RESUMO

AIM: This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS: Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS: Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Assuntos

RESUMO

AIM: To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS: Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS: CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.

Assuntos

RESUMO

BACKGROUND: This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs). METHODS: Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1 mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes. RESULTS: CD coverage was 72.9% for CTG versus 50.7% for XDM (P < 0.001). Recession reduction was 2.3 mm for CTG versus 1.5 mm for XDM (P < 0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96 mm vs. XDM: 0.3 mm, P = 0.04) and gingival thickness (CTG: 0.9 mm vs. XDM: 0.3 mm, P < 0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min, P < 0.001) and less time to no pain (visual analog scale  =  0; CTG: 6.5 days vs. XDM: 3.5 days, P = 0.04). CONCLUSION: CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

Assuntos

RESUMO

As recessões gengivais acometem grande parte da população e ­ frequentemente ­ tratam-se de lesões combinadas onde há recessão acompanhada de lesão cervical não-cariosa. Diferentes estudos avaliaram opções de tratamentos cirúrgicorestauradores para melhor reestabelecimento estético e funcional desse tipo de condição. No entanto, estudos avaliando a longo prazo o desempenho de biomateriais para o tratamento de defeitos combinados restaurados ainda são escassos na literatura. Desta forma, o objetivo do presente estudo é avaliar longitudinalmente o desempenho da matriz colágena suína associada ao retalho posicionado coronariamente e a restauração parcial para o tratamento de defeitos combinados. Para tal, foi realizado um acompanhamento pós-operatório de 5 anos de um estudo previamente realizado. Quarenta pacientes (n=40) apresentaram-se na revocação e foram previamente tratados com: restauração parcial da lesão cervical e cirurgia para recobrimento radicular associado à matriz colágena xenógena de origem suína (CAF+MC; grupo teste; n=22) ou recobrimento radicular por meio do retalho posicionado coronariamente (CAF; grupo controle; n=18) foram avaliados. Foram realizados parâmetros clínicos, fotográficos e centrados no paciente, analisados e comparados em baseline e 1 ano após o procedimento cirúrgico-restaurador. Aos 5 anos, CAF e CAF+MC apresentaram resultados satisfatórios e sem diferença estatisticamente relevante entre si de Redução da Recessão (RedRec; 1,82 ± 0,89; 2,08 ± 1,08), Porcentagem de Recobrimento do Defeito Combinado (%CDC; 56,80 ± 23,90%; 57,25 ± 27,48%) e Recessão Gengival Relativa (RGR; 9,04 ± 0,99; 9,47 ± 1,51), sugerindo eficácia do tratamento em longo prazo. Os parâmetros ATQ e ETQ mostraram-se estáveis longitudinalmente no grupo CAF, embora os resultados de 1 ano do grupo teste tenham sido superiores, aos 5 anos não apresentaram diferença estatisticamente relevante ao grupo controle. Todos os grupos apresentaram redução significativa da hipersensibilidade dentinária (p<0,001) e melhora nas condições estéticas (p<0,001). Pode-se concluir que, em comparação a dados anteriores, o grupo que foi tratado com associação do biomaterial não mostrou benefícios adicionais quanto ao recobrimento radicular em 5 anos. (AU)

The gingival recessions affect the population majority and - very often ­ these are combined defects, associating recessions, and non-carious cervical lesions. Different studies evaluated options of surgical-restorative treatments for a better aesthetic and functional reestablishment for that type of condition. However, studies evaluating a long-term of soft tissue substitutes performance to the treatment of combined defects restored are scarce in the literature. Thus, the objective of the present study is to evaluate longitudinally the performance of a xenogeneic collagen matrix associated to coronally positioned flap and partial restoration for the treatment of combined defects. To this end, a 5-year postoperative follow-up of a previously conducted study was carried out. Forty patients (n=40) presented for recall and were previously treated with: partially restoration of the non-carious cervical lesion and root coverage procedure by coronally advanced flap associated with collagen matrix (CAF+MC; test group; n=22) or partial restoration of the cervical lesion and root coverage through the coronally advanced flap alone (CAF; control group; n=18) were evaluated. Clinical, photographic, and patient-centered parameters were analyzed and compared at baseline and 1 year after the surgical-restorative procedure. At 5 years, CAF, and CAF+MC showed satisfactory results, with no statistically significant difference between them in Gingival Recession Reduction (RedRec; 1.82 ± 0.89; 2.08 ± 1.08), CD Coverage (%CDC; 56.80 ± 23.90; 57.25 ± 27.48) and Relative Gingival Recession (RGR; 9.04 ± 0.99; 9.47 ± 1.51), suggesting long-term treatment efficiency. The ATQ and ETQ parameters were shown to be longitudinally stable in the CAF group, although the 1-year results of the test group were superior, at 5 years there was no statistically significant difference in relation to the control group. All groups showed a significant reduction in dentin hypersensitivity (p<0.001) and improvement in esthetic conditions (p<0.001). It can be concluded that, compared to previous data, the group that was treated with the biomaterial association did not show additional benefits in terms of root coverage in 5 years. (AU)

