An organized medical response for the Vancouver International Marathon (2006-2011): when the rubber hits the road.

OBJECTIVE: We described an organized, on-site medical response for a large-scale urban marathon event and documented illness/injury rates as well as ambulance transfer rates at the Vancouver International Marathon (VIM). METHODS: Case-series report of medical encounters was documented prospectively over a 6-yr period at the VIM. The planning and organization of the on-site medical response is the main focus of this report. RESULTS: A total of 67,402 runners participated in the VIM from 2006 to 2011. Over the 6-yr period, 2,986 patient encounters were documented. The patient presentation rate for the series was 45/1,000, the ambulance transfer rate was 0.09-0.58/1,000, and the medical transfer rate was 0.37-1.09/1,000. CONCLUSION: A coordinated on-site medical team covering the entire event site and race route was deployed to reduce the severity of illness and injury at a long-distance running event.

Small blood stem cells for enhancing early osseointegration formation on dental implants: a human phase I safety study.

BACKGROUND: Small blood stem cells (SB cells), isolated from human peripheral blood, demonstrated the ability to benefit bone regeneration and osseointegration. The primary goal of our study is to examine the safety and tolerability of SB cells in dental implantation for human patients with severe bone defects. METHODS: Nine patients were enrolled and divided into three groups with SB cell treatment doses of 1 × 105, 1 × 106, and 1 × 107 SB cells, and then evaluated by computed tomography (CT) scans to assess bone mineral density (BMD) by Hounsfield units (HU) scoring. Testing was conducted before treatment and on weeks 4, 6, 8, and 12 post dental implantation. Blood and comprehensive chemistry panel testing were also performed. RESULTS: No severe adverse effects were observed for up to 6-month trial. Grade 1 leukocytosis, anemia, and elevated liver function were observed, but related with the patient's condition or the implant treatment itself and not the transplantation of SB cells. The levels of cytokines and chemokines were detected by a multiplex immunological assay. Elevated levels of eotaxin, FGF2, MCP-1, MDC, and IL17a were found among patients who received SB cell treatment. This observation suggested SB cells triggered cytokines and chemokines for local tissue repair. To ensure the efficacy of SB cells in dental implantation, the BMD and maximum stresses via stress analysis model were measured through CT scanning. All patients who suffered from severe bone defect showed improvement from D3 level to D1 or D2 level. The HU score acceleration can be observed by week 2 after guided bone regeneration (GBR) and prior to dental implantation. CONCLUSIONS: This phase I study shows that treatment of SB cells for dental implantation is well tolerated with no major adverse effects. The use of SB cells for accelerating the osseointegration in high-risk dental implant patients warrants further phase II studies. TRIAL REGISTRATION: Taiwan Clinical Trial Registry ( SB-GBR001 ) and clinical trial registry of the United States ( NCT04451486 ).

Evaluation of the implant stability and the marginal bone level changes during the first three months of dental implant healing process: A prospective clinical study.

Achievement of adequate implant stability is one of the determinants for long-term successful osseointegration. Resonance frequency analysis was developed to monitor implant stability and is now a well-recognized, non-invasive tool for determining the appropriate time for functional loading. However, there have been few studies with continuous evaluation and comparison of implant stability and marginal bone level changes between two different macro designs and clinical situations during the implant healing process. Thus, the purpose of this clinical trial is to evaluate the implant stability and marginal bone level changes of straight and conical implants during the implant healing process. In this prospective clinical trial, 25 participants were randomized to either straight or conical implants. A total of 32 titanium dental implants with a length of 9 mm or 11 mm were installed in the maxilla and the mandible according to the manufacturer's instructions. A resonance frequency analyzer was used to measure the implant stability quotient (ISQ) at the time of implant placement and after 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, and 12 weeks of healing. The changes in the peri-implant marginal bone level were evaluated from digital radiographic films taken at the time of implant placement and after 4 weeks, 8 weeks, and 12 weeks of healing. The preliminary results of this study revealed higher ISQ values and better healing tendency for conical implants in comparison with straight implants in the maxilla. Similar ISQ values and healing tendency were observed for straight and conical implants in the mandible. No significant differences in marginal bone loss were found between the straight and conical implants. However, in the mandible, slightly more marginal bone loss was found with the conical implants than straight implants after 12 weeks of healing. In conclusion, ISQ healing tendency and marginal bone loss are influenced by implant macro-design and jaw regions. Straight implants revealed similar ISQ healing tendency and marginal bone loss in both the mandible and maxilla. Conical implants were confirmed more beneficial for maintenance of implant stability and marginal bone level in the maxilla.

