Aesthetic effect evaluation of the xenogeneic collagen matrix in keratinized mucosa augmentation around dental implants / 口腔疾病防治

Objective@#To evaluate the stability and aesthetic effect of a xenogeneic collagen matrix (mucograft) on achieving an adequate keratinized mucosa width (KMW) around implants and to provide a reference basis for the clinical application of xenogeneic collagen matrix materials.@*Methods@#The hospital ethics committee approved the study protocol, and the patients provided informed consent. Twenty patients with a KMW<2 mm at the buccal implant site who were treated in Binzhou Medical University Affiliated Yantai Stomatological Hospital from July 2020 to September 2022 were included, and a total of 36 implants were included. The mean age of the patients was (52.0±10.4) years, of which 18 were females and 2 were males. They were divided into a free gingival graft group (FGG, control group) and a xenogeneic collagen matrix group (test group) according to different graft materials. The incremental effect of the KMW on the buccal side of the implant and the mucosal shrinkage rate was measured at 1 month and 3 months after the operation. The mucosal scar index (MSI) was evaluated after the operation.@*Results@#At 3 months postoperatively, the KMW was (3.67 ± 1.06) mm in the control group and (2.96 ± 0.98) mm in the test group, and the difference was statistically significant (t = 2.076, P<0.05). The KMW shrinkage rate was (33.34 ± 16.30) % in the test group and (22.05 ± 15.47) % in the control group at 1 month postoperatively and (51.95 ± 12.60) % in the test group and (37.44 ± 16.30) % in the control group at 3 months postoperatively, with statistically significant differences between the two groups at the same time points (P<0.05). Three months after surgery, the test group showed significantly better outcomes than the control group in terms of the five scar indicators (scar width, scar convexity, scar color, scar trace, and overall appearance), and the difference was statistically significant (P<0.05).@*Conclusion@#Xenogeneic collagen matrix can increase the peri-implant KMW and achieve a more natural and coordinated soft tissue aesthetic effect but with a higher shrinkage rate.

Evidencia clínica e histológica de regeneración de tejido blando a partir de una matriz colágena porcina. Reporte de Caso

RESUMEN: La pérdida de un diente resulta en la pérdida de volumen de tejidos duros y blandos lo que dificulta lograr resultados estéticamente satisfactorios. Con el fin de disminuir la morbilidad que provoca un injerto autólogo en el sellado del alveolo se puede reemplazar por una matriz reabsorbible de colágeno. El presente reporte de caso evaluó clínica e histológicamente una matriz colágena de porcino, en la regeneración de tejido blando, durante la instalación de un implante inmediato a una extracción dentaria. A los 6 meses clínicamente se obtuvo un tejido con una apariencia estética final óptima e histológicamente se evidenció la formación de un tejido epitelial y conjuntivo compatible con la de una mucosa normal.

ABSTRACT: Tooth loss results in loss of hard and soft tissue volume, making it difficult to achieve aesthetically pleasing results. In order to decrease the morbidity caused by an autologous graft in the alveolus seal, it can be replaced by a resorbable matrix of collagen. The present case report evaluated clinically and histologically a porcine collagen matrix, in soft tissue regeneration, during the installation of an implant immediately after dental extraction. At 6 months, clinically, a tissue with an optimal final aesthetic appearance was obtained and histologically, the formation of an epithelial and connective tissue compatible with that of a normal mucosa was evidenced.

Incidence of complications following non-watertight dural reconstruction with a non-suturable, absorbable collagen matrix onlay graft in elective cranial surgery

Background: Collagen matrices are effective duraplasty grafts with increasing acceptability. However, little evidences exits for dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Purpose of our retrospective analysis was to advance our understanding of the use of semisynthetic collagen as dural substitute in elective cranial surgery.Methods: A consecutive series of sixty patients who underwent elective cranial surgery, where non-watertight dural reconstructions were done with a non-suturable, absorbable collagen matrix onlay graft, has been analysed retrospectively.Results: Overall, the most common indication for duraplasty was tumor resection (93.3%). CSF leak rate was 10.0%. Incidence of aseptic meningitis was 8.3% and all cases has been resolved with steroids alone. Similarly, postoperative surgical site infection rate was 8.3%. Incidence of pseudomeningocele in follow-up was 6.7%. Only in one case (1.7%), permanent CSF (cerebrospinal fluid) diversion was needed due to troublesome CSF leak with associated hydrocephalus.Conclusions: Semisynthetic, monolayer collagen matrix used as an onlay dural graft is a simple, yet an attractive alternative in duraplasty due to their easy handling, lower surgical time, and high biocompatibility, where primary dural closure is undesirable or not feasible. Our study provides greater insight into non-water tight duraplasty procedure.  However, further study is needed to determine the optimal strategy for dural reconstruction. Data from this study may be used to compare alternative methods of dural reconstruction in elective cranial surgery.

