FIBRINA RICA EM PLAQUETAS (PRF) COMO TRATAMENTO DE COMUNICAÇÃO BUCO-SINUSAL: RELATO DE CASO

ResumoAs comunicações buco-sinusais são complicações pós-cirúrgicas que ocorrem mais frequentemente após exodontia de molares superiores devido a relação anatômica íntima entre o ápice das raízes desses dentes com o seio maxilar. O seu diagnóstico envolve procedimentos clínicos e radiográficos, sendo a manobra de Valsalva um passo importante do exame físico. Essas comunicações diretas entre o seio maxilar e a cavidade oral, se não tratadas de forma adequada, podem evoluir para fístulas permanentes que ocorrem quando há epitelização da mucosa. A literatura defende diferentes formas de tratamento cirúrgico, sendo a maioria através de retalhos que demandam um segundo sítio de cicatrização. Objetivando-se diminuir a morbidade desses procedimentos e a melhora da cicatrização tecidual, uma opção de tratamento é a utilização de PRF (Fibrina Rica em Plaquetas). Trata-se de uma membrana de fibrina autógena, rica em leucócitos, plaquetas e fatores de crescimento, obtida através do sangue do paciente que passa por um processo de centrifugação. O objetivo do presente trabalho é relatar um caso clínico do paciente V.A.P., leucoderma, sexo masculino, 56 anos de idade, que compareceu à Faculdade de Odontologia da Universidade Federal Fluminense, apresentando ao exame clínico e por imagem, comunicação buco - sinusal com cerca de 2,5 cm em seu maior diâmetro. Com isso, foi proposto ao paciente a ressecção da fístula e fechamento através da utilização de membranas de PRF. Após prévia utilização de antibiótico e corticoide nasal, o procedimento cirúrgico foi realizado sob anestesia local em ambiente ambulatorial, sem intercorrências e o mesmo segue em controle pós-operatório com cerca de 2 meses, com boa evolução e sem sintomatologia.Palavras-chave: seio maxilar, comunicação buco-sinusal, fibrina rica em plaquetas.AbstractBuco-sinus communications are postoperative complications that occur most frequently after maxillary molar extraction due to the close anatomical relationship between the apex of the roots of these teeth and the maxillary sinus. Its diagnosis involves clinical and radiographic procedures, and the Valsalva maneuver is an important step of the physical examination. These direct communications between the maxillary sinus and the oral cavity, if not properly treated, can progress to permanent fistulas that occur when mucosal epithelialization occurs. The literature defends different forms of surgical treatment, most of them through flaps that require a second healing site. In order to reduce the morbidity of these procedures and improve tissue healing, one treatment option is the use of PRF (Fibrin Rich Platelet). It is an autogenous fibrin membrane, rich in leukocytes, platelets and growth factors that is obtained through the patient's blood that goes through a centrifugation process. The aim of the present study is to report a clinical case of VAP patient, leucoderma, male, 56 years old, who attended the Fluminense Federal University Dental School, presenting oral and sinus communication with 2.5 cm at its largest diameter. Thus, the patient was proposed for resection of the fistula and closure through the use of PRF membranes. After previous use of antibiotics and nasal corticosteroids, the surgical procedure was performed under local anesthesia in an outpatient setting, uneventful and the same follows in postoperative control for 2 months, with good evolution and without symptoms.Keywords: maxillary sinus, oral-sinus communication, platelet-rich fibrin.

Gustatory dysfunction in relation to circumvallate papilla’s taste buds structure upon unilateral maxillary molar extraction in Wistar rats: an in vivo study

Background: The interaction between taste sensation and dentoalveolar innervation is still under research. teeth loss can alter taste thresholds in humans, but the underlying mechanisms are still obscure. This study investigated the effect of unilateral maxillary molars extraction on the structure of circumvallate papilla in rats. Methods: Thirty-two male Wister rats, aged 3-4 months were randomly distributed into four groups (one control and 3 experimental ) each including 8 animals. The rats were euthanized 3, 6 or 9 weeks following the procedure. The changes in trough length and the taste buds structure and number of both sides of CVP were investigated using routine histological examination followed by statistical analysis. Results: the trough toward the extraction side was obviously shorter with a noticeable decrease of taste buds’ number than the non-extraction side. Taste buds were reduced in size and most of them showed signs of degeneration which was more evident in group II followed by group III, less deformity detected in group IV in comparison to the preceding 2 experimental groups. the non-extraction side of all experimental groups showed normal trough length and generally normal histology of taste buds. Conclusions: Maxillary molars extraction has a degenerative effect on the structure of taste buds and gustatory epithelium which were more marked at the extraction side and showed improvement upon elongation of follow up period

Efficacy of Alveolar Ridge Preservation after Maxillary Molar Extraction in Reducing Crestal Bone Resorption and Sinus Pneumatization: A Multicenter Prospective Case-Control Study

Aim. To evaluate, with three-dimensional analysis, the effectiveness of alveolar ridge preservation (ARP) after maxillary molar extraction in reducing alveolar bone resorption and maxillary sinus pneumatization when compared to unassisted socket healing. Methods. Patients were included in the study following inclusion criteria and underwent minimally traumatic maxillary molar extraction followed by ARP using synthetic nanohydroxyapatite (Fisiograft Bone, Ghimas, Italy) (test group) or unassisted socket healing (control group). Cone-beam computerized tomographies (CBCT) were performed immediately after tooth extraction (T0) and 6 months postoperatively (T1). CBCTs were superimposed by using a specific software (Amira, Thermo Fisher Scientific, USA) and the following items were analyzed in both groups: (i) postextractive maxillary sinus floor expansion in coronal direction and (ii) postextractive alveolar bone dimensional changes (both vertical and horizontal). All data were tested for normality and equality of variance and subsequently analyzed by independent samples T-test and Mann–Whitney test. Results. Thirty patients were treated by three centers and twenty-six (test n=13; control n=13) were included in the final analysis. Mean sinus pneumatization at T1 was 0.69±0.48 mm in the test group and 1.04±0.67 mm in the control group (p=0.15). Mean vertical reduction of the alveolar bone at T1 was 1.62±0.49 mm in the test group and 2.01±0.84 mm in the control group (p=0.08). Mean horizontal resorption of crestal bone at T1 was 2.73±1.68 mm in test group and 3.63±2.24 mm in control group (p=0.24). Conclusions. It could be suggested that ARP performed after maxillary molar extraction may reduce the entity of sinus pneumatization and alveolar bone resorption, compared to unassisted socket healing. This technique could decrease the necessity of advanced regenerative procedures prior to dental implant placement in posterior maxilla.