AIM/PURPOSE: To investigate the correlation between the histopathology of periapical lesion of endodontic origin and the radiographic findings of the maxillary sinus observed by cone-beam computed tomography (CBCT). MATERIAL AND METHODS: Retrospective record review study, data collected of patients received surgical root canal treatment at Boston University school of dental medicine. Total of 39 periapical lesions all had CBCT scans and pathology reports. Each periapical lesion was biopsied and examined by oral & maxillofacial pathologist. CBCT scans for each lesion were examined by two examiners: endodontic resident and board-certified endodontic faculty. RESULTS: 65% of the lesions associated with changes in the maxillary sinus and 35% had no changes as seen on the CBCT scans. 82% of the lesions were granulomas 15.5% were cysts and 2.5% OKC. Out of the 65% (26 lesions) maxillary sinus changes were 50% (13) were periapical mucositis (PAM) & 50% (13) were periapical osteoperiostitis (PAO). CONCLUSION: Histopathology of the periapical lesion didn’t have an effect on the type of changes observed in the sinus. And the closer the lesion was to the sinus the more chances of developing changes in the sinus.

Objectives: With increasing utilization of cone beam computed tomography for diagnosis and treatment planning of complex dentomaxillofacial rehabilitation, more incidental findings of pathology in the maxillary sinus have been identified by clinicians. Part one of this article discusses the association between age, gender, ethnicity and dentition status in relation to prevalence of sinus pathology. The aim of this study is to expand the current knowledge base in regards to the prevalence of maxillary sinus pathologies in patients of Temple University Kornberg School of Dentistry and to determine if smoking and allergies have relationship with the prevalence of pathology. Materials and Methods: : Three hundred and sixty-three cone beam computed tomography scans taken were evaluated at Temple University Kornberg School of Dentistry Department of Oral and Maxillofacial Radiology between 2009 to July 31, 2013. Scans were classified into 1 of 5 categories based upon the type of sinus pathology detected. The categories of sinus findings were: healthy, mucosal thickening > 3-4 mm, polypoidal mucosal thickening, partial opacification and complete opacification. Medical health questionnaires were reviewed for patient's social history such as smoking and systemic factors such as allergies. Chi-square statistical analysis using SAS was done to examine the relationship. Results: This study included a total of 363 subjects subdivided by gender into 203 females and 160 males. The subjects were further subdivided by ethnicity into 217 Caucasians, 86 African Americans, 35 Asians, and 25 Hispanics. Also, 129 of the subjects had a history of smoking, 98 had seasonal allergies, and 50 had environmental allergies. In addition 129 of the subjects had at least 1 type of sinus pathology. Chi-square analyses showed that there was no relationship between the prevalence of sinus pathology and allergy or smoking status. History of allergies was marginally higher in females and significantly higher in African Americans (p=0.007). History of smoking was higher in older subjects (p=0.0004), males (p=0.01) and Caucasians (p<0.0001). Conclusions: This CBCT cross sectional study shows that there is no statistically significant correlation between prevalence of sinus pathology and smoking or allergy status. Further cohort studies are needed to determine if smoking or allergies may or may not contribute to sinus pathology. / Oral Biology

Para oferecer mais informações aos cirurgiões no planejamento de intervenções cirúrgicas maxilofaciais, o presente estudo teve como objetivo avaliar a presença, localização e tamanho dos canais alveolares superiores (CAS), anterior (CASA) e posterior (CASP), canal infra-orbital (CI) e forame infra-orbital (FI) em imagens de tomografia computadorizada de feixe cônico (TCFC) de 100 pacientes adultos (&#x2265; 20 anos), obtidas pelo aparelho i-CAT Classic®. Um examinador calibrado observou a presença dos CAS, CI e FI bilateralmente. Quando presentes, eram medidos comprimento (parte descendente, parte do assoalho da órbita e total), largura e altura do CI; altura, largura e distância ao rebordo inferior da órbita (RIO) do FI; distância da borda inferior dos CAS a crista do rebordo alveolar em 5 regiões: canino (CAN), primeiro pré-molar (1PM), segundo pré-molar (2PM), primeiro molar (1M) e segundo molar (2M); e os diâmetros dos CAS. Foram também observados a localização dos CAS em relação ao seio maxilar e a presença de reparos anatômicos como canal duplo/múltiplo, anastomose intra-óssea e extensão do CASA para a abertura piriforme. Associações entre homens e