Vertical bone augmentation with guided bone regeneration: a scoping review / Aumento óseo vertical con regeneración ósea guiada: scoping review

Introduction: There are multiple techniques for vertical bone augmentation. Guided bone regeneration is one of them; however, the literature is diverse and includes different study designs, which makes it difficult to synthesize results. Objective: To analyze the general technical characteristics, clinical results, and complications of vertical bone augmentation performed with guided bone regeneration in humans. Material and Methods: This scoping review was based on the PRISMA-ScR guidelines. A search was performed in the Pubmed, Scielo, and Worldcat databases. Papers published from 1990 to April 2020 were included in the study. Research articles not conducted in humans or published in languages other than English and Spanish were excluded. Title and abstract were screened by two reviewers, then full studies were extracted, and data tabulated. Results: 89 studies were included. The highest percentage reported having obtained a vertical bone increase of less than 5 mm and having used non-resorbable membranes. The most frequent type of graft is autogenous and combinations of grafts, the most common being autogenous with xenograft. All studies that reported bone stability of implants in regenerated bone were favorable, as was implant survival, reporting values between 83.8% and 100%. Membrane exposure is the most frequently reported complication, followed by infection or abscesses, and tissue dehiscence. Conclusion: Vertical bone regeneration is a reliable technique, with high predictability and low incidence of complications compared to other vertical bone augmentation techniques.

Introducción: Existen múltiples técnicas para el aumento óseo vertical siendo una opción la regeneración ósea guiada, sin embargo, la literatura es diversa y con distintos diseños que dificultan la síntesis de resultados. Objetivo: Analizar las características generales técnicas, resultados clínicos y complicaciones del aumento óseo vertical realizado con regeneración ósea guiada en humanos. Material y Métodos: Esta revisión de alcance se basó en la guía PRISMA-ScR. Se realizó una búsqueda en las bases de datos Pubmed, Scielo y Worldcat. Fueron incluidos aquellos publicados desde el año 1990 hasta abril de 2020. Se excluyeron los estudios no realizados en humanos o publicados en idiomas distintos al inglés y español. Dos revisores examinaron título y resumen, luego los estudios completos se extrajeron y se ordenaron los datos en tablas. Resultados: 89 estudios fueron incluidos. El mayor porcentaje reportó haber obtenido un aumento óseo vertical menor a 5 mm y haber utilizado membranas no reabsorbibles. El tipo de injerto que más frecuente es el autógeno y las combinaciones de injertos, siendo el más común autógeno con xenoinjerto. Todos los estudios que reportaron estabilidad ósea de implantes en hueso regenerado fueron favorables, al igual que la supervivencia de implantes, reportando valores entre 83,8% y 100%. La exposición de membrana es la complicación que más se repite en los estudios, seguido por infección o abscesos y dehiscencia de tejidos. Conclusión: La regeneración ósea vertical es una técnica confiable, con alta predictibilidad y baja incidencia de complicaciones en comparación a otras técnicas de aumento óseo vertical.

Dental stem cells in intraoral regenerative therapy: a systematic review / Células-tronco dentárias na terapia regenerativa intraoral: uma revisão sistemática

Objective: 1) To critically review the published literature on applications of dental stem cells in the regeneration of intraoral tissues. 2) To provide an evidence-based level on research regarding application of dental stem cells in intraoral tissues regeneration. Methodology: This systematic review is conducted as per the JBI guidelines and reported as per the PRISMA. An initial literature search of papers published between 2004 and 2018 yielded 421 manuscripts. Nineteen studies satisfied the inclusion / exclusion criteria and were included for qualitative synthesis. Studies were categorized as animal (11) and human (8) trials. Five independent reviewers critically assessed the included studies. Risk of bias was assessed using SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) bias risk tool, robins-I tool for non-randomised clinical trial and Cochrane Collaboration's Tool for randomised clinical trial. Evidence levels were assessed based on JBI Criteria. Results: Animal trials mainly focused on periodontal regeneration. A high or unclear Risk of bias was more commonly found amongst animal studies. Laboratory, clinical and radiographic evaluation were used to assess the outcome. A total of Eight Human studies were conducted on a total samples size of 153 upon a wide age ranging from seven years to 60 years. Nearly 70% of the human studies used DPSC for regenerating alveolar bone defects. Conclusion: Appropriate well designed double-blind randomized clinical trials of longer duration are yet to be performed. Evidence for the included studies were 1C and 1D as per the JBI Criteria. Stem cell therapy demonstrated promising results in Periodontal tissue and alveolar bone regeneration. However, the number of studies to claim such a benefit are very limited (AU)

