Acompanhamento clínico e dados moleculares de pacientes submetidos à cirurgia de implante – estudo de casos
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Data
2023-02-03
Autores
Strabelli, Priscila Rossi Santos
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A prática clínica dos implantodontistas mostra uma importante taxa de insucesso pós reabilitações com implantes, cujas causas variam e muitas vezes não são identificadas. Este estudo de caso avaliou a presença de doenças peri-implantares em pacientes fumantes, pacientes fumantes em terapia anti-hipertensiva, pacientes em terapia anti-hipertensiva e pacientes controle, levando em consideração os seguintes dados: avaliação da expressão gênica por reação em cadeia da polimerase, por tempo real e transcrição reversa, do osso do leito receptor do implante; profundidade de sondagem (PS) das próteses implantadas; sangramento a sondagem; índice de biofilme dental; análise radiográfica da perda óssea e avaliação de citocinas inflamatórias do fluido gengival desses pacientes, por ELISA (Enzyme-linked immunosorbent assay). O presente estudo objetivou avaliar marcadores moleculares relacionados ao remodelamento ósseo e ao processo inflamatório expressos pelo osso no momento de inserção do implante, traçando correlações clínicas de 16 pacientes, que foram avaliados 3 anos após terem sido reabilitados com implantes dentais osseointegrados, na busca de fatores preditivos de sucesso do tratamento. Os dados foram avaliados por estatística descritiva (média, mediana, desvio padrão), pelos testes paramétricos (ANOVA) e não paramétricos (Kruskall Wallis) e por análises de correlação de Pearson. Não houveram correlações significativas entre os marcadores moleculares do metabolismo ósseo e citocinas inflamatórias do fluido gengival com as condições clínicas avaliadas após a reabilitação com próteses. A profundidade de sondagem foi maior nos pacientes fumantes e correlacionou-se significativamente à perda óssea. Concluiu-se os fatores moleculares não tiveram significância preditiva de sucesso dos tratamentos com implantes dentais osseointegrados e que pacientes com um ou mais fatores de risco apresentam um pior prognóstico cuja manifestação inicial ocorre com uma maior profundidade de sondagem correlacionada com maior perda óssea.
The clinical practice of implant dentists shows an important failure rate after implant rehabilitations, whose causes vary and are often not identified. This present case study evaluated the presence of peri-implant diseases in smokers, smokers on antihypertensive therapy, patients on antihypertensive therapy and control patients, taking into account the following data: evaluation of gene expression by chain reaction of polymerase, by real time and reverse transcription, of the bone of the implant recipient bed; probing depth (PS) of implanted prostheses; bleeding on probing; dental biofilm index; radiographic analysis of bone loss and evaluation of inflammatory cytokines in the gingival fluid of these patients, by ELISA (Enzymelinked immunosorbent assay). The present study aimed to evaluate molecular markers related to bone remodeling and the inflammatory process expressed by the bone at the time of implant insertion, tracing clinical correlations of 16 patients, who were evaluated 3 years after being rehabilitated with osseointegrated dental implants, in the search for predictive factors of treatment success. The data were evaluated by descriptive statistics (mean, median, standard deviation), by parametric (ANOVA) and non-parametric (Kruskall Wallis) tests and by Pearson transfer analysis. There was no correlation between molecular markers of bone metabolism and cytokines, inflammation of the gingival fluid with clinical conditions after rehabilitation with prostheses. Probing depth was greater in smokers and was significantly correlated with bone loss. It was concluded that molecular factors had no predictive significance for the success of treatments with osseointegrated dental implants and that patients with one or more risk factors had a worse prognosis whose initial manifestation occurs with a greater depth of probing correlated with greater bone loss.
The clinical practice of implant dentists shows an important failure rate after implant rehabilitations, whose causes vary and are often not identified. This present case study evaluated the presence of peri-implant diseases in smokers, smokers on antihypertensive therapy, patients on antihypertensive therapy and control patients, taking into account the following data: evaluation of gene expression by chain reaction of polymerase, by real time and reverse transcription, of the bone of the implant recipient bed; probing depth (PS) of implanted prostheses; bleeding on probing; dental biofilm index; radiographic analysis of bone loss and evaluation of inflammatory cytokines in the gingival fluid of these patients, by ELISA (Enzymelinked immunosorbent assay). The present study aimed to evaluate molecular markers related to bone remodeling and the inflammatory process expressed by the bone at the time of implant insertion, tracing clinical correlations of 16 patients, who were evaluated 3 years after being rehabilitated with osseointegrated dental implants, in the search for predictive factors of treatment success. The data were evaluated by descriptive statistics (mean, median, standard deviation), by parametric (ANOVA) and non-parametric (Kruskall Wallis) tests and by Pearson transfer analysis. There was no correlation between molecular markers of bone metabolism and cytokines, inflammation of the gingival fluid with clinical conditions after rehabilitation with prostheses. Probing depth was greater in smokers and was significantly correlated with bone loss. It was concluded that molecular factors had no predictive significance for the success of treatments with osseointegrated dental implants and that patients with one or more risk factors had a worse prognosis whose initial manifestation occurs with a greater depth of probing correlated with greater bone loss.
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Palavras-chave
Implantes dentais, Marcadores Moleculares, Peri implantite, Estudo de Casos, Dental implants, Molecular markers, Peri-implantitis, Case reports