İntraoral yara iyileşmesinde berrak sıvı diyetin etkisinin klinik ve histopatolojik değerlendirilmesi
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Tarih
2024
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: İntraoral yara iyileşmesi diş hekimliğinde, özellikle de periodontoloji ve çene cerrahisi branşları için yüksek önem taşıyan bir olaydır. Mukogingival deformitelerin tedavilerinde yumuşak doku ogmentasyonları için serbest dişeti grefti ve bağ dokusu grefti sıklıkla tercih edilmektedir. Otojen yumuşak doku grefti alınması sonucu verici sahada geniş bir sekonder yara bölgesi oluşmaktadır. Bu geniş yara bölgesi hem hastalarda konforsuzluğa hem de cerrahi komplikasyonlara yol açabilmektedir. Yara iyileşmesini geliştirmek, hasta konforunu artırmak ve morbiditeyi en aza indirmek için farklı teknikler uygulanmaktadır. Beslenme, yara iyileşmesi ile birebir ilişkisi olan bireyin metabolik aktiviteleri için esastır. Oral cerrahiler sonrası dönemde yarayı korumak için beslenme kısıtlamaları sıklıkla uygulanmaktadır. Berrak sıvı diyet (BSD); çeşitli sebeplerden dolayı oral katı gıda tüketiminin uygun olmadığı durumlarda oral yolla beslenmenin başlaması veya devam edebilmesi için başvurulan bir beslenme protokolüdür. Literatürde BSD protokolünün intraoral yara iyileşmesi üzerine etkilerinin incelendiği herhangi bir çalışma bulunmamaktadır. Çalışmamızın amacı, intraoral yara iyileşmesi üzerinde berrak sıvı diyet protokolünün etkilerinin karşılaştırılmasıdır. Gereç ve Yöntem: 48 adet Albino Wistar sıçan; Berrak Sıvı Test (BST), Normal Test (NT), Berrak Sıvı Kontrol (BSK) ve Normal Kontrol (NK) olmak üzere 4 gruba ayrılmıştır. Test gruplarında 3. 7. ve 14. gün takip periyotlarının her birinde altışar sıçan olmak üzere toplam n=18, kontrol gruplarında ise sadece 14. gün takip periyodu için n=6 olarak belirlenmiştir. Test gruplarındaki sıçanların palatinal mukozasında 4 mm çaplı eksizyonel yara oluşturulmuştur. İyileşme döneminde BST ve BSK grupları tüm takip periyodu boyunca BSD ile beslenmiştir. NT ve NK grupları ise standart rodent pellet yemle beslenmiştir. Sıçanların iyileşme dönemi boyunca günlük vücut ağırlıkları kaydedilmiştir. 3. 7. ve 14. günlerde test gruplarının her birinden altı, 14. günde kontrol gruplarının her birinden altı sıçan sakrifiye edilmiştir. Sakrifiye edilen hayvanlarda maksilla diseksiyonu yapılarak yara bölgesini içeren dokular ayrılmıştır. Bu dokularda standart büyütme ile yara fotoğrafları çekilmiş bu fotoğraflar üzerinden yara boyutları ve yara yüzey alanı ölçümleri yapılmıştır. Daha sonra yara dokularında histopatolojik yara iyileşme parametreleri değerlendirilmiştir. İmmunohistokimyasal analizlerde CK14 ve CD34 ekspresyonları yönünden gruplar karşılaştırmalı olarak incelenmiştir. Bulgular: Takip periyodunda berrak sıvı ile beslenen gruplarda, cerrahi işlem geçirilmesinden bağımsız olarak, belirgin bir ağırlık kaybı olduğu görülmüş ve iki grup arasındaki bu farkların 3. günden sonra gittikçe belirginleştiği gözlemlenmiştir. Yara fotoğrafları üzerinde yapılan milimetrik yara boyutları ölçümlerinde BST grubunda daha hızlı küçülme trendi olduğu fakat iki grup arasında istatistiksel olarak anlamlı bir fark olmadığı belirlenmiştir. Histopatolojik incelemelerde reepitelizasyon açısından BST grubu, neokapillarizasyon yönünden NT grubu daha başarılı bulunmuştur. İmmunohistokimyasal analizlerde CK14 ekspresyonu BST grubunda daha yüksek ölçülmüştür ve bu fark 14. günde istatistiksel olarak anlamlı düzeye ulaşmıştır. CD34 ekspresyonu, BST grubu değerleri diğer gruplara göre 3. günde anlamlı derecede daha yüksekken 14. güne gelindiğinde NT grubunda diğer gruplara göre anlamlı düzeyde daha yüksek CD34 ekspresyonu belirlenmiştir. Sonuç: BSD protokolü; intraoral yara iyileşme sürecinde erken dönemde normal katı beslenmeye göre daha başarılıdır. Uzun süre uygulandığında bireyde malnütrisyona ve kilo kaybına yol açabilmektedir. Bu çalışma, BSD'nin intraoral yara iyileşmesi üzerine etkilerinin değerlendirildiği ilk çalışma olarak benzer laboratuvar ve klinik çalışmalara öncülük teşkil edebilir. Sonuçların klinik pratiğe taşınabilmesi için klinik çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Berrak sıvı diyet, intraoral yara iyileşmesi, serbest dişeti grefti, SDG, bağ dokusu grefti, BDG, mukogingival cerrahi, palatal verici saha, otojen yumuşak doku grefti.