mulheres, lados direito e esquerdo e regiões foram investigadas para todas as medidas e visibilidade, utilizando separadamente os métodos estatísticos. A presença do CI e FI foi de 100%. A visibilidade do CASA/CASP foi de: 99%/0% (CAN), 99%/21% (1PM), 89%/41% (2PM), 46%/44% (1M) e 7%/61% (2M). As médias dos comprimentos da parte descendente, da parte do assoalho da órbita e total do CI foram de 8,82mm, 19,44mm e 28,35mm, respectivamente. Altura e largura médias do CI foram, respectivamente, 2,08mm e 3,91mm. As médias da altura, largura e distância ao RIO do FI foram: 4,43mm, 5,18mm e 7,52mm, respectivamente. As distâncias médias do CASA ao rebordo alveolar foram: 18,54mm (CAN), 25,47mm (1PM), 28,43mm (2PM), 30,78mm (1M) e 33,21mm (2M); e do CASP: 22,3mm (1PM), 17,65mm (2PM), 15,34mm (1M) e 16,87mm (2M). As médias dos diâmetros do CASA e do CASP foram 0,90mm e 0,83mm, respectivamente, sendo que 77,5% dos CASA e 82% dos CASP eram &#x2264; 1mm e 22,5% dos CASA e 18% dos CASP eram entre 1-2 mm. Em relação ao seio maxilar, 53% e 44% dos CASA foram encontrados no terço superior e médio, respectivamente, e 64% e 36% dos CASP foram encontrados no terço inferior e médio, respectivamente. Houve diferença estatisticamente significativa (p<0,05) entre homens e mulheres para o comprimento, altura e largura do CI; para a altura, largura e distância ao RIO do FI; e para as distâncias dos CAS ao rebordo alveolar. CASA duplo, anastomose intra-óssea e extensão do CASA para a abertura piriforme foram detectados em 24,5%, 38,5% e 84% dos casos, respectivamente. A localização da anastomose foi teve maior ocorrência entre o CAN e 1PM (43%). Os resultados sugerem que a TCFC seja uma ferramenta adequada para examinar os CAS, CI e FI no planejamento de procedimentos cirúrgicos do terço médio da face, a fim de evitar danos a estruturas neurovasculares importantes. / To provide more information to clinicians in planning maxillofacial surgical interventions, the present study evaluated the presence, location and size of the superior alveolar canals (SAC), anterior (ASAC) and posterior (PSAC), infraorbital canal (IC) and infra-orbital foramen (IF) in cone beam computed tomography (CBCT) of 100 adult patients (&#x2265; 20 years old), obtained by i-CAT Classic®. One calibrated examiner observed SAC, IC and IF presence, bilaterally. When present, were measured: length (descending part, orbital floor part and total), width and height of the IC, height, width and distance from the IF to the inferior orbital rim (IOR), distance from the lower border of SAC to the alveolar crest in 5 regions: canine (CAN), first premolar (1PM), second premolar (2PM), first molar (1M) and second molar (2M); and the diameters of SAC. It was also observed the location of SAC in relation to the maxillary sinus floor and the presence of anatomical landmarks such as doble/multiple canal, intraosseous anastomosis and ASAC extension to the piriform aperture. Associations between men and women, right and left sides and regions were investigated for all measurements and presence using statistical methods separately. The presence of the IC and IF was 100%. The presence of ASAC/PSAC was: 99%/0% (CAN), 99%/21% (1PM), 89%/41% (2PM), 46%/44% (1M) e 7%/61% (2M). The mean lengths of the IC descending part, IC orbital floor part and total lenght of the IC were 8.82mm, 19.44mm and 28.35mm, respectively. The mean height and width of the IC were, respectively, 2.08mm and 3.91mm. The mean height, width and distance to the IOR of IF were: 4.43mm, 5.18mm and 7.52mm, respectively. The mean distances of ASAC to the alveolar crest were: 18.54mm (CAN), 25.47mm (1PM), 28.43mm (2PM), 30.78mm (1M) and 33.21mm (2M); and of PSAC: 22.3mm (1PM), 17.65mm (2PM) 15.34mm (1M) and 16.87mm (2M). The mean diameters of ASAC and PSAC were 0.90mm and 0.83mm, respectively, and that, 77.5% of ASAC and 82% of PSAC were &#x2264; 1mm and 22.5% of ASAC and 18% of PSAC were between 1-2 mm. In relation to the maxillary sinus, 53% e 44% of the ASAC were found in the upper and middle third of maxillary sinuses, respectively, and 64% and 36% of the PSAC were found in lower and middle third, respectively. There was a statistically significant difference (p<0.05) between men and women for the length, height and width of the IC, for the height, width and distance to the IOR of IF, and for distances of SAC to the alveolar crest. Double ASAC, intraosseous anastomosis and ASAC extension to the piriform aperture were present in: 24.5%, 38.5% and 84% of the cases, respectively. The location of the anastomosis had more incidence between the CAN and 1PM (43%). The results suggest that CBCT is a suitable tool to evaluate the SAC, IC and IF, assisting surgeons in planning surgical procedures of the midface, in order to avoid damage to important neurovascular structures.

