Browsing by Author "Santos, Nuno Bernardo Malta dos"
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- #080 Alongamento coronário com o uso do laser díodo e sistema piezoelétrico: relato de casoPublication . Raso, Mariaselene; Marques, Tiago Miguel; Sousa, Manuel Correia; Santos, Nuno Bernardo Malta dos; Fernandes, Gustavo Vicentis de OliveiraIntrodução: O uso do laser de díodo de alta intensidade em cirurgias periodontais proporciona maior precisão do corte cirúrgico e permite pouca absorção de luz pelos tecidos duros quando se utilizam parâmetros adequados, não gerando assim qualquer dano térmico. Outras vantagens seriam a mais rápida coagulação tecidual, a redução do tempo cirúrgico e a diminuição do risco de infeções pós?operatórias. Outro equipamento com crescente uso é o piezoelétrico, o qual também está indicado em cirurgias orais, a proporcionar também osteotomias mais precisas, limpas e com menor trauma para os tecidos moles. Portanto, o objetivo deste relato foi mostrar a utilização de tecnologias em procedimento estético periodontal. Descrição do caso clínico: Paciente do sexo feminino, 25 anos, saudável, com tratamento ortodôntico prévio, com queixa principal de grande exposição gengival ao sorrir. Planeou?se um alongamento coronário com uso do laser de díodo, em região estética superior (1.4 – 2.4). Após uso do laser para corte gengival, foi feito retalho de espessura total para visualização do osso de sustentação e posterior osteotomia com piezoelétrico, a seguir mensurações e proporções estéticas. Posteriormente, retalho foi reposicionado e suturado. No pós?operatório de 7 dias e 14 dias, pode? se confirmar a excelente recuperação do tecido local e da paciente. Discussão e conclusões: Existem evidências de que a cirurgia em tecidos moles com laser a díodo, e a cirurgia de tecidos duros com aparelho piezoelétrico, proporcionam um bom prognóstico e melhorando assim o pós? cirúrgico do paciente. O laser de díodo permite ter um campo cirúrgico limpo, sem hemorragia, diminuindo o risco de inflamação e infeção pós? cirúrgica quando comparado a sistema tradicional de cirurgias. A osteotomia com piezoeléctrico permite um corte preciso e menos traumático, proporcionando um menor perfil inflamatório a nível ósseo. As vantagens para o paciente são: diminuição da dor e do edema. Enquanto as vantagens para o profissional são: maior sensibilidade tátil e uma melhor visibilidade do campo operatório. Também proporciona proteção dos tecidos moles e das estruturas nobres adjacentes, incluindo um maior controlo da assepsia. A utilização destas tecnologias em cirurgia periodontal mostrou maior exequibilidade e visibilidade, campo cirúrgico mais limpo e menor hemorragia e edema. Inclusive, estas técnicas permitiram reparo ósseo e gengival mais favorável.
- #102 Comparação da resistência á tração de diferentes membranas de fibrina rica em plaquetasPublication . Pascoal, Martim; Santos, Nuno Bernardo Malta dos; Fernandes, Gustavo Vicentis de OliveiraObjetivos: Este estudo teve por objectivo fazer comparação directa da resistência à tração entre membranas produzidas com diferentes protocolos de centrifugação, Leucocyte?Platelet Rich Fibrin (L? PRF) versus advanced? Platelet Rich Fibrin (a?PRF). Materiais e métodos: Após a colheita de sangue de uma pessoa saudável e sem histórico de toma de anticoagulantes ou outro medicamento, sob controlo alimentar, procedeu? se à confeção de membranas segundo os protocolos de L? PRF e a? PRF previamente descritos na literatura. De seguida, as membranas, n=26 (13 para cada protocolo), foram submetidas a um teste mecânico de tração, para os quais foram obtidos valores de tração máxima e de tração média. A análise estatística dos dados foi feita com o teste t?Student não pareado. Resultados: Relativamente à tração média, o protocolo a? PRF e L?PRF, respetivamente, foram de 0.0288 N.mm? 2 e 0.0192 N.mm? 2 (p
- A 3D digital analysis of the hard palate wound healing after free gingival graft harvestPublication . Marques, Tiago; Ramos, Sara; Santos, Nuno Bernardo Malta dos; Borges, Tiago; Montero, Javier; Correia, André; Fernandes, Gustavo Vicentis de OliveiraPurpose: Within this context, this pilot study aimed to evaluate the healing dynamics process of the hard palate after free gingival graft harvesting in the short term (3 months), utilizing digital imaging technology and tridimensional analysis software. Furthermore, assessing the results found to verify the existence of a relationship between gender or age with tissue loss. Materials and Methods: For connective-tissue harvesting, fifteen patients with gingival recessions type (RT) 1 and RT2 were selected. On the surgery day (before the procedure) and after three months, palatal impressions were taken in all patients, and cast models were done for posterior model scanning. The following variables were analyzed: mean thickness alterations (x¯ TA), maximum thickness loss (MTL), mean maximum thickness loss (x¯ MTL), and volume alterations (VA). A descriptive and bivariate analysis of the data was done. The data were submitted for statistical evaluation and were significant if p < 0.05. Results: Fifteen patients were analyzed, 11 females (73.3%) and four males (26.7%). The patients’ average age was 28 ± 8.52 years (ranging between 16 and 48 years old). The palatal wound region’s mean thickness and volume changes were −0.26 mm (±0.31) and 46.99 mm3 (±47.47 mm3) at three months. There was no statistically significant result correlating age/gender with any variable evaluated. Conclusions: Connective tissue graft harvesting promoted changes with a standard volume and thickness loss of palatal soft tissue. A 3D digital evaluation was a non-invasive method with a reproducible technique for measuring thickness or volume after connective tissue is collected. There was no relationship between age/gender and any variables analyzed.
