Avaliação das alterações dimensionais horizontais dos tecidos mole e ósseo por meio de diferentes técnicas de preservação do rebordo alveolar / Assessment of horizontal dimensional changes in soft and bone tissue through diferente alveolar ridge preservation techniques

Com a perda de um dente após uma exodontia, tem-se início o processo de remodelação óssea de uma cicatrização espontânea que levará a perdas dimensionais desse alvéolo, principalmente em volume, comprometendo o formato original do rebordo. Técnicas de preservação do rebordo alveolar têm sido descritas há muito tempo, porém, sem um consenso sobre qual procedimento escolher e tampouco qual substituto usar. O objetivo desse estudo foi comparar algumas técnicas já citadas na literatura, utilizando substitutos ósseos e membranas para avaliar as alterações dimensionais horizontais. Foram tratados 25 pacientes (n=5) com necessidade de exodontia de dentes da maxila, com exceção dos molares. Os pacientes foram dispostos aleatoriamente em 5 grupos: GI membrana de politetrafluoretileno denso (Cytoplast®); GII enxerto ósseo xenógeno com uma membrana de colágeno (Bio Oss Collagen® associado a Bio Gide®); GIII membrana de polipropileno (Bone Heal®) 7 dias; GIV membrana de polipropileno (Bone Heal® 21 dias e GV Controle (cicatrização espontânea). O desfecho primário foi a alteração dimensional horizontal do rebordo alveolar encontrada entre as imagens tomográficas de início (T0) antes da exodontia e final (T1) após 6 meses da intervenção, na espessura abaixo da crista óssea em 1 mm (H1), 3 mm (H3) e 5 mm (H5), além da redução em volume do tecido mole avaliadas por meio de modelos de gesso escaneados e sobrepostos com um software de precisão (GOM Inspect®), medidos em 6 pontos em mimímetros a partir da margem gengival (0, 1, 2, 3, 4 e 5). As médias em mm das reduções em espessura óssea foram: em H1 (GI = 1,30, GII = 1,89, GIII = 1,30, GIV = 1,20, GV = 1,97); em H3 (GI = 1,71, GII = 1,98, GIII = 1,16, GIV = 0,34, GV = 1,75) e em H5 (GI = 1,11, GII = 0,74, GIII = 0,86, GIV = 0,26, GV = 1,36) chegando a uma conclusão estatisticamente significante entre os grupos de que GIV apresenta menores desvios que GII. Já as médias em mm das reduções horizontais dos tecidos ósseos foram: Ponto 0 (3,21; 2,26; 1,71; 1,49; 2,57 mm), ponto 1 (2,24; 2,39; 1,58; 1,59; 2,42 mm). Ponto 2 (1,77; 2,20; 1,21; 1,37;2,26 mm), ponto 3 (1,61; 1,90; 1,13; 1,13; 2,03 mm), ponto 4 (1,49; 1,68; 1,21; 0,94; 1,86 mm) e ponto 5 (1,28; 1,69; 1,06; 1,27; 1,70mm) respectivamente para os grupos GI, GII, GII, GIV e GV. Concluindo que houve diferenças entre os grupos estatisticamente significantes entre GIII com menores reduções que GII e GV, GIV com menores reduções que GV. Demonstrando que a técnica de preservação do rebordo alveolar pode ser utilizada como uma alternativa na limitação das perdas horizontais em tecido mole e ósseos.

Physico-Chemical comparison of four commercially available mineral trioxide aggregates / Comparación fisicoquímica de cuatro mineral trióxido agregados disponibles comercialmente

Abstract To compare the physicochemical composition of 4 MTAs commercially available in Latin America. ProRoot MTA (Dentsply, USA), MTA Angelus (Angelus, Brazil), MTA Flow (Ultradent, USA), and MTA Viarden (Viarden, Mexico) were physically and chemically compared. Scanning electron microscopy (SEM) images were obtained from the MTA powder and the prepared presentations. Energy Dispersive X-Ray Spectroscopy (EDS) analyses were performed by triplicate, to calculate the mass proportion of calcium (Ca), silicon (Si), the Ca/Si proportion among the 4 brands. Thermogravimetric analyses (TGA) were conducted (50ºC-1000ºC), and mass loss and inflection points were calculated for each material. Statistical differences for Ca and Si content were determined by ANOVA (p<0.05). SEM images showed evident differences in the appearance of both the powder and the prepared MTAs among brands. Angelus MTA showed cubic prisms not observed in the other 3 brands. ProRoot MTA and MTA Flow showed similar homogeneous structures. MTA Viarden was the less homogeneous, with random structures (>15um). When comparing the mass proportions of Ca and Si between the 4 powder samples, MTA Viarden showed a significantly lower proportions of both elements when compared with the other brands (p<0.005). TGA análisis showed a similar behavior for ProRoot MTA, MTA Angelus and MTA Flow, with less than 2% mass loss when the 1000C temperature was reached. MTA Viarden showed a mass loss of 9,94% before the 700C, indicating the presence of different content sensible to temperature degradation. The analyzed MTAs demonstrated to vary significantly in their chemical composition and physical characteristics. Clinicians must be aware of the differences between different brands of a same material, and future research should focus on the clinical implications of these differences.

Resumen Comparar la composición fisicoquímica de 4 MTA disponibles comercialmente en América Latina. Se compararon física y químicamente ProRoot MTA (Dentsply, EE. UU.), MTA Angelus (Angelus, Brasil), MTA Flow (Ultradent, EE. UU.) y MTA Viarden (Viarden, México). Se obtuvieron imágenes de microscopía electrónica de barrido (SEM) del polvo de MTA y de las presentaciones preparadas. Los análisis de espectroscopía de dispersión de energía de rayos X (EDS) se realizaron por triplicado para calcular la proporción de masa de calcio (Ca), silicio (Si), la proporción Ca/Si entre las 4 marcas. Se realizaron análisis termogravimétricos (TGA) (50ºC-1000ºC), y se calcularon las pérdidas de masa y los puntos de inflexión para cada material. Las diferencias estadísticas para el contenido de Ca y Si se determinaron mediante ANOVA (p<0,05). Los análisis SEM mostraron diferencias evidentes en la apariencia tanto del polvo como las preparaciones de los MTA, entre las diferentes marcas. MTA Angelus mostró prismas cúbicos no observados en las otras 3 marcas. ProRoot MTA y MTA Flow mostraron estructuras homogéneas similares. MTA Viarden fue el menos homogéneo, con estructuras aleatorias (>15um). Al comparar las proporciones de masa de Ca y Si entre las 4 muestras de polvo, MTA Viarden mostró proporciones significativamente más bajas de ambos elementos en comparación con las otras marcas (p<0,005). El análisis TGA mostró un comportamiento similar para ProRoot MTA, MTA Angelus y MTA Flow, con menos del 2 % de pérdida de masa al alcanzar los 1000 °C de temperatura. El MTA Viarden mostró una pérdida de masa de 9,94% antes de los 700 °C, indicando la presencia de diferentes contenidos sensibles a la degradación por temperatura. Los MTA analizados demostraron diferencias significativas en su composición química y características físicas. Los clínicos deben ser conscientes de las diferencias entre las diferentes marcas de un mismo material, y futuras investigaciones deben enfocarse en las implicaciones clínicas de estas diferencias.

Comparación Placas de Titanio vs. Placas Reabsorbibles en Fracturas de Orbita: Revisión de literatura / Comparison of Titanium Plates vs. Resorbable Plates in Orbital Fractures: Literature Review

RESUMEN Introducción: Los tratamientos para fracturas de órbita se basan en la corrección del defecto de las lesiones orbitarias de tipo blow in y blow out (o de estallido), mediante diversas placas y mallas biocompatibles con el organismo, dándose una cicatrización de primera generación evitando un callo óseo y una fijación más rígida. Para el diagnóstico de este tipo de lesiones tenemos inflamación periorbitaria, enoftalmos, diplopía, equimosis, hemorragia subconjuntival. Existen diversos materiales reconstructivos siendo estos compuestos por distintas materias primas, como son los aloplásticos y autógenos; donde encontramos varios tipos como placas de titanio y las placas reabsorbibles siendo estas las más comunes y usadas actualmente, por su bajo estímulo a reabsorciones óseas y evitando efectos secundarios a largo plazo. Estas placas presentan diversos grados de ductilidad y resistencia. Se informó sobre varias complicaciones según el tipo de placas como es la cicatrización, las cirugías postquirúrgicas en caso de placas de titanio, etc. El objetivo de esta revisión es la evaluación de la eficacia las placas reabsorbibles versus placas de titanio en fracturas de órbita. Materiales y métodos: La investigación es de carácter documental, descriptivo y no experimental. En el cual se emplea una metodología de identificación e inclusión de artículos científicos tipo prisma. Resultados y conclusiones: Se verificaron las ventajas y desventajas tanto de las placas reabsorbibles como las de titanio siendo estas similares en la biocompatibilidad con el organismo humano, así como también varias diferencias como el soporte, fuerzas, resistencia de estas, concluyendo que es debatible el material ideal para tratar fracturas de órbita. Se seleccionaron artículos tomando en cuenta el título y objetivos; considerando estudios comparativos, revisiones sistemáticas, revisiones de literatura, los cuales comprendían criterios con respecto a fracturas de órbita y tratamientos quirúrgicos. La búsqueda arrojó 55 artículos en PubMed, 65 en Google, 4 en Scielo y 29 en Science direct, de los cuales se excluyeron libros, monografías, estudios experimentales, dando como resultado 21 artículos para el desarrollo de esta revisión bibliográfica. Y que fueron leídos y analizados en su totalidad, estudiando los objetivos, metodología y conclusión de cada uno de ellos para la posterior comparación.

ABSTRACT Introduction: Treatments for orbit fractures are based on the correction of the defect of blow in and blow out orbital injuries, by means of various plates and meshes biocompatible with the organism, giving a first-generation healing avoiding a bony callus and a more rigid fixation. For the diagnosis of this type of lesions we have periorbital inflammation, enophthalmos, diplopia, ecchymosis, subconjunctival hemorrhage. There are several reconstructive materials being these composed of different raw materials, such as alloplastic and autogenous, where we find several types such as titanium plates and resorbable plates being these the most common and currently used, for its low stimulus to bone resorption and avoiding long-term side effects. These plates have different degrees of ductility and resistance. Several complications have been reported depending on the type of plates, such as scarring, post-surgical surgeries in the case of titanium plates, etc. The objective of this review is to evaluate the efficacy of resorbable versus titanium plates in orbital fractures. Materials and methods: This research are a documentary, descriptive and non-experimental nature. A prism-type methodology of identification and inclusion of scientific articles was used. Results and conclusions: The advantages and disadvantages of both resorbable and titanium plates were verified, being these similar in biocompatibility with the human organism, as well as several differences such as support, forces, resistance of the same, concluding that it is debatable. The ideal material to treat orbital fractures. Articles were selected considering the title and objectives; considering comparative studies, systematic reviews, literature reviews, which included criteria regarding orbital fractures and surgical treatments. The search yielded 55 articles in PubMed, 65 in Google, 4 in Scielo and 29 in Science direct, from which books, monographs, experimental studies were excluded, resulting in 21 articles for the development of this bibliographic review. The 21 articles were read and analyzed in their entirety, studying the objectives, methodology and conclusion of each one of them for subsequent comparison.