Objetivo: 1) Revisar criticamente a literatura publicada sobre aplicações de células-tronco dentárias na regeneração de tecidos intraorais. 2) Fornecer um nível baseado em evidências sobre pesquisas relacionadas à aplicação de células-tronco dentárias na regeneração de tecidos intraorais. Metodologia: Esta revisão sistemática é conduzida de acordo com as diretrizes do JBI e relatada de acordo com o PRISMA. Uma pesquisa bibliográfica inicial de artigos publicados entre 2004 e 2018 resultou em 421 manuscritos. Dezenove estudos satisfizeram os critérios de inclusão / exclusão e foram incluídos para síntese qualitativa. Os estudos foram categorizados como ensaios em animais (11) e humanos (8). Cinco revisores independentes avaliaram criticamente os estudos incluídos. O risco de viés foi avaliado usando a ferramenta de risco de viés do Centro de Revisão Sistemática para Experimentação com Animais de Laboratório (SYRCLE), a ferramenta robins-I para ensaios clínicos não randomizados e a Ferramenta da Colaboração Cochrane para ensaios clínicos randomizados. Os níveis de evidência foram avaliados com base nos critérios JBI. Resultados: Os ensaios em animais focaram principalmente na regeneração periodontal. Um risco alto ou pouco claro de viés foi mais comumente encontrado entre os estudos com animais. Avaliações laboratorial, clínica e radiográfica foram utilizadas para avaliar o resultado. Um total de oito estudos em humanos foram conduzidos em um tamanho total de amostras de 153 com ampla faixa etária, variando de sete a 60 anos. Quase 70% dos estudos em humanos usaram DPSC para regeneração de defeitos ósseos alveolares. Conclusão: Ensaios clínicos randomizados duplo-cegos apropriados e bem elaborados de maior duração ainda precisam ser realizados. As evidências para os estudos incluídos foram 1C e 1D de acordo com os critérios JBI. A terapia com células-tronco demonstrou resultados promissores na regeneração do tecido periodontal e do osso alveolar. No entanto, o número de estudos para reivindicar tal benefício é muito limitado (AU)

Clinical classification and treatment decision of implant fracture / 北京大学学报(医学版)

OBJECTIVE@#To propose a set of two-dimensional clinical classification of fractured implants based on the follow-up of fracturing pattern of implant body and peri-implant bone defect morphology of 32 fractrued implants, and summarize the treatment decisions of fractured implants according to this new set of classification, so as to provide guidance for clinical practice.@*METHODS@#During 25 years of clinical practice, clinical records of 27 patients of 32 fractured implants in 5 481 patients with 10 642 implants were made. The fracturing pattern of implant body, implant design, peri-implant bone defect morphology and treatment options were analyzed. A set of two-dimensional clinical classification based on the morphology and bone absorption of implant fracture was proposed. The treatment decision-making scheme based on the new classification of implant fracture was discussed.@*RESULTS@#In the new classification system, vertical fracture of implant neck (Type 1 of implant fracture morphology, F1) and horizontal fracture of implant neck (Type 2 of implant fracture morphology, F2) were common, accounting for 50% and 40.6% respectively, while deep horizontal fracture of implant body (Type 3 of implant fracture morphology, F3) (9.4%) were rare, while the three types of bone defects (D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects, D3, wide 3-wall or 2-wall defects) around implants were evenly distributed. In the two-dimensional classification system of implant fracture, F1D1 (31.3%) and F2D2 (25%) were the most frequent. There was a significant positive correlation between F1 and D1 (r=0.592, P < 0.001), a significant positive correlation between F2 and D2 (r=0.352, P=0.048), and a significant negative correlation between F1 and D2 (r=-0.465, P=0.007). The most common treatment for implant fracture was implant removal + guided bone regeneration(GBR) + delayed implant (65.6%), followed by implant removal + simultaneous implant (18.8%). F1D1 type was significantly related to the treatment strategy of implant removal + simultaneous implantation (r=0.367, P=0.039). On this basis, the decision tree of implant fracture treatment was summarized.@*CONCLUSION@#The new two-dimensional classification of implant fracture is suitable for clinical application, and can provide guidance and reference for clinical treatment of implant fracture.

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

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

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

Effect of Er:YAG laser combined with ethylenediamine tetra acetic acid on three-walled periodontal intrabony defects adjacent to implant sites / 华西口腔医学杂志

OBJECTIVES@#To investigate the clinical effect of Er:YAG laser combined with ethylenediamine tetra acetic acid (EDTA) on three-walled periodontal intrabony defects adjacent to implant sites.@*METHODS@#A total of 30 patients with three-walled periodontal intrabony defects adjacent to implant sites were treated with the combination therapy. Patients with three-walled intrabony defects were divided into two groups according to the depth of the intrabony pocket between the implant and natural teeth. Evaluation of wound healing was performed 10 days after the operation, and bone augmentation was evaluated 6 months after the operation.@*RESULTS@#Primary healing in group 1 was 92.31%, primary healing in group 2 was 82.35%. No significant difference was observed between the two groups (@*CONCLUSIONS@#The effect of bone augmentation with combination therapy was more ideal in group 2 than in group 1. Implant placement with combination therapy may be a viable technique to reconstruct three-walled intrabony defects due to the space maintenance provided by implants and bone grafts and the good root surface biocompatibility provided by the Er:YAG laser and EDTA.

