Radiographic and Histologic Evaluations of Peri-implantitis on the Grafted Maxillary Sinus: A Report of Two Cases.

Management of peri-implantitis is becoming an increasing issue for implantologists and periodontists. The need for bone augmentation is more and more frequent, especially in the posterior maxilla requiring sinus augmentation. Peri-implantitis represents a real danger for implants, but to this day, the available literature concerning the impact of this disease on regenerated bone and on maxillary sinus pathology is very limited. This report presents two cases showing bone alterations due to peri-implantitis and its possible impact on maxillary sinus health. In both cases, the causal implant was removed regardless of prior functional endoscopic surgery to restore sinus health, and it was not necessary to implement any reconstruction procedure because bone regeneration occurred naturally. Further research will be necessary to confirm these initial findings.

Lateral alveolar ridge augmentation procedure using subperiosteal tunneling technique: a pilot study.

BACKGROUND: In this research article, we evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of ß-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge. METHODS: A total of 9 patients with deficient mandibular alveolar ridges were included in the present pilot study. Ten lateral ridge augmentation were carried out using the sub-periosteal tunneling technique, including a bilateral procedure in one patient. The increase in ridge width was assessed using CBCT evaluation of the ridge preoperatively and at 4 months postoperatively. Histological assessment of the quality of bone formation was also carried out with bone cores obtained at the implant placement re-entry in one patient. RESULTS: The mean bucco-lingual ridge width increased in average from 4.17 ± 0.99 mm to 8.56 ± 1.93 mm after lateral bone augmentation with easy-graft CRYSTAL using the tunneling technique. The gain in ridge width was statistically highly significant (p = 0.0019). Histomorphometric assessment of two bone cores obtained at the time of implant placement from one patient revealed 27.6% new bone and an overall mineralized fraction of 72.3% in the grafted area 4 months after the bone grafting was carried out. CONCLUSIONS: Within the limits of this pilot study, it can be concluded that sub-periosteal tunneling technique using in situ hardening biphasic calcium phosphate is a valuable option for lateral ridge augmentation to allow implant placement in deficient alveolar ridges. Further prospective randomized clinical trials will be necessary to assess its performance in comparison to conventional ridge augmentation procedures.

Ridge preservation using an in situ hardening biphasic calcium phosphate (ß-TCP/HA) bone graft substitute-a clinical, radiological, and histological study.

BACKGROUND: Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/ß-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane. METHODS: A total of 15 patients reported for tooth extraction were enrolled in this study. Implants were placed in average 5.2 ± 2 months after socket grafting. At this visit, Cone Beam CT (CBCT) images and core biopsies were taken. Implant stability (ISQ) was assessed at the insertion as well as at the day of final restoration. RESULTS: CBCT data revealed 0.79 ± 0.73 mm ridge width reduction from grafting to implant placement. Histomorphometric analysis of core biopsy samples revealed in average 21.34 ± 9.14% of new bone in the grafted sites. Primary implant stability was high (ISQ levels 70.3 ± 9.6) and further increased until final restoration. CONCLUSIONS: The results of this study show that grafting of intact post-extraction sockets using a biphasic in situ hardening bone graft substitute results in an effective preservation of the ridge contour and sufficient new bone formation in the grafted sites, which is imperative for successful implant placement.

Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery.

BACKGROUND: Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities. METHODS: Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported. RESULTS: In 11 of 17 patients (64.7 %), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5 ± 1.9 mm, p < 0.02), widths (3.7 ± 0.9 mm) or area (21.1 ± 9.1 mm(2)), had vital margins of perforations and 1.1 ± 0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3 %) showed larger perforation lengths (13.4 ± 8.8 mm, p < 0.02), widths (5 ± 4.5 mm) and area (97.6 ± 149 mm(2)), had necrotic or soft inflammatory margins and significantly more OTSC (2.3 ± 0.5, p = 0.018) were tried. CONCLUSIONS: OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected.

Metastatic insulinoma - prolonged survival after multimodal approach.

BACKGROUND: Metastatic insulinoma is a disease associated with a poor life expectancy. CASE REPORT: The case of a presently 68 year old female with malignant, metastatic insulinoma is reported. Due to severe clinical symptoms surgical tumor mass reduction was conducted. Furthermore the patient underwent a chemotherapy using streptozotocine and fluorouracil. After two years without any symptoms, the remaining hepatic metastases increased in size and again hypoglycemias occurred. To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine. After the first treatment the patient was hypoglycemia - free for 3 months, after another more extensive chemoembolization the patient is presently symptom free for 8 months. CONCLUSIONS: Since the diagnosis of extended disease was established, the patient has survived for 36 months. We regard this as the result of a multimodal approach and the extensive use of local tumor therapy. The different therapeutic options for local tumor therapy are reported and discussed.