Dental Implant Surrounding Marginal Bone Level Evaluation: Platform Switching versus Platform Matching-One-Year Retrospective Study.

The benefits and feasibility of platform switching have been discussed in several studies, reporting lesser crestal bone loss in platform-switched implants than in platform-matched implants. Objective. The aim of the present study was to observe the changes in vertical and horizontal marginal bone levels in platform-switched and platform-matched dental implants. Materials and Methods. 51 patients received 60 dental implants in the present study over a 1-year period. Measurement was performed between the implant shoulder and the most apical and horizontal marginal defect by periapical radiographs to examine the changes of peri-implant alveolar bone before and 12 months after prosthodontic restoration delivery. Results. These marginal bone measurements showed a bone gain of 0.23 ± 0.58 mm in the vertical gap and 0.22 ± 0.53 mm in the horizontal gap of platform matching, while in platform switching a bone gain of 0.93 ± 1 mm (P < 0.05) in the vertical gap and 0.50 ± 0.56 mm in the horizontal gap was found. The average vertical gap reduction from the baseline until 12 months was 0.92 ± 1.11 mm in platform switching and 0.29 ± 0.85 mm in platform matching (P < 0.05). Conclusions. Within the limitations of the present study, platform switching seemed to be more effective for a better peri-implant alveolar bone vertical and horizontal gap reduction at 1 year.

Surface analysis of titanium biological modification with glow discharge.

BACKGROUND: Glow discharge plasma (GDP) technology has been used to graft various proteins to the titanium surface, including albumin, type I collagen, but without fibronectin. PURPOSE: The aim of this study was to evaluate and analyze the physical properties of fibronectin-grafted titanium surfaces after GDP treatment. MATERIALS AND METHODS: Grade II titanium discs after cleaning and autoclaving were considered as original specimens, thus divided into four groups. The groups were different upon two treatments (GDP only and fibronectin grafting after GDP) and two storage temperature (4°C and 25°C). The implant surface morphology was characterized by scanning electron microscopy (SEM), roughness measurement, and wettability evaluation. The concentration relationship of fibronectin was by fluorescein isothiocyanate (FITC) labeling. RESULTS: SEM images showed that regular planar texture revealed on the surface of GDP-treated group, and irregular-folding protein was found on the fibronectin-grafted discs. Fibronectin-grafted groups had higher hydrophilicity and greater surface roughness than GDP-treated specimens. The storage temperature did not make obvious difference on the surface topography, wettability, and roughness. The number of fibronectin dots on the titanium surface labeling by FITC had positive relationship with the concentration of fibronectin solution used. CONCLUSIONS: Biologically modified titanium surface is more hydrophilic and rougher than GDP-treated ones. GDP treatment combined with fibronectin grafting increased the surface hydrophilicity and surface roughness of titanium discs, which may attribute to the affinity of cell adhesion, migration, proliferation, and differentiation.

The Children's Hospital of Philadelphia modification of the Furlow double-opposing z-palatoplasty: long-term speech and growth results.

Of the 261 nonsyndromic patients we studied, over 90% had minimal or absent hypernasality, almost 86% had inconsistent or no nasal emission, and 95% had no articulation errors related to velar function. The patients with a Pittsburgh score indicating an incompetent velopharyngeal mechanism comprised only about 6% of the group. Ninety-four percent had a socially functional speech quality. Secondary surgery was done in 6.5% of patients and was done or was recommended in about 8% of patients. Patients with isolated cleft palate seemed to do less well, although their outcomes were not statistically different from those with complete unilateral and bilateral clefts. Relaxing incisions have kept our fistula rate to an acceptably low rate of 6.8%. No major soft palate dehiscences or hard palate flap losses have occurred. The speech outcomes we are achieving are improved over our historical results and compared with published reports using nondouble reversing z-palatoplasty techniques. Similar outcomes with the Furlow repair have been confirmed. Maxillary growth, occlusion, and the need for orthognathic surgery do not seem to be influenced by the CHOP modification of the Furlow double-opposing z-palatoplasty. These modifications facilitate a tension free-closure and a low fistula rate.

