published_or_final_version / abstract / Dentistry / Master / Master of Dental Surgery

PURPOSE: The aim of this study is to examine the healing of intact extraction sockets grafted with leukocyte-platelet rich fibrin (L-PRF) as compared to sockets grafted with freeze-dried bone allograft (FDBA) and a resorbable collagen barrier membrane (RCM). METHODS: This prospective randomized, examiner blinded pilot study included 17 subjects randomized to two treatment groups. Serum total cholesterol, low density lipoprotein (LDL), 25-hydroxyvitamin-D3, and platelet counts were determined preoperatively in all subjects. The experimental arm consisted of 8 posterior tooth-bounded intact extraction sites receiving L-PRF plugs. The control group consisted of 9 posterior tooth-bounded intact extraction sites receiving FDBA and RCM. An acrylic stent was fabricated to take duplicate clinical and CBCT measurements immediately post-extraction and at time of implant placement. A repeat-measures analysis of variance was utilized for statistical analysis. RESULTS: The study failed to detect a clinical or radiographic difference between treatment groups in horizontal or vertical ridge dimension changes. Serum cholesterol, LDL, 25-hydroxyvitamin-D3, and buccal plate thickness had a non-significant effect on outcome measurements, although there was a high prevalence of hyperlidpidemia and hypovitaminosis in the study population. CONCLUSIONS: The alveolar ridge dimension changes in intact posterior extraction sockets may be similar when either L-PRF or FDBA and RCM are utilized as socket grafting material. Although there was a high prevalence of high cholesterol and low 25-hydroxyvitamin-D3 levels in the population, this study failed to detect a significant correlation between preoperative serum levels and postoperative ridge dimension changes.

Entwicklung eines dreidimensionalen Fibringelmodells zur In-Vitro-Analyse von Fibrose und Angiogenese Alginat-mikroverkapselter Langerhans-Inseln / Immunoprotection of the pancreatic islets by encapsulation with alginate can potentially provide their transplantation without immunosuppression. The fundamental obstacle to large-scale clinical transplantation of encapsulated islets is limited graft survival. Critical for adequate long-term function of the graft is the absence of fibrotic overgrowth and sufficient supplementation with oxygen and nutrients. The aim of this study was to develop a model to investigate molecular and cellular mechanisms of fibrosis and vascularization of alginate-encapsulated islets. A 3D fibrin-gel model was developed to assess the mitogenic and angiogenic activity of encapsulated islet cells and encapsulation material per se. The 3D fibrin-gel matrix, containing filled or empty capsules, was seeded with fibroblasts and endothelial cells. Their migration and prolifiration were evaluated by phase-contrast microscopy and histology. Viability (FDA/PI) and function (insulin-ELISA) of encapsulated islets were assessed at different time-points. Inflammatory and angiogenic cytokines were tested with ELISA. Embedded into the 3D fibrin-gel, encapsulated islet cells preserved their viability and function to day +14 in culture. Encapsulated islet cells influenced migration, proliferation and cytokine production of fibroblasts when these were seeded into the 3D fibrin gel: fibroblasts migrated directly to encapsulated islets and grew firmly around the capsules, migration to empty capsules was much slower and overgrowth less prominent. TNFa production increased significantly after 10 days incubation of encapsulated islets with fibroblasts, but not with empty fibroblasts. Co-culture of encapsulated islets with endothelial cells induced the formation of vascular-like tubular structures around the capsules . This model was useful to test the mitogenic and angiogenic properties of the encapsulation material (purified versus non-purified alginates). Adhesion of endothelial cells to collagen-layered capsules was much more prominent than to non-layered capsules; endothelial cells strongly proliferated, forming a monolayer on the capsule surface. Moreover, they migrated into the fibrin-gel-matrix, forming new tube-like structures. These processes were accelerated by VEGF. The 3D fibrin-gel model is very useful for studying the mechanisms of fibrosis and vascularization of encapsulated islets in vitro. In vivo conditions can be imitated, and factors involved in these processes can be analyzed separately.

Tem sido proposto que a Fibrina Rica em Plaquetas e Leucócitos (L-PRF) pode estimular a neoformação óssea e melhorar a incorporação de enxertos ósseos. Este estudo avaliou a cicatrização de defeitos de tamanho crítico (DTCs) criados em calvária de ratas com osteoporose induzida por ovariectomia e tratados com L-PRF associada ou não a enxerto ósseo bovino (XENO). 32 ratas foram divididas em 4 grupos (n=8): C, PRF, XENO e PRF-XENO. Todos os animais foram submetidos a um procedimento de ovariectomia bilateral no início do estudo. Após 3 meses, DTCs de 5 mm de diâmetro foram criados na calvária dos animais. No grupo C, o defeito foi preenchido apenas com coágulo sanguíneo. Nos grupos PRF e XENO, os defeitos foram preenchido com 0,02 mL de L-PRF e 0,02 mL de XENO, respectivamente. No grupo PRF-XENO o defeito foi preenchido com uma mistura de 0,02 mL de PRF e 0,02 mL de XENO. Todos os animais foram submetidos à eutanásia aos 30 dias pós-operatórios. Foram realizadas análises histomorfométrica, microtomográfica e imunohistoquímica. Os dados obtidos foram estatisticamente analisados (ANOVA, Tukey, p < 0,05). O Grupo PRF-XENO apresentou maior quantidade de osso neoformado (ON) quando comparado ao Grupo XENO, bem como maiores expressões de Fator de Crescimento Endotelial Vascular (VEGF), Osteocalcina (OCN) e Proteína Morfogenética Óssea (BMP)-2/4 (p < 0,05). O Grupo PRF apresentou maior quantidade de ON e maiores expressões de VEGF, OCN, BMP-2/4 e Fator de transcrição relacionado a Runt 2 (RUNX-2) quando comparado ao Grupo C (p < 0,05). Conclui-se que a L-PRF pode favorecer a neoformação óssea de DTCs e potencializar a cicatrização de XENO em ratas com osteoporose induzida por ovariectomia. / It has been proposed that Platelet Rich Fibrin and Leukocyte (L-PRF) can stimulate bone neoformation and improve bone graft incorporation. This study evaluated the healing of critical caliber defects (CSDs) created in the calvaria of rats with osteoporosis induced by ovariectomy and treated with L-PRF associated or not with bovine bone graft (XENO). 32 rats were divided into 4 groups (n = 8): C, PRF, XENO and PRF-XENO. All animals underwent a bilateral ovariectomy procedure at the start of the study. After 3 months, CDSs of 5 mm diameter were created in calvaria of the animals. In group C, the defect was filled only with blood clot. In the PRF and XENO groups, the defects were filled with 0.02 mL of L-PRF and 0.02 mL of XENO, respectively. In the PRF-XENO group the defect was filled with a mixture of 0.02 mL of PRF and 0.02 mL of XENO. All animals were submitted to euthanasia at 30 postoperative days. Histomorphometric, microtomographic and immunohistochemical analyzes were performed. The data were statistically analyzed (ANOVA, Tukey, p < 0.05). The PRF-XENO group presented higher amount of neoformed bone (NB) when compared to the XENO group, as well as higher expression of Vascular Endothelial Growth Factor (VEGF), Osteocalcin (OCN) and Bone Morphogenetic Protein (BMP -2/4 (p < 0.05). The PRF group presented higher amounts of NB and higher expression of VEGF, OCN, BMP-2/4 and Runt-related transcription factor 2 (RUNX-2) when compared to the group C (p <0.05). It can be concluded that L-PRF can improve bone neoformation in CSDs and potentiates the healing of XENO in rats with osteoporosis induced by ovariectomy.

