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.

Materiales bioactivos para restauraciones directas en dientes posteriores / Bioactive materials for direct restorations in posterior teeth

Se trata de paciente femenino de 22 años de edad, en quien se realizó una restauración en un molar siguiendo la filosofía de mínima intervención desde el diagnóstico hasta la obturación con un material bioactivo. Los objetivos del tratamiento fueron devolver la funcionalidad y estética de dicho molar, pero sobre todo brindar una protección a largo plazo mediante la liberación y recarga de iones de calcio, fosfato y flúor proporcionado por el material bioactivo (AU)

t is about a female patient of twenty-two years, in which a restoration was made in a molar following the philosophy of minimal intervention from diagnosis to filling with a bioactive material. The objectives of the treatment were to restore the functionality and aesthetics, but mainly to provide long-term protection through the release and recharge of calcium, phosphate and fluoride ions provided by the bioactive material used (AU)

Protección pulpar directa y posterior apexogénesis: informe de un caso clínico / Direct pulp capping followed by apexogenesis: a clinical case report

Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

Células madre en odontología: nuevas perspectivas / Stem cells in dentistry: new perspectives

En el campo de la odontología, prevalecen actualmente alternativas terapéuticas con una filosofía conservadora. Sin embargo, con el advenimiento de los tratamientos con células madre (CM), se amplían las posibilidades terapéuticas, que buscan la combinación y el equilibrio entre la intervención tradicional y las posibilidades de reposición de estructuras anatómicas dañadas, a través de la regeneración de tejidos utilizando células madre o sus derivados (AU)

In the dentistry field, therapeutic alternatives with a conservative philosophy currently prevail. However, with the advent of stem cell (SC) treatments, therapeutic possibilities are expanding, seeking a combination and balance between traditional intervention and the pos- sibility of replacing damaged anatomical structures through tissue regeneration, using stem cells or their derivatives (AU)

Aplicación de Biodentine en Endodoncia Regenerativa: Presentación de Tres Casos Clínicos / Application of Biodentine in Regenerative Endodontics: Presentation of Three Clinical Cases

El Biodentine es un material biocerámico y bioacti-vo que puede emplearse como sustituto activo de la dentina. Entre sus numerosos usos se incorpora su utilización como sellador del coágulo en los procedi-mientos endodónticos regenerativos, logrando me-jores propiedades con respecto al Gold standard. Se presenta la resolución clínica y radiográfica de tres situaciones clínicas, mediante la aplicación del proto-colo de los procedimientos endodónticos regenerati-vos, en los que se utilizó Biodentine como alternativa para el sellado del coágulo a nivel cérvico-radicular, en la obturación a nivel del límite amelocementario (AU)

Biodentine is a bio-ceramic and bioactive material that can be used as an active substitute for dentin. Its many uses include its use as a clot sealer in regenerative endodontic procedures, achieving better properties compared to the Gold standard. The clinical and radiographic resolution of three clinical situations is presented, by applying the protocol of regenerative endodontic procedures, where Biodentine was used as an alternative for sealing the clot at the cervical-radicular level in the obturation at the level of the cementoenamel limit (AU)

Uso da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas produzidas em ratos Wistar / Use of canine vaginal tunic preserved in 98% glycerin as biological curative in the treatment of skin produced in wound Wistar rats

