Browsing by Subject "Microsurgery"

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    Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial
    (Springer, 2021-11-17) Moreno Rodríguez, José Antonio; Ortiz Ruiz, Antonio José; Dermatología, Estomatología, Radiología y Medicina Física
    Objectives This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue. Material and methods Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post‐surgery, and supra‐alveolar attachment gain (SUPRA-AG) was recorded at 1 year post‐surgery. Results At 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05). Conclusions NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue. Clinical relevance NIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain.
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    Open Access
    Diseño e implementación de escalas de evaluación para mejorar la adquisición de competencias básicas en microcirugía vascular
    (Universidad de Murcia. Servicio de Publicaciones, 2025) López Ríos, Adolfo Alejandro; Patrón Gómez, Alfredo Salvador; Rojas-Galvis, Manuel Andrés; Sin departamento asociado
    Introducción: El nivel de competencia mide las habilidades y destrezas que un estudiante posee para realizar una actividad. El objetivo de este estudio fue implementar dos escalas OSATS (Objective Structured Assessment of Technical Skills) diseñadas para evaluar competencias en microcirugía en residentes quirúrgicos que completaron un programa de entrenamiento en habilidades básicas de microcirugía en entornos de laboratorio y simulación. Metodología: Estudio descriptivo, observacional y transversal realizado entre agosto de 2018 y marzo de 2019, con una muestra de 29 residentes. Se empleó una metodología formativa para la adquisición de habilidades técnicas en microcirugía. Como instrumento de medición, se diseñaron dos escalas de evaluación (OSATS M1.5 y OSATS M2-0), aplicadas en cinco sesiones: sesión 1 (prueba diagnóstica), sesiones 2, 3 y 4 (formativas) y sesión 5 (evaluación final para identificar el impacto de la estrategia en el desempeño). Resultados: En la sesión 1, el 13.79% de los residentes presentó un rendimiento bajo y el 86.21% un rendimiento medio. Durante las sesiones formativas (2, 3 y 4), el 68.97% alcanzó un rendimiento alto, mientras que el 31.03% fue medio y no hubo rendimiento bajo. En la sesión 5, el 75.86% obtuvo un rendimiento alto y el 24.14% medio. La prueba de permeabilidad vascular positiva aumentó del 34.48% en la sesión 1 al 79.31% en la sesión 5. Conclusión: La creación e implementación de las escalas evaluativas OSATS permiten un seguimiento efectivo del desempeño, evidenciando un avance significativo. Esto sugiere que el modelo es aplicable y útil para los programas de formación en microcirugía vascular.
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    Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study
    (2022-03-16) Moreno Rodríguez, José Antonio; Ortiz Ruiz, Antonio José; Dermatología, Estomatología, Radiología y Medicina Física
    Purpose The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. Methods Twenty patients (stage III–IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. Results GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. Conclusions PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.