Tem sido proposto que a Fibrina Rica em Plaquetas e Leucócitos (L-PRF) pode estimular a neoformação óssea e melhorar a incorporação de enxertos ósseos. Este estudo avaliou a cicatrização de defeitos de tamanho crítico (DTCs) criados em calvária de ratas com osteoporose induzida por ovariectomia e tratados com L-PRF associada ou não a enxerto ósseo bovino (XENO). 32 ratas foram divididas em 4 grupos (n=8): C, PRF, XENO e PRF-XENO. Todos os animais foram submetidos a um procedimento de ovariectomia bilateral no início do estudo. Após 3 meses, DTCs de 5 mm de diâmetro foram criados na calvária dos animais. No grupo C, o defeito foi preenchido apenas com coágulo sanguíneo. Nos grupos PRF e XENO, os defeitos foram preenchido com 0,02 mL de L-PRF e 0,02 mL de XENO, respectivamente. No grupo PRF-XENO o defeito foi preenchido com uma mistura de 0,02 mL de PRF e 0,02 mL de XENO. Todos os animais foram submetidos à eutanásia aos 30 dias pós-operatórios. Foram realizadas análises histomorfométrica, microtomográfica e imunohistoquímica. Os dados obtidos foram estatisticamente analisados (ANOVA, Tukey, p < 0,05). O Grupo PRF-XENO apresentou maior quantidade de osso neoformado (ON) quando comparado ao Grupo XENO, bem como maiores expressões de Fator de Crescimento Endotelial Vascular (VEGF), Osteocalcina (OCN) e Proteína Morfogenética Óssea (BMP)-2/4 (p < 0,05). O Grupo PRF apresentou maior quantidade de ON e maiores expressões de VEGF, OCN, BMP-2/4 e Fator de transcrição relacionado a Runt 2 (RUNX-2) quando comparado ao Grupo C (p < 0,05). Conclui-se que a L-PRF pode favorecer a neoformação óssea de DTCs e potencializar a cicatrização de XENO em ratas com osteoporose induzida por ovariectomia. / It has been proposed that Platelet Rich Fibrin and Leukocyte (L-PRF) can stimulate bone neoformation and improve bone graft incorporation. This study evaluated the healing of critical caliber defects (CSDs) created in the calvaria of rats with osteoporosis induced by ovariectomy and treated with L-PRF associated or not with bovine bone graft (XENO). 32 rats were divided into 4 groups (n = 8): C, PRF, XENO and PRF-XENO. All animals underwent a bilateral ovariectomy procedure at the start of the study. After 3 months, CDSs of 5 mm diameter were created in calvaria of the animals. In group C, the defect was filled only with blood clot. In the PRF and XENO groups, the defects were filled with 0.02 mL of L-PRF and 0.02 mL of XENO, respectively. In the PRF-XENO group the defect was filled with a mixture of 0.02 mL of PRF and 0.02 mL of XENO. All animals were submitted to euthanasia at 30 postoperative days. Histomorphometric, microtomographic and immunohistochemical analyzes were performed. The data were statistically analyzed (ANOVA, Tukey, p < 0.05). The PRF-XENO group presented higher amount of neoformed bone (NB) when compared to the XENO group, as well as higher expression of Vascular Endothelial Growth Factor (VEGF), Osteocalcin (OCN) and Bone Morphogenetic Protein (BMP -2/4 (p < 0.05). The PRF group presented higher amounts of NB and higher expression of VEGF, OCN, BMP-2/4 and Runt-related transcription factor 2 (RUNX-2) when compared to the group C (p <0.05). It can be concluded that L-PRF can improve bone neoformation in CSDs and potentiates the healing of XENO in rats with osteoporosis induced by ovariectomy.

