Contributos dos suplementos alimentares para resolver problemas de fixação de implantes dentários e as sucessivas perdas dos mesmos : relato retrospetivo de caso
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2022
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Enquadramento: A resistência óssea é dependente dos níveis de cálcio plas-máticos e, de acordo com a Orientação técnica Nº: 13/DSCS/DPCD/DSQC da Dire-ção-Geral da Saúde sobre suplementos de Cálcio (Ca2+) e Vitamina D em pessoas idosas, as pessoas com mais de 65 anos têm indicação para realizar suplementação com cálcio e vitamina D, com precauções. Aproximadamente 99% do Ca2+ corporal encontra-se no esqueleto, principalmente sob a forma de cristais de hidroxiapatite [Ca10(PO4)6(OH)2]. O restante (1%) encontra-se nos dentes, tecidos moles e no flu-ido extracelular. Objetivo e Justificação do Estudo: Relatar o caso de um paciente geriátrico com perimplantite que revelou rejeição permanente a implantes e ao qual foi feita uma abordagem não farmacológica de suplementação complementarmente a uma profila-xia anti-infeciosa. Embora a eficácia da Suplementação com Vitamina D3 em Osteoi-ntegração de Implantes seja muito referenciada, continuam a ser necessários mais estudos, com mais evidências para que se pretendeu contribuir com o presente es-tudo. Descrição do caso: Um homem de 65 anos de idade que demonstra repetida-mente rejeição in loci (localizações múltiplas) a implantes dentários. Ele estava sob profilaxia anti-infeciosa e um regime de suplementação complementar. Nenhum his-tórico familiar de doença óssea ou de má nutrição. Estudos laboratoriais apresentam alto nível de Ferritina, GGT e Homocisteína e baixo nível de 25-Hydroxyvitamina D assim como em determinada altura apresenta osteomalacia. A ortopantomografia apresenta perimplantite nos implantes existentes. Aos 5/6 anos de idade, o seu Mé-dico efetuou-lhe uma transfusão de sangue de ambos os pais, não sabendo para que efeito. Intervenção: Optámos por uma abordagem complementar baseada num re-gime dietético e suplementar alimentar. Com o regime aplicado o paciente deixou de apresentar osteomalacia dando-nos mais possibilidades de integração de implantes Conclusão: A falta de osteointegração é dependente dos níveis de cálcio plas-máticos assim como a diminuição da massa óssea e alteração da qualidade microes-trutura do osso. Contudo, a falta de resposta à suplementação e a existência de hi-perhomocisteinemia ligeira levou à pesquisa e identificação, no paciente, de um Poli-morfismo do MTHFR C-677-T, em que ocorre a troca do Aminoácido ALANINA na posição 222 por VALINA, devido à substituição de uma CITOSINA por uma TIMIDINA no nucleótido 677. Esta mudança produz grandes reduções da atividade da enzima MTHF, as quais justificam a falta de resposta do paciente. Recomenda-se que sejam investigados os polimorfismos genéticos quando são diagnosticadas alterações teci-duais orais levando tanto à perda precoce de dentes e falha de osteointegração de implantes. Palavras-Chave: Implantes, Suplementação; Vitamina D e Cálcio; Homocisteína; Níveis de Ca2+; Vita-mina D3; Vitamina K2; Magnésio; Osteointegração de implante dentário; Saúde es-quelética; Perimplantite dentária; Ortopantemografias e Raio-X periapical
Framework: Bone strength is dependent on plasma calcium levels and, in ac-cordance with Technical Guidance Nº: 13/DSCS/DPCD/DSQC of the Directorate-Gen-eral for Health on Calcium (Ca2+) and Vitamin D supplements in elderly people, people over 65 years of age are recommended to supplement with calcium and vitamin D, with precautions. Approximately 99% of body Ca2+ is found in the skeleton, mainly in the form of hydroxyapatite crystals [Ca10(PO4)6(OH)2]. The remainder (1%) is found in the teeth, soft tissues and extracellular fluid. Objective and Justification of the Study: To report the case of a geriatric pa-tient with peri-implantitis who revealed permanent rejection of implants and who was given a non-pharmacological approach of supplementation in addition to anti-infectious prophylaxis. Although the effectiveness of Supplementation with Vitamin D3 in Oste-ointegration of Implants is widely referenced, further studies are still needed, with more evidence to which this study intended to contribute. Case description: A 65-year-old male who repeatedly demonstrates in loci (multiple locations) rejection of dental implants. He was on anti-infective prophylaxis and a supplemental supplementation regimen. No family history of bone disease or malnutrition. Laboratory studies show high levels of Ferritin, GGT and