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Análisis de variables volumétricas y cicatrización de tejidos blandos en regeneración ósea guiada de dehiscencias periimplantarias con un sustituto óseo sintético. ensayo clínico aleatorizado. Resultados preliminares

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2019
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Objetivo: comparar la eficacia de un sustituto óseo sintético (SOS) (OsteonTM III, Dentium, Suwon, Corea del Sur) y de un xenoinjerto bovino (BioOss®, Geistlich, Wolhusen, Switzerland) en el tratamiento de defectos periimplantarios de tipo dehiscencia empleando un enfoque de regeneración ósea guiada (ROG) simultánea a la colocación de implantes. Material y métodos: El presente estudio se diseñó como un ensayo clínico aleatorizado de grupos paralelos en el que participaron 2 centros de investigación y con un seguimiento de 1,5 años. Los pacientes recibieron implantes y los defectos de tipo dehiscencia se trataron con un xenoinjerto en el grupo control y con un SOS en el grupo test. En ambos casos, el injerto óseo se cubrió con una membrana reabsorbible. El cambio dimensional en la altura del defecto periimplantario 6 meses después de la cirugía se consideró la variable respuesta principal. De manera adicional, se evaluaron los cambios volumétricos del hueso en el área regenerada, el cambio volumétrico en el contorno vestibular de la cresta y la cicatrización de los tejidos blandos tras el procedimiento de aumento de hueso. Resultados: El siguiente análisis preliminar incluye los primeros 17 pacientes con resultados a 6 meses tras la cirugía de reentrada. Para la altura del defecto, el grupo control obtuvo una reducción de un 88,2% (reducción media 3,75±2,18 mm) y el grupo test del 94,33% (reducción media de 6,0±2,68 mm). Estas diferencias entre grupos no fueron estadísticamente significativas. Para los cambios volumétricos del área regenerada durante la cirugía de reentrada la media del volumen del área aumentada en el grupo test fue de 69,30±49,35 mm3 y en el grupo control de 40,03±29,27 mm3, sin diferencias estadísticamente significativas entre ambos. En cuanto al volumen del contorno de la cresta previo a la apertura del colgajo de la cirugía de reentrada la ganancia fue de 53,2±25,68 mm3 en el grupo test y de 16,93±7,12 mm3 en el grupo control. Estas diferencias fueron estadísticamente significativas (p= 0,05). Por último, para la evaluación de la cicatrización de los tejidos blandos se registraron 12 casos de edema (70,58%), 13 11 de enrojecimiento (76,47%), 3 de dehiscencia de la herida (17,64%) y ninguno de exposición de la membrana. Conclusiones: Teniendo en cuenta las limitaciones del presente estudio preliminar, podemos concluir que el nuevo SOS analizado consiguió resultados similares al xenoinjerto bovino en cuanto a la reducción de la altura del defecto periimplantario de tipo dehiscencia en el tratamiento de regeneración ósea horizontal simultánea a la colocación de implantes.
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