Cell therapy, including human mesenchymal stem cell (hMSC) therapy, has the potential to treat different pathologies, including myocardial infarctions (heart attacks). Biological sutures composed of fibrin have been shown to effectively deliver hMSCs to infarcted hearts. However, hMSCs rapidly degrade fibrin making cell seeding and delivery time sensitive. To delay the degradation process, we propose using aprotinin, a proteolytic enzyme inhibitor that has been shown to slow fibrinolysis. This project investigated the effects of aprotinin on hMSCs and suture integrity. Viability of hMSCs incubated with aprotinin, examined using a LIVE/DEAD stain, was similar to controls. No differences in proliferation, as determined by Ki-67 presence, and were observed. hMSCs incubated in aprotinin differentiated into adipocytes, osteocytes, and chondrocytes, confirming multipotency. CyQuant assays were used to determine the number of cells adhered to fibrin sutures. The number of adhered cells was increased through aprotinin supplementation at Days 2, 3, and 5 time points. To examine the effect of aprotinin on suture integrity, sutures were loaded to failure to determine ultimate tensile strength (UTS) and modulus (E). Sutures exposed to aprotinin had higher UTS and E when compared to sutures exposed to standard growth media. Degradation of fibrin was quantified using an ELISA to quantify fibrin degradation products (FDP) and by measuring suture diameter. Fibrin sutures incubated in aprotinin had larger diameters and less FDP compared to the controls, confirming decreased fibrinolysis. These data suggest that aprotinin can reduce degradation of biological sutures, providing a novel method for extending the implantation window and increasing the number of cells delivered for hMSC seeded biological sutures.

Bioprinting, defined as depositing cells, extracellular matrices and other biologically relevant materials in user-defined patterns to build tissue constructs de novo or to build upon pre-fabricated scaffolds, is among one of the most promising techniques in tissue engineering. Among the various technologies used for Bioprinting, pressure driven systems are most conducive to preserving cell viability. Herein, we explore the abilities of a novel bioprinter - Digilab, Inc.'s prototype cell printer. The prototype cell printer (Digilab Inc., Holliston, MA) is an automated liquid handling device capable of delivering cell suspension in user-defined patterns onto standard cell culture substrates or custom-designed scaffolds. In this work, the feasibility of using the cell printer to deliver cell suspensions to biological sutures was explored. Cell therapy using stem cells of various types shows promise to aid healing and regeneration in various ailments, including heart failure. Recent evidence suggests that delivering bone-marrow derived mesenchymal stem cells to the infarcted heart reduces infarct size and improves ventricular performance. Current cell delivery systems, however, have critical limitations such as inefficient cell retention, poor survival, and lack of targeted localization. Our laboratories have developed a method to produce discrete fibrin microthreads that can be bundled to form a suture and attached to a needle. These sutures can then be seeded with bone-marrow derived mesenchymal stem cells to deliver these cells to a precise location within the heart wall, both in terms of depth and surface localization. The efficiency of the process of seeding cells onto fibrin thread bundles (sutures) has previously been shown to be 11.8 ± 3.9 %, suggesting that 88% of the cells in suspension are not used. Considering that the proposed cell-therapy model for treatment of myocardial infarction contemplates use of autologous bone-marrow derived stem cells, an improvement in the efficiency of seeding cells onto the fibrin sutures is highly desirable. The feasibility of using Digilab's prototype cell printer to deliver concentrated cell suspension containing human mesenchymal stem cells (hMSCs) directly onto a fibrin thread bundle was explored in this work, in order to determine if this technology could be adapted to seed cells onto such biological sutures. First the effect of the printing process on the viability of hMSCs was assessed by comparing to cells dispensed manually using a hand-held pipette. The viability of hMSCs 24 hours post-dispensing using the cell printer was found to be 90.9 ± 4.0 % and by manual pipetting was 90.6 ± 8.2 % (p = ns). Thereafter a special bioreactor assembly composed of sterilizable Delrin plastic and stainless steel pins was designed to mount fibrin thread bundles onto the deck of the cell printer, to deliver a suspension containing hMSCs on the bundles. Highly targeted delivery of cell suspension directly onto fibrin thread bundles (average diameter 310 µm) was achieved with the bundle suspended in mid-air horizontally parallel to the printer's deck mounted on the bioreactor assembly. To compare seeding efficiency, fibrin thread bundles were simultaneously seeded with hMSCs using either the cell printer or the current method (tube-rotator method) and incubated for 24 hours. Seeded thread bundles were visualized using confocal microscopy and the number of cells per unit length of the bundle was determined for each group. The average seeding efficiency with the tube rotator method was 7.0 ± 0.03 % while the cell printer was 3.46 ± 2.24% (p = ns). In conclusion, the cell printer was found to handle cells as gently as manual pipetting, preserve their viability, with the added abilities to dispense cells in user-defined patterns in an automated manner. With further development, such as localized temperature, gas and humidity control on the cell printer's deck to aid cell survival, the seeding efficiency is likely to improve. The feasibility of using this automated liquid handling technology to deliver cells to biological scaffolds in specified patterns to develop vehicles for cell therapy was shown in this study. Seeding other cell types on other scaffolds along with selectively loading them with growth factors or multiple cell types can also be considered. In sum, the cell printer shows considerable potential to develop novel vehicles for cell therapy. It empowers researchers with a supervision-free, gentle, patterned cell dispensing technique while preserving cell viability and a sterile environment. Looking forward, de novo biofabrication of tissue replicates on a small scale using the cell printer to dispense cells, extracellular matrices, and growth factors in different combinations is a very realistic possibility.