Uso de fibrina rica em plaquetas na periodontia: uma revisão de literatura / Use of platelet-rich fibrin in periodontia: a literature review

Fibrina rica em plaquetas (PRF) é um concentrado plaquetário de uso autólogo cuja implicação é promover uma melhor e mais rápida cicatrização além de reparo das lesões cirúrgicas, isso devido à sua disponibilidade ilimitada e ao seu potencial regenerativo com liberação de fatores de crescimento. Objetivo: fazer uma revisão de literatura sobre a utilização da PRF na periodontia. Metodologia: o estudo caracterizou-se como revisional, a partir de busca na literatura selecionando estudos transversais, longitudinais, casos clínicos e revisões sistemáticas, em português e inglês, indexados nas bases de dados portal de periódico da Capes, Medline e PubMed. Revisão: PRF tem sido utilizada na regeneração periodontal por sua capacidade de cicatrização e por conter proteínas biologicamente ativas que se ligam a uma malha de fibrina em desenvolvimento ou à matriz extracelular. Conclusão: observa-se que há uma melhora expressiva no processo de regeneração tecidual e na cicatrização quando se utiliza também a PRF no tratamento, o que a torna uma importante aliada na terapia periodontal.(AU)

Platelet Rich Fibrin is an autologous platelet concentrate whose implication is to promote better and faster healing and repair of surgical lesions. The aim of this study was to review the literature on the use of PRF in periodontics. Methodology: the study was characterized as a review, based on a search in the literature, selecting cross-sectional, longitudinal studies, clinical case and systematic reviews, in Portuguese and English, indexed in the Capes, Medline and PubMed journal databases. Review: PRF has been used in periodontal regeneration for its healing capacity and for containing biologically active proteins that bind to a developing fibrin mesh or the extracellular matrix. Conclusion: it is observed that there is an expressive improvement in the process of tissue regeneration and healing when the PRF is also used in the treatment, which makes it an important ally in periodontal therapy.(AU)

Preservación alveolar post extracción en zona estética: decisiones clinicas predecibles en sitio severamente afectado / Alveolar ridge preservation in the esthesic zone: predictable decisions in a severly affected site

INTRODUCCIÓN: La valoración particular de sitios severamente comprometidos, involucra considerar los tiempos necesarios de cicatrización, así como evidencia actual en términos de biomateriales y técnicas quirúrgicas con el fin de lograr un tratamiento exitoso. MATERIAL Y MÉTODO: Paciente sexo femenino, 28 años, asiste por dolor e infección en diente 2.1 al Postítulo de Periodoncia UDD. Se observa defecto extenso y lesión que compromete tanto las tablas óseas vestibular como palatina. El tratamiento consistió en: exodoncia y regeneración ósea, instalación del implante 6 meses después de la exodoncia y cirugía de conexión 7 meses después más injerto de tejidos blandos. RESULTADOS: El tratamiento de defectos combinados (tejidos duros y blandos), asociados a procesos infecciosos de larga data, mediante rehabilitación implanto soportada puede ser muy predecible y exitoso en la medida que se respeten los tiempos de regeneración de diferentes estructuras.

INTRODUCTION: The specific assessment of a severely compromised sites involves: the consideration of healing time according to the different kinds of tissues involved and the knowledge of the evidence available concerning biomaterials and surgical techniques. MATERIAL AND METHODS: Female patient attends the postgraduate school of periodontics, UDD University in Santiago de Chile, because of pain and chronic infection compromising tooth 2.1. At clinical evaluation, the site has an extensive defect, with active fistula that compromises the buccal and palatal bone plates. The treatment consisted of exodontia and guided bone regeneration, implantation six months after initial exodontia and abutment connection surgery seven months after implant insertion. RESULTS: the treatment of combined defects associated with a long-standing infectious process can be very predictable and successful, only if the measures of time and tissue handling are considered and applied.

