Análise clínica, tomográfica e histológica comparativa entre ha+β-tcp isolado ou associado a proteínas derivadas do esmalte utilizadas como enxertos após a elevação da membrana do seio maxilar e colocação de implantes: estudo piloto

The aim of this study was to evaluate the clinical, tomographic, and histological similarity within the use of HA+β-TCP (Boneceramic) alone or associated with enamel matrix derived (EMD) proteins in sinus lifting procedures with subsequent dental implant placement. We selected two patients with residual bony ridges between 3 mm and 5 mm in height in need of bone grafts. Six months later, eight implants were installed (two implants at each site). Biopsies were made, and the tissue was processed and stained with HE solution. Tomographic evaluation showed bone height gain up to 10.0 mm on average. Histology showed new bone formation for both groups, with similar bone density and trabecular interconnectivity. It can be concluded that the HA+β-TCP graft isolated or associated to EMD provided bone height gain in sinus lifting procedures, with similar clinical, tomographic and histological characteristics.

Incorporação de enxertos ósseos autógenos e homógenos em humanos: abordagem tomográfica

The objective of this study was to evaluate the remodeling of autologous and homologous bone grafts in humans, using tomographic images. For this, CT images from 10 patients (5 treated with autologous bone grafts and 5 treated with homologous bone grafts), made previously to the grafting procedures, and 14 and 180 days post operatory were evaluated regarding to bone height, width, and density, in a total of 19 bone blocks, 10 homologous and 9 autologous. Results showed similarities between the two tested materials regarding bone width and density. It can be concluded that the homologous bone presented, in a tomographic approach, after 180 days of follow-up, characteristics which can corroborate its use as a bone graft material, providing and sustaining a good bone volume for oral rehabilitation with dental implants.

Osteotomia sagital da crista alveolar para instalação de implantes Bicon

This case report presents details of a new surgical technique for mandibular ridge sagittal osteotomy and expansion associated to immediate dental implants in atrophic ridges. The bone atrophies represents a challenge for the surgeons that intends to modify this situation. In the past, the only viable option was the onlay bone graft. However, the bone graft requests a second surgical site that certainly increases the postoperative morbidity, without mentioning the longer treatment time required. The sagittal osteotomy of the alveolar crest represents a faster option, because it eliminates the time requested for bone graft integration, providing rehabilitation of edentulous areas with thin alveolar crests that otherwise would need additi onal surgical procedures for a satisfactory result. The authors report a clinical case in which this technique was used with the installation of a Bicon dental implant in the same surgical time, showing all the steps for this single-tooth rehabilitation.

Tecido ósseo homólogo para utilização em odontologia

The use of bone grafts from bone tissue banks, also known as bone allografts, has increased in the last years, although most of its users still have concerns on resources and processing protocols. The objective of this paper was to make a literature review about the use of bone allografts in Dentistry, and also about the legal considerations regarding this biomaterial. Studies regarding the donor selection, the cross-infection risks and processing protocols of this biomaterial are still rare but essential, and allied to those regarding its clinical application, can base its use.

A utilização do enxerto ósseo autógeno para tratamento de lesão de furca grau II

Destruction of bone and periodontal ligament as a result of periodontal disease can lead to anatomical defects in the furcation area. Treatment of these lesions is a major challenge to the clinician. Periodontal instruments have limited access to this area and plaque and calculus removal from root surfaces are extremely difficult. For proper treatment planning a number of factors must be taken into consideration to achieve immediate and long term success. Surgical therapy associated with bone grafts may be a viable option in the treatment of class II furcation defects, aiming to restore lost tissues. The aim of this paper is to report a clinical case where a simplified surgical approach with the use of autogenous graft was used to treat a class II furcation defect Twelve months after the surgery, an increase in clinical attachment level and pocket depth reduction resulted in a complete closure of the furcation lesion.

Avaliação da espessura do osso parietal como região doadora de enxertos ósseos.

Introduction: The study of graft donor sites, whether from the anatomical, physiological or morphological point of view, has become a topic of current interest, due to the increasing number of patients needing facial bone reconstruction for various reasons. Purpose: In view of the need to constantly improve surgical techniques for autogenous bone graft harvesting, still considered the best choice for facial bone reconstruction, this paper describes an anatomical study on dry skulls in order to evaluate the average thickness of the parietal bone. Material and Methods: Measurements of this bone were taken with a goniometer, at four previously defined points, in the region that is often used as a donor site, in 49 dry skulls (98 parietal bones). The results were evaluated using the T test. Results: Thickness was measured at four predetermined points. The mean values (Point A = 4898mm, B = 4517mm, C = 6185mm, D = 4280mm) show that the bone can be even thinner than previously reported in the literature in other studies of the same nature. The largest bone thickness is in the medial and posterior region. Conclusion: A knowledge of these anatomical characteristics is helpful in preventing possible surgical complications, as well as making it safer for the surgeon to remove this graft and providing more information on whether or not to indicate this region as a bone graft donor site.