Na procura por material alternativo no tratamento de feridas cutâneas, buscou-se com este estudo avaliar o comportamento da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas provocadas experimentalmente em ratos. Foram utilizados 16 ratos Wistar, nos quais foram induzidas experimentalmente duas lesões cutâneas na região dorsal, sendo uma cranial e a outra caudal. Uma ferida serviu de controle, a qual não recebeu tratamento, a outra recebeu a túnica vaginal recobrindo toda extensão da lesão. A seleção de qual das feridas, cranial ou caudal, iria receber a membrana foi feita de forma aleatória. Os animais foram distribuídos em quatro grupos de igual número para análises clínicas, macroscópicas e histológicas decorridos três, sete, 14 e 21 dias de pós-operatório. Na avaliação clínica e macroscópica pode-se observar que o processo de reparação teve evolução semelhante tanto no grupo controle quanto no grupo membrana. Na análise histopatológica foi constatada grande quantidade de infiltrado inflamatório nos períodos iniciais, no entanto, decorridos 21 dias, a epiderme já se encontrava reparada, e em todos os momentos foi observada maior presença de tecido conjuntivo no grupo membrana, sugerindo maior precocidade na cicatrização. Deste modo, concluiu-se que a túnica vaginal canina pode ser utilizada como nova alternativa no tratamento de feridas cutâneas.

In the search for alternative material in the treatment of cutaneous wounds, this study aimed to evaluate the behavior of canine vaginal tunic conserved in glycerin 98% as a biological dressing in the treatment of cutaneous wounds provoked experimentally in rats. Sixteen animals were used in which two cutaneous lesions were caused in the dorsal region, one cranial and the other caudal. One wound served as a control which did not receive treatment, the other received the vaginal tunic covering all extension of the lesion. The selection of which of the wounds, cranial or caudal, would receive the membrane was made at random. The animals were divided into four groups of equal numbers for clinical, macroscopic, and histological analyzes after three, seven, 14 and 21 postoperative days. In the clinical and macroscopic evaluation, it can be observed that the healing process had similar evolution in both the control group and the membrane group. In the histopathological analysis, a large amount of inflammatory infiltrate was observed in the initial periods; however, after 21 days the epidermis was already healed, and at all times a greater presence of connective tissue was observed in the membrane group, suggesting a greater precocity in healing. Thus, it was concluded that the canine vaginal tunic can be used as a new alternative in the treatment of cutaneous wounds.

Utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar / Bibliographic update on the use of biomaterials and autologous bone grafts in patients with alveolar atrophy

RESUMEN El material de elección para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos (hueso del propio paciente). A partir de la introducción del concepto de osteointegración por Branemark, los implantes dentales son parte de la terapéutica diaria para rehabilitar áreas edéntulas. La atrofia alveolar es quizás una de las condiciones bucales más incapacitantes; la razón reside en que es crónica, progresiva, acumulativa e irreversible, altera las relaciones maxilomandibulares, reduce la cantidad de hueso del área dentosoportada y la profundidad del surco. El material de injerto óseo ideal no debería ser sólo un sustituto óseo, sino un material de regeneración que se reabsorba completamente de modo simultáneo a la formación de hueso nuevo. Evaluar el éxito y fracaso de una terapia permite tomar decisiones para un mejoramiento continuo de la práctica clínica. El objetivo de la investigación fue demostrar la importancia de la utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar (AU).

SUMMARY The elective material for replacing the bone lost by trauma, congenital or acquired pathological processes and atrophy are the autogenic or autologous bone grafts (the patient´s own bones). From the introduction of the concept of osseointegration by Branemark on, dental implants are part of the daily therapeutic for rehabilitating edentulous areas. Alveolar atrophy is perhaps one of the most disabling oral conditions, because it is chronic, progressive, cumulative and irreversible. It alters maxilla-mandibular relations, reduces the bone quality of the dentosupported area and the depth of the sulcus. The ideal bone graft material should not be only a bone substitute, by a regenerative material that could be completely reabsorbed simultaneously with the new bone formation. To assess the success and failure of a therapy allows taking decisions for the continuous improvement of the clinical practice. The aim of the research was to prove the importance of using biomaterials or autologous bone grafts in patients with alveolar atrophy (AU).