Comparação do enxerto de tecido conjuntivo e de uma matriz de colágeno xenógena no recobrimento radicular de recessões gengivais unitárias em fenótipo gengival fino / Comparison of connective tissue graft and a xenogeneic collagen matrix in root coverage of single gingival recessions in thin gingival phenotype

As recessões gengivais podem causar hipersensibilidade dentinária, desconforto estético e aumentar a prevalência de cáries ou lesões cervicais não-cariosas. Cirurgias para recobrimento radicular associadas a enxertos têm sido consideradas padrão ouro no tratamento das recessões gengivais. OBJETIVO: Comparar o enxerto de tecido conjuntivo e uma matriz de colágeno xenógena no recobrimento radicular de recessões gengivais unitárias em fenótipo gengival fino, em 6 meses de acompanhamento. METODOLOGIA: Este ensaio clínico, controlado, randomizado, duplo cego, de boca dividida, avaliou 28 pacientes com recessões gengivais bilaterais submetidos à cirurgia para recobrimento radicular, através do retalho estendido associado ao enxerto de tecido conjuntivo subepitelial (grupo controle) e matriz de colágeno (grupo teste). Os parâmetros avaliados foram profundidade de sondagem, recessão gengival, nível clínico de inserção, mucosa ceratinizada e sangramento à sondagem tanto dos dentes que receberam os enxertos, como dos dentes distais e mesiais a esse. Além de espessura gengival e alteração do fenótipo gengival dos dentes que receberam os enxertos, dor pós-operatória e qualidade de vida, através do Oral Health-Related Quality of Life, no baseline, três e seis meses após a cirurgia. Os dados foram analisados estatisticamente através dos testes de Friedman, Wilcoxon, Mann-Whitney, Qui-quadrado, McNemar, ANOVA e teste t, sendo pré-estabelecido um nível de significância de 5%. RESULTADOS: 14 homens e 14 mulheres foram incluídos, com uma média de idade de 30,3 (± 6,2) anos. Foram observadas reduções estatisticamente significativas para a recessão gengival e ganho significativo do nível clínico de inserção tanto dos dentes que receberam os enxertos (p<0,001), como dos dentes distais (p=0,001) e mesiais (p<0,001), na análise intragrupo, em ambos os grupos de tratamento, nos períodos avaliados. Além disso, houve aumento significativo da mucosa ceratinizada (p<0,001) e espessura gengival (p<0,001) para os grupos teste e controle, respectivamente, com diferença significativa entre os grupos de tratamento. O protocolo de tratamento proposto também foi capaz melhorar a qualidade de vida (p<0,001). CONCLUSÃO: Ambos os tratamentos resultaram em melhoria dos parâmetros clínicos avaliados em seis meses de acompanhamento. A matriz de colágeno representa uma excelente alternativa ao enxerto de tecido conjuntivo subepitelial no tratamento de recessões gengivais unitárias em fenótipo gengival fino (AU).

Gingival recession may cause dental hypersensitivity, esthetical discomfort and increase the prevalence of carious or non-carious cervical lesion. Root coverage procedures using grafts placement has been the gold standard on this treatment. AIM: To compare the root coverage performed connective tissue graft and collagen matrix using the extended flap technique in single gingival recessions in thin gingival phenotype, at 6 months of follow- up. METHOD: This controlled, randomized, double-blind, split-mouth, clinical trial evaluated 28 patients with bilateral gingival recession subjected to root coverage procedure through extended flap technique with subepithelial connective tissue graft (control) and xenogenic collagen matrix (test). The parameters evaluated were deep on probing, gingival recession, clinical attachment level, keratinized mucosa and bleeding on probing for teeth that received the graft and the distal and mesial teeth. In addition, gingival thickness and gingival phenotype change of the teeth that received the grafts, postoperative pain and quality of life through Oral Health-Related Quality of Life, at baseline, three and six months after surgery. The data were statistically analyzed through the tests of Friedman, Wilcoxon, Mann-Whitney, Qui-quadrado, McNemar, ANOVA and t Test. The significance level of 5% was pre-estlablished. RESULTS: 14 men and 14 women were included, with an average of 30.3 years (± 6.2). Statistically significant reductions were observed for gingival recession and clinical attachment level significant increase of both teeth of the grafts (p <0.001), distal (p=0.001) and mesial (p<0.001) teeth, within each group and in both treatment groups, during the follow-up. In addition, there was keratinized mucosa significant increase (p <0.001) and gingival thickness (p<0.001) for test and control group, respectively, with statistical difference between groups. The treatment protocol was able to improve the quality of lite (p<0.001). CONCLUSION: Both treatments resulted in improved clinical parameters at six months of follow-up. The collagen matrix represents an excellent alternative to the subepithelial connective tissue graft in the treatment of single gingival recessions in thin gingival phenotype (AU)

