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1.
Periodontol 2000 ; 92(1): 299-328, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37345386

RESUMO

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.


Assuntos
Levantamento do Assoalho do Seio Maxilar , Humanos , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/métodos , Seio Maxilar/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Fatores de Risco , Implantação Dentária Endóssea/efeitos adversos , Implantação Dentária Endóssea/métodos
2.
Periodontol 2000 ; 81(1): 91-123, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31407430

RESUMO

Maxillary sinus augmentation is the most predictable of the pre-prosthetic surgical procedures. There are, however, known and well-documented complications that can and do occur. The most common are the intraoperative complications of sinus membrane perforation and bleeding, and the postoperative complications of sinus graft infections, sinus infections, and sinusitis. The majority of these complications can be prevented, or their incidence greatly reduced, through a thorough understanding of maxillary sinus anatomy, the multifaceted etiologies of these conditions, and the steps that can be taken to avoid them. This volume of Periodontology 2000 will discuss both the preoperative and intraoperative procedures that will prevent these untoward outcomes and the necessary treatment modalities that will limit their adverse effects.


Assuntos
Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endóssea , Humanos , Complicações Intraoperatórias , Seio Maxilar , Complicações Pós-Operatórias , Fatores de Risco
3.
Implant Dent ; 25(5): 588-93, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27513162

RESUMO

PURPOSE: The present, randomized, controlled clinical trial compared the histologic and histomorphometric results from maxillary sinus augmentation with either biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate) or autogenous bone (AB) as bone-grafting materials. MATERIAL AND METHODS: Ten patients received bilateral sinus elevation surgery with intraoral AB chips (control group) on one side and BCP (test group) on the contralateral side. After a healing period of 6 to 8 months, implant sites were created and trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. RESULTS: The histological examination of biopsies showed BCP particles interconnected by bridges of a vital newly formed bone. Histomorphometry demonstrated that the amount of newly formed bone in the control group (36.8%) was significantly greater than that in the BCP (28.2%) group (P = 0.0032). BCP and AB cores revealed an average of residual graft particles of 32.9% and 4.8%, respectively. The average percentage of soft tissue components was 38.9% in the BCP cores and 58.4% in the AB cores. CONCLUSIONS: Based on our findings, the amount of vital bone formation was significantly higher for AB than that for BCP. However, BCP seemed to be a biocompatible and osteoconductive material that can be used with success as a bone substitute in maxillary sinus procedures.


Assuntos
Transplante Ósseo/métodos , Cerâmica/uso terapêutico , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Idoso , Regeneração Óssea , Substitutos Ósseos/uso terapêutico , Humanos , Hidroxiapatitas/uso terapêutico , Seio Maxilar/patologia , Pessoa de Meia-Idade
4.
Clin Implant Dent Relat Res ; 26(3): 564-570, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38462798

RESUMO

INTRODUCTION: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts. METHODS: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. RESULTS: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic. CONCLUSIONS: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst.


Assuntos
Seio Maxilar , Levantamento do Assoalho do Seio Maxilar , Humanos , Levantamento do Assoalho do Seio Maxilar/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Seio Maxilar/cirurgia , Seio Maxilar/diagnóstico por imagem , Cistos/cirurgia , Cistos/complicações , Adulto , Estudos de Coortes , Idoso , Implantação Dentária Endóssea/métodos
5.
Int J Oral Implantol (Berl) ; 17(1): 89-100, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38501401

RESUMO

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Humanos , Idoso , Maxila/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Consenso , Técnica Delphi , Estética Dentária , Atrofia/patologia
6.
J Evid Based Dent Pract ; 12(3 Suppl): 161-71, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23040346

RESUMO

CONTEXT: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. EVIDENCE ACQUISITION: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. EVIDENCE SYNTHESIS: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. CONCLUSIONS: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.


