Orientadores: Paulo Henrique Ferreira Caria, Felippe Bevilacqua Prado / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T17:30:42Z (GMT). No. of bitstreams: 1 Freire_AlexandreRodrigues_D.pdf: 4165235 bytes, checksum: 39a64cbf8afdf28035d38f8c66914ac2 (MD5) Previous issue date: 2015 / Resumo: Os fenômenos mecanobiológicos envolvem as características mecânicas do tecido, a nível microscópico, relacionadas às mudanças de metabolismo, apresentando mudanças estruturais e fisiológicas. Os estímulos mecânicos na estrutura óssea implicam na presença de tensões e deformações que resultam alterações na remodelação óssea. Nos tecidos dentoalveolares, especialmente no periodonto de suporte, são conhecidas as alterações estruturais resultantes da perda do equilíbrio da oclusão, especialmente no trauma oclusal. Para entender como ocorrem tais alterações mecânicas e respostas biológicas específicas nestes locais, estudos recentes propõem a aplicação da teoria do mecanostato associada à simulação computacional por análise de elementos finitos. Foram apresentados dois estudos para demonstrar as alterações nos estímulos mecânicos computacionalmente e relacionar com as respostas biológicas que alteraram estruturalmente o osso alveolar de suporte na região dos molares. No primeiro estudo foram utilizados animais que se submeteram à cirurgia de extração do segundo e terceiros molares inferiores, unilateralmente, permanecendo o primeiro molar em oclusal isoladamente, o qual ficou sujeito a um trauma oclusal. A oclusão no primeiro molar foi simulada por análise de elementos finitos e os resultados foram comparados com resultados em análise histológica. O estudo conclui que as regiões com aumento de compressão mecânica devido ao dente estar isolado foram compatíveis com áreas de reabsorção observadas histologicamente. O segundo estudo apresentou um modelo experimental de trauma oclusal em animais com a cimentação de resina sobre a superfície oclusal dos molares superiores, unilateralmente. A mordida posterior foi simulada em análise de elementos finitos para observar os estímulos mecânicos no osso alveolar de suporte tanto no primeiro molar superior quanto no inferior do lado com o trauma. Em comparação foi realizada microtomografia computadorizada para avaliar os efeitos biológicos resultando em alteração estrutura, na qual o volume da crista óssea alveolar foi mensurado. O estudo conclui que aumento da compressão observada computacionalmente, possibilita entender a causa da redução de volume óssea na região de interesse, sendo essa redução maior no molar superior, ou seja, com a presença do material cimentado / Abstract: The mechanobiology phenomena involve the mechanical characteristics of tissue in microscopic level, which is related to changes of metabolism and presenting structural and physiological alterations. The mechanical stimuli in bone structure imply in stresses and strain in the tissue which results in changes in bone remodeling. In dentoalveolar tissues, mainly in the supportive periodontium, the structural changes resulted by the loss of occlusal equilibrium are known. To understand how these mechanical changes occurs and its consequent biological responses, recent studies proposed the application of mechanostat theory associated to computational simulation by finite element analysis. Two studies were presented to demonstrate by computational method the changes in mechanical stimuli and relate to biological responses that resulted in structural changes in the alveolar bone support in molar region. In the first study, animals were submitted to extraction of second and third lower molars, unilaterally, and the first lower molar was kept, which was subject to occlusal stress. The molar occlusion was simulated by finite element analysis and the results were compared with histological analysis. The study concluded that the regions with increase of mechanical compression in isolated molar were compatible with resorption areas in histological observation. The second study presented an experimental model of occlusal stress in animals, where a resin block was cemented on the occlusal surface of upper molars, unilaterally. The posterior occlusion was simulated by finite element analysis to observe the mechanical stimuli both first upper and lower molars, in the same side of occlusal stress. In comparison, the micro-CT was performed to evaluate the biological effect resulting in structural changes, in which the alveolar bone crest volume was measured. The study conclude that the increase of compression, observed in computational analysis, gives the possibility to understand the cause of bone volume reduction in the region of interest, being this reduction was major in the upper molar support tissue, i.e. with the presence of cemented material / Doutorado / Anatomia / Doutor em Biologia Buco-Dental

