Ozone therapy improves early stages of osseointegration in ovariectomized rats.

OBJECTIVE: the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats. METHODOLOGY: ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg - OZ Group (n=15) - and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05). RESULTS: our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32). CONCLUSION: it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

Polydioxanone Enhances Bone Regeneration After Resection and Reconstruction of Rat Femur with rhBMP2.

The aim of this study was to assess the bone regeneration potential of a polydioxanone (PDO) scaffold together with recombinant human bone morphogenetic protein-2 (rhBMP-2) for the reconstruction of large bone defect. In total, 24 male rats (6 months old) were subjected to bilateral femoral stabilization using titanium plates to create a 2 mm gap, and reconstruction using rhBMP-2 (Infuse®; 3.25 µg). The bone defects were covered with PDO (PDO group), or with titanium mesh (Ti group). Animals were euthanized on days 14 and 60. Simultaneously, 16 rats received PDO and Ti in their dorsum for the purpose of biocompatibility analysis at 3, 5, 7, and 10 days postoperatively. X-ray densitometry showed a higher density in the PDO group on day 14. On day 60, coverage of the bone defect with PDO showed a larger quantity of newly formed bone than that found for the Ti group, a lower inflammatory infiltrate value, and a more significant number of blood vessels on day 14. By immunohistochemical assessment, runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN) showed higher labeling on day 14 in the PDO group. On day 60, bone morphogenetic protein-2 (BMP-2) showed higher labeling in the PDO group, whereas Ti showed higher labeling for osteoprotegerin, nuclear factor kappa B ligand-activating receptor, RUNX2, and OCN. Furthermore, biocompatibility analysis showed a higher inflammatory response in the Ti group. The PDO scaffold enhanced bone regeneration when associated with rhBMP-2 in rat femur reconstruction. Impact statement Regeneration of segmental bone defects is a difficult task, and several techniques and materials have been used. Recent advances in the production of synthetic polymers, such as polydioxanone (PDO), produced by three-dimensional printing, have shown distinct characteristics that could improve tissue regeneration even in an important bone defect. The present preclinical study showed that PDO membranes used as scaffolds to carry recombinant human bone morphogenetic protein-2 (rhBMP-2) improved bone tissue regeneration by more than 8-fold when compared with titanium mesh, suggesting that PDO membranes could be a feasible and useful material for use in guided bone regeneration. (In English, viable is only used for living creatures capable of sustaining life.

Ozone therapy improves early stages of osseointegration in ovariectomized rats

Abstract Objective the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats. Methodology ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg — OZ Group (n=15) — and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05). Results our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32). Conclusion it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

Feasible low bone density condition for assessing bioactivity in ex-in vivo and in vivo studies.

OBJECTIVE: To choose a critical animal model for assessments of bone repair with implant installation by comparing senile rats (SENIL) to young ovariectomized rats (OXV). METHODOLOGY: For the ex-in vivo study, the femurs were precursors for bone marrow mesenchymal stem cells. Cellular responses were performed, including cell viability, gene expression of osteoblastic markers, bone sialoprotein immunolocalization, alkaline phosphatase activity, and mineralized matrix formation. For the in vivo study, the animals received implants in the region of the bilateral tibial metaphysis for histometric, microtomography, reverse torque, and confocal microscopy. RESULTS: Cell viability showed that the SENIL group had lower growth than OVX. Gene expression showed more critical responses for the SENIL group (p<0.05). The alkaline phosphatase activity obtained a lower expression in the SENIL group, as for the mineralization nodules (p<0.05). The in vivo histological parameters and biomechanical analysis showed lower data for the SENIL group. The confocal microscopy indicated the presence of a fragile bone in the SENIL group. The microtomography was similar between the groups. The histometry of the SENIL group showed the lowest values (p<0.05). CONCLUSION: In experimental studies with assessments of bone repair using implant installation, the senile model promotes the most critical bone condition, allowing a better investigation of the properties of biomaterials and topographic changes.

What are the Consequences of Incorrect Handling in the Treatment of Blunt-Cut Lip Injuries?

This study aimed report two cases of blunt-cut lip injury which occurred in postoperatory dehiscence. Patients were referred to the emergence attendance and the clinical examination revealed extensive laceration on the upper and lower lips of both patients, highly contaminated with asphalt residue. The affected regions were properly cleaned with saline and antiseptic solution, and, under local anesthesia, suturing was performed in layers in the muscle and oral mucosa region with 4-0 resorbable thread and in the skin region with 6-0 non-absorbable thread. Patients presented different levels of dehiscence on post-operatory evaluation. Thus, it was prescribed antibiotic and healing ointments for decontamination and improvement of the healing process. Third days post-operatory one of the patients presented a great healing of external lips and vermilion lip. However, the other patient presented aesthetic sequelae in the vermilion region of the lip, with a line of fibrosis and misalignment in the region, but not function sequelae. Thus, it was concluded that blunt injuries on the lip must strictly follow the established treatment protocols and must begin aiming for favorable results in the first intervention. Moreover, the postoperative care of the patient and the surgeon are as important as the procedure itself.

Single intraoperative infrared laser optimized bone repair in rat femoral osteotomies with experimentally induced osteoporosis.

This study aimed to evaluate the effect of infrared laser (IRL) on bone repair in ovariectomized rats subjected to femoral osteotomies. Of 32 rats, half underwent bilateral ovariectomy (OVX) and the other half underwent sham ovariectomy (SHAM). A period of 3 months was defined to observe the presence of osteoporosis. The rats were subjected to osteotomies in the femurs and then fixed with a miniplate and 1.5-mm system screws. Thereafter, half of the rats from both SHAM and OVX groups were not irradiated, and the other half were irradiated by IRL using the following parameters: wavelength, 808 nm; power, 100 mW; 60 s for each point; 6 J/point; and a total of 5 points of bone gap. All animals were euthanized 60 days after surgery. The femur gap was scanned using micro-computed tomography (micro-CT). The samples were then examined under a confocal laser microscope to determine the amounts of calcein and alizarin red. The slides were stained with alizarin red and Stevenel's blue for histometric analysis. In the micro-CT analysis, the OVX groups had the lowest bone volume (P < 0.05). When the laser was applied to the OVX groups, bone turnover increased (P < 0.05). New bone formation (NBF) was comparable between SHAM and OVX/IR (P > 0.05) groups; however, it was less in the OVX groups (P < 0.05). In conclusion, the results encourage the use of IRL intraoperatively as it optimizes bone repair, mainly in animals with low bone mineral density.

Feasible low bone density condition for assessing bioactivity in ex-in vivo and in vivo studies

Abstract Objective To choose a critical animal model for assessments of bone repair with implant installation by comparing senile rats (SENIL) to young ovariectomized rats (OXV). Methodology For the ex-in vivo study, the femurs were precursors for bone marrow mesenchymal stem cells. Cellular responses were performed, including cell viability, gene expression of osteoblastic markers, bone sialoprotein immunolocalization, alkaline phosphatase activity, and mineralized matrix formation. For the in vivo study, the animals received implants in the region of the bilateral tibial metaphysis for histometric, microtomography, reverse torque, and confocal microscopy. Results Cell viability showed that the SENIL group had lower growth than OVX. Gene expression showed more critical responses for the SENIL group (p<0.05). The alkaline phosphatase activity obtained a lower expression in the SENIL group, as for the mineralization nodules (p<0.05). The in vivo histological parameters and biomechanical analysis showed lower data for the SENIL group. The confocal microscopy indicated the presence of a fragile bone in the SENIL group. The microtomography was similar between the groups. The histometry of the SENIL group showed the lowest values (p<0.05). Conclusion In experimental studies with assessments of bone repair using implant installation, the senile model promotes the most critical bone condition, allowing a better investigation of the properties of biomaterials and topographic changes.

A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions.

The aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries. The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 h before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 h. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48 h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 h, and 7 days. Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 h after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05). The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET) in the pre-operative time, only a few rescue analgesics are necessary.

Is an anodizing coating associated to the photobiomodulation able to optimize bone healing in ovariectomized animal model?

This in vivo study investigated whether the bioactivity of anodizing coating, produced by plasma electrolytic oxidation (PEO), on mini-plate in femur fracture could be improved with the association of photobiomodulation (PBM) therapy. From the 20 ovariectomized Wistar female rats, 8 were used for model characterization, and the remaining 12 were divided into four groups according to the use of PBM therapy by diode laser (808 nm; power: 100 mW; energy: 6.0 J; energy density: 212 J/cm2; power density: 3.5 W/cm2) and the type of mini-plate surface (commercially pure titanium mini-plate -cpTi- and PEO-treated mini-plate) as follow: cpTi; PEO; cpTi/PBM; and PEO/PBM. After 60 days of surgery, fracture healing underwent microstructural, bone turnover, histometric, and histologic adjacent muscle analysis. Animals of groups with PEO and PBM showed greater fracture healing than cpTi control group under histometric and microstructural analysis (P < 0.05); however, bone turnover was just improved in PBM's groups (P < 0.05). there was no difference between cpTi and PEO without PBM (P > 0.05). Adjacent muscle analysis showed no metallic particles or muscle alterations in all groups. PEO and PBM are effective strategies for bone repair in fractures, however their association does not provide additional advantages.