Correção secundária de Fratura Blow-Out: relato de caso / Secondary correction of Blow-Out Fracture: case report / Corrección secundaria de Fractura Blow-Out: reporte de caso

Objetivo: Discutir o tratamento cirúrgico secundário de uma fratura de órbita tipo Blow-Out, explorando os desafios e limitações relacionados a este padrão de fratura. Relato de Caso: Paciente sexo masculino, 50 anos, ASA I relatando histórico de agressão física e quatro cirurgias prévias em região orbitária direita. Clinicamente foram observados sinais como enoftalmo, hipoftalmo, encurtamento da pálpebra inferior, dificuldade de oclusão palpebral, entrópio, hiperemia em conjuntiva, além de presença de secreção purulenta, todos em região orbitária à direita. Diante do exposto, uma nova intervenção cirúrgica foi proposta pela Cirurgia e Traumatologia Bucomaxilofacial, na tentativa corrigir alguns problemas listados, além de encaminhamento a outras especialidades. Encontra-se em acompanhamento de um ano, com boa evolução. Conclusão: O tratamento de fraturas orbitárias é um dos mais desafiadores, especialmente quando se trata sequelas. A definição pelo melhor momento para realização destes procedimentos não é um consenso, sendo necessário uma avaliação clínica criteriosa. Apesar da utilização dos enxertos autógenos ser amplamente recomendada, os materiais aloplásticos vem se tornando a primeira escolha para tratamento das correções secundárias pelas diversas vantagens oferecidas.

Aim: To discuss the secondary surgical treatment of a Blow-Out orbit fracture, exploring the challenges and limitations related to this fracture pattern. Case report: Male patient, 50 years old, ASA I reporting a history of physical aggression and four previous surgeries in the right orbital region. Clinically, enophthalmos, hypophthalmos, shortening of the lower eyelid, difficulty in eyelid occlusion, entropion, hyperemia in the conjunctiva were observed, in addition to the presence of purulent secretion, all in the right orbit. In view of the above, a new surgical intervention was proposed by Buccomaxillofacial Surgery and Traumatology, in an attempt to correct some listed problems, in addition to referral to other specialties. He is being followed up for one year, with good progress. Conclusion: The treatment of orbital fractures is one of the most challenging, especially when dealing with sequelae. The definition of the best time to perform these procedures is not a consensus, requiring a careful clinical evaluation. Although the use of autogenous grafts is widely recommended, alloplastic materials are becoming the first choice for treating secondary corrections due to the several advantages offered.

Objetivo: Discutir el tratamiento quirúrgico secundario de una fractura orbitaria Blow-Out, explorando los desafíos y las limitaciones relacionadas con este patrón de fractura. Caso Clínico: Paciente masculino, 50 años, ASA I, que refi ere antecedentes de agresión física y cuatro cirugías previas en región orbitaria derecha. Clínicamente se observaron signos como enoftalmos, hipoftalmos, acortamiento del párpado inferior, difi cultad en la oclusión palpebral, entropión, hiperemia en la conjuntiva, además de la presencia de secreción purulenta, todos en la región orbitaria derecha. Ante lo anterior, se propuso una nueva intervención quirúrgica desde Cirugía Oral y Maxilofacial y Traumatología, en un intento de corregir algunos de los problemas enumerados, además de la derivación a otras especialidades. Está en seguimiento desde hace un año, con buena evolución. Conclusión: El tratamiento de las fracturas de órbita es uno de los más desafi antes, especialmente cuando se trata de secuelas. La defi nición del mejor momento para realizar estos procedimientos no es un consenso, lo que requiere una evaluación clínica cuidadosa. A pesar de que se recomienda ampliamente el uso de injertos autógenos, los materiales aloplásticos se han convertido en la primera opción para el tratamiento de correcciones secundarias debido a las múltiples ventajas que ofrecen.

A tecnologia da Fibrina Rica em Plaquetas (PRF) pode ser aplicada em diversas áreas da Odontologia e Medicina? / Can Platelet Rich Fibrin (PRF) technology be applied in different areas of Dentistry and Medicine? / Se puede aplicar la tecnología de Fibrina Rica en Plaquetas (PRF) en diferentes áreas de la Odontología y la Medicina?

A Fibrina Rica em Plaquetas (PRF) é um material biológico feito do próprio sangue do paciente. É um material natural e não sintético. A PRF é rica em fatores de crescimento necessários para a cicatrização e o reparo tecidual. Também é rica em leucócitos, que são células do sistema imunológico que ajudam a proteger o paciente contra infecções. A PRF pode ser usada para acelerar o processo de cicatrização, redução da dor, do sangramento e melhora a estética do resultado final. Também pode ser usada para melhorar a eficácia de outros tratamentos médicos e odontológicos que vão desde Exodontia à aplicação na harmonização orofacial. Essa tecnologia pode ser usada na cirurgia oral e maxilofacial, implantodontia, periodontia, harmonização orofacial, cirurgia plástica, queimaduras, feridas crônicas, doenças degenerativas e doenças autoimunes. A PRF é uma tecnologia segura e eficaz que tem o potencial de melhorar a qualidade de vida de muitos pacientes.

Platelet Rich Fibrin (PRF) is a biological material made from the patient's own blood. It is a natural material and not synthetic. PRF is rich in growth factors necessary for tissue healing and repair. It is also rich in leukocytes, which are immune system cells that help protect the patient against infections. PRF can be used to accelerate the healing process, reduce pain and bleeding and improve the aesthetics of the final result. It can also be used to improve the effectiveness of other medical and dental treatments, ranging from extractions to orofacial harmonization. This technology can be used in oral and maxillofacial surgery, implant dentistry, periodontics, orofacial harmonization, plastic surgery, burns, chronic wounds, degenerative diseases and autoimmune diseases. PRF is a safe and effective technology that has the potential to improve the quality of life for many patients.