Região metafisária da tíbia de coelhos: uma opção para estudos dos substitutos ósseos / Metaphyseal region of the tibia of rabbits: an option for bone substitutes studies

Apresenta-se um modelo experimental de ostectomia de tíbia em coelhos para estudo de biomateriais em processos de reparação óssea. Foi realizada falha segmentar de 6mm de diâmetro na região metafisária medial proximal de tíbia de 72 coelhos as quais foram preenchidas com substituto ósseo e avaliadas clinicamente, por exame radiográfico e por meio de tomografia computadorizada feixe cônico, em diferentes tempos. Conclui-se que a metáfise medial proximal de tíbia de coelhos é adequada como modelo para estudos que avaliem o comportamento de enxertos e/ou biomateriais em falhas ósseas.

Is presented an experimental model of tibial ostectomy in rabbits to study biomaterials during bone repair process. Segmental failure of 6 mm diameter was performed in the medial proximal tibial metaphyseal region of 72 rabbits, which were filled with bone substitute and evaluated by clinical exam, X-ray, and cone beam computed tomography at different times. It is concluded that the medial proximal tibial metaphysis region of rabbits is suitable as a model for studies that evaluate the behavior of grafts and/or biomaterials on bone defects.

Osteossíntese femoral associada ao biovidro 60S em tamanduá-bandeira: relato de caso / Femoral osteosynthesis associated with 60s bioglass in tamanduá bandeira: case report

Atropelamentos de animais silvestres são frequentes e muitas vezes causam fraturas ósseas que, se não tratadas adequadamente, levam à morte do animal por complicações ou por inabilidade de sobrevivência no seu habitat natural. O objetivo do presente trabalho foi relatar o uso de placa associada ao pino intramedular e ao biovidro 60S (BV60S) para o tratamento de fratura de fêmur em tamanduá-bandeira. O animal foi resgatado pela polícia ambiental com suspeita de atropelamento. Foi sedado para avaliação clínica e radiográfica, que revelou fratura em fêmur direito. Utilizou-se dexmedetomidina como medicação pré-anestésica, midazolam e cetamina para indução, e isoflurano para manutenção. Também foi realizado bloqueio peridural com bupivacaína e morfina. A osteossíntese foi feita com placa bloqueada 2,7 e pino intramedular 2,5. Colocaram-se 4g de BV60S no foco de fratura para favorecer a osteogênese. O paciente teve recuperação funcional imediata do membro acometido. A reparação óssea ocorreu por segunda intenção, observando-se ossificação completa do calo com consolidação clínica, aos 30 dias, e remodelação quase completa, aos 180 dias. Conclui-se que o uso de placa e pino associado ao BV60S é eficiente no tratamento de fratura de fêmur em tamanduá, permitindo a rápida recuperação e a reintrodução do animal na natureza.(AU)

Roadblocks of wild animals are frequent and often cause bone fractures that if not properly treated lead to the death of the animal due to complications or inability to survive in its natural habitat. The objective of the present study was to report the use of plate rod and bioglass 60S (BG60S) for the treatment of femoral fracture in anteater. The animal was rescued by environmental police on suspicion of being hit. It was sedated for clinical and radiographic evaluation, which revealed a fracture in the right femur. Dexmedetomidine was used as preanesthetic medication, midazolam and ketamine for induction, and isoflurane for maintenance. Epidural blockade with bupivacaine and morphine was also performed. Osteosynthesis was done with a locking plate 2.7 and 2.5 intramedullary pin. 4G of BG60S was placed in the focus of fracture to favor osteogenesis. The patient had immediate functional recovery of the affected limb. The bone repair occurred by second intention, with complete ossification of the callus with clinical consolidation at 30 days, and near complete remodeling at 180 days. It is concluded that the use of plate rod to the BG60S is efficient in the treatment of femur fracture in anteater, allowing the rapid recovery and reintroduction of the animal in the wild.(AU)

Uso da pele de tilápia do Nilo em medicina regenerativa: Status atual e perspectivas futuras / Nile tilapia fish skin use in regenerative medicine: Current status and future perspectives