A erupção dentária depende de uma coordenada interação entre o germe dentário e o tecido ósseo da cripta que o envolve. Para que seja formada a via eruptiva, a reabsorção da porção oclusal da cripta óssea por osteoclastos é indispensável. Os bisfosfonatos são drogas com reconhecida capacidade de inibir a atividade clástica e foram empregados no presente estudo a fim de interferir no tecido ósseo da cripta alveolar durante a formação e erupção de molares de ratos. Doses diárias dos bisfosfonatos alendronato ou etidronato de 2,5 e 8 mg/kg, respectivamente, foram administradas a ratos recém nascidos. Os controles foram injetados com solução salina. Nos períodos de 4, 8, 14, 21 e 28 dias, as maxilas foram fixadas em 2,5% de formaldeído + 2% de glutaraldeído, 4% de formaldeído + 0,1% de glutaraldeído ou fixador Zamboni, descalcificadas em EDTA a 4,13% e processadas para análise em microscopias de luz, eletrônica de transmissão e confocal, histoquímica TRAP, imunocitoquímica para OPN, BSP, RANK, RANKL e OPG. Alguns espécimes não foram descalcificados para análise em microscopia eletrônica de varredura, ou congelados em nitrogênio líquido para extração e análise e da expressão de proteínas por Western Blotting. O etidronato ocasionou alterações no metabolismo ósseo da cripta que resultaram no atraso da erupção e da formação radicular em relação ao controle. O alendronato aumentou o número de osteoclastos no osso alveolar, porém a maioria apresentou estado latente, o que diminuiu a reabsorção óssea da cripta ao redor do germe dentário e impediu a erupção dos molares e a formação radicular. A expressão de RANKL, molécula ativadora dos osteoclastos, durante o início do processo eruptivo, diminuiu em comparação ao controle. Com a diminuição da remodelação óssea, o tecido apresentou distribuição de OPN e BSP típica de osso primário. Os resultados demonstram que a reabsorção óssea é importante em todos os pontos da cripta e não apenas em sua porção oclusal durante a formação da via eruptiva, para que a formação e erupção dentária ocorram adequadamente. / Tooth eruption depends on coordinated interactions between the tooth germ and the surrounding bony crypt. The formation of the eruptive pathway requires the resorption of the occlusal portion of the bony crypt by osteoclasts. The bisphosphonates are drugs with known capability to inhibit clastic activity, and were employed in the present study with the aim of interfering in the alveolar bony crypt during the formation and eruption of rat molars. Daily alendronate or etidronate 2.5 and 8 mg/kg doses, respectively, were administered to newborn rats. The controls were injected with saline solution. At 4, 8, 14, 21 and 28 days, the maxillae were fixed in 2.5% formaldehyde + 2% glutaraldehyde, 4% formaldehyde + 0,1% glutaraldehyde or Zambonis fixative, decalcified in 4.13% EDTA and processed for light, confocal and transmission electron microscopy analyzes, TRAP histochemistry, and immunocytochemistry for OPN, BSP, RANK, RANKL and OPG. Some specimens were left undecalcified for scanning electron microscopy analyzes, or frozen in liquid nitrogen for protein extraction and Western Blotting protein expression analyzes. Etidronate occasioned alterations in the alveolar bony crypt metabolism that resulted in the delay of tooth eruption. Alendronate increased osteoclast number in the alveolar bone; however, most of them were latent, which decreased the resorption of the bony crypt surrounding the tooth germ and impeded the eruption and root formation of the molars. The expression of RANKL, an osteoclast-activating molecule, was decreased. The inhibition of the bone remodeling resulted in typical primary bone OPN and BSP labeling pattern. These results demonstrate that bone resorption at the entire surface of the crypt, and not only during the eruptive pathway formation, is crucial for adequate tooth eruption and formation.

