Hard tissue volumetric and soft tissue contour linear changes at implants with different surface characteristics after experimentally induced peri-implantitis: an experimental in vivo investigation.

OBJECTIVE: To evaluate the hard tissue volumetric and soft tissue contour linear changes in implants with two different implant surface characteristics after a ligature-induced peri-implantitis. MATERIAL AND METHODS: In eight beagle dogs, implants with the same size and diameter but distinct surface characteristics were placed in the healed mandibular sites. Test implants had an external monolayer of multi-phosphonate molecules (B+), while control implants were identical but without the phosphonate-rich surface. Once the implants were osseointegrated, oral hygiene was interrupted and peri-implantitis was induced by placing subgingival ligatures. After 16 weeks, the ligatures were removed and peri-implantitis progressed spontaneously. Bone to implant contact (BIC) and bone loss (BL) were assessed three-dimensionally with Micro-Ct (µCT). Dental casts were optically scanned and the obtained digitalized standard tessellation language (STL) images were used to assess the soft tissue vertical and horizontal contour linear changes. RESULTS: Reduction of the three-dimensional BIC percentage during the induction and progression phases of the experimental peri-implantitis was similar for both the experimental and control implants, without statistically significant differences between them. Soft tissue analysis revealed for both implant groups an increase in horizontal dimension after the induction of peri-implantitis, followed by a decrease after the spontaneous progression period. In the vertical dimension, a soft tissue dehiscence was observed in both groups, being more pronounced at the buccal aspect. CONCLUSIONS: The added phosphonate-rich surface did not provide a more resistant environment against experimental peri-implantitis, when assessed by the changes in bone volume and soft tissue contours. CLINICAL RELEVANCE: Ligature-induced peri-implantitis is a validated model to study the tissue changes occurring during peri-implantitis. It was hypothesized that a stronger osseointegration mediated by the chemical bond of a phosphonate-rich implant surface would develop an environment more resistant to the inflammatory changes occurring after experimental peri-implantitis. These results, however, indicate that the hard and soft tissue destructive changes occurring at both the induction and progression phases of experimental peri-implantitis were not influenced by the quality of osseointegration.

Experimental peri-implantitis around titanium implants with a chemically modified surface with a monolayer of multi-phosphonate molecules: a preclinical in vivo investigation.

OBJECTIVES: The purpose of this experimental in vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the development of experimental peri-implantitis. MATERIAL AND METHODS: Eight beagle dogs received 5 tests and 5 control implants each following a split-mouth design 3 months after premolar and molar extraction. On the most mesial implant of each side, a 3-mm buccal dehiscence was artificially created. Experimental peri-implantitis was induced by silk ligatures over a 4-month period; after ligature removal, peri-implantitis was left to progress for another 4 months without plaque control. Clinical, histological, and radiographic outcomes were evaluated. RESULTS: Radiographically, both implant groups showed a similar bone loss (BL) at the end of the induction and progression phases. BL measured on the histological sections of the test and control groups was 3.14 ± 0.42 mm and 3.26 ± 0.28 mm, respectively; the difference was not statistically significant (p > 0.05). The remaining buccal bone to implant contact (bBIC) percentage of the test and control groups was 59.38 ± 18.62 and 47.44 ± 20.46%, respectively; the difference, however, was not statistically significant (p > 0.05). Bone loss observed at dehiscent sites compared to non-dehiscent ones showed no statistically significant difference (p > 0.05). CONCLUSIONS: Addition of a monophosphonate layer to a moderately rough implant surface did not affect development of experimental peri-implantitis. CLINICAL RELEVANCE: Influence of implant surface on peri-implantitis may condition implant selection by the clinician, especially on patients with disease risk factors. In that sense, monophosphate layer implants do not show higher peri-implantitis risk than control implants.

Alveolar crest contour changes after guided bone regeneration using different biomaterials: an experimental in vivo investigation.