Assuntos

RESUMO

ABSTRACT Introduction: The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). Methods: Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. Results: Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P=0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P=0.351, respectively). Postoperative respiratory impairment was more common in the PRC group (P=0.012); however, nerve injuries (P=0.254), surgical wound hematomas (P=0.605), surgical site infections (P=0.679), and mortality (P=0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P=0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P=0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P=0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P=0.580) were not significantly different between the PRC and PAC groups. Conclusion: We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

RESUMO

Introduction: Due to the extensive number of studies developed on periodontal pathologies and the clinical need generated to correct bonvze defects, we have carried out an Overview of systematic reviews using the FRISBEE methodology. Material and Methods: Through this study we expect to bridge the knowledge gap generated regarding the clinical question on the effectiveness of autologous bone substitutes and xenografts in maxillary and mandibular bone defects. Results: For this study, we carried out a systematic search in Epistemonikos and PubMed, we included 3 systematic reviews and 5 primary studies included in these reviews to extract their data. We analyzed data using RevMan 5.4. and GRADEpro. Assessed outcomes included: bone gain [MD 0.06 mm lower (0.26 lower to 0.14 higher)] and bone resorption [MD 0.03 mm higher (0.12 lower to 0.18 higher)], where no significant differences were found between the study groups. The certainty of the evidence was moderate for both outcomes. Bone length and bone density outcomes were not measured or reported in the included studies. Conclusion: We concluded that there are no significant clinical differences between the application of autologous bone grafts and xenografts for bone defects correction for the assessed outcomes, therefore, these biomaterials should be applied at the discretion of the clinician and according to the needs and preferences of patients.

Introducción: Debido al extenso número de estudios desarrollados sobre patologías periodontales y a la necesidad clínica generada para corregir defectos óseos, hemos realizado un Overview de revisiones sistemáticas tipo FRISBEE para acortar la brecha de conocimiento generada respecto a la pregunta clínica sobre la efectividad de sustitutos óseos tipo autólogo y xenoinjertos en defectos óseos a nivel maxilar y mandibular. Material y Métodos: Para este estudio realizamos una búsqueda sistemática en Epistemonikos y PubMed, de los cuales incluimos 3 revisiones sistemáticas y 5 estudios primarios incluidos en estas revisiones para extraer sus datos. Los datos fueron analizados a través de RevMan 5.4. Y GRADEpro. Resultados: Los estudios analizaron los desenlaces propuestos: ganancia ósea posterior a la aplicación del injerto óseo [MD 0.06 mm menos (0.26 menos a 0.14 más)] y reabsorción ósea posterior a la aplicación del injerto óseo [MD 0.03 mm más (0.12 menos a 0.18 más)], donde no se encontraron diferencias significativas entre los grupos de estudio. La certeza de la evidencia fue moderada para ambos desenlaces. Los desenlaces longitud ósea y densidad ósea no fueron medidos o reportados en los estudios incluidos. Conclusión: Se concluyó que no hay diferencias que sean clínicamente significativas entre la aplicación de injertos óseos autólogos y xenoinjertos para la corrección de defectos óseos para los desenlaces analizados, por lo que, la aplicación de estos biomateriales queda a criterio del clínico, y de acuerdo a las necesidades y preferencias de los pacientes.