OBJETIVO: O presente estudo tem como objetivo apresentar a trajetória do desenvolvimento da pele de tilápia como curativo biológico. MÉTODO: Descrição do processo de desenvolvimento da pele de tilápia como curativo biológico, desde a concepção da ideia para utilização no tratamento de queimaduras, até as perspectivas de sua utilização como scaffold em múltiplas especialidades médicas. RESULTADOS: Com o objetivo de oferecer uma alternativa segura, eficaz e de baixo custo para o tratamento de queimaduras, pesquisadores brasileiros desenvolveram um curativo biológico derivado da pele de tilápia. CONCLUSÃO: A pele de tilápia vem demonstrando um notável potencial como curativo biológico no tratamento de queimaduras e na medicina regenerativa.

OBJECTIVE: The present study aims to present the development trajectory of the tilapia skin as a biological dressing. METHODS: To describe the development process of tilapia skin as biological dressing, from the conception to the burn wounds treatment to the perspectives of its use as a scaffold in multiple medical specialties. RESULTS: In order to provide a safe, effective and low-cost alternative for the treatment of burn injuries, Brazilian researchers have recently developed a biological dressing derived from tilapia skin. CONCLUSION: The tilapia skin have been demonstrating the remarkable potential as a biological dressing in burn injuries treatment and in regenerative medicine.

La reparación de la pulpa dental. Materiales y alternativas de tratamiento: revisión de la información bibliográfica / Dental pulp repair. Materials and alternative therapies: review of the literature

Este trabajo pretende actualizar los conocimientos acerca de los diversos materiales utilizados en las terapias pulpares (tanto en dientes primarios como en permanentes) que buscan una respuesta reparativa cada vez más conservadora, biológica y sustentable. Se trata de un recorrido por el uso de agentes como el agregado de trióxido mineral (MTA), el láser, Biodentine® y los concentrados de plasma rico en plaquetas, con sus características, sus posibles aplicaciones y su eficacia, evaluadas clínica y radiográficamente en múltiples trabajos de investigación, informes de casos, estudios comparativos (in vitro e in vivo) y ensayos experimentales en animales que documentan sus resultados (AU)

This literature review aims to update knowledge about the different materials used in pulp therapies (both in primary and permanent teeth) that seek for an increasingly conservative, biological and sustainable reparative response. It is a journey through the use of agents such as mineral trioxide aggregate (MTA), lasers, biodentine and platelet rich plasma concentrates, their properties, applications and efficacy, clinically and radiographically evaluated in multiple research papers, case reports, comparative studies (in vitro and in vivo) and experimental studies in animals that document their results

Elaboração, desenvolvimento e instalação do primeiro banco de pele animal no Brasil para o tratamento de queimaduras e feridas / Elaboration, development, and installation of the first animal skin bank in Brazil for the treatment of burns and wounds

Introdução: A produção e a distribuição de pele humana pelos Bancos de Pele do Brasil é insuficiente para atender a demanda do país, suprindo menos de 1% da necessidade para tratar as vítimas de queimaduras. O objetivo do trabalho foi apresentar a elaboração e o desenvolvimento da implantação do primeiro Banco de Pele Animal do Brasil para tratamento da queimadura. Métodos: Trata-se de um estudo metodológico. O Banco de Pele Animal Aquático foi elaborado, desenvolvido e instalado a partir do desenvolvimento do processamento de pele da tilápia, da revisão sistemática de estudos referentes a banco de pele animal, de visitas à pscicultura em Jaguaribara-CE, da visita técnica aos bancos de pele humana no Brasil, de consulta técnica e de treinamento no Banco de Pele de Recife, da observação de todas as fases de processamento da pele de tilápia e da identificação da estrutura física da área onde ocorrem todos os processos. Resultados: Além da produção e da distribuição da pele da tilápia para os estudos em vítima de queimaduras, o banco está processando mais de 5000 peles de tilápia e encontra-se em fase de distribuição desta pele para estudos multicêntricos em outros estados e outras especialidades, que desenvolvem pesquisas nas áreas de ginecologia, ortopedia, endoscopia, estomaterapia, cirurgia vascular, odontologia e veterinária. Conclusão: este trabalho possibilitou a elaboração, o desenvolvimento e a implementação do primeiro Banco de Pele Animal do país e o primeiro Banco de Pele Aquática do mundo.