OBJECTIVE: To evaluate the changes in alveolar contour after guided bone regeneration (GBR) with two different combinations of biomaterials in dehiscence defects around implants. MATERIAL AND METHODS: Chronic alveolar ridge defects were created bilaterally in the mandible of eight Beagle dogs. Once implants were placed, three treatment groups were randomly allocated to each peri-implant dehiscence defect: (i) test group received a bone substitute composed of hydroxyapatite (HA) and ß-tricalcium phosphate (ß-TCP) covered by a cross-linked collagen membrane, (ii) positive control group with placement of deproteinized bovine bone mineral (DBBM) plus a porcine natural collagen membrane, and (iii) a negative control with no treatment. Two healing periods (8 and 16 weeks) were evaluated. Dental casts were optically scanned, the obtained files were uploaded into an image analysis software and superimposed to evaluate the linear changes. RESULTS: In both healing periods, the gains in linear contours were higher in the test group and at the intermediate level (3 mm below the gingival margin). While at 8 weeks, no significant differences were found between the groups; at 16 weeks, the test and positive control groups demonstrated significant gains in contour compared with negative control. CONCLUSIONS: GBR using different biomaterials significantly increased the buccal contours of the alveolar crest when used at dehiscence defects around dental implants. CLINICAL RELEVANCE: Particulate highly porous synthetic bone substitute and a cross-linked collagen membrane demonstrated similar outcomes in terms of contour augmentation when compared to bovine xenograft (DBBM) and a collagen membrane.

Comparação de métodos para avaliação de beta-hidroxibutirato em ovelhas / Comparison of methods for evaluation of beta-hydroxybutyrate in ewes

Atualmente o uso de sensores portáteis para mensuração de corpos cetônicos está padronizado e difundido na rotina clínica, contudo estudos em ovinos são escassos. Assim, a presente pesquisa objetivou avaliar a acurácia dos sensores portáteis de uso humano e de uso veterinário para a determinação de beta-hidroxibutirato (BHB) em ovelhas no final da gestação e no pós-parto recente. Foram utilizadas 37 amostras de sangue provenientes de nove ovelhas mestiças Corriedale. A determinação bioquímica de BHB no soro, considerada como o padrão-ouro, foi realizada utilizando-se metodologia enzimática colorimétrica. A média obtida na bioquímica sérica foi de 0,497mmol/L; no sensor de uso humano, a média foi igual a 0,537mmol/L, enquanto no sensor de uso veterinário foi de 0,751mmol/L. Foi verificada alta correlação entre o dosímetro de uso humano e o padrão-ouro (r=0,93, P<0,001). A média do aparelho de uso veterinário diferiu das demais (51%; P<0,05), superestimando os resultados em ovelhas. As medições obtidas no aparelho veterinário também apresentaram menor precisão e veracidade. Concluiu-se que o sensor portátil de uso humano é mais acurado e mais preciso no diagnóstico precoce de toxemia da gestação em ovelhas.

Currently the use of portable sensors for measuring ketone bodies is standardized and diffused in the clinical routine, however, studies in sheep are scarce. Therefore, the present study aimed to evaluate the accuracy of the human portable sensor and the veterinary portable sensor for the determination of beta-hydroxybutyrate (BHB) in sheep at the end of gestation and postpartum. We used 37 samples of blood from nine crossbred Corriedale sheep. Biochemical determination of serum BHB, considered gold standard, was performed using colorimetric enzymatic methodology. The mean serum biochemistry was 0.497mmol/L, in the human sensor the mean was 0.537mmol/L, while in the veterinary sensor it was 0.751mmol/L. A high correlation was verified between the dosimeter for human use and the gold standard (r= 0.93, P< 0.001). The mean of the veterinary apparatus differed from the others, being 51% (P< 0,05), higher than the standard, that is, it was less accurate and had lower veracity, overestimating the results in sheep. It was concluded that the portable sensor for human use is more accurate and accurate in the early diagnosis of toxemia of pregnancy in sheep.

Influência da gestação e do puerpério no lipidograma de bovinos da raça Holandesa / Influence of gestation and puerperium on the lipid profile of Holstein cattle

Avaliou-se a influência da gestação e do puerpério no lipidograma de bovinos da raça Holandesa por meio da determinação de colesterol, triglicérides, ácidos graxos não esterificados (AGNE), β-hidroxibutirato (β-HBO) e glicose em 80 amostras de soro e plasma sangüíneo. Os animais foram distribuídos em cinco grupos (G) experimentais: G1 - constituído por 16 fêmeas não prenhes; G2 -18 fêmeas na fase inicial da gestação (com até três meses); G3 - 15 fêmeas prenhes, entre três e seis meses de gestação; G4 - 15 fêmeas na fase final da gestação (entre seis e nove meses); G5 - 16 fêmeas recém-paridas, com até 30 dias de puerpério. Houve influência da gestação sobre o lipidograma, pois os teores séricos de AGNE foram mais altos no terço final da gestação, enquanto os teores séricos de β - HBO foram mais elevados durante o terço inicial de gestação. O puerpério influenciou os constituintes do lipidograma, pois, nos primeiros 30 dias após a parição, os teores séricos de AGNE e β - HBO foram mais altos, enquanto os de triglicérides foram mais baixos nos animais no puerpério em relação aos que estavam em gestação.

