Maresin 1 Promotes Wound Healing and Socket Bone Regeneration for Alveolar Ridge Preservation.

Tooth extraction results in alveolar bone resorption and is accompanied by postoperative swelling and pain. Maresin 1 (MaR1) is a proresolving lipid mediator produced by macrophages during the resolution phase of inflammation, bridging healing and tissue regeneration. The aim of this study was to examine the effects of MaR1 on tooth extraction socket wound healing in a preclinical rat model. The maxillary right first molars of Sprague-Dawley rats were extracted, and gelatin scaffolds were placed into the sockets with or without MaR1. Topical application was also given twice a week until complete socket wound closure up to 14 d. Immediate postoperative pain was assessed by 3 scores. Histology and microcomputed tomography were used to assess socket bone fill and alveolar ridge dimensional changes at selected dates. The assessments of coded specimens were performed by masked, calibrated examiners. Local application of MaR1 potently accelerated extraction socket healing. Macroscopic and histologic analysis revealed a reduced soft tissue wound opening and more rapid re-epithelialization with MaR1 delivery versus vehicle on socket healing. Under micro-computed tomography analysis, MaR1 (especially at 0.05 µg/µL) stimulated greater socket bone fill at day 10 as compared with the vehicle-treated animals, resulting in less buccal plate resorption and a wider alveolar ridge by day 21. Interestingly, an increased ratio of CD206+:CD68+ macrophages was identified in the sockets with MaR1 application under immunohistochemistry and immunofluorescence analysis. As compared with the vehicle therapy, local delivery of MaR1 reduced immediate postoperative surrogate pain score panels. In summary, MaR1 accelerated extraction wound healing, promoted socket bone fill, preserved alveolar ridge bone, and reduced postoperative pain in vivo with a rodent preclinical model. Local administration of MaR1 offers clinical potential to accelerate extraction socket wound healing for more predictable dental implant reconstruction.

Is Metal Particle Release Associated with Peri-implant Bone Destruction? An Emerging Concept.

Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research.

Eagle's syndrome-A non-perceived differential diagnosis of temporomandibular disorder.

INTRODUCTION: This article unveils a case of the classic styloid syndrome and states that panoramic imaging and ultrasound can be an alternative to computed tomography. In addition, the endoscope-assisted extraoral approach using CT-based navigation is useful. Eagle's Syndrome is an aggregate of symptoms described by Eagle in 1937. He described different forms: the classic styloid syndrome consisting of elongation of the styloid process which causes pain. Second, the stylo-carotid-artery syndrome which is responsible for transient ischemic attack or stroke. PRESENTATION OF CASE: Using the example of a 66 years old male patient suffering from long term pain, we explain our diagnostic and surgical approach. After dissecting the styloid process of the right side using an extraoral approach, the pain ceased and the patient could be discharged without any recurrence of the pain up to this point. DISCUSSION: Eagle's syndrome, with its similar symptoms, is rather difficult to differentiate from temporomandibular joint disorders (TMD), but can be easily excluded from possible differential diagnoses of TMD using panoramic radiographs and ultrasound. CONCLUSION: Making use of low cost and easily accessible diagnostic workup techniques can reveal this particular cause for chronic pain restricting quality of life. Thereby differentiation from the TMD symptomatic complex is possible.

Recurrence rate and shift in histopathological differentiation of oral squamous cell carcinoma ­ A long-term retrospective study over a period of 13.5 years.

OBJECTIVE: Little information is available as to whether recurrences of oral squamous cell carcinoma (OSCC) show different histopathological grades than the primary tumor and whether postoperative radiotherapy (PORT) influences the grade of differentiation in the case of recurrence. The objective of this study was the evaluation of recurrence rates and change in differentiation. MATERIAL AND METHODS: This retrospective, single-institution cohort study included surgically treated OSCC patients over a 13-year period (2000-2013). The relationship among tumor size, lymph node metastases, and recurrence rate of OSCC was investigated. Primary tumor differentiation was compared with differentiation of recurrence. RESULTS: A total of 429 patients (277 men and 152 women) were included in this study. Of these, 124 (28.9%) received PORT. The incidence of primary cervical metastases increased significantly with tumor size (p < 0.001). Recurrence developed in 82 patients (19.1%). Stage T1/T2 showed a significantly lower recurrence rate than stage T3/T4 (16.3% vs. 30.2%) (p < 0.01). A total of 23 (30.7%) patients with recurrence showed a change in differentiation. CONCLUSION: Increasing primary tumor size correlates with incidence of cervical metastases and recurrence rate. Initial cervical metastases show no effect on recurrence rates. Differentiation of primary tumor does not correlate with the recurrence rate. The majority of recurrences show consistent histopathological grading.

Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest.

OBJECTIVE: The purpose of the present study was to evaluate crestal bone level changes around dental implants after iliac bone augmentation in the long term. MATERIAL AND METHODS: A total of 32 partially edentulous/edentulous patients (mean age, 52 years; range, 22-70 years) and a remaining bone volume of less than 5 mm of the alveolar ridge underwent maxillary or mandibular iliac bone graft augmentation. All patients received spaced standardized radiological examination for evaluation of peri-implant crestal bone loss. RESULTS: The grafting procedure was successfully performed in all patients. A total of 150 implants were placed. The mean observation period was 69 months (range, 12-165 months; success rate for maxilla, 96%; success rate for mandible, 92%). The mean amount of crestal bone loss after 10 years was 1.8 mm. A significant difference between gender and crestal bone loss was shown, but no influence was found regarding the implant system, diameter of implant, and age of the patients. CONCLUSION: In patients with atrophic jaws, a sufficient long-term reconstruction can be achieved with the combination of iliac onlay grafting and dental implants. The results demonstrate high success rates and a stable peri-implant bone level in the long term.

A prospective study of factors influencing morbidity after iliac crest harvesting for oral onlay grafting.

OBJECTIVE: The present study evaluates the morbidity after iliac crest harvesting from the anterior iliac rim for oral onlay grafting and identifies influential factors. MATERIAL AND METHODS: Twenty partially edentulous or edentulous patients (15 females and 5 males) with a mean age of 54.25 years (range 20-78 years, SD 13.86 years, remaining bone height <5 mm of the alveolar ridge) underwent iliac onlay bone grafting. The postoperative clinical morbidity was classified in minor and major complications and was evaluated with respect to body mass index (BMI). RESULTS: The grafting procedure was successfully performed in all patients with a mean BMI of 23.34 (range 18-29, SD 3.36). A significant difference between BMI and walking aid necessity (p = 0.018) was demonstrated, but no difference between BMI and hip pain, duration of disturbance, gait disturbance, complication rate, and sensory loss was identified (p > 0.05). Between hip pain and scar length, age and hip/jaw pain did not demonstrate a significant difference (p > 0.05). Postoperative complications were minor and consisted of hematoma, seroma, and transient sensory disturbance. CONCLUSION: Patients undergoing bone harvest from the anterior superior iliac crest with oral grafting show a low minor complication rate and a high overall satisfaction of 95%.

[Endovascular treatment of acute ischemic stroke under conscious sedation compared to general anesthesia - safety, feasibility and clinical and radiological outcome]. / Endovaskuläre Therapie des akut ischämischen Schlaganfalls unter Analgosedierung im Vergleich zur Intubationsnarkose - Durchführbarkeit, periprozedurale Sicherheit, klinisches und radiologisches Outcome.

PURPOSE: Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS. MATERIALS AND METHODS: We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri- and post-procedural complications. RESULTS: There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) peri-procedural conversion to GA was necessary. Primary intra-arterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01). CONCLUSION: Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA.