Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial.

INTRODUCTION: The aim of this randomized clinical trial was to assess the aesthetical and clinical outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) with vertical incisions or the envelope flap in the treatment of thin phenotype, multiple-recession defects. MATERIAL AND METHODS: Twenty-two participants with 55 class recession type 1 (RT1) with a depth of ≥3 mm were investigated. Control group was treated with ADMG plus conventional CAF with vertical releasing incisions, whereas test group received the envelope flap with ADMG. Primary outcome variables were complete root coverage (CRC), root coverage aesthetic score and patient satisfaction. RESULTS: Tooth-based CRC was observed in 23 of the 28 recession defects in mCAF + ADMG group (82.1%), whereas in 19 of the 27 recession defects in CAF + ADMG group (70.37%), with no inter-group difference (p > .05). CRC was observed in 9 of the 11 patients in mCAF + ADMG group (81.8%). On the other hand, in CAF + ADMG group, CRC was achieved in 8 of the 11 patients (72.7%). Results were similar between the groups (p > .05). CONCLUSIONS: Both techniques were successful in the management of multiple recessions; however, superior results regarding patient's satisfaction were achieved with mCAF + ADMG.

Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions.

OBJECTIVES: The aim of this study was to evaluate acellular dermal matrix graft (ADM) combination with laterally positioned flap (LPF) and to compare the results with LPF alone in terms of root coverage, esthetics, and patient perspectives in gingival recessions. MATERIALS AND METHODS: Twenty-two patients with localized Miller Class I/II recessions ≥ 3 mm with gingival thickness (GT) < 0.8 mm were included. Outcome parameters such as recession height and width, keratinized tissue (KT) height, GT, mean and complete defect coverage, patient satisfaction, and root coverage esthetic score (RES) were re-evaluated at 12 months postoperatively. RESULTS: Mean and complete defect coverage were 94.80 and 72.73% in LPF+ADM group and 77.25 and 45.45% in LPF group, respectively. Significant differences were observed for KT and GT gain, patient satisfaction, and RES in favor of LPF group (p < 0.05). A significant positive correlation was established between GT and mean defect coverage (r = 0.448; p < 0.05). CONCLUSION: LPF is a successful approach in the treatment of localized Miller I/II gingival recessions. On the other hand, when thin donor tissue was thickened with an allogenic graft, more successful results regarding complete defect coverage, patient satisfaction, and RES were obtained. CLINICAL RELEVANCE: Increase in gingival thickness and keratinized tissue height represents critical improvements in the prognosis of the advanced localized recessions and will be beneficial for patient's periodontal health and esthetics. Both approaches can be used successfully as an alternative for soft tissue root coverage in specific localized cases with a limited amount of keratinized tissue apical to the defect.

Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions.

OBJECTIVES: The aim of this randomized, controlled study was to assess the clinical effect of platelet-rich fibrin (PRF) in combination with coronally advanced flap (CAF) on root coverage, esthetics, and patient satisfaction when compared to CAF alone for the treatment of multiple Miller class I recessions. MATERIALS AND METHODS: A total of 24 patients with 52 Miller class I multiple recessions ≥ 3 mm were included and divided into CAF + PRF and CAF groups. At baseline and 12 months after surgery, recession height (RH), keratinized tissue height, gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage esthetic scores were also assessed. RESULTS: Baseline RH in CAF + PRF and CAF groups was 3.15 ± 0.24 and 3.36 ± 0.34 mm, respectively. Intragroup comparisons revealed significant differences at 12 months for all parameters (p < 0.05). RH reduction was 2.75 ± 0.33 and 2.51 ± 0.33 mm (mean root coverage of 88.36 and 74.63%) in the CAF + PRF and CAF groups, respectively. Intergroup differences were found to be significant for GT gain (p < 0.05). CONCLUSIONS: The additional use of PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of PRF membranes increased tissue thickness significantly.

Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions.

AIM: The aim of this randomized controlled clinical study was to evaluate the outcomes of acellular dermal matrix (ADM) graft in combination with tunnel technique (TUN) on root coverage, aesthetics, and patient satisfaction and to compare with coronally advanced flap (CAF)+ADM in the treatment of multiple gingival recessions. MATERIAL AND METHODS: A total of 20 patients with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups. At baseline and 12 months, probing depth (PD), clinical attachment level (CAL), recession height (RH) and width (RW), keratinized tissue height (KT), gingival thickness, and complete and mean root coverage (CRC, MRC) were evaluated. Patient satisfaction and root coverage aesthetic scores (RES) were also assessed. RESULTS: Mean root coverage was 75.72% in TUN+ADM and 93.81% in CAF+ADM. Intragroup comparisons revealed significant differences at 12 months for all parameters in both groups (p < 0.05). Intergroup differences were found to be statistically significant for RH and RW reduction, KT increase, CAL gain, MRC, CRC, and RES in favour of CAF+ADM group (p < 0.05). CONCLUSION: Both techniques were effective in root coverage of multiple recessions; however, better clinical results were achieved with CAF and ADM combination.

Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study.

AIM: The objective of this study was to evaluate the effects of lozenges containing L. reuteri as an adjuvant treatment to initial periodontal therapy for chronic periodontitis patients and to detect the level of L. reuteri colonization in the periodontal pockets of treated patients. MATERIAL AND METHODS: A total of 40 patients were selected and randomly divided into two groups. Each patient had at least two teeth with one approximal site each with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant. Group I received scaling and root planing (SRP) plus L. reuteri-containing lozenges, and Group II received SRP plus placebo. The plaque index (PI), GI, bleeding on probing (BoP), PD and relative attachment level were measured. Microbiological sampling was performed at baseline and on days 21, 90, 180 and 360 and were analysed by culturing. The Bonferroni-corrected paired sample t-test, Bonferroni-corrected Wilcoxon signed rank test and paired sample t-test were used to evaluate intra-group differences. The Bonferroni-corrected Student's t-test and the Mann-Whitney U-tests were used to evaluate inter-group differences. RESULTS: After treatment, the measured PI, GI, BoP and PD were significantly (p < 0.05) lower in Group I compared with Group II at all time points. Similar observations were made for the total viable cell counts and the proportions of obligate anaerobes with the exception of day 360. In Group I, significantly fewer patients required surgery on ≥3 sites. CONCLUSION: L. reuteri-containing lozenges may be a useful adjuvant agent to slow re-colonization and improve clinical outcomes of chronic periodontitis. Further studies are required to clarify the optimal dose of the lozenges.

Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype.

AIM: The objective of this study was to compare acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, aesthetics and patient satisfaction with CAF alone for multiple recessions with gingival thickness (GT) <0.8 mm. MATERIALS AND METHODS: Forty-eight Miller Class I multiple recessions ≥3 mm were divided into test (CAF + ADM) and control (CAF) groups. At baseline and 12 months, recession height (RH), keratinized tissue height (KT), GT, mean and complete defect coverage were evaluated. Patient satisfaction, root coverage aesthetic score (RES) and the correlation between GT and defect coverage were also assessed. RESULTS: Baseline RH in CAF + ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Mean and complete defect coverage were 94.84% and 83.33% in test group, 74.99% and 50.00% in control group, respectively. Inter-group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage and RES in favour of test group (p < 0.05). There was a significant positive correlation between GT and mean defect coverage (p < 0.05). CONCLUSION: Coronally advanced flap in association with ADM can be proposed as a valid approach for the treatment of multiple recessions with thin tissue biotype.

A 30-year bibliometric analysis of the literature in the disciplines of orthopedics, surgery, or oncology on chondrosarcoma from 1993 to 2023.

BACKGROUND: A thorough bibliometric analysis of publications published in the field of chondrosarcoma research has not yet been performed using the Web of Science database, especially for publications published between 1993 and 2023. This study, with a focus on the fields of orthopedics, surgery, and oncology, aims to fill this knowledge gap by providing a thorough analysis of current knowledge in the field of chondrosarcoma. METHODS: In this bibliometric study, a literature search was performed using the Web of Science database to find all publications on chondrosarcoma. A bibliometric software program was used for data visualization and analysis (opensource visualization application, Vosviewer). The Web of Science Core Collection data used for this retrospective bibliometric study, which covers the period from January 1993 to September 2023, revealed interesting trends in chondrosarcoma research. RESULTS: As the most popular fields of study, orthopedics, surgery, and oncology account for a sizable portion of publications. A noteworthy increase in research output from 2014 to 2023, accounting for 41.74% of the papers, reflects the thriving research environment. The leading countries for publication were China, Japan, and the United States, demonstrating cross-border cooperation in chondrosarcoma research. Their contributions were highlighted by their important affiliations with institutions such as Harvard University, Leiden University, and China Medical University Taiwan. A thorough keyword mapping analysis also highlighted research priorities and encouraged interdisciplinary cooperation. The field's scholarly importance and ongoing relevance are highlighted by the study's high citation count (30,076) and highly cited articles. CONCLUSION: Overall, this study offers crucial insights into the development and collaborative nature of the chondrosarcoma research landscape and its long-lasting influence on academic research and clinical practice.

Investigation