Research progress on cemental tears in terms of clinical diagnosis and treatment / 口腔疾病防治

@#A cemental tear is defined as an incomplete or complete detachment of the cementum along the dentino-cemental junction (CDJ) or the incremental line within the body of the cementum, which can also involve part of the root dentine adjacent to the cementum. The pathogenesis of cemental tears is not fully elucidated. From the literature review, possible predisposing factors were identified, including tooth type, sex, age, periodontitis, previous periodontal treatment or root canal treatment, history of dental trauma, and occlusal trauma or excessive occlusal force. The morphology of cemental tears can be either piece-shaped or U-shaped, which usually contributes to periodontal and periapical breakdown. Clinically, cemental tears have a unitary periodontal pocket and present with symptoms mimicking localized periodontitis, apical periodontitis, and vertical root fractures. Imaging examination is of great significance for the clinical diagnosis of cemental tears, which often manifest as thin ‘prickle-like’ radiopaque masses located longitudinally adjacent to the affected root surface. Exploratory surgery is needed in some cases. Although intraoperative cemental fragments and cemental lines on the root surface can assist in the diagnostic process, histopathology examination is the gold standard for the diagnosis of cemental tears. The treatment methods vary depending on the timing of the correct diagnosis and the clinical or radiological manifestations. With the development of regenerative biomaterials and the development of intentional replantation, an increasing number of affected teeth can survive for a long time. The aim of this review is to systematically describe the biological basis and predisposing factors, clinical features, radiographic and histological characteristics, diagnosis and clinical management of cemental tears, and treatment outcomes to help make a clear diagnosis and develop a personalized treatment plan.

Uso de L-PRF en defectos infraóseos de pacientes con estadios avanzados de periodontitis / Use of L-PRF in intrabone defects in patients with advanced stages of periodontitis

Objetivo: El propósito de este estudio fue observar el efecto del uso de L-PRF en defectos infraoseos de pacientes con periodontitis en estadios avanzados. Métodos: Se incluyeron 32 defectos infraoseos de 12 pacientes con diagnóstico de Periodontitis estadio III y IV (Workshop 2018). Se realizó raspaje a campo abierto con colocación de membrana de L-PRF. Se incluyeron defectos infraóseos de 1-2-3 paredes y cráter óseo. Se registró la profundidad de sondaje (PS), nivel de inserción clínica (NIC), índice de placa (IP) e índice de sangrado (IS). Se realizaron radiografías periapicale digitales antes de la cirugía y al cuarto mes para observar el llenado óseo. Resultados: De los 32 defectos el 75 % mostró disminución de la profundidad de sondaje (PS) y el 66 % mejoro el nivel de inserción clínica (NIC). Se realizó un análisis de correlación pre y posquirúrgico en PS: MV (p = 0,02), MP/L (p = 0,00), DP/L (p = 0,00) y V (p =0,00). El porcentaje de llenado óseo fue de 62,96 % (DS± 3,88). Conclusiones: La mayoría de los defectos infraóseos mostraron radiográficamente llenado óseo parcial o total con el uso de membranas L-PRF. Además, se mejoraron los parámetros clínicos de profundidad de sondaje y nivel de inserción clínica.

Objective: The purpose of this study was to observe the effect of L-PRF (Leuko- cyte-Platelet Rich Fibrin) usage in intraosseous defects in patients with advanced-stages of periodontitis. Methods: Thirty-two intraosseous defects in 12 patients diagnosed with stage III and IV periodontitis (Workshop 2018) were included in the study. Open flap debridement was performed with the placement of L-PRF membranes. Included defects consisted of 1-2-3 wall defects and osseous craters. Parameters such as probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding index (BI) were recorded. Digital periapical radiographs were taken before surgery and at the fourth month to assess bone fill. Results: Out of the 32 defects, 75% showed a reduction in probing depth (PD), and 66% showed improvement in clinical attachment level (CAL). Pre- and post-surgical correlation analysis was performed for PD: MV (p = 0.02), PI/L (p = 0.00), BI/L (p = 0.00), and CAL (p = 0.00). The percentage of bone fill was 62.96% (±3.88 SD). Conclusion: The majority of intraosseous defects exhibited partial or complete radiographic bone fill with the use of L-PRF membranes. Furthermore, clinical parameters such as probing depth and clinical attachment level improved.

Neo-osteogenesis using an intentionally exposed polypropylene membrane after tooth extraction versus guided bone regeneration technique: a single-blind randomized controlled trial / Neo-osteogénesis utilizando una membrana de polipropileno expuesta intencionalmente después de la extracción del diente versus técnica de regeneración ósea guiada: ensayo clínico aleatorizado ciego / Neo-osteogênese utilizando uma membrana de polipropileno exposta intencionalmente após extração dentária versus técnica de regeneração óssea guiada: ensaio clínico randomizado e cego

Introduction: The intentionally exposed polypropylene (PP) membrane has been proposed for guided bone regeneration (GBR) of the alveo lar bone after extraction; however, there are biological limitations to this proposal. This study aimed to describe the effects of the PP membrane on neo-osteogenesis after tooth extraction, comparing to intentionally ex posed and primary soft tissue coverage techniques. Methodology: This clinical trial followed the TIDieR checklist and guide. Clinical and histo logical parameters of alveolar repair were compared between groups: 1 (control group), without regenerative procedure; 2, GBR; and 3, inten tionally exposed membrane. Results: Group 3 showed slight effect on the quality of new bone, compared to the control group. Although the GBR was underestimated by the early exposure of the membrane, alveo lar repair and newly formed bone were superior to the other groups. Poly propylene membrane intentionally exposed compromised the volume density of the immature and mineralized bone matrix, the osteoblast and osteocyte count, and stimulated the granulation tissue formation and local inflammatory infiltrate. Conclusions: Despite the exposure of the PP membrane in GBR, this technique improved the quality of new bone and alveolar repair compared to the surgical technique of intentional exposure and alveolus only sutured.