A Ciclosporina A (CsA) é o medicamento de escolha utilizado no controle da rejeição de órgãos em pacientes transplantados. Efeitos adversos associados ao fármaco, como alterações ósseas e o aumento gengival são fatores de risco para a doença periodontal. O objetivo do estudo foi avaliar o efeito da indução de doença periodontal no tecido ósseo, tecido epitelial e tecido conjuntivo de ratos previamente tratados com a CsA. Foram utilizados quarenta ratos Wistar, com 12 semanas de vida, divididos em quatro grupos (n=10): grupo Controle (GC); grupo Ciclosporina A (GCsA), administração de 10mg/kg de CsA durante sessenta dias a partir do início do experimento; grupo Ciclosporina A Ligadura (GCsAL), inserção da ligadura após trinta dias do início do experimento e administração de 10mg/Kg de CsA desde o início do experimento, durante sessenta dias; grupo Ligadura (GL), inserção da ligadura após trinta dias do início do experimento. Os animais foram sacrificados após sessenta dias por meio de perfusão cardíaca para a realização da análise histológica e histomorfométrica do tecido gengival e tecido ósseo, análise radiográfica do suporte ósseo periodontal e da densidade radiográfica e análise bioquímica da Fosfatase Alcalina. Os resultados foram submetidos à análise de variância (ANOVA, Tukey) a 5% e ao teste não paramétrico de Kruskal- Wallis. Os valores médios para GC (60.5 2.22%) e GCsAL (58.1 2.24%) foram equivalentes entre si para o suporte ósseo periodontal e diferentes de GCsA (55.0 4.44%) e GL (54.8 3.11%) (p=0.0007). Os valores médios da densidade radiográfica não apresentaram diferença estatística significativa (p=0.1776). Em relação à fosfatase alcalina, novamente não foi observada diferença significativa entre os grupos (p=0.2806). Os valores médios de células TRAP+ por grupo experimental, não apresentaram diferença estatística significativa (p=0.3995). Os valores médios para GC (0.29 0.03mm2) e GCsA (0.30 0.02mm2) foram equivalentes entre si para a área do ligamento periodontal e diferentes de GCsAL (0.43 0.17mm2) e GL (0.41 0.11mm2) (p=0.3994). Na área total do tecido gengival, os valores médios para GCsA (0.088 0.033mm2) e GL (0.101 0.034mm2) foram equivalentes entre si e diferentes de GC (0.053 0.020mm2) e GCsAL (0.146 0.047mm2) (p=0.000001). Na proporção área do conjuntivo e área total, os valores médios para GC (28.60 8.64%) foi equivalente ao GCsA (32.72 14.13%) e diferente do GCsAL (38.50 10.98%) e GL (37.70 7.49%) (p=0.0093). Em relação à proporção área do epitélio e área total, os valores médios para GC (71.39 8.64%) foi equivalente ao GCsA (67.27 14.13%) e diferente do GCsAL (61.49 10.98%) e GL (63.37 7.44%) (p=0.0142). Na proporção área do epitélio e área do conjuntivo, os valores médios para GC (2.80 1.13) foi equivalente ao GCsA (2.18 1,32) e diferente do GCsAL (1.89 1.17) e GL (1.81 0.80) (p=0.0334). Baseados nestes resultados pode-se concluir que a exposição prévia a CsA não modificou significativamente a evolução da doença periodontal induzida em ratos. / Cyclosporine A (CsA) is the drug of choice used to prevent organ transplant rejection. Side effects associated to the drug, like bone alterations and gingival overgrowth are considered risk factors to periodontal disease. The objective of the present study was to evaluate the effect of periodontal disease on the bone tissue, epitelial tissue and connective tissue of the rats previously treated with CsA. Forty Wistar rats with 12 weeks were divided into four groups: Control Group (CG, n=10); CsA Group (CsAG, n=10), with CsA (10mg/kg) administration during 60 days since the beginning of the experiment; CsA and Ligature Group (CsALG, n=10), with ligature placement at 30 days after the beginning of the experiment with CsA administration during the whole period; and, Ligature Group (LG, n=10), with ligature placement at 30 days after the beginning of the experiment. After blood sample collection for the biochemical analysis of the Alkaline Phosphatase (PA) activity, the animals were sacrificed by intracardiac perfusion at 60 days after the beginning of the experiment. The mandibles were removed for histologic and histometric analyses of the gingival and bone tissues, and radiographic analysis of the alveolar bone support and density. The data were subjected to analysis of variance (ANOVA, Tuckey) at 5% and to the non-parametric test of Kruskal-Wallis. The mean percentage of alveolar bone support for the CG (60.5 2.22%) was similar to the CsALG (58.1 2.24%) and different to the CsAG (55.0 4.44%) and LG (54.8 3.11%) (p=0.0007). Bone density and PA activity were not statistically different among groups (p=0.1776, and p=0.2806, respectively). The mean values for TRAP+ cells were not statistically different among experimental groups (p=0.3995). The mean values of the periodontal ligament area for CG (0.29 0.03mm2) were similar to the CsAG (0.30 0.02mm2) and statistically different to the CsALG (0.43 0.17mm2) and to the LG (0.41 0.11mm2) (p=0.3994). With regards to the total area of the gingival tissue, the mean values for the CsAG (0.088 0.033mm2) and LG (0.101 0.034mm2) were similar between each other and statistically different to the CG (0.053 0.020mm2) and CsALG (0.146 0.047mm2) (p=0.000001). Regarding the proportion of connective tissue area to the total area, the mean value of the CG (28.60 8.64%) was similar to the CsAG (32.72 14.13%) and statistically different to the CsALG (38.50 10.98%) and to the LG (37.70 7.49%) (p=0.0093). In relation to the proportion of the epithelial tissue area to the total area, the mean value for the CG (71.39 8.64%) was similar to the CsAG (67.27 14.13%) and different to the CsALG (61.49 10.98%) and LG (63.37 7.44%) (p=0.0142). In the proportion of epithelial tissue area to the connective tissue area, the mean value for the CG (2.80 1.13) was similar to the CsAG (2.18 1.32) and different to the CsALG (1.89 1.17) and LG (1.81 0.80) (p=0.0334). Based on these results it can be concluded that previous exposure to CsA did not significantly modify the development of periodontal disease induced in rats.