Assuntos

RESUMO

AIM: To compare the efficacy of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone block (ABB) for lateral alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: Sixty-four patients with tooth gaps up to four teeth and atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. Lateral bone thickness (LBT) was measured 2 mm below the alveolar crest at augmentation surgery and 30 weeks later at implant placement. Implant-related outcomes, adverse events, surgery duration, pain sensation, analgesic consumption, and oral health-related quality of life were also assessed. Data were analysed using Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS: At 30 weeks, the median change in LBT amounted to 2.90 (CXBB) and 3.00 (ABB), respectively. Secondary endpoints demonstrated similar results for CXBB and ABB in terms of possibility to place an implant, need to perform a secondary bone augmentation at implant placement and rate of complications. Early implant failure was 20% for CXBB and 10% for ABB, with no difference between the groups. Pain scores and post-operative consumption of analgesics were significantly lower in the CXBB group than in the ABB group, especially during the first days post-surgery. CONCLUSIONS: CXBB is non-inferior to ABB for horizontal alveolar ridge augmentation and two-stage implant placement.

Assuntos

RESUMO

OBJECTIVES: There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS: Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS: Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION: CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE: CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.

Assuntos

RESUMO

INTRODUCTION: The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). METHODS: Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. RESULTS: Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P=0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P=0.351, respectively). Postoperative respiratory impairment was more common in the PRC group (P=0.012); however, nerve injuries (P=0.254), surgical wound hematomas (P=0.605), surgical site infections (P=0.679), and mortality (P=0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P=0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P=0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P=0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P=0.580) were not significantly different between the PRC and PAC groups. CONCLUSION: We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

Assuntos

RESUMO

Introdução: O uso de pericárdio bovino teve início em 1972 nas cirurgias cardiovasculares. A partir da evolução da engenharia de tecidos com os cuidados na preparação do material, minimizando os riscos de rejeição e facilitando a utilização para diversos tipos de cirurgias, o pericárdio bovino tornou-se ferramenta importante em procedimentos cirúrgicos reconstrutivos. Objetivos: Nessa casuística, o presente estudo propõe avaliar o atual cenário da utilização do pericárdio bovino em procedimentos cirúrgicos de diversas especialidades e os resultados pósoperatórios encontrados. Métodos: Assim, foi realizada uma revisão sistemática da literatura e a base de dados consultada foi a MEDLINE, utilizando a palavra-chave "bovine pericardium", elencando estudos publicados nos últimos cinco anos em inglês e português, e que não utilizavam outro tipo de "patch". Resultados: Foram selecionados 14 artigos que totalizam 507 pacientes, submetidos a cirurgias em diversas áreas, tais quais, cardiologia, neurologia, vascular, pediatria, urologia e oftalmologia. Conclusão: Depreende-se que o uso de pericárdio bovino como remendo cirúrgico é seguro, tendo em vista que existem poucos casos de rejeição do hospedeiro, além de fácil e rápido de ser manuseado, possuindo benefícios frente a próteses mecânicas. Faz-se relevante, portanto, ampliar o número de estudos sobre o tema, visando o grande potencial que esse tipo de material possui para a medicina regenerativa.

Introduction: The use of bovine pericardium started in 1972 in cardiovascular surgeries. From the evolution of tissue engineering with care in the preparation of the material, minimizing the risk of rejection and facilitating the use for various types of surgeries, the bovine pericardium has become an important tool in reconstructive surgical procedures. Purpose: In this series, the present study proposes to evaluate the current scenario of the use of bovine pericardium in surgical procedures of different specialties, and the postoperative results found. Methods: Thus, a systematic literature review was carried out and the database consulted was MEDLINE, using the keywords "bovine pericardium", listing studies published in the last five years in English and Portuguese and that did not use another type of patch. Results: 14 articles were selected, totaling 507 patients, who underwent surgery in several areas, such as cardiology, neurology, vascular, pediatrics, urology, and ophthalmology. Conclusion: It appears that the use of bovine pericardium as a surgical patch is safe, given that there are few cases of host rejection, in addition to being easy and quick to handle, with benefits compared to mechanical prostheses. It is relevant, therefore, to expand the number of studies on the subject, aiming at the great potential that this type of material has for regenerative medicine.

Assuntos