A Randomized Clinical Trial Evaluating rh-FGF-2/ß-TCP in Periodontal Defects.

Biological mediators have been used to enhance periodontal regeneration. The aim of this prospective randomized controlled study was to evaluate the safety and effectiveness of 3 doses of fibroblast growth factor 2 (FGF-2) when combined with a ß-tricalcium phosphate (ß-TCP) scaffold carrier placed in vertical infrabony periodontal defects in adult patients. In this double-blinded, dose-verification, externally monitored clinical study, 88 patients who required surgical intervention to treat a qualifying infrabony periodontal defect were randomized to 1 of 4 treatment groups-ß-TCP alone (control) and 0.1% recombinant human FGF-2 (rh-FGF-2), 0.3% rh-FGF-2, and 0.4% rh-FGF-2 with ß-TCP-following scaling and root planing of the tooth prior to a surgical appointment. Flap surgery was performed with EDTA conditioning of the root prior to device implantation. There were no statistically significant differences in patient demographics and baseline characteristics among the 4 treatment groups. When a composite outcome of gain in clinical attachment of 1.5 mm was used with a linear bone growth of 2.5 mm, a dose response pattern detected a plateau in the 0.3% and 0.4% rh-FGF-2/ß-TCP groups with significant improvements over control and 0.1% rh-FGF-2/ß-TCP groups. The success rate at 6 mo was 71% in the 2 higher-concentration groups, as compared with 45% in the control and lowest treatment groups. Percentage bone fill in the 2 higher-concentration groups was 75% and 71%, compared with 63% and 61% in the control and lowest treatment group. No increases in specific antibody to rh-FGF-2 were detected, and no serious adverse events related to the products were reported. The results from this multicenter trial demonstrated that the treatment of infrabony vertical periodontal defects can be enhanced with the addition of rh-FGF-2/ß-TCP (ClinicalTrials.gov NCT01728844).

Altered gene expression profile in vaginal polypoid endometriosis resembles peritoneal endometriosis and is consistent with increased local estrogen production.

BACKGROUND: In a university hospital setting, a 25-year-old woman presented with large vaginal and cervical polyps. Past medical history was significant for stage IV endometriosis. Polypectomy was performed and the polyps were histologically consistent with endometriosis. Gene expression was compared with control vaginal tissue to assess if the altered gene expression profile was similar to peritoneal endometriosis. METHODS AND RESULTS: Using quantitative reverse transcription, real-time PCR, estrogen receptor-ß expression was found to be upregulated 10-fold while estrogen receptor-α expression was downregulated 5-fold in the vaginal polyp relative to control vaginal tissue. The estrogen-synthesizing enzyme aromatase was upregulated 8-fold and 3ß-hydroxysteroid dehydrogenase was upregulated 400-fold in the polyp. Immunohistochemical staining revealed altered cell type localization for progesterone receptor in the polyp and increased cell proliferation in polyp stromal cells relative to control. CONCLUSIONS: Increased proliferation in the vaginal polypoid endometriotic tissue may be due to increased local estrogen production. The altered gene expression profile was very similar to the altered gene expression profile seen in peritoneal endometriosis.

Periodontal implications: anxiety.

1. Monitoring significantly improves patient outcomes. 2. Observing and communicating with the patient is the most important means of monitoring the patient's status during sedation. 3. Monitoring of ventilations along with the assessment of oxygen saturation via a pulse oximeter is significant in preventing hypoxemia. 4. The use of supplemental oxygen is recommended. 5. Monitoring of blood pressure and pulse is highly recommended for assessing hemodynamic status. 6. Use of electrocardiograms is recommended for the patients with cardiovascular disorders.

The clinical effectiveness of open versus closed scaling and root planing on multi-rooted teeth.