RESUMEN Introducción: La membrana de polipropileno (PP) intencionalmente expuesta ha sido propuesta para la regeneración ósea guiada (GBR) del hueso alveolar después de la extracción; sin embargo, existen limitaciones biológicas a esta propuesta. Este estudio tuvo como objetivo describir los efectos de la membrana de PP en la neo-osteogénesis después de la extracción del diente, en comparación con las técnicas de cobertura de tejido blando primarias y expuestas intencionalmente. Metodología: Este ensayo clínico siguió la lista de verificación y la guía TIDieR. Se compararon los parámetros clínicos e histológicos de la reparación alveolar entre los grupos: 1 (grupo control), sin procedimiento regenerativo; 2, GBR; y 3, membrana expuesta intencionalmente. Resultados: el grupo 3 mostró un ligero efecto sobre la calidad del hueso nuevo, en comparación con el grupo de control. Aunque la GBR fue subestimada por la exposición temprana de la membrana, la reparación alveolar y el hueso neoformado fueron superiores a los otros grupos. La membrana de polipropileno expuesta intencionalmente comprometió la densidad de volumen de la matriz ósea inmadura y mineralizada, el recuento de osteoblastos y osteocitos, y estimuló la formación de tejido de granulación y el infiltrado inflamatorio local. Conclusiones: A pesar de la exposición de la membrana de PP en GBR, esta técnica mejoró la calidad del hueso nuevo y la reparación alveolar en comparación con la técnica quirúrgica de exposición intencional y alvéolo solo suturado.

Introdução: A membrana de polipropileno (PP) intencionalmente exposta tem sido proposta para regeneração óssea guiada (ROG) do osso alveolar após exodontia; no entanto, existem limitações biológicas a esta proposta. Este estudo teve como objetivo descrever os efeitos da membrana de PP na neo-osteogênese após a extração dentária, comparando com as técnicas de exposição intencional e cobertura primária de tecidos moles. Metodologia: Este ensaio clínico seguiu a lista de verificação e o guia TIDieR. Parâmetros clínicos e histológicos do reparo alveolar foram comparados entre os grupos: 1 (grupo controle), sem procedimento regenerativo; 2, GBR; e 3, membrana intencionalmente exposta. Resultados: O Grupo 3 apresentou leve efeito na qualidade do novo osso, em comparação com o grupo controle. Embora o GBR tenha sido subestimado pela exposição precoce da membrana, o reparo alveolar e o osso neoformado foram superiores aos outros grupos. A exposição intencional da membrana de polipropileno comprometeu a densidade volumétrica da matriz óssea imatura e mineralizada, a contagem de osteoblastos e osteócitos e estimulou a formação de tecido de granulação e infiltrado inflamatório local. Conclusões: Apesar da exposição da membrana PP na ROG, esta técnica melhorou a qualidade do novo osso e da reparação alveolar em comparação com a técnica cirúrgica de exposição intencional e alvéolo apenas suturado.

In vitro evaluation of membranes for regenerative procedures against oral bacteria

Abstract The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.

Resumo O objetivo deste estudo foi avaliar, in vitro, a aderência do biofilme multiespécie e a passagem de bactérias através dos diferentes tipos de membranas disponíveis comercialmente para RTG/ROG. Quatro tipos de membranas foram testados (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; e LP) Lumina PTFE®. Papel alumínio (AL) simulou uma barreira impermeável e foi usado como controle negativo. As membranas foram adaptadas à um aparato específico e desafiadas com uma cultura bacteriana mista composta de A. actinomycetemcomitans b, S. mutans, S. mitis, e A. israelii. Após 2 h ou 7 dias, a aderência e passagem bacteriana foi avaliada através da contagem de UFCs. Duas membranas de cada grupo foram analisadas através da microscopia eletrônica de varredura (MEV). LC e LP apresentaram valores semelhantes de células bacterianas aderidas (p < 0.05), significativamente inferiores quando comparados aos outros grupos, em ambos os períodos experimentais (p < 0.05). Desde a análise inicial, todos os grupos testados foram permeáveis às células bacterianas, sem diferença significativa entre o período experimental de 2 h e 7 dias (p > 0.05). As análises em MEV demonstraram que o número de bactérias aderidas aumentou com o tempo (2 h < 7 days). Membranas biológicas comercialmente disponíveis demonstraram intensa aderência bacteriana e passagem de bactérias, que aumentou durante os períodos experimentais.

Efficacy of treatment of class II furcation lesions using membrane associated with bone grafting in mandibular molars compared to membrane only: a systematic review and meta-analysis / Eficacia del tratamiento de lesiones de furca grado II utilizando membrana asociada con injerto óseo en molares mandibulares en comparación con solamente membrana: revisión sistemática y metanálisis

Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.

Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.

