Preservação da arquitetura tecidual de alvéolos com defeito ósseo vestibular: análise clínica e tomográfica de uma série de casos
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Data
2016-03-31
Autores
Segnini, Bruno [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi avaliar em humanos a preservação do contorno do tecido ósseo e gengival após a exodontia e enxertia com matriz de colágeno suíno (mucograft), membrana de colágeno (suíno) e osso bovino desproteinizado associado a colágeno suíno (collagen). Foram selecionados 6 pacientes provenientes da clínica da Faculdade de Odontologia de Araraquara que possuíam um pré-molar, canino ou incisivo superior indicado para exodontia e que apresentaram defeito ósseo vestibular. Todos os alvéolos receberam enxerto com matriz de colágeno suíno, membrana de colágeno e osso bovino desproteinizado acrescido de colágeno. Os dados clínicos e fotográficos foram coletados ao início do estudo, aos 7, 15, 30 e 120 dias após o procedimento cirúrgico. Foram realizados exames clínicos referentes ao aspecto da área operada, altura e espessura de gengiva queratinizada, nível gengival, biotipo gengival, assim como mensurações digitais da altura de margem gengival, e das papilas mesial e distal. Para verificação da estrutura óssea e gengival inicial e após os enxertos foram realizados exames tomográficos no início do estudo e após quatro meses do procedimento cirúrgico inicial. Os resultados mostraram que a técnica promoveu um ganho de osso vestibular, dessa forma foi concluído que a manutenção do alvéolo com a associação da matriz de colágeno suíno, membrana de colágeno e osso bovino desproteinizado promoveu boa estabilidade do volume do alvéolo com aumento do osso associado a parede vestibular, entretanto, serão necessários estudos clínicos controlados e randomizados para entender o real benefício dessa técnica em comparação a outras técnicas de manutenção do volume alveolar anteriormente propostas.
The purpose of this case-series trial was to evaluate the maintenance of the soft and hard tissues margins after tooth-extraction and grafting with a combination of the following materials: demineralized bovine bone associated with pig-collagen; pig-collagen membrane; and pig-collagen matrix. For this study six patients were selected among those who attended to the Araraquara Dental School Clinics throughout the last six months of 2015; they all had a pre-molar, canine or incisive tooth with buccal bone loss, which needed to be extracted. All the sockets were grafted with a combination of the same biomaterials: demineralized bovine bone associated with pig-collagen; pig-collagen membrane; and pig-collagen matrix. Clinical and photographic data were collected at base line, 7, 15, 30 and 120 days after surgery. Clinical assessments of the surgical site included keratinized mucosa height and thickness; gingival level; gingival biotype; as well as digital measurements of the gingival margin and both proximal papillae heights. In order to assess changes at the gingival and bone structures, cone-beam tomographic examinations were carried out at baseline and 4 months after surgery. Results showed buccal bone gain as this reconstructive technique was employed, so it was concluded that the treatment with demineralized bovine bone associated with pig-collagen, combined with pig-collagen membrane and pig-collagen matrix promoted satisfactory socket volume maintenance with associated buccal wall bone gain. Further randomized-clinical-controlled studies, however, need to be carried out in order to investigate the actual advantages of this approach when compared to other socket-volume-maintenance techniques previously described in the literature.
The purpose of this case-series trial was to evaluate the maintenance of the soft and hard tissues margins after tooth-extraction and grafting with a combination of the following materials: demineralized bovine bone associated with pig-collagen; pig-collagen membrane; and pig-collagen matrix. For this study six patients were selected among those who attended to the Araraquara Dental School Clinics throughout the last six months of 2015; they all had a pre-molar, canine or incisive tooth with buccal bone loss, which needed to be extracted. All the sockets were grafted with a combination of the same biomaterials: demineralized bovine bone associated with pig-collagen; pig-collagen membrane; and pig-collagen matrix. Clinical and photographic data were collected at base line, 7, 15, 30 and 120 days after surgery. Clinical assessments of the surgical site included keratinized mucosa height and thickness; gingival level; gingival biotype; as well as digital measurements of the gingival margin and both proximal papillae heights. In order to assess changes at the gingival and bone structures, cone-beam tomographic examinations were carried out at baseline and 4 months after surgery. Results showed buccal bone gain as this reconstructive technique was employed, so it was concluded that the treatment with demineralized bovine bone associated with pig-collagen, combined with pig-collagen membrane and pig-collagen matrix promoted satisfactory socket volume maintenance with associated buccal wall bone gain. Further randomized-clinical-controlled studies, however, need to be carried out in order to investigate the actual advantages of this approach when compared to other socket-volume-maintenance techniques previously described in the literature.
Descrição
Palavras-chave
Cirurgia bucal, Transplante ósseo, Perda do osso alveolar