Estudo comparativo do vidro bioativo e osso autógeno em aumento do assoalho de seios maxilares de humanos
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Data
2016-07-19
Autores
Pereira, Rodrigo dos Santos [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A deficiência óssea vertical do seio maxilar impossibilita a instalação de implantes dentais necessários para a reabilitação protética contudo, técnicas cirúrgicas para a elevação da membrana sinusal e o uso dos biomateriais para enxertia óssea permitiram alterar esta condição. O ósseo autógeno é considerado o mais previsível e o padrão ouro para tal finalidade porém, biomateriais como o vidro bioativo, amplamente utilizado na odontologia, permitem substituí-lo. O objetivo deste estudo foi avaliar formação óssea, o comportamento celular e a taxa de reabsorção do vidro bioativo em 2 proporções: puro (grupo 1); adicionado ao osso autógeno 1:1 (grupo 2), comparando com o osso autógeno (grupo 3) em seios maxilares de humanos. Com 15 dias de operados os pacientes realizaram um tomografia computadorizada (TC) cone beam para determinar o volume inicial do enxerto (T1). Após 6 meses uma nova TC foi realizada determinando o volume ósseo final (T2) e também, a coleta das biópsias com a instalação simultânea de implantes dentais. As amostras foram divididas em 3 áreas: leito, intermediária e apical onde foram avaliadas a histomorfometria e imunomarcações para Runx2, VEGF, osteocalcina e TRAP. No grupo 1 os resultados foram de 42.6%, 44.5% e 48% de formação óssea no leito, intermediária e apical respectivamente. No grupo 2 as taxas encontradas foram de 36.6% no leito, 33.2% na intermediária e 45.8% na apical. No grupo 3 foi de 34.4% para o leito, 35.0 na intermediária e 42.0% na apical. (p>0.05) Os 3 grupos apresentaram-se com comportamento semelhante nas imunomarcações realizadas mostrando estar maturado e calcificado o suficiente para receber implantes dentais. As taxas de reabsorção também mostraram-se semelhantes com 44.2% para o grupo 1, 37.9% para o grupo 2 e 45.7% no grupo 3. (p>0.05) Assim, podemos concluir que o vidro bioativo possui resultados equiparados ao osso autógeno.
Vertical bone deficit due maxillary sinus pneumatization forbid the dental implants placement required for prosthetic rehabilitation however, surgical techniques to elevate maxillary sinus membrane and studies about biomaterials, allows repair these situation. Autogenous bone graft is considered the most predictable and the gold standard for this nevertheless, biomaterials as bioactive glass, has been widely used in dental surgery and allows substitute it. The aim of this study was evaluate the bone formation, the cellular behavior and the resorption rates of bioactive glass in 2 proportions: pure (group 1); add to autogenous bone graft (group 3), comparing then with autogenous bone graft in human maxillary sinus. Post-operative cone beam computed tomography (CT) was used to measure the initial graft volume after 15 days (T1). Six months later, another CT was performed to evaluate the final graft volume (T2) and determine the graft resorption rate and the harvest of biopsies with dental implants placement simultaneously. The samples were divided in 3 areas: bed, intermediately and apical which were evaluated to histomorphometric and immunostaining to Runx2, VEGF, osteocalcin and TRAP. In group 1 the bone formation were 42.6%, 44.5 and 48.0% for bed, intermediately and apical respectively. In group 2 the rates were 36.6% in bed, 33.2% in intermediately and 45.8% in apical. In group 3 were 34.4% in bed, 35.0% in intermediately and 42.0% in apical. (p>0.05) the 3 groups had the same behavior for the 4 proteins showing be matured and calcified to receive dental implants. The resorption rates were similar for the 3 groups with 44.2% % for group 1, 37.9% for group 2 and 45.7% for group 3. (p>0.05) In conclusion, the bioactive glass is a good substitute to autogenous bone graft in both proportions evaluated.
Vertical bone deficit due maxillary sinus pneumatization forbid the dental implants placement required for prosthetic rehabilitation however, surgical techniques to elevate maxillary sinus membrane and studies about biomaterials, allows repair these situation. Autogenous bone graft is considered the most predictable and the gold standard for this nevertheless, biomaterials as bioactive glass, has been widely used in dental surgery and allows substitute it. The aim of this study was evaluate the bone formation, the cellular behavior and the resorption rates of bioactive glass in 2 proportions: pure (group 1); add to autogenous bone graft (group 3), comparing then with autogenous bone graft in human maxillary sinus. Post-operative cone beam computed tomography (CT) was used to measure the initial graft volume after 15 days (T1). Six months later, another CT was performed to evaluate the final graft volume (T2) and determine the graft resorption rate and the harvest of biopsies with dental implants placement simultaneously. The samples were divided in 3 areas: bed, intermediately and apical which were evaluated to histomorphometric and immunostaining to Runx2, VEGF, osteocalcin and TRAP. In group 1 the bone formation were 42.6%, 44.5 and 48.0% for bed, intermediately and apical respectively. In group 2 the rates were 36.6% in bed, 33.2% in intermediately and 45.8% in apical. In group 3 were 34.4% in bed, 35.0% in intermediately and 42.0% in apical. (p>0.05) the 3 groups had the same behavior for the 4 proteins showing be matured and calcified to receive dental implants. The resorption rates were similar for the 3 groups with 44.2% % for group 1, 37.9% for group 2 and 45.7% for group 3. (p>0.05) In conclusion, the bioactive glass is a good substitute to autogenous bone graft in both proportions evaluated.
Descrição
Palavras-chave
Seio Maxilar, Substitutos Ósseos, Tomografia computadorizada de feixe cônico espiral, Imunno-histoquímica, Implantes dentais, Maxillary Sinus, Bone Substitute, Dental Implants, Cone Bean Computed Tomography, Immunohistochemistry