Orientador: Eduardo Hochuli-Vieira / Banca: Idelmo Rangel Garcia Júnior / Banca: Leonardo Perez Faverani / Banca: Nicolas Homsi / Banca: Joel Ferreira Santiago Junior / Resumo: A deficiência óssea vertical do seio maxilar impossibilita a instalação de implantes dentais necessários para a reabilitação protética contudo, técnicas cirúrgicas para a elevação da membrana sinusal e o uso dos biomateriais para enxertia óssea permitiram alterar esta condição. O ósseo autógeno é considerado o mais previsível e o padrão ouro para tal finalidade porém, biomateriais como o vidro bioativo, amplamente utilizado na odontologia, permitem substituí-lo. O objetivo deste estudo foi avaliar formação óssea, o comportamento celular e a taxa de reabsorção do vidro bioativo em 2 proporções: puro (grupo 1); adicionado ao osso autógeno 1:1 (grupo 2), comparando com o osso autógeno (grupo 3) em seios maxilares de humanos. Com 15 dias de operados os pacientes realizaram um tomografia computadorizada (TC) cone beam para determinar o volume inicial do enxerto (T1). Após 6 meses uma nova TC foi realizada determinando o volume ósseo final (T2) e também, a coleta das biópsias com a instalação simultânea de implantes dentais. As amostras foram divididas em 3 áreas: leito, intermediária e apical onde foram avaliadas a histomorfometria e imunomarcações para Runx2, VEGF, osteocalcina e TRAP. No grupo 1 os resultados foram de 42.6%, 44.5% e 48% de formação óssea no leito, intermediária e apical respectivamente. No grupo 2 as taxas encontradas foram de 36.6% no leito, 33.2% na intermediária e 45.8% na apical. No grupo 3 foi de 34.4% para o leito, 35.0 na intermediária e 42.0% na apical. (p>0.05) Os 3 grupos apresentaram-se com comportamento semelhante nas imunomarcações realizadas mostrando estar maturado e calcificado o suficiente para receber implantes dentais. As taxas de reabsorção também mostraram-se semelhantes com 44.2% para o grupo 1, 37.9% para o grupo 2 e 45.7% no grupo 3. (p>0.05) Assim, podemos concluir que o vidro bioativo possui resultados equiparados ao osso autógeno / Abstract: Vertical bone deficit due maxillary sinus pneumatization forbid the dental implants placement required for prosthetic rehabilitation however, surgical techniques to elevate maxillary sinus membrane and studies about biomaterials, allows repair these situation. Autogenous bone graft is considered the most predictable and the gold standard for this nevertheless, biomaterials as bioactive glass, has been widely used in dental surgery and allows substitute it. The aim of this study was evaluate the bone formation, the cellular behavior and the resorption rates of bioactive glass in 2 proportions: pure (group 1); add to autogenous bone graft (group 3), comparing then with autogenous bone graft in human maxillary sinus. Post-operative cone beam computed tomography (CT) was used to measure the initial graft volume after 15 days (T1). Six months later, another CT was performed to evaluate the final graft volume (T2) and determine the graft resorption rate and the harvest of biopsies with dental implants placement simultaneously. The samples were divided in 3 areas: bed, intermediately and apical which were evaluated to histomorphometric and immunostaining to Runx2, VEGF, osteocalcin and TRAP. In group 1 the bone formation were 42.6%, 44.5 and 48.0% for bed, intermediately and apical respectively. In group 2 the rates were 36.6% in bed, 33.2% in intermediately and 45.8% in apical. In group 3 were 34.4% in bed, 35.0% in intermediately and 42.0% in apical. (p>0.05) the 3 groups had the same behavior for the 4 proteins showing be matured and calcified to receive dental implants. The resorption rates were similar for the 3 groups with 44.2% % for group 1, 37.9% for group 2 and 45.7% for group 3. (p>0.05) In conclusion, the bioactive glass is a good substitute to autogenous bone graft in both proportions evaluated / Doutor