Introduction: Intraoral wound healing is a crucial phenomenon in dentistry, particularly in the fields of periodontology and maxillofacial surgery. Soft tissue augmentations using free gingival grafts and connective tissue grafts are commonly preferred in the treatment of mucogingival deformities. However, harvesting autogenous soft tissue grafts results in a broad secondary wound area in the donor site, leading to discomfort and surgical complications for patients. Various techniques are employed to enhance wound healing, improve patient comfort, and minimize morbidity. Nutrition plays a vital role in the metabolic activities of individuals, directly influencing wound healing. Post-operative healing periods following oral surgeries often involve dietary restrictions to preserve the wound. Clear fluid diet (CFD) is a nutritional protocol used to initiate or continue oral feeding when solid food consumption is not suitable for various reasons. There is a lack of studies in the literature investigating the effects of CFD protocol on intraoral wound healing. The aim of our study is to compare the effects of clear fluid diet protocol on intraoral wound healing. Materials and Methods: Forty-eight Albino Wistar rats were divided into four groups: Clear Fluid Test (CFT), Normal Test (NT), Clear Fluid Control (CFC), and Normal Control (NC). In each of the test groups, six rats each were assigned for the 3rd, 7th, and 14th-day follow-up periods (total n=18), while in the control groups, only 6 rats were designated for the 14th-day follow-up period. Excisional wounds of 4 mm diameter were created in the palatal mucosa of rats in the test groups. During the healing period, CFT and CFC groups were fed with CFD throughout the follow-up period, while NT and NC groups were fed with standard rodent pellet feed. Daily body weights of rats were recorded throughout the healing period. On the 3rd, 7th, and 14th days, six rats from each test group and six rats from each control group were sacrificed. Maxillary dissection was performed on sacrificed animals to separate tissues containing the wound region. Wound areas are photographed under standard magnification. Wound dimensions and wound surface area were measured from these photographs. Subsequently, histopathological parameters of wound healing were evaluated. Comparative analysis of CK14 and CD34 expressions was conducted through immunohistochemical analyses. Results: In the follow-up period, significant weight loss was observed in groups fed with clear fluids, independent of surgical procedures, and these differences became more pronounced after the 3rd day. Measurements of millimetric wound dimensions on wound photographs showed a faster reduction trend in the CFT group, although there was no statistically significant difference between the two groups. Histopathological examinations revealed that the CFT group was more successful in terms of reepithelialization, while the NT group showed greater success in neovascularization. Immunohistochemical analysis demonstrated higher CK14 expression in the CFT group, reaching statistical significance on the 14th day. CD34 expression was significantly higher in the CFT group on the 3rd day but became more intense in the NT group compared to other groups on the 14th day. Conclusion: The CFD protocol is more successful than a normal solid diet in the early stages of intraoral wound healing. Prolonged application may lead to malnutrition and weight loss in individuals. This study serves as the first investigation into the effects of CFD on intraoral wound healing, paving the way for similar laboratory and clinical studies. Clinical trials are needed to translate the results into clinical practice. Keywords: Clear fluid diet, intraoral wound healing, free gingival graft, FGG, connective tissue graft, CTG, mucogingival surgery, palatal donor site, autogenous soft tissue graft.
