RESUMO
A execução de um plano de tratamento cirúrgico-odontológico adequado em pacientes com história de Infarto do Miocárdio tem sido baseada em protocolos estabelecidos desde as décadas de 1960 e 1970, que estipulavam um período de espera mínimo de seis meses para a execução de cirurgia não-cardíaca. Atualmente, os recentes avanços na avaliação médica do risco cirúrgico com base na análise individual de cada caso, bem como a disponibilidade de novos recursos terapêuticos tanto no que se refere ao tratamento médico quanto odontológico, permitem que novas posturas sejam adotadas na execução de um cirurgia odontológica segura nestes pacientes. Neste trabalho, a partir da revisão de literatura, procurou-se abordar as tendências atuais do tratamento de pacientes com história de infarto agudo do miocárdio, no que se refere aos cuidados específicos durante o pré, trans e pós-operatório, tendo em vista a avaliação laboratorial e terapêutica medicamentosa; bem como na possibilidade de tratamento cirúrgico-odontológico prévio aos seis meses pós-infarto.
The execution of a appropriate odontological surgical treatment for patients with Myocardial Infarction has been based in established protocols for important works in world wide literature during the sixty?s and seventy?s decade, established with a minimum of six months before the noncardiac surgery. The recent advancements in the medical assessment of surgical risk based on the individual analysis of each case with availability of new therapeutic tools in reference to medical or dental treatment, allowing for new procedures that can be used in the execution of safer odontological surgery for each patients. This review of the literature shows the actual tendencies of the treatment of patients with Myocardial Infarction concerning specific care before, during and after surgery based on laboratory evaluation and drug therapy as well as the possibility of surgical treatment before six months post-infarction.
Assuntos
Assistência Odontológica , Cirurgia Bucal , Infarto do MiocárdioRESUMO
From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar) were randomly assigned to receive an endovenous injection (penile vein) of either citrate buffer solution (Group 1 - control; n=20) or streptozotocin dissolved in citrate buffer solution (35 mg/kg) to induce diabetes (Group 2 - diabetic; n=20). After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.