O aloenxerto ósseo desmineralizado irradiado (ALD) e o aloenxerto ósseo congelado mineralizado (ACM) são alternativas ao osso autógeno para o aumento do rebordo ósseo alveolar. Individualmente, já foram testados quanto a eficiência, de certa forma, comparável aos autógenos e suas vantagens sobre eles. Entretanto, não há estudos padronizados comparando o desempenho clínico entre esses dois tipos de aloenxertos, quando utilizados em região de maxila atrófica para instalação e implantes. O objetivo deste estudo foi realizar um ensaio clínico randomizado controlado que envolve a elevação bilateral do seio maxilar empregando o osso alógeno liofilizado desmineralizado irradiado (ALD) ou o osso alógeno congelado mineralizado (ACM) e verificar comparativamente os desfechos clínicos para estabilidade de implantes, quantidade e qualidade de neoformação óssea. Dez pacientes foram submetidos a cirurgia de elevação do seio maxilar bilateral na qual foi utilizado um dos tipos de aloenxerto, de forma randômica em um dos lados. Seis a nove meses após o aumento do rebordo ósseo, no momento da instalação de implantes osseointegrados, foram obtidas amostras ósseas por meio de trefina de 2x10mm para análises microtomográficas e histológicas. A estabilidade dos implantes foi aferida por frequência de ressonância em dois momentos, imediato e após 6 meses da instalação dos implantes. Os resultados mostraram aumento do rebordo, radiograficamente detectável em todos os pacientes e grupos. Os implantes osseointegrados, inseridos em enxertos ACM, apresentaram melhor estabilidade primária, embora o acréscimo de estabilidade tenha sido mais significativo no ALD. As análises microtomográficas e histológicas revelaram mais formação óssea de melhor qualidade nos ALD do que nos ACM. Não houve resposta a corpo estranho para nenhum dos tipos de aloenxertos. Notou-se mais quantidade de material remanescente para ACM do que para ALD. Concluímos que os aloenxertos liofilizados desmineralizados irradiados (ALD) apresentaram melhor desempenho quanto aos parâmetros estudados. / Demineralized bone irradiated allograft (DFDBA) and fresh- frozen (FF) are alternative grafts to autogenous bone in alveolar ridge augmentation. Individually, these allografts have been tested for their efficiency, in a way comparable to autogenous, and so their advantages over autogenous grafts. However, there are no standardized clinical studies comparing the clinical and histological performance between these two allografts in atrophic maxilla bone augmentation for implants instalment. The aim of this study was to perform a randomized controlled clinical trial involving bilateral sinus floor elevation employing demineralized freeze-dried irradiated allograft (DFDBA) or fresh-frozen (FF) and to compare clinical and histological outcomes for stability of implants, quantity and quality of bone formation. Ten patients underwent bilateral maxillary sinus lifting surgery in which side was randomly used one of those allografts for alveolar ridge augmentation. Six to nine months after grafting, at the time of dental implants instalment, trephine 2x10mm bone core biopsies were obtained to micro computed tomographic and histological analyses. The stability of the implants was measured by resonance frequency in two stages, immediately and 6 months after implants installation. Results showed that there was an increase, radiographically detectable, in all patients and groups. The dental implants inserted in FF grafts showed better primary stability but implant stability, lately, increased significantly in DFDBA. Micro tomographic and histological analyses revealed that bone formation amount and quality was superior in DFDBA than in FF. There was no foreign body response for any of the allografts. There was a greater amount of persisting graft-materialin FF than in DFDBA. We conclude that demineralized freeze-dried irradiated allograft (DFDBA) presented a superior performance than mineralized FF.