Complicações Associadas aos Enxertos Ósseos Aposicionais com Osso Autógeno

Introdution: Tooth extraction results in alveolar ridge resorption due to the progressive reabsorption, which frequently is a limitating factor of dental implants treatment, in function of the insufficient bone height for execution, could be indicated the use of grafts for increase of the alveolar edge. However, the success of the bone graft requests the meticulous attendance of the clinical stages. Proposition: The objective of this research was to evaluate the postoperative complications associated to the autogenous bone grafts. Materials and Methods: Through a random retrospective analysis, 90 file records of patients submitted to the surgical procedure of autogenous bone graft in the period of January from 2000 to the March of 2008. A clinical record was elaborated with base in the necessary data for this evaluation. Results: About the file data analysis, 59 female with average of 49,42 years and 31 male with average of 47,90 years. The previous diseases most related were arterial hypertension, stomachache and diabetis. The smokers was noticed in 13,3% of patients. The donor site most used was a mandibular ramus. The postoperative complications in receiving area represented 17,8% of file datas analysed and in the donor site only one patient showed parestesis. Conclusion: Among the total analyzed files it was observed that the postoperative complications associated with the autogenous bone grafts represented 18,9% of the patients submitted to the procedure, more frequently affecting the receiving area, obtaining partial exposure of the bone graft and absence of inserted gingiva on vestibular cortical bone.

A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration: a 2-year follow-up

Introduction: The demand for optimal esthetics has increased with the advance of the implant dentistry and with the desire for easier, safer and faster technique allowing predictable outcomes. Thus, the aim of this case report was to describe a combined approach for the treatment of a periodontally compromised tooth by means of atraumatic tooth extraction, immediate flapless implant placement, autogenous block and particulate bone graft followed by connective tissue graft and immediate provisionalization of the crown in the same operatory time. Case Report: A 27-year-old woman underwent the proposed surgical procedures for the treatment of her compromised maxillary right first premolar. The tooth was removed atraumatically with a periotome without incision. A dental implant was inserted 3 mm apical to the cement-enamel junction of the adjacent teeth enabling the ideal tridimensional implant position. An osteotomy was performed in the maxillary tuber for block bone graft harvesting that allowed the reconstruction of the alveolar buccal plate. Thereafter, an autogenous connective tissue graft was placed to increase both the horizontal and vertical dimensions of the alveolar socket reaching the patient functional and esthetic expectations. Conclusion: This treatment protocol was efficient to create a harmonious gingival architecture with sufficient width and thickness, maintaining the stability of the alveolar bone crest yielding excellent aesthetic results after 2-years of follow-up. We suggest that this approach can be considered a viable alternative for the treatment of periodontally compromised tooth in the maxillary esthetic area enhancing patient comfort and satisfaction.

Avaliação das alterações no nível da crista óssea e na estabilidade de implantes em função instalados na região anterior da maxila enxertada com osso autógeno ou rhBMP-2

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Fixação do enxerto ósseo autógeno em bloco com adesivos a base de cianoacrilato ou parafuso de titânio: estudo histológico em coelhos

Pós-graduação em Odontologia - FOA

Healing at mandibular block-grafted sites: an experimental study in dogs

AimThe aim of this study was to evaluate the healing of autologous bone block grafts or deproteinized bovine bone mineral (DBBM) block grafts applied concomitantly with collagen membranes for horizontal alveolar ridge augmentation.Material and methodsIn six Labrador dogs, molars were extracted bilaterally, the buccal bony wall was removed, and a buccal box-shaped defect created. After 3months, a bony block graft was harvested from the right ascending ramus of the mandible and reduced to a standardized size. A DBBM block was tailored to similar dimensions. The two blocks were secured with screws onto the buccal wall of the defects in the right and left sides of the mandible, respectively. Resorbable membranes were applied at both sides, and the flaps sutured. After 3months, one implant was installed in each side of the mandible, in the interface between grafts and parent bone. After 3months, biopsies were harvested and ground sections prepared to reveal a 6-month healing period of the grafts.Results776.2% and 5.9 +/- 7.5% of vital mineralized bone were found at the autologous bone and DBBM block graft sites, respectively. Moreover, at the DBBM site, 63 +/- 11.7% of connective tissue and 31 +/- 15.5% of DBBM occupied the area analyzed. Only 0.2 +/- 0.4% of DBBM was found in contact with newly formed bone. The horizontal loss was in a mean range of 0.9-1.8mm, and 0.3-0.8mm, at the autologous bone and DBBM block graft sites, respectively.ConclusionsAutologous bone grafts were vital and integrated to the parent bone after 6months of healing. In contrast, DBBM grafts were embedded into connective tissue, and only a limited amount of bone was found inside the scaffold of the biomaterial.

Optimizing maxillary aesthetics of a severe compromised tooth through orthodontic movement and dental implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

Use of a new fibrin sealant and laser irradiation in the repair of skull defects in rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação comparativa do processo de incorporação de bloco sintético bifásico, e do osso autógeno: estudo histológico, histométrico e imunoistoquímico em coelhos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

An alternative maneuver to treat gingival recession

This article reports a clinical case in which was applied autologous bone graft associated with subepithelial connective tis- sue graft, harvested by gingivectomy procedure with technical modifications to increase gingival graft extension, also to be used as guided tissue regeneration, to treat a single gingival recession. After 1 year and 2 months of follow-up, the cover- age of the recession was 4.0 mm, which corresponded to the gain of attached keratinized gingival tissue. An increase in the gingival tissue thickness was observed, without significant probing depth. The procedures applied to treat this case may be biologically and clinically useful to treat gingival recession.