Contexte : La greffe osseuse alvéolaire est désormais considérée comme une étape clé du traitement chirurgical des fentes labio-palatines. La particularité de cette greffe réside dans sa géométrie particulière car l’os spongieux est alors placé entre deux surfaces corticales. Méthodes : L’objectif de cette recherche est d’abord d’obtenir, à l’aide d’une revue de la littérature, une meilleure compréhension de l’histoire de la greffe, des matériaux utilisés et des facteurs influençant son résultat. Ce travail se porte ensuite sur le développement d’un modèle permettant de simuler les résultats de la greffe en fonction de l’influence de différents paramètres, en particulier l’effet du compactage mécanique sur la greffe osseuse. Les caractéristiques de la greffe sont observées en fonction de la magnitude de la force appliquée (0 à 50 N). L’os spongieux fémoral et iliaque est utilisé. Une analyse par microscanner et des cultures de CFU-F sont effectuées. Résultats : Le micro-scanner permet une caractérisation précise de la structure du greffon en fonction de la force de compaction appliquée 0, 5, 20 et 50N. Le nombre de CFU-F (Colony Forming Units-Fibroblats) révèle que l’application d’une force de compaction a un impact positif sur la prolifération cellulaire. Conclusion : Cette recherche tend à mieux comprendre le remodelage osseux influencé par les forces de compaction dans le cas particulier de la fente alvéolaire, l'objectif ultime étant de guider le chirurgien vers un résultat optimisé. / Background and purpose: Alveolar cleft bone grafting is now widely accepted as one step of cleft surgical treatment. The peculiarity of this graft stands in its particular geometry: bone is placed in between two cortical surfaces. Methods: The objective of this research is first to get, trough literature, a better comprehension of graft history, graft materials and influencing factors of bone graft integration. Then this work aims to develop a model to simulate graft results according to the influence of different parameters, especially the effect of mechanical compaction on bone graft. Graft features are observed relying on magnitude of the applied force (0 to 50N). Cancellous human femoral and iliac bones are used. Micro-CT scanning and CFUs culture are performed. Results: Micro-CT scan gives a precise characterization of the structure of the graft depending of the applied compaction forces 0, 5, 20 and 50N. The number of CFUs (Colony Forming Units) shows a positive impact of compaction force on mesenchymal stem cells proliferation. Conclusion: This research tends to better understand the bone remodeling influenced by compaction forces in the alveolar cleft particular environment, with the ultimate objective to guide the surgical procedure.

