Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study.

STUDY OBJECTIVES: Maxillomandibular advancement surgery (MMA) is a therapeutic option for obstructive sleep apnea (OSA). The main objective of this study was to determine the impact of MMA on the physical and airflow characteristics of the upper airway based on data obtained by computational fluid dynamics (CFD) and to correlate these data with polysomnography parameters. Other objectives included the identification of presurgical variables that could help avoid surgeries likely to have a low success rate. METHODS: This was a retrospective observational study of 18 patients with moderate-severe OSA who underwent MMA. Polysomnography and computed axial tomography imaging were performed before and after the surgery. Three-dimensional models for CFD study were made based on the images obtained. RESULTS: MMA achieved an average increase in airway volume of 43.75%, with a mean decrease in the maximum airway velocity of 40.3%. We found significant correlations between improved apnea-hypopnea index values and both the increase in airway volume and decrease in maximum airway speed. Patients with a maximum velocity of less than 7.2 m/s before the intervention had a high rate of surgical failure (43%). CONCLUSIONS: MMA generates a significant increase in the volume of the upper airway, which was associated with improved flow conditions in the CFD simulation. These findings also correlated with improved polysomnography parameters. Thus, CFD simulation on three-dimensional anatomical models of patients with OSA could contribute to the better selection of candidates for MMA. CITATION: Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med. 2024;20(3):371-379.

The Use of Human Sterilized Crushed Tooth Particles Compared with BTCP Biomaterial and Empty Defects in Bone Formation inside Critical Rabbit Calvaria Sites.

This study aimed to assess the bone regeneration of critical-size defects in rabbit calvaria filled with freshly crushed extracted teeth, comparing them with BTCP biomaterial and empty sites. Materials and methods: Twenty-one female New Zealand rabbits were used in this study. Two critical-size defects 6 mm in size were created in the skull bone, each with a 3 mm separation between them. Three experimental groups were evaluated: Group A (human sterilized crushed teeth granules alone), Group B (Bioner Bone, Bioner Sitemas Implantológicos), and Group C (unfilled defects). The animals were sacrificed at 4 and 8 weeks. Evaluation of the samples involved histological and histomorphometric analyses with radiographic evaluation. The histological evaluation showed a higher volume reduction in Group A compared with Group B (p < 0.05) and Control. Group A showed the highest values for cortical closure and bone formation around the particles, followed by Group B and Group C (p < 0.05). Within the limitations of this animal study, we can conclude that the use of human tooth particles leads to increased bone formation and reduced connective tissue in critical-size defects in rabbit calvaria when compared to BTCP biomaterial. The calvarial model is a robust base for the evaluation of different biomaterials.

IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population.

Non-syndromic cleft lip with or without cleft palate (NSCL/P) is the most common developmental defect that significantly affects the morphology and function of the stomatognathic system in children. The etiology of these birth defects is multifactorial, and single nucleotide polymorphisms (SNPs) in IRF6 and FGF1 have been associated with NSCL/P. This study aimed to evaluate whether SNPs in IRF6, namely rs2013162, rs642961, rs2235373, and rs34010 in FGF1, are associated with NSCL/P occurrence in the Polish population. The study included 627 participants: 209 children with NSCL/P and 418 healthy controls. DNA was isolated from saliva in the study group and from umbilical cord blood in controls. Genotyping of polymorphisms was performed using quantitative PCR. There was no statistically significant association of IRF6 gene variants with NSCL/P occurrence, although for rs2013162, AA genotype, odds ratio (OR) = 1.16 and for AC genotype, OR = 0.83; for rs642961, AA genotype, OR = 0.84 and for AG genotype, OR = 1.41; and for rs2235373, AA genotype, OR = 0.79 and for AG, OR = 0.85. In the instance of rs34010 polymorphism in FGF1, the presence of the AA genotype was statistically significant in reducing the risk of NSCL/P (OR = 0.31, p = 0.001). Genetic variation in FGF1 is an important risk marker of NSCL/P in the Polish population, which cannot be stated for the polymorphisms in the IRF6 gene.

Evaluation of Contour Augmentation in Immediate Single-Tooth Implants With and Without Flaps in the Anterior Maxilla: A 1-Year Prospective Study.

This prospective clinical study involved 20 patients in whom implants were immediately placed in extraction sockets. Residual bone defects were grafted, and the buccal bone plate was overcontoured with a xenogeneic bone substitute and covered by a collagen membrane. One year after implant placement, CBCT images were acquired to evaluate buccal bone, and implant stability was analyzed through resonance frequency analysis. Results showed that buccal bone covered the rough surface of all implants 1 year after implantation. Hard tissues responded more favorably in the flapless group. No correlation was found between initial bone defects and bone dimensions in the follow-up exam.