Localized vertical maxillary ridge augmentation using symphyseal bone cores: a technique and case report.

Vertical augmentation of the alveolar ridge is intended to restore resorbed alveolar ridges. This procedure is important for the placement of dental implants in a favorable position and also to enhance restoration esthetics. This article presents an approach for vertical ridge augmentation in the anterior maxilla utilizing symphyseal bone cores. A patient presented with 2 localized bony defects around the maxillary lateral incisors. Following extraction of these teeth, vertical bone defects of 7 mm on the right and 6 mm on the left were observed in relation to the cementoenamel junction of the adjacent teeth. Two bone cores were harvested from the mandibular symphysis using a trephine. These bone cores were tapped into 2 predrilled osteotomy sites with corresponding diameters until stabilization was achieved. The 2 sites were grafted with demineralized freeze-dried bone allograft and a titanium-reinforced expanded polytetrafluoroethylene membrane. After 5 months, the membranes were removed and vertical ridge augmentation of 5 mm on the right and 4 mm on the left was observed. The width of the ridge was increased as well. Two implants were placed in favorable positions, restored after 6 months, and followed successfully for 1 year after loading. This technique represents a viable approach for augmentation of deficient alveolar ridges prior to the placement of dental implants.

One-stage maxillary sinus elevation using a bone core containing a preosseointegrated implant from the mandibular symphysis.

This report presents a novel surgical approach of a one-stage maxillary sinus elevation using a bone core containing a preosseointegrated implant harvested from the mandibular symphysis. As a result, the elevation of the floor of the maxillary sinus and the placement of the implant were achieved at the same time, and the required healing time was significantly reduced. Three months after placement of the implant in the symphysis, a bone core containing the implant was retrieved using a trephine. The bone core was placed in the resorbed posterior maxillary ridge, thereby elevating the maxillary sinus floor. The bone core containing the implant was allowed to heal for 5 months, after which the implant was restored and followed up for 30 months. This technique represents a surgical modification intended to avoid the conventional two-step sinus elevation surgery in which the surgical procedure of graft placement is followed by surgical implant placement. This approach requires significantly reduced healing time and provides an increased bone quality around the implant, which is of clinical importance, particularly in the posterior maxilla.

In vivo evaluation of resorbable bone graft substitutes in beagles: histological properties.

Calcium phosphate cement (CPC) is a promising material for use in minimally invasive surgery for bone defect repairs due to its bone-like apatitic final setting product, biocompatibility, bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping into complicated geometrics. However, even though CPC is stable in vivo, the resorption rate of this bone cement is very slow and its long setting time poses difficulties for clinical use. Calcium sulfate dehydrate (CSD) has been used as a filler material and/or as a replacement for cancellous bone grafts due to its biocompatibility. However, it is resorbed too quickly to be optimal for bone regeneration. This study examines the invivo response of a hydroxyapatite (HA), [apatitic phase (AP)]/calcium sulfate (CSD) composite using different ratios in the mandibular premolar sockets of beagles. The HA (AP)/CSD composite materials were prepared in the ratios of 30/70, 50/50, and 70/30 and then implanted into the mandibular premolar sockets for terms of 5 and 10 weeks. The control socket was left empty. The study shows better new bone morphology and more new bone area in the histological and the histomorphometric study of the HA (AP)/CSD in the 50/50 ratio.

Er:YAG laser-roughened enamel promotes osteoblastic differentiation.