Introduction: The production and distribution of human skin by Brazilian skin banks is insufficient to meet the country's demand, supplying less than 1% of the need for treating burn victims. The objective of this work was to present the elaboration and development of the first animal skin bank of Brazil for the treatment of burns. Methods: This methodological study elaborated, developed, and installed The Aquatic Animal Skin Bank in terms of the development of tilapia skin processing after a systematic review of studies referring to animal skin banks based on visits to the pisciculture center in Jaguaribara-CE, technical visits to human skin banks in Brazil, technical consultation and training in the Recife Skin Bank, the observation of all phases of tilapia skin processing, and the identification of the physical structure of the area where the processes occur. Results: In addition to the production and distribution of tilapia skin for studies on burn victims, the bank is processing more than 5000 tilapia skin samples and is in the distribution phase of this skin for multicentric studies in other states and specialties including gynecology, orthopedics, endoscopy, stomatherapy, vascular surgery, dentistry, and veterinary medicine. Conclusion: This work enabled the elaboration, development, and implementation of Brazil's first animal skin bank and the world's first aquatic skin bank.

Hemocomponentes en urgencias: tratamiento vital para los pacientes politraumatizados / Blood products in the emergency room: vital treatment for polytraumatized patients

Introducción: La principal causa de mortalidad temprana en pacientes politraumatizados es la hipovolemia secundaria a hemorragia masiva. La terapia con hemocomponentes y cristaloides constituye un mecanismo esencial y salvavidas en estas situaciones como medida de reemplazo de volumen. De la misma manera los pacientes con lesiones traumáticas graves tienen una disminución aguda significativa en el recuento de plaquetas circulantes que los hace candidatos a la transfusión de componentes plaquetarios; sin embargo, el uso de estos componentes sanguíneos puede traer consigo desenlaces no deseados como aumento en la mortalidad. Si bien muchos estudios revelan un aumento de la mortalidad como desenlace asociado al uso de hemocomponentes, otros establecen su uso como una medida reductora de este desenlace. Objetivo: Exponer las principales indicaciones de hemocomponentes en los pacientes politraumatizados, así como relacionar los eventos adversos asociados a su uso que influyen sobre la mortalidad y el tiempo de hospitalización de estos pacientes. Desarrollo: La mortalidad asociada al uso de hemocomponentes aún es un tema controvertido. En la hemorragia masiva el apoyo transfusional rápido y eficiente es esencial en el tratamiento y la atención de politraumatismos, de ahí que sea necesario contar con protocolos de transfusión que mejoren los resultados y disminuyan las complicaciones. Además, se identificó la necesidad de nuevos estudios sobre el tema para mejorar estos protocolos y reducir las complicaciones.(AU)

Introduction: The main cause of early mortality in polytrauma patients is hypovolemia secondary to massive hemorrhage. Hemocomponent and crystalloid therapy is an essential and life-saving mechanism in these situations as a measure of volume replacement. In the same way, patients with severe traumatic injuries have a significant acute decrease in circulating platelet counts that makes them candidates for transfusion of platelet components; However, the use of these blood components can lead to unwanted outcomes such as increased mortality. Although many studies reveal an increase in mortality as an outcome associated with the use of blood components, others establish its use as a reducing measure of this outcome. Objective: to present the main indications of blood components in polytrauma patients, as well as to relate the adverse events associated with their use that influence the mortality and hospitalization time of these patients. Devlopment: Mortality associated with the use of blood components is still a controversial issue. In massive hemorrhage, rapid and efficient transfusion support is essential in the treatment and care of polytrauma, hence it is necessary to have transfusion protocols that improve results and reduce complications. In addition, the need for new studies on the subject to improve these protocols and reduce complications was identified(AU)