Efficiency analysis of commercial polymeric membranes for bone regeneration in rat cranial defects

Purpose: To evaluate the in vivo efficiency of commercial polymeric membranes for guided bone regeneration. Methods: Rat calvarial critical size defects was treated with LuminaCoat (LC), Surgitime PTFE (SP), GenDerm (GD), Pratix (PR), Techgraft (TG) or control (C-) and histomorphometric analysis determined the percentage of new bone, connective tissue and biomaterial at 1 or 3 months. Statistical analysis used ANOVA with Tukey's post-test for means at same experimental time and the paired Student's t test between the two periods, considering p < 0.05. Results: New bone at 1 month was higher for SP, TG and C-, at 3 months there were no differences, and between 1 and 3 months PR had greater increase growthing. Connective tissue at 1 month was higher for C-, at 3 months for PR, TG and C-, and between 1 and 3 months C- had sharp decline. Biomaterial at 1 month was higher for LC, in 3 months for SP and TG, and between 1 and 3 months, LC, GD and TG had more decreasing mean. Conclusion: SP had greater osteopromotive capacity and limitation of connective ingrowth, but did not exhibit degradation. PR and TG had favorable osteopromotion, LC less connective tissue and GD more accelerated biodegradation.

Stem cell-derived exosomes from human exfoliated deciduous teeth promote angiogenesis in hyperglycemic-induced human umbilical vein endothelial cells

Abstract Objective To investigate the angiogenesis in human umbilical vein endothelial cells (HUVEC) under high glucose concentration, treated with exosomes derived from stem cells from human exfoliated deciduous teeth (SHED). Methodology SHED-derived exosomes were isolated by differential centrifugation and were characterized by nanoparticle tracking analysis, transmission electron microscopy, and flow cytometric assays. We conducted in vitro experiments to examine the angiogenesis in HUVEC under high glucose concentration. Cell Counting Kit-8, migration assay, tube formation assay, quantitative real-time PCR, and immunostaining were performed to study the role of SHED-derived exosomes in cell proliferation, migration, and angiogenic activities. Results The characterization confirmed SHED-derived exosomes: size ranged from 60-150 nm with a mode of 134 nm, cup-shaped morphology, and stained positively for CD9, CD63, and CD81. SHED-exosome significantly enhanced the proliferation and migration of high glucose-treated HUVEC. A significant reduction was observed in tube formation and a weak CD31 staining compared to the untreated-hyperglycemic-induced group. Interestingly, exosome treatment improved tube formation qualitatively and demonstrated a significant increase in tube formation in the covered area, total branching points, total tube length, and total loop parameters. Moreover, SHED-exosome upregulates angiogenesis-related factors, including the GATA2 gene and CD31 protein. Conclusions Our data suggest that the use of SHED-derived exosomes potentially increases angiogenesis in HUVEC under hyperglycemic conditions, which includes increased cell proliferation, migration, tubular structures formation, GATA2 gene, and CD31 protein expression. SHED-exosome usage may provide a new treatment strategy for periodontal patients with diabetes mellitus.

An experimental study on the biological characteristics of SDF-1/CS/β-GP composite bio-membrane in vitro / 口腔医学

Objective@#To prepare a composite membrane by chitosan/β-sodium glycerophosphate(CS/β-GP) thermosensitive hydrogel combined with stromal cell derived factor-1(SDF-1) and observe its biological characteristics in vitro.@*Methods@#Different doses of SDF-1 were added into CS/β-GP solution and then the thermosensitive gel time was measured. The SDF-1/CS/β-GP solution was membrane paved and dried to prepare composite membranes. The morphological characteristics were observed by scanning electron microscope(SEM). Composite membranes were placed into cell culture medium, and the supernatant(n=3) was extracted after standing at 6, 12, 24, 36, 48, 60 h, respectively. The concentration of SDF-1 in the solution was measured. Bone mesenchymal stem cells(BMSCs) were cultured in the Transwell room, and the composite membranes containing different concentrations of SDF-1 were placed in the lower chamber. There were four groups(n=3): Group M0 used CS/β-GP membrane(control group), Group M1, M2, M3 used SDF-1/CS/β-GP membrane(SDF-1 was 100, 200, 400 ng/mL respectively). After culture for 6, 12 and 24 h, the cells under the membrane were preserved and Giemsa stained and counted. The absorbance(OD) value was measured by MTT method to calculate the cell proliferation rate. SPSS 19.0 was used for multi-factor analysis of variance.@*Results @#After adding a certain amount of SDF-1 into CS/β-GP solution, the gel time did not change significantly(P>0.05). The SDF-1/CS/β-GP membrane was translucent and porous at 37 ℃. In this experiment, the volumic mass of SDF-1 released by SDF-1/CS/β-GP composite membrane increased gradually with the experimental time(P<0.01). Transwell cell chemotaxis test showed that the number of BMSCs cells with directional migration increased with the prolongation of observation time(P<0.01) and the increase of SDF-1 volumic mass(P<0.01). In MTT test, the OD value of migration cell solution increased with the prolongation of time(P<0.01) and the increase of SDF-1 volumic mass(P<0.01). @*Conclusion@# The SDF-1/CS/β-GP composite membrane has a porous structure and biological activity of chemotactic BMSCs directional migration. It is a potential membrane for guided tissue regeneration.