In order to establish the influence of gestation and puerperium on the lipid profile of Holstein cattle, the concentrations of cholesterol, triglycerides, nonesterified fatty acids (NEFA), β-hydroxibutyrate (β-HBO), and glucose were determined in samples of serum and plasma from 80 animals distributed into five experimental groups (G): G1 - 16 non pregnant females; G2 - 18 females in the initial phase of gestation, up to three months; G3 -15 pregnant females, with gestation from three to six months; G4 - 15 females in the last stage of gestation, from six to nine months; G5 - 16 females soon after delivering, up to 30 days in puerperium. The lipid profile of healthy Holstein cows was influenced by gestation. The concentration of NEFA was higher in the last trimester of gestation while the serum concentration of β-HBO was higher in the first trimester of gestation. In the first 30 days after delivering, the concentrations of NEFA and β-HBO were higher, while those of triglycerides were lower when compared to those of cows during gestation.

Teores de cloretos, lactose e índice cloretos/lactose na secreção láctea de bovinos da raça Jersey no primeiro mês da lactação / Chloride and lactose contents and chloride/lactose ratio in milk from Jersey cows in the first month of lactation

Avaliou-se a influência do período colostral nos teores lácteos de cloretos, lactose e do índice cloretos/lactose. Foram colhidas 418 amostras de leite provenientes de glândulas mamárias sadias, e que não apresentavam crescimento bacteriano ao exame microbiológico, de 127 vacas da raça Jersey. As amostras foram distribuídas em oito grupos: 0 ┤1/2 dia; 1/2 ┤1 dia; 1 ┤2 dias; 2 ┤3 dias; 3 ┤5 dias; 5 ┤7 dias; 7 ┤15 dias; 15 ┤30 dias em lactação. Nas amostras, colhidas antes da ordenha, foram determinados os valores de cloretos, por titulação colorimétrica, e de lactose, por radiação infravermelho, e calculou-se o índice cloretos/lactose. Nas primeiras 24 horas da lactação, observou-se abrupta diminuição no teor lácteo de cloretos e do índice cloretos/lactose, associada com o aumento no teor lácteo de lactose. A transição da secreção de colostro para leite em relação ao teor de cloretos e lactose e ao índice cloretos/lactose na secreção láctea ocorreu na primeira semana da lactação, a partir do terceiro dia da lactação para o valor de cloretos e para a relação cloretos/lactose e a partir do quarto dia da lactação para o teor de lactose. Recomenda-se, nas primeiras 24 horas da lactação, a adoção dos seguintes limites de normalidade: cloretos, <173,4mg/dL; lactose >3,94g/dL e índice cloretos/lactose, <6,11 por cento. Entre o segundo e o sétimo dia da lactação (transição de colostro para leite), indicamse os seguintes limites: cloretos <125,9mg/dL; lactose, >4,03g/dL e índice cloretos/lactose <3,54.

In order to assess the influence of the colostral period on chloride and lactose levels and on the chloride/lactose ratio, 419 milk samples from 127 Jersey cows were analyzed. The samples were collected from healthy udders that did not present any bacterial growth in the microbiological examination. Cows were distributed into eight groups as follows: 0 ┤1/2 day; 1/2 ┤1 day; 1 ┤2 days; 2 ┤3 days; 3 ┤5 days; 5 ┤7 days; 7 ┤15 days; 15 ┤30 days of lactation. The samples were collected before milking to analyze the levels of chloride by colorimetric titration, lactose by infrared radiation, and to determine the chloride/lactose ratio. In the first 24 hours after partition, there was an abrupt reduction in chloride levels as well in chloride/ lactose ratio, associated with an increase in lactose levels. It was observed that the transition of the secretion from colostrum to milk, regarding chloride and lactose levels and chloride/lactose ratio occurred during the first week of lactation: from the 3rd day of lactation for chloride and chloride/lactose ratio and from 4th for the lactose levels. It is recommended the use the following thresholds as normal ranges for the first 24 hours of lactation: chloride <173.4mg/dL; lactose >3.94g/dL, and chloride/lactose ratio <6.11 percent; and between 2nd and 7th days of lactation (transition from colostrum to milk), it was suggested the use of the following values: chloride <125.9mg/dL; lactose >4.03g/dL and chloride/lactose ratio <3.54.

