Five-year clinical results for treatment of intrabony defects with EMD, guided tissue regeneration and open-flap debridement: a case series.

BACKGROUND AND OBJECTIVE: Although regenerative periodontal surgery with EMD or guided tissue regeneration (GTR) has been shown to enhance periodontal regeneration, there are limited data on the long-term results following these treatment modalities. The purpose of the present study was to investigate the long-term clinical outcomes in intrabony defects following regenerative periodontal surgery with EMD or GTR compared with open-flap debridement (OFD). MATERIAL AND METHODS: Data from 40 subjects (44 teeth), with no history of smoking or systemic diseases that could interfere with periodontal disease and who received one of three surgical procedures (EMD, GTR or OFD) for two- or three-wall intrabony defects, were analyzed. Postoperative reduction in probing pocket depth, gain in clinical attachment level, gingival recession and percentage bone fill were compared at 1, 3 and 5 years. RESULTS: Reduction in probing pocket depth after GTR was significantly higher than after OFD at 1 and 3 years postoperatively, but there was no difference between the groups at 5 years. The gains in clinical attachment level for EMD (at 3 and 5 years) and for GTR (at 1, 3 and 5 years) were significantly greater than for OFD. Gingival recession after treatment with EMD and GTR showed a tendency toward positive results, whereas no such tendency was observed for OFD. Postoperative percentage bone fill for EMD and GTR was significantly greater than for OFD at 3 and 5 years. CONCLUSIONS: This is a retrospective study and an exploratory report with a high risk of bias. Within the limits of the current study, it may be concluded that superior gains in clinical attachment level and improved percentage bone fill can be obtained with EMD and GTR when compared with OFD, and these can be maintained over a period of 5 years.

Sarcomatous overgrowth in recurrent ameloblastic fibrosarcoma.

A case of recurrent ameloblastic fibrosarcoma (AFS) in the mandibular molar region of a 22-year-old male is reported. The tumor was first diagnosed as a sarcoma of undetermined origin, because the benign epithelial component of AFS had disappeared after repeated surgical procedures. The lesion grew rapidly in the time from hospital admission until operation, suggesting progression from low to high malignancy. The correlation between the benign epithelial component and malignancy is discussed.

Relationship between body core and peripheral temperatures at the onset of thermoregulatory responses in rats.

The relationships between body core temperature and environmental temperature (T(a)) at the onset of tail skin vasodilation, thermally-induced salivary secretion and cold-induced thermogenesis were examined in rats. Hypothalamic temperature (Thy) was measured as an index of body core temperature. Internal body heating and cooling were made using an intravenous thermode chronically implanted in the inferior vena cava at various T(a)s. External heating and cooling were made by changing T(a) at a constant rate, while Thy was controlled at constant levels with the thermode. Internal heating induced tail skin vasodilation but not thermally-induced salivary secretion, and internal cooling induced cold-induced thermogenesis. External warming caused tail skin vasodilation and thermally-induced salivary secretion, but external cooling failed to induce cold-induced thermogenesis. There were significant correlations between Thy and T(a) at the onset of tail skin vasodilation, thermally-induced salivary secretion and cold-induced thermogenesis. When T(a) was taken as an indicator of thermal input from the skin, the ratios of the potency of inputs from the body core and skin were estimated to be between 8:1 and 6:1 at the onset of tail skin vasodilation, 8:1 at the onset of thermally-induced salivary secretion, and 5:1 for the control of cold-induced thermogenesis. These results suggest that, in rats, the contribution of thermal input from the skin to the onset of thermoregulatory responses is relatively small.

Solid variant of an aneurysmal bone cyst (giant cell reparative granuloma) of the 3rd lumbar vertebra.

A 9-year-old girl with a solid variant of an aneurysmal bone cyst in the 3rd lumbar vertebra showed a good response to low-dose radiation as the only treatment. The solid variant of aneurysmal bone cyst is thought to be a reactive response to intraosseous hemorrhage and is also called giant cell reparative granuloma or giant cell reaction. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. Aneurysmal bone cysts of the spine also show a fairly high recurrence rate after incomplete resection or radiation therapy. However, 7 previous cases of the solid variant of aneurysmal bone cyst in the spine and this case did not show recurrence after a mean follow-up period of 45 months. This difference in behaviour suggests that the solid variant should be recognized before surgery as being distinct from conventional aneurysmal bone cysts, especially in the spine.

Minimally invasive approach with tissue engineering for severe alveolar bone atrophy case.

The gold standard of bone augmentation for dental implants in severe alveolar bone atrophy is autogenous bone graft, but it has disadvantages such as limited amounts of grafted bone, poor morphological and aesthetic outcomes, and donor-site morbidity and invasiveness, especially in cases with diseases. In this reported case, the authors applied a novel tissue engineering method as minimally invasive surgery for a 58-year-old patient who had severe bone atrophy. The method, tissue-engineered bone (TEB), composed of mesenchymal stem cells as stem cells, platelet-rich plasma as growth factor and guided bone regeneration membrane. After bone regeneration by TEB, three 13 mm long dental implants were inserted. Adequate bone regeneration was shown by radiological analysis and histological observation. The augmented bone height was 4.2mm after the operation and the radiopaque areas were increased. The clinical progress over 2 years showed a good course without bone resorption. These results indicated that TEB, as bone regeneration treatment with minimal invasiveness, could be useful as one of the novel options in dental implant treatment with severe bone atrophy.

Factors influencing surgical results in proliferative diabetic retinopathy.

Although the anatomical results of diabetic vitrectomy have been reported to be rather good when silicone oil is used as a tamponade substitute, the functional results remain unsatisfactory. To investigate the factors influencing the functional results in these cases of severe diabetic retinopathy, the correlation between the surgical results and the overall condition of these patients, including the tamponade substitute, was examined. The vitrectomy results obtained in cases of diabetic retinopathy treated using silicone-oil tamponade were studied retrospectively in comparison with those obtained using SF6 gas tamponade or without any tamponade substitute. The visual acuity of more than 80% of eyes belonging to the groups treated with SF6 gas or without any tamponade improved postoperatively, whereas the rate of improvement in the silicone-oil group was limited to low and the postoperative vision ranged widely, since the silicone was usually used in much more severe cases. Iris rubeosis that occurred after pars plana vitrectomy subsided following secondary silicone-oil injection into the vitreous cavity. Only one disadvantage in using silicone oil was that an additional operation was required to remove it, and the visual acuity of nearly 30% of the eyes deteriorated after its removal. As far as the general condition of these patients is concerned, the visual outcome of subjects who had hypoalbuminemia and anemia due to renal dysfunction was poor as compared with that of patients who did not have these disorders. Blood transfusion did not lead to better function.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a single drip infusion of lipo-prostaglandin E1 on vibratory threshold in patients with diabetic neuropathy.

We evaluated acute effects of prostaglandin E1 encapsulated in lipid microspheres (lipo-PGE1), in 14 type 2 diabetic patients with neuropathy. Nerve conduction velocity (NCV), vibratory threshold (VT), skin temperature and subjective symptoms were evaluated for 24 hours after a single drip infusion of lipo-PGE1. In 6 of the 14 patients, the decrease in VT (P < 0.05) more than 50% measured by an SMV-5 vibrometer was observed at 6 hours after the infusion (responders). Subjective symptoms were improved (P < 0.05) in 5 of the 6 responders, whereas it improved in only 1 of the 8 patients who had no change in VT (nonresponders). NCV did not change (P > 0.05) either in the responders or in the nonresponders by the infusion. The responders had less impairment in VT and milder retinopathy and nephropathy than the nonresponders (P < 0.05). Our results demonstrate that vibratory sensation and subjective symptoms can be improved by a single infusion of lipo-PGE1 in type 2 diabetic patients with mild neuropathy.

alpha-Galactosyl oligosaccharides conjugated with polyethylene glycol as potential inhibitors of hyperacute rejection upon xenotransplantation.

Antibodies to an alpha-galactosyl saccharide structure are mainly responsible for hyperacute rejection after pig-to-primate xenotransplantation. The beneficial effect of alpha-galactosyl oligosaccharides has been shown on the inhibition of anti-pig natural antibodies. We synthesized polyethylene glycol (PEG)-conjugates of alpha-galactosyl disaccharide (Di) and trisaccharide (Tri) as potential inhibitors of the rejection reaction. The half lives of Di, Tri, PEG-conjugated Di (Di-PEG) and PEG-conjugated Tri (Tri-PEG) were 18.1 +/- 2.3 min, 20.2 +/- 0.9 min, 38.7 +/- 2.8 min and 35.8 +/- 1.6 min, respectively. Furthermore, Di-PEG and Tri-PEG showed biphasic clearance, and their half lives at the second phase were longer than 10 hours. PEG-conjugated oligosaccharides (Di-PEG, Tri-PEG) markedly inhibited cytotoxic action of human sera to pig kidney cell line (PK15) compared to unconjugated oligosaccharides (Di, Tri). The binding of IgM antibodies to PK15 cells, however, was more strongly blocked by unconjugated oligosaccharides than PEG-conjugated oligosaccharides. This phenomenon can be explained by the finding that PEG has anti-complement activity and masks antigenic sites of oligosaccharides. In conclusion, conjugation of PEG to oligosaccharides provided two beneficial effects; prolonged intravascular retention time and anti-complement activity, upon systemic application of the oligosaccharides. The present findings opened a new approach to treatment of hyperacute rejection after xenotransplantation.

Evaluation of pulse sequences used for magnetic resonance sialography.

OBJECTIVES: To determine the most appropriate sequences for the visualization of small parotid ducts in MR sialography. METHODS: MR images of a phantom consisting of distilled water in polyethylene tubes were obtained with turbo-spin echo (TSE), single-shot turbo-spin echo (SSTSE), half-fourier acquisition, single-shot turbo-spin echo (HASTE) and turbo gradient-spin echo (TGSE) pulse sequences and compared visually and quantitatively. MR sialograms obtained from healthy volunteers and patients with Sjögren's syndrome (SS) were obtained using the same four sequences. RESULTS: In the phantom, TSE images were best and the contrast-noise ratio (CNR) highest. In the volunteers, the main ducts were especially clearly visualized with TSE and in SSTSE; however, the majority of secondary and/or tertiary parotid ducts were not depicted by any of the sequences used. In SS patients, images of small main ducts and small pseudocysts were clearer using TSE. However, TSE could not depict the narrow main ducts or peripheral ducts or very small pseudocysts. CONCLUSIONS: TSE is considered the most suitable MR sequence for assessing small parotid gland ducts. However, further improvement is needed since it does not always visualize them sufficiently.