La fibrina rica en plaquetas (PRF) es un material biológico elaborado a partir de la propia sangre del paciente. Es un material natural y no sintético. PRF es rico en factores de crecimiento necesarios para la curación y reparación de tejidos. También es rico en leucocitos, que son células del sistema inmunológico que ayudan a proteger al paciente frente a infecciones. PRF se puede utilizar para acelerar el proceso de curación, reducir el dolor y el sangrado y mejorar la estética del resultado final. También se puede utilizar para mejorar la eficacia de otros tratamientos médicos y dentales, desde extracciones hasta armonización orofacial. Esta tecnología puede ser utilizada en cirugía oral y maxilofacial, implantología, periodoncia, armonización orofacial, cirugía plástica, quemaduras, heridas crónicas, enfermedades degenerativas y enfermedades autoinmunes. PRF es una tecnología segura y eficaz que tiene el potencial de mejorar la calidad de vida de muchos pacientes.

Estudio de biocompatibilidad de matrices poliméricas combinadas, responsivas al pH, con aplicación en Ingeniería de Tejido Óseo / Biocompatibility study of combined pH-responsive polymeric matrices with application in Bone Tissue Engineering

El presente trabajo muestra la obtención de un material a partir de un polímero sintético (TerP) y otro natural, mediante entrecruzamiento físico y su caracterización fisicoquímica y biológica, con el fin de emplearlos para regeneración de tejido óseo. Las membranas fueron obtenidas por la técnica de evaporación del solvente y caracterizadas por espectroscopia FTIR, ensayos de hinchamiento, medidas de ángulo de contacto y microscopia electrónica de barrido (SEM). Se encontró que la compatibilidad entre los polímeros que la constituyen es estable a pH fisiológico y que, al incorporar mayor cantidad del TerP a la matriz, esta se vuelve más hidrofóbica y porosa. Además, teniendo en cuenta la aplicación prevista para dichos materiales, se realizaron estudios de biocompatibilidad y citotoxicidad con células progenitoras de médula ósea (CPMO) y células RAW264.7, respectivamente. Se evaluó la proliferación celular, la producción y liberación de óxido nítrico (NO) al medio de cultivo durante 24 y 48 horas y la expresión de citoquinas proinflamatorias IL-1ß y TNF-α de las células crecidas sobre los biomateriales variando la cantidad del polímero sintético. Se encontró mayor proliferación celular y menor producción de NO sobre las matrices que contienen menos proporción del TerP, además de poseer una mejor biocompatibilidad. Los resultados de este estudio muestran que el terpolímero obtenido y su combinación con un polímero natural es una estrategia muy interesante para obtener un biomaterial con posibles aplicaciones en medicina regenerativa y que podría extenderse a otros sistemas estructuralmente relacionados. (AU)

In the present work, the preparation of a biomaterial from a synthetic terpolymer (TerP) and a natural polymer, physically crosslinked, is shown. In order to evaluate the new material for bone tissue regeneration, physicochemical and biological characterizations were performed. The membranes were obtained by solvent casting and characterized using FTIR spectroscopy, swelling tests, contact angle measurements, and scanning electron microscopy (SEM). It was found that the compatibility between the polymers is stable at physiological pH and the incorporation of a higher amount of TerP into the matrix increases hydrophobicity and porosity.Furthermore, considering the intended application of these materials, studies of biocompatibility and cytotoxicity were conducted with Bone Marrow Progenitor Cells (BMPCs) and RAW264.7 cells, respectively. Cell proliferation, NO production and release into the culture medium for 24 and 48 hours, and proinflammatory cytokine expression of IL-1ß and TNF-α from cells grown on the biomaterials while varying the amount of the synthetic polymer were evaluated. Greater cell proliferation and lower NO production were found on matrices containing a lower proportion of TerP, in addition to better biocompatibility. The results of this study demonstrate that the obtained terpolymer and its combination with a natural polymer is a highly interesting strategy for biomaterial preparation with potential applications in regenerative medicine. This approach could be extended to other structurally related systems. (AU)

Reconstrução óssea de defeito crítico com a utilização de tela de titânio: relato de caso / Bone reconstruction of a critical defect using titanium mesh: case report / Reconstrucción ósea de un defecto crítico con malla de titanio: reporte de caso

Introdução: O uso de membranas de barreira de exclusão de epitélio para regeneração óssea guiada tem sido apresentado na literatura como abordagem de tratamento bem sucedida, essas barreiras irão impedir a incorporação de células de tecidos moles no enxerto ósseo ou no es paço criado pelo defeito e permitir que apenas as células osteogênicas estejam presentes. Relato de caso: Trata-se de um caso clinico de um paciente que evoluiu com perda óssea significativa por lesão Endo-periodontal levando a perda dentaria, para a reabilitação com implantes se fez necessário uma reconstrução de um defeito crítico com a utilização de tela de titânio para arcabouço ósseo de mistura de enxerto autógeno e biomaterial e recobrimento com membrana de colágeno, o enxerto autógeno foi removido de área doadora na mandíbula e utilizado de forma particulada. Conclusão: As telas de titânio apresentam viabilidade e previsibilidade no aumento ósseo vertical, horizontal e tridimensional em decorrência da sua ampla aplicabilidade, elasticidade, plasticidade adequadas e boas propriedades mecânicas. Avanços na diminuição de suas taxas de exposição e risco de complicações no período de cicatrização melhoram a cada dia a previsibilidade da técnica, bem como a associação com outros materiais como os hemoderivados... (AU)

