RESUMO
BACKGROUND: Fibular free flap (FFF) bone has thick cortical bone surrounding a fatty marrow. The cortex has sufficient density for dental implantation, but the marrow limits bone stock. A novel technique was devised to increase bone density: the bone-impacted fibular free flap (BIFFF). The purpose of this study was to: (1) describe the BIFFF technique; (2) evaluate the bone density of BIFFF; and (3) evaluate the stability/success of implants placed in BIFFFs. METHODS: Patients undergoing maxillary/mandibular reconstruction with FFFs were prospectively enrolled from 1998 to 2008. Two cohorts were compared: BIFFF and nonmodified FFF. The main outcome was bone density as seen on CT scans. Primary dental implant stability was determined via Periotest. RESULTS: Thirty-eight patients were included in this study. BIFFFs achieved higher bone density versus unmodified FFFs (p < .05). Greater primary dental implant stability occurred in BIFFFs (p < .05). One hundred percent of BIFFF and 59% of nonmodified FFF implants were successful at 1 year. CONCLUSION: BIFFF increases reconstructed bone density, initial dental implant stability, and 1-year implant success.
Assuntos
Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Fíbula/transplante , Retalhos de Tecido Biológico/transplante , Procedimentos de Cirurgia Plástica/métodos , Idoso , Densidade Óssea/fisiologia , Estudos de Coortes , Implantação Dentária Endóssea/efeitos adversos , Feminino , Fíbula/cirurgia , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Caspases are crucial activators of apoptosis and NF-kappaB signaling in vertebrates and invertebrates. In Drosophila, the caspase-9 counterpart Dronc is essential for most apoptotic death, whereas the caspase-8 homolog Dredd activates NF-kappaB signaling in response to gram-negative bacterial infection. The mechanics of caspase regulation are conserved and include the activities of a family of inhibitor of apoptosis (IAP) proteins. The RING-domain-bearing protein Defense repressor 1 (Dnr1), blocks ectopic Dredd-mediated induction of an NF-kappaB reporter in the Drosophila S2 cell line. In this study, we present novel data indicating that Dnr1 impacts on Dronc-dependent regulation of the apoptotic program. We show that depletion of Dnr1 results in elevated Dronc protein levels, which translates to increased caspase activation and activity upon induction of apoptosis. Conversely, we demonstrate that overexpression of Dnr1 blocks apoptotic caspase activity and prevents induction of apoptosis in tissue culture assays. Furthermore, we show that Dnr1 overexpression significantly reduces Dronc protein levels and identify the domains of Dnr1 necessary for these effects. From these data, we propose that Dnr1 inhibits initiator caspases in S2 cells.