OBJECTIVE: The aim of this study was to test whether Er:YAG laser-etched enamel of human teeth could act as a biologically active scaffold for tissue regeneration. BACKGROUND DATA: Hydroxylapatite (HA) with rough surface created by acid etching treatment has been used as a scaffold for tissue engineering. However, whether tooth HA can be a scaffold for osteoblastic cell seeding is still unclear. MATERIALS AND METHODS: Enamel samples from human teeth were pretreated with an Er:YAG laser to create a rough surface. Then the surface of the laser-treated enamel was examined using a surface roughness profilometer and a scanning electron microscope. In addition, static water contact angles of the Er:YAG laser-treated enamel samples were measured using goniometry. To observe the effects of cell behavior on an Er:YAG laser-roughened enamel surface, we cultured MG63 osteoblast-like cells on the surface-modified enamel samples. Alkaline phosphatase activity, a marker of cell proliferation and differentiation, was monitored and compared with that in untreated control and acid-etched enamel samples. RESULTS: Er:YAG laser treatment significantly improved the surface roughness of the enamel samples. Furthermore, MG63 osteoblast-like cells cultured on the Er:YAG laser-roughened enamel surface expressed more alkaline phosphatase activity and exhibited greater degrees of cellular differentiation than did cells that had been cultured on untreated enamel samples. CONCLUSIONS: These results demonstrate that Er:YAG laser-roughened enamel promotes osteoblastic differentiation. This finding suggests that Er:YAG laser-roughened enamel surfaces can potentially serve as a scaffold for tissue engineering.

Endoscope-assisted temporoparietal fascia harvest for auricular reconstruction.

BACKGROUND: Reconstruction of microtia may require a temporoparietal fascia flap. The authors modified existing endoscopic temporoparietal fascia harvest techniques and applied them to auricular reconstruction to reduce incision size, scarring, and visible alopecia. Flap design was altered to include posterior occipital circulation to improve perfusion and decrease venous congestion. Cases of open and endoscope-assisted auricular reconstruction techniques have not been compared in the literature. METHODS: Seventeen patients underwent Medpor auricular reconstruction with temporoparietal fascia flaps (eight open and nine endoscope-assisted). Physical outcome (scar size, location, appearance, and complication rate), flap size, surgical times, and blood loss were compared. Equipment and dissection techniques are reviewed. RESULTS: No flap complications occurred with either group. Endoscope-assisted incision length was 18 to 25 mm, compared with 150 to 200 mm using the open technique. No significant alopecia was noted in the endoscopic group, whereas most open patients had visible alopecia. Open surgical time averaged 325.9 minutes, and endoscopic surgical time averaged 276.5 minutes. Estimated blood loss averaged 56.3 cc for open and 45.6 cc for endoscopic procedures. Open temporoparietal fascia flap size averaged 8.87 x 9.75 cm, whereas endoscopic temporoparietal fascia flap size averaged 7.9 x 10.2 cm. Standard endoscopic brow-lift instruments were used. The optimal superior access port placement was the upper one-third/lower two-thirds junction of the flap. CONCLUSIONS: The endoscope-assisted temporoparietal fascia harvest technique for auricular reconstruction can minimize scarring, alopecia, and surgical time, with comparable blood loss. Flap size is comparable to that of the traditional open approach. The authors recommend a broadly based pedicle instead of one based solely off the superficial temporal artery.

Who needs the surgical headlight?

OBJECTIVE: The use of surgical headlights may lead to awkward posture and limit the mobility and visibility of the operating team. Despite the vast availability of fiber-optic instruments, many surgeons continue to use the surgical headlight, which may be harmful to their health and career. We report the use of the Lumitex LightMat surgical illuminator instead of the conventional surgical headlight in cleft palate surgery. METHODS: The LightMat is a disposable single-use device that is bright, flexible, and malleable and attaches easily to most retractors. Twenty cleft palate and five pharyngeal flaps cases were performed in which the LightMat was attached to the Dingman mouth retractor with biocompatible two-sided adhesive tapes. RESULTS: The LightMat was successfully used in all 25 cases. No cases required the surgeon to put on additional lighting such as a headlight. In addition, no cases required the LightMat surgical illuminator to be replaced. CONCLUSION: The LightMat provides excellent surgical light for cleft palate surgery and pharyngeal procedures. It affords the surgeon several advantages: it provides a cool operative light, flexibility in surgical position, and improved visibility and mobility; the surgeon avoids the delay in obtaining an appropriate working headlight; and, more importantly, it may prevent postural problems that could lead to spinal sprain and disability.