It is essential to maintain the alveolar bone ridge to ensure the success of implant therapy. Platelet-rich fibrin (PRF) may benefit bone repair, but its quantitative microscopic results are still inconclusive. The aim of this study was to histomorphometrically analyze human dental alveoli after extraction treated with autologous fibrin, biphasic calcium phosphate or sticky bone. The sample consisted of healthy adult volunteer patients, with clinical and tomographic indication for single post-extraction graft of upper premolars for maintenance of the alveolar ridge and subsequent implantation. The 10 remaining patients in the study were divided into three groups according to the type of filling used in the dental socket: autologous PRF plug covered by a PRF membrane (G1), PRF associated with an alloplastic graft based on hydroxyapatite with beta tricalcium phosphate covered by a collagen membrane (G2) or alloplastic graft based on beta tricalcium phosphate covered by collagen membrane (control). After 8 months, bone biopsies were performed at the grafted sites and the patients underwent implant-prosthetic rehabilitation. Paraffin-embedded tissue blocks were routinely processed and sectionsfrom different depths were mounted in 3 slides and stained with HE. The histomorphometric evaluation analyzed 30 photomicrographs per block, quantifying the percentage presence of newly formed bone, connective tissue and remaining biomaterial using the ImageJ software. Parametric data enabled intergroup comparisons using ANOVA and Tukey’s post-hoc test for multiple comparison with statistical significance of 5% (p<0.05), with normality of the 3 groups by the Jarque-Bera test (p>0.05). There was a higher mean of newly formed bone in G1 (68.83%) compared to G2 (35.69%) and control (16.28%). There was greater presence of connective tissue in the control (61.56%). Remaining biomaterial was higher in G2 (15.75%), but did not differ statistically from the control. Bone regeneration obtained with PRF alone or sticky bone suggests the efficacy of these therapies, encouraging the clinical use of this blood concentrate in dental procedures.
Indicadores cienciométricos são úteis para dimensionar a produtividade acadêmica e seu impacto temporo-espacial. O objetivo deste estudo foi realizar um levantamento retrospectivo sobre pesquisas odontológicas brasileiras com biomateriais para regeneração óssea guiada. Resumos temáticos originais foram recuperados nos anais da SBPqO das últimas quatro décadas, perfazendo uma amostra de 1310 trabalhos, distribuídos nas categorias de aplicação, origem e composição do biomaterial, tipo de estudo, regionalidade e financiamento. A quantidade de pesquisas cresceu significativamente a partir da década de 1990 e se manteve estável até a década de 2010. Foi evidente a prevalência de pesquisa in vivo sobre clínica, estrutural e in vitro e a diminuição de outras formas de aplicação alternada com o incremento de enxerto ósseo, membrana e hemoderivado. A origem autógena foi a maior na década de 1980, xenógena nas décadas de 1990 e 2000 e aloplástica na década de 2010. Embora compósitos fossem mais prevalentes ao longo de todo o período estudado, a partir da década de 1990 polímeros foram mais frequentes do que cerâmicas e biovidros. A região Sudeste liderou pesquisas e fomentos ao longo de todas as décadas analisadas, apesar das regiões Sul, Nordeste e Centro-Oeste crescerem significativamente na temática e a região Norte não exibir produção. O estudo do escopo de biomateriais para a regeneração óssea guiada indica sua gradativa evolução técnico-científica e reforça sua relevância histórica para a pesquisa odontológica brasileira.
Clinical use of platelet-rich fibrin (PRF) have incresead in dental procedures and represents a promising alternative in the regeneration of soft and hard tissues, whether associated with biomaterials or alone. PRF presentation forms in membrane, plug or sticky bone are discussed. Versatility, biological security of autologous material, simplicity, cost-effectiveness and maleability are attractive factors to the multivariate use of PRF in-office. However, more randomized clinical trials protocol standardization are required to obtain reproducible results. The choice of most indicated therapeutic modality of PRF applied to alveolar ridge preservation should be made based on evidence to ensure a good clinical results in-office and patient satisfaction.
The main requirement for the insertion of dental implants is a good bone and gum condition and guided bone regeneration (GBR) combines grafts and membranes to increase such parameters in tissue deficiencies and thus achieve treatment success. This clinical case reports the oral rehabilitation of the anterosuperior area by the association of bone graft, autologous membrane and implantodontic therapy. Female patient, 45 years old, normosystemic, reported aesthetic complaint and implant mobility in the maxilla. Upon clinical and radiographic examination, an implant was diagnosed in the region of tooth 11 with unfavorable esthetics, mobility, inadequate prosthesis and bone loss, and tooth 22 with suppuration, fracture line and periapical radiolucency. The treatment consisted of removal of the implant and tooth 22, with immediate GBR using filling with Bio-Oss® and liquid leukocyte- and platelet-rich fibrin (L-PRF) and coating with L-PRF membrane. After 7 months, the second GBR was performed with the installation of 2 dental implants. After 6 months, healers were placed and 20 days after the adaptation of the provisional implant-supported single prostheses. There was a good gain in thickness and mucogingival limit, bone dimensions in height and thickness, and the case continues to be followed up until the final prosthesis is completed. This case suggests that sticky bone and L-PRF membrane can contribute to multiple GBR in the anterior maxillary region, favoring bone gain and osseointegration.
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