Marcação de incisões receptoras em cirurgia da restauração capilar - nova metodologia para simetria de densidade / Marking the recipient sites in hair restoration surgery - new methodology to attain symmetric density

Introdução: Em cirurgias de restauração capilar, as incisões receptoras para a inserção das unidades foliculares são realizadas com micro lâminas ou agulhas, procurando conseguir a maior proximidade possível, mas visando a segurança da nutrição sanguínea dos enxertos. O objetivo deste trabalho é relatar uma metodologia de marcação prévia de traços ou pontos na pele calva da região frontal, usando carimbos criados pelo autor, objetivando fazer incisões nessas marcas, a fim de se obter simetria de densidade. Métodos: Alguns tipos de carimbos são descritos, e também suas opções de utilização na região frontal, juntamente com três tipos de tinta, uma em cada indivíduo de quatro grupos de pacientes, visando a escolha da tinta que apresentasse maior tempo de permanência na pele. Nos grupos A e B, foram testados, respectivamente, o uso das concentrações usuais das tintas de uso médico e o de uma tinta permanente. Nos grupos C e D, foi testada uma solução alcoólica de 3% de violeta de genciana, sem e com uma película de barreira em spray. Resultados: Os carimbos descritos, umedecidos com o corante testado no grupo D, deixaram traços e pontos sobre o couro cabeludo que, cobertos com a película de barreira, foram resistentes a sangue e lavagens freqüentes. Conclusões: O uso de carimbos para marcar a pele calva, usando o método descrito, facilita a simetria das incisões e a identificação das fendas para a inserção das unidades foliculares, resultando em densidade simétrica na região frontal.

Introduction: In hair restoration surgery, recipient sites for insertion of follicular units are made with microblades or needles, with the goals of achieving the closest proximity possible and to maintain vascular nutritional support for the grafts. This study describes the methodology for preparatory marking of the frontal scalp with dots or lines. Stamps developed by the author are used to make incisions at these sites in order to attain symmetric density. Methods: Several types of stamps are described. Individualized options for use in the frontal region were defined in four groups of patients; three types of inks were used in order to choose the ink with greater permanence in the skin. Groups A and B were respectively tested with common concentrations of inks for medical use and with a permanent ink. Groups C and D were tested with an alcoholic solution of 3% gentian violet, with and without the application of a barrier film spray. Results: Stamps moistened with the ink tested in group D marked lines and dots on the scalp which were resistant to blood and frequent washing, when covered with a barrier film. Conclusions: The use of stamps to mark bald skin with the methodology described improves incision symmetry and slot identification for the insertion of follicular units, in turn resulting in symmetric density in the frontal region.

Primary stability of implants in ilium of cadaver by the methods of recipient site preparation

PURPOSE: This study was performed to evaluate the effect of the implant recipient site preparation methods on primary stability of implants with the instruments of Osstell(TM) and Periotest(R) in the iliac bone of cadaver. METHODS AND MATERIALS: The 8 iliac bones in 4 cadavers and implants treated with resorbable blasting media (RBM) were used. Periotest(R) (Simens AG, Germany) and Osstell(TM)(Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden) were used to measure primary stability of implants. Implants were inserted into the iliac crest of the cadaver. In control group, the recipient site was prepared according to the manufacturer's recommendation: 1.8 mm guide drill, 2.0 mm initial drill, 2.7 mm pilot drill, 2.7 mm twist drill, 3.0 mm twist drill, 3.3 mm pilot drill, 3.3 mm twist drill, and 3.3 mm countersink drill as well as tapping drill were used in order. In the group 1, implant recipient sites were prepared by sequentially drilling from 1.8 mm guide drill to 3.0 mm twist drill and then inserted implants without countersinking and tapping. In the group 2, implant recipient sites were prepared to 3.0 mm twist drill and countersink drill and then inserted implants without tapping. In the group 3, the sites were prepared to 3.0 mm twist drill and countersink drill as well as tapping drill. In the group 4, the sites were prepared to 3.3 mm twist drill. In the group 5, the sites were prepared to 3.3 mm twist drill and countersink drill. A total of 60 implants were placed (n=10). The stability was measured using Osstell(TM) and Periotest(R) mesiodistally and buccolingually. To compare the mean stability of each group statistically, One-way ANOVA was used and correlation of instrument were analyzed using SPSS 12.0. The results obtained were as follows; 1. The stability of group 1 measured using Osstell(TM) and Periotest(R) buccolingually showed the highest, and there are significant difference statistically between control group and experimental group 1,2,4 in each instruments respectively (P<0.05). 2. The stability of group 1 measured using Osstell(TM) and Periotest(R) mesiodistally showed the highest. There are significant difference statistically between control group and all experimental groups in Osstell(TM), and between control group and experimental group 1,2,3,4 (P<0.05). 3. There are high correlation between the measurements of Osstell(TM) and Periotest(R) (P<0.05). CONCLUSION: These results indicate that the primary stability of implant can be obtained by the recipient sites preparation with smaller diameter drill than that of implant or minimal drilling.

Primary stability of implants in ilium of cadaver by the methods of recipient site preparation

PURPOSE: This study was performed to evaluate the effect of the implant recipient site preparation methods on primary stability of implants with the instruments of Osstell(TM) and Periotest(R) in the iliac bone of cadaver. METHODS AND MATERIALS: The 8 iliac bones in 4 cadavers and implants treated with resorbable blasting media (RBM) were used. Periotest(R) (Simens AG, Germany) and Osstell(TM)(Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden) were used to measure primary stability of implants. Implants were inserted into the iliac crest of the cadaver. In control group, the recipient site was prepared according to the manufacturer's recommendation: 1.8 mm guide drill, 2.0 mm initial drill, 2.7 mm pilot drill, 2.7 mm twist drill, 3.0 mm twist drill, 3.3 mm pilot drill, 3.3 mm twist drill, and 3.3 mm countersink drill as well as tapping drill were used in order. In the group 1, implant recipient sites were prepared by sequentially drilling from 1.8 mm guide drill to 3.0 mm twist drill and then inserted implants without countersinking and tapping. In the group 2, implant recipient sites were prepared to 3.0 mm twist drill and countersink drill and then inserted implants without tapping. In the group 3, the sites were prepared to 3.0 mm twist drill and countersink drill as well as tapping drill. In the group 4, the sites were prepared to 3.3 mm twist drill. In the group 5, the sites were prepared to 3.3 mm twist drill and countersink drill. A total of 60 implants were placed (n=10). The stability was measured using Osstell(TM) and Periotest(R) mesiodistally and buccolingually. To compare the mean stability of each group statistically, One-way ANOVA was used and correlation of instrument were analyzed using SPSS 12.0. The results obtained were as follows; 1. The stability of group 1 measured using Osstell(TM) and Periotest(R) buccolingually showed the highest, and there are significant difference statistically between control group and experimental group 1,2,4 in each instruments respectively (P<0.05). 2. The stability of group 1 measured using Osstell(TM) and Periotest(R) mesiodistally showed the highest. There are significant difference statistically between control group and all experimental groups in Osstell(TM), and between control group and experimental group 1,2,3,4 (P<0.05). 3. There are high correlation between the measurements of Osstell(TM) and Periotest(R) (P<0.05). CONCLUSION: These results indicate that the primary stability of implant can be obtained by the recipient sites preparation with smaller diameter drill than that of implant or minimal drilling.