Nanostructured platelet-rich plasma: state of art in dental treatments / Plasma-rico em plaquetas nanoestruturado: estado da arte nos tratamentos dentais

Objectives: Reviewing information available about platelet-rich plasma (PRP) applied to dental treatments, introducing the general concept of PRP, as well as analyzing actual data about, and challenges faced by, the dental field. Data & sources: The current study analyzed the most informative publications about PRP application available in this field and gathered the maximum information about it as possible. Conclusions: PRP use, either alone or in association with other biomaterials, can significantly favor different fields such as tissue engineering, since it is an innovative technique that attracts the interest of clinicians and basic scientists. However, it is necessary conducting better designed and controlled experiments to enable successful tissue healing based on PRP use. Clinical significance: The current review can be used by clinicians as source of information about the actual rules and protocols adopted in the herein addressed field, besides providing specific examples of such applications. (AU)

Objetivos: Revisar as informações disponíveis sobre o plasma-rico em plaquetas (PRP) aplicado a tratamentos odontológicos, introduzir o conceito geral de PRP e analisar dados reais sobre os desafios enfrentados pelo campo odontológico. Dados e fontes: O presente estudo analisou as publicações mais informativas sobre a aplicação do PRP disponíveis neste campo e reuniu o máximo de informações possível. Conclusões: O uso do PRP, isoladamente ou em associação com outros biomateriais, pode favorecer significativamente diferentes campos, como a engenharia de tecidos, uma vez que é uma técnica inovadora que atrai o interesse de clínicos e cientistas básicos. No entanto, é necessário realizar experimentos mais bem projetados e controlados para permitir a cura bem-sucedida dos tecidos com base no uso do PRP. Significado clínico: A revisão atual pode ser usada pelos médicos como fonte de informações sobre as regras e protocolos atuais adotados no campo aqui tratado, além de fornecer exemplos específicos de tais aplicações.(AU)

Effect of concentrated growth factors combined with guided tissue regeneration in treatment of classII furcation involvements of mandibular molars / 北京大学学报(医学版)

OBJECTIVE@#Tissues loss due to periodontal disease is typically treated by a variety of regenerative treatment modalities, including bone grafts, guided tissue regeneration (GTR) and growth factors, to reform the supporting tissues of teeth. Concentrated growth factors (CGF) are produced by centrifuging blood samples at alternating and controlled speeds using a special centrifuge. The purpose of this study was to evaluate whether GTR could improve the effect of CGF combined with bone graft in the treatment of classII furcations of mandibular molars.@*METHODS@#In the present study, thirty-five classII furcation involvements were included and randomly divided into two groups. The experimental group (n=17) accepted GTR combined with CGF and bone graft therapy, and the controlled group (n=18) accepted CGF combined with bone graft therapy. The clinical examinations and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery. Comparisons of clinical and CBCT data before and after operation between the experimental group and the control group were made.@*RESULTS@#The clinical and CBCT data of both groups were not statistically different at baseline (P>0.05). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). The probing depths of the experimental group were (4.81±1.95) mm and (3.56±1.94) mm, respectively, significantly higher than the changes of the control group (P<0.001). The vertical and horizontal attachment gains of the experimental group were (4.11±1.98) mm and (3.84±1.68) mm, respectively, significantly higher than the changes of the control group (P<0.001). At the end of 1 year post-surgery, the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with those of the control group: (3.84±1.68) and (3.88±2.12) mm, respectively (P<0.001).@*CONCLUSION@#Within the limitation of the present study, GTR showed positive role in the effect of CGF combined with bone graft in the treatment of classII furcation involvements of mandibular molars.

Behavior of Mesenchymal Stem Cells Obtained From Dental Tissues: A Review of the Literature / Comportamiento de células mesenquimales obtenidas de tejidos dentales: Revisión de literatura

Abstract 20. The success of tissue engineering in combination with tissue regeneration depends on the behavior and cellular activity in the biological processes developed within a structure that functions as a support, better known as scaffolds, or directly at the site of the injury. The cell-cell and cell-biomaterial interaction are key factors for the induction of a specific cell behavior, together with the bioactive factors that allow the formation of the desired tissue. Mesenchymal Stem Cells (MSC) can be isolated from the umbilical cord and bone marrow; however, the behavior of Dental Pulp Stem Cells (DPSC) has been shown to have a high potential for the formation of bone tissue, and these cells have even been able to induce the process of angiogenesis. Advances in periodontal regeneration, dentin-pulp complex, and craniofacial bone defects through the induction of MSC obtained from tooth structures in in vitro-in vivo studies have permitted the obtaining of clinical evidence of the achievements obtained to date.

Resumen 24. El éxito de la ingeniería de tejidos en combinación con la regeneración de tejidos depende del comportamiento y la actividad celular en los procesos biológicos desarrollados dentro de una estructura que funciona como soporte mejor conocida como andamio o directamente en el sitio de la lesión. La interación célula-célula y célula-biomaterial son factores claves para la inducción a un comportamiento célular específico junto con factores bioactivos que permitan la formación del tejido deseado. Las células troncales mesenquimales (MSCs) pueden ser aisladas del cordón umbilical y de la medula ósea, sin embargo, el comportamiento de las células troncales de pulpa dental (DPSCs) han demostrado tener un alto potencial para la formación de tejido óseo e incluso han logrado inducir el proceso de angiogénesis. Avances en la regeneración periodontal, complejo dentino-pulpar y defectos óseos craneofaciales a travez de la inducción de MSCs obtenidas de estructuras de dientes en estudios in vitro-in vivo han permitido obtener evidencia clínica de los logros obtenidos hasta el momento.