- Mixed-Thickness Tunnel Access (MiTT) through a linear vertical mucosal incision for a minimally invasive approach for root coverage procedures in anterior and posterior sites: technical description and case series with 1-year follow-upPublication . Marques, Tiago; Santos, Nuno Bernardo Malta dos; Sousa, Manuel; Fernandes, Juliana Campos Hasse; Fernandes, Gustavo Vicentis OliveiraPurpose: The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. Methods: Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1–2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum–enamel junction (CEJ). Results: Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. Conclusion: The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.
- Tensile strength assay comparing the resistance between two different autologous platelet concentrates (leucocyte-platelet rich fibrin versus advanced-platelet rich fibrin): a pilot studyPublication . Pascoal, Martim de Almeida Nóbrega Correia; Santos, Nuno Bernardo Malta dos; Completo, António Manuel Godinho; Fernandes, Gustavo Vicentis de OliveiraBackground: Since the leucocyte-platelet rich fibrin (L-PRF) was published in 2001, many studies have been developed, analyzing its properties, and also verifying new possibilities to improve it. Thereby, it emerges the advanced-platelet rich fibrin (A-PRF) with a protocol that optimizes the properties obtained by the L-PRF. Nonetheless, there is a gap in the literature to landmark the evolutive process concerning the mechanical properties in specific the resistance to tensile strength which consequently may influence the time for membrane degradation. Thus, this study had the goal to compare the resistance to the traction of membranes produced with the original L-PRF and A-PRF protocols, being the first to this direct comparison. Findings: The harvest of blood from a healthy single person, with no history of anticoagulant usage. We performed the protocols described in the literature, within a total of 13 membranes produced for each protocol (n = 26). Afterward, the membranes were prepared and submitted to a traction test assessing the maximal and the average traction achieved for each membrane. The data were analyzed statistically using the unpaired t test. Regarding average traction, A-PRF obtained a value of 0.0288 N mm−2 and L-PRF 0.0192 N mm−2 (p < 0.05 using unpaired t test). For maximal traction, A-PRF obtained 0.0752 N mm−2 and L-PRF 0.0425 N mm−2 (p < 0.05 using unpaired t test). Conclusion: With this study, it was possible to conclude that indeed A-PRF has a significative higher maximal traction score and higher average traction compared to L-PRF, indicating that it had a higher resistance when two opposing forces are applied.
- Tensile strength essay comparing three different platelet-rich fibrin membranes (L-PRF, A-PRF, and A-PRF plus): a mechanical and structural in vitro evaluationPublication . Simões-Pedro, Mara; Tróia, Pedro Maria B. P. S.; Santos, Nuno Bernardo Malta dos; Completo, António M. G.; Castilho, Rogerio Moraes; Fernandes, Gustavo Vicentis de OliveiraPredictable outcomes intended by the application of PRF (platelet-rich fibrin) derivative membranes have created a lack of consideration for their consistency and functional integrity. This study aimed to compare the mechanical properties through tensile strength and analyze the structural organization among the membranes produced by L-PRF (leukocyte platelet-rich fibrin), A-PRF (advanced platelet-rich fibrin), and A-PRF+ (advanced platelet-rich fibrin plus) (original protocols) that varied in centrifugation speed and time. L-PRF (n = 12), A-PRF (n = 19), and A-PRF+ (n = 13) membranes were submitted to a traction test, evaluating the maximum and average traction. For maximum traction, 0.0020, 0.0022, and 0.0010 N·mm−2 were obtained for A-PRF, A-PRF+, and L-PRF, respectively; regarding the average resistance to traction, 0.0012, 0.0015, and 0.006 N·mm−2 were obtained, respectively (A-PRF+ > A-PRF > L-PRF). For all groups studied, significant results were found. In the surface morphology observations through SEM, the L-PRF matrix showed a highly compact surface with thick fibers present within interfibrous areas with the apparent destruction of red blood cells and leukocytes. The A-PRF protocol showed a dense matrix composed of thin and elongated fibers that seemed to follow a preferential and orientated direction in which the platelets were well-adhered. Porosity was also evident with a large diameter of the interfibrous spaces whereas A-PRF+ was the most porous platelet concentrate with the greatest fiber abundance and cell preservation. Thus, this study concluded that A-PRF+ produced membranes with significant and higher maximum traction results, indicating a better viscoelastic strength when stretched by two opposing forces.
- The influence of root prominence on the onset of gingival recession: a systematic reviewPublication . Raso, Girolamo; Santos, Nuno Bernardo Malta dos; Nassani, Leonardo M.; Mello-Moura, Anna Carolina Volpi; Fernandes, Juliana Campos Hasse; Fernandes, Gustavo Vicentis OliveiraThis systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition.