Demineralized dentin matrix technique - a comparison of different demineralizing solutions

Abstract This study aimed to evaluate the microstructure formed after the chemical treatment of teeth, for the development of autogenous grafts from the demineralized dentin matrix (DDM) technique, in order to identify the most efficient demineralizing solution. The specimens, originating from the root and coronal portion, were submitted to ultrasonic cleaning and drying in an oven for 1h at 100 ºC. Then, the density was determined by Archimedes' principle for each specimen, using distilled water as immersion liquid. The samples were separated into five groups: Control group: negative control, Distilled water;EDTA group: positive control, trisodium EDTA; NaOCl group: 2.5% sodium hypochlorite; HCl-0.6M group: 0.6M hydrochloric acid; and H2O2/H2SO4 group: hydrogen peroxide and sulfuric acid. Each specimen was immersed for 1h in the corresponding group descaling solution at 60 ºC. Subsequently, the mass loss and density of the treated specimens were determined by Archimedes' principle. Ultimately, the specimens of each group were characterized by microtomography, Scanning Electron Microscopy, and Energy Dispersive Spectrometry X-ray (SEM-EDS). The results demonstrated that the H2O2/H2SO4 solution allowed the formation of interconnected micropores, suggesting better pore structures for application in scaffolds, when compared to the other studied solutions.

Resumo Este estudo teve como objetivo avaliar a microestrutura formada após o tratamento químico em dentes, para o desenvolvimento de enxertos autógenos a partir da técnica de matriz de dentina desmineralizada (DDM), a fim de identificar a solução desmineralizante mais eficiente. Os espécimes, provenientes da raiz e porção coronal, foram submetidos à limpeza ultrassônica e secagem em estufa por 1h a 100 ºC. Em seguida, a densidade foi determinada pelo princípio de Arquimedes para cada espécime, utilizando água destilada como líquido de imersão. As amostras foram separadas em cinco grupos: Controle: controle negativo, Água destilada; EDTA: controle positivo, EDTA trissódico; NaOCl: hipoclorito de sódio 2,5%; HCl-0.6M: ácido clorídrico 0,6M; e H2O2/H2SO4: peróxido de hidrogênio e ácido sulfúrico. Cada espécime foi imerso por 1h na solução descalcificante de grupo correspondente a 60 ºC. Posteriormente, a perda de massa e a densidade dos espécimes tratados foram determinadas pelo princípio de Arquimedes. Por fim, os espécimes de cada grupo foram caracterizados por microtomografia, microscopia eletrônica de varredura e espectrometria de energia dispersiva de raios-X (SEM-EDS). Os resultados demonstraram que a solução H2O2/H2SO4 permitiu a formação de microporos interligados, sugerindo melhores estruturas de poros para aplicação em scaffolds, quando comparada às demais soluções estudadas.

Utilização de enxerto autógeno fixado por implantes / Use of autogenous graft fixed by implants / Uso de injerto autógeno fijado mediante implantes

OBJETIVO: Relatar um caso clínico em que foi utilizado enxerto autógeno na região anterior da maxila fixado com implantes. RELATO DE CASO: Paciente do gênero feminino, 46 anos, há 13 anos compareceu à Clínica de Implantodontia do Programa de Pós Graduação da UFPA tendo como queixa principal desconforto estético e dificuldade na mastigação, durante o exame clínico intraoral observou-se a ausência dos elementos 11,12, 21,22 e grande defeito ósseo em formato de U invertido. O tratamento foi dividido em duas etapas: na primeira foi realizada a correção do defeito ósseo em espessura com enxerto ósseo em bloco retirado da região mentoniana, e na segunda etapa foi realizada a correção em altura com enxerto ósseo em bloco retirado do ramo mandibular, na fixação do referido enxerto instalou-se simultaneamente os implantes. Após 13 anos, a paciente retornou para uma consulta de controle e durante a avaliação dos exames clínicos e radiológicos, observou-se que os implantes encontravam-se osseointegrados, sem sintomatologia e com ligeira perda óssea. CONCLUSÃO: Os implantes quando associados ao enxerto autógeno em bloco demonstraram-se eficazes em relação á estética e função no decorrer dos anos... (AU)

OBJECTIVE: To report a clinical case in which autogenous graft was used in the anterior region of the maxilla fixed with implants. CASE REPORT: 13years ago, a 46-year-old female patient, attended the Implantology Clinic of the UFPA Graduate Program with aesthetic discomfort and difficulty chewing as the main complaint, during the intraoral clinical examination, the absence of elements 11, 12, 21, 22 and large bone defect in inverted U format was observed. The treatment was divided into two stages: in the first one, the bone defect was correct in thickness with a block osseum graft removed from the mentionian region, and in the second stage, the correction was performed in height with block bone graft removed from the mandibular branch, and the implants were installed in the fixation of the said graft. After 13 years, the patient returned for a control consultation, and during the evaluation of clinical and radiological examinations, it was observed that the implants were Osseo integrated, without symptomatology and with slight bone loss. CONCLUSION: Implants when associated with autogenou block graft have been shown to be effective in relation to aesthetics and function over the years... (AU)

OBJETIVO: Relatar un caso clínico en que fue utilizado injerto autógeno en la región anterior de la maxila fijado con implantes. CASO CLÍNICO: Paciente del género femenino,46 años, compareció a Clínica de Implantología del Programa de Post-Graduación de la UFPA teniendo como queja principal, el malestar estético y la dificultad para masticar, durante el examen clínico intraoral, se observó la ausencia de elementos 11,12,21,22 y grande defecto óseo en formato U invertida. El tratamiento fue dividido en dos etapas: en la primera fue realizada la corrección de lo defecto óseo en espesor con material retirado de la región mentoniana, y en la segunda etapa fue realizada la corrección en altura con injerto óseo retirado de la rama mandibular, en la fijación de dicho injerto, se instalaron los implantes simultáneamente. Después de 13 años, el paciente retornó para una consulta de control, y durante la evaluación de los exámenes clínicos y radiológicos, se observó que los implantes estaban osteointegrados, sin sintomatología y con ligera pérdida ósea. CONCLUSIÓN: Los implantes cuando asociados el injerto de bloqueo autógeno se demostraron eficaces en relación con la estética y la función, en el trascurso de los años... (AU)

Bone formation in maxillary sinus lift using autogenous bone graft at 2 and 6 months / Formación ósea en elevación de seno maxilar usando injerto óseo autógeno a los 2 y 6 meses

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

El objetivo de este estudio es comparar la formación ósea en técnicas de elevación de seno maxilar utilizando injerto óseo autógeno en evaluaciónhistológica a las 2 y 6 meses. Un estudio comparativo fue diseñado donde 10 pacientes con dientes perdidos de forma bilateral en el sector posterior de maxila fueron incluidos. Los pacientes recibieron injerto óseo particulado bajo las mismas condiciones quirúrgicas, seleccionando el sitio para tomar la biopsia y el análisis histológico respectivo a los 2 meses en un lado y 6 meses en el lado contralateral. La histomorfometría se realizó y fueron utilizadas la prueba de Kolmogorov-Smirnov, la prueba t de student y la prueba de Spearman, considerando un valor de p<0,05. Fueron observadas diferencias en infiltrado inflamatorio y características de vascularización; sin embargo, los grupos analizados a los dos meses presentaron 38.12% ± 6.64% de tejido mineralizado, mientras que los grupos de estudio a los 6 meses presentaron en promedio 38.45 ± 9.27%. No se observo diferencias significativas entre los grupos. Se concluye que la formación ósea puede ser similar en elevaciones de seno maxila realizada con hueso autógeno particulado a los dos o seis meses; en estas condiciones, la instalación temprana de implantes puede ser viable.

Treatment of Dehiscence during Implant Placement using Intraoral Ledge Bone Autograft: A Case Report.

Dental implants are established substitutes for replacing missing teeth. For the successful implant placement, the volume of adequate bone at the recipient site is absolutely essential. Peri-implant dehiscence defects are most often encountered at the site of implant placement that requires bone augmentation. These defects may range from very small lack of marginal bone to large areas of denuded implant surfaces. Recent clinical studies have demonstrated that the application of autogenous bone grafts in conjunction with placement of implants leads to successful coverage of the previously exposed implant surfaces. The present case report highlights the bone augmentation of the peri-implant dehiscence defect by intraoral autogenous bone graft while performing the first-stage implant surgery for multiple edentulous areas.

