RESUMEN
Background: Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re?) treatment. To achieve this, continuous improvement in surgical techniques, materials and instruments is being done to enhance the outcome of periapical endodontic surgeries. The purpose of this study was to compare, radiographically, the healing kinetics of platelet?rich fibrin (PRF) and mineralized freeze?dried bone allograft (FDBA) in patients undergoing apicoectomy. Materials and Methods: Nineteen patients (aged 18–40 years) were included in the study and randomly assigned to groups A or B, where they received PRF or FDBA, respectively. Following apicoectomy, PRF gel and FDBA graft were prepared and placed in the osseous defect followed by placement of PRF membrane for graft stabilization and flap closure. Radiographic follow?up was done at the 1st, 3rd, 6th and 12th months for evaluation of healing using Molven’s criteria. Statistical analysis was done with Pearson’s and McNemar’s Chi?square tests. Results: A highly significant difference (P = 0.002) in radiographic healing was observed at 6 months. Complete healing was observed in 50% of cases in Group A whereas in Group B, none of the cases presented with complete radiographic healing. However, at the end of 12 months, complete radiographic healing was observed in both groups. Conclusion: Our data suggest that PRF accelerates bone healing as compared to FDBA and is both time and cost?efficient.
RESUMEN
Within oral rehabilitation alveolar ridge preservation following extraction is important. This research study shows a histological, histochemical and histomorphometrical evaluation in two cases of post extraction ridge-socket preservation performed with FDBA. In two patients dental extraction procedures were performed and sockets were immediately filled with FDBA. Six months later a biopsy of grafted area was obtained and rehabilitated through dental implant. Grafted bone samples were treated for histological and histochemical analysis. Bone tissue area was measured. Laboratory analysis of three samples showed inactive bone surfaces, neither osteoblasts nor osteoclasts were found, only osteocyte and osteogenous cells were observed. These findings do not mean that tissue is metabolically inactive, rather bone genesis develop from a tissue matrix with the potential to generate undifferentiated osteocytes, and a micro environment with proteins such as bone morphogenetic proteins (BPM). Inactive biomaterial particles were not observed. Samples showed 0 percent and 30 percent bone tissue respectively. Considering histological differences between this and other research studies, it is necessary to develop further investigation to increase knowledge of processes involved in bone regeneration as well as bone quality, considering the variability that could be seen in each patient.
Dentro de la rehabilitación oral, es importante preservar el reborde alveolar post exodoncia. Se expone un análisis histológico, histoquímico e histomorfométrico de dos casos clínicos de terapias de regeneración ósea de alvéolos post extracción mediante FDBA. En dos pacientes se extrajeron piezas dentarias destruidas y se indujo regeneración ósea mediante FDBA. Seis meses después, se obtuvo una biopsia del injerto y mediante un implante de titanio fue rehabilitado. Para el análisis Histológico e Histomorfométrico, las muestras fueron tratadas con las técnicas Hematoxilina-Eosina, Azul de Alcián, Masson, Von Kossa y colorante Picrosirius de Junqueira.Se midió el área total de tejido, así como el área de tejido óseo. Las superficies de hueso de las muestras se observaron inactivas, no fueron encontrados osteoblastos ni osteoclastos, sólo osteocitos y células osteógenas, lo que no significa que el hueso esté en estado quiescente, sino mas bien a que su génesis ocurre a partir de la matriz de tejido donde se encuentran células con potencialidad de formar osteocitos indiferenciados y un microambiente con proteinas de la familia de factor de crecimiento transformante beta. No fueron encontradas partículas de biomaterial inactivo. En las muestras se cuantificó 0 por ciento y 30 por ciento de hueso mineralizado. Dadas las diferencias histológicas encontradas con otros estudios, es necesario profundizar el conocimiento en los procesos involucrados en la regeneración ósea dependiendo del biomaterial utilizado, y la calidad ósea resultante en cada procedimiento en particular sin perder de vista la variabilidad que puede presentarse dependiendo de cada caso clínico.