Orientador: Tetuo Okamoto / Resumo: Este estudo avaluoi-se o proceso de reparo de feridas de extração dental após irrigação com solução a 5% de ácido epsilon-amino-capróico (EACA) e implante de adesivo fibrínico (Tissucol). Foram utilizados 60 ratos (Wistar), machos, com peso entre 250 gramas e 300 gramas e divididos em 03 grupos com 20 animais cada, onde foram realizados os seguintes procedimentos: No grupo 1 foi administrado 0,1 ml/100mg de peso corporal de solução salina a 0,9%, iniciando-se 06 dias antes da exodontia, administração diária de 0,03ml de varfarina sódica sendo mantida durante todo o experimento. Após a exodontia do incisivo superior direito, seus alvêolos foram preenchido com adesivo fibrinico, No grupo III, os animais desse grupo receberam os mesmos procedimentos dos animais do grupo IIe, após a exodontia, tiveram seus alvêolos irrigados com 5ml de solução a 5% de ácido epsilon-amino-capróico e também preenchidos com adesivos fibrinico (Tissucol)...(Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Este trabalho tem por objetivo comparar a eficácia da cola biológica de fibrina e da drenagem de aspiração pós-operatória na prevenção de complicações cirúrgicas como hematoma e seroma após a realização de ritidoplastia pela equipe da Clínica Rezende no Hospital Moinhos de Vento, na cidade de Porto Alegre/RS. Realizou-se estudo prospectivo, controlado, randomizado e duplo cego. Foram analisadas 72 pacientes, divididas em dois grupos de 36, sendo que no grupo dreno utilizou-se drenagem de aspiração e no grupo cola utilizou-se cola de fibrina. Quarenta e oito horas após a realização dos procedimentos, todas as pacientes foram submetidas a aferição ecográfica da lâmina de exsudato presente sob os retalhos cutâneos da face. O volume total médio foi de 3,21 mL no grupo dreno e 1,02 mL no grupo cola, com magnitude de efeito de 68,1% e intervalo de confiança de 55,3 a 77,2 e p <0,001. Com esses resultados, comprovou-se que a cola apresenta eficácia significativa, demonstrando que sua utilização é 68,1 % mais efetiva que a drenagem de aspiração na prevenção de hematomas ou seromas em ritidoplastia. / This study aimed to compare the efficacy of fibrin glue and suction drainage in preventing postoperative complications such as hematoma and seroma following rhytidoplasties conducted by the staff of Clínica Rezende at Hospital Moinhos de Vento in Porto Alegre, Brazil. A prospective, controlled, randomized, double-blind trial was conducted. The 72 patients assessed in the study were divided into two groups of 36 each, one treated with suction drainage and other with fibrin glue. Forty-eight hours after the procedures, all patients underwent ultrasound evaluation of the volume of exudate under facial skin flaps. The average volume of exudate was 3.21 mL in the drainage group and 1.02 mL in the fibrin glue group, with a size effect of 68.1%, 95% confidence interval of 55.3 to 77.2, and p <0.001. The results of this investigation significant favor the use of fibrin glue, showing that was 68.1 % more effective than suction drainage in preventing hematoma or seroma following rhytidoplasty.