Autoinjerto a corta distancia en la seudoartrosis del antebrazo / Short-distance auto-graft in forearm pseudoarthrosis

INTRODUCCIÓN. Son objetivos de esta presentación investigar sobre el comportamiento de un grupo de variables encontradas en los pacientes intervenidos quirúrgicamente por seudoartrosis de los huesos del antebrazo mediante autoinjerto a corta distancia, conocer el tipo de lesión traumática previa a la seudoartrosis y evaluar los resultados en la casuística estudiada. MÉTODOS. Se realizó un estudio descriptivo de los pacientes con diagnóstico de seudoartrosis del antebrazo, atendidos en la consulta de ortopedia del Hospital General Docente Dr. Ernesto Guevara de la Serna y del Hospital Nacional de Dili (Timor Leste), en el período comprendido entre enero del 2004 y enero del 2008. Se tomó una muestra de 38 pacientes. RESULTADOS. La seudoartrosis del antebrazo resultó ser más frecuente en las edades comprendidas entre los 41 y 50 años (15 pacientes) y hubo predominio del sexo masculino. Las localizaciones más frecuentes fueron los huesos del antebrazo, especialmente el cúbito (26 pacientes). Es importante destacar que en 5 pacientes se diagnosticó la seudoartrosis en ambos huesos del antebrazo. Solamente 5 pacientes evolucionaron tórpidamente y alrededor del 87 por ciento de los pacientes evolucionaron de forma satisfactoria. CONCLUSIONES. El autoinjerto a corta distancia mostró resultados buenos en 22 pacientes (57,9 por ciento), lo cual demuestra la utilidad de la técnica quirúrgica con el uso de injerto autógeno

INTRODUCTION: The aims of present presentation is to research on the behavior of a group of variables founded in patients operated on due to pseudoarthrosis of he forearm at short-distance to know the type of traumatic lesion previous to pseudoarthrosis and to assess the results from the study cases. METHODS: A descriptive study was conducted in patients diagnosed with forearm pseudoarthrosis in Orthopedics consultation of "Dr. Enrneto Guevara de la Serna" Hospital and the "Dili NationalHospital" (Timor Lester) during January, 2004 and January, 2008. Sample included 38 patients. RESULTS: Forearm pseudoarthrosis is more frequent in ages between 41 and 50 years old (15 patients) with a predominance of male sex. The more frequent locations were the forearm bones, specially the cubitus (26 patients). It is important to emphasize that in 5 patients the pseudoarthrosis was diagnosed in both bones of forearms. Only 5 patients evolved in a torpid way and around the 87 percent of patients evolved in a satisfactory way. CONCLUSIONS: The short-distance autograft showed good results in 22 patients (57,9 percent) demonstrating the usefulness of surgical technique using autogenous graft

RÉSUMÉINTRODUCTION. Le but de cette présentation est d'examiner le comportement d'un groupe de variables rencontrées chez des patients traités par autogreffe à petite distance, dû à une pseudarthrose des os de l'avant-bras; de connaître le type de lésion traumatique préalable à la pseudarthrose, et d'évaluer les résultats dans la casuistique étudiée.MÉTHODES. Une étude descriptive des patients diagnostiqués de pseudarthrose de l'avant-bras, et traités au Service d'orthopédie de l'hôpital général universitaire « Dr. Ernesto Guevara de la Serna» et de l'hôpital national à Dili (Timor de l'est), dans la période comprise entre janvier 2004 et janvier 2008, a été réalisée. L'échantillon a compris 38 patients.RÉSULTATS. La pseudarthrose de l'avant-bras a été l'affection la plus fréquemment trouvée dans la tranche d'âge de 41-50 ans (15 patients), et il y a eu une prédominance du sexe masculin. Cette anomalie a été souvent localisée au niveau des os de l'avant-bras, notamment l'os cubitus (26 patients). Il est important à souligner que cinq patients ont été diagnostiqués de pseudarthrose au niveau des deux os de l'avant-bras. Cinq patients seulement ont évolué de façon torpide, et 87percent de patients environ ont évolué de façon satisfaisante.CONCLUSIONS. L'autogreffe à petite distance a montré de bons résultats chez 22 patients (57,9 percent), ce qui démontre l'efficacité de cette technique chirurgicale avec l'emploi du greffon autogène.