Odontocrexis / Odontocrexis / Odontocrexis

Los cambios en la presión atmosférica pueden ocasionar patología odontológica en personas que presentan dientes con caries, obturaciones deficientes o temporales y en todas aquellas lesiones cavitadas donde puedan quedar albergadas burbujas de aire.Se presenta el caso clínico de un buceador de la Armada Española que acude al servicio de odontología de la Jefatura de Apoyo Sanitario del Arsenal de Cartagena, por presentar fractura dental completa, “odontocrexis”, derivado de la expansión volumétrica de los gases en el ascenso a la superficie terrestre durante la realización de un ejercicio de buceo militar. (AU)

Changes in atmospheric pressure can cause dental disease in people with decayed teeth, poor or temporary fillings, and in all cavitated lesions where air bubbles can be lodged.The clinical case of a diver from the Spanish Navy who attends the dentistry service of the Sanitary Support Headquarters of the Cartagena Arsenal is presented, due to presenting a complete dental fracture, “odontocrexis”, derived from the volumetric expansion of the gases during the ascent to the ground during a military diving exercise. (AU)

Mudanças na pressão atmosférica podem causar patologia dentária em pessoas com dentes cariados, obturações deficientes ou temporárias e em todas as lesões cavitadas onde bolhas de ar podem se alojar.É apresentado o caso clínico de um mergulhador da Marinha Espanhola que frequenta o serviço de odontologia do Quartel de Apoio Sanitário do Arsenal de Cartagena, por apresentar uma fratura dentária completa, “odontocrexia”, decorrente da expansão volumétrica dos gases durante a subida ao solo durante um exercício de mergulho militar. (AU)

Autologous Tooth Dentin Graft: A Retrospective Study in Humans.

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets' preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties.

Clinical and radiographic findings without the use of bone substitute materials in extraction sockets and delayed implant placement- A case series.

AIM: To observe clinically and radiographically (CBCT), the extent of bone resorption in extraction socket without the use of bone graft substitutes and delayed implant placement. MATERIAL AND METHODS: 50 compliant patients were selected for study. All the patients who were advised extraction were followed up for entire duration of the treatment, at 5th week CBCT showed horizontal and vertical bone loss. To prevent further bone resorption, after 5 weeks implant was placed along with bone graft. RESULTS: Bone resorption after extraction is an unavoidable phenomenon. Clinical and radiographic (CBCT) analysis showed massive bone resorption by 5th week. At 5 month CBCT, all patients showed stable implant integration. There was no implant failure at the end of the study. CONCLUSION: Alveolar preservation is proven to slow down socket wall collapse with the use of a bone substitute material without which larger procedures maybe needed to restore alveolar integrity and harmony. Immediate implant placement is effective when bone graft is placed in the jumping distance.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique.

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients' files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6-9 months of healing time. Mean follow-up was 17.5 months, range 12-36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Prospective, Clinical Pilot Study with Eleven 4-Mm Extra-Short Implants Splinted to Longer Implants for Posterior Maxilla Rehabilitation.

In many clinical situations, rehabilitation with implants in the posterior maxillary region is complicated by limited bone availability. In this context, the use of 4 mm long implants (known as extra-short implants) may be used thanks to the concept of osseointegration enhancement. It has been demonstrated that short implants offer an alternative to the regeneration procedures involved in placing longer implants in areas where bone height is compromised. This prospective pilot study tested a treatment protocol in which 11 extra-short (4 mm) implants were splinted to 11 mesially placed longer (8 mm) implants in the posterior maxillary regions of partially edentulous patients, without using supplementary bone regeneration procedures. Eleven patients were included in this single cohort study. The clinical performance of the extra-short implants was assessed during a two-year follow-up period, obtaining a 100% survival rate and mean bone loss of 0.3 mm. Implant stability measured by resonance frequency analysis (RFA) at the time of placement was 54.9 ± 4.9, increasing to 77.0 ± 2.6 at 24 months. The study demonstrated the gradual consolidation of osseointegration in bone of less-than-ideal quality in the posterior maxillary region. The results obtained show that a partially edentulous maxilla with reduced bone height may be rehabilitated by using an extra-short implant splinted to a mesial implant of 8mm length or longer. Despite the small sample size, this pilot study observed that extra-short implants achieved adequate bone stability and clinical performance after a 24-month follow-up.

Nurse's A-Phase-Silicocarnotite Ceramic-Bone Tissue Interaction in a Rabbit Tibia Defect Model.