Short-term clinical efficacy of a collagen matrix and free gingival graft in augmenting keratinized mucosa around dental implants / 中华口腔医学杂志

Objective@#To compare the short-term outcomes of a collagen matrix (CM) and free gingival graft (FGG) in augmenting keratinized mucosa around dental implants.@*Methods@#Nineteen partially edentulous patients who had undergone implant surgery or implant review from June 2017 to June 2018 at Department of Periodontology, Peking University School and Hospital of Stomatology with lack of keratinized mucosa at buccal aspect of implants (<2 mm) were recruited in this study. According to the width of keratinized mucosa (KW) pre-operation, 9 patients including 5 males and 4 females were assigned into control group (KW<0.5 mm) which performed free gingival graft (17 implants) and 10 patients including 3 males and 7 females were assigned into experimental group (KW≥0.5 mm) which used collagen matrix as the grafts (15 implants). The KW at buccal aspect of each implant were measured pre-operation and 2 weeks, 1 month, 2 months, 3 months after surgery respectively. Each of the patients was required to fill out a questionnaire using a visual analogue scale to assess the postoperative morbidity.@*Results@#The KWs around implants were increased significantly during the 3 months follow-up period in both groups (P<0.01). At 3 months after surgery, KW gain in control group was (3.44±1.64) mm, in experimental group was (2.30±0.82) mm, the difference between two groups was statistically significant (P<0.05). Meantime, the total shrinkage of KW in control group [(34±25)%] and experimental group [(51±11)%] also showed a statistically significant difference (P<0.01). However, by using collagen matrix as the grafts, augmented tissues had a much more comparable appearance with adjacent tissues than that in control group. And the patients of experimental group experienced much less postoperative bleeding than those of control group.@*Conclusions@#Both collagen matrix and free gingival graft can significantly increase the KW around implants within the 3 months post-surgery follow-up period. There were more KW gain and less shrinkage in group FGG than that in group CM. However, surgery time were reduced and the postoperative bleeding were less in group CM than in group FGG as no harvesting procedure was needed.

Periodontal healing using a collagen matrix with periodontal ligament progenitor cells in a dehiscence defect model in beagle dogs

PURPOSE: To histologically characterize periodontal healing at 8 weeks in surgically created dehiscence defects in beagle dogs that received a collagen matrix with periodontal ligament (PDL) progenitor cells. METHODS: The bilateral maxillary premolars and first molars in 6 animals were used. Standardized experimental dehiscence defects were made on the buccal side of 3 premolars, and primary culturing of PDL progenitor cells was performed on the molars. Collagen matrix was used as a scaffold and a delivery system for PDL progenitor cells. The experimental sites were grafted with collagen matrix (COL), PDL progenitor cells with collagen matrix (COL/CELL), or left without any material (CTL). Histologic and histomorphometric analyses were performed after 8 weeks. RESULTS: The defect height from the cementoenamel junction to the most apical point of cementum removal did not significantly differ across the CTL, COL, and COL/CELL groups, at 4.57±0.28, 4.56±0.41, and 4.64±0.27 mm (mean ± standard deviation), respectively; the corresponding values for epithelial adhesion were 1.41±0.51, 0.85±0.29, and 0.30±0.41 mm (P<0.05), the heights of new bone regeneration were 1.32±0.44, 1.65±0.52, and 1.93±0.61 mm (P<0.05), and the cementum regeneration values were 1.15±0.42, 1.81±0.46, and 2.57±0.56 mm (P<0.05). There was significantly more new bone formation in the COL/CELL group than in the CTL group, and new cementum length was also significantly higher in the COL/CELL group. However, there were no significant differences in the width of new cementum among the groups. CONCLUSIONS: PDL progenitor cells carried by a synthetic collagen matrix may enhance periodontal regeneration, including cementum and new bone formation.

Encapsulated Bleb Excision with Collagen Matrix Implantation Following Failed Ahmed Glaucoma Valve Implantation

PURPOSE: To investigate the clinical features and surgical outcomes of encapsulated bleb excision with collagen matrix implantation performed in patients with failed Ahmed glaucoma valve (AGV) implantation. METHODS: Eighteen eyes of 18 patients underwent encapsulated bleb excision and collagen matrix implantation. Patients were divided into two groups by reference to intraocular pressure (IOP) after preoperative ocular massage: group 1, patients who exhibited substantial IOP reductions; and group 2, patients who did not show substantial changes in IOP. Needling was conducted in group 2. The clinical features of the two groups were compared, including IOP changes after ocular massage and needling, AGV status, and surgical outcomes 6 months after surgery. RESULTS: The mean preoperative IOP among the 18 patients was 30.6 ± 5.7 mmHg. After ocular massage, the IOPs decreased by 22 and 26 mmHg in the two patients in group 1 and the 16 patients in group 2 showed a mean IOP reduction of 1.6 ± 2.2 mmHg (p = 0.013). IOPs decreased after needling in group 2 (range, 6 to 30 mmHg; p < 0.001). Fibrovascular tissue ingrowth into the AGV was observed in the two patients in group 1 and the same ingrowth was observed in 10 of the 16 patients in group 2. Six months after surgery the mean IOP among the 18 patients decreased significantly (19.1 ± 3.2 mmHg, p < 0.001). There was no significant difference in the mean postoperative IOP at 6 months between group 1 (14.0 ± 2.8 mmHg) and group 2 (19.8 ± 2.6 mmHg, p = 0.052). CONCLUSIONS: Encapsulated bleb excision with collagen matrix implantation resulted in a significant IOP-lowering effect 6 months after surgery. Fibrovascular ingrowth into the AGV was common but did not seem to be a major cause of AGV implantation failure.

O uso da matriz colágena porcina na reconstrução tecidual em Periodontia / The use of the porcin collagen matrix in the periodontal tissue reconstruction

A doença periodontal causa uma perda na estrutura de suporte dos elementos dentários. Como consequência, ocorre o aparecimento de sequelas provenientes dessa doença. Por conta disso foram desenvolvidos materiais com a fi nalidade de regeneração tecidual na estrutura de suporte, para que houvesse maior sobrevida desses elementos, aumento na quantidade de gengiva inserida e melhor otimização estética para os pacientes. Dentre os inúmeros materiais, temos a Matriz Colágena Porcina, que simplesmente é uma membrana obtida a partir de suínos, sendo que esta passa por uma cadeia de procedimentos, com a fi nalidade de minimizar e/ou eliminar qualquer tipo de interação alergênica no ser humano. A sua utilização é dada principalmente no aumento de tecidos moles ao redor de dentes afetados com a doença periodontal e em implantes osseointegrados, trazendo como principal vantagem a redução de morbidade do paciente, evitando, assim, a necessidade de um segundo sítio cirúrgico.

Periodontal disease results in the loss of structural support on dental elements. As such, sequels can be seen in the mouth. For this, materials were develop for tissue regeneration in order to increase the amount of attached gingiva and to optimize patient esthetics. The porcine collagen matrix is a product were the collagen undergoes a series of several treatments to minimize any type of allergic reaction to the human body. For example, it can be used for soft tissue augmentation around affected teeth and dental implants. Also, the porcine collagen matrix can reduce patient morbidity because it avoids autologous soft tissue harvesting.

Tratamento das retrações gengivais unitárias classes I e II de miller com matriz de colágeno xenógena: revisão de literatura / Treatment of single Miller class I and II gingival recessions with a xenogeneic collagen matrix: literature review

Objetivo: Verificar, através de uma revisão da literatura, a eficácia de uma matriz de colágeno xenógena associada ao retalho deslocado coronalmente no tratamento das retrações gengivais unitárias classes I e II de Miller. Materiais e métodos: A estratégia de busca das pesquisas foi realizada na base de dados MEDLINE pela combinações dos termos MESH e palavras-chave. Além disso, as bibliografias de todos os artigos incluídos e de revisões relevantes ao assunto foram consideradas para possível análise. Um mesmo pesquisador realizou as três fases da pesquisa. A primeira fase, a análise dos títulos, foi realizada para eliminar os materiais claramente irrelevantes ou que não tinham relação com o assunto abordado.A segunda fase, avaliação dos resumos dos artigos, foi baseada no tipo de estudo, característica da população/problema, intervenção e resultados obtidos. Na terceira fase, os textos completos selecionados para a revisão foram analisados e interpretados de acordo com os princípios da leitura crítica de artigos científicos. Resultados: Os estudos selecionados ficaram, assim, distribuídos: 05 (cinco) revisões sistemáticas, 12 (doze) ensaios clínicos randomizados, 02 (dois) estudos com modelo animal, (01) um estudo transversal observacional, 05 (cinco) séries de casos, 02 (dois) relatos de casos clínicos e 02 (duas) revisões de literatura, totalizando 29 (vinte e nove) artigos científicos. Conclusão: Por meio de uma revisão da literatura, constatou-se que a matriz de colágeno xenógena associada ao retalho deslocado coronalmente representa uma alternativa viável para o tratamento das retrações gengivais unitárias classes I e II de Miller, bem como proporciona satisfação estética aos pacientes.(AU)

Aim: To verify, through a review of the literature, the efficacy of a xenogeneic collagen matrix plus the coronally advanced flap in the treatment of Miller's class I and II single gingival recessions. Materials and methods: The studies` search strategy was carried out in the MEDLINE database through the combinations of the MESH terms and keywords. In addition, the bibliographies of all articles included and relevant reviews to the subject were considered for possible analysis. The same researcher carried out the three steps of the study. The first step, the analysis of the titles, was carried out to eliminate materials that were clearly irrelevant or had no relation to the subject addressed. The second, evaluation of the abstracts of the articles, was based on the type of study, characteristic of the population/problem, intervention and results obtained. In the third step, the complete texts selected for these review were analyzed and interpreted according to the principles of critical reading of scientific articles. Results: The selected studies were thus distributed: 05 systematic reviews, 12 randomized clinical trials, 02 animal model studies, 01 cross-sectional study, 05 case series, 02 clinical cases and 02 reviews of the literature, totaling 29 articles. Conclusion: Through a review of the literature, it was found that the xenogeneiccollagen matrix plus the coronally advanced flap represents a viable alternative in the treatment of Miller's class I and II single gingival recessions, as well as provides patients` aesthetic satisfaction.(AU)

Comparison of Effects and Complications between Conventional Trabeculectomy and Trabeculectomy with a Collagen Matrix Insertion

PURPOSE: To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy. METHODS: An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups. RESULTS: In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group. CONCLUSIONS: The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.

Collagen matrix compared with mitomycin C for treatment of primary open-angle glaucoma with trabeculectomy performed / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the effectiveness and safety between trabeculectomy with collagen matrix versus trabeculectomy with mitomycin C(MMC) for patients with primary open-angle glaucoma(POAG).METHODS:In this prospective randomized comparative study from January 2015 to December 2016.Thirty-two eyes presented with POAG were included in this study, 14 eyes treated by trabeculectomy with subconjunctival implant of collagen matrix (study group) and the other 18 eyes treated by trabeculectomy with mitomycin C.Postoperative IOP, the success rate of operation, number of postoperative glaucoma medications and postoperative complications were recorded.Each patient was followed up at least 6mo.RESULTS:The mean postoperative IOP was statistically different between the study group and the control group after 1d (P0.05), and the mean postoperative IOP was statistically different between the two groups (P0.05).The IOP decreased at 1d after openations compared with before, kept stable at 1wk to 6mo.IOP of study group was lowen than control.IOP was controlled by glaucoma medications in the study group by 28% compared to control group by 33% at 6mo after operation, but there was no significant difference.There was no significant difference between the study group and the control group in complications (P<0.05).CONCLUSION:Trabeculectomy with collagen matrix implant is comparable to the use of MMC with a similar success rate in open-angle glaucoma and the range in reducing intraocular pressure was significantly higher than that of MMC and it can significantly avoid the occurrence of low IOP postoperatively, transient anterior chamber, conjunctival wound leakage complications has no advantages compared with the use of MMC.

Establishment of human scleral fibroblasts-seeded collagen matrix and its mechanical properties / 中华实验眼科杂志

Background Excessive elongation of axis and expansion of sclera is one of the hot topics in the study of the pathogenesis of high myopia.To establish a human scleral fibroblasts (HSFs)-collagen matrix culture model is helpful for understanding the reciprocal and adaptive interactions between HSFs and the collagen matrix in tissue.Objective The aim of this study was to establish a HSFs-seeded collagen three-dimension culture system that may mimic the sclera remolding in myopia.Methods HSFs were isolated and cultured from donor eyes by explant culture and purified by passages culture in vitro.The expressions of vimentin and keratin in the cells were detected by immunofluorescence technique to identify the cells.Rat tail tendon was obtained from 8-week-old SPF SD rats to prepare the collagen matrix.The mixed solution of 400 μl collagen matrix and 1 100 μl PBS,200 μ1 nutrient medium,50 μ1 NaOH and HSF suspension were mixed to prepare the collagen gel three-demension culture system.The growth and morphology of the cells in the culture system were observed under the inverted phase contrast microscope,and IPP-5 software was used to measure the contraction area of collagen gel,and the mechanical creep properties of the HSFs-seeded collagen matrix were measured by a biomechanics test instrument.Results HSFs emigrated from tissue 7 days after culture and passage could be performed 14 days after culture.The expression of keratin was absent in HSFs,while vimentin was positively expressed.The free-cell collagen gel was clear and unchanged in the experimental duration.However,the cells were obviously increased on the three-demension culture system and showed a tissue-like structure of net-like arrangement on dozens of layers.In 7-14 days after culture,the collagen gel area in a three-demension collagen matrix revealed a decrease of 90％.Duotriode-like and fusiform cells were seen 24 hours after culture.The biomechanical creep curve of HSFs-seeded collagen matrix consisted of the nonlinear section (0-100 seconds) and linear section (100-600 seconds),and the former appeared to be an elastic change of the gel under the temporal stress,and the latter was the creeping of the gel with the time.Conclusions Rat tail collagen appears to have a good biocompatibility to HSFs.HSFs-seeded collagen matrix can retain the mechanical creep properties,and it may be a good tool for the study on the relationship between HSFs and extracellular matrix or intercellular biological behaviour for scleral remodeling.

