Efeito da laserterapia e do plasma rico em plaquetas em dentes reimplantados tardiamente: análise histológica, histoquímica e por microtomografia computadorizada
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Data
2017-03-17
Autores
Rabello, Ariele Patricia [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O melhor tratamento para dentes permanentes avulsionados é o reimplante imediato, porém, quando o dente permanece fora do alvéolo por longo período, o prognóstico pode ser prejudicado. Condutas têm sido buscadas na tentativa de melhorar os problemas decorrentes de reimplantes tardios. A laserterapia, devido à sua propriedade anti-inflamatória, e o plasma rico em plaquetas (PRP), devido à liberação de fatores de crescimento, são boas alternativas visando atenuar o processo inflamatório e auxiliar o processo de reparo. Avaliou-se os efeitos da laserterapia, da aplicação do PRP e da associação de ambos sobre o reimplante tardio de incisivos superiores de ratos. Cinquenta animais foram divididos em dez grupos experimentais (n=5): grupo controle onde o incisivo superior direito não recebeu alguma intervenção, e nove grupos onde houve a extração dentária simulando uma avulsão seguida do reimplante após 40 minutos. Em um desses grupos, a polpa foi mantida no canal radicular, e os demais foram submetidos à um protocolo de tratamento, de acordo com a condição da cavidade pulpar (manutenção da polpa, preenchimento com hidróxido de cálcio ou preenchimento com PRP) e tratamento do alvéolo/periodonto (coágulo ou PRP com ou sem laserterapia). As avaliações foram realizadas por meio de análise histológica e histoquímica após 30 dias e por microtomografia computadorizada (micro-CT) sobrepondo-se as imagens dos períodos imediato e 30 dias após o reimplante. Os dados obtidos a partir das avaliações histológica e histoquímica foram analisados pelos testes ANOVA e Tukey e os dados microtomográficos pelos testes Kruskall Wallis e Dunn, com nível de significância 5%. Após análise histológica e histoquímica, verificou-se que não houve diferença estatística significante entre os grupos quanto ao número de clastos/mm de superfície reabsorvida (p > 0,05). Nos grupos onde o PRP foi inserido no alvéolo dentário, independentemente da associação ao laser ou do tratamento intracanal, a porcentagem de reabsorção radicular foi menor do que no grupo que recebeu o tratamento convencional com hidróxido de cálcio intracanal e coágulo no alvéolo -HC/Co (p<0,05). Nos grupos onde o coágulo foi mantido no alvéolo, somente o grupo que foi irradiado com LBI e o canal preenchido com PRP (PRP/Co/L) apresentou índice de reabsorção radicular significativamente menor que o grupo HC/Co (p<0,05). Os resultados obtidos pela análise micro-CT mostraram que o PRP ou LBI empregados isoladamente não ofereceram melhora significativa nos índices de reabsorção radicular de dentes de rato reimplantados tardiamente (p < 0,05). Os grupos que foram tratados com a associação do PRP no alvéolo e com a irradiação com LBI, independentemente do material usado para preencher o canal radicular, apresentaram menos reabsorção radicular em relação ao grupo HC/Co (p < 0,05). Pode-se concluir que a associação PRP e LBI pode se constituir em um protocolo promissor de tratamento de dentes reimplantados tardiamente.