Assuntos
Substitutos Ósseos , Transplante Ósseo/métodos , Maxila/cirurgia , Seio Maxilar/cirurgia , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Implantes Dentários , Humanos , Membranas Artificiais , Piezocirurgia/métodos , Transplante Heterólogo/métodos
7.
Artigo em Inglês | MEDLINE | ID: mdl-35353085

RESUMO

Maxillary sinus elevation by the lateral window approach has been shown to be a highly predictable surgical procedure for increasing bone volume in the posterior maxilla. There are occasions, however, where this procedure may be difficult or impossible to perform in a highly predictable manner. There are many presurgical conditions and anatomical features that can make lateral window access difficult, leading to an increase in intraoperative complications and procedural failures. These complicating factors include complex internal sinus anatomy (multiple septa, anteroposterior septa), a narrow available window space, a thin or absent labial plate on adjacent teeth, and the presence of a root apex in the proposed window area, or it may be due to iatrogenically created defects, such as a previous failed sinus elevation, a healed oroantral fistula, or defects created by difficult extractions. While not frequently used or routinely reported in the literature, the palatal window approach may negate many of these obstacles. When it is reported, success rates are similar to those of lateral window procedures, and as an added advantage, postoperative morbidity is dramatically reduced, allowing the patient to wear a removable appliance immediately after surgery. There are, however, anatomical limitations that dictate when this procedure can be used. This case report is unique in that many of the lateral window complicating factors are present, and the palatal anatomy proved ideal for performing the technique.


Assuntos
Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endóssea/métodos , Humanos , Maxila/cirurgia , Seio Maxilar/cirurgia , Palato/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos
8.
Clin Adv Periodontics ; 12(3): 169-174, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34347383

RESUMO

INTRODUCTION: Maxillary sinus augmentation is a common and predictable procedure utilized to gain vertical alveolar bone height to allow for successful placement of dental implants in the deficient posterior maxilla. The surgical techniques, however, may be associated with intraoperative complications, the most common of which is Schneiderian membrane perforation and, less commonly, bleeding and the loss of an implant into the sinus cavity. CASE PRESENTATION: In the current report, we present two cases with unique complications. A large perforation which was discovered after the graft material had been placed was successfully managed by carefully removing the graft material from both sides of the perforation and sealing the perforation with a resorbable membrane and a tack fixation. The second case involved a patient who presented with an implant that had migrated into the sinus during an unsuccessful transcrestal sinus lift. The case was successfully treated by locating and removing the implant through an intentional membrane perforation, repairing the perforation, and placing a new implant with simultaneous grafting. CONCLUSION: Management and repair of maxillary sinus membrane perforations that are either intentionally or iatrogenically created can be predictable procedures with favorable outcomes if thoughtful evaluation and treatment are provided. Managing such complications at the time of occurrence avoids unnecessary additional surgical procedures that might prove to be even more complicated.


Assuntos
Implantes Dentários , Seio Maxilar , Implantação Dentária Endóssea/métodos , Implantes Dentários/efeitos adversos , Humanos , Doença Iatrogênica , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia
9.
Artigo em Inglês | MEDLINE | ID: mdl-35830308

RESUMO

Recently, the Low Window technique was proposed to facilitate sinus augmentation and reduce postsurgical patient discomfort. It was shown to be both safe and effective. This case series evaluates the postsurgical discomfort of patients undergoing Low Window sinus augmentation, the bone gain achieved, and whether these factors correlate with the osteotomy area. Records of patients (n = 26) who underwent a sinus elevation using the Low Window approach (n = 34 interventions), followed by implant placement and prosthetic rehabilitation (n = 97 implants), were assessed retrospectively. The analyzed outcomes were the medial, middle, and lateral bone gain ≥ 9 months after augmentation; pain at 5 to 6 hours postsurgery, evaluated on a visual analog scale (VAS; 0 to 100); pain, swelling, and hematoma formation every day up to 7 days postsurgery, evaluated by VAS; implant and prosthetic success and survival rates; and rate of complications. The average follow-up time was 62.1 ± 14.9 months. No intraoperative sinus membrane perforations or other complications occurred. Medial, middle, and lateral bone gains were 10.1 ± 1.7 mm, 11.6 ± 0.8 mm, and 10.7 ± 0.9 mm, respectively. At the last follow-up, the implant success rate was 99%. Postsurgical VAS pain 5 to 6 hours postsurgery was 12.3 ± 8.0 and decreased significantly thereafter. Swelling prevalence was 29.4% at 1 day postsurgery, 20.6% at 2 days, and 2.9% the following day. No swelling was observed from day 4 onward. Prevalence of hematoma was 8.8% for 2 days postsurgery, 2.9% the day after, and no hematoma was observed thereafter. Only the osteotomy area correlated with immediate postsurgical pain, but not with other discomfort outcomes or with bone gain. Low Window sinus elevation might allow bone gain and medium-term implant and prosthetic success rates similar to that of other access window designs. Prospective, comparative studies are needed to investigate whether the technique is more advantageous than traditional approaches.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endóssea/efeitos adversos , Implantação Dentária Endóssea/métodos , Humanos , Maxila/cirurgia , Seio Maxilar/cirurgia , Dor/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/métodos
10.
Int J Oral Implantol (Berl) ; 15(3): 265-275, 2022 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-36082660