Introduction: The use of epithelial exclusion barrier membranes for guided bone regeneration has been presented in the literature as a successful treatment approach, these barriers will prevent the incorporation of soft tissue cells into the bone graft or the space created by the defect and allow that only osteogenic cells are present. Case report: This is a clinical case of a patient who evolved with significant bone loss due to an endo-periodontal lesion leading to tooth loss, for rehabilitation with implants it was necessary to reconstruct a critical defect using mesh titanium for bone framework of mixture of autogenous graft and biomaterial and covering with collagen membrane, the autogenous graft was removed from the donor area in the mandible and used in a particulate form. Conclusion: Titanium meshes are viable and predictable in vertical, horizontal and three-dimensional bone augmentation due to their wide applicability, adequate elasticity and plasticity, good mechanical properties. Advances in reducing their exposure rates and risk of complications during the healing period improve the predictability of the technique every day, as well as the association with other materials such as blood products... (AU)

Introducción: El uso de membranas de barrera de exclusión epitelial para la regeneración ósea guiada se ha presentado en la literatura como un enfoque de tratamiento exitoso, estas barreras evitarán la incorporación de células de tejido blando al injerto óseo o el espacio creado por el defecto y permitirán que solo presencia de células osteogénicas. Reporte de caso: Este es un caso clínico de un paciente que evolucionó con una pérdida ósea importante debido a una lesión endo-periodontal que lo llevó a la pérdida de un diente, para rehabilitación con implantes fue necesario reconstruir un defecto crítico utilizando malla de titanio para armazón óseo de mezcla de injerto autógeno y biomaterial y cubriendo con membrana de colágeno, el injerto autógeno se extrajo del área donante en la mandíbula y se usó en forma de partículas. Conclusión: Las mallas de titanio son viables y predecibles en el aumento óseo vertical, horizontal y tridimensional debido a su amplia aplicabilidad, adecuada elasticidad y plasticidad, buenas propiedades mecánicas. Los avances en la reducción de sus tasas de exposición y riesgo de complicaciones durante el periodo de cicatrización mejoran día a día la predictibilidad de la técnica, así como la asociación con otros materiales como los hemoderivados... (AU)

Agentes de abultamiento en incontinencia de orina de esfuerzo femenina: una alternativa a las mallas suburetrales / Bulking agents in female stress urinary incontinence: an alternative to suburethral mesh

OBJETIVO: Presentar una serie de casos de agentes de abultamiento (AA) de nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo. Se evaluaron todos los casos operados con AA entre 2017 y 2022. La inyección de AA se realizó en quirófano, bajo sedación con anestesia local periuretral o raquídea. La inyección se realizó con uretroscopia, 0,5 cc en 4 puntos periuretrales (horas 2, 5, 7 y 10). Se analizaron datos demográficos, quirúrgicos y de seguimiento. RESULTADOS: 15 casos. 13/15 presentaron incontinencia urinaria mixta. Solo dos casos tenían incontinencia de orina de esfuerzo pura. El procedimiento fue ambulatorio. La mediana del tiempo operatorio fue 15 minutos (15-20). La mediana de seguimiento fue 5 meses (1-9). El índice de severidad preoperatorio promedio fue 10,6 y en el seguimiento fue 2,79. La Escala de Mejoría Global mostró mejoría en 12/15, y 12/15 estaban satisfechas con la cirugía con mejoría en la calidad de vida. CONCLUSIÓN: Los AA son una opción quirúrgica efectiva, con una tasa de éxito del 80% en otros reportes, siendo similar con nuestra casuística. Ofrecer esta opción es posible a la hora de hablar de terapias alternativas.

OBJECTIVE: To present a case series of bulking agents (BA) from our center. MATERIAL AND METHODS: Retrospective study. All cases operated with BA between 2017 and 2022 were evaluated. A BA injection was performed in the operating room, under periurethral local anesthesia sedation or spinal anesthesia. The injection was performed with urethroscopy, 0.5 cc in 4 periurethral points (hours 2, 5, 7 and 10). Demographic, surgical, and follow-up data were analyzed. RESULTS: 15 cases were reported. 13/15 patients presented with mixed urinary incontinence. Only 2 cases had pure stress urinary incontinence. The procedure was ambulatory. Median operative time was 15 minutes (15-20). Median follow-up was 5 months (1-9). The average preoperative Sandvik Severity Index was 10.6 and in follow-up was 2.79. The PGI showed improvement in 12/15, and 12/15 were satisfied with the surgery with quality-of-life improvement. CONCLUSION: BA are an effective surgical option, with a success rate of 80%, according to other reports, being similar with our casuistry. Offer this option is possible at the moment of discussing alternative therapies.

Macroporous latex biomembrane from Hancornia speciosa modulates the inflammatory process and has a debridement effect on wound healing in rats

Purpose: The angiogenic, osteogenic and anti-inflammatory activity of latex of Hancornia speciosa has been evidenced and indicates pharmacological potential with great applicability in the health area, especially in the wound healing process. The present work aimed to compare the effects of the H. speciosa macroporous latex biomembrane with saline on wound healing. Methods: Forty-three Wistar rats were submitted to excisional wound induction procedure and divided into groups according to treatment: saline (G1), and macroporous biomembrane (G2). The animals were euthanized at three, seven, 14, and 21 days after injury induction (DAI), and three animals were used for the debridement test. Morphometric, macroscopic, and microscopic analyses of general pathological processes were performed. Results: The macroporous biomembrane minimized necrosis and inflammation during the inflammatory and proliferative phases of the healing process, confirmed by the lower intensity of the crust and the debridement effect. In addition, the wounds treated with the macroporous biomembrane presented greater contraction rates in all the experimental periods analyzed. Conclusions: The macroporous biomembrane presents angiogenic, anti-inflammatory and debridement effects, contributing to the healing process, and can be considered a potentially promising new biomaterial to be used as a dressing.

