fatores associados - e câncer bucal. Conclusão: frente à indisponibilidade de dados caracterizando casos reais de periodontite e as dificuldades metodológicas, concluiu-se que é fraco o nível de evidência científica relacionando a periodontite com o câncer bucal
Introduction: Periodontitis represents a chronic inflammatory site in response to oral biofilm which may be involved in oral cancer development. Objective: The objective of this narrative literature review was to comprehend and assess the evidences of association between periodontitis and oral cancer. Literature review: Articles which assessed the relationship between periodontitis -and its associated factors - and oral cancer were searched. Conclusion: Due to unavailable data representing real periodontitis cases and methodological difficulties, it was concluded that the level of evidence relating periodontitis with oral cancer is weak.
Assuntos
Epidemiologia , Neoplasias Bucais , PeriodontiteRESUMO
A doença periodontal é uma doença inflamatória crônica que resulta na destruição dos tecidos de suporte com consequente perda dental. A substituição dos dentes perdidos por restaurações implantossuportadas tem demonstrado ser um método de tratamento altamente previsível com bom prognóstico em longo prazo. Contudo, algumas sequelas da perda dentária inviabilizam a instalação de implantes osseointegrados em posição ideal, sendo, neste caso, necessários procedimentos regenerativos para tornar possível este tipo de reabilitação. Procedimentos menos invasivos, como próteses convencionais, surgem como uma opção terapêutica para reabilitação de casos em que não há estrutura óssea suficiente para implantes e não há aceitação de procedimentos invasivos por parte dos pacientes. Sendo assim, este trabalho teve como objetivo apresentar a resolução de uma reabilitação por meio de tratamento não invasivo e multidisciplinar. A paciente, gênero feminino, compareceu a clínica da faculdade apresentando próteses fixas mandibulares mal adaptadas bilateralmente, lesões endodônticas, recessão gengival nos dentes pilares e sensibilidade dentinária. Para a adequada resolução deste caso foi proposto à associação de implantes osseointegrados, prótese parcial fixa, exodontia e procedimentos periodontais estéticos, com a utilização de enxerto de tecido conjuntivo subepitelial. Após dois anos de pós-operatório, a paciente mostrou satisfação estética e mastigatória. Com base no caso apresentado, este trabalho discutiu os diversos fatores que podem afetar a escolha de uma determinada modalidade de tratamento, para a reabilitação de espaços edêntulos unitários.
Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Implantação Dentária , Prótese Parcial FixaRESUMO
A destruição do tecido ósseo e do ligamento periodontal como consequênciada doença periodontal pode gerar defeitos anatômicos na regiãode furca. O tratamento destas lesões é um grande desafio para o clínico,pois esta área possui acesso limitado para os instrumentais de raspagem,tornando difícil a remoção eficiente do biofilme dental e do cálculo dassuperfícies radiculares. Para o planejamento adequado da terapêutica a serutilizada, uma série de fatores devem ser levados em consideração visandoa obtenção de sucesso imediato e a longo prazo do caso. A terapiacirúrgica com a utilização de enxertos pode ser uma opção viável em casosde lesões de furca Grau II visando o fechamento da lesão e maior estabilidadeperiodontal. O objetivo deste artigo foi relatar um caso clínicoonde foi realizada uma abordagem cirúrgica simplificada com a utilizaçãoapenas de enxerto autógeno para o tratamento de um dente com lesãode furca Grau II. Após 12 meses de pós-operatório houve aumento nonível de inserção clínica e diminuição da profundidade de sondagem comconsequente fechamento total da lesão de furca.
Assuntos
Humanos , Masculino , Adulto , Transplante Ósseo , Doenças Periodontais/cirurgia , Defeitos da Furca , PeriodontiteRESUMO
A periodontite leva a perda de inserção clínica do dente, promovendo alterações no periodonto de proteção e sustentação. A progressão da doença leva a perda de suporte ósseo podendo interferir na estética do paciente e na adequada função do dente. O tratamento periodontal permite melhoras nos parâmetros clínicos, promovendo a cura e controle da doença. Contudo, a regeneração dos tecidos perdidos dificilmente ocorre pelo método convencional de tratamento, e para tanto, a utilização de materiais de enxertia são necessários. Os enxertos estão indicados em situações clínicas distintas onde exista a presença de lesões infraósseas extensas ou de grau 11 de furca. Os defeitos periodontais mais prevalentes são os horizontais ou oblíquos e a sua regeneração é difícil de ser realizada. Desta maneira um enfoque vem sendo utilizado de maneira a inter-relacionar diferentes áreas com intuito de se obter resultados satisfatórios nestes tipos de defeito, utilizando a terapia celular. Esta terapia visa restabelecer a função de um órgão ou tecido, transplantando novas células para substituir outras destruídas por patologias ou defeitos genéticos. O objetivo deste artigo é fazer uma revisão de literatura acerca do uso da terapia celular na regeneração periodontal, e verificar a viabilidade de sua aplicação clínica.
Periodontitis leads to a clinical attachment Joss of the tooth, promoting changes in the protective and sustention periodontal tissue. The disease progression results in boneloss and may interfere with the aesthetics of the patient and in the proper function of the tooth. Periodontal treatment improves clinical outcomes, promoting healing and disease control. However. tissue regeneration difficultly occurs by the conventional treatment method, and for this, the use of grafting materials are needed. The grafts are indicated in different clinical situations where there is the presence of extensive infra-bone lesions or class II furcation. The horizontal or oblique defect is the most prevalent periodontal defects and your regeneration is difficult to achieve. Thus, an approach has been used in order to inter-relate different areas with the aim to obtain satisfactory results in these types of defects, usingcell therapy. The cell therapy aims to restore the function of an organ or tissue, transplanting new cells to replace ones destroyed by diseases or genetic defects. The aim of this paper is to review the literature on the use of cell therapy in periodontal regeneration, and check the feasibility of clinical application.