Associação da fibrina rica em plaquetas e leucócitos ao osso bovino desproteinizado em cirurgias de elevação do assoalho do seio maxilar: análise clínica, histológica e radiográfica
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Data
2022-05-06
Autores
Zandim-Barcelos, Daniela Leal
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Resumo
O objetivo deste estudo clínico randomizado foi avaliar a influência da fibrina rica em
plaquetas e leucócitos (L-PRF) na reparação e neoformação óssea quando associada
ao osso bovino desproteinizado (OBD) em procedimentos cirúrgicos de elevação do
seio maxilar. Um total de 24 pacientes, apresentando 36 seios maxilares com
indicação de enxertia óssea previamente à instalação de implantes na região posterior
da maxila, foram incluídos no estudo. Os seios foram distribuídos aleatoriamente em
3 grupos de acordo com tratamento a ser realizado: OBD (grupo controle) - apenas
OBD foi utilizado e o período de reparação para instalação dos implantes foi de 8
meses; LPRF/OBD 4 - OBD + L-PRF e o período de reparação foi de 4 meses;
LPRF/OBD 8 - OBD + L-PRF e o período de reparação foi de 8 meses. Todos os
pacientes realizaram exame tomográfico uma semana após a elevação do seio e
previamente ao procedimento de instalação dos implantes para avaliação das
alterações dimensionais do volume do enxerto. Durante a instalação dos implantes,
foram obtidas biópsias da área enxertada para análise histomorfométrica e
imunoistoquímica. A estabilidade primária dos implantes foi determinada por análise
de frequência de ressonância. Todos os tratamentos realizados foram eficazes para
elevação do seio maxilar em dois estágios cirúrgicos. Nenhuma intercorrência ou
complicação foi observada. A porcentagem de osso neoformado foi significativamente
maior nos grupos em que a L-PRF foi utilizada (LPRF/OBD 4 - 44,58 ± 13,09%;
LPRF/OBD 8 - 46,56 ± 12,28%) do que no grupo controle (32,34 ± 9,49%). O grupo
controle (12,58 ± 9,19%) apresentou maior porcentagem de enxerto residual em
relação aos demais grupos (LPRF/OBD 4 - 3,59± 4,22%; LPRF/OBD 8 - 7,01 ± 8,49%),
sendo a diferença significativa apenas entre os grupos OBD e LPRF/OBD 4. Não foi
observada diferença significativa entre os grupos para a porcentagem de tecido mole.
A marcação de VEGF foi mais intensa nos grupos em que a L-PRF foi utilizada do que
no grupo controle. O grupo LPRF/OBD 4 apresentou maior imunomarcação para
RUNX-2, OPN e OCN em comparação aos demais grupos. Em todos os grupos houve
uma redução significativa do volume do enxerto. A taxa de reabsorção volumétrica do
enxerto foi semelhante entre os grupos. Apesar da estabilidade primária dos implantes
ter sido significativamente menor no grupo LPRF/OBD 4 do que nos demais grupos,
os valores de ISQ foram considerados adequados e não interferiram na
osseointegração dos implantes. Baseado nos resultados deste estudo, pode-se
concluir que a adição de L-PRF ao OBD nos procedimentos de elevação do seio
maxilar parece ser uma alternativa viável e segura para aumentar a quantidade de
osso neoformado assim como para acelerar a maturação do enxerto possibilitando a
instalação precoce de implantes.