Matriz porosa do BV60S associada a células osteoprogenitoras alógenas no tratamento de defeitos ósseos críticos em rádios de cães / Porous matrix of BG60S associated with allogenic osteoprogenitor cells in the treatment of critical bone defects in the radius of dogs

O objetivo do estudo foi avaliar o efeito da matriz porosa do biovidro 60S (BV60S) associada a células osteoprogenitoras (CO) alógenas no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos de idade e massa corporal média de 25kg. Com os cães sob anestesia geral, foram criados defeitos ósseos críticos no terço médio dos ossos rádios. Procedeu-se à fixação óssea com uma placa em ponte, e os defeitos foram tratados de acordo com cada grupo experimental. Constituíram-se três grupos experimentais, em que os defeitos ósseos foram preenchidos com: BV60S associado a CO alógenas (grupo BV60S+CO), osso autógeno (grupo C+), ou não preenchidos (grupo C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. Os grupos C- e BV60S+CO mostraram preenchimento ósseo parcial do defeito de, no máximo, 56,68% e 35,23%, respectivamente, sem a formação de ponte óssea entre as extremidades, e o controle positivo (C+) mostrou regeneração óssea completa. Conclui-se que a matriz porosa do BV60S associada às células osteoprogenitoras não é eficiente no tratamento de defeitos ósseos críticos em rádios de cães.(AU)

The objective of this study was to evaluate the effect of the porous matrix of bioglass 60S (BV60S) associated with allogenic osteoprogenitor cells (CO) in the treatment of critical bone defects of dogs. 20 male mongrel dogs at two years old and mean weight of 25kg were used. Dogs were anesthetized and critical bone defects were created in the middle third of the radios bones. With dogs under general anesthesia, critical bone defects were created in the middle third of bone radios. Bone fixation was done with a bridge plate and defects treated according to each experimental group. Three experimental groups were formed according to the treatment. The defects filled with BV60S associated with allogenic CO (Group-BV60S+CO), autogenous bone (Group-C+) or unfilled (Group-C-). Bone regeneration was evaluated by radiography, bone densitometry and histomorphometry over 90 days. The BV60S+CO and C- groups showed partial bone filling of the defect of at most 56.68% and 35.23%, respectively. No bone bridge formation was observed between the extremities in the BV60S+CO and C- groups. Positive control showed complete bone regeneration at 90 days. It was concluded that the porous matrix of BV60S associated with osteoprogenitor cells was not effective in the treatment of critical bone defects in the radius of dogs.(AU)

Additive effect of pulp pequi oil (Caryocar brasiliense Camb. ) on the biocompatibility of collagen and gelatin membranes in subcutaneous implants / Efeito aditivo do óleo de polpa de pequi (Caryocar brasiliense Camb. ) sobre a biocompatibilidade de membranas de colágeno e gelatina implantadas no subcutâneo

Trauma or disease inflicted by tissue injuries may cause tissue degeneration. The use of biomaterials for direct or indirect repair has emerged as a promising alternative, and has become an important research topic. The pequi fruit (Caryocar brasiliense Camb.) has shown antifungal, antibacterial, anti-inflammatory, healing, antitumor, and antioxidant properties. The objective of this study was to develop a new biomaterial using a combination of collagen, gelatin, and pulp pequi oil, and to evaluate its biocompatibility in comparison with that of biomaterials produced without pulp pequi oil. Membranes were prepared from a mixture of bovine tendon collagen, commercial gelatin, and pulp pequi oil. The inflammatory and cicatricial processes were assessed via histopathology of the tissue interface/implants in the subcutaneous tissues and quantitative evaluation of leukocyte and collagen production in Wistar rats. It was observed that the presence of pequi oil reduced the amount of foreign-body giant cells and favored the recruitment of fibroblasts (P< 0.01), thereby promoting greater production of collagen membrane than that in the membranes of control samples. Therefore, it can be concluded that the addition of pequi oil improved the biocompatibility of collagen and accelerated the healing process.(AU)