Colgajo con preservación de papilas en defecto óseo del sector anterior / Papilla-preserving flap in bone defect of the anterior sector

RESUMEN La técnica de preservación de papilas en el tratamiento de las periodontitis ofrece ventajas en cuanto a la protección del sitio del defecto cuando en este se pretende realizar cirugía ósea aditiva. La combinación de este proceder con la regeneración tisular guiada garantiza mayor protección a la membrana colocada con este fin. Se presenta el caso de un paciente de 47 años de edad, masculino, cibernético de profesión, que recibió tratamiento periodontal pero no acudió a su fase de mantenimiento y en este momento lo hace por presentar movilidad y sangrado gingival manifestado fundamentalmente al realizar los procedimientos de higiene bucal. Se le realizó un colgajo con preservación de papilas, entre los incisivos centrales superiores, colocándole un injerto de Bio-Oss y una membrana de colágeno, con lo que se obtuvo una mayor altura del hueso y una disminución de la profundidad de la bolsa.

ABSTRACT The papillae preservation technique in the treatment of periodontitis offers advantages in terms of protecting the defect site when additive bone surgery is intended to be performed on it. The combination of this procedure with guided tissue regeneration guarantees greater protection for the membrane placed for this purpose. We present a 47-year-old male patient, computer engineer as a profession, who received periodontal treatment but did not attend his maintenance phase; he does so due to mobility and gingival bleeding manifested mainly when performing oral hygiene procedures. A papilla-preserving flap was made between the upper central incisors, placing a Bio-Oss graft and a collagen membrane, which resulted in greater bone height and decreased pocket depth.

Sponges with colloidal silver nanoparticles help restore bone lost in endo-periodontal injuries

Introduction: Endo-periodontal lesions can lead to the formation of severe intraosseous defects in the periodontium; which can lead to tooth loss. Objective: Demonstrate that surgical periodontal therapy with the help of gelatin sponges, with colloidal silver nanoparticles, restores bone tissue lost in endo-periodontal lesions. Case presentation: 55-year-old male patient without systemic alterations, diagnosed with grade 3 endo-periodontal lesion in patients with periodontitis. It was treated first with ducts and then with periodontal surgery combined with gelatin sponges, which contain colloidal silver nanoparticles, and were placed filling the 2-wall bone defect involving > 80 percent of the root length, with 24 months of radiographic and clinical follow-up. Conclusions: Based on the case report, surgical periodontal therapy and filling of bone defects with gelatin sponges, which contain colloidal silver nanoparticles, were sufficient to restore the lost bone at a 24-month follow-up. However, further studies are needed to assess the clinical benefit of this material for the treatment of intraosseous defects(AU)

Efectividad de la regeneración tisular guiada en lesiones de furcación dentarias mandibulares

RESUMEN Introducción: La lesión de furcación se define como la reabsorción patológica del hueso interradicular, con la consiguiente exposición de la furca, el aumento del riesgo de pérdida ósea y la aparición de defectos óseos difíciles de tratar, los que pueden mejorar con el uso de membranas a través de la regeneración tisular guiada. Objetivo: Determinar la efectividad de la regeneración tisular guiada en lesiones de furca dentarias mandibulares en la Clínica Estomatológica Provincial "Mártires del Moncada", de Santiago de Cuba, durante el periodo septiembre de 2018 a diciembre de 2019. Método: Se realizó un estudio cuasi-experimental de intervención terapéutica con una muestra de 20 pacientes con lesiones de furca mandibulares, seleccionados por muestreo no probabilístico intencional. Se conformaron 2 grupos aleatorios por orden de llegada de 10 pacientes cada uno. Un grupo estudio recibió la terapia regenerativa y un grupo control fue tratado de forma convencional. Ambos, cumplieron con el criterio diagnóstico y fueron examinados antes y después de los tratamientos a los 6 meses y al año. Resultados: Al evaluar al año de tratamiento, en el grupo I, el sangrado desapareció y la profundidad al sondaje disminuyó al menos 1 mm en el 100% de los casos, la ganancia de inserción tipo I se logró en el 60% de ellos, con marcada superioridad sobre el grupo control. Conclusiones: El tratamiento con regeneración tisular guiada demuestra ser efectivo en los pacientes tratados con lesión de furcación a diferencia del tratamiento convencional.

ABSTRACT Introduction: The furcation lesion is defined as a pathological resorption of the interradicular bone, with the consequent exposure of the furcation, increased risk of bone loss and the onset of difficult-to-treat bone defects, which can be improved with the use of membranes through guided tissue regeneration. Objective: To determine the effectiveness of guided tissue regeneration in mandibular dental furcation lesions at the Clínica Estomatológica Provincial "Mártires del Moncada" in Santiago de Cuba, from Septembre 2018 to December 2019. Method: A quasi-experimental study of therapeutic intervention was carried out with a sample of 20 patients with mandibular furcation lesions and selected by non-probabilistic purposive sampling. One cluster (study group) received regenerative therapy and the other cluster (control group) was treated conventionally. Both met the diagnostic criteria and were examined before and after the treatments (6 months after treatment and 1 year after treatment). Results: after assessed the year of treatment, in group I (study group), bleeding disappeared and probing depth decreased by at least 1 mm in 100% of the cases, type I insertion gain was achieved in 60% of them, with a marked superiority in the control group. Conclusions: Treatment with guided tissue regeneration has been shown to be effective in patients treated with furcation lesions in contrast to conventional treatment.

