Estudo comparativo entre o biomaterial Cerabone® e osso autógeno na elevação do seio maxilar em humanos: análise histométrica, volumétrica (TC) e micro-tomográfica (Micro-CT)
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Data
2022-12-09
Autores
Santos, Déborah Laurindo Pereira
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A intervenção cirúrgica pela elevação da membrana sinual e enxertia óssea, possibilita que volumes ósseos perdidos sejam reestabelecidos. E assim, condições adequadas sejam proporcionadas para instalação de implantes em quantidade e qualidade óssea ideais. Esta pesquisa tem como objetivo comparar pela análise histomorfométrica, volumétrica e por micro-tomografia computadorizada, o comportamento do biomaterial Cerabone® (CBP) e do Cerabone® associado ao osso autógeno (CBA) e compará-los ao osso autógeno puro (AUT) utilizado na enxertia de seios maxilares em humanos. E assim discorrer sobre o processo de formação e reabsorção óssea frente a esses materiais. Como também sobre os benefícios e eficácia na realização da enxertia cirúrgica com os mesmos. Sendo este um estudo clínico, 15 voluntários foram selecionados e convidados para fazer parte da pesquisa, resultando em 24 seios maxilares enxertados. Estes voluntários apresentavam atrofia do rebordo alveolar de 5 mm ou inferior, e desejavam ser reabilitados com implantes dentais. Os voluntários foram divididos em três grupos, de maneira aleatória, sendo o grupo controle composto pelo osso autógeno (GAC); Grupo Cerabone® (GCB); Grupo Cerabone® associado ao osso autógeno (GCA). Foram realizadas tomografias computadorizadas pré- operatórias das regiões cirúrgicas e em seguida as intervenções para enxertias ósseas com os materiais propostos. Após a realização do procedimento cirúrgico, no pós-operatório imediato (7 dias) e pós-operatório tardio (6 meses), novos exames tomográficos foram feitos. E após 6 meses, os voluntários foram submetidos a nova intervenção cirúrgica para realização de biópsias ósseas da região de interesse dos enxertos, no mesmo momento da instalação dos implantes. As peças anatômicas adquiridas foram submetidas à análises direcionadas para histomorfometria e micro-tomografia. Os dados foram tabulados e avaliados estatisticamente de acordo com testes de comparações. Na análise de micro- CT para BV/TV (%) os grupos apresentaram média e desvio padrão de 51,6 18,8 GCB; 59,6 7,3 GCA e 37,3 11,5 GAC. Na análise de Tb.Th (mm) 30,9 9,7 GCB; 23,5 1,3 GCA e 16,3 5,2 GAC. Na análise Tb.Sp. (mm) 26,6 14,2 GCB; 17,0 3,7 GCA e 29,4 9,2 GAC. Na análise Tb.N (1/mm) foi referido a mediana de 0,01 GCB; 0,02 GCA e 0,02 GAC. Para a análise volumétrica o grupo GCB apresentou melhor conservação do volume enxertado com média e desvio padrão de 7,9 19,3, já o GCA - 50,9 15,5 e - 51,0 15,5 GAC apresentaram reabsorção. E por fim, na análise histomorfométrica o grupo GCA apresentou maior média de osso neoformado 41,5 8,4, seguido do GAC 38,0 14,2 e GCB 27,6 7,0. Para presença de tecido conjuntivo 52,9 5,7 GCB; 47,4 6,9 GCA e 58,3 13,0 GAC. E para os remanescentes de biomaterias 19,2 7,8 GCB; 11,1 5,0 GCA e 3,8 3,4 GAC. Desta maneira, concluiu-se que o biomaterial Cerabone®, principalmente quando associado ao osso autógeno, apresenta resultados eficazes quanto ao processo de reparo e formação óssea.