Mucopolysaccharidosis VI (MPS VI) is a hereditary lysosomal storage disease caused by the absence of the enzyme arylsulfatase B (ARSB). Craniofacial defects are common in MPS VI patients and manifest as abnormalities of the facial bones, teeth, and temporomandibular joints. Although enzyme replacement therapy (ERT) is the treatment of choice for MPS VI, the effects on the craniofacial and dental structures are still poorly understood. In this study, we used an Arsb-deficient mouse model (Arsb m/m ) that mimics MPS VI to investigate the effects of ERT on dental and craniofacial structures and compared these results with clinical and radiological observations from three MPS VI patients. Using micro-computed tomography, we found that the craniofacial phenotype of the Arsb m/m mice was characterized by bone exostoses at the insertion points of the masseter muscles and an overall increased volume of the jaw bone. An early start of ERT (at 4 weeks of age for 20 weeks) resulted in a moderate improvement of these jaw anomalies, while a late start of ERT (at 12 weeks of age for 12 weeks) showed no effect on the craniofacial skeleton. While teeth typically developed in Arsb m/m mice, we observed a pronounced loss of tooth-bearing alveolar bone. This alveolar bone loss, which has not been described before in MPS VI, was also observed in one of the MPS VI patients. Interestingly, only an early start of ERT led to a complete normalization of the alveolar bone in Arsb m/m mice. The temporomandibular joints in Arsb m/m mice were deformed and had a porous articular surface. Histological analysis revealed a loss of physiological cartilage layering, which was also reflected in an altered proteoglycan content in the cartilage of Arsb m/m mice. These abnormalities could only be partially corrected by an early start of ERT. In conclusion, our results show that an early start of ERT in Arsb m/m mice achieves the best therapeutic effects for tooth, bone, and temporomandibular joint development. As the MPS VI mouse model in this study resembles the clinical findings in MPS VI patients, our results suggest enzyme replacement therapy should be started as early as possible.

Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt. Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV). Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition. Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

Radiographic modalities are used in addition to clinical methods to gain information about the patients. In the examination of the periodontium, which is comprised of the gingiva, alveolar bone, periodontal ligament, and cementum, the radiographic examination plays an integral role for diagnosis of periodontal disease. The diagnosis periodontitis is based on a finding of alveolar bone loss. Changes of the alveolar bone can be assessed by different radiographic modalities, such as intraoral radiography (bitewing and periapical radiography) and panoramic radiography. Analysis of alveolar bone loss (alveolar bone level, detection of vertical bone defect and furcation involvement) in radiographic modalities and a systematic review could be helpful to suggest the more applicable radiographic methods for diagnosis of periodontal disease. The purpose of the present study was to examine diagnostic properties of panoramic radiography for the assessment of alveolar bone loss for the diagnosis of periodontal diseases as compare to posterior bitewing radiography. For 96 patients panoramic and posterior bitewing radiographs were performed and results of analysis of visibility of radiographic images and assessment of alveolar bone loss were compared. Also, the systematic review on diagnostic properties of panoramic radiography in the assessment of alveolar bone loss was performed. Based on the results of this study, recommendations for clinical practice and for research were proposed. / Rentgeniniai tyrimo metodai taikomi, kad būtų papildyti klinikinio tyrimo duomenys. Tiriant periodontą, kurį sudaro dantenos, dantinė atauga, periodonto raiščiai ir cementas, rentgeninis tyrimas svarbus diagnozuojant periodonto ligas, nes jo metu nustatomi dantinės ataugos pokyčiai. Dantinės ataugos pokyčiams vertinti