Introduction: Intraoral wound healing is a crucial phenomenon in dentistry, particularly in the fields of periodontology and maxillofacial surgery. Soft tissue augmentations using free gingival grafts and connective tissue grafts are commonly preferred in the treatment of mucogingival deformities. However, harvesting autogenous soft tissue grafts results in a broad secondary wound area in the donor site, leading to discomfort and surgical complications for patients. Various techniques are employed to enhance wound healing, improve patient comfort, and minimize morbidity. Nutrition plays a vital role in the metabolic activities of individuals, directly influencing wound healing. Post-operative healing periods following oral surgeries often involve dietary restrictions to preserve the wound. Clear fluid diet (CFD) is a nutritional protocol used to initiate or continue oral feeding when solid food consumption is not suitable for various reasons. There is a lack of studies in the literature investigating the effects of CFD protocol on intraoral wound healing. The aim of our study is to compare the effects of clear fluid diet protocol on intraoral wound healing. Materials and Methods: Forty-eight Albino Wistar rats were divided into four groups: Clear Fluid Test (CFT), Normal Test (NT), Clear Fluid Control (CFC), and Normal Control (NC). In each of the test groups, six rats each were assigned for the 3rd, 7th, and 14th-day follow-up periods (total n=18), while in the control groups, only 6 rats were designated for the 14th-day follow-up period. Excisional wounds of 4 mm diameter were created in the palatal mucosa of rats in the test groups. During the healing period, CFT and CFC groups were fed with CFD throughout the follow-up period, while NT and NC groups were fed with standard rodent pellet feed. Daily body weights of rats were recorded throughout the healing period. On the 3rd, 7th, and 14th days, six rats from each test group and six rats from each control group were sacrificed. Maxillary dissection was performed on sacrificed animals to separate tissues containing the wound region. Wound areas are photographed under standard magnification. Wound dimensions and wound surface area were measured from these photographs. Subsequently, histopathological parameters of wound healing were evaluated. Comparative analysis of CK14 and CD34 expressions was conducted through immunohistochemical analyses. Results: In the follow-up period, significant weight loss was observed in groups fed with clear fluids, independent of surgical procedures, and these differences became more pronounced after the 3rd day. Measurements of millimetric wound dimensions on wound photographs showed a faster reduction trend in the CFT group, although there was no statistically significant difference between the two groups. Histopathological examinations revealed that the CFT group was more successful in terms of reepithelialization, while the NT group showed greater success in neovascularization. Immunohistochemical analysis demonstrated higher CK14 expression in the CFT group, reaching statistical significance on the 14th day. CD34 expression was significantly higher in the CFT group on the 3rd day but became more intense in the NT group compared to other groups on the 14th day. Conclusion: The CFD protocol is more successful than a normal solid diet in the early stages of intraoral wound healing. Prolonged application may lead to malnutrition and weight loss in individuals. This study serves as the first investigation into the effects of CFD on intraoral wound healing, paving the way for similar laboratory and clinical studies. Clinical trials are needed to translate the results into clinical practice. Keywords: Clear fluid diet, intraoral wound healing, free gingival graft, FGG, connective tissue graft, CTG, mucogingival surgery, palatal donor site, autogenous soft tissue graft.
Açıklama
Diş Hekimliği Fakültesi, Periodontoloji Ana Bilim Dalı
Anahtar Kelimeler
Diş Hekimliği, Dentistry
