Vertical ridge augmentation (VRA) with the use of a cross-linked resorbable membrane, tenting screws, and a combination grafting technique: a report of three cases.

OBJECTIVE: The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. REPORT: Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with > 35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm. CONCLUSION: Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm.

Oxidative damage to plasma proteins in patients with chronic alcohol dependence: the effect of smoking.

BACKGROUND: Accumulating evidence implicates oxidative stress in ethanol-induced toxicity. Ethanol has been reported to be involved in oxidative damage, mostly in vitro, or in post mortem tissues, while biochemical abnormalities in the blood or serum are scanty or lacking. The aim of the present study was to examine the oxidative status of plasma proteins as markers of oxidative stress in subjects with chronic alcohol dependence (CAD). Since smoking has also been associated with oxidative stress this factor was also considered. PATIENTS AND METHODS: A total of 71 patients with CAD and 61 healthy volunteers of comparable age were included in the study. The protein carbonyl assay was carried out in plasma, as a reliable measure of general oxidative protein damage, in these two groups. RESULTS: Increased plasma protein carbonyls (PCs) were found in patients with CAD as compared with the control group [mean values (nmollmg protein): 4.73+/-1.46 and 3.62+/-0.91 respectively, p<0.000001]. Within the control group, smokers had higher PCs than the non-smokers, however this difference was of marginal significance [mean values (nmol/mg protein): 3.93+/-1.32 and 3.47+/-0.63, respectively]. The CAD group had significantly increased PCs compared with both the smoker and the non-smoker subgroups of the controls (p<0.001 and p<0.0001, respectively). Duration of alcohol consumption, daily alcohol intake, smoke load, folic acid and vitamin B12 levels did not correlate significantly with PC levels. CONCLUSION: The above results support the evidence for systemic oxidative stress in CAD, which must be attributed mainly to alcohol consumption, while smoking may act synergistically.