Funcionalização de matriz colágena estável em volume utilizando Fibrina Rica em Plaquetas injetável (i-PRF) para o tratamento de Recessão Gengival unitária / Volume-stable collagen matrix (VCMX) biofunctionalized wit injectable platelet-rich fibrin (i-PRF) for the treatment of single gingival recession: randomized clinical trial

Substitutos de enxerto de tecido conjuntivo têm sido amplamente utilizados para superar as limitações dos enxertos autógenos no tratamento de defeitos dos tecidos moles periodontais e peri-implantares. No entanto, o desempenho clínico desses biomateriais ainda é inferior. A biofuncionalização de matrizes colágenas usando fibrina rica em plaquetas injetável (i-PRF) foi proposta como uma estratégia para aprimorar a bioatividade e, portanto, a eficácia clínica desses substitutos mucosos. Desta forma, o objetivo deste estudo foi avaliar a eficácia do uso da matriz colágena estável em volume (FG) biofuncionalizada com i-PRF no tratamento de recessões gengivais unitárias (RGs) do ponto de vista clínico, estético e de parâmetros centrados no paciente. Para tal, foram selecionados 66 pacientes portadores de RGs unitárias RT1, os quais foram alocados aleatoriamente em um dos seguintes grupos: grupo CAF (n=22), retalho posicionado coronariamente (CAF); grupo CAF+FG (n=22), CAF associado à FG; e grupo CAF+FG+i-PRF (n=22), CAF associado à FG biofuncionalizada com i-PRF. Após 6 meses, os três grupos apresentaram taxas de recobrimento radicular significativas [CAF: 69,1% (2,02 ± 1,06 mm); CAF+FG: 67,44% (1,7 ± 0,81 mm) e CAF+FG+i-PRF: 64,92% (1,64 ± 0,80 mm), sem diferença entre os grupos (p=0,33). Os grupos que receberam os biomateriais forneceram um maior ganho em espessura de tecido queratinizado (ETQ) (CAF: 0,12 ± 0,2 mm; CAF+FG: 0,43 ± 0,24 mm; CAF+FG+i-PRF: 0,48 ± 0,25 mm; p=0,000). Não foram observadas diferenças significativas em termos de altura de tecido queratinizado em nenhum dos grupos e tempos avaliados (p>0,05). Todos os grupos apresentaram redução significativa da hipersensibilidade dentinária e melhorias nas condições estéticas (p>0,05). Também não foram observadas diferenças em termos de dor e morbidade pósoperatórias (p>0,05). Dentro das limitações do presente estudo, conclui-se que as três abordagens forneceram resultados semelhantes e satisfatórios após 6 meses de acompanhamento. A adição da FG, biofuncionalizada ou não com i-PRF, proporcionou benefícios adicionais em termos de ganho de ETQ. (AU)

Soft tissue graft substitutes have been widely used to overcome the limitations of autogenous grafts in the treatment of periodontal and peri-implant soft tissue defects. However, the clinical performance of these biomaterials is still inferior. The biofunctionalization of collagen matrices using injectable platelet-rich fibrin (i-PRF) has been proposed as a strategy to enhance the bioactivity and, therefore, the clinical efficacy of these biomaterials. Thus, the aim of this study was to evaluate the effectiveness of using biofunctionalized volume-stable collagen matrix (VCMX) with i-PRF in the treatment of single gingival recessions (GRs) from clinical, esthetic, and patient-centered parameters. For this purpose, 66 patients with single RT GRs were selected and randomly allocated to one of the following groups: CAF group (n=22), coronally advanced flap (CAF); CAF+VCMX group (n=22), CAF combined with VCMX; and CAF+ VCMX +iPRF group (n=22), CAF combined with biofunctionalized VCMX with i-PRF. After 6 months, all three groups exhibited significant root coverage rates [CAF: 69.1% (2.02 ± 1.06 mm); CAF+FG: 67.44% (1.7 ± 0.81 mm); and CAF+FG+iPRF: 64.92% (1.64 ± 0.80 mm), with no difference between the groups (p=0.33). The groups that received the biomaterials showed a greater gain in keratinized tissue thickness (KTT) (CAF: 0.12 ± 0.2 mm; CAF+FG: 0.43 ± 0.24 mm; CAF+FG+i-PRF: 0.48 ± 0.25 mm; p=0.000). No significant differences were observed in terms of keratinized tissue height in any of the groups and assessed time points (p>0.05). All groups showed a significant reduction in dentin hypersensitivity and improvements in esthetic conditions (p>0.05). No differences were also observed in terms of post-operative pain and morbidity (p>0.05). Within the limitations of this study, it is concluded that all three approaches provided similar and satisfactory results after 6 months of follow-up. The addition of VCMX, whether biofunctionalized or not with i-PRF, provided additional benefits in terms of keratinized tissue thickness gain. (AU)

Applicatoin of chitosan-based hydrogel in oral tissue engineering / 中南大学学报(医学版)