Rhinoplasty using Various Autogenous Tissues

PURPOSE: In Korean rhinoplasty, alloplasts such as silicone rubber have been used for dorsal and tip augmentations. However, alloplasts have produced complications such as deviation, exposure, and infection. Although autogenous tissue is an ideal material, the amount of the cartilage in Korean is not sufficient. Therefore, the authors developed a method to harvest the maximum amount of the septal and conchal cartilage. The authors first performed a complete septal extension graft for short and retruded columella and then performed nasal augmentation using various autogenous tissues. METHODS: These surgical techniques were performed on 11 patients. Their average age was 27 years. An open approach with a V-shaped columellar labial incision was performed. At first, the complete septal extension graft was fixed on the entire caudal margin of the septum, and the alar cartilage was suspended to the septal extension graft to make the tip projected and the columella advanced caudally. A temporal fascial ball was used for radix augmentation. For dorsal augmentation, a batten-shaped septal cartilage graft wrapped with or without the temporal fascia or a diced cartilage graft wrapped with the temporal fascia was performed. For nasal tip augmentation, a shield graft and a cap graft or a folded conchal cartilage graft was performed. RESULTS: The mean follow-up period was 11.2 months. The overall results were natural and satisfactory. Two patients underwent slight absorption and caudal displacement. With the exception of these cases, no complications were observed. CONCLUSION: Korean rhinoplastic surgeons are accustomed to using the alloplasts despite of serious complications. When rhinoplasty using autogenous tissue was performed, some complications occurred such as the displacement of the diced cartilage graft wrapped with the fascia, but many of the complications of alloplastic rhinoplasty were avoided. Therefore, we propose that by this time Korean rhinoplastic surgeons need to change their preference from alloplastic rhinoplasty to autogenous rhinoplasty.

Estado actual del manejo de recesiones gingivalesmediante cirugía plástica periodontal / Current status of the management of gingival recession by periodontal plastic surgery

El término cirugía mucogingival ha sido introducido desde los años 50. A partir de este momentose ha publicado una variedad de literatura relacionada con el tema. Es frecuente observar como los pacientes relatan preocupación ante la presencia de recesiones gingivales que generan incomodidades como: demanda estética, hipersensibilidad, caries radicular y pérdida dental. Para corregir estos inconvenientes se ha llevado a cabo procedimientos que han ayudado a tener una correcta predecibilidad de los resultados. Es importante realizar un buen diagnóstico preoperatorio delas características de la zona afectada y las condiciones generales de cada paciente. De esta manera podremos seleccionar la técnica más adecuada para cada caso, asegurar el éxito del tratamiento y el bienestar de los pacientes.

The term muco-gingival surgery was introduced in the 1950s. Since then, many studies and literature reports have been published on the subject. Patients frequently report concern on the presence of gingival recessions which create problems such as esthetic compromise, hypersensitivity, root cavities and tooth loss. In order to overcome these problems, different procedures have been reported aimed at predicting the results. It is important to establish an adequate diagnosis of the characteristics of the affected area and the general condition of each patient. This will allow an adequate selection of the most appropriate technique for each case, ensuring success of treatment and comfort for patients.

Plasma rico em plaquetas para reparação de falhas ósseas em cães / Platelet-rich plasma for canine bone restoration

As plaquetas chegam rapidamente ao local da ferida e liberam múltiplos fatores de crescimento (FC) e citocinas que contribuem para a reparação óssea e aumentam a vascularização local. O Plasma Rico em Plaquetas (PRP) concentra as plaquetas e os FC liberados por elas, aceleram a formação óssea e melhora a qualidade do trabeculado. Este trabalho apresenta um protocolo para confecção de PRP e demonstra alguns aspectos da sua utilização na reparação óssea de cães. O protocolo foi desenvolvido a partir de sangue coletado por punção jugular em três cães adultos, pesando em média 20kg. Para avaliação da aplicação clínica e dos aspectos da reparação óssea, foram criadas duas falhas mediais no terço proximal de cada tíbia. Assim, a falha 1 não foi preenchida, constituindo o controle, a falha 2 foi preenchida com 3mg de enxerto ósseo autógeno da crista da tíbia, a falha 3 com gel de plaquetas (PRP) e falha a número 4 com a associação PRP e 3mg de enxerto ósseo autógeno. O protocolo laboratorial proposto mostrou-se de fácil execução e de baixo custo e possibilitou a concentração adequada de plaquetas no PRP final, cujo número foi dependente da contagem inicial no sangue total de cada animal. A comparação da radiopacidade na região da falha, em todos os tratamentos, e ao longo do tempo demonstrou que o PRP associado ao enxerto determinou maior precocidade e uniformidade de radiopacidade, quando comparado à falha preenchida pelo PRP e ao enxerto usados isoladamente, e sendo que ambos determinam melhores resultados de preenchimento que a falha mantida sem tratamento.