RESUMO Introdução: A lesão de furca é definida como a reabsorção patológica do osso interradicular, com a conseqüente exposição da furca, aumento do risco de perda óssea e aparecimento de defeitos ósseos de difícil tratamento, que podem melhorar com o uso de membranas através da regeneração tecidual guiada. Objetivo: Determinar a eficácia da regeneração tecidual guiada em lesões de furca dentária mandibular na Clínica Estomatológica Provincial "Mártires del Moncada", Santiago de Cuba, durante o período de setembro de 2018 a dezembro de 2019. Método: Foi realizado um quasi-estudo experimental de intervenção terapêutica com amostra de 20 pacientes com lesões de furca mandibular, selecionados por amostragem não probabilística intencional. 2 grupos randomizados foram formados em ordem de chegada de 10 pacientes cada. Um grupo de estudo recebeu terapia regenerativa e um grupo controle foi tratado de forma convencional. Ambos preencheram os critérios diagnósticos e foram examinados antes e depois dos tratamentos aos 6 meses e 1 ano. Resultados: Ao avaliar um ano de tratamento, no grupo I, o sangramento desapareceu e a profundidade de sondagem diminuiu em pelo menos 1 mm em 100% dos casos, o ganho de inserção tipo I foi alcançado em 60% deles, com acentuada superioridade sobre o grupo de controle. Conclusões: O tratamento com regeneração tecidual guiada mostra-se eficaz em pacientes tratados com lesão de furca, ao contrário do tratamento convencional.

Oral multidisciplinary considerations for clinical strategies of endodontic microsurgery / 口腔疾病防治

@#Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment. The principle is to determine the reason for failure, completely eliminate the infection and promote periapical healing. Within recent years, endodontic microsurgery has evolved to become standardized and presents with a high success rate. However, its outcome is still influenced by many factors, including anatomy, periodontal condition, crown-to-root ratio, occlusion, the type of periradicular lesion, and prosthesis. Moreover, endodontists always concentrate on “the apex”, paying little attention to the general preoperative evaluation, accurate diagnosis, and comprehensive treatment plan. This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines, including periodontology, prosthodontics, oral implantology, oral and maxillofacial surgery and orthodontics. The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system, periradicular lesion, adjacent anatomical relationships, periodontal condition, occlusion, and esthetic rehabilitation. Based on these findings, the continuity of treatment will be optimized, and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

Impact of soft tissue graft on the preservation of compromised sockets / Impacto do enxerto de tecido mole na preservação de alvéolos comprometidos

ABSTRACT The aim of this pilot study was to evaluate the impact of the association of free gingival graft (FGG) or collagen-matrix xenograft (CMX) to deproteinized bovine bone graft (DBBG) on the preservation of post-extraction sockets with facial-wall defects. Sixteen patients who presented a maxillary tooth with a facial bone defect and indication of extraction were selected. After the surgical procedure, all the post-extraction sockets were filled with DBBG and covered with a collagen membrane. The cervical part of the socket was then sealed with either FGG or CMX. Clinical and tomographic analyses were performed at baseline and 4 months after the grafting procedure. The FGG sockets showed higher values for the width of the bone ridge than the CMX sockets at 4 months. There was no difference regarding biopsy composition. In conclusion, regardless of the type of soft tissue graft used, socket preservation with DBBG at sites presenting facial bone defects enabled implant placement without further guided bone regeneration, whether the sockets were sealed with FGG or CMX.

RESUMO

Eficácia das membranas não absorvíveis na regeneração óssea guiada: uma revisão de literatura / Effectiveness of membranes non-absorbible in guided bone regeneration: a literature review

Introdução: As alterações dimensionais do processo alveolar após extração dentária é uma conse quência natural e fisiológica indesejável, podendo dificultar a colocação de um implante dentário na posição desejada. Portanto, a Regeneração Óssea Guiada (ROG) tem um papel relevante na pre venção da perda óssea. Objetivo: Compreender a eficácia do uso de membranas não absorvíveis na ROG de alvéolos pós extração. Metodologia: A pesquisa foi realizada nas bases de dados Pubmed, Scielo e BVS (Biblioteca Virtual em Saúde), além da busca no Google Acadêmico. Não foi aplicado nenhum limite temporal, nem restrição de idioma, como forma de abranger a maioria quantidade de trabalhos sobre o tema. Foram excluídos estudos que se distanciavam do objetivo desta revi são, bem como estudos de casos. Resultados e discussão: A ROG se consolida como uma técnica de preservação óssea e o seu princípio se relaciona com a osteopromoção. A fim de melhorar a capacidade de formação de osso, as membranas têm sido utilizadas como barreiras que guiam a cicatrização óssea e auxiliando na preservação do osso alveolar. Considerações finais: O uso da membrana não reabsorvível é muito viável e promissor na ROG em alvéolos pós-extração, com evidência em sua vantagem de preservação alveolar significativa... (AU)

Introduction: Dimensional changes in the alveolar process after tooth extraction is an undesirable natural and physiological consequence, which may make it difficult to place a dental implant in the desired posi tion. Therefore, Guided Bone Regeneration (ROG) has an important role in preventing bone loss. Objective: To understand the effectiveness of the use of non-absorbable membranes in the ROG of extraction sock ets. Methodology: The research was carried out in the databases Pubmed, Scielo and BVS (Virtual Health Library), in addition to the Google Scholar search. No time limit or language restriction was applied, as a way to cover the majority of works on the topic. Studies that differed from the objective of this review were excluded, as well as case studies. Results and discussion: ROG consolidates itself as a bone preservation technique and its principle is related to osteopromotion. In order to improve bone formation capacity, membranes have been used as barriers that guide bone healing and assist in the preservation of alveolar bone. Final considerations: The use of the non-resorbable membrane is very feasible and promising in ROG in post-extraction sockets, with evidence of its significant alveolar preservation advantage... (AU)

