Publication: Efecto de la melatonina aplicada localmente en el interior de alveolos post-extracción de terceros molares retenidos.Estudio piloto
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2013
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La inflamación y el dolor son problemas frecuentes que sufre el paciente y a los que debe hacer frente el profesional tras la realización de tratamientos quirúrgicos. Por otra parte la ausencia de densidad ósea suficiente es la principal limitación a la hora de realizar tratamientos implantológicos exitosos reduciendo los tiempos de espera. La exodoncia quirúrgica de los terceros molares inferiores retenidos es un modelo característico en el que se produce inflamación y dolor tempranos, seguido de un proceso de curación ósea del lecho alveolar de varios meses de duración. Varios estudios han demostrado las propiedades antiinflamatorias y analgésicas tempranas de la melatonina, así como su efecto osteogénico y osteodiferenciador, reduciendo el periodo de curación. Por este motivo se realiza el presente ensayo clínico aleatorizado, a triple ciego, unicéntrico, empleando un diseño a boca-partida en el Departamento de Medicina y Cirugía Bucofacial de la Facultad de Odontología de la Universidad Complutense de Madrid. Se estudiaron 10 pacientes con indicación de extracción quirúrgica de ambos terceros molares inferiores. Se aplicaron 3 mg de melatonina en uno de los alveolos post-extracción de forma aleatorizada por ordenador frente a un placebo. Para determinar las propiedades antiinflamatorias y analgésicas se analizaron muestras de suero sanguíneo mediante pruebas de enzimoinmunoanálisis independientes cuantificando las concentraciones de interleuquina-6 y nitrotirosina. La cuantificación de las propiedades osteogénicas se realizó mediante la medición de la densidad ósea radiográfica (número de unidades Hounsfield por área) en cortes panorámicos y seccionales obtenidos por escáner digital. Las muestras fueron codificadas (a=lado de melatonina previo; b=lado de control previo; A=lado de melatonina posterior; B=lado de control posterior), de modo que el paciente, el cirujano y el evaluador externo desconocieron el lado de aplicación de la melatonina. La concentración de interleuquina-6 tras la aplicación de melatonina fue de 361,32 ± 235,22 pg/ml, mientras que tras la aplicación del placebo fue de 262,58 ± 233,92 pg/ml. El análisis estadístico de las concentraciones de nitrotirosina no pudo realizarse ya que los valores de densidad óptica obtenidos se encontraban por debajo de la curva patrón de detectabilidad (< 0,001 nM). La densidad ósea en los cortes panorámicos a nivel del alveolo tras la aplicación de melatonina fue de 561,98±105,92 UH, mientras que tras la aplicación del placebo fue de 598,82±209,03 UH. En los cortes seccionales, la densidad ósea en la región alveolar fue de 377,42 ±125,67 UH tras la aplicación de melatonina y de 347,56±97,02 UH en el lado control. En el presente estudio no existen diferencias entre la aplicación de melatonina y placebo en cuanto a la concentración de IL-6. Tampoco se hallaron diferencias en cuanto a densidad ósea en los cortes panorámicos ni seccionales en función del tratamiento. Por tanto, no se encontraron diferencias entre la aplicación de melatonina y placebo en el alveolo post-extracción de los cordales inferiores retenidos.
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