bone regeneration impact in anti aging final
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Bone regeneration and its impact in Anti aging
Óscar Prim da Costa Serviço de Cirurgia Maxilofacial - Hospital
de São JoséClínica Maxfac – Cirurgia Estética da Face
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Chester (1991):
São materiais destinados a estar em contacto com os tecidos vivos e/ou fluidos biológicos para avaliar, tratar, e modificar as formas ou substituir todo um tecido, orgão ou função do corpo.
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Classificação
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Biomateriais
Para que são usados?
Para a regeneração de um tecido lesado ou em falta e com fim estético e/ou funcional
Se o tecido a regenerar é osso o tratamento é definido como regeneração óssea guiada (ROG) .
Se for necessário regenerar, para além de osso, a estutura de suporte periodontal (osso, cemento e ligamento periodontal) então define-se como regeneração tecidual guiada (RTG)
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Biomateriais
Definição do biomaterial idealO biomaterial ideal deve cumprir as seguintes funções:
a) preencher o espaço do defeito ósseo
b) criar o “ambiente” favorável para a regeneração óssea
(biocompatível)
c) estimular a regeneração óssea (substrato)
d) Reabsorver em tempo semelhante ao tempo necessário para a
neo formação óssea fisiológica (tipo de material , granulometria e
processo productivo)
e) Manter o volume original do enxerto
enxerto 1° mês 2° mês 3° mês 4° mês
20%
40%
60%
80%
100%
0%
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Biomateriais Factores biológicos determinantes da regeneração óssea
Resposta das stem cells osteoprogenitoras
Bone Morfogenetic Proteins
Substrato: colagéneo
Esqueleto: mineral orgânico e inorgânico
Tempo de reabsorção
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Biomateriais
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Biomateriais
Análise comparativa dos biomateriais
Biological factor GBR Osso
AutologoOsso
Alogenico Sinteticos
biomateriais
Não colag. Heterologo
Osso
Osteo-progenitoras Paciente paciente paciente paciente
BMP’s SIM patiente paciente paciente
Substrato (colageneo) SIM SIM NÃO NÃO
Esqueleto SIM SIM SIM SIMAverage re-entry time 4/5 meses 4/5 meses Variável 5/6 meses
% osso neo formado 70% variável variável 33%% non-
reabsorbed biomaterials+
connective tissue
30% variável Variável 67%
Advantage/disadvantage
Raramente suficiente sem colheita extra-
oral
Problemas éticos
Preço alto
Reabsorção muito rápida ou
muito lenta
Reabsorção muito lenta
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Afinidade natural pelas BMPs
Protege BMPs de proteólise não especifica
Previne a difusão prematura das BMPs
É completamente reabsorvido
É substituido por novo tecido ósseo formado
Excelente substrato para o recrutamento, ancoragem e diferenciação de células progenitoras de osso
Colagéneo: o substrato ideal
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Bibliografia sobre colagéneo
Bruce E, Steven P, Louis M. Use of microcristalline collagen for hemostasis after oral surgery in a hemophylic. J Oral Surg 1979 37(2): 126-128
Capuano A, Bargelli F, Fadda GM, Parrini S. Collagene eterologo in chirurgia odontostomatologica. Il dentista moderno. Dicembre 2002
Centrella M, McCarthy TL, Canalis E. Trasforming growth factor beta is a bifunctional regular of replication and collagen synthesis in osteoblast-enriched cell cultures from fetal rat bone. J Biol Chem, 1987; 262: 2869-2874
Charulatha V, Rajaram A. Influence of different crosslinking treatments on the physical properties of collagen membranes. Biomater, 2003; 24: 759-767
Hsu FY, Chueh SC, Wang YJ. Microspheres of hydroxyapatite/reconstituted collagen as supports for osteoblast cell growth. Biomater, 1999; 20: 1931-1936
Kadler KE, Holmes DF, Trotter JA, Chapman JA. Collagen fibril formation. Biochem J, 1996; 316: 1-11
Liu LS, Thomson AY, Heidaran MA, et al. An osteoconductive collagen/hyaluronate matrix for bone regeneration. Biomater, 1999; 12: 1097-1108
Lucas PA, Syftestad GT, Goldberg VM, Caplan AI. Ectopic induction of cartilage and bone by water soluble proteins from bovine bone using a collagenous delivery vehicle. J Biomed Mater Res, 1989; 23(A1): 23-29
Meyer U et al. Microstructural investigations of strain-related collagen mineralization. British J Oral Maxillofacial Surgery, 2001; 39: 381-389
Patino MG, Neiders ME, Andreana S, Noble B, Cohen RE. Collagen as an implantable material in medicine and dentistry. J Oral Implantology, 2002; 28(5): 220-225
Stein MD, Salkin LM, Freedman AL, Glushko V. Collagen sponge as a topical hemostatic agent in mucogingival surgery. J Periodontol 1985; 56: 35-38
Salasznyk RM, Williams WA, Boskey A, Batorsky A,, Plopper GE. Adhesion to vitronectin and collagen I promotes osteogenic differentiation of human mesenchymal stem cells. Journal of Biomedicine and Biotechnology, 2004; 1: 24-34
Wallace DG, Rhee W, et al. Injectable cross-linked collagen with imporved flow properties. J Biomed Mater Res, 1989; 23: 931-945
Werkmeister JA, Tebb TA, White JF, Ramshaw JAM. Collagenous tissue formation in association with medical implants. Current Opinion in Solid State and Materials Science, 2001; 5: 185-191
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Int J Oral Maxillofac Implants. 2004 Mar-Apr;19(2):199-207
Histomorphometric analysis of natural bone mineral for maxillary sinus augmentation.
