Influência das dimensões do seio maxilar na formação óssea. Estudo prospectivo clínico, histológico e tomográfico
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Data
2018-03-23
Autores
Pignaton, Túlio Bonna [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi avaliar a influência da anatomia do seio maxilar na qualidade da formação óssea. Vinte pacientes foram selecionados considerando análises tomográficas (altura óssea do rebordo residual <5 mm) para a realização de enxerto ósseo bilateral do seio maxilar exclusivamente com osso inorgânico bovino. Após oito meses, durante a instalação dos implantes, foram coletadas biópsias ósseas dos seios enxertados. Ao todo, foram instalados 146 implantes e 105 biópsias foram coletadas, dentre elas 103 foram consideradas para análise. O artigo 1 avaliou o gradiente de formação óssea a partir do assoalho do seio maxilar. As análises histológicas foram realizadas a cada 1 (um) milímetro (mm) considerando a área enxertada, e os parâmetros avaliados foram o percentual de novo osso (NO), material de enxerto residual (B-oss) e espaço medular (EM). As 103 biópsias foram avaliadas e o percentual de NO, B-oss e EM foram: 31.62 ± 9.85, 18.94 ± 7.88, e 49.41 ± 9.52, no primeiro mm; 27.15 ± 9.83, 23.33 ± 9.45, e 49.53 ± 11.73, no segundo mm; 23.61 ± 13.02, 21.35 ± 11.08, e 55.03 ± 16.14, no terceiro mm; e 21.67 ± 12.29, 19.67 ± 10.28, e 58.66 ± 12.46, no quarto mm. A correlação entre o percentual de NO e EM em relação a distância do osso autógeno foi estatisticamente significativa (p<0.001). A quantidade de NO diminuiu, enquanto a quantidade de EM aumentou com a distância do osso autógeno. Concluiu-se que em seios maxilares enxertados exclusivamente com osso inorgânico bovino, a quantidade de NO reduziu a medida que a distância do osso nativo aumentou. O artigo 2 avaliou a influência da altura óssea do rebordo residual posterior (ARR) e da largura do seio (LS) na formação óssea de seios enxertados exclusivamente com osso inorgânico bovino. As análises histológicas foram realizadas considerando toda a área enxertada das biópsias e os parâmetros considerados foram NO, B-oss e EM. Baseado nas análises tomográficas, os sítios que tiveram implantes instalados foram alocados de acordo com a LS em estreito (E), médio (M) ou largo (L) e de acordo com ARR em ≤2 mm ou >2 mm. As 103 biópsias foram avaliadas e a formação de NO nos sítios alocados como E (69 sítios), M (19 sítios) e L (15 sítios) foram 28.54 ± 9.24, 28.91 ± 8.61, e 30.30 ± 7.80, respectivamente. A ARR média foi de 3.97 ± 2.43 mm, considerando esses valores, 26 e 77 sítios foram alocados nos grupos ≤2 mm e >2 mm, respectivamente. A formação de NO foi de 26.21 ± 9.10 e 29.76 ± 8.67 nos sítios alocados em ≤2 mm e >2 mm, respectivamente. Não houve diferença estatística significativa na formação de NO quando considerado a LS nos sítios alocados como E, M e L, bem como a ARR dos sítios alocados em ≤2 mm e >2 mm. Pode-se concluir que a largura do seio e a altura do rebordo residual não influenciaram na formação de novo osso em seios enxertados exclusivamente com osso inorgânico bovino após 8 meses de remodelação.