RESUMO

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.


Assuntos
Implantes Dentários , Sinusite , Consenso , Técnica Delphi , Implantes Dentários/efeitos adversos , Humanos , Seio Maxilar/diagnóstico por imagem
11.
Int J Oral Maxillofac Implants ; 26(1): 123-31, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21365047

RESUMO

PURPOSE: Long-term success of dental implants has been demonstrated when placed simultaneously with or after a sinus augmentation procedure. However, optimal bone formation can be from 6 to 9 months or longer with grafting materials other than autogenous bone. For this reason, there is interest in any surgical technique that does not require autogenous bone harvesting, yet results in sufficient bone formation within a relatively short time frame. MATERIALS AND METHODS: This study evaluated and compared bone formation following sinus-augmentation procedures using either an allograft cellular bone matrix (ACBM), containing native mesenchymal stem cells and osteoprogenitors, or conventional allograft (CA). RESULTS: Histomorphometric analysis of the ACBM grafts revealed average vital bone content of 32.5% ± 6.8% to residual graft content of 4.9% ± 2.4% for the 21 sinuses in the study, at an average healing period of 3.7 ± 0.6 months. Results for the CA, in the same time frame, were average vital bone content of 18.3% ± 10.6% to residual graft content of 25.8% ± 13.4%. A comparison of ACBM and CA grafts, for both vital and residual bone contents, showed P values of .003 and .002, respectively, indicating a statistically significant difference between the groups. CONCLUSION: The high percentage of vital bone content, after a relatively short healing phase, may encourage a more rapid initiation of implant placement or restoration when a cellular grafting approach is considered.


Assuntos
Aumento do Rebordo Alveolar/métodos , Matriz Óssea/transplante , Seio Maxilar/cirurgia , Transplante de Células-Tronco Mesenquimais/métodos , Adulto , Idoso , Processo Alveolar/patologia , Biópsia , Criopreservação/métodos , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Maxila/patologia , Maxila/cirurgia , Seio Maxilar/patologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Preservação de Tecido/métodos , Tomografia Computadorizada por Raios X , Transplante Homólogo , Cicatrização/fisiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34818399

RESUMO

Maxillary sinus grafting is generally a safe procedure. However, intraoperative complications, as well as early and late postoperative complications, may occur. Included in the latter group are graft infections that can be triggered by peri-implantitis. The aim of the present study was to report three cases of late maxillary sinus graft infections and to histologically evaluate the effects of peri-implantitis in the grafted area. In peri-implantitis cases in grafted sinuses, the sole removal of the implant along with accompanying debridement of the infected area may not be sufficient to resolve the infection, and a more-aggressive treatment may be necessary.


Assuntos
Implantes Dentários , Sinusite Maxilar , Peri-Implantite , Levantamento do Assoalho do Seio Maxilar , Implantes Dentários/efeitos adversos , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Sinusite Maxilar/diagnóstico por imagem , Sinusite Maxilar/etiologia , Sinusite Maxilar/cirurgia , Peri-Implantite/etiologia , Levantamento do Assoalho do Seio Maxilar/efeitos adversos
13.
Int J Periodontics Restorative Dent ; 30(2): 139-49, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20228973

RESUMO

The objective of the following case reports was to assess whether mineralized bone replacement grafts (eg, xenografts and allografts) could be added to recombinant human bone morphogenetic protein-2/acellular collagen sponge (rhBMP-2/ACS) in an effective manner that would: (1) reduce the graft shrinkage observed when using rhBMP-2/ACS alone, (2) reduce the volume and dose of rhBMP-2 required, and (3) preserve the osteoinductivity that rhBMP-2/ACS has shown when used alone. The primary outcome measures were histomorphometric analysis of vital bone production and analysis of serial computed tomographic scans to determine changes in bone graft density and stability. Over the 6-month course of this investigation, bone graft densities tended to increase (moreso with the xenograft than the allograft). The increased density in allograft cases was likely the result of both compression of the mineralized bone replacement graft and vital bone formation, seen histologically. Loss of volume was greater with the four-sponge dose than the two-sponge dose because of compression and resorption of the sponges. Vital bone formation in the allograft cases ranged from 36% to 53% but, because of the small sample size, it was not possible to determine any significant difference between the 5.6 mL (four-sponge) dose and the 2.8 mL (two-sponge) dose. Histology revealed robust new woven bone formation with only minimal traces of residual allograft, which appeared to have undergone accelerated remodeling or rhBMP-2-mediated resorption.


Assuntos
Proteínas Morfogenéticas Ósseas/farmacologia , Regeneração Óssea/efeitos dos fármacos , Transplante Ósseo/fisiologia , Seio Maxilar/cirurgia , Procedimentos Cirúrgicos Pré-Protéticos Bucais , Proteínas Recombinantes/farmacologia , Fator de Crescimento Transformador beta/farmacologia , Implantes Absorvíveis , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas/administração & dosagem , Colágeno , Portadores de Fármacos , Sobrevivência de Enxerto , Humanos , Proteínas Recombinantes/administração & dosagem , Fator de Crescimento Transformador beta/administração & dosagem
14.
Int J Oral Maxillofac Implants ; 35(3): 631-638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32406663

RESUMO

Maxillary sinus augmentation is a procedure commonly performed in patients in need of posterior maxillary implants with limited vertical ridge height and sinus pneumatization. However, minimal information has been presented to evaluate the complexity of the sinus elevation procedure via a lateral window approach based on patient examination, including extraoral findings, anatomical factors, and the possible influence from the surgeon's experience. Therefore, this article presents a new scheme of maxillary sinus floor elevation difficulty score based on comprehensive patient- and surgical-related factors. The proposed scoring tool aims to aid surgeons in performing a comprehensive presurgical evaluation prior to the lateral wall sinus augmentation surgery and also enhance communication between clinicians and patients regarding the complexity of the case.


Assuntos
Seio Maxilar/cirurgia , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endóssea , Humanos , Maxila/cirurgia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31226194

RESUMO

This retrospective study investigated the changes in the maxillary sinus floor and alveolar crest following extraction of maxillary molars. Pre- and postextraction cone beam computed tomography scans of 23 patients were analyzed. Paired-sample t tests compared pre- and postextraction measurements, and independent-sample t tests were utilized for intergroup comparisons. Pearson correlation was used to assess the association between the measured variables and the outcome measures. The mean alveolar bone height reduction was 3.42 ± 2.40 mm and the alveolar crest loss was 3.07 ± 2.53 mm. The maxillary sinus floor position shifted coronally by a mean of 0.47 ± 0.32 mm. Approximately 88% of postextraction changes in alveolar bone height were due to alveolar crest changes, compared to 12% due to changes in the sinus floor position. The results of this study challenge the commonly held concept of extensive postextraction maxillary sinus floor alterations leading to sinus pneumatization.


Assuntos
Levantamento do Assoalho do Seio Maxilar , Tomografia Computadorizada de Feixe Cônico Espiral , Tomografia Computadorizada de Feixe Cônico , Humanos , Seio Maxilar , Dente Molar , Estudos Retrospectivos
16.
Cytometry A ; 73(11): 1019-34, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18785636

RESUMO

Cell-tracking reagents such as the green-fluorescent protein labeling dye CFSE and the red-fluorescent lipophilic membrane dye PKH26 are commonly used to monitor cell proliferation by flow cytometry in heterogeneous cell populations responding to immune stimuli. Both reagents stain cells with a bright homogeneous fluorescence, which is partitioned between daughter cells during each cell division. Because daughter cell fluorescence intensities are approximately halved after each division, the intensity of a cell relative to its intensity at the time of staining provides information about how many divisions it has undergone. Knowing how many rounds of division have occurred and the relative number of cells in each daughter generation, one can back-calculate the number of cells in the original population (i.e., cells present at the time of stimulus) that went on to respond by proliferating. Using this information, the precursor cell frequencies and extent of expansion to a specific antigen or mitogen of interest can be calculated. Concurrently, the phenotype of the cells can be determined, as well as their ability to bind antigen or synthesize cytokines, providing more detailed characterization of all cells responding to the antigen, not just effector cells. In multiparameter flow cytometric experiments to simultaneously analyze antigen-specific tetramer binding, cytokine production and T-cell proliferation, we found that only approximately half of the cells that exhibited specific binding to influenza tetramer also proliferated, as measured by dye dilution, and synthesized IFNgamma in response to antigen. We expect the advent of new cell tracking dyes emitting from the violet to the near infrared combined with the increasing number of lasers and detectors on contemporary flow cytometers to further expand the usefulness of this approach to characterization of complex antigen-driven immunological responses.


Assuntos
Antígenos/imunologia , Técnica de Diluição de Corante , Citometria de Fluxo/métodos , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD8-Positivos/citologia , Proliferação de Células , Fluoresceínas/metabolismo , Humanos , Compostos Orgânicos/metabolismo , Reprodutibilidade dos Testes , Coloração e Rotulagem , Succinimidas/metabolismo
17.
Int J Periodontics Restorative Dent ; 28(1): 9-17, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18351198

RESUMO

The most frequent intraoperative complication with sinus elevation is perforation of the schneiderian membrane. In most instances, the repair of this perforation is necessary to contain particulate grafting material and complete the procedure. New techniques are presented here for the management of large perforations of the schneiderian membrane. A bioabsorbable collagen membrane is stabilized outside the antrostomy and then folded inward to create either a new superior wall that can obliterate a large perforation or a "pouch" that can completely contain the particulate material. This can make it possible to complete a procedure that otherwise may have had to be aborted by preventing dispersion of the particulate graft within the sinus cavity. Clinical cases are shown, along with follow-up at 6 to 9 months, demonstrating histologic and/or radiographic evidence of success, continued sinus health, and superior vital bone formation. The authors have used this technique on 20 consecutive patients without experiencing any procedural failures.


Assuntos
Implantes Absorvíveis , Colágeno , Complicações Intraoperatórias/cirurgia , Seio Maxilar/lesões , Membranas Artificiais , Aumento do Rebordo Alveolar/efeitos adversos , Aumento do Rebordo Alveolar/métodos , Materiais Biocompatíveis , Matriz Óssea/transplante , Substitutos Ósseos/uso terapêutico , Seguimentos , Humanos , Maxila/cirurgia , Seio Maxilar/cirurgia , Minerais/uso terapêutico , Mucosa/lesões , Mucosa/cirurgia , Osteogênese/fisiologia , Osteotomia/efeitos adversos , Osteotomia/métodos , Resultado do Tratamento
18.
Int J Periodontics Restorative Dent ; 28(3): 273-81, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18605603

RESUMO

This blinded, randomized, controlled pilot investigation is the first to histomorphometrically compare vital bone formation following bilateral sinus grafting with a biphasic calcium phosphate (BCP) (Straumann Bone Ceramic) to an anorganic bovine bone matrix (ABBM) (Bio-Oss) 6 to 8 months following graft placement. Twelve patients were selected. Following elevation of the lateral sinus walls, one material was placed in the right sinus and the other material was placed in the left sinus, as determined by randomization. Six to 8 months after grafting (with the same time frame used for each patient), a trephine core was taken from the grafted area and sent for histomorphometric analysis. Cores were obtained from 21 healed sinuses in 12 patients. Nine patients provided bilateral cores. Histomorphometric analysis of 10 BCP cores and 11 ABBM cores revealed an average vital bone content of 28.35% and 22.27%, respectively. The average percentage of residual graft particles was 28.4% in the BCP cores and 26.0% in the ABBM cores. The difference in vital bone formation was not significantly different (n = 9 patients, paired t test) between bilateral sinuses treated with the BCP and those treated with the ABBM. Histologically, both materials appeared to be osteoconductive and support new bone formation. Future studies are needed to confirm the ability of this regenerated bone to support dental implant maintenance over time.


Assuntos
Aumento do Rebordo Alveolar/métodos , Substitutos Ósseos/uso terapêutico , Fosfatos de Cálcio/uso terapêutico , Maxila/cirurgia , Seio Maxilar/cirurgia , Minerais/uso terapêutico , Osteogênese/fisiologia , Implantes Absorvíveis , Medula Óssea/patologia , Matriz Óssea/patologia , Matriz Óssea/transplante , Colágeno , Tecido Conjuntivo/patologia , Implantes Dentários , Seguimentos , Humanos , Maxila/patologia , Seio Maxilar/patologia , Membranas Artificiais , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento , Cicatrização/fisiologia
19.
Immunol Invest ; 36(5-6): 861-85, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18161533

RESUMO

The advent of contemporary digital instrumentation has enhanced both the potential and the complexity of flow cytometric experiments, allowing for the detailed dissection of immune cell subsets and their functions. The use of cell tracking labels such as PKH26 and CFSE has been important in observing such cellular functions, but their visible emission characteristics have limited the design of such analyses. As the demand for multiparametric flow cytometry intensifies, it will become increasingly important to utilize a broader range of cell tracking reagents to optimize the measurement of fluorescence signals and to provide flexibility in the use of commercially available fluorochrome - antibody combinations. We report on the evaluation of three lipophilic membrane dyes, CellVue Lavender, CellVue Plum and CellVue NIR780; with fluorescence emissions in the violet, far-red and near infrared wavelength regions, respectively. These reagents are similar to established tracking dyes such as PKH26 and CFSE in terms of staining procedure, membrane stability, optimal concentration, and lack of effect on cellular proliferation. The CellVue dyes however, exhibit different spectral characteristics than existing tracking compounds, and capitalize upon the increased number of lasers incorporated into commercially available instrumentation; thus permitting measurement of labeled populations in underexploited regions of the spectrum.


Assuntos
Citometria de Fluxo/instrumentação , Citometria de Fluxo/métodos , Corantes Fluorescentes/metabolismo , Compostos Orgânicos , Técnicas de Cultura de Células , Proliferação de Células , Fluoresceínas/metabolismo , Humanos
20.
Int J Periodontics Restorative Dent ; 27(5): 413-9, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17990437

RESUMO

The lateral window sinus elevation procedure has become a routine and highly successful preprosthetic procedure that is used to increase bone volume in the posterior maxilla for the placement of dental implants. Many surgical techniques have been proposed that provide access to the maxillary sinus through the lateral wall to allow for elevation of the sinus membrane. Among these are the multiple variations of the hinge and complete osteotomy techniques, which make use of rotary cutting instruments for the antrostomy. The most common intraoperative complication with these surgical approaches is perforation of the schneiderian membrane, with perforation rates of 14% to 56% reported in the literature. In most instances, perforation occurs either while using rotary instruments to make the window or when using hand instruments to gain initial access to begin the elevation of the membrane from the sinus walls. This article presents an alternative approach that uses a piezoelectric instrument for the sinus elevation procedure. Although new to the United States, this approach has been used successfully in Europe for many years. The membrane perforation rate in this series of 100 consecutive cases using the piezoelectric technique has been reduced from the average reported rate of 30% with rotary instrumentation to 7%. Furthermore, all perforations with the piezoelectric technique occurred during the hand instrumentation phase and not with the piezoelectric inserts.


Assuntos
Seio Maxilar/cirurgia , Mucosa/lesões , Procedimentos Cirúrgicos Pré-Protéticos Bucais/efeitos adversos , Terapia por Ultrassom/métodos , Humanos , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Osteotomia/efeitos adversos , Osteotomia/instrumentação , Osteotomia/métodos , Ruptura/etiologia , Ruptura/prevenção & controle , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/instrumentação
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