Short time guided bone regeneration using beta-tricalcium phosphate with and without fibronectin - An experimental study in rats

BACKGROUND: The aim of this histomorphometric study was to assess the bone regeneration potential of beta-tricalcium phosphate with fibronectin (Beta-TCP-Fn) in critical-sized defects (CSDs) in rats calvarial, to know whether Fn improves the new bone formation in a short time scope. MATERIAL AND METHODS: CSDs were created in 30 Sprague Dawley rats, and divided into four groups (2 or 6 weeks of healing) and type of filling (Beta-TCP-Fn, Beta-TCP, empty control). Variables studied were augmented area (AA), gained tissue (GT), mineralized/non mineralized bone matrix (MBM/NMT) and bone substitute (BS). RESULTS: 60 samples at 2 and six weeks were evaluated. AA was higher for treatment groups comparing to controls (p < 0.001) and significant decrease in BS area in the Beta-TCP-Fn group from 2 to 6 weeks (p = 0.031). GT was higher in the Beta-TCP-Fn group than in the controls expressed in % (p = 0.028) and in mm2 (p = 0.011), specially at two weeks (p=0.056). CONCLUSIONS: Both Beta-TCP biomaterials are effective as compared with bone defects left empty in maintaining the volume. GT in defects regeneration filed with Beta-TCP-Fn are significantly better in short healing time when comparing with controls but not for Beta-TCP used alone in rats calvarial CSDs

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Guided bone regeneration using beta-tricalcium phosphate with and without fibronectin-An experimental study in rats.

OBJECTIVE: This histomorphometric study compared bone regeneration potential of beta-tricalcium phosphate with fibronectin (ß-TCP-Fn) in critical-sized calvarial defects (CSDs) in rats to assess whether fibronectin (Fn) improved new bone formation. MATERIAL AND METHODS: Critical-sized calvarial defects were created in 30 adult male Sprague Dawley rats, which were divided into four groups according to the time of euthanasia (6 or 8 weeks of healing) and type of filling (ß-TCP-Fn/6 weeks, ß-TCP/6 weeks, ß-TCP-Fn/8 weeks and ß-TCP/8 weeks). The primary variables related to new bone formation were augmented area (AA) and gained tissue (GT; sum of mineralized bone matrix [MBM] and bone substitute [BS]). Secondary variables were the diameter of the defect, MBM, non-mineralized tissue (NMT) and BS. RESULTS: A total of 29 rats and 58 histological samples were evaluated, 28 (48.3%) samples obtained at 6 weeks and 30 (51.7%) at 8 weeks, homogeneously distributed between right and left sides. Thirteen (22.4%) were treated with ß-TCP-Fn, 16 (27.6%) with ß-TCP and 29 (50%) were controls. At 8 weeks, histomorphometric analysis showed significant differences in AA using ß-TCP and ß-TCP-Fn versus controls (p = 0.001 and p = 0.005, respectively). Bone turnover expressed as % within the target area was slightly higher but not statistically significant in the ß-TCP-Fn than in ß-TCP (MBM) at 6 weeks versus 8 weeks (p = 0.067 and p = 0.335, respectively). Finally, the total GT area in mm2 was higher using ß-TCP-Fn as compared to ß-TCP (p = 0.044). CONCLUSIONS: ß-TCP-Fn was slightly but non-significantly more effective than ß-TCP without Fn for improving the volume of regenerated bone in CSDs of rats, possibly allowing a more efficient bone remodelling process. This effect however should continue being investigated.

Dental implications in oral cancer patients

Objectives. A study is made of the dental implications of oral cancer, with a view to avoiding the complicationsthat appear once oncological treatment is started.Patients and Methods. The study comprised a total of 22 patients diagnosed with oral cancer according to clinicaland histological criteria in the Service of Maxillofacial Surgery (Dental Clinic of the University of Barcelona,Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona.Results. Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could notbe located; these subjects were thus excluded from the analysis. All of the smokers had abandoned the habit. Themost common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularlybefore the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried outin 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperativeradiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, xerostomia orspeech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergoregular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50%had active periodontal disease.Conclusions. Protocols are available for preventing the complications of oral cancer treatment, and thus for improvingpatient quality of life. However, important shortcomings in the application of such protocols on the part ofthe public health authorities make it difficult to reach these objectives (AU)

Dental implications in oral cancer patients.

OBJECTIVES: A study is made of the dental implications of oral cancer, with a view to avoiding the complications that appear once oncological treatment is started. PATIENTS AND METHODS: The study comprised a total of 22 patients diagnosed with oral cancer according to clinical and histological criteria in the Service of Maxillofacial Surgery (Dental Clinic of the University of Barcelona, Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona. RESULTS: Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12 subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could not be located; these subjects were thus excluded from the analysis. All of the smokers had abandoned the habit. The most common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularly before the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried out in 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperative radiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, xerostomia or speech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergo regular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50% had active periodontal disease. CONCLUSIONS: Protocols are available for preventing the complications of oral cancer treatment, and thus for improving patient quality of life. However, important shortcomings in the application of such protocols on the part of the public health authorities make it difficult to reach these objectives.

Application of ultrasound in bone surgery: Two case reports

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases.The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the othercase a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinusmembrane lift procedure.The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding.One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures indental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver.The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve (AU)

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Scientific evidence on the usefulness of intraarticular hyaluronic acid injectionin the management of temporomandibular dysfunction

Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes – exerting joint lubrication and buffering actions thanks to its viscoelastic properties.The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articlesfound in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the “Strength of Recommendation Taxonomy” criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen (AU)

Application of ultrasound in bone surgery: two case reports.

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction.

Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes-exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articles found in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the "Strength of Recommendation Taxonomy" criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen.

Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to deficient lip sealing, micrognathia, microstomia, bifid uvula, gothic and fissured palate, fissured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants (AU)

Oral implant rehabilitation in a patient with Moebius syndrome.

INTRODUCTION: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to deficient lip sealing, micrognathia, microstomia, bifid uvula, gothic and fissured palate, fissured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. CLINICAL CASE: We report the case of a woman with Moebius syndrome and total edentulism . Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. DISCUSSION: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants.

Nasopalatine duct cyst: report of 22 cases and review of the literature.

OBJECTIVES: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. STUDY DESIGN: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. RESULTS: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root resorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. CONCLUSIONS: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case.

Nasopalatine duct cyst: Report of 22 cases and review of the literature

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Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogeniccysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject.Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4.Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt.Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case

Inferior alveolar nerve damage because of overextended endodontic material: a problem of sealer cement biocompatibility?

Damage to the inferior alveolar nerve is a relatively infrequent complication in dental practice. When root canal treatment of a lower molar or premolar surpasses and/or overextends beyond the apical foramen and invades the periapical zone, the foreign material introduced within such a sensitive anatomical space may mechanically or even chemically affect the inferior alveolar nerve. We describe a case of endodontic treatment of a permanent right lower first molar in which the sealer cement overextended in large amounts and damaged the right inferior alveolar nerve. The condition reverted a few months after the surgical removal of the material. Evaluation of the removed material, using powder x-ray diffraction and scanning electron microscopy with coupled dispersive energy spectroscopy, showed it to consist of calcium tungstate (scheelite [CaWO4]) and zirconium oxide (baddeleyite [ZrO2]), which were chemical components of the sealer cement.