ß-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.

BACKGROUND: It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with ß-TCP/HA in combination with or without EMD in humans. METHODS: In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using ß-TCP/HA mixed with EMD (BC + EMD) and the other side using only ß-TCP/HA (BC). After 6 months, biopsies were harvested from grafted areas during implant installation, being histologically and histomorphometrically analyzed. Differences between the groups considering new bone formation, soft tissues, and remaining BC were statistically evaluated. RESULTS: All patients showed uneventful healing after MSFA, and dental implant installation was possible in all patients after 6 months. Histological analysis showed newly formed bone that was primarily woven in nature; it was organized in thin trabeculae, and it was occasionally in contact with residual bone substitute particles, which appeared in various forms and sizes and in advanced stage of degradation. Mean bone area was 43.4% (CI95 38.9; 47.8) for the BC group and 43.0% (CI95 36.6; 49.5) for the BC + EMD group. Mean soft tissue area was 21.3% (CI95 16.5; 26.2) for BC group and 21.5% (CI95 17.7; 25.3) for BC + EMD group, while the remaining biomaterial was 35.3% (CI95 36.6; 49.5) and 35.5% (CI95 29.6; 41.3) for BC and BC + EMD group, respectively. CONCLUSIONS: MSFA with BC resulted in adequate amounts of new bone formation allowing successful implant installation; adding EMD did not have a significant effect.

Retalho deslocado coronalmente com a utilização de enxerto conjuntivo subepitelial e Emdogain para recobrimento radicular ­ controle clínico de cinco anos / Coronally repositioned flap with subepithelial connective tissue graft and Emdogain for root coverage ­ a 5 year follow-up case report

Uma situação desafiadora na Odontologia é a recessão gengival. Seu tratamento deve ser capaz de promover um completo recobrimento do defeito da recessão com mínima profundidade de sondagem pós-tratamento, além de promover resultados de cor e textura na área recoberta compatível com a dos tecidos moles adjacentes. Algumas situações clínicas prévias devem ser observadas quando do exame do paciente, dentre elas: a etiologia da lesão, o grau de classificação e a existência de lesões cariosas na raiz exposta. Uma abordagem previsível para o recobrimento radicular é o retalho deslocado coronalmente associado ao enxerto de tecido conjuntivo subepitelial. As proteínas derivadas da matriz do esmalte vêm sendo utilizadas associadas a técnicas de recobrimento com o intuito de aumentar o potencial regenerativo da região. Neste relato, com controle clínico de cinco anos, foi realizada a recuperação do tecido gengival perdido na região do dente 31, com o uso da técnica do retalho deslocado coronalmente associado ao enxerto de tecido conjuntivo subepitelial e ao Emdogain. Esta associação resultou em um importante ganho de inserção, além da melhora estética na região para o paciente.

A challenging situation in dentistry is gingival recession. Its treatment should be able to promote a complete coverage of the recession defect with minimum post-treatment probing depth, in addition to promoting color and texture results in the covered area compatible with the adjacent soft tissue. Some previous medical conditions must be observed when examining the patient, among them the etiology, the degree of classifi cation and the existence of caries on the exposed root. A predictable approach to root coverage is the coronally repositioned flap associated with subepithelial connective tissue grafting. The enamel derived matrix has been associated with coverage techniques in order to increase the regenerative potential. In this 5 year case report, the lost gingival tissue was recovered at the region of tooth 31 using a coronally advanced fl ap associated to STG and Emdogain. There were esthetic improvements and better attachment levels observed in the clinical results.

Microvessel Density Evaluation of the Effect of Enamel Matrix Derivative on Soft Tissue After Implant Placement: A Preliminary Study.

Enamel matrix derivative (EMD) is commonly used in periodontal therapy and has been used successfully for periodontal regeneration. In addition, this material has a possible angiogenic effect that has been associated with enhanced wound healing. The aim of this study was to evaluate the effect of EMD on microvessel density (angiogenesis) on the soft tissues surrounding newly placed implants after 14 days. Five patients were selected, each requiring at least one implant on each side of the maxilla, in a split-mouth experimental design. The implants were placed in a two-stage procedure. Each side was then randomized as test or control. On the test side, 0.1 mL of EMD was topically applied to the soft tissues surrounding the implants, while the control side did not receive any treatment. Second-stage surgery was performed after 14 days. A 6-mm punch biopsy was performed for each implant, with the samples subsequently prepared for histology and immunohistochemistry. Quantitative vascularization analysis was performed, which involved counting three areas or "hotspots" containing vessels strongly positive for CD34 and CD105, a pan-endothelial and new vessel marker, respectively. There was no significant difference between test and control groups when evaluating the formation of new blood vessels. The total number of blood vessels, however, was significantly higher in the group treated with EMD (test group). Within the limits of the present study, it can be concluded that topical application of EMD on the soft tissues surrounding newly placed implants resulted in an increased number of blood vessels at 14 days, suggesting that EMD may play a beneficial role in this aspect of wound healing.

Instalação e provisionalização imediata de implantes após exodontia em dentes com reabsorção externa / Immediate installation and provisionalization of implants after extraction of teeth with external resorption

Vários fatores podem levar à perda dentária, entre eles a reabsorção externa das raízes. Para este, entre outros casos, a reposição dos dentes perdidos com a instalação imediata de implantes e provisionalização imediata tem sido um procedimento com bom prognóstico. Fatores como extração minimamente traumática, manutenção das cristas ósseas proximais e das tábuas ósseas vestibular e lingual, estabilidade primária do implante e a confecção de provisório imediato livre de contatos oclusais são parâmetros importantes para a previsibilidade do caso. Esta técnica tem sido descrita por vários autores desde a década de 90 com alto índice de sucesso, otimizando a reabilitação dos pacientes com menor tempo de espera e a preservação da arquitetura dos tecidos gengival e ósseo. Este trabalho apresenta o relato de dois casos clínicos de exodontias de dentes com reabsorção externa, previamente submetidos ao tracionamento ortodôntico, seguidas de instalação imediata de implantes e provisionalização imediata, com acompanhamento clínico e radiográfico de 7 anos...

Several factors can lead to tooth loss, including external root resorption. In these cases, among others, the replacement of missing teeth with immediate implant placement and provisionalization has been a procedure with good prognosis. Factors including minimally traumatic extraction, maintenance of proximal bone crests and buccal and lingual bone plates, primary implant stability and immediate provisionalization free of occlusal contacts are strictly important for success and good long-term result. This technique has been described since the 90s with a high success rate. It can optimize the rehabilitation with a shorter waiting time maintaining of bone and gingival contours. This article describes a 7-year radiographic and clinical follow-up of two extraction cases of teeth with external root resorption followed by immediate implant placement and immediate provisionalization...

Implante imediato com provisionalização e utilização da coroa natural do elemento extraído / Immediate dental implant after tooth extraction using the natural dental crown as a provisional restoration. A case report

A implantação imediata após a exodontia com a confecção de um elemento protético provisório tem se tornado uma proposta viável, amplamente documentada na literatura e que diminui consideravelmente o tempo de tratamento e a quantidade de intervenções, contribuindo para maior satisfação do paciente. A observação de fatores relevantes da estrutura óssea remanescente e do contorno gengival da região deve ser considerada, com o objetivo de otimizar o prognóstico. Outras considerações quanto ao desenho e superfície do implante, conduta cirúrgica e protética também devem ser criteriosamente analisadas. O objetivo deste trabalho foi demonstrar, por meio de um relato de caso clínico, a utilização de implante imediato após a exodontia de um dente perfurado endodonticamente, seguido de provisionalização imediata, utilizando-se da coroa do dente extraído como elemento provisório, com acompanhamento de seis meses.

Immediate implantation after extraction followed by a provisional prosthetic element has become a viable proposition, widely documented in the literature and which significantly reduces treatment time and number of interventions, contributing to greater patient satisfaction. The observation of relevant factors of the remaining bone structure and gingival contour of the region must be considered in order to optimize the prognosis. Other considerations such as implant design and surface, surgical and prosthetic protocols should also be carefully analyzed. The objective of this paper is to demonstrate through a clinical case report, the use of immediate implant after extraction of a tooth endodontically perforated, followed by immediate provisionalization, using the crown of the extracted tooth as provisional element representing the 6-month follow-up report.

Análise clínica, tomográfica e histológica comparativa entre (Boneceramic) isolado ou associado a proteínas derivadas do esmalte utilizadas como enxertos após a elevação da membrana do seio maxilar e colocação de implantes: estudo piloto / Clinical, tomographic, and histological analysis comparing (Boneceramic) alone or associated with enamel matrix derived proteins in sinus lifting procedures and dental implant placement: a pilot study

O objetivo deste estudo foi a avaliação clínica, tomográfica e histológica do uso do HA+β-TCP (Boneceramic) isolado ou associado a proteínas derivadas da matriz do esmalte (EMD) nos procedimentos de elevação da membrana do seio maxilar em humanos. Foram selecionados dois pacientes com rebordo ósseo residual entre 3 mm e 5 mm de altura (avaliados através de tomografia de feixe cônico) e que necessitavam de enxertos ósseos para viabilizar a instalação de implantes. Nesses pacientes, seis meses após as cirurgias de enxerto HA+β-TCP isolado ou associado com matriz do esmalte, foram instalados oito implantes (dois implantes em cada sítio enxertado). Neste momento, procedeu-se a coleta de uma biópsia óssea (utilizando-se uma trefina). A avaliação tomográfica mostrou ganho de material mineralizado em altura nas regiões previamente enxertadas, até uma média de 10,0 mm. A análise histológica demonstrou, para ambos os casos, tecido ósseo neoformado predominantemente lamelar, com densidade óssea e interconectividade das trabéculas ósseas neoformadas semelhantes entre os grupos estudados. Dentro do limite deste estudo pôde-se concluir que tanto o HA+β-TCP isolado como a sua associação ao EMD são capazes de promover ganho em altura óssea quando utilizados em procedimentos de enxertia para aumento ósseo no assoalho do seio maxilar em humanos, apresentando características clínicas, tomográficas e histológicas semelhantes

The aim of this study was to evaluate the clinical, tomographic, and histological similarity within the use of HA+β-TCP (Boneceramic) alone or associated with enamel matrix derived (EMD) proteins in sinus lifting procedures with subsequent dental implant placement. We selected two patients with residual bony ridges between 3 mm and 5 mm in height in need of bone grafts. Six months later, eight implants were installed (two implants at each site). Biopsies were made, and the tissue was processed and stained with HE solution. Tomographic evaluation showed bone height gain up to 10.0 mm on average. Histology showed new bone formation for both groups, with similar bone density and trabecular interconnectivity. It can be concluded that the HA+β-TCP graft isolated or associated to EMD provided bone height gain in sinus lifting procedures, with similar clinical, tomographic and histological characteristics.