Combined periodontal regeneration of molar severely compromised by furcation, intrabony defects and attachment loss to the apex: a case report / Regeneración periodontal combinada de molar gravemente comprometido por furcación, defectos intraóseos y pérdida de inserción en el ápice: reporte de un caso

Introduction: Clinicians tend to encounter unfavorable situations in the treatment of teeth with severe attachment loss. Periodontal regeneration has been a successful therapeutic approach in treatments that require a long-term prognosis improvement. This case shows the benefits of combined regenerative periodontal therapy in a patient with a molar severely compromised by furcation, intrabony defects and attachment loss to the apex. Case Report: The clinical case included an endo-periodontal, class III furcation and intrabony defects in a generalized periodontitis, Stage III Grade C patient. After non-surgical periodontal treatment and re-evaluation, a full-thickness flap and surgical debridement were performed. Dental root surface was treated with EDTA and enamel matrix derivatives and the defects were filled with allograft and platelet-rich fibrin, additionally a collagen membrane was applied over the graft. After a 12-month follow-up there was a resolution of the intrabony defects and periodontal regeneration. Clinical and radiographic evaluation also showed the partial resolution of the class III furcation defect. Conclusion: Combined periodontal regeneration can be a therapeutic approach to improve the prognosis and prevent the extraction of molars severely compromised by furcation, intrabony defects and attachment loss to the apex.

Introducción: Los clínicos tienden a encontrar situaciones desfavorables en el tratamiento de dientes por pérdida de inserción severa. La regeneración periodontal ha sido un enfoque terapéutico exitoso en tratamientos que requieren una mejora del pronóstico a largo plazo. Este caso demuestra los beneficios de la terapia periodontal regenerativa combinada en un paciente con un molar gravemente comprometido por furcación, defectos intraóseos y por pérdida de inserción hasta el ápice. Reporte de caso: El caso clínico incluyó un defecto endoperiodontal, furcación clase III y defectos intraóseos en una Periodontitis estadio III generalizada grado C. Tras el tratamiento periodontal no quirúrgico y la reevaluación, se realizó un colgajo de espesor total y un desbridamiento quirúrgico. La superficie de la raíz dental se trató con EDTA y derivados de la matriz de esmalte y los defectos se rellenaron con aloinjerto y fibrina rica en plaquetas, adicionalmente se aplicó una membrana de colágeno sobre el injerto. Después de un seguimiento de 12 meses hubo resolución de los defectos intraóseos y regeneración periodontal. La evaluación clínica y radiográfica también mostró la resolución parcial del defecto de furcación de clase III. Conclusión: La regeneración periodontal combinada puede ser un abordaje terapéutico para mejorar el pronóstico y prevenir la extracción de molares severamente comprometidos por furcación, por defectos y hasta el ápice.

Bioactivity effects of extracellular matrix proteins on apical papilla cells

Abstract Potent signaling agents stimulate and guide pulp tissue regeneration, especially in endodontic treatment of teeth with incomplete root formation. Objective This study evaluated the bioactive properties of low concentrations of extracellular matrix proteins on human apical papilla cells (hAPCs). Methodology Different concentrations (1, 5, and 10 µg/mL) of fibronectin (FN), laminin (LM), and type I collagen (COL) were applied to the bottom of non-treated wells of sterilized 96-well plates. Non-treated and pre-treated wells were used as negative (NC) and positive (PC) controls. After seeding the hAPCs (5×103 cells/well) on the different substrates, we assessed the following parameters: adhesion, proliferation, spreading, total collagen/type I collagen synthesis and gene expression (ITGA5, ITGAV, COL1A1, COL3A1) (ANOVA/Tukey; α=0.05). Results We observed greater attachment potential for cells on the FN substrate, with the effect depending on concentration. Concentrations of 5 and 10 µg/mL of FN yielded the highest cell proliferation, spreading and collagen synthesis values with 10 µg/mL concentration increasing the ITGA5, ITGAV, and COL1A1 expression compared with PC. LM (5 and 10 µg/mL) showed higher bioactivity values than NC, but those were lower than PC, and COL showed no bioactivity at all. Conclusion We conclude that FN at 10 µg/mL concentration exerted the most intense bioactive effects on hAPCs.