daromos rentgeno nuotraukos taikant vidinių burnos rentgeno nuotraukų darymo metodus, t. y. kandimo ar dantų šaknų rentgeno nuotraukų darymo metodus, ir išorinės burnos rentgeno nuotraukos darymo metodą, t. y. panoraminės rentgeno nuotraukos darymo metodą. Atlikus dantinės ataugos pokyčių (kaulo lygio arba rezorbcijos, kaulo defekto ir tarpšaknio kaulo pažeidimų) analizę, taikant rentgeninius metodus, ir padarius sisteminę literatūros apžvalgą, galima būtų pasiūlyti tinkamiausią rentgeno metodą periodonto ligoms diagnozuoti. Šio darbo tikslas – ištirti ir palyginti panoraminės rentgeno nuotraukos ir kaplių bei krūminių dantų rentgeno nuotraukų darymo metodų diagnostikos ypatybes vertinant dantinės ataugos pokyčius periodonto ligoms diagnozuoti. Kiekvienam, iš 96 pacientų įtrauktų į tyrimą, buvo padaryta panoraminė rentgeno nuotrauka ir kaplių bei krūminių dantų kandimo rentgeno nuotraukos. Atlikta dantinės ataugos rentgeno atvaizdo vizualioji kokybė analizė ir vertinimai skirtingose rentgeno nuotraukose bei palyginti rezultatai. Padaryta sisteminė literatūros apžvalga apie panoraminės rentgeno nuotraukos vertę diagnozuojant periodonto ligas. Pagal šio tyrimo... [toliau žr. visą tekstą]

Rentgeniniai tyrimo metodai taikomi, kad būtų papildyti klinikinio tyrimo duomenys. Tiriant periodontą, kurį sudaro dantenos, dantinė atauga, periodonto raiščiai ir cementas, rentgeninis tyrimas svarbus diagnozuojant periodonto ligas, nes jo metu nustatomi dantinės ataugos pokyčiai. Dantinės ataugos pokyčiams vertinti daromos rentgeno nuotraukos taikant vidinių burnos rentgeno nuotraukų darymo metodus, t. y. kandimo ar dantų šaknų rentgeno nuotraukų darymo metodus, ir išorinės burnos rentgeno nuotraukos darymo metodą, t. y. panoraminės rentgeno nuotraukos darymo metodą. Atlikus dantinės ataugos pokyčių (kaulo lygio arba rezorbcijos, kaulo defekto ir tarpšaknio kaulo pažeidimų) analizę, taikant rentgeninius metodus, ir padarius sisteminę literatūros apžvalgą, galima būtų pasiūlyti tinkamiausią rentgeno metodą periodonto ligoms diagnozuoti. Šio darbo tikslas – ištirti ir palyginti panoraminės rentgeno nuotraukos ir kaplių bei krūminių dantų rentgeno nuotraukų darymo metodų diagnostikos ypatybes vertinant dantinės ataugos pokyčius periodonto ligoms diagnozuoti. Kiekvienam, iš 96 pacientų įtrauktų į tyrimą, buvo padaryta panoraminė rentgeno nuotrauka ir kaplių bei krūminių dantų kandimo rentgeno nuotraukos. Atlikta dantinės ataugos rentgeno atvaizdo vizualioji kokybė analizė ir vertinimai skirtingose rentgeno nuotraukose bei palyginti rezultatai. Padaryta sisteminė literatūros apžvalga apie panoraminės rentgeno nuotraukos vertę diagnozuojant periodonto ligas. Pagal šio tyrimo... [toliau žr. visą tekstą] / Radiographic modalities are used in addition to clinical methods to gain information about the patients. In the examination of the periodontium, which is comprised of the gingiva, alveolar bone, periodontal ligament, and cementum, the radiographic examination plays an integral role for diagnosis of periodontal disease. The diagnosis periodontitis is based on a finding of alveolar bone loss. Changes of the alveolar bone can be assessed by different radiographic modalities, such as intraoral radiography (bitewing and periapical radiography) and panoramic radiography. Analysis of alveolar bone loss (alveolar bone level, detection of vertical bone defect and furcation involvement) in radiographic modalities and a systematic review could be helpful to suggest the more applicable radiographic methods for diagnosis of periodontal disease. The purpose of the present study was to examine diagnostic properties of panoramic radiography for the assessment of alveolar bone loss for the diagnosis of periodontal diseases as compare to posterior bitewing radiography. For 96 patients panoramic and posterior bitewing radiographs were performed and results of analysis of visibility of radiographic images and assessment of alveolar bone loss were compared. Also, the systematic review on diagnostic properties of panoramic radiography in the assessment of alveolar bone loss was performed. Based on the results of this study, recommendations for clinical practice and for research were proposed.