Homocysteine and low levels of 25-Hydroxyvitamin D, as well as osteomalacia at some point. Or-thopantomography shows peri-implantitis in existing implants. At 5/6 years of age, his Doctor gave him a blood transfusion from both parents, not knowing for what purpose. We opted for a complementary approach based on a dietary and supplementary diet. With the regimen applied, the patient no longer had osteomalacia, giving us more pos-sibilities for implant integration. Intervention: We opted for a complementary approach based on a dietary reg-imen and supplementary food. With the regimen applied, the patient no longer had osteomalacia, giving us more possibilities for implant integration. Conclusion: The lack of osteointegration is dependent on plasma calcium lev-els as well as the decrease in bone mass and alteration of the microstructure quality of the bone. However, the lack of response to supplementation and the existence of mild hyper homocysteinemia led to the research and identification, in the patient, of a Polymorphism of the MTHFR C-677-T, in which the Amino Acid ALANINE at position 222 is replaced by VALINE, due to the replacement of a CYTOSINE by a THYMIDINE at nucleotide 677. This change produces large reductions in the activity of the MTHF enzyme, which explain the patient's lack of response. It is recommended that genetic polymorphisms be investigated when diagnosing oral tissue alterations leading to both early loss of teeth and failure of osteointegration of implants.
Framework: Bone strength is dependent on plasma calcium levels and, in ac-cordance with Technical Guidance Nº: 13/DSCS/DPCD/DSQC of the Directorate-Gen-eral for Health on Calcium (Ca2+) and Vitamin D supplements in elderly people, people over 65 years of age are recommended to supplement with calcium and vitamin D, with precautions. Approximately 99% of body Ca2+ is found in the skeleton, mainly in the form of hydroxyapatite crystals [Ca10(PO4)6(OH)2]. The remainder (1%) is found in the teeth, soft tissues and extracellular fluid. Objective and Justification of the Study: To report the case of a geriatric pa-tient with peri-implantitis who revealed permanent rejection of implants and who was given a non-pharmacological approach of supplementation in addition to anti-infectious prophylaxis. Although the effectiveness of Supplementation with Vitamin D3 in Oste-ointegration of Implants is widely referenced, further studies are still needed, with more evidence to which this study intended to contribute. Case description: A 65-year-old male who repeatedly demonstrates in loci (multiple locations) rejection of dental implants. He was on anti-infective prophylaxis and a supplemental supplementation regimen. No family history of bone disease or malnutrition. Laboratory studies show high levels of Ferritin, GGT and Homocysteine and low levels of 25-Hydroxyvitamin D, as well as osteomalacia at some point. Or-thopantomography shows peri-implantitis in existing implants. At 5/6 years of age, his Doctor gave him a blood transfusion from both parents, not knowing for what purpose. We opted for a complementary approach based on a dietary and supplementary diet. With the regimen applied, the patient no longer had osteomalacia, giving us more pos-sibilities for implant integration. Intervention: We opted for a complementary approach based on a dietary reg-imen and supplementary food. With the regimen applied, the patient no longer had osteomalacia, giving us more possibilities for implant integration. Conclusion: The lack of osteointegration is dependent on plasma calcium lev-els as well as the decrease in bone mass and alteration of the microstructure quality of the bone. However, the lack of response to supplementation and the existence of mild hyper homocysteinemia led to the research and identification, in the patient, of a Polymorphism of the MTHFR C-677-T, in which the Amino Acid ALANINE at position 222 is replaced by VALINE, due to the replacement of a CYTOSINE by a THYMIDINE at nucleotide 677. This change produces large reductions in the activity of the MTHF enzyme, which explain the patient's lack of response. It is recommended that genetic polymorphisms be investigated when diagnosing oral tissue alterations leading to both early loss of teeth and failure of osteointegration of implants.
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Orientação: Maria do Céu Costa
Palavras-chave
MESTRADO EM PRODUTOS DE SAÚDE E SUPLEMENTOS ALIMENTARES, SUPLEMENTOS ALIMENTARES, CASOS PRÁTICOS, IMPLANTES DENTÁRIOS, DIETARY SUPPLEMENT, PRACTICAL CASE STUDIES, DENTAL IMPLANTS