The objective of this randomized clinical trial was to evaluate the influence of platelet and leukocyte-rich fibrin (L-PRF) on bone healing and formation when associated with deproteinized bovine bone (OBD) in maxillary sinus augmentation procedures. A total of 24 patients, with 36 maxillary sinuses in need of bone augmentation prior to implant placement in the maxillary posterior region, were enrolled to the study. The sinuses were randomly allocated to 3 groups according to the treatment protocol: OBD (control group) - only OBD was used and the healing period for implant placement was 8 months; LPRF/OBD 4 - OBD + L-PRF and the healing period was 4 months; LPRF / OBD 8 - OBD + L-PRF and the healing period was 8 months. All patients underwent a tomographic exam one week after the sinus augmentation and prior to the implant placement to assess dimensional changes in graft volume. During implant placement, bone graft biopsies were harvested for histomorphometric and immunohistochemical analysis. Implant primary stability was determined by resonance frequency analysis. All treatments were effective for two-stage maxillary sinus augmentation. The sites healed uneventfully with no complications. Statistically higher percentage of newly formed bone was observed in the groups treated with L-PRF (LPRF/OBD 4 - 44.58 ± 13.09%; LPRF/OBD 8 - 46.56 ± 12.28%) compared to the control group (32.34 ± 9.49%). The control group showed higher percentage of residual graft (12.58 ± 9.19%) than the other groups (LPRF/OBD 4 - 3.59 ± 4.22%; LPRF/OBD 8 - 7.01 ± 8, 49%), but the difference was significant only between the groups OBD and LPRF/OBD 4. No differences were found amongst the groups for the percentage of soft tissue. VEGF immunostaining was more intense in the groups treated with L-PRF than in the control group. The LPRF/OBD 4 group showed greater immunostaining for RUNX-2, OPN and OCN compared to the other groups. All groups presented significant dimensional changes after the healing period. The percentage of graft volume reduction observed in each group was similar. The primary implant stability was significantly lower in the LPRF/OBD 4 group than in the other groups, but the ISQ values were considered adequate and did not hamper the osseointegration of dental implants. Based on the results of this study, it can be concluded that the addition of L-PRF to the DBBM in maxillary sinus elevation procedures seems to be a viable and safe alternative to increase the amount of newly formed bone as well as to accelerate graft maturation enabling early implant placement.
The objective of this randomized clinical trial was to evaluate the influence of platelet and leukocyte-rich fibrin (L-PRF) on bone healing and formation when associated with deproteinized bovine bone (OBD) in maxillary sinus augmentation procedures. A total of 24 patients, with 36 maxillary sinuses in need of bone augmentation prior to implant placement in the maxillary posterior region, were enrolled to the study. The sinuses were randomly allocated to 3 groups according to the treatment protocol: OBD (control group) - only OBD was used and the healing period for implant placement was 8 months; LPRF/OBD 4 - OBD + L-PRF and the healing period was 4 months; LPRF / OBD 8 - OBD + L-PRF and the healing period was 8 months. All patients underwent a tomographic exam one week after the sinus augmentation and prior to the implant placement to assess dimensional changes in graft volume. During implant placement, bone graft biopsies were harvested for histomorphometric and immunohistochemical analysis. Implant primary stability was determined by resonance frequency analysis. All treatments were effective for two-stage maxillary sinus augmentation. The sites healed uneventfully with no complications. Statistically higher percentage of newly formed bone was observed in the groups treated with L-PRF (LPRF/OBD 4 - 44.58 ± 13.09%; LPRF/OBD 8 - 46.56 ± 12.28%) compared to the control group (32.34 ± 9.49%). The control group showed higher percentage of residual graft (12.58 ± 9.19%) than the other groups (LPRF/OBD 4 - 3.59 ± 4.22%; LPRF/OBD 8 - 7.01 ± 8, 49%), but the difference was significant only between the groups OBD and LPRF/OBD 4. No differences were found amongst the groups for the percentage of soft tissue. VEGF immunostaining was more intense in the groups treated with L-PRF than in the control group. The LPRF/OBD 4 group showed greater immunostaining for RUNX-2, OPN and OCN compared to the other groups. All groups presented significant dimensional changes after the healing period. The percentage of graft volume reduction observed in each group was similar. The primary implant stability was significantly lower in the LPRF/OBD 4 group than in the other groups, but the ISQ values were considered adequate and did not hamper the osseointegration of dental implants. Based on the results of this study, it can be concluded that the addition of L-PRF to the DBBM in maxillary sinus elevation procedures seems to be a viable and safe alternative to increase the amount of newly formed bone as well as to accelerate graft maturation enabling early implant placement.
Descrição
Palavras-chave
Seio maxilar, Implantes dentários, Fibrina rica em plaquetas, Transplante ósseo, Regeneração óssea, Maxillary Sinus, Dental Implants, Platelet-Rich Fibrin, Bone Transplantation, Bone Regeneration