Leucocyte Platelet Rich Fibrin with Autologous Gingival Fibroblasts in the Treatment of Adjacent Recession Defects / Fibrina Rica en Plaquetas Leucocitarias con Fibroblastos Gingivales Autólogos en el Tratamiento de Defectos de Recesión Adyacentes

ABSTRACT: Periodontium can submit changes that lead to loss of integrity, such as periodontal disease, immune disorders or traumatic brushing. One of the most common consequences resulting from these events is the apical migration of gingival marginal tissue. Among biomaterials used for periodontal tissue regeneration, fibrin matrices have received significant attention to correct gingival recessions. Five oral mucosa biopsies were extracted, fibroblasts were in vitro cultured and frozen in liquid nitrogen. Three 10 mL glass sterile tubes were filled with patient blood and centrifuged immediately; clots were extracted and compressed to obtain L-PRF membranes. Autologous oral mucosa fibroblasts were added to the membranes and surgical procedures were performed in five patients. L-PRF fibrin network pore size was too small to allow human fibroblasts penetration but they were firmly attached to membrane surface. Gingival fibroblasts from fresh cell culture and recently thawed were used to attach on the L-PRF membranes. It was possible to establish a protocol for blood collection, centrifugation, fibrin clot compression, fibroblast adhesion to the membrane surface and patient application in a relatively short time (1 hour-1 hour and 30 minutes). Two patients expressed pain symptoms and the other ones presented light swelling without pain. In the first week, adjacent tissue showed few inflammation signs. Research efforts are being conducted to develop more conservative surgical techniques and new biomaterials that can promote cellular proliferation. Because of its properties, L-PRF membranes represent a tempting alternative. A combined technique to treat adjacent recession defects with L-PRF membranes and autologous oral mucosa fibroblasts in a coronal displaced flap did not show initial advantage compared with a gold standard surgery that includes an autologous soft tissue graft. Nevertheless, it could be an alternative for clinical application as a new functional cell biomaterial. More clinical evidence is needed.

RESUMEN: El periodonto puede presentar cambios que conducen a la pérdida de integridad, como la enfermedad periodontal, los trastornos inmunes o el cepillado traumático. Una de las consecuencias más comunes que resultan de estos eventos es la migración apical del tejido marginal gingival. Entre los biomateriales utilizados para la regeneración del tejido periodontal, las matrices de fibrina han recibido una atención significativa para corregir las recesiones gingivales. Se extrajeron cinco biopsias de mucosa oral, los fibroblastos se cultivaron in vitro y se congelaron en nitrógeno líquido. Tres tubos de vidrio estériles de 10 ml se llenaron con sangre del paciente y se centrifugaron inmediatamente. Los coágulos fueron extraídos y comprimidos para obtener membranas de L-PRF. Se agregaron fibroblastos autólogos de mucosa oral a las membranas y se realizaron procedimientos quirúrgicos en cinco pacientes. El tamaño de poro de la red de fibrina L-PRF era demasiado pequeño para permitir la penetración de los fibroblastos humanos, pero estaban firmemente unidos a la superficie de la membrana. Se usaron fibroblastos gingivales de cultivos de células frescas y recientemente descongelados para unirlos a las membranas L-PRF. Fue posible establecer un protocolo para la extracción de sangre, centrifugación, compresión de coágulos de fibrina, adhesión de fibroblastos a la superficie de la membrana y aplicación al paciente en un tiempo relativamente corto (1 hora, 1 hora y 30 minutos). Dos pacientes expresaron síntomas de dolor y los otros presentaron hinchazón leve sin dolor. En la primera semana, el tejido adyacente mostró pocos signos de inflamación. Se están realizando esfuerzos de investigación para desarrollar técnicas quirúrgicas más conservadoras y nuevos biomateriales que puedan promover la proliferación celular. Debido a sus propiedades, las membranas L-PRF representan una alternativa tentadora. Una técnica combinada para tratar los defectos de recesión adyacentes con membranas de L-PRF y fibroblastos de mucosa oral autóloga en un colgajo coronal desplazado no mostró una ventaja inicial en comparación con una cirugía estándar que incluye un injerto de tejido blando autólogo. Sin embargo, podría ser una alternativa para la aplicación clínica como un nuevo biomaterial de células funcionales. Se necesita más evidencia clínica.