Miniplates coated by plasma electrolytic oxidation improve bone healing of simulated femoral fractures on low bone mineral density rats.

The treatment of polytrauma patients represents a great challenge in the maxillofacial and orthopedic surgery fields. Therefore, this study tested the hypothesis that the use of a bioactive coating (by plasma electrolytic oxidation, PEO) on titanium microplates could improve the fracture healing of low bone mineral density (BMD) rats. Thirty female rats underwent bilateral ovariectomy surgery (OVX), and 35 rats underwent fake surgery (SHAM). Three months later, animals were subjected to femoral fracture simulation and were fixed with either non-coated (CONV) or coated (PEO) titanium miniplates. Eight weeks postoperatively, microplate/bone complexes were analyzed through computed microtomography, histometric, confocal microscopy, molecular, and biomechanical analysis. Bioactive elements (Ca and P) were incorporated on the PEO microplate and the surface was modified in a volcano-like structure. In the microCT analysis the OVX/PEO group had greater values for Tb.Th (bone trabecular thickness), Tb.Sp (separation of bone trabeculae) and Tb.N (number of trabeculae) parameters compared to the OVX/CONV group. According to histometric analysis, the OVX/PEO group showed significantly higher new bone formation than the OVX/CONV group (P < 0.05). For the fluorochrome area, the OVX groups (PEO and CONV) showed greater values for calcein precipitation (old bone) than alizarin red (new bone). Molecular results showed greater values for proteins related to the final phase of bone formation (P < 0.05) in the OVX/PEO group. The OVX/PEO group showed higher bone/miniplate system resilience compared to the others (P < 0.05). It was concluded that PEO coating optimizes bone healing on simulated femoral fractures in low bone mineral density rats. This sheds new light in the treatment of osteoporotic patients with bone fractures.

Author Correction: Plasma Electrolytic Oxidation as a Feasible Surface Treatment for Biomedical Applications: an in vivo study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Plasma Electrolytic Oxidation as a Feasible Surface Treatment for Biomedical Applications: an in vivo study.

OBJECTIVES: In this in vivo animal study, we evaluated the effect of plasma electrolytic oxidation (PEO) coating on the topographic and biological parameters of implants installed in rats with induced osteoporosis and low-quality bones. MATERIALS AND METHODS: In total 44 Wistar rats (Rattus novergicus), 6 months old, were submitted to ovariectomy (OXV group) and dummy surgery (SHAM group). After 90 days, the ELISA test was performed and the ovariectomy effectiveness was confirmed. In each tibial metaphysis, an implant with PEO coating containing Ca2+ and P5+ molecules were installed, and the other tibia received an implant with SLA acid etching and blasting (AC) (control surface). After 42 days, 16 rats from each group were euthanized, their tibias were removed for histological and immunohistochemical analysis (OPG, RANKL, OC and TRAP), as well as reverse torque biomechanics. Data were submitted to One-way ANOVA or Kruskal-Wallis tests, followed by a Tukey post-test; P < 0.05. Histological analyses showed higher bone neoformation values among the members of the PEO group, SHAM and OVX groups. Immunohistochemical analysis demonstrated equilibrium in all groups when comparing surfaces for TRAP, OC and RANKL (P > 0.05), whereas OPG showed higher PEO labeling in the OVX group (P < 0.05). Biomechanical analysis showed higher reverse torque values (N.cm) for PEO, irrespective of whether they were OVX or SHAM groups (P < 0.05). CONCLUSION: The results indicated that the PEO texturing method favored bone formation and showed higher bone maturation levels during later periods in osteoporotic rats.

Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face.

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.

Simultaneous Occurrence of Central Giant Cell Granuloma and Odontogenic Keratocyst in Mandible.

Odontogenic keratocysts and central giant cell granulomas are distinct entities of separate origin that may appear simultaneously in the jaw, making them difficult to differentiate. The objectives of this paper are to report a case of a 54-year-old man presenting with a large lesion in the right mandible and to describe the histological characteristics of that lesion. Imaging revealed tumefaction and multilobulation. The case was surgically managed. Histopathological examination revealed that the lesion was a hybrid of an odontogenic keratocyst and a central giant cell granuloma. It remains unclear as to whether this lesion represented a coincidental or related injury. Since both types of lesion involved have a high rate of recurrence, however, long-term follow-up is scheduled.