This study was conducted to evaluate the influence of sinus anatomy and dimensions in bone formation in sinuses grafted with anorganic bovine bone alone. Bilateral sinus grafting was performed with ABB in twenty patients with RBH of <5 mm, according to cone bean computed tomography (CBCT) evaluation. Trephine samples were removed at the implant insertion site 8 months after the grafting procedure. A total of 146 implants were installed and 105 biopsies were removed. However, 103 biopsies were considered for analysis. Article 1 evaluated the gradient of bone formation in maxillary sinuses grafted exclusively with anorganic bovine bone (ABB). Histomorphometric analyses were performed to examine the gradient of bone formation in every one mm from the maxillary sinus floor. In the part corresponding to the grafted area, the percentage of new bone (NB), residual graft material (rABB), and soft tissue (ST) were evaluated. A total of 103 biopsies were evaluated and the NB, rABB, and ST were, 31.62 ± 9.85, 18.94 ± 7.88, and 49.41 ± 9.52 in the 1st mm, 27.15 ± 9.83, 23.33 ± 9.45, and 49.53 ± 11.73 in the 2nd mm, 23.61 ± 13.02, 21.35 ± 11.08, and 55.03 ± 16.14 in the 3rd mm, and 21.67 ± 12.29, 19.67 ± 10.28, and 58.66 ± 12.46 in the 4th mm. The correlation between NB and ST percentages, and the distance to the native bone was statistically significant (p<0.001). The amount of the NB decreased while the amount of ST increased with the distance from the native bone. In conclusion, in sinuses grafted exclusively with ABB the amount of NB decreased while the amount of ST increased along with the distance from the native bone. Article 2 evaluated the influence of the posterior maxillary residual bone height (RBH) and sinus width (SW) in the outcome of maxillary sinus bone augmentation using anorganic bovine bone (ABB). Histological and histomorphometric analyses were performed to examine the percentage of NB, rABB, and ST in the part corresponding to the grafted area. Based on CBCT evaluation, the sites of implant insertion were allocated according to SW in narrow (N), average (A), and wide (W), or according to RBH into ≤2 mm and >2 mm. A total of 103 biopsies were evaluated. NB formation in sites allocated as N (69 sites), A (19 sites), and W (15 sites) was 28.54 ± 9.24, 28.91 ± 8.61, and 30.30 ± 7.80, respectively. The mean RBH was 3.97 ± 2.43 mm, based on these values, 26 and 77 sites were allocated into ≤2 mm and >2 mm, respectively. The NB formations was 26.21 ± 9.10 and 29.76 ± 8.67, for RBH ≤2 mm and >2 mm, respectively. There was no significant difference in NB formation considering SW in sites allocated as N, A, W or considering RBH in sites allocated as ≤2 mm and >2 mm. Within the limitations of the present study, SW and RBH did not influence NB formation in sinuses grafted exclusively with ABB after 8 months of healing.
This study was conducted to evaluate the influence of sinus anatomy and dimensions in bone formation in sinuses grafted with anorganic bovine bone alone. Bilateral sinus grafting was performed with ABB in twenty patients with RBH of <5 mm, according to cone bean computed tomography (CBCT) evaluation. Trephine samples were removed at the implant insertion site 8 months after the grafting procedure. A total of 146 implants were installed and 105 biopsies were removed. However, 103 biopsies were considered for analysis. Article 1 evaluated the gradient of bone formation in maxillary sinuses grafted exclusively with anorganic bovine bone (ABB). Histomorphometric analyses were performed to examine the gradient of bone formation in every one mm from the maxillary sinus floor. In the part corresponding to the grafted area, the percentage of new bone (NB), residual graft material (rABB), and soft tissue (ST) were evaluated. A total of 103 biopsies were evaluated and the NB, rABB, and ST were, 31.62 ± 9.85, 18.94 ± 7.88, and 49.41 ± 9.52 in the 1st mm, 27.15 ± 9.83, 23.33 ± 9.45, and 49.53 ± 11.73 in the 2nd mm, 23.61 ± 13.02, 21.35 ± 11.08, and 55.03 ± 16.14 in the 3rd mm, and 21.67 ± 12.29, 19.67 ± 10.28, and 58.66 ± 12.46 in the 4th mm. The correlation between NB and ST percentages, and the distance to the native bone was statistically significant (p<0.001). The amount of the NB decreased while the amount of ST increased with the distance from the native bone. In conclusion, in sinuses grafted exclusively with ABB the amount of NB decreased while the amount of ST increased along with the distance from the native bone. Article 2 evaluated the influence of the posterior maxillary residual bone height (RBH) and sinus width (SW) in the outcome of maxillary sinus bone augmentation using anorganic bovine bone (ABB). Histological and histomorphometric analyses were performed to examine the percentage of NB, rABB, and ST in the part corresponding to the grafted area. Based on CBCT evaluation, the sites of implant insertion were allocated according to SW in narrow (N), average (A), and wide (W), or according to RBH into ≤2 mm and >2 mm. A total of 103 biopsies were evaluated. NB formation in sites allocated as N (69 sites), A (19 sites), and W (15 sites) was 28.54 ± 9.24, 28.91 ± 8.61, and 30.30 ± 7.80, respectively. The mean RBH was 3.97 ± 2.43 mm, based on these values, 26 and 77 sites were allocated into ≤2 mm and >2 mm, respectively. The NB formations was 26.21 ± 9.10 and 29.76 ± 8.67, for RBH ≤2 mm and >2 mm, respectively. There was no significant difference in NB formation considering SW in sites allocated as N, A, W or considering RBH in sites allocated as ≤2 mm and >2 mm. Within the limitations of the present study, SW and RBH did not influence NB formation in sinuses grafted exclusively with ABB after 8 months of healing.
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Palavras-chave
Seio maxilar, Osteogênese, Transplante ósseo, Maxillary sinus, Osteogenesis, Bone transplantation