Creeping attachment após enxerto gengival livre: relato de caso / Creeping attachment after autogenous free gingival grafting: case report

Introdução: As técnicas de enxerto gengival livre têm como principal objetivo a criação/aumento da faixa de mucosa ceratinizada. Quando se utiliza o tratamento químico da raiz e o correto posicionamento do enxerto no leito receptor podem acarretar em um fenômeno incomumdenominado de Creeping Attachment. Objetivo: descreverum caso de recobrimento radicular apósum enxerto gengival livre e Creeping Attachment. Relato do caso: Paciente sexo masculino, 28 anos de idade, não fumante e sem alterações sistêmicas apresentouse a faculdade de odontologia Universidade Federal de Santa Catarinacom a queixa principal de comprometimento estético e hipersensibilidade dentinária na região anterior-inferior. No exame clínico verificou-se uma recessão gengival unitária no dente 41, classificada como classe I de Miller. Logo indicou-se a cirurgia de enxerto gengival livre, obtido da região de palato duro, visandouma melhora estética efuncional, bem como a remissão da hipersensibilidade. Conclusão: Diante dos resultados clínicos podemos concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para o aumentoda faixa de mucosa queratinizada para posterior recobrimento radicular, contudo apesar de incomum o fenômeno Creeping Attachment deve ser esperado como alternativa a etapade recobrimento radicular. (AU)

Introduction: Free gingival graft techniques have as main objective the creation / increase of the keratinized mucosa band. When using the chemical treatment of the root surfaceand the correct positioning of the graft in the recipiente bed can lead to anuncommon phenomenon calledCreeping Attachment. Objective: This scientific paper describes a clinical case of root coverage after a free gingival graft and Creeping Attachment. Case Report: A 28-year-old male patient, non-smoker, was assisted in the Federal University of Santa Catarina by students and teachers of dentistry presented the main complaint the aesthetic impairment and dentin hypersensitivity in the anterior region of the jaw. In the clinical examination was observed an unitary gingival recession in tooth 41, classified as Miller class I. The gingival graft surgery, obtained from the hard palate region, was then indicated to improve the esthetic and functional condition, as well as to promove the end of symptoms of hypersensitivity. Conclusion: Inview of the clinical results we can conclude that the free gingival graft is a predictable and easy to perform technique to increase the line of keratinized mucosa for the subsequent root coverage. However, although the Creeping Attachment phenomenon is uncommon, it should be expected as an alternative to the root coverage (AU)

New strategies and developments for peri-implant disease

Abstract The aim of this illustrated review is to present the new strategies and developments to treatment and diagnosis of periimplant diseases. Periimplant disease is a subject of great concern for modern dentistry. The numbers of implant exhibiting biological complications grows as implant dentistry expands thought-out the world. Diagnosis and treatment of those diseases are still controversial and difficult. We present novel treatment for infection control and biological rationale of additional use of guided bone regeneration, with an illustrative explanation of the treatments presented with two cases.

Dental Pulp Regeneration: Insights from Biological Processes / Regeneración pulpar: Perspectivas desde los procesos biológicos

Abstract One of the major approaches on dental research in this century is the development of biological strategies (tissue engineering) to regenerate/biomineralize lost dental tissues. During dentin- pulp regeneration, the interaction between stem cells, signaling molecules, biomaterials and the microenvironment in the periapical area drives the process for pulp tissue engineering. Understanding the signaling mechanisms and interactions involved with the biological process for the formation of a new tissue is essential. The knowledge of the micro-environment is the key for the application of tissue engineering. The present article is a short review of the current state of this topic, with the purpose of showing insights of pulp regeneration.

Resumen Actualmente la investigación en odontología se orienta al desarrollo de estrategias basadas en principios biológicos (ingeniería de tejidos) para la regeneración/biomineralización de estructuras dentales perdidas. El proceso de regeneración del complejo dentino-pulpar está guiado por la compleja interacción entre las células indiferenciadas de origen dental (DTSC), moléculas de señalización y biomateriales con el microambiente donde se va a restablecer. Es esencial comprender detalladamente, los mecanismos de señalización e interacciones involucradas en los procesos biológicos para la formación de un nuevo tejido, además de la identificación de los componentes presentes en los tejidos dentales implicados en este proceso (características del microambiente), ya que representan la base sobre la cual se debe emplear la ingeniería de tejidos. El presente articulo es una breve revisión del estado actual del tema, con el fin de entender el proceso de regeneración pulpar, basado en la comprensión de los fundamentos biológicos.