Trauma ou lesões causadas por doenças podem enfraquecer e degenerar os tecidos humanos e animais. O uso de biomateriais para reparação direta ou indireta surgiu como uma alternativa promissora e tornou-se um importante tema de pesquisa. O óleo de pequi (Caryocar brasiliense Camb.) mostrou propriedades antifúngicas, antibacterianas, anti-inflamatórias, curativas, antitumorais e antioxidantes. O objetivo deste estudo foi obter um novo biomaterial, produzido pela combinação de óleo de pequi, colágeno e gelatina, para avaliar sua biocompatibilidade em comparação às membranas produzidas sem o óleo. As membranas foram preparadas por meio da mistura de colágeno de tendão bovino, gelatina comercial e óleo de pequi. Os processos inflamatórios e cicatriciais foram avaliados por histopatologia da interface / implantes de tecido subcutâneo de ratos Wistar para avaliação quantitativa da produção de leucócitos e colágeno. Observou-se que a presença de óleo de pequi reduziu a quantidade de células gigantes de corpo estranho e favoreceu o recrutamento de fibroblastos (P<0,01), promovendo, assim, maior produção da membrana de colágeno em comparação com a membrana de controle. Portanto, pode-se concluir que a adição de óleo de pequi melhorou a biocompatibilidade do colágeno e acelerou o processo de cicatrização.(AU)

Management of merged external/internal root resorption using CEM cement: a case report

Chronic pulpal inflammation and infection are the main predisposing factors for internal and external root resorption (IRR & ERR); however, merging of IRR and ERR is a rare lesion which rigorously alters the anatomy of root canals. this study reports a case of merged IRR and ERR in an asymptomatic maxillary left central incisor in a 33-year old caucasian woman that was managed by one-visit root canal therapy (RCT) using calcium-enriched mixture (CEM) cement. radiographic examination showed a short root with under-filled root canal obturation associated with ERR/IRR and an apical lesion. after thorough chemo-mechanical preparation, the root canal was obturated with CEM cement; one week later, the access cavity was permanently restored. clinical/radiographic examinations at 1-year follow-up revealed uneventful healing, reestablishment of lamina dura and stabilization of the resorptive defects. the treatment outcome demonstrates that one-visit RCT using CEM cement may be a viable treatment option in cases with merged external/internal root resorption. further clinical trials with a larger number of cases are suggested to document a higher level of evidence.

Bacterial cellulose to reinforce urethrovesical anastomosis. A translational study

Abstract Purpose: To evaluate the efficacy of the cellulosic exopolysaccharide membrane (CEM) as a urethral reinforcement for urethrovesical anastomosis. Methods: Twenty eight rabbits were submitted to urethrovesical anastomosis with or without CEM reinforcement. The animals were divided into 4 groups: C7, CEM7, C14 and CEM14: (C= only anastomosis or CEM = anastomosis + CEM), evaluated after 7 weeks, and 14 weeks. The biointegration and biocompatibility of CEM were evaluated according to stenosis, fistula, urethral wall thickness, urethral epithelium, rate of inflammation and vascularization. Results: Between the two experimental groups, the difference in the number of stenosis or urinary fistula was not statistically significant. The morphometric analysis revealed preservation of urethral lumen, well adhered CEM without extrusion, a controlled inflammatory process and implant vascularization. The urothelium height remained constant over time after CEM reinforcement and the membrane wall was thicker, statistically, after 14 weeks. Conclusion: The absence of extrusion, stenosis or urinary fistula after 14 weeks of urethrovesical anastomosis demonstrates cellulosic exopolysaccharide membrane biocompatibility and biointegration with tendency to a thicker wall.

Use of a porous cellulose membrane (Membracel®) and moxibustion for severe excoriative injury in a chilean skua (Catharacta chilensis) / Utilização de membrana celular porosa (Membracel®) e moxabustão em lesão escoriativa severa em mandrião chileno(Catharacta chilensis)

The use of alternative therapeutic approaches in wild animals has gained notoriety due to its efficiency, low cost and reduced or nonexistent stressors. The present study evaluated the efficacy of treatment of a bilateral excoriative lesion in the region of the dorsal metacarpus in a Chilean skua (Catharacta chilensis) in a rehabilitation process with the use of a porous cell membrane, sold commercially, in concomitance with moxibustion sessions with herbs (Artemisia vulgaris). The healing time of 14 days was reduced when compared to traditional techniques and proved the viability and efficacy of the treatment.(AU)

O uso de abordagens terapêuticas alternativas em animais selvagens tem ganhado notoriedade em virtude de sua eficiência, baixo custo e estímulos estressores reduzidos ou inexistentes. Este estudo avaliou a eficácia do tratamento de uma lesão escoriativa bilateral em região do dorsal metacarpo em um mandrião chileno (Catharacta chilensis) em processo de reabilitação com o uso de uma membrana celular porosa vendida comercialmente, em concomitância com sessões de moxabustão com ervas (Artemisia vulgaris). O tempo de cicatrização de catorze dias mostrou-se reduzido quando comparado ao de outras técnicas tradicionais e provou a viabilidade e eficácia do tratamento.(AU)

Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children

ABSTRACT Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non--biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed. Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con- trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.

Avaliação do aumento ósseo obtido após cirurgias de enxerto em seio maxilar com um biomaterial aloplástico / Evaluation of bone augmentation obtained after maxillary sinus grafting with alloplastic biomaterial

Objetivos: avaliar o aumento ósseo com um biomaterial aloplástico no seio maxilar. Materiais e métodos: foram selecionados seis pacientes, totalizando nove seios maxilares, que realizaram cirurgia de reconstrução óssea em região posterior de maxila. Todas as cirurgias de elevação do seio maxilar traumáticas utilizaram o biomaterial sintético Straumann Bone Ceramic. Os pacientes realizaram uma tomografia pré-operatória, e uma após seis meses do ato cirúrgico, em que foram obtidas medidas lineares horizontais e verticais na imagem panorâmica da tomografia e medidas lineares horizontais e verticais no corte sagital da tomografia, ambas no centro das imagens. Resultados: identificou-se 100% de sucesso nas cirurgias de elevação de seio maxilar, em que verticalmente obteve-se diferença estatística significante (p < 0,05) e horizontalmente sem significância estatística (p > 0,05). Em média, obteve-se ganho vertical ósseo de 14,73 mm na imagem panorâmica e 16,05 mm no corte sagital, e espessura 20,82 mm na imagem panorâmica e 11,37 mm no corte sagital. Conclusão: o biomaterial sintético Straumann Bone Ceramic demonstrou-se excelente para a reconstrução de seios maxilares.

Objectives: to evaluate bone augmentation using an alloplastic material. Material and methods: six patients (9 maxillary sinuses) underwent surgical bone reconstruction at the posterior maxillary region. All surgeries were performed after atraumatic sinus membrane lifting and packing of Straumann BoneCeramic. Also, CBCTs were made at baseline and 6 months later to generate horizontal and vertical measurements at the panoramic and sagittal view modes both at the center of the images. Results: operative procedures were considered 100% successful. At the vertical dimension, statistical differences were obtained (p<0.05) but no significant differences were seen in the horizontal dimension (p>0.05). Overall, the vertical mean gain was 14.73mm at the panoramic and 16.05mm at the sagittal sections, being the observed thicknesses of 20.82mm and 11.37mm, respectively. Conclusion: the Straumann BoneCeramic biomaterial provided excellent results for maxillary sinus reconstructions.