Knochendefekte, die in der Behandlung von gutartigen Knochentumoren und tumorähnlichen Läsionen entstehen, stellen ein klinisches Problem mit limitierten Therapieoptionen dar. In der Regel werden diese Defekte mit autologem Knochen aufgefüllt. Die Gewinnung von autologem Knochen, z. B. vom Beckenkamm ist jedoch quantitativ limitiert und häufig mit Komplikationen verbunden. Aus diesem Grund wird versucht, synthetische Knochenersatzmaterialien mit ähnlichen Eigenschaften, wie denen des autologen Knochens, zu entwickeln. In der vorliegenden prospektiven Studie wurde die Anwendung einer biphasischen Keramik aus 60% Hydroxylapatit und 40% beta-Tricalciumphosphat in Verbindung mit verdünntem Fibrinkleber für die Therapie von gutartigen Knochentumoren und tumorähnlichen Läsionen bei 51 Patienten untersucht. Hierfür wurden die Röntgenbilder analysiert und das Resorptionsverhalten beurteilt. Eine komplette Resorption wurde anhand der radiologischen Verläufe in keinem Fall beobachtet. Die günstigsten Voraussetzungen für eine Resorption wurde bei kleinen Defekten (< 10,5 cm³) beobachtet (p < 0,05). Die übrigen Einflussgrößen zeigten nach einer Nachuntersuchungszeit von bis zu 56 Monaten keine statistisch signifikanten Unterschiede. In der histologischen Untersuchung eines Präparates bei einer Revision wurde Knochenneubildung auf dem Knochenersatzmaterial nachgewiesen. In diesem Fall war das Knochenersatzmaterial noch nachweisbar. Die Verwendung des Materials ist klinisch einfach und sicher. Die aufgetrete-nen Komplikationen entsprechen in ihrer Häufigkeit den zu erwartenden postoperativen Komplikationen und sind mit den Angaben der Literatur vergleichbar. Es wurden keine postoperativen Frakturen oder Beeinträchtigung des Längenwachstums von Röhrenknochen beobachtet. In einem Fall musste aufgrund eines intraossären Ganglions eine operative Revision erfolgen. In der histologischen Aufarbeitung dieser Biopsie konnte Knochenneubildung und Osseointegration sowie eine partielle Resorption des Knochenersatzmaterials nachgewiesen werden. Die Verwendung des Knochenersatzmaterials wird von den Patienten überwiegend als positiv beurteilt. Zusammenfassend ist das verwendete Knochenersatzmaterial eine einfach und sicher anzuwendende Alternative zu autologem Knochen in der Therapie von gutartigen Knochentumoren und tumorähnlichen Läsionen. / Bone defects resulting from tumor resection represent a challenge facing limited therapeutic options. Most commonly, defects are reconstructed with autologous bone graft which is associated with limited availability and donor site morbidity. Therefore, recent research has focused on synthetic biomaterials as bone graft substitutes. In the present study, a biphasic ceramic consisting of 60% hydroxyapatite and 40% beta-tricalciumphosphate combined with a fibrin sealant was used to reconstruct defects in 51 patients after resection of benign bone tumors or tumor-like lesions. Radiologic analysis showed complete bony defect consolidation in 50 out of 51 patients after up to 56 months. No postoperative fractures were observed. Revision surgery had to be performed in one case. Histological analysis showed new bone formation and good biocompatibility and osseointegration of the implanted material. Subjective patient satisfaction after application of bone substitute was predominantly positive. In summary, the biphasic ceramic in combination with fibrin sealant was proven an effective, safe and easy to handle alternative to autologous bone graft eliminating the risk of donor site morbidity for the patient.