The platelets arrive quickly at the injury site and release several growth factors (GF) and citokines that contribute to bone repair and increasing local vascularization. The Platelet-rich Plasma (PRP) concentrates the platelets and their growth factors, increasing the rate of bone formation and better quality of trabecular bone. This research presents a protocol to PRP formulation and demonstrates some aspects about the use in canine bone repair. In this protocol blood was obtained from the jugular ven of tree adult dogs with medium weight of 20kg to produce PRP. Two defects in the medial aspect of proximal third of the tibia were surgically created to evaluate the clinical and radiographic aspect of PRP. The control defect wasn’t treated.The defect 2 was filled with 3 mg of autogenous bone graft from the tibia crest. The defect 3 was filled with PRP alone and the number 4 with PRP in the combination with 3mg autogenous bone graft. The proposed laboratory protocol demonstrated to be easy to execute at low cost. Further, it was adequate to concentrate platelets in final PRP, whose number was dependent on the blood from each dog. Comparing the defect regions, was concluded that the association of PRP and bone graft showed greater precocity and uniform radiopacity than the PRP or bone graft isolated, although both determine better results than the defect without treatment.

Dorsal Augmentation in Secondary Rhinoplasty

Two most common pathologic mechanisms which cause secondary rhinoplasty are related with nasal framework and it's envelope. The reasonable definition defining key features of the secondary rhinoplasty 'Scarred nasal soft tissue envelope overlying adherent and distorted nasal framework' gives full explanation about main deformities in the secondary rhinoplasty, and leads us to focus on reconstructing and reinforcing both structures when the secondary rhinoplasty is performed. Moreover, artificial alloplastic implants and injectable materials, popularly used for augmentation rhinoplasty, erode skin and give damages to skin and appendages. It is, therefore, essential to understand the importance of skin problem and to know that one must be ready to suffer from another more difficult operations and its unpredictable results, unless it is properly reinforced. I have used several autogenous materials (n=294) and two kinds of xenografts (n=35) in the secondary rhinoplasties during the last 8 years for reinforcing the envelopes in pathologic conditions and augmenting the dorsal volume. I have learned a lesson from these 8 years of experience about dorsal augmentation in secondary rhinoplasty. 1) Even though it seems to be time consuming and annoying to harvest and prepare autogenous graft materials, no xenografts or artificial materials are safer and more consistent than autogenous materials, and no convenience is more valuable than consistency and safety in secondary rhinoplasty. 2) If you need to augment nasal dorsum in secondary rhinoplasty, get the permission from the nasal envelope. 3) Remind this aphorism: Alloplastics are only convenient on the day of surgery.

Anterior Fusion with Corpectomy and Autogenous Iliac Graft for Cervical Kyphosis in Neurofibromatosis: A case report / 대한척추외과학회지

Scoliosis is the most common deformity of the spine in neurofibromatosis patient, but kyphosis of the cervical spine has rarely been reported. Most authors have reported anterior corpectomy and multilevel interbody grafting and plate osteosynthesis, combined with posterior arthrodesis, as the treatment of cervical kyphosis in neurofibromatosis. A case is presented of a 17-yearold boy with neurofibromatosis Who had 52 degrees of dystrophic kyphosis (as measured on radiographs between C3 and C7) of the cervical spine. He was treated successfully by anterior multilevel interbody grafting using an autogenous iliac bone graft. Anterior corpectomy and arthrodesis appears to provide another surgical option with a moderate degree of cervical kyphosis.

Autogenous Temporalis Fascia Graftin Exposure of Hydroxyapatite Implant

Hydroxyapatite recently has been used for its excellent results compared with other implant materials, but the tissue breakdown and exposure of the hydroxyapatite implant was reported due to hemorrhage or infection. Five patients with exposed hydroxyapatite implant after evisceration or enucleation were studied.The hydroxyapatite implant exposure occurred in 2 to 8 weeks (mean 4.2 weeks)after implantation.Conjunctival defects with various sizes were noted in all cases and purulent discharge in one case. An autogenous temporalis fascia patch graft was placed instead of preserved sclera or fascia lata for the intensification of the defect area.No reexposure occurred during a follow-up examination and we could keep the implant well in all cases. The temporalis fascia is advantageous over preserved sclera or fascia lata because it is firm and can be easily obtained from the same operative field as the primary surgery.Therefore, it is thought to be suitable for graft material in surgery of the exposed hydroxyapatite.No scars are visible after obtaining temporalis fascia.