Efeitos positivos preliminares de estratégias cirúrgicas e peri-implantares, combinadas para redução dos defeitos alveolares na zona estética provocados após trauma de avulsão, reimplantação dentária e reabsorção radicular / Positive preliminary effects of combined surgical and peri-implant strategies to reduce the alveolar defects at the esthetic zone after avulsion trauma, tooth replantation, and root resorption ­ a case report

Este relato de caso demonstra uma combinação de estratégias de RTG para alívio do defeito residual na zona estética. Um paciente do sexo masculino havia sofrido um acidente traumático no dente 11 durante a infância, com tratamento endodôntico e reimplantação imediata. Dez anos depois, o desnível entre as margens gengivais era de 10 mm, e uma reabsorção radicular estava presente. Para tentar diminuir a recessão de tecido mole e o contorno ósseo deficiente, uma matriz colágena suína (MucoGraft) foi montada no sentido vertical substituindo a parede vestibular, e o alvéolo de extração foi preenchido com osso bovino inorgânico (Bio-Oss). A coroa dentária natural foi usada como pôntico no aparelho ortodôntico de contenção. Três meses depois, e após um exame por tomografia computadorizada feixe cônico para determinação dos níveis ósseos resultantes, o conjunto implante dentário (3,4 mm x 10 mm)/pilar (platformswitching) e osso bovino foi colocado no alvéolo cicatrizado, e a coroa natural foi trocada por uma coroa provisória cimentada. Seis meses depois, um enxerto gengival livre foi aplicado. Após o condicionamento do tecido mole, o desnivelamento gengival entre as margens reduziu-se para 2 mm. A restauração definitiva recebeu infraestrutura em zircônia CAD/CAM recoberta por porcelana feldspática. Mesmo que a estratégia combinada tenha se mostrado útil no alívio da situação clínica, estudos longitudinais com amostras maiores são necessários para comprovar sua eficácia.

This case report demonstrates a combination of RTG strategies to alleviate a residual defect in the esthetic zone. A male patient had suffered a traumatic accident at the tooth 11 during childhood, with endodontic treatment and immediate replantation. Ten years later, the unbalance between the gingival margins was 10 mm, and a root resorption was detected. In an attempt to reduce the soft tissue recession and poor bone contour, a porcine collagen matrix (MucoGraft) was mounted vertically replacing the labial wall, and the alveolar extraction socket fi lled with xenogeneic bovine bone (Bio-Oss). The natural dental crown was used as the pontic in the orthodontic device. Three months later and after a cone beam computerized tomography to determine the resulting bone levels, the dental implant (3.4 mm x 10 mm)/abutment (platform-switching) assembly and bovine bone were placed in the healed socket, and the natural crown was replaced by a cemented temporary crown. Six months later, a free gingival graft was applied. After soft tissue conditioning, the unbalance between gingival margins between was reduced to 2 mm. The final restoration received a CAD/CAM zirconia infrastructure veneered with feldspathic porcelain. Even that the combined strategy has proven useful in this clinical situation. Longitudinal studies with larger samples are needed to confi rm its effectiveness.

Biocompatibility of bone marrow mesenchymal stem cells on acellular collagen matrix double-layer material / 国际生物医学工程杂志

Objective To study the biocompatibility of bone marrow mesenchymal stem cells (BMSCs) on acellular collagen matrix double-layer material.Methods BMSCs with acellular collagen matrix double-layer material were trained as experimental group,while separately cultured BMSCs as control group.The growth and proliferation of BMSCs on acellular collagen matrix double-layer material were investigated.Scanning electron microscope was used to observe the adherence of cells,and cell vitality was detected by CCK-8 method.Results The acellular collagen matrix double-layer material did not influence the growth and proliferation of BMSCs.The difference between the growth curves of experimental group and control group was not significant (P＞0.05).Conclusions The acellular collagen matrix double-layer material has acceptable biocompatibility.This research provides a scientific basis for the application of this composite material.

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

OBJECTIVE: Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. METHODS: We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. RESULTS: Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). CONCLUSION: When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

Evaluation of the Biological Behavior of Mucograft® in Human Gingival Fibroblasts: An In Vitro Study

Mucograft(r) is a resorbing porcine matrix composed of type I and type III collagen, used for soft tissue augmentation in guided tissue bony regeneration procedures. This in vitro study aimed to evaluate the biological behavior of Mucograft(r) in human gingival fibroblasts, as well as the ability of the matrix to induce production of extracellular matrix. Six resorbing Mucograft(r) matrices (MCG) were cut into 3 x 2 mm rectangles and 5 x 5 mm squares and were placed in 96- and 24-well plates, respectively. The control group (CTRL) consisted of cells plated on polystyrene without the MCG. After one, two, three and seven days, cell proliferation and viability were assessed using the Trypan exclusion method and MTT test, respectively. Type III collagen (COL 3A1) and vimentin (VIM) expression were also evaluated at 10 and 14 days, using Western blotting. Statistical analysis, using ANOVA with post hoc Bonferroni test, revealed that human gingival fibroblasts from MCG showed similar results (p>0.05) for proliferation and viability as the cells cultured on CTRL. After 14 days, a significant decrease in COL 3A1 expression (p<0.05) was observed when cultured with the MCG. VIM expression showed no significant difference at any time period (p>0.05). Although no increase in extracellular matrix secretion was observed in this in vitro study, Mucograft(r) presented cellular compatibility, being an option for a scaffold whenever it is required.