Pulpitis, periodontitis, jaw bone defect, and temporomandibular joint damage are common oral and maxillofacial diseases in clinic, but traditional treatments are unable to restore the structure and function of the injured tissues. Due to their good biocompatibility, biodegradability, antioxidant effect, anti-inflammatory activity, and broad-spectrum antimicrobial property, chitosan-based hydrogels have shown broad applicable prospects in the field of oral tissue engineering. Quaternization, carboxymethylation, and sulfonation are common chemical modification strategies to improve the physicochemical properties and biological functions of chitosan-based hydrogels, while the construction of hydrogel composite systems via carrying porous microspheres or nanoparticles can achieve local sequential delivery of diverse drugs or bioactive factors, laying a solid foundation for the well-organized regeneration of defective tissues. Chemical cross-linking is commonly employed to fabricate irreversible permanent chitosan gels, and physical cross-linking enables the formation of reversible gel networks. Representing suitable scaffold biomaterials, several chitosan-based hydrogels transplanted with stem cells, growth factors or exosomes have been used in an attempt to regenerate oral soft and hard tissues. Currently, remarkable advances have been made in promoting the regeneration of pulp-dentin complex, cementum-periodontium-alveolar bone complex, jaw bone, and cartilage. However, the clinical translation of chitosan-based hydrogels still encounters multiple challenges. In future, more in vivo clinical exploration under the conditions of oral complex microenvironments should be performed, and the combined application of chitosan-based hydrogels and a variety of bioactive factors, biomaterials, and state-of-the-art biotechnologies can be pursued in order to realize multifaceted complete regeneration of oral tissue.

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.

Does low-intensity pulsed ultrasound accelerate phasic calcium phosphate ceramic-induced bone formation?

Purpose: Low-intensity pulsed ultrasound (LIPUS) has been used to stimulate the healing of the fresh fracture, delayed union, and non-union in both animal and clinical studies. Besides, biphasic calcium phosphate ceramic (BCP) is a promising biomaterial for bone repair as it shows favorable biocompatibility, osteoinduction, and osteoconduction. However, scarcity is known about the combined effect of LIPUS and BCP on bone formation. Methods: The combined effect of LIPUS and BCP was studied in a beagle model. Twelve dogs were used. BCP granules without any additions were implanted into bilateral erector spinae muscles. One side is the BCP group, while the counterlateral side is LIPUS + BCP group. Histological and histomorphometric analyses, and quantitative real-time polymerase chain reaction were evaluated. Results: Compared with BCP alone, the LIPUS + BCP showed no advantages in early bone formation. Furthermore, the Notch signaling pathway-related mRNA has no significant difference between the two groups. Conclusions: The preliminary results showed that the BCP, which has intrinsic osteoinduction nature, was an effective and promising material. However, LIPUS has no enhanced effect in BCP induced ectopic bone formation. Furthermore, LIPUS has no effect on the Notch signaling pathway. Whether costly LIPUS could be used in combination with BCP should be a rethink.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial / Fração soro do látex de Hancornia speciosa: um biomaterial não alergênico

Abstract Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Resumo Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis ​​pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Effect of ascorbic acid and epidermal growth factor in a rat tibia defect

Purpose: Bone repair aims to restore the anatomical, biomechanical, and functional integrity of the affected structure. Here we study the effects of ascorbic acid (AA) and epidermal growth factor (EGF) applied in a single dose and in combination on the repair of a noncritical bone defect model. Methods: Twenty-four rats were divided into four groups: an intact G-1 control group, and three groups that underwent a noncritical bone defect in the right tibia: G-2 treated with AA, G-3 treated with EGF, and G-4 treated with AA in combination with EGF. After 21 days of treatment, rats were sacrificed, the tibias were dissected and a destructive biomechanical analysis of three-point flexion test was performed in a universal testing machine; the values of stiffness, resistance, maximum energy, and energy at maximum load were statistically compared. Results: G-3 and G-4 recovered the biomechanical properties of strength and stiffness of an intact tibia 3 weeks after their application. Not so the energy and energy at maximum load. For G-2, only the stiffness of an intact tibia was recovered. Conclusion: EGF and AA-EGF applied to a noncritical bone defect in the rat tibia favors the recovery of bone resistance and stiffness.

Effect of pH on the chelation between strontium ions and decellularized small intestinal submucosal sponge scaffolds / 北京大学学报(医学版)

OBJECTIVE@#To investigate the preparation of decellularized small intestinal submucosa (dSIS) sponge scaffolds with chelated strontium (Sr) ions at different pH values, and to select the appropriate pH values for synthesizing Sr/dSIS scaffolds using the physicochemical properties and biocompatibility of the scaffolds as evaluation indexes.@*METHODS@#(1) Sr/dSIS scaffolds preparation and grouping: After mixing dSIS solution and strontium chloride solution in equal volumes, adjusting pH of the solution to 3, 5, 7, and 9 respectively, porous scaffolds were prepared by freeze-drying method after full reaction at 37℃, which were named Sr/dSIS-3, -5, -7, and -9 respectively, and the dSIS scaffolds were used as the control group. (2) Physicochemical property evaluation: The bulk morphology of the scaffolds was observed in each group, the microscopic morphology analyzed by scanning electron microscopy, and the porosity and pore size determined, the surface elements analyzed by energy spectroscopy, the structure of functional groups analyzed by infrared spectroscopy, the chelation rate determined by atomic spectrophotometry, the water absorption rate detected by using specific gravity method, and the compression strength evaluated by universal mechanical testing machine.(3) Biocompatibility evaluation: The cytotoxicity and proliferative effect to bone mesenchymal stem cells (BMSCs) of each group were evaluated by Calcein-AM/PI double staining method.@*RESULTS@#Scanning electron microscopy showed that the scaffolds of each group had an interconnected three-dimensional porous structure with no statistical difference in pore size and porosity. Energy spectrum analysis showed that strontium could be detected in Sr/dSIS-5, -7 and -9 groups, and strontium was uniformly distributed in the scaffolds. Functional group analysis further supported the formation of chelates in the Sr/dSIS-5, -7 and -9 groups. Chelation rate analysis showed that the Sr/dSIS-7 group had the highest strontium chelation rate, which was statistically different from the other groups (P < 0.05). The scaffolds in all the groups had good water absorption. The scaffolds in Sr/dSIS-5, -7 and -9 groups showed significantly improved mechanical properties compared with the control group (P < 0.05). The scaffolds in all the groups had good biocompatibility, and the Sr/dSIS-7 group showed the best proliferation of BMSCs.@*CONCLUSION@#When pH was 7, the Sr/dSIS scaffolds showed the highest strontium chelation rate and the best proliferation effect of BMSCs, which was the ideal pH value for the preparation of the Sr/dSIS scaffolds.