Scaling and root planing are the most common techniques utilized to achieve a biologically-acceptable root surface. Thorough root debridement is a demanding task, with residual deposits of plaque and calculus a not uncommon finding after instrumentation. This study evaluated the effectiveness of scaling and root planing via a closed versus an open flap approach. Sixty multi-rooted teeth were assigned to one of three groups: untreated controls, closed scaling/root planing, and open flap scaling/root planing. Following debridement, teeth were extracted, immersed in methylene blue, and examined for the percent surface area having stainable residual deposits. The mean percent stained surface area covered by residual plaque and calculus was 54.3% in the closed root planing group compared to 33.0% in the open flap root planing group. The untreated control teeth had 91.0% of the root surface covered with stainable deposits. Within-group comparisons showed no significant difference in the percent stained residual plaque and calculus in shallow areas of the pocket (< or = 3 mm apical to the gingival margin) compared to deeper areas (> 3 mm subgingival). Examination of furcation regions demonstrated heavy residual stainable deposits for both treatment methods, with no significant differences between techniques. There was no correlation between the time spent in root debridement and the percent residual deposit area. The results demonstrate that hand instrumentation alone is inadequate for thorough debridement of furcations and suggest that new approaches are needed to provide a root surface which is compatible with formation of new periodontal attachment. High frequency ultrasonic instruments, rotary burs, and chemical agents may assist in debridement of such surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoral palatal mucosal graft harvest.

The anatomy of the hard plate is reviewed with respect to the clinical considerations of harvesting intraoral hard palate grafts for various reconstructive eyelid procedures. Recommendations for harvesting grafts based on these anatomic principles are given.

Soft tissue management during implant maintenance.

Peri-implant soft tissue problems seen during the maintenance phase of implant therapy include an inadequate zone of keratinized tissue, mobility of grafted tissue, mucosal "pouching," gingival hyperplasia, gingival fistulas, and gingivitis. Techniques to alleviate or reduce these problems include free soft tissue autografts, apically positioned flaps, reduction of tissue thickness by a flap procedure or gingivectomy, and increased attention to the control of inflammation.

The surface characteristics produced by various oral hygiene instruments and materials on titanium implant abutments.

The purpose of this investigation was to determine the comparative surface roughness produced by various oral hygiene instruments and materials on titanium implant abutments. Ten Brånemark titanium abutment cylinders were used, with one serving as an untreated control. One abutment was used to evaluate each of nine oral hygiene instrumentation methods used for specified lengths of time or instrument strokes. Each abutment was sonically cleaned, air dried, and viewed with a scanning electron microscope. Polaroid photomicrographs were made of abutment surfaces at predetermined magnifications. They were analyzed by three investigators, who compared individual test parameters in terms of time application or stroke number. The resulting abutment surface roughness was also evaluated. The rubber cup with flour of pumice created a smoother surface than the control; the interdental brush, soft nylon toothbrush, plastic scaler, Eva plastic tip, rubber cup, and Cavi-jet left a surface comparable to the control; the metal scalers and the Cavitron created a severely roughened surface.

Periodontal wound healing responses to varying oxygen concentrations and atmospheric pressures.

Oxygen effects on healing gingival wedge excisions were tested using Sprague-Dawley rats. 40 operated controls were maintained at normal pressure in room air. 3 experimental groups of 40 rats each were exposed for 90 min daily to one of the following: (1) 20.8% oxygen at 2.4 atmospheres pressure, (2) 100% oxygen at 1 atmosphere, or (3) 100% oxygen at 2.4 atmospheres. 5 animals in each group were sacrificed at the following times: 30, 54, 78 h and weeks 1, 2, 3, 6 and 12. Histometric analysis was performed using light microscopy. The connective tissue healing above a reference notch on the maxillary first molar mesial root was assessed. The controls failed to show healing comparable to experimental animals until the end of 2 weeks. Enhanced connective tissue healing above the notch was most significant (p less than or equal to 0.05) in the 2.4 atmospheres pressure groups at 3 and 6 weeks when compared to controls. However, by 12 weeks, no significant differences could be detected. New cementum formation was rare and occasional root resorption was observed. Early connective tissue adaptation does not imply eventual attachment as epithelial downgrowth progressively displaced the connective tissue adjacent to the root in both experimental and control groups of this study.

Quantitative distribution of inflammatory cells in recurrent aphthous stomatitis.

Histologic quantitation of leukocytes in biopsies of recurrent aphthous ulcers revealed at least two morphologically-distinct inflammatory infiltrates. Lymphocytes were found consistently in pre-ulcerative lesions and in the expanding margins of the developing ulcer. In contrast, polymorphonuclear leukocytes predominated only in areas of frank ulceration.