Submitted by JOÃO PAULO BONARDI null (joao_bonardi@hotmail.com) on 2017-03-06T16:15:16Z No. of bitstreams: 1 Dissertação João Paulo corrigido.pdf: 3605304 bytes, checksum: d85c867eef7490b5298db3147e3a1be1 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-03-09T20:16:15Z (GMT) No. of bitstreams: 1 bonardi_jp_me_araca.pdf: 3605304 bytes, checksum: d85c867eef7490b5298db3147e3a1be1 (MD5) / Made available in DSpace on 2017-03-09T20:16:15Z (GMT). No. of bitstreams: 1 bonardi_jp_me_araca.pdf: 3605304 bytes, checksum: d85c867eef7490b5298db3147e3a1be1 (MD5) Previous issue date: 2017-02-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivos: Comparar através de análise hitométrica e imunoistoquimica o comportamento do ChronOs® (β-TCP) e do Bio-Oss® (Osso bovino inorgânico ) puros e misturados ao osso autógeno na proporção 1:1 em seios maxilares de humanos. Metodologia: 30 pacientes foram convidados para participar deste trabalho, resultando em 30 seios enxertados com osso autógeno puro (grupo A (controle)), ChronOs® puro (grupo C), ChronOs® em adição de osso autógeno na proporção 1:1(grupo CA), Bio-Oss® puro (grupo B) e Bio-Oss® em adição de osso autógeno na proporção de 1:1 (grupo BA), onde foram realizadas biopsias 6 meses após a realização desses enxertos e analisadas através de histometria (analisadas através do software ImageJ) e imunoistoquimica (RUNX2, VEGF e Osteocalcina). Os resultados foram tabulados, o teste de Shapiro-Wilk foi aplicado para avaliação da normalidade, em seguida foram aplicado os testes Kruskal-Wallis e Anova 1 fator para os dados paramétricos e não paramétricos sucetivamente e o teste de Tukey como pós teste. Resultados: Para neoformação óssea o grupo A foi maior que os grupos B e BA e o grupo CA foi maior que o grupo BA (p<0,05). Para os remanescentes de biomateriais o grupo BA apresentou um número maior que os grupos Chronos C, CA e A (p<0,05). Para tecido mole o grupo C foi maior que o grupo B (p<0,05). O resultado das imunomarcações mostrou marcação fraca para RUNX 2 nos grupos A, C, B e BA e marcação moderada para o grupo CA. Marcação intensa para VEGF nos grupos B e CA, moderada nos grupos A e C e fraca no grupo BA. Para a Osteocalcina houve uma marcação intensa em todos os grupos. Conclusão: Conclui-se que o Chronos puro ou misturado apresentam comportamento mais próximo ao osso autógeno em termos de quantidade de tecido ósseo neoformado e remanescentes de biomateriais que o Bio Oss puro ou associado ao osso autógeno. / Objectives: To compare the performance of ChronOs® (β-TCP) and Bio-Oss® (Inorganic bovine bone) pure and mixed with autogenous bone in a 1: 1 ratio in maxillary sinuses of humans through histometric and immunohistochemical analysis. Metodology: 30 patients were invited to participate of this study, resulting in 30 grafted sinuses with pure autogenous bone (group A (control)), pure ChronOs® (group C), ChronOs® in addition 1: 1 autogenous bone (group CA), pure Bio-Oss®(group B) and Bio-Oss® in addition1: 1 (group BA), which biopsies were performed 6 months after the grafting and analyzed by histology (analyzed using ImageJ software) and immunohistochemistry (RUNX2, VEGF and Osteocalcin). The results were tabulated, the Shapiro-Wilk test was applied to evaluate the normality, then the Kruskal-Wallis and Anova 1 tests were applied for the parametric and non-parametric data and Tukey test as post test was applied. Results: The group A was higher than B and BA groups, and the group CA was higher than the BA group (P <0.05). For the remainder of biomaterials, BA group presented a higher number than Chronos C, CA and A groups (P <0.05). For soft tissue, group C was greater than group B (P <0.05). The immunolabeling results showed poor labeling for RUNX 2 in groups A, C, B and BA and moderate labeling for CA group. Intense labeling for VEGF in B and CA groups, moderate in groups A and C and weak in BA group. For Osteocalcin, there was an intense marking in all groups. Conclusion: It was concluded that pure or mixed Chronos present behavior closer to the autogenous bone in terms of amount of neoformed bone tissue and biomaterial remnants than the pure or mixed Bio Oss.

