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Aplicação clínica de células mesenquimatosas em cirurgia oral: uma revisão sistemática da literatura
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Introdução: A capacidade das BMSCs se diferenciarem em células osteoblásticas e formarem osso tem sido extensivamente investigada. O princípio fundamental da terapia in vivo utilizando BMSCs em engenharia óssea defende que as células indiferenciadas após migrarem para o local da lesão, irão, sob a influência de sinais locais, sofrer diferenciação em células com o fenótipo apropriado para a reparação do tecido lesado. Apesar de existirem fontes celulares alternativas, as BMSCs continuam a ser o tipo celular primordial a utilizar em engenharia óssea. Objetivo: Pretende-se responder à questão PICO: “Em pacientes adultos com deficiências ósseas alveolares a utilização de BMSCs para regeneração alveolar é mais eficaz quando comparada com outras terapias com base na utilização de enxertos ósseos autógenos e outros tipos de células estaminais a nível da localização do defeito ósseo; volume, altura e densidade óssea; sucesso da terapia implantar/ necessidade de transplante ósseo adicional; e evidência de regeneração de novo tecido ósseo?” Materiais e Métodos: Foi efetuada uma pesquisa na base de dados primária (MEDLINE) com as palavras-chave mesenchymal stem cells e regenerative oral medicine para estudos humanos, sem restrições temporais, nas línguas portuguesa, espanhola e inglesa. Dos 217 estudos foram incluídos 4, duas revisões sistemáticas, 1 estudo coorte e 1 RCT. Resultados: Num total de 419 pacientes foram avaliados os seguintes parâmetros: localização do defeito ósseo; técnica regenerativa utilizada; volume, altura e densidade óssea; sucesso da terapia implantar/ necessidade de transplante ósseo adicional e evidência de regeneração de tecido ósseo. Os resultados foram superiores nas terapias com base na utilização de células estaminais da medula óssea. Conclusões: A eficácia relatada nos estudos de engenharia tecidual continua a ser controversa e uma pesquisa mais aprofundada é necessária antes de poder implementar de forma segura este tipo de terapias regenerativas na prática clínica.
Introduction: The ability of BMSCs to differentiate into osteoblastic cells and generate bone has been extensively investigated. The principle of in vivo therapy based on the use of BMSCs in bone engineering defends that the undifferentiated cells after migrating to the injury site will, under the influence of local signals, differentiate into cells having the appropriate phenotype for repair the damaged tissue. Although there are alternative cell sources, BMSCs remain the primary cell type to be used in bone engineering. Purpose: The aim was to answer the PICO question: "In adult patients with alveolar bone deficiencies the use of BMSCs to cellular regeneration is more effective when compared with other therapies based on the use of autogenous bone grafts and other types of stem cells tanking into account the bone defect location; volume, height and bone density; success from the implant therapy/ need for additional bone grafting and evidence of new bone tissue regeneration?'' Materials and Methods: Scientific search was performed in a primary database using the keywords mesenchymal stem cells and regenerative oral medicine for studies in humans, without time restrictions, written in Portuguese, Spanish or English. A total of 217 records were identified, only 4 were included (two systematic reviews, 1 cohort study and 1 RCT). Results: 419 patients were evaluated taking into account the follow parameters: location of the bone defect; regenerative technique; volume, height and bone density; success from the implant therapy/need for additional bone grafting; and bone regeneration evidence. The results were higher in the therapies based on the use of stem cells from bone marrow. Conclusions: The efficacy reported in studies of tissue engineering remains controversial and further research is needed before this type of regenerative therapies can be safely implement in the clinical practice.
Introduction: The ability of BMSCs to differentiate into osteoblastic cells and generate bone has been extensively investigated. The principle of in vivo therapy based on the use of BMSCs in bone engineering defends that the undifferentiated cells after migrating to the injury site will, under the influence of local signals, differentiate into cells having the appropriate phenotype for repair the damaged tissue. Although there are alternative cell sources, BMSCs remain the primary cell type to be used in bone engineering. Purpose: The aim was to answer the PICO question: "In adult patients with alveolar bone deficiencies the use of BMSCs to cellular regeneration is more effective when compared with other therapies based on the use of autogenous bone grafts and other types of stem cells tanking into account the bone defect location; volume, height and bone density; success from the implant therapy/ need for additional bone grafting and evidence of new bone tissue regeneration?'' Materials and Methods: Scientific search was performed in a primary database using the keywords mesenchymal stem cells and regenerative oral medicine for studies in humans, without time restrictions, written in Portuguese, Spanish or English. A total of 217 records were identified, only 4 were included (two systematic reviews, 1 cohort study and 1 RCT). Results: 419 patients were evaluated taking into account the follow parameters: location of the bone defect; regenerative technique; volume, height and bone density; success from the implant therapy/need for additional bone grafting; and bone regeneration evidence. The results were higher in the therapies based on the use of stem cells from bone marrow. Conclusions: The efficacy reported in studies of tissue engineering remains controversial and further research is needed before this type of regenerative therapies can be safely implement in the clinical practice.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2016
Palavras-chave
Cirurgia oral Células estaminais Teses de mestrado - 2016