O objetivo deste trabalho foi de avaliar em Modelo animal, coelhos (raça Nova Zelândia) divididos em três grupos randomizados, (jovem com 60 dias (G1), um idoso com aterosclerose e ingestão de colesterol (G2) e um idoso com aterosclerose e sem ingestão do colesterol (G3)) se, a dieta rica em colesterol e a idade, causam lesões de aterosclerose e placas ateroscleróticas nos animais, alterações nos comprimentos dos dentes, aumento ou diminuição dos espaços periapicais dos dentes, perda óssea alveolar na maxila e mandíbula. Através da metodologia descrita e após as análises histológicas e morfológicas, verificou-se diferença estatisticamente significante, nas variáveis dos comprimentos dos dentes 1º prémolares superiores entre os grupos G3 versus G1 p<5%. médias de 1247,88 (p=0,017) e G3 versus G2, com diferença das médias de 1190,85 (p=0,025) ou seja o comprimento dos dentes fora diferente no grupo G2. Com relação à variável, espessura do osso alveolar, não ocorreu significância estatística, porém tendências de que este esteja sendo alterado. Com relação a variável espessura do espaço periapical fora verificado significância estatística com p=0,017 em relação ao G1, na região dos 1º Pré-molares, apresentando a diferença das médias (403,42) a favor do G2, ou seja aumento do espaço periapical. A variável da área de placa de aterosclerose, correlacionada, com os comprimentos dos dentes e espessura do osso alveolar, também teve resultado significante na região 1º e 2º pré-molares entre G2 e G3. com p=0,025 e r=0,476. Confirmando assim a correlação da aterosclerose, dietas hiperclesterolêmicas e as alterações da cavidade bucal e estrutura de sustentação dos dentes. / The aim of this study is, to evaluate on animal model (New Zealand rabbits), on different and randomized groups (G1 a young group, G2 an older rabbit, with atherosclerosis and ingesting hipercholesterolemic fat diet and another group G3, just an older group) investigated than the hipercholesterolemic fat diet induced atherosclerotic lesions and plaques in ascendant aorta, bone loss in maxillary and jaw, alterations on length of the tooth, alterations on tooth periapical spaces. By the methodology described and aplicated, before the histological and morphological analysis, was verified significant statistical variance in the length of the first premolar tooth and second premolar on maxillary region, the length of this tooth is reduced in G2 (p<5%). The medias are 1247,88 (p=0,017) and 1190,85 (p=0,025). Analyzing another variable on the alveolar bone thickness, was not found any statistical significance, but tendencies that this event may occur. According to another variable of the thickness found on the periapical space, it was verified a significant variable statistic such as p=0,017 related on G1, on first premolar region, suggesting a different statistic, between medias, favoring G2 meaning the increase of periapical space. The variable on the atherosclerosis plaque area, related to the teeth length and alveolar bone thickness, also showed significant results on first and second premolars regions between G2 and G3, with p=0,025 and r=0,476. That confirms the atherosclerosis correlations and hipercholestrolemic fat diet, also alterations in oral cavity and teeth implantation structure.

A reabsorção óssea alveolar associada as perdas dentais constitui uma condição inerente ao processo de cicatrização fisiológico natural. Técnicas como a instalação de implantes imediatos e técnicas de preservação alveolar têm sido sugeridas com o objetivo de limitar as alterações adversas sofridas pelo processo alveolar. Contudo, frequentemente as perdas dentárias estão associadas a infecções crônicas que tradicionalmente contraindicariam os procedimentos de enxerto ou implantes imediatos, a menos que meticulosos debridamento e irrigação alveolar associados a adequado protocolo antibiótico pré e pós-operatório sejam empregados. Alternativas precisam ser testadas para a substituição do uso indiscriminado de antibioticoterapia sistêmica. O objetivo do presente estudo foi avaliar o efeito da TFDa na descontaminação de alvéolos infectados previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não ao uso de enxertos xenógeno através de análises microtomográficas e histomorfométricas. Para tanto, foram selecionados 8 cães, os quais foram submetidos a uma fase de indução de doença periodontal por ligadura, seguida por um período de estabelecimento da doença. Após a exodontia dos prémolares bilaterais, aleatoriamente os alvéolos de um lado da mandíbula foram descontaminados por debridamento mecânico associado a irrigação com solução salina (grupo controle) e do outro lado por debridamento mecânico e irrigação com solução salina associados a terapia fotodinâmica antimicrobiana (grupo teste), e subsequentemente submetidos a instalação de implantes imediatos, dando origem aos grupos GT-I (Grupo Teste - Implante) e GC-I (Grupo Controle - Implante). Os demais alvéolos, foram utilizados para o estudo da dinâmica de cicatrização alveolar. Os sítios foram aleatoriamente alocados em: GT-C (Grupo teste - Coágulo), GT-BO (Grupo Teste - Bio-Oss®), GT-BOC (Grupo Teste - Bio-Oss® Collagen), GC-C (Grupo Controle - Coágulo), GC-BO (Grupo Controle - Bio-Oss®) e GC-BOC (Grupo Controle - Bio-Oss® Collagen). Após 12 semanas, os cães foram sacrificados e as amostras processadas para as análises de microtomografia computadorizada, histologia e histomorfometria. Na avaliação da cicatrização dos alvéolos pós-extração, embora os alvéolos descontaminados com TFDa (GT-C, GT-BO, GT-BOC) tenham apresentado melhores resultados numéricos, em relação a altura da crista óssea vestibular (ACOV) e a dimensão buco-lingual (DBL), não foram evidenciadas diferenças relevantes na análise histomorfométrica. Apenas a ACOV, mensurada na avaliação microtomográfica bidimensional, demonstrou-se significativamente inferior nos alvéolos do grupo teste que não receberam material de enxerto (GT-C) quando comparados aos respectivos alvéolos do grupo controle (GC-C). Na avaliação dos implantes imediatos, a análise histomorfométrica dos parâmetros: reabsorção da crista óssea vestibular (RCOV) e contato osso implante (BIC) demonstrou resultados significantemente superiores no GT-I em relação ao GC-I, e do parâmetro densidade óssea (DO) demonstrou apenas resultado numericamente superior no GT-I em relação ao GC-I. Todas as análises microtomográficas bidimensionais (RCOV) e tridimensionais (volume ósseo BV, porcentagem óssea BV/TV, densidade de superfície óssea BS/TV, espessura trabecular Tb.TH, número de trabéculas Tb.N e separação trabecular Tb.SP) demonstraram resultados significantemente melhores nos implantes do grupo teste (GT-I) em relação aos implantes do grupo controle (GC-I). A TFDa demonstrou potencial como agente de descontaminação de alvéolos pósextração periodontalmente infectados, previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não a materiais de enxerto xenógenos, sem o uso de antibioticoterapia sistêmica associada. / Alveolar bone resorption following tooth loss is an inherent condition of the natural healing process. Therefore, several techniques, such as immediate implants placement and post extraction socket preservation, have been suggested in order to limit the adverse changes suffered by the alveolar process. However, extraction sockets commonly results from the removal of teeth affected by chronic infection, which conventionally contraindicates immediate bone graft and implant placement unless meticulous wound debridement and alveolar irrigation associated to a suitable pre- and post-operatory antibiotic protocol are employed. Alternatives ought to be tested in order to substitute the indiscriminate use of systemic antibiotic therapy. The aim of the present study was to evaluate the effect of the antimicrobial photodynamic therapy (aPDT) in the decontamination of infected post extraction sockets, previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenografts. In the first phase, periodontitis was induced with ligatures in the mandibular premolars of eight beagle dogs. After 2 months, in the second phase of the study the dogs had their mandibular bicuspids bilaterally extracted, and randomly one hemi-mandible was decontaminated by mechanic debridement associated to saline solution irrigation (Control Group - CG), and the other hemi-mandible was decontaminated with mechanic debridement and saline solution irrigation associated to antimicrobial photodynamic therapy (Test Group - TG). Thereafter, 3 immediate implants in each side of the mandible were placed and the following groups were devised: TG-I (Test Group - Implant) and CG-I (Control Group - Implant). The remaining sockets were used for the study of the healing dynamic. The sockets were randomly assigned to the following groups: Test Group - Blood clot (TG-BC), Test Group Bio- Oss® (TG-BO), TG - BOC (Test Group Bio-Oss® Collagen), Control Group - Blood Clot (CG-BC), Control Group - Bio-Oss® (CG-BO) and Control Group - Bio-Oss® Collagen (CG-BOC). After 12 weeks, the dogs were sacrificed and the specimens were processed for microtomographic, histological and histomorphometric analysis. When the post extraction healing process was evaluated, the aPDT decontaminated sockets (TG-BC, TG-BO and TG-BOC) presented better numerical results in comparison to both buccal bone crest height (BCL) and in the bucco-lingual dimension (BLD). However, there were no statistically differences among the groups for these parameters in the histomorphometric analysis. Only the BCL measured in the two-dimensional microtomographic analysis showed statistic better results in the TG-BC when compared to the CG-BC. In the evaluation of the immediate implant placement the histomorphometric analysis presented statistically better results for the TG-I in the bone-implant contact (BIC), as well as in the vertical buccal bone loss (VBBL). The bone density (BD) was numerically better in the TG-I than in the CG-I. Both two-dimensional (VBBL) and three-dimensional (bone volume BV, percentage of the total bone volume - BV/TV, bone surface density - BS/TV, trabecular thickness Tb.Th, trabecular separation Tb.Sp and trabecular number TB.N) microtomographic analysis showed statistically better results in the TG-I. The aPDT showed potential in the decontamination of infected post extraction sockets previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenogeneic grafts, without the use of systemic antibiotics.