Orientador: Idelmo Rangel Garcia Júnior / Resumo: O complexo zigomático maxilar é a segunda área da face mais atingida por injúrias, superada apenas pelos ossos nasais. É elemento essencial na configuração da face, uma vez que é a principal estrutura formadora do terço médio facial. É importante na biomecânica, está situado entre o víscero e o neurocrânio, desempenha papel fundamental na absorção e escoamento das forças de mastigação através dos pilares de reforço e sustentação. Nesse contesto encontra-se o seio maxilar cujas funções destacamse: diminuição do peso do crânio; auxiliar a ressonância da voz, a produção e a armazenagem do muco, a umidificação do ar inspirado, a manutenção do aquecimento da fossa nasal, servir como acessório do olfato, definir o contorno facial, entre outras. Avaliamos, através de radiografias PA de Waters, 40 pacientes, sendo 20 pacientes traumatizados nessa região, que foram submetidos à fixação interna rígida em dois pontos e 20 pacientes hígidos, comparando a projeção da imagem do contorno do seio maxilar. Estas avaliações foram realizadas em um período pós-operatório superior a 6 meses. Após análise dos resultados, concluímos que baseado nos achados radiográficos e nos valores de áreas dos seios maxilares, a fixação interna rígida em dois pontos mostrou-se eficaz no tratamento das fraturas não cominutivas do complexo zigomáticomaxilar. / Abstract: The ZMC is the second facial area most affected by injuries, only surpassed by nasal bones fractures. It's an essential element in facial configuration because it's the middle third facial main structure. It's important biomechanical being situated between the visceral and neurocranium, develop fundamental absorving and draining of the chewing forces job, across the sustaintation and strenghten pillars. Inside this complex the maxillary sinus and its functions are: to reduce head weight, to help voice ressonance, to produce and to store mucus, to umidificate the breathen air, to maintain the nasal fossa warm, olfative accessory and to define the facial contour and others. The research was performed through PA Waters radiography; 40 patients: 20 traumatizated patients in this region, submitted to the two points IRF and 20 health patients were evaluated, comparing the image projection of the maxillary sinus and observating the stability of this kind of fixation. These evaluations were made in post-operative periods, latter 6 months. After result analysis we concluded, based radiography evidence and measurement maxillary sinus area, the two points IRF are efficient on treatment of ZMC fractures not cominutive. / Mestre

Orientador: Rui Seabra Ferreira Junior / Banca: Ana Liz Garcia Alves / Banca: Antonio Carlos Rodrigues / Resumo: Este trabalho teve como objetivos, a avaliação da capacidade osteoindura do selante de fibrina derivado de peçonha de serpente (SFPS) quando associado ao Bio-Oss® (BHA). Além disso, comparou-se a reparação de fenestração de membranas sinusais com SFPS e membrana de colágeno em enxertos ósseos. Para tanto, foram utilizados 32 coelhos adultos tendo seus seios maxilares bilateralmente operados e preenchidos com enxerto ósseo. No grupo 1 formado por 16 coelhos, uma ferida cirúrgica de lesão de 4 mm foi realizada na membrana sinusal maxilar em ambos os lados, sendo tratadas com selante de fibrina e membrana de colágeno (collatape®) no lado contralateral. No grupo 2, 16 coelhos receberam BHA e BHA+SFPS em cada um dos seios. Os animais do grupo 1 foram eutanasiados aos 3, 7, 14 e 30 dias , e do grupo 2 aos 7, 14, 30 e 60 dias. A avaliação se deu por microscopia ótica e análise histomorfométrica. No grupo 1 ambas as técnicas foram eficazes e não foi observado nenhuma fibrose, defeito no epitélio ciliado ou inflamação intensa na membrana sinusal em nenhum caso. No grupo 2, o SFPS criou uma rede que impediu a penetração de células, sendo totalmente reabsorvido próximo aos 30 dias, retardando a ossificação. A reabsorção da fibrina promoveu um infiltrado inflamatório intenso sendo dissipada ao longo do tempo e não impediu a ossificação. O selante de fibrina mostrou ser eficaz na correção de lesões de membrana sinusal, mas retardou a formação óssea, quando associado ao Bio-Oss®. A sua utilização clínica em combinação com o Bio-Oss® aparece como uma importante alternativa para casos que necessitem de um processo de ossificação mais lento, bem como na reparação de membrana sinusal rompida / Abstract: The aim of this paper is to evaluate the osteoinduction ability of fibrin sealant derived from snake venom (SFPS) when combined with Bio-Oss ® (BHA) and compare SFPS and collagen membrane in repairing the sinus membranes perforations during sinus lift. In group 1, 16 rabbits underwent a lesion of 4 mm in the sinus membrane on both sides and then treated with sealant or collagen membrane. In group 2, 16 rabbits received BHA and BHA + SFPS on each side of the sinus. The group 1 animals were euthanized at 3, 7, 14 and 30 days and Group 2 at 7, 14, 30 and 60 days. The evaluation was made by optical microscopy and histomorphometric analysis. In group 1 both techniques were effective and no fibrosis, defective in the ciliated epithelium or intense inflammation were observed in any case. In group 2, the SFPS created a network that prevented the penetration of cells, being completely reabsorbed in 30 days, delaying the ossification. The resorption of fibrin promoted an intense inflammatory infiltrate that dissipated with time and did not prevent the ossification. Fibrin sealant has proven effective in the correction of sinus membrane lesions, but delayed bone formation, when combined with Bio-Oss® / Mestre