Surgical intervention by metabolism of the sinus membrane and bone exercise allows the lost bone volumes to be restored. And so, the required conditions are provided for installation of implants in optimal quantity and bone quality. This research aims to compare, through histometric, volumetric and micro-computed tomography analysis, the behavior of the biomaterial Cerabone® (CBP) and Cerabone® associated with autogenous bone (CBA) and compare them to the pure autogenous bone (AUT) used in human maxillary sinus grafting. And so to discuss the process of bone formation and resorption in the face of these materials. As well as on the benefits and effectiveness in carrying out corporate grafting with them. As this is a clinical study, 15 volunteers were selected and invited to take part in the research, resulting in 24 maxillary sinuses being exercised. These patients had alveolar ridge atrophy of 5 mm or less, and who wanted to be rehabilitated with dental implants. The volunteers were randomly divided into three groups, with the control group consisting of autogenous bone (GAC); Cerabone® Group (GCB); Cerabone® group associated with autogenous bone (GCA). There were pre-surgical computed tomography scans of surgical surgeries and then interventions for bone grafting with standard materials. After completing the surgical procedure, the immediate postoperative period (7 days) and the late postoperative period (6 months) were performed. After 6 months, the volunteers were admitted to a new surgical intervention to perform bone biopsies in the region of interest for the grafts, at the same time as the implants were installed. The acquired anatomical pieces were researched for analyzes directed to histomorphometry and micro-tomography. Data were tabulated and statistically evaluated according to comparison tests. In the micro-CT analysis for BV/VT (%) the groups presented mean and standard deviation of 51.6 18.8 GCB; 59.6 7.3 GCA and 37.3 11.5 GAC. In the analysis of Tb.Th (mm) 30.9 9.7 GCB; 23.5 1.3 GCA and 16.3 5.2 GAC. In the Tb.Sp. (mm) 26.6 14.2 GCB; 17.0 3.7 GCA and 29.4 9.2 GAC. In the Tb.N analysis (1/mm) a median of 0.01 GCB was reported; 0.02 GCA and 0.02 GAC. For the volumetric analysis, the GCB group showed better conservation of the grafted volume with mean and standard deviation of 7.9 19.3, while the GCA - 50.9 15.5 and - 51.0 15.5 GAC showed resorption . And finally, in the histomorphometric analysis, the GCA group had the highest average of newly formed bone 41.5 8.4, followed by the GAC 38.0 14.2 and GCB 27.6 7.0. For connective tissue 52.9 5.7 GCB; 47.4 6.9 GCA and 58.3 13.0 GAC. And for the remnants of biomaterials 19.2 7.8 GCB; 11.1 5.0 GCA and 3.8 3.4 GAC. Thus, it was concluded that the Cerabone® biomaterial, especially when associated with autogenous bone, presents effective results in terms of the repair process and bone formation.
Surgical intervention by metabolism of the sinus membrane and bone exercise allows the lost bone volumes to be restored. And so, the required conditions are provided for installation of implants in optimal quantity and bone quality. This research aims to compare, through histometric, volumetric and micro-computed tomography analysis, the behavior of the biomaterial Cerabone® (CBP) and Cerabone® associated with autogenous bone (CBA) and compare them to the pure autogenous bone (AUT) used in human maxillary sinus grafting. And so to discuss the process of bone formation and resorption in the face of these materials. As well as on the benefits and effectiveness in carrying out corporate grafting with them. As this is a clinical study, 15 volunteers were selected and invited to take part in the research, resulting in 24 maxillary sinuses being exercised. These patients had alveolar ridge atrophy of 5 mm or less, and who wanted to be rehabilitated with dental implants. The volunteers were randomly divided into three groups, with the control group consisting of autogenous bone (GAC); Cerabone® Group (GCB); Cerabone® group associated with autogenous bone (GCA). There were pre-surgical computed tomography scans of surgical surgeries and then interventions for bone grafting with standard materials. After completing the surgical procedure, the immediate postoperative period (7 days) and the late postoperative period (6 months) were performed. After 6 months, the volunteers were admitted to a new surgical intervention to perform bone biopsies in the region of interest for the grafts, at the same time as the implants were installed. The acquired anatomical pieces were researched for analyzes directed to histomorphometry and micro-tomography. Data were tabulated and statistically evaluated according to comparison tests. In the micro-CT analysis for BV/VT (%) the groups presented mean and standard deviation of 51.6 18.8 GCB; 59.6 7.3 GCA and 37.3 11.5 GAC. In the analysis of Tb.Th (mm) 30.9 9.7 GCB; 23.5 1.3 GCA and 16.3 5.2 GAC. In the Tb.Sp. (mm) 26.6 14.2 GCB; 17.0 3.7 GCA and 29.4 9.2 GAC. In the Tb.N analysis (1/mm) a median of 0.01 GCB was reported; 0.02 GCA and 0.02 GAC. For the volumetric analysis, the GCB group showed better conservation of the grafted volume with mean and standard deviation of 7.9 19.3, while the GCA - 50.9 15.5 and - 51.0 15.5 GAC showed resorption . And finally, in the histomorphometric analysis, the GCA group had the highest average of newly formed bone 41.5 8.4, followed by the GAC 38.0 14.2 and GCB 27.6 7.0. For connective tissue 52.9 5.7 GCB; 47.4 6.9 GCA and 58.3 13.0 GAC. And for the remnants of biomaterials 19.2 7.8 GCB; 11.1 5.0 GCA and 3.8 3.4 GAC. Thus, it was concluded that the Cerabone® biomaterial, especially when associated with autogenous bone, presents effective results in terms of the repair process and bone formation.
Descrição
Palavras-chave
Seio maxilar, Materiais biocompatíveis., Substitutos ósseos, Maxillary sinus, Biocompatible materials, Bone substitutes