Effects of periodontal tissue regeneration combined with orthodontics on periodontitis / 中国基层医药

Objective:To investigate the effects of periodontal tissue regeneration combined with orthodontics on periodontitis.Methods:Eighty-six patients with periodontitis who received treatment in the Yongkang First People's Hospital, China between January 2017 and December 2018 were included in this study. They were randomly assigned to receive either periodontal tissue regeneration (control group, n = 43) or periodontal tissue regeneration combined with orthodontics (observation group, n = 43). Periodontal function, clinical efficacy, complications and patient satisfaction were compared between the control and study groups. Results:Before treatment, there were no significant differences in plaque index, gingival bleeding index, probing depth, bleeding on probing and attachment loss between the control and study groups (all P > 0.05). After treatment, plaque index, gingival bleeding index, probing depth, bleeding on probing and attachment loss in the observation group were (0.85 ± 0.27) points, (0.64 ± 0.25) points, (2.25 ± 0.24) mm, (34.30 ± 0.48)% and (3.70 ± 0.55) mm, respectively, and they were (1.36 ± 0.30) points, (1.24 ± 0.53) points, (3.49 ± 0.38) mm, (57.88 ± 0.75) %, and (4.61 ± 0.92) mm, respectively. There were significant differences in these indexes between the observation and control groups ( t = 8.286, 6.714, 18.092, 173.648, 5.567, all P < 0.05). Total effective rate in the observation group was significantly higher than that in the control group [95.35% (41/43) vs. 79.07% (34/41), χ2 = 5.108, P < 0.05). Total effective rate in the observation group was significantly lower than that in the control group [2.33% (1/43) vs. 16.28% (7/43), χ2 = 4.962, P < 0.05]. Patient satisfaction in the observation group was significantly higher than that in the control group [(91.17 ± 3.52) points vs. (84.43 ± 2.50) points, t = 10.237, P < 0.05]. Conclusion:Periodontal tissue regeneration combined with orthodontics on periodontitis for treatment of periodontitis is highly safe and effective. It can promote the recovery of oral function and increase patient satisfaction.

Membranas e barreiras para regeneração óssea guiada / Membranes and barriers for guided bone regeneration

Introdução: a evolução das técnicas de reconstrução alveolar e dos biomateriais na regeneração óssea guiada (ROG), vêm trazendo consigo o desenvolvimento de novas membranas com diferentes características e propriedades. Objetivo: este trabalho tem como objetivo reunir dados das membranas utilizadas em procedimentos de ROG, presentes no mercado nacional, para facilitar ao clínico a escolha de um biomaterial que seja adequado ao procedimento planejado e com um desempenho favorável para a regeneração. Metodologia: foram incluídas 30 membranas para ROG registradas e regulamentadas pela Agência Nacional de Vigilância Sanitária (ANVISA). As empresas fabricantes foram contatadas para fornecer as informações dos seus respectivos produtos. Resultados: 30 membranas foram encontradas e tabuladas. Após a análise das informações obtidas pelos fabricantes, as mesmas foram classificadas nos seguintes itens: nome, empresa fabricante, origem, tempo de bioreabsorção, possibilidade de exposição ao meio bucal, diâmetro dos orifícios e apresentação. Discussão: as propriedades e características específicas de cada membrana podem determinar diferentes resultados, sendo importante para o profissional conhecer essas diferenças para selecionar os materiais mais indicados aos procedimentos de ROG de acordo com os objetivos de cada caso. Dessa forma, os resultados podem ser previsíveis e atender da melhor forma possível as expectativas do tratamento com embasamento científico. Conclusão: o presente estudo tabulou 30 membranas quanto as suas principais características, visando orientar os profissionais da saúde na seleção da membrana mais adequada para alcançar seus objetivos no tratamento da ROG.

Introduction: the evolution of alveolar reconstruction techniques and biomaterials in guided bone regeneration (GBR), have brought with it the development of new membranes with different characteristics and properties. Objective: this study aims to gather data from the membranes used for ROG procedures present in the national market, to facilitate the clinician to choose a biomaterial that is suitable for the planned procedure and with a favorable performance for regeneration. Metodology: 30 membranes were included, registered and regulated by ANVISA. The manufacturing companies were contacted to provide information on their respective products. Results: 30 membranes were found and tabulated after analyzing the information obtained by the manufacturers, they were classified in the following items: name, manufacturer company, origin, time of resorption, possibility of exposure to the oral environment, diameter of the holes and presentation. Discussion: the specific properties and characteristics of each membrane can determine different results and, therefore, it is important for the professional to know these differences in order to select the most suitable materials for the GBR procedures according to the objectives of each case. In this way, the results can be predictable and best meet the expectations of the treatment with a correct scientific basis. Conclusion: the present study tabulated 30 membranes as to their main characteristics, aiming to guide health professionals in the selection of the most appropriate membrane to achieve their goals in the treatment of GBR.

Simvastatin-enriched macro-porous chitosan-calcium-aluminate scaffold for mineralized tissue regeneration

Abstract The present study evaluated the odontogenic potential of human dental pulp cells (HDPCs) exposed to chitosan scaffolds containing calcium aluminate (CHAlCa) associated or not with low doses of simvastatin (SV). Chitosan scaffolds received a suspension of calcium aluminate (AlCa) and were then immersed into solutions containing SV. The following groups were established: chitosan-calcium-aluminate scaffolds (CHAlCa - Control), chitosan calcium-aluminate with 0.5 µM SV (CHAlCa-SV0.5), and chitosan calcium-aluminate with 1.0 µM SV (CHAlCa-SV1.0). The morphology and composition of the scaffolds were evaluated by SEM and EDS, respectively. After 14 days of HDPCs culture on scaffolds, cell viability, adhesion and spread, mineralized matrix deposition as well as gene expression of odontogenic markers were assessed. Calcium aluminate particles were incorporated into the chitosan matrix, which exhibited regular pores homogeneously distributed throughout its structure. The selected SV dosages were biocompatible with HDPCs. Chitosan-calcium-aluminate scaffolds with 1 µM SV induced the odontoblastic phenotype in the HDPCs, which showed enhanced mineralized matrix deposition and up-regulated ALP, Col1A1, and DMP-1 expression. Therefore, one can conclude that the incorporation of calcium aluminate and simvastatin in chitosan scaffolds had a synergistic effect on HDPCs, favoring odontogenic cell differentiation and mineralized matrix deposition.