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

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

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

Efeito da ativação do receptor ativado por protease do tipo 1 (PAR1) sobre as atividades osteogênica e cementogênica de células mesenquimais do ligamento periodontal / Effect of protease activated receptor type 1 (PAR1) activation on the osteogenic activity of periodontal ligament cells

O receptor ativado por protease do tipo 1 (PAR1) foi o primeiro membro clonado da família de receptores acoplados à proteína G. Sua ativação tem sido associada ao reparo tecidual e cicatrização óssea. O objetivo do presente estudo foi avaliar o efeito da ativação do PAR1 nas atividades osteogênica e cementogênica de células mesenquimais do ligamento periodontal (CMLP). CMLP obtidas de 3 indivíduos foram cultivadas e tratadas com meio clonogênico (MC) ou meio osteogênico (MO) por 2, 7 e 14 dias. Depósitos de cálcio, concentração de cálcio (sobrenadante), atividade de fosfatase alcalina (ALP), proliferação celular, expressão gênica (qPCR) e níveis proteicos (ELISA) de fatores osteogênicos e cementogênicos foram avaliados na presença de trombina, agonista do PAR1 ou antagonista do PAR1. A ativação do PAR1 levou ao aumento da formação de depósitos de cálcio (p<0,05), o que foi associado ao aumento da concentração de cálcio (p<0,05), atividade da ALP (p<0,05) e proliferação celular (p<0,05). Além disso, os ensaios qPCR e ELISA mostraram que a ativação do PAR1 pode aumentar a expressão gênica de Runx2, OPG e CEMP1 (p<0,05) e níveis proteicos de Runx2 e OPG (p<0,05). Em conclusão, nossos resultados demonstram que a ativação de PAR1 aumenta as atividades osteogênica e cementogênica de CMLP.

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

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

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

Inter-relação periodontia/dentística na correção de sorriso gengival: relato de caso clínico / Periodontic / dentistry interrelation on gingival smile correction: case report

Introdução: a procura por cirurgias plásticas periodontais por pacientes que relatam "excesso de gengiva ao sorrir", tem sido mais constante na prática clínica odontológica. Objetivo: relatar um caso clínico de planejamento e correção de sorriso gengival com cirurgia plástica periodontal e facetas de resina composta. Relato do caso: a paciente de 23 anos relatava como queixa principal insatisfação estética, coroas dos dentes anteriores superiores curtas e excesso de exposição gengival. Após avaliação clínica e periodontal, observou-se que a paciente apresentava biótipo espesso, erupção passiva alterada e sorriso gengival de 5 mm nos caninos e incisivos centrais superiores e 5,5 mm nos incisivos laterais superiores. A correção da erupção passiva alterada foi realizada por meio de gengivectomia em bisel interno e osteotomia, com a finalidade de restabelecer as distâncias biológicas periodontais e aumentar as coras clínicas dos elementos, diminuindo consequentemente a faixa de exposição gengival da paciente ao sorrir. Após o procedimento cirúrgico e completo reparo do tecido periodontal, foi planejada a confecção de facetas diretas dos elementos 13 ao 23. Resultado: houve diminuição do sorriso gengival e correção da estética dentária, proporcionando uma maior exposição das coroas clínicas dos dentes. Conclusão: o planejamento da reabilitação estética do sorriso permitiu através da técnica e procedimentos adequados um tratamento eficaz, reduzindo a exposição gengival ao sorrir em 4 mm nos incisivos centrais e caninos superiores e em 3 mm nos incisivos laterais superiores. A inter-relação de especialidades odontológicas na reabilitação do sorriso atendeu às expectativas da paciente, mostrando resultados estéticos e funcionais satisfatórios. (AU)

Introduction: the search for periodontal plastic surgeries by patients who report excessive gingiva when smiling has been more constant in dental practice. Objective: to report a clinical case of gingival smile planning and correction with periodontal plastic surgery and composite resin facets. Case report: the 23-year-old patient reported as main complaint aesthetic dissatisfaction, short crowns of upper anterior teeth and excessive gingival exposure. After clinical and periodontal evaluation, it was observed that the patient presented thick biotype, altered passive eruption and gingival smile of 5 mm in the canines and upper central incisors and 5.5 mm in the upper lateral incisors. The altered passive eruption was corrected by means of internal beveled gingivectomy and osteotomy, in order to restore the periodontal biological distances and increase the clinical coronal of the elements, consequently decreasing the gingival exposure range of the patient when smiling. After the surgical procedure and complete repair of the periodontal tissue, it was planned to make direct facets of elements 13 to 23. Result: there was a satisfactory reduction of the gingival smile and correction of the dental esthetics, providing a greater exposure of the clinical crowns of the teeth. Conclusion: the design of smile aesthetic rehabilitation allowed through the appropriate technique and procedures an effective treatment, reducing the gingival exposure when smiling in 4 mm in the central incisors and upper canines and in 3 mm in the upper lateral incisors. The interrelation of dental specialties in smile rehabilitation answered about the patient's expectations, showing satisfactory aesthetic and functional results.(AU)