John HD, Wenz B.
PURPOSE: Lack of bone height in the posterior maxilla often necessitates augmentation prior to or simultaneously with dental implant placement. The purpose of this clinical study was to evaluate the use of the natural bone mineral Bio-Oss alone or in combination with autogenous bone in sinus floor elevations performed as 1- or 2-step procedures. MATERIALS AND METHODS: Thirty-eight patients required sinus augmentation. Natural bone mineral alone was used in sinus floor augmentation in 21 patients. In 13 patients, a mixture of the bone substitute and autogenous bone was used, and in 4 patients autogenous bone alone was used. In all of the patients, samples were taken for biopsy 3 to 8 months postoperatively, and bone regeneration was evaluated histologically and histomorphometrically. RESULTS: In all patients, the amount of new bone significantly increased over the observation time, while marrow areas decreased. There was no statistically significant difference in the amount of new bone formation between the Bio-Oss group (new bone 29.52% +/- 7.43%) and the Bio-Oss/autogenous bone group (new bone 32.23% +/- 6.86%). In the 4 patients treated with autogenous bone alone, a greater amount of newly formed bone was found; however, in these cases the area volume filled was smaller than in the other 2 groups. DISCUSSION: The data showed that new bone formation takes place up to 8 months after sinus floor elevation and that there is no difference in the amount of bone formation between procedures done with the bone substitute alone or with the mixture of the substitute and autogenous bone. CONCLUSION: These data suggest that predictable bone formation can be achieved with the use of Bio-Oss.
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Casos clínicos
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Regeneração Periodontal
Rx peri-apical: defeito profundo na raiz mesial do 3.6
Imagem per op: Defeito infra ósseo
Cortesia Drs. Giuseppe Corrente e Roberto Abundo
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Preenchimento do defeito com Gen-Os.
Regeneração Periodontal no 3.6
Membrana X-Fine Evolution membrane
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Membrana colocada para protecção do material de enxerto
Regeneração Periodontal 3.6
Controle rx 6 meses após cirurgia
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PRODUTOS USADOS
GEN-OS MEMBRANAEVOLUTION
Regeneração Periodontal 3.6
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Defeito mesial do 4.1
RX mostra defeito profundo mesial do 4.1.
Defeito ósseo de 7 mm
Cortesia Dr. Walter Rao
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Colagéneo com 60% osso suino
Imagem per operatória mostra defeito de 2 paredes
Defeito mesial do 4.1
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Membrana de pericárdio equinoEnxerto com Gel 40.
Defeito mesial do 4.1
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Controle Rx pós op Bolsa com 2 mm.
Defeito mesial no 4.1
Controle 8 meses pós op
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Sinus lift maxilar
I
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Defeito ósseo maxilar Remoção ponte fixa
Sinus lift maxilar
Cortesia Dr. Roberto Rossi
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Sinus lift Técnica de Summers Colocação de implantes
Sinus lift maxilar técnica de summers
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RX pós op 8 meses após carga
Sinus lift maxilar
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Atrofia óssea maxilar e ramo horizontal mandibula
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Sinus lift
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Implantes após enxerto
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Colheita enxerto ramo horizontal
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Enxerto ramo horiz esq mand
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1 ano após carga
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1 ano após carga
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Perda de suporte ósseo
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Perda de suporte ósseo
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Exodontias
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Membrana reabsorvível
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Enxerto Putty
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Enxerto onlay
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Membrana duo teck
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Enxerto
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Membrana
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Sutura
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6 meses após cirurgia
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Sinus lift técnica Summers
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Enxerto calote e implantes
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Parietal e sinus lift
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Osteotomia e expansão com implantes
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Expansão com osteotomia e implantes
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Enxerto ósseo com PRGF
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Traumatismo alveolo dentário
Enxerto com putty e fixação com parafuso osteossintese
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Traumatismo alveolo dentário
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Quistos da pré maxila
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Quistos da pré maxila
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Quistos da pré maxila
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Quistos pré maxila
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Quistos pré maxila
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Quistos pré maxila
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Atrofia óssea maxilar
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Perda de suporte ósseo
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Perda de suporte ósseo
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Perda de suporte ósseo
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Perda de suporte ósseo
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Perda de suporte ósseo
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Perda de suporte ósseo
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Atrofia mandibula
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Atrofia mandibula
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IMPLANTES
ZIGOMÁTICOS INDICAÇÕES
Maxilar Edéntulo com Grande Reabsorção óssea
Pneumatização do Seio Maxilar
Status Pós-Maxilectomia
Fenda Lábio-Palatina
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IMPLANTES ZIGOMÁTICOS
Hipoplasia maxilar
Falso prognatismo
FRACASSO FACIAL
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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IMPLANTES ZIGOMÁTICOS
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