Non-familial Cherubism – Report of a case / Querubim não familiar - Relatório de caso

The Cherubism is a rare disease that affects the middle and lower third of the facein individuals at the time of childhood. It is a rarehereditary benign bone disease with an autosomal dominant inheritance. The familial distribution may affect different generations and isolated nonfamilial cases have also been reported in literature. Lesions appear as cystic multilocular radiolucencies, histologically, they resemble central giant cell granluloma and hyperpara thyroidism brown tumorwith numerous randomly distributed multinuclea tedgiant cells and vascular spaces within a fibrous connective tissue stroma. Objective: The aim of this study is to report the importance of the diagnosis of this pathology and the variety of treatments availablein the literature, thus guiding to an individualized treatment. Case Report: Caucasian 8 years-oldfemale, in good general condition, was referred to Service of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital (EGH), Curitiba – PR, Brazil, complaining of bilateral swelling of the maxilla and mandible since 4 years-old. Apparently, the girl isthe first one who developed the genetic pathologyin at least 4 generations of her family. After biopsy, cherubism diagnosis was confirmed and the treatment of choice was periodic monitoring. Discussion: Cherubism studies with long-term follow-up with clinical and radiographic documentation indicate that the spontaneous resolution of bone lesions israre. Treatment of cherubism is controversial and various modalities have been reported as the use of calcitonin, osseous plasty surgery, curettage, orthognathic surgery, liposuction and palliative treatments. Conclusion: cherubism is a rarecondition that affects individuals in childhood that lead to some facial alterations, those patients need an special care and an well trained team to treat these disease more carefully and wisely noting that exist a series of option of new treatments in this cases...

Introdução: O Querubismo é uma doença rara que afeta o terço médio e inferior da face em indivíduos no momento da infância. É uma doença óssea hereditária benigna com herança autossômica dominante sendo que a distribuição familial pode afetar diferentes gerações, todavia casos não-familiares isolados também foram relatados na literatura. As lesões apresentam se radiograficamente como cistos multiloculados radiolúcidos e histologicamente se assemelham ao granuloma central de células gigantes e ao tumor marrom do hiper paratireoidismo com numerosas células gigantes multinucleadas distribuídos aleatoriamente e espaços vasculares dentro de um estroma de tecido conjuntivo fibroso. Objetivos: O objetivo deste estudo é relatar a importância do diagnóstico desta patologia e da variedade de tratamentos disponíveis na literatura, orientando dessa maneira a um tratamento individualizado. Relato de Caso: Mulher, caucasiana, 8 anos de idade, em bom estado geral. Foi encaminhada ao Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner (EGH), Curitiba - PR, Brasil, com queixa de inchaço bilateral da maxila e da mandíbula desde os 4 anos de idade. Em avaliação notou-se que menina é a primeira pessoa que desenvolveu a patologia empelo menos quatro gerações de sua família. Após biópsia o diagnóstico de cherubism foi confirmado e o tratamento de escolha foi a monitorização periódica. Discussão: estudos de cherubism a longo prazo de follow-up com documentação clínica e radiográficas indicam que a resolução espontânea das lesões ósseas são raras. O tratamento do cherubism é controverso e diversas modalidades têm sido relatados como o uso de calcitonina, a cirurgia de plastia óssea, curetagem cirurgia ortognática, lipoaspiração e tratamentos paliativos...

Implications of the use of bisphosphonates in dental treatment - experience of the service of oral and maxillofacial surgery, Erasto Gaertner Hospital, Curitiba, Brazil

Introduction: Bisphosphonates (BP) are effective drugs in the prevention and treatment of various bone pathologies, acting in the regulation of osteoclast function through different mechanisms. Despite the success in the treatment of various diseases, these drugs have the ability to induce an avascular necrosis of bone tissue, especially in the maxilla and mandible. Objective: Due the significant increase number of cases of patients with oral complications associated with BP therapy in the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, the study aimed to report our experience in the care of these patients. Material and methods: Patients submitted to BP therapy were enrolled prospectively between the years of 2011 and 2012. Clinical examination was performed in all patients to evaluate dental health as well oral mucosa. All patients are under follow-up in our service. Results: 26 patients who used BP were attended in the ambulatory. Twenty-three patients used BP for oncological indication and three for osteoporosis. Most of patients were women (6666%) with average age of 56 years old. The most frequent medication used was Pamidronate (54%), followed by Zoledronic acid (30%) and Alendronate (15%). Ten patients showed bone exposition, most of then in the mandible (80%), with an average time of one year of exposure. Conclusion: Dentists should advise their patients about the use of BP and the implications for oral health and treatments. These patients must have periodic consultations for evaluation and early detection of osteonecrosis associated to BP for adequate treatment.