Orientador: Idelmo Rangel Garcia Júnior / Banca: Francisley Ávila Souza / Banca: André Luís Da Silva Fabris / Resumo: A proposta deste estudo foi avaliar o processo de regeneração óssea com o uso do biomaterial Biogran®, um vidro bioativo, como uma opção de substituto ósseo para técnicas de enxerto em levantamento do assoalho do seio maxilar através de análises histológica e histomorfométrica. Para tal, 24 coelhos da raça Nova Zelândia foram submetidos ao procedimento de levantamento do seio maxilar bilateralmente, sendo divididos em dois grupos: grupo coágulo implante (GCI), no qual foi realizado o levantamento do seio maxilar, seguindo implante imediato, sem enxerto; e o grupo biovidro implante (GBI), no qual foi realizado o levantamento do seio maxilar, preenchimento com Biogran® e instalação de implante imediata. Os animais foram submetidos à eutanásia aos 7, 15 e 40 dias. A análise histológica mostrou no grupo GCI uma formação de tecido ósseo gradual, sendo maior aos 40 dias, com característica lamelar. Porém, não apresentava diferença estatística entre os períodos de 15 e 40 dias de eutanásia (p=0,210). O grupo GBI revelou uma formação de tecido ósseo mais tardia, com maior quantidade aos 40 dias, com reabsorção lenta e progressiva dos grânulos do biomaterial e sinais indicativos de atividade osteoblástica. Este grupo mostrou diferença estatística entre os períodos de 7 e 15 dias quando comparados aos 40 dias (p<0,05). Na análise intergrupos, não houve diferença estatisticamente significante aos 7 e aos 40 dias, mas sim, aos 15 dias. Dessa forma, pode-se concluir que o Biogran® é um bi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The purpose of this study was to evaluate the bone regeneration process with the use of the Biogran® biomaterial, a bioactive glass, as a bone substitute option for grafting techniques in the maxillary sinus floor through histological and histomorphometric analysis. To that end, 24 New Zealand rabbits underwent a bilateral maxillary sinus removal procedure, and were divided into two groups: an implant clot group (ICG), in which the maxillary sinus was removed, followed by immediate implantation without graft ; and the implant bioglass group (GBI), in which the maxillary sinus was removed, filled with Biogran® and implanted in the immediate implant. The animals were submitted to euthanasia at 7, 15 and 40 days. The histological analysis showed a formation of gradual bone tissue in the GCI group, being larger at 40 days, with a lamellar characteristic. However, there was no statistical difference between the periods of 15 and 40 days of euthanasia (p = 0.210). The GBI group revealed a later bone formation with a greater amount at 40 days, with slow and progressive resorption of the biomaterial granules and signs indicative of osteoblastic activity. This group showed statistical difference between the periods of 7 and 15 days when compared to the 40 days (p <0.05). In the intergroup analysis, there was no statistically significant difference at 7 and 40 days, but at 15 days. Thus, it can be concluded that Biogran® is a biomaterial with osteoconductive properties, of slow resorpt... (Complete abstract click electronic access below) / Mestre

Dental caries and periodontal disease are the major causes for tooth loss. While dental caries commonly involve the posterior teeth in both jaws, the teeth most commonly lost due to periodontal problems are the first and second molars in the maxilla. As a consequence, the upper posterior jaw is frequently edentulous. Implant therapy today is a predictable treatment modality for prosthetic reconstruction of edentulous patient. Insufficient amounts of bone, due to atrophy following loss of teeth or due to the presence of the maxillary sinus, can make it impossible to insert implants in the posterior maxilla. During the 1970s and 1980s, Tatum, Boyne and James and Wood and Moore first described maxillary sinus floor augmentation whereby, after the creation of a lateral access point, autologous bone grafts are inserted to increase crestal bone height and to create the necessary conditions for the insertion of implants. This surgical procedure requires a two-stage approach and a double surgical site: first, bone is harvested from a donor site and transplanted to the recipient site; then, after a proper healing period of between 4 to 6 months, the implants are inserted. This kind of bone reconstruction, even if well documented, has its limitations, not least in the creation of two different surgical sites and the consequent increased risk of morbidity. In 2004, Lundgren et al. described a new, simplified technique for the elevation of the sinus floor. The authors showed that by lifting the sinus membrane an empty space was created in which blood clot formations resulted in the establishment of new bone. The implants were placed simultaneously to function as “tent poles”, thus maintaining the sinus membrane in a raised position during the subsequent healing period. An essential prerequisite of this technique is to obtain optimal primary implant stability from the residual bone in the sinus floor. An extremely resorbed maxillary sinus floor, with, for example, less than 2-3 mm of poor quality residual bone, could impair implant insertion. The aims of the present research project were (i) to evaluate the donor site morbidity and the acceptance level of patients when a bone graft is harvested from the anterior iliac crest, (ii) to evaluate implant stability, new bone formation inside the maxillary sinus and marginal bone resorption around the implants in long term follow up when maxillary sinus floor augmentation is performed through sinus membrane elevation and without the addition of any grafting material, (iii) to investigate new bone formation inside the maxillary sinus, in experimental design, using a resorbable space-maker device in order to maintain elevation of the sinus membrane where there is too little bone to insert implants with good primary stability. In Paper I, 70 consecutively treated patients were retrospectively evaluated in terms of postoperative donor site morbidity and donor site complications. With regard to donor site morbidity, 74% of patients were free of pain within 3 weeks, whereas 26% had a prolonged period of pain lasting from a few weeks to several months. For 11% of patients there was still some pain or discomfort 2 years after the grafting surgery. Nevertheless, patients acceptance was high and treatment significantly improved oral function, facial appearance, and recreation/social activities and resulted in an overall improvement in the quality of life of formerly edentulous patients. In Paper I and III, some differently shaped space-making devices were tested on primates (tufted capuchin - Cebus apella) in two experimental models aimed at evaluating whether a two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device to increase the bone volume and enable later implant installation with good primary stability, without the use of any grafting material. An histological examination of the specimens showed that it is possible to obtain bone formation in contact with both the Schneiderian membrane and the device. In most cases the device was displaced. The process of bone formation indicated that this technique is potentially useful for two-stage sinus floor augmentation. The lack of device stability within the sinus requires further improvement in space-makers if predictable bone augmentation is to be achieved. In Paper IV, a total of 84 patients were subjected to 96 membrane elevation procedures and the simultaneous placement of 239 implants. Changes of intra-sinus and marginal bone height in relation to the implants were measured in intraoral radiographs carried out during insertion after 6 months of healing, after 6 months of loading and then annually. Computerised tomography was performed pre-surgically and 6 months post-surgically. Resonance frequency analysis measurements were performed at the time of implant placement, at abutment connection and after 6 months of loading. The implant follow-up period ranged from a minimum of one to a maximum of 6 years after implant loading. All implants were stable after 6 months of healing. A total of three implants were lost during the follow-up period giving a survival rate of 98.7%. Radiography demonstrated an average of 5.3 ± 2.1 mm of intra-sinus new bone formation after 6 months of healing. RFA measurements showed adequate primary stability (implant stability quotient 67.4 ± 6.1) and small changes over time. In conclusion, harvesting bone from the iliac crest could result in temporary donor site morbidity, but in 11% of patients pain or discomfort was still present up to 2 years after surgery. However, patient satisfaction was good despite this slow or incomplete recovery, as showed by the quality of life questionnaire. Maxillary sinus membrane elevation without the use of bone grafts or bone substitutes results in predictable bone formation both in animal design, where the sinus membrane is supported by a resorbable device, and in clinical conditions, where the membrane is kept in the upper position by dental implants. This new bone formation is accompanied by a high implant survival rate of 98.7% over a follow-up period of up to 6 years. Intra-sinus bone formation remained stable in the long-term follow-up. It is suggested that the secluded compartment allowed bone formation in accordance with the principle of guided tissue regeneration. This technique reduces the risks of morbidity related to bone graft harvesting and eliminates the costs of grafting materials.