Resumo A Mucograft(r) é uma matriz reabsorvível, de origem suína, composta de colágenos do tipo I e III, utilizada para aumento de tecido mole em regeneração óssea guiada. Este estudo in vitro teve como objetivo avaliar o comportamento biológico da Mucograft(r), em fibroblastos gengivais humanos, bem como a indução da síntese de matriz extracelular. Seis matrizes reabsorvíveis de Mucograft(r) (MCG) foram cortadas em retângulos e quadrados medindo 3 x 2 mm e 5 x 5 mm e alocadas em placas de 96 e 24 poços, respectivamente. O grupo controle (CTRL) consistiu no plaqueamento celular em poliestireno, sem MCG. Após um, dois, três e sete dias, a proliferação e a viabilidade celular foram avaliadas utilizando o corante vital azul de Trypan e o teste MTT, respectivamente. Além disso, a expressão de colágeno tipo III (COL 3A1) e vimentina (VIM) foi avaliada após 10 e 14 dias, por meio de Western-blotting. Após análise estatística (Anova e pós teste de Bonferroni), pode-se observar que os fibroblastos gengivais humanos, cultivados sobre MCG, apresentaram proliferação e viabilidade semelhantes em comparação às células que foram cultivadas apenas no poliestireno (CTRL). Após 14 dias, notou-se uma diminuição significativa da expressão de COL 3A1 (p<0,05) quando as células foram cultivadas sobre a MCG. A expressão da VIM não mostrou diferença significativa em nenhum dos períodos estudados (p>0,05). No presente estudo in vitro pode-se concluir que apesar de não ter sido observado aumento da síntese de matriz extracelular, a Mucograft(r) apresentou compatibilidade celular, sendo uma opção de biomaterial em casos que o arcabouço é necessário.

Porcine collagen matrix for treating gingival recession: randomized clinical trial / Matriz de colágeno de origen porcino en el tratamiento de las recesiones gingivales: ensayo clínico aleatorio

Achieving root coverage after exposure caused by gingival recession is one of the main goals of reconstructive periodontal surgery. Even though a large variety of techniques and mucogingival grafting procedures are available, their long-term results are not clear yet. Therefore, this study aimed to compare clinical effectiveness of the porcine collagen matrix with subepithelial connective graft for treating Miller class I and II gingival recessions. Materials and methods: The randomized clinical trial included twelve patients assigned to two groups. In the first group (experimental), six patients were treated using collagen matrix (mean age, 54.3 +/- 5.6 years; mean recession 2. 67 ± 1.03 mm). Another group (control) of six patients was treated using connective grafts (mean age, 57.1 +/- 2.7 years; mean recession 4.33 +/- 1.03 mm). All patients underwent periodontal evaluation and pre-surgical preparation including oral hygiene instruction and supragingival scaling. Gingival recessions were exposed through partial thickness flaps where the grafts and matrices were placed. Patients were assessed periodically until complete healing of tissue. Results: Root coverage parameters, amount of keratinized gingiva, gingival biotype and clinical attachment level were evaluated. The root coverage percentage for the group using connective graft was 24.7 +/- 13.5 percent and 16.6 +/- 26.8 percent for the one treated with the matrix. The amount of increased keratinized tissue was 4.33 +/- 2.06 mm and 4.5 +/- 0.83 mm for the control and experimental group respectively. Both groups increased gingival biotypes from thin to thick at 100 percent. The final clinical attachment level was 4.17 +/- 3.17 +/- 04mm for the control group and 0.98 mm for the experimental group. There were significant differences between the outcome of gingival recession and clinical attachment. Conclusion: Results indicate both techniques, besides being predictable...

