Publication: Tratamiento de los defectos óseos tras la extracción quirúrgica de terceros molares inferiores mediante la técnica de preservación alveolar con dentina autóloga
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2020
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Abstract
Introducción La extracción de los terceros molares inferiores retenidos, supone un procedimiento muy común en la actividad del cirujano oral. Entre las complicaciones relacionadas, destaca la lesión periodontal localizada en la superficie distal del segundo molar, para la cual múltiples autores aconsejan la utilización de injertos óseos. En los últimos años se ha descrito el empleo de dentina autógena, aunque ningún estudio publicado hasta la fecha lo ha empleado para el tratamiento de este tipo de defectos.
Material y método Se realizó un ensayo clínico aleatorizado a boca partida, en el que tras la extracción, se colocó injerto de dentina autógena en uno de los alveolos, y se dejó el alveolo contralateral cicatrizar mediante la formación de un coágulo sanguíneo. Se incluyó a 15 pacientes que fueron intervenidos de manera bilateral (30 alveolos), con el objetivo de evaluar la eficacia post-operatoria de la dentina autógena en la evolución de la PS, el dolor, la inflamación y la capacidad de apertura bucal, la densidad ósea radiográfica, el grado de corticalización y el mantenimiento de la altura crestal.
Resultados La evaluación de la PS supuso una reducción de 1.53 vs 0,27 mm en la superficie disto-vestibular, 2.8 vs 0.07 mm en la superficie disto-medial y 2.33 vs 1.4 mm en la superficie disto-lingual, del grupo de estudio respecto al grupo control. La densidad ósea radiográfica fue superior en el grupo de estudio respecto al grupo control (1538.93 vs 1122.26 UH) y se produjo mantenimiento de la altura crestal en el grupo de estudio vs una pérdida en el grupo control (0.54 vs -0.68 mm). El grupo de estudio y el grupo control no presentaron diferencias estadísticamente significativas en la evaluación del dolor, la inflamación, la capacidad de apertura bucal y el grado de corticalización.
Conclusiones La dentina autógena redujo la PS y mejoró el NIC de manera post-operatoria, en comparación con la extracción convencional. La densidad ósea y el mantenimiento de la altura crestal obtuvieron mejores resultados en el grupo en el que se empleó dentina como material de injerto, mientras que el grado de corticalización fue superior en el grupo control. Sin embargo, ambos grupos presentaron similar dolor, inflamación y capacidad de apertura bucal.
Introduction Lower third molar extraction is a common procedure performed by oral surgeons. It is accompanied by complications such as periodontal problems characterized by bone loss on the distal aspect of the second molar. Numerous authors suppor the use of regenerative techniques as complimentary treatments in these procedures. Although autogenous dentin has been used in many studies, it has not been evaluated regenerating these defects. Material and method A split mouth clinical trial has been conducted, using autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar in the test side, leaving the control side to heal spontaneously. 15 patients underwent bilateral extraction surgery (30 third molars), to assess the efficacy of autogenous dentin in periodontal parameters, pain, inflammation, mouth opening, radiographic bone density, and alveolar bone crest maintenance, evaluated postoperatively. Results Probing depth evolution obtained a reduction of 1.53 vs 0.27 mm in distovestibular, 2.8 vs 0.07 mm in disto-medial surface, and 2.33 vs 1.4 mm in disto-lingual surface, in test group compared to control group. Bone density in Hounsfield units was greater in the test group compared with the control group (1538.93 vs 1122.26 HU). Alveolar bone crest was mantained in test group (0.54 mm) compared with control group (-0.68 mm). No significant differences were found between the groups for the variables pain, inflammation, mouth opening capacity and degree of corticalization. Conclusions Autogenous dentin reduced probing depth and improved clinical attachment level post-operatively in comparison with the conventional approach. Bone density and bone height maintenance had better results in test compared to control group, while degree of corticalization was better in control group. Nevertheless, no differences were found between groups in pain, inflammation, mouth opening.
Introduction Lower third molar extraction is a common procedure performed by oral surgeons. It is accompanied by complications such as periodontal problems characterized by bone loss on the distal aspect of the second molar. Numerous authors suppor the use of regenerative techniques as complimentary treatments in these procedures. Although autogenous dentin has been used in many studies, it has not been evaluated regenerating these defects. Material and method A split mouth clinical trial has been conducted, using autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar in the test side, leaving the control side to heal spontaneously. 15 patients underwent bilateral extraction surgery (30 third molars), to assess the efficacy of autogenous dentin in periodontal parameters, pain, inflammation, mouth opening, radiographic bone density, and alveolar bone crest maintenance, evaluated postoperatively. Results Probing depth evolution obtained a reduction of 1.53 vs 0.27 mm in distovestibular, 2.8 vs 0.07 mm in disto-medial surface, and 2.33 vs 1.4 mm in disto-lingual surface, in test group compared to control group. Bone density in Hounsfield units was greater in the test group compared with the control group (1538.93 vs 1122.26 HU). Alveolar bone crest was mantained in test group (0.54 mm) compared with control group (-0.68 mm). No significant differences were found between the groups for the variables pain, inflammation, mouth opening capacity and degree of corticalization. Conclusions Autogenous dentin reduced probing depth and improved clinical attachment level post-operatively in comparison with the conventional approach. Bone density and bone height maintenance had better results in test compared to control group, while degree of corticalization was better in control group. Nevertheless, no differences were found between groups in pain, inflammation, mouth opening.
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Trabajo Fin de Master encuadrado en la línea de investigación Eficacia de protocolos quirúrgicos y regenerativos en implantología.
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