The best treatment for avulsed permanent teeth is immediate replantation, but when the tooth remains outside the alveolus for a long period, the prognosis may be impaired. Pipelines have been sought in an attempt to improve the problems arising from late reimplants. Laser therapy, due to its anti-inflammatory property, and platelet-rich plasma (PRP), due to the release of growth factors, are good alternatives aimed at attenuating the inflammatory process and assisting the repair process. The effects of laser therapy, the application of PRP and the association of both on the delayed replantation of upper incisors of rats were evaluated. Fifty animals were divided into ten experimental groups (n = 5): control group where the right upper incisor did not receive any intervention, and nine groups where the dental extraction was performed simulating an avulsion followed by reimplantation after 40 minutes. In one of these groups, the pulp was maintained in the root canal, and the others were submitted to a treatment protocol, according to the condition of the pulp cavity (pulp maintenance, calcium hydroxide filling or filling with PRP) and treatment of the pulp. Alveolus / periodontium (clot or PRP with or without laser therapy).The evaluations were performed through histological and histochemical analysis after 30 days and by computerized microtomography (micro-CT) overlapping the images of the periods immediately and 30 days after the replantation. The data obtained from the histological and histochemical evaluations were analyzed by the ANOVA and Tukey tests and the microtomographic data by the Kruskall Wallis and Dunn tests, with a significance level of 5%. After histological and histochemical analysis, it was verified that there was no statistically significant difference between groups regarding the number of clasts/mm of resorbed surface (p > 0.05). In the groups where PRP was inserted into the dental alveolus, regardless of the association with the laser or the intracanal treatment, the percentage of root resorption was lower than in the group that received the conventional treatment with intracanal calcium hydroxide and blood clot in the alveolus - HC/Co (P < 0.05). In the groups where the clot was kept in the alveolus, only the group that was irradiated with LBI and the channel filled with PRP (PRP/Co/L) presented a significantly lower root resorption index than the HC/Co group (p < 0.05 ). The results obtained by the micro-CT analysis showed that the PRP or LBI used alone did not offer a significant improvement in the root resorption rates of delayed replanted rat teeth (p < 0.05). The groups that were treated with the association of PRP in the alveolus and with LBI irradiation, regardless of the material used to fill the root canal, presented less root resorption in relation to the HC/Co group (p<0.05). It can be concluded that the association PRP and LBI may constitute a promising protocol for treatment of delayed replanted teeth.
The best treatment for avulsed permanent teeth is immediate replantation, but when the tooth remains outside the alveolus for a long period, the prognosis may be impaired. Pipelines have been sought in an attempt to improve the problems arising from late reimplants. Laser therapy, due to its anti-inflammatory property, and platelet-rich plasma (PRP), due to the release of growth factors, are good alternatives aimed at attenuating the inflammatory process and assisting the repair process. The effects of laser therapy, the application of PRP and the association of both on the delayed replantation of upper incisors of rats were evaluated. Fifty animals were divided into ten experimental groups (n = 5): control group where the right upper incisor did not receive any intervention, and nine groups where the dental extraction was performed simulating an avulsion followed by reimplantation after 40 minutes. In one of these groups, the pulp was maintained in the root canal, and the others were submitted to a treatment protocol, according to the condition of the pulp cavity (pulp maintenance, calcium hydroxide filling or filling with PRP) and treatment of the pulp. Alveolus / periodontium (clot or PRP with or without laser therapy).The evaluations were performed through histological and histochemical analysis after 30 days and by computerized microtomography (micro-CT) overlapping the images of the periods immediately and 30 days after the replantation. The data obtained from the histological and histochemical evaluations were analyzed by the ANOVA and Tukey tests and the microtomographic data by the Kruskall Wallis and Dunn tests, with a significance level of 5%. After histological and histochemical analysis, it was verified that there was no statistically significant difference between groups regarding the number of clasts/mm of resorbed surface (p > 0.05). In the groups where PRP was inserted into the dental alveolus, regardless of the association with the laser or the intracanal treatment, the percentage of root resorption was lower than in the group that received the conventional treatment with intracanal calcium hydroxide and blood clot in the alveolus - HC/Co (P < 0.05). In the groups where the clot was kept in the alveolus, only the group that was irradiated with LBI and the channel filled with PRP (PRP/Co/L) presented a significantly lower root resorption index than the HC/Co group (p < 0.05 ). The results obtained by the micro-CT analysis showed that the PRP or LBI used alone did not offer a significant improvement in the root resorption rates of delayed replanted rat teeth (p < 0.05). The groups that were treated with the association of PRP in the alveolus and with LBI irradiation, regardless of the material used to fill the root canal, presented less root resorption in relation to the HC/Co group (p<0.05). It can be concluded that the association PRP and LBI may constitute a promising protocol for treatment of delayed replanted teeth.
Descrição
Palavras-chave
Reimplante dentário, Plasma rico em plaquetas, Terapia com luz de baixa intensidade, Tooth replantation, Platelet-rich plasm, Low-level light therapy