Surgical treatment of the child's and adolescent's flexible flatfoot.

Operative intervention for juvenile flexible flatfoot is considered after a protracted course of orthotics and shoe modifications have failed to relieve associated symptoms. Surgical treatment options include hindfoot fusion, soft tissue procedures, calcaneal osteotomies, limited midtarsal arthrodeses, combination techniques, and subtalar arthroereisis. Long-term, high success rates have been documented with use of combination procedures and the anterior calcaneal osteotomy of Evans.

Osseointegrated implant for single-tooth replacement: a retrospective multicenter study on routine use in private practice.

BACKGROUND: Implant restorations first started with total edentulism. Later, the scientific community gave its approval for restorations in partial edentulism, and only recently some studies confirmed the validity of the treatment for single-tooth replacement. PURPOSE: The purpose of the study was to evaluate implant survival and prosthesis stability of Brånemark implants (titanium screws) when used routinely for single-tooth replacement in all regions. MATERIALS AND METHODS: Two hundred and fourteen patients received 252 implants for single-tooth replacement over a period of 8 years at five private clinics in Italy. The patients were treated in accordance with the protocol for Brånemark implants, and the data gathered have been analyzed according to established evaluation methods. RESULTS: During the observation period, 10 failures were recorded and 229 restorations were carried out. After the first year of loading, the total cumulative survival rate (CSR) was 96%, which then remained stable over the study time. The most frequent complication was loosening of the abutment screws (n = 22), amounting to 35% of all of the complications. This problem was related mainly to earlier types of abutments, whereas the more recent design, CeraOne abutment, showed a low frequency of screw loosening. CONCLUSIONS: The high survival rate, which is similar to that presented for prospective multicenter studies for single-tooth restorations with Brånemark implants, led to the conclusion that the use of this treatment modality is a reliable treatment for routine use in all oral regions.

Lengthening of pediatric forearm deformities using the Ilizarov technique: functional and cosmetic results.

Eight patients (average age, 10 years) had a unilateral forearm lengthening procedure using the technique developed by Ilizarov. The procedure was performed in 4 patients with radial agenesis, in 2 with multiple hereditary exostosis, in 1 with ulnar agenesis, and in 1 with multiple enchondromatosis. Patients underwent distraction osteogenesis through either a unifocal or bifocal corticotomy. Forearm length increased on average 6.0 cm (range, 3.6-8.1 cm) or 54% (range, 21% to 94%) with a lengthening index of 1.3 months per centimeter (range, 0.6-1.9 months per centimeter). The length of follow-up averaged 4.5 years and involved office examinations with task evaluation and a questionnaire addressing function and appearance. Limb length discrepancy at follow-up measured 3.7 cm (range, 0.0-8.0 cm). Lengthening of the forearm was found to improve upper extremity function; it allowed the patient to reach distant body parts and to perform select activities requiring near-equal arm length. Forearm lengthening also improved the appearance of the arm if adequate soft tissue was preserved. Full restoration of arm length was not a requirement for a successful outcome and patient satisfaction with the results of the procedure was high.

Patellar stabilization: a quantitative evaluation of the vastus medialis obliquus muscle.

Twenty-one cadaveric knees were dissected to analyze the functional anatomy of the vastus medialis complex (VMC), which is composed of the vastus medialis obliquus (VMO) and the vastus medialis longus (VML) muscles. The physiologic cross-sectional area of the VMO for 20 of the knees was 29% of the total physiologic cross-sectional area for the VMC. These values differed in one knee with a dysplastic VMO. The quantitative description of the VMO provided by this study will facilitate future efforts to accurately model the physiologic function of the VMO in cadaveric investigations on patellofemoral mechanics. The effect of simulated pathologies and surgical reconstructions then may be determined with more certainty to improve patient management.

Polished versus autoglazed dental porcelain.

This study compared the finishes on dental porcelain polished with four different polishing paste systems with oven reglazing and with a porcelain adjustment kit without a polishing paste. The polished/reglazed samples were rated according to quality of finish by independent observers and by scanning electron microscopy. On the basis of visual examination, two of the polishing paste systems tested were found to produce a surface equal to or better than oven glazing. On the basis of SEM examination, oven glazing was found to produce a better surface than the other polishing methods. Not all porcelain polishing systems produce a surface comparable to oven-glazed porcelain, and porcelain polishing systems should be chosen carefully.