Abstract
From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar) were randomly assigned to receive an endovenous injection (penile vein) of either citrate buffer solution (Group 1 - control; n=20) or streptozotocin dissolved in citrate buffer solution (35 mg/kg) to induce diabetes (Group 2 - diabetic; n=20). After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2-mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.
Highlights
The loss of bone tissue from the alveolar ridge, as a cause of pathologies, periodontitis or invasive surgical procedures, may cause structural, functional and esthetic impairments to the dental arch, generating mechanical problems and hindering the installation of prostheses and implants
Similar results were observed in the diabetic group at 10 and 30 postoperative days, which presented significantly larger bone area in the grafted defects (52.0 ± 7%; p
In the defects that received blood clot, an unexpected inversion of results occurred at the 10-day period (43.8 ± 4%), since the diabetic group presented a slightly more accentuated new bone formation than that observed in the control group (42.4 ± 7%), though without statistical significance
Summary
The loss of bone tissue from the alveolar ridge, as a cause of pathologies, periodontitis or invasive surgical procedures, may cause structural, functional and esthetic impairments to the dental arch, generating mechanical problems and hindering the installation of prostheses and implants. In an attempt to improve the repair process or even to recover the alveolar anatomy, graft materials and bone substitutes have been used to fill these defects. Autogenous bone graft has become the material with the highest biological acceptance and tissue compatibility, presenting minimal inflammatory response. The clinical success of bone grafts depends on inflammatory events that are controlled by regulatory mechanisms, represented by hormones (insulin, glucocorticoids) and specific tissue factors. Any alteration in those mechanisms, diabetes mellitus, an endocrine alteration, may induce unfavorable reactions in the normal inflammatory process, possibly causing great changes in the revascularization, incorporation, substitution and remodeling grafts stages.
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