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1.
Artigo em Inglês | MEDLINE | ID: mdl-31908138

RESUMO

BACKGROUND: Short implants (intra-bony length ≤ 8 mm) are generally considered as an alternative to bone augmentation in challenging situations; however, clinical evidence from large-scale studies with long follow-up regarding the application of short implants remains deficient. PURPOSE: The present study aimed to assess the mid-term clinical outcomes of short implants supporting fixed prostheses in the posterior region, and to investigate the effects of the crown-to-implant ratio (C/I), and other patient-, implant-, prosthesis-relevant factors on the clinical conditions around short implants. MATERIALS AND METHODS: 180 Thommen short implants in 130 partially edentulous patients were enrolled in the study after 3 to 7 (mean 4.2) years of follow-up. Potential risk factors (patient sex and age, implant diameter and location, splinted vs single-tooth restorations, retention mode, anatomical and clinical C/I ratios) were evaluated according to the following outcomes: Implant survival, marginal bone loss (MBL), and mechanical and biological complications. RESULTS: In total, four implants in four patients failed as a result of peri-implantitis. The cumulative survival rate was 97.8% for implant-based analysis. The peri-implant MBL around 180 short implants was 0.90 ± 0.78 mm. The mean clinical C/I ratio was 1.16 ± 0.36. Correlation analysis revealed that the influence of the clinical C/I ratio and patient age were significant for MBL (P < .05), whereas other potential risk factors showed no significant association with the outcome. Among 180 short implants, 24 cases (13.3%) had biological complications and 32 cases (17.8%) had mechanical complications, respectively. Peri-implant MBL and complication rates around splinted and non-splinted implants were not statistically different. CONCLUSION: Within the limitations of this study, short implants supporting fixed prostheses in the posterior region achieved predictable clinical outcomes over a 3 to 7 year period. Within the range of 0.47 to 3.01, the higher the C/I ratio, the less the peri-implant MBL.

2.
J Vet Pharmacol Ther ; 42(6): 602-608, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31529627

RESUMO

Ceftiofur, a third-generation cephalosporin antibiotic, is being extensively used by pet doctors in China. In the current study, the detection method was developed for ceftiofur and its metabolites, desfuroylceftiofur (DCE) and desfuroylceftiofur conjugates (DCEC), in feline plasma. Then, the pharmacokinetics studies were performed following one single intravenous and subcutaneous injection of ceftiofur sodium in cats both at 5 mg/kg body weight (BW) (calculated as pure ceftiofur). Ceftiofur, DCE, and DCEC were extracted from plasma samples, then derivatized and further quantified by high-performance liquid chromatography. The concentrations versus time data were subjected to noncompartmental analysis to obtain the pharmacokinetics parameters. The terminal half-life (t1/2λz ) was calculated as 11.29 ± 1.09 and 10.69 ± 1.31 hr following intravenous and subcutaneous injections, respectively. After intravenous treatment, the total body clearance (Cl) and volume of distribution at steady-state (VSS ) were determined as 14.14 ± 1.09 ml hr-1  kg-1 and 241.71 ± 22.40 ml/kg, respectively. After subcutaneous injection, the peak concentration (Cmax ; 14.99 ± 2.29 µg/ml) was observed at 4.17 ± 0.41 hr, and the absorption half-life (t1/2ka ) and absolute bioavailability (F) were calculated as 2.83 ± 0.46 hr and 82.95%±9.59%, respectively. The pharmacokinetic profiles of ceftiofur sodium and its related metabolites demonstrated their relatively slow, however, good absorption after subcutaneous administration, poor distribution, and slow elimination in cats. Based on the time of drug concentration above the minimum inhibitory concentration (MIC) (T>MIC) calculated in the current study, an intravenous or subcutaneous dose at 5 mg/kg BW of ceftiofur sodium once daily is predicted to be effective for treating feline bacteria with a MIC value of ≤4.0 µg/ml.

3.
Clin Implant Dent Relat Res ; 21(1): 94-100, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30556644

RESUMO

BACKGROUND: Maxillary sinus pathologies are a potential risk for failure of implant and bone augmentation. Management of lateral sinus floor elevation in the presence of a pseudocyst remains controversial, and reports on histological outcomes of endo-sinus bone augmentation with maxillary cysts are scarce. PURPOSE: To present a modified surgical technique for removal of maxillary pseudocyst with simultaneous sinus floor elevation, and to evaluate clinical and histological outcomes of the bone grafting. MATERIALS AND METHODS: Patients with a radiographic dome-shaped opacity in the posterior maxillary sinus were included to receive lateral sinus floor elevation with simultaneous pseudocyst removal. Bone core specimens harvested from the lateral aspect of the augmentation sites were histomorphometrically analyzed. Data were recorded and evaluated in terms of survival rates and complications. RESULTS: A total of 15 patients were included who underwent 17 maxillary sinus augmentation surgeries. Implant survival rate was 97.0%. Bone biopsy specimens were obtained at 6 months after surgery. Histomorphometric analysis revealed that mean percentages of mineralized bone, bone substitute, and nonmineralized tissue were 24.9% ± 18.1%, 14.4% ± 12.5%, and 60.1% ± 12.44%, respectively. No recurrence of the pseudocyst was detected on radiographic examination. CONCLUSIONS: The described technique could be successfully applied in clinical practice to perform sinus augmentation in the presence of pseudocysts.


Assuntos
Cistos/cirurgia , Doenças Maxilares/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Transplante Ósseo , Cistos/complicações , Cistos/patologia , Implantação Dentária Endo-Óssea , Feminino , Humanos , Masculino , Doenças Maxilares/complicações , Doenças Maxilares/patologia , Seio Maxilar/patologia , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
4.
J Craniomaxillofac Surg ; 46(8): 1199-1204, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29909943

RESUMO

PURPOSE: The aim of this prospective study was to evaluate the efficacy and long-term outcomes of onlay grafting with bovine bone mineral block for reconstruction of horizontal alveolar ridge defects in anterior maxillae. MATERIALS AND METHODS: Fourteen patients requiring rehabilitation of edentulous anterior maxillae were enrolled to receive onlay grafting in two layers. A cortical block harvested from the lateral aspect of the mandibular ramus was split to acquire approximately 1-mm-thick bone laminae. The cortical bone plate and block graft were compressed and fixed to the recipient sites. After 6 months, the width of the augmentation was recorded, and implants were inserted. Provisional and definitive prostheses were delivered 3 and a further 6 months later. Implant success and associated complications were assessed. RESULTS: The horizontal bone gain was 8.73 ± 0.82, with a resorption rate of 7.03%. Severe bone resorption was noticed 6 months and 2 years after loading. Fistula occurred with the nonintegrated bovine block on the labial sides of the augmented sites 6 years after loading. CONCLUSION: Onlay grafting with bovine bone mineral block in the anterior maxilla may yield optimal horizontal gain with low resorption rates, under the condition of at least 6 months' healing time, mixation with autogenous particulate bone, and application of a membrane to cover the graft site.


Assuntos
Enxerto de Osso Alveolar/métodos , Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Adulto , Animais , Reabsorção Óssea , Bovinos , Feminino , Humanos , Masculino , Maxila/cirurgia , Estudos Prospectivos , Resultado do Tratamento
5.
Clin Implant Dent Relat Res ; 20(4): 493-500, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29691967

RESUMO

BACKGROUND: It is complicated to select an appropriate sinus floor elevation and the procedure for sinus floor elevation lacks of consensus. Sinus contour plays an important role in choosing a surgery approach. But there are still no published articles revealing the influence of sinus contours to sinus floor elevation surgery. PURPOSE: We propose a new classification depending on sinus contours from cone-beam computed tomography (CBCT), analyze clinical characters of different types, and investigate the relationship between sinus contours and sinus floor elevation. MATERIALS AND METHODS: We divide sinus into five categories: narrow tapered, tapering, ovoid, square, and irregular. For the first four types, subtypes are classified into three categories: without recess, with buccal-sinus-recess (BSR), and with palate-nasal-recess (PNR). For irregular type, subtypes are classified into three categories: tooth protruding into sinus floor, irregular floor, and septa/exostosis on sinus floor. Then the distribution features of sinuses of 698 patients are described. Sinus widths are measured at second premolar, first and second molar on both sides, and are compared among different types and subtypes. RESULTS: Narrow tapered sinus occupies 88% at second premolar sites, while tapered sinus occupies almost 50% at first and second molar sites. At second premolar and first molar sites, 62% are without recess types. While 92% are without recess types at second molar. Sinuses with BSR present in only three of 3765 sites. There is an increasing trend of sinus width from narrow tapered to irregular type. Sinus width of the group with recesses is significantly higher than the one without recess. At the end, we provide corresponding treatment recommendations for each sinus types and subtypes. CONCLUSION: This is the first classification system that gives treatment recommendations for sinus floor elevation surgery based on sinus contours. The classification system is consistent, easy to visualize, and practicable.


Assuntos
Variação Anatômica , Maxila/anatomia & histologia , Seio Maxilar/anatomia & histologia , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dente Pré-Molar , Tomografia Computadorizada de Feixe Cônico/métodos , Arco Dental/diagnóstico por imagem , Feminino , Humanos , Imagem Tridimensional/métodos , Arcada Parcialmente Edêntula/diagnóstico por imagem , Masculino , Maxila/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Dente Molar , Perda de Dente/diagnóstico por imagem , Adulto Jovem
6.
J Craniomaxillofac Surg ; 46(2): 323-328, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29242025

RESUMO

OBJECTIVE: To introduce a novel method of split-thickness labial flap in maxillary anterior ridge horizontal augmentation and to evaluate its efficacy and morbidity. MATERIALS AND METHODS: 230 patients were selected to receive either particulate or onlay grafting. A split-thickness labial flap was applied to cover the grafted area and close the wound. The incidence of postsurgical complications and the level of patient discomfort were evaluated. A visual analog scale was used to quantify the amount of pain and swelling in the patients. RESULTS: In all 375 surgical sites, passive primary closure was achieved with the split-thickness labial flap method. Membrane exposure after surgery was seen in 6 cases in the onlay group and in 4 in the particulate group. No long-lasting pain (>1 week), paresthesia, or signs of infection occurred during the follow-up period of 6 months. The mean pain and swelling scores in the particulate graft group (2.75 ± 3.01 and 2.02 ± 2.51, respectively) were lower than the scores in the onlay graft group (3.18 ± 2.79 and 3.85 ± 2.25, respectively). CONCLUSIONS: The flap advancement technique presented in this study facilitates clinically passive primary closure. This technique can be used successfully in both particulate and onlay horizontal graft procedures.


Assuntos
Aumento do Rebordo Alveolar/métodos , Lábio/cirurgia , Maxila/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Aumento do Rebordo Alveolar/efeitos adversos , Implantação Dentária Endo-Óssea/efeitos adversos , Implantação Dentária Endo-Óssea/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
7.
Clin Implant Dent Relat Res ; 19(6): 1099-1105, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29034598

RESUMO

BACKGROUND: Maturation of the grafted volume after lateral sinus elevation is crucial for the long-term survival of dental implants. PURPOSE: To compare endo-sinus histomorphometric bone formation between the solo- and two-window maxillary sinus augmentation techniques with or without membrane coverage for the rehabilitation of multiple missing posterior teeth. MATERIALS AND METHODS: Patients with severely atrophic posterior maxillae were randomized to receive lateral sinus floor elevation via the solo-window technique with membrane coverage (Control Group) or the two-window technique without coverage (Test Group). Six months after surgery, bone core specimens harvested from the lateral aspect were histomorphometrically analyzed. RESULTS: Ten patients in each group underwent 21 maxillary sinus augmentations. Histomorphometric analysis revealed mean newly formed bone values of 26.08 ± 16.23% and 27.14 ± 18.11%, mean connective tissue values of 59.34 ± 12.42% and 50.03 ± 17.13%, and mean residual graft material values of 14.6 ± 14.56% and 22.78 ± 10.83% in the Test and Control Groups, respectively, with no significant differences. CONCLUSIONS: The two-window technique obtained comparative maturation of the grafted volume even without membrane coverage, and is a viable alternative for the rehabilitation of severely atrophic posterior maxillae with multiple missing posterior teeth.


Assuntos
Maxila/cirurgia , Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Regeneração Óssea , Implantes Dentários , Feminino , Humanos , Arcada Parcialmente Edêntula/cirurgia , Masculino , Maxila/patologia , Maxila/fisiologia , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Prospectivos
8.
Clin Implant Dent Relat Res ; 19(5): 783-792, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28580654

RESUMO

BACKGROUND: Implant failures are more common when multiple missing posterior teeth need lateral sinus floor elevation owing to inadequate tissue maturation after grafting. Effects of lateral window dimensions on vital bone formation have rarely been compared. PURPOSE: To compare endo-sinus bone formation between two- and solo-window techniques to rehabilitate multiple missing posterior teeth that need substantial augmentation. METHODS AND MATERIALS: Patients with severely atrophic posterior maxilla were randomized to receive lateral sinus floor elevation via solo or two bony windows. Bone core specimens harvested from lateral aspect of the augmentation sites were histomorphometrically analyzed. Proportions of mineralized bone (MB), bone substitute materials (BS), and nonmineralized tissue (NMT) were quantified. RESULTS: Twenty-one patients underwent 23 maxillary sinus augmentations. One patient in each group dropped out during the follow-up period. Lateral window dimensions were 81.65 ± 4.59 and 118.04 ± 19.53 mm2 in the test and control groups, respectively. Histomorphometric analysis revealed mean MB of 42.32% ± 13.07% and 26.00% ± 15.23%, BS of 40.34% ± 9.52% and 60.03% ± 10.13%, and NMT of 18.14% ± 14.24% and 14.75% ± 10.38% in test and control groups, respectively, with significant differences. CONCLUSION: The two-window technique could facilitate faster maturation and consolidation of the grafted volume and is an effective alternative for rehabilitation of severely atrophic posterior maxilla with multiple missing posterior teeth.


Assuntos
Maxila/patologia , Maxila/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Atrofia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento
9.
Clin Implant Dent Relat Res ; 19(1): 111-122, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27436543

RESUMO

BACKGROUND: Very few controlled studies have compared short and long implants placed with appropriate sinus floor elevation techniques. PURPOSE: To compare the 2-year outcomes of 6.5-mm hydrophilic implants placed with osteotome sinus floor elevation (OSFE) and standard implants placed with lateral sinus floor elevation in patients with a severely atrophic posterior maxilla. MATERIALS AND METHODS: Thirty-eight patients with a residual bone height of 4-5 mm were randomized to receive one of the two above-mentioned treatments. Intra- and postoperative complications were recorded. The implant survival rate, peri-implant bone level, and periapical endosinus bone gain were assessed. RESULTS: Of the 80 inserted implants, one in the long implant group failed because of abscess formation. The peri-implant bone level change (0.35 ± 0.60 mm vs 0.40 ± 0.71 mm) was not significantly different between the two groups. The endosinus bone gain was 2.94 ± 0.81 mm and 10.19 ± 0.95 mm in the short and long implant groups, respectively. No serious adverse events related to implant surgery were recorded. CONCLUSIONS: The results suggest that the placement of 6.5-mm short implants with OSFE is an effective alternative for the rehabilitation of a severely atrophic posterior maxilla.


Assuntos
Projeto do Implante Dentário-Pivô , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Maxila/cirurgia , Osteotomia Maxilar/métodos , Boca Edêntula/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Perda do Osso Alveolar/cirurgia , Falha de Restauração Dentária , Feminino , Seguimentos , Humanos , Interações Hidrofóbicas e Hidrofílicas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
10.
J Craniomaxillofac Surg ; 44(7): 868-75, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27235152

RESUMO

OBJECTIVE: To evaluate the efficacy and long-term outcome of the bilaminar cortical tenting grafting technique for reconstruction of vertical and horizontal alveolar ridge defects. MATERIAL AND METHODS: A bone block harvested from the lateral aspect of the mandibular ramus was bisected into two cortical laminae, which were then used to reconstruct the buccal and palatal walls of an alveolar ridge defect. The inter-laminar space was filled with particulate autogenous bone and the whole graft was covered with anorganic bone graft and collagen membrane. After 4-6 months, the width and height of the augmentation were recorded. The study sample consisted of 21 patients who were followed up for 6.09 ± 1.18-years. RESULTS: Vertical and horizontal bone gain was 5.70 ± 1.09 and 8.45 ± 0.87 mm, respectively, and respective resorption rates were 10.20% and 6.15%. One patient showed soft-tissue dehiscence, while all others healed without complication. After an average follow-up of 6-years, the block grafts were well integrated into the recipient sites and there was only a small reduction in the peri-implant bone level (0.77 ± 0.50 mm). CONCLUSION: This technique was effective and reliable for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae.


Assuntos
Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Mandíbula/transplante , Maxila/cirurgia , Adulto , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/patologia , Aumento do Rebordo Alveolar/efeitos adversos , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Atrofia/cirurgia , Clorexidina/uso terapêutico , Implantação Dentária Endo-Óssea/efeitos adversos , Implantação Dentária Endo-Óssea/métodos , Feminino , Seguimentos , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Radiografia Panorâmica , Transplante Autólogo , Resultado do Tratamento
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