Bone-conditioned medium contributes to initiation and progression of osteogenesis by exhibiting synergistic TGF-β1/BMP-2 activity / 国际口腔科学杂志·英文版

Guided bone regeneration (GBR) often utilizes a combination of autologous bone grafts, deproteinized bovine bone mineral (DBBM), and collagen membranes. DBBM and collagen membranes pre-coated with bone-conditioned medium (BCM) extracted from locally harvested autologous bone chips have shown great regenerative potential in GBR. However, the underlying molecular mechanism remains largely unknown. Here, we investigated the composition of BCM and its activity on the osteogenic potential of mesenchymal stromal cells. We detected a fast and significant (P < 0.001) release of transforming growth factor-β1 (TGF-β1) from autologous bone within 10 min versus a delayed bone morphogenetic protein-2 (BMP-2) release from 40 min onwards. BCMs harvested within short time periods (10, 20, or 40 min), corresponding to the time of a typical surgical procedure, significantly increased the proliferative activity and collagen matrix production of BCM-treated cells. Long-term (1, 3, or 6 days)-extracted BCMs promoted the later stages of osteoblast differentiation and maturation. Short-term-extracted BCMs, in which TGF-β1 but no BMP-2 was detected, reduced the expression of the late differentiation marker osteocalcin. However, when both growth factors were present simultaneously in the BCM, no inhibitory effects on osteoblast differentiation were observed, suggesting a synergistic TGF-β1/BMP-2 activity. Consequently, in cells that were co-stimulated with recombinant TGF-β1 and BMP-2, we showed a significant stimulatory and dose-dependent effect of TGF-β1 on BMP-2-induced osteoblast differentiation due to prolonged BMP signaling and reduced expression of the BMP-2 antagonist noggin. Altogether, our data provide new insights into the molecular mechanisms underlying the favorable outcome from GBR procedures using BCM, derived from autologous bone grafts.

Vestibuloplastia peri-implantar associada à regeneração tecidual guiada no tratamento da peri-implantite / Peri-implant vestibuloplasty and guided tissue regeneration in the peri-implantitis treatment

Levando em consideração que a peri-implantite é de etiologia multifatorial, embora o fator determinante seja o biofilme dentário, é interessante buscar formas de minimizar as perdas ósseas ocorridas. Desta maneira, ainda que ressalvas possam ser feitas à possibilidade concreta de se obter uma regeneração tecidual guiada, pode-se entender como uma alternativa válida para buscar, pelo menos, estabilizar o processo de progressão desta perda. Concomitantemente a este procedimento, e tendo em vista a indicação de vestibuloplastia para melhor prevenção da recidiva de peri-implantite, foi possível obter um resultado favorável dentro do objetivo proposto, em uma única intervenção cirúrgica. Material e métodos: paciente do sexo feminino, com 68 anos de idade, fumante moderada (8-10 cigarros/dia), se apresentou com exsudato purulento na face mesiovestibular do implante 46. Debelada a fase aguda por meio de fisioterapia local, a paciente foi submetida à cirurgia peri-implantar visando à interceptação da perda óssea por meio de "regeneração tecidual guiada" associada à vestibuloplastia, com a utilização de enxerto gengival subepitelial. Resultados: foi possível obter estabilização da perda óssea, bem como diminuição na profundidade de sondagem, além da redução de exsudato no implante em discussão. Conclusão: além disso, a vestibuloplastia criou melhores condições anatômicas estruturais devido ao tecido ceratinizado obtido e, sobretudo, criou um favorável acesso à escovação em toda a extensão dos quatro implantes, antevendo- -se melhor possibilidade de preservação do resultado.

Taking into account that the peri-implantitis is of multifactorial etiology, although the determining factor is the dental biofilm, it is interesting to look for ways to minimize the bone losses that have occurred. Thus, although safeguards can be made to the concrete possibility of obtaining a guided tissue regeneration, it can be understood as a valid alternative to seek to at least stabilize the process of progression of this loss. Concomitantly to this procedure and in view of the indication of vestibuloplasty for better prevention of recurrence of peri-implantitis, it was possible in a single surgical intervention to obtain a favorable result within the proposed objective. Material and methods: a 68-year-old female patient, moderate smoker (8-10 cigarettes/day) presented with purulent exudate on the mesiobuccal surface of the implant in the region of the 46. After the acute phase, through local physiotherapy, the patient underwent to peri-implant surgery aiming the interception of bone loss by means of "guided tissue regeneration" associated with vestibuloplasty with the use of subepithelial gingival graft. Results: it was possible to obtain a stabilization of the bone loss, as well as a decrease in the depth of probing, besides the reduction of exudate in the implant under discussion. Conclusion: the vestibuloplasty created better anatomical structural conditions due to the keratinized tissue obtained, and above all, the favorable access to brushing throughout the four implants, predicting a better possibility of preservation of the result.