Research Advances in Medical Materials and Products for Soft Tissue Repairs / 中国医疗器械杂志

Soft tissue is an indispensable tissue in human body. It plays an important role in protecting the body from external physical, chemical or biological factors. Mild soft tissue injuries can self-heal, while severe soft tissue injuries may require related treatment. Natural polymers (such as chitosan, hyaluronic acid, and collagen) and synthetic polymers (such as polyethylene glycol and polylactic acid) exhibit good biocompatibility, biodegradability and low toxicity. It can be used for soft tissue repairs for antibacterial, hemostatic and wound healing purposes. Their related properties can be enhanced through modification or preparation of composite materials. Commonly used soft tissue repairs include wound dressings, biological patches, medical tissue adhesives, and tissue engineering scaffolds. This study introduces the properties, mechanisms of action and applications of various soft tissue repair medical materials, including chitosan, hyaluronic acid, collagen, polyethylene glycol and polylactic acid, and provides an outlook on the application prospects of soft tissue repair medical materials and products.

Preparation of silk fibroin/hyaluronic acid composite hydrogel based on thiol-ene click chemistry / 浙江大学学报·医学版

OBJECTIVES@#To design and prepare silk fibroin/hyaluronic acid composite hydrogel.@*METHODS@#The thiol modified silk fibroin and the double-bond modified hyaluronic acid were rapidly cured into gels through thiol-ene click polymerization under ultraviolet light condition. The grafting rate of modified silk fibroin and hyaluronic acid was characterized by 1H NMR spectroscopy; the gel point and the internal microstructure of hydrogels were characterized by rheological test and scanning electron microscopy; the mechanical properties were characterized by compression test; the swelling rate and degradation rate were determined by mass method. The hydrogel was co-cultured with the cells, the cytotoxicity was measured by the lactate dehydrogenase method, the cell adhesion was measured by the float count method, and the cell growth and differentiation on the surface of the gel were observed by scanning electron microscope and fluorescence microscope.@*RESULTS@#The functional group substitution degrees of modified silk fibroin and hyaluronic acid were 17.99% and 48.03%, respectively. The prepared silk fibroin/hyaluronic acid composite hydrogel had a gel point of 40-60 s and had a porous structure inside the gel. The compressive strength was as high as 450 kPa and it would not break after ten cycles. The water absorption capacity of the composite hydrogel was 4-10 times of its own weight. Degradation experiments showed that the hydrogel was biodegradable, and the degradation rate reached 28%-42% after 35 d. The cell biology experiments showed that the cytotoxicity of the composite gel was low, the cell adhesion was good, and the growth and differentiation of the cells on the surface of the gel were good.@*CONCLUSIONS@#The photocurable silk fibroin/hyaluronic acid composite hydrogel can form a gel quickly, and has excellent mechanical properties, adjustable swelling rate and degradation degree, good biocompatibility, so it has promising application prospects in biomedicine.

Research progress in leveraging biomaterials for enhancing NK cell immunotherapy / 浙江大学学报·医学版

NK cell immunotherapy is a promising antitumor therapeutic modality after the development of T cell immunotherapy. Structural modification of NK cells with biomaterials may provide a precise, efficient, and low-cost strategy to enhance NK cell immunotherapy. The biomaterial modification of NK cells can be divided into two strategies: surface engineering with biomaterials and intracellular modification. The surface engineering strategies include hydrophobic interaction of lipids, receptor-ligand interaction between membrane proteins, covalent binding to amino acid residues, click reaction and electrostatic interaction. The intracellular modification strategies are based on manipulation by nanotechnology using membranous materials from various sources of NK cells (such as exosome, vesicle and cytomembranes). Finally, the biomaterials-based strategies regulate the recruitment, recognition and cytotoxicity of NK cells in the solid tumor site in situ to boost the activity of NK cells in the tumor. This article reviews the recent research progress in enhancing NK cell therapy based on biomaterial modification, to provide a reference for further researches on engineering NK cell therapy with biomaterials.

The peri-implant ligament: a scoping review

The peri-implant ligament is formed from the interface of bone tissue, through the anchoring of proteins and the surface of the dental implant. In this sense, it is relevant to understand the extent to which this ligament is structured and biomimics the periodontal ligament functions. Aim: The goal of this scoping review is to present and analyze the peri-implant ligament composition and compare the extent to which this ligament is structured and biomimics the periodontal ligament functions. Methods: This scoping review was performed according to the Joanna Briggs Institute methodology for scoping reviews and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review. Two independent researchers searched Pubmed, Cochrane, Embase, Virtual Health Library, Scielo, Scopus, Web of Science, Brazilian Bibliography of Dentistry, Latin American and Caribbean Literature in Health Sciences, Digital Library of Theses and Dissertations from the University of São Paulo and Portal Capes. Studies published in English, Portuguese and Spanish, over the last 21 years (2000-2021). Results: A total of 330 titles were identified and after applying inclusion and exclusion factors, 27 studies were included in this review. All proteins were identified regarding their tissue function and classified into 6 major protein groups. After that this new protein ligament was compared with the periodontal ligament regarding its function and composition. The main proteins associated with osseointegration, and thus, with the peri-implant ligament are recognized as belonging to the periodontal ligament. Conclusion: This scoping review results suggest evidence of the composition and function of the periimplant ligament. However, variations may still exist due to the existence of several modulants of the osseointegration process