Reparação alveolar pós-exodôntica em indivíduos com insuficiência renal crônica submetidos à hemodiálise

Abstract

Andrade NS. Post-extraction socket healing in subjects with chronic renal failure undergoing hemodialysis [thesis]. São Paulo: Universidade de São Paulo, Faculdade de Odontologia; 2018. Versão Original. Chronic kidney disease is the metabolic disorder resulting from progressive and irreversible decline of the renal function. The final stage of this disease is known as chronic kidney failure (CKF) that demands the start of renal replacement therapy, usually hemodialysis (HD). The clinical management of people with CKF can represent a challenge for dentists, especially when performing invasive dental procedures. Despite the lack of studies and clinical or scientific evidences that investigate the risk of post-extraction complications in people with CKF, several authors still recommend that dentists prescribe the use of prophylactic antibiotics to these individuals. Thus, our study aimed to assess clinically and radiographically the process of post-extraction socket healing in individuals with CKF submitted to HD, comparing to a control group without CKF, without the prescription of the prophylactic antibiotic. It was a prospective observational study that included 48 individuals with CKF in HD to compose the study group (SG) and 29 control subjects without CKF to form the control group (CG). The same dentist applied the questionnaire on medical history of the patient, conducted the clinical odontological exam and requested laboratory tests (hemogram, coagulogram, urea, creatinine, total calcium, alkaline phosphatase and parathyroid hormone). All participants were submitted to exodontia of erupted teeth, always by the same dental surgeons, without the use of prophylactic antibiotics, during the period from October 2016 to December 2018. Postoperative assessments were conducted 3, 7, 21 and 60 days after the extractions. On the SG, teeth extractions were performed in 65 distinct surgical times, totaling 87 extractions. On the CG, 76 extractions were performed in 36 surgical times. In SG there was a significant delay in surgical wound epithelization, which is observed 21 days after exodontia (29.9% versus 3.9%, p <0.001) and 2 hemorrhagic complications. We did not observe complications of infectious origins in any case for any group. The delay in alveolar epithelization on SG was significantly associated with a lower neutrophil count and wider HD time (p <0.05). Presence of bone spicules, 21 days after exodontia, was associated with lower values of serum calcium (p <0.05). In the radiographic evaluation of SG subjects, we observed a decreased bone density measured by the intensity of pixels and a lower complexity of the bone structure at the fractal dimension 60 days after exodontia, when compared to CG (p <0.001). We concluded that alveolar repair after extractions in individuals with CKF undergoing HD is similar to controls, with only a delay in the epithelization of the surgical wound that did not impact on the final repair of the alveolus. We can expect in some cases the occurrence of hemorrhagic events in individ...