Calcium phosphate materials are widely used as bone substitutes due to their bioactive and biodegradable properties. Also, the presence of silicon in their composition seems to improve the bioactivity of the implant and promote bone tissue repair. The aim of this study was to develop a novel ceramic scaffold by partial solid-state sintering method with a composition lying in the field of the Nurse's A-phase-silicocarnotite, in the tricalcium phosphate-dicalcium silicate (TCP-C2S) binary system. Also, we evaluated its osteogenic and osteoconductive properties after being implanted into tibia defects in New Zealand rabbits. X-ray, microcomputer tomography, and histomorphometry studies demonstrated that this porous ceramic is highly biocompatible and it has excellent osteointegration. The material was being progressively reabsorbed throughout the study and there was no unspecified local or systemic inflammatory response observed. These results suggest that ceramic imitates the physicochemical characteristics of bone substitutes used in bone reconstruction.

Management of Schneiderian Membrane Perforations during Sinus Augmentation Procedures: A Preliminary Comparison of Two Different Approaches.

BACKGROUND: The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. METHODS: A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. RESULTS: Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. CONCLUSIONS: Both surgical techniques yielded therapeutic success.

Bacterial Adherence Around Sutures of Different Material at Grafted Site: A Microbiological Analysis.

Closure of the surgical incision has been the primary function of sutures since their introduction. However, whatever the type, they are known to carry bacteria, which can be a source of infection. Five types of surgical sutures, Gut, Silk, Vicryl, PTFE, and Polyamide, were selected and tested on their ability to carry aerobic and anaerobic bacteria and were rated on the basis of forming colony-forming units (CFUs). Aerobic bacteria grown around gut sutures showed minimum CFUs (≈30 × 104/suture). Though very less anaerobic bacteria growth was seen among all tested suture materials, it was maximum around Vicryl and polyamide sutures. Every suture material is capable, albeit not equally, of holding bacterial biofilm formation, which can be a source of surgical site infection.

Effects of occlusal forces on the peri-implant-bone interface stability.

The occlusal forces and their influence on the initiation of peri-implant bone loss or their relationship with peri-implantitis have created discussion during the past 30 years given the discrepancies observed in clinical, animal, and finite element analysis studies. Beyond these contradictions, in the case of an osseointegrated implant, the occlusal forces can influence the implant-bone interface and the cells responsible for the bone remodeling in different ways that may result in the maintenance or loss of the osseointegration. This comprehensive review focuses on the information available about the forces transmitted through the implant-crown system to the implant-bone interface and the mechano-transduction phenomena responsible for the bone cells' behavior and their interactions. Knowledge of the basic molecular biology of the peri-implant bone would help clinicians to understand the complex phenomenon of occlusal forces and their effects on the implant-bone interface, and would allow better control of the negative effects of mechanical stresses, leading to therapy with fewer risks and complications.

Retraction: Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC. A dog study.

In relation to the article of the Journal of Clinical and Experimental Dentistry "Calvo-Guirado JL, Aguilar-Salvatierra A, Guardia J, Delgado-Ruiz R, Ramírez-Fernández MP, Pérez-Sánchez C, Gómez-Moreno G. Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC. A dog study. J Clin Exp Dent. 2012 Feb 1;4(1):e8-e13", the authors have used three figures that are the same as those published in three different publications (J Pineal Res 2010; COIR 2010; COIR 2012). The copyright of the mentioned publications was consequently not respected. Retraction of the article is therefore decided.

Development of a Novel Nanotextured Titanium Implant. An Experimental Study in Rats.

This animal study evaluated the osseointegration level of a new nanotextured titanium surface produced by anodization. Ti-cp micro-implants (1.5 mm diameter by 2.5 mm in length) divided into two groups: titanium nanotextured surface treatment (Test Group) and acid etched surface treatment (Control Group). Surface characterization included morphology analysis using scanning electron microscopy and wettability by measuring contact angle. Sixteen Wistar rats were submitted to two micro implants surgical placement procedures. In each rat, one type of micro implant placed in each tibia. The animals sacrificed after two (T1) and six weeks (T2) post-implantation. After the euthanasia, tibias processed for histomorphometric analysis, which allowed the evaluation of bone to implant contact (BIC) and the bone area fraction occupancy between the threads (BAFO). Our surface analysis data showed that the Control Group exhibited an irregular and non-homogenous topography while the Test Group showed a nanotextured surface. The Test Group showed higher wettability (contact angle = 5.1 ± 0.7°) than the Control Group (contact angle = 75.5 ± 4.6°). Concerning the histomorphometric analysis results for T1, Control and Test groups showed BIC percentages of 41.3 ± 15.2% and 63.1 ± 8.7% (p < 0.05), respectively, and for BAFO, 28.7 ± 13.7% and 54.8 ± 7.5%, respectively (p < 0.05). For T2, the histomorphometric analysis for Control and Test groups showed BIC percentages of 51.2 ± 11.4% and 64.8 ± 7.4% (p < 0.05), respectively and for BAFO, 36.4 ± 10.3% and 57.9 ± 9.3% (p < 0.05), respectively. The findings of the current study confirmed that the novel nanotextured surface exhibited superior wettability, improved peri-implant bone formation, and expedited osseointegration.