Resumo O presente estudo avaliou o potencial odontogênico de células da polpa dental humana (HDPCs) em contato com scaffolds de quitosana contendo aluminato de cálcio (CHAlCa) associado ou não à baixas dosagens de sinvastatina (SV). Scaffolds de quitosana receberam uma suspensão de aluminato de cálcio e foram imersos em soluções contendo a droga. Foram estabelecidos três grupos experimentais: scaffolds de quitosana e aluminato de cálcio (CHAlCa - controle), scaffolds de quitosana-aluminato de cálcio com 0.5 µM SV (CHAlCa-SV0.5), e quitosana-aluminato de cálcio com 1.0 µM SV (CHAlCa-SV1.0). A morfologia e composição foram avaliados por MEV e EDS, respectivamente. Após 14 dias do cultivo das HDPCs sobre os scaffolds, foram avaliados a viabilidade celular, adesão e espalhamento, deposição de matriz mineralizada e expressão gênica de marcadores odontogênicos. Observou-se que as partículas de aluminato de cálcio foram incorporadas à matriz de quitosana, a qual exibiu poros regulares distribuídos por toda sua estrutura. As dosagens selecionadas de sinvastatina foram biocompatíveis com as HDPCs. A concentração de 1 µM de SV induziu intensa expressão de fenótipo odontoblástico pelas HDPCs, demonstrando aumento da deposição de matriz mineralizada e maior expressão de ALP, Col1A1 e DMP-1. Portanto, podemos concluir que a incorporação de aluminato de cálcio e sinvastatina em scaffolds de quitosana apresentou um efeito sinérgico nas HDPCs, favorecendo a diferenciação celular e deposição de matriz mineralizada.

La técnica del cono de helado, una posibilidad de tratamiento predecible / The ice cream cone technique, a predictable treatment possibility

ABSTRACT Introduction: The volumetric preservation of bone and soft tissue after a tooth extraction has special relevance in the esthetic zone when it will be rehabilitated by a dental implant. Objective: Describe the prosthodontics treatment in a socket with advanced buccal bone resorption, with a flapless technique for guided bone regeneration and with a dental implant and implant-supported single fixed prosthesis. Case presentation: A case is presented of a male 62-year-old partially dentate patient. Radiographic examination showed the presence of advanced buccal bone resorption in relation to the maxillary left lateral incisor. It was a result of the root displacement secondary to root fracture. In a first surgical phase the lateral incisor was extracted using an atraumatic periotome technique. Particulate cortical bone allograft was compacted into the site to fill the space that was previously occupied by the root of the tooth. Temporary restoration was performed using the extracted natural tooth, which was adhesively bonded to the adjacent teeth. Four months after grafting the extraction site showed an adequate height and width of the bone. In a second surgical phase, an implant was placed. Six months after implant placement, osseointegration was clinically confirmed and a provisional crown was screwed on the implant performed. The final restoration with a zirconium dioxide abutment and a full ceramic crown was obtained and cemented. Conclusions: Regeneration of the buccal plate was possible through the use of particulate cortical bone allograft and a resorbable collagen membrane adapted to the bone defect and placed in a position to recreate the buccal plate. This allowed the installation of an implant 4 months later, the procedure allowing esthetic and functional results using a single fixed prosthesis(AU)

RESUMEN Introducción: La preservación volumétrica de los huesos y tejidos blandos después de una extracción dental tiene especial relevancia en la zona estética cuando será rehabilitada por un implante dental. Objetivo: Describir el tratamiento de prótesis en una cavidad con reabsorción ósea bucal avanzada, con una técnica sin colgajo para la regeneración ósea guiada y con un implante dental y una prótesis fija única con soporte de implante. Presentación del caso: Paciente masculino de 62 años, edente parcial. El examen radiográfico mostró la presencia de reabsorción ósea bucal avanzada en relación con el incisivo lateral superior izquierdo. Fue el resultado del desplazamiento de la raíz secundario a la fractura de esta. En una primera fase quirúrgica, el incisivo lateral se extrajo utilizando una técnica de periotoma atraumático. El aloinjerto de hueso cortical particulado se compactó en el sitio para llenar el espacio que anteriormente ocupaba la raíz del diente. La restauración temporal se realizó utilizando el diente natural extraído, que se unió adhesivamente a los dientes adyacentes. Cuatro meses después del injerto, el sitio de extracción mostró una altura y anchura adecuadas del hueso. En una segunda fase quirúrgica, se colocó un implante. Seis meses después de la colocación del implante, se confirmó clínicamente la osteointegración y se realizó una corona provisional atornillada al implante. La restauración final con un pilar de dióxido de circonio y una corona de cerámica completa se obtuvo y se cementó. Conclusiones: La regeneración de la placa bucal fue posible mediante el uso de aloinjerto de hueso cortical particulado y una membrana de colágeno reabsorbible adaptada al defecto óseo y colocada en una posición para recrear la placa bucal. Esto permitió la instalación de un implante 4 meses después. El procedimiento permitió la estética y los resultados funcionales utilizando una única prótesis fija(AU)