Lograr la cobertura radicular que se expone por las recesiones gingivales es uno de los principales objetivos de las cirugías periodontales reconstructivas. Una gran variedad de técnicas e injertos mucogingivales se encuentran como opciones terapéuticas. Sin embargo, los resultados y efectividad a largo plazo aún no son claros. Este estudio tuvo como objetivo comparar la efectividad clínica de la matriz de colágeno de origen porcino versus el injerto conectivo subepitelial en el tratamiento de las recesiones gingivales Miller clase I y II. Materiales y métodos: Ensayo clínico aleatorizado donde participaron 12 pacientes asignados de manera aleatoria en 2 grupos; el primer grupo de 06 pacientes (grupo experimental) fueron tratados con la matriz de colágeno (promedio de edad de 54,3 +/- 5,6; promedio de las recesiones de 2,67 +/-1,03mm) y el segundo grupo de 06 pacientes (grupo control) fueron tratados con el injerto conectivo (promedio de edad de 57,1 +/- 2,7; promedio de las recesiones de 4,33 +/- 1,03mm). Todos los pacientes recibieron una evaluación periodontal y una preparación pre quirúrgica incluyendo las instrucciones de higiene oral y una raspaje supragingival. Las recesiones gingivales fueron expuestas a través de colgajos de espesor parcial en los cuales se colocaron los injertos y las matrices. Los pacientes fueron evaluados periódicamente hasta completar la cicatrización de los tejidos. Resultados: Se evaluaron los parámetros de cobertura radicular, cantidad de encía queratinizada, biotipo gingival y nivel de inserción clínica. El porcentaje de cobertura radicular para el grupo del injerto fue de 24,7 +/-13,5 por ciento y de 16,6+/- 26,8 por ciento para el grupo de la matriz. La cantidad de encía queratinizada aumentada fue de 4,33 +/- 2,06mm y de 4,5 +/- 0,83mm para el grupo del injerto y la matriz respectivamente. Ambos grupos aumentaron los biotipos gingivales de finos a gruesos...

The Analysis of the Clinical Findings and Effects of Biodegradable Collagen Matrix in Trabeculectomy

PURPOSE: To observe the effects of biodegradable collagen matrix (OculusGen(TM)) on filtering bleb formation and maintenance and to investigate its clinical effects and usefulness in trabeculectomy. METHODS: Ophthalmologic examinations were preformed 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months postoperatively in the case and control groups. The clinical findings of the filtering bleb were observed, and the clinical effects measured by mean intraocular pressure and complications were evaluated in both groups. RESULTS: The success rates were 76% in the case group and 88% in the control group, and there were no significant differences between the case and control groups. In the case group, postoperative conjunctival injection persisted for more than 1 month with increasing severity, while ultrasound biomicroscopy revealed increased echogenicity of the subconjuctival and tenon tissue with no definite space-occupying effect. CONCLUSIONS: Trabeculectomy utilizing collagen matrix showed similar clinical results compared to the current traditional trabeculectomy; slit-lamp and ultrasound biomicroscopy findings did not reveal any advantageous changes to filtering bleb function.

Clinical experience with a novel bovine collagen dura mater substitute / Experiência clínica com um novo substituto dural derivado de matriz de colágeno bovino

Dural substitutes are used to achieve watertight closure of the dura mater when adequate closure is not possible. The purpose of this study was to evaluate the efficacy and safety of a new collagen matrix dural substitute (Duradry, Technodry, Belo Horizonte MG) in the repair or expansion of cranial and spinal dura mater. METHOD: Thirty patients, operated on between March and September, 2008, were studied. Surgical records were reviewed for sex, age, location of graft, technique, and presence of fistula or infection. The patients were followed up for at least 3 months, and presence of complications, such as cerebrospinal fluid leakage, infection, asseptic meningitis hydrocephalus, pseudomeningocele, was analyzed. RESULTS: Only one patient presented cerebrospinal fluid fistula. No patients presented wound infections, hydrocephalus, pseudomenigocele, meningites, brain abscesses or signs of toxicity related to the dural substitute. CONCLUSION: The new dural substitute used in this study is effective and safe, and the initial results are similar to those of other dural substitutes reported in the literature.

Substitutos de dura máter são utilizados quando não conseguimos um fechamento dural hermético. O objetivo deste estudo foi avaliar a eficácia e segurança de um novo substituto dural derivado de matriz colágena bovina (Duradry, Tecnodry, Belo Horizonte MG) no reparo ou expansão da dura máter craniana ou espinhal. MÉTODO: Trinta pacientes operados entre março e setembro de 2008 foram estudados. Foram analisados sexo, idade, localização do enxerto, técnica e presença de fístula ou infecção. Os pacientes foram acompanhados por, pelo menos, 3 meses e a presença de complicações como fístula liquórica, infecção, meningite asséptica, hidrocefalia, pseudomeningocele foram analisadas. RESULTADOS: Apenas um paciente apresentou fístula liquórica. Nenhuma infecção de ferida cirúrgica foi observada. Também não ocorreram casos de hidrocefalia, pseudomeningocele, meningite, abscesso ou sinais de toxicidade relacionada ao implante. CONCLUSÃO: O novo substituto dural utilizado neste estudo é seguro e efetivo e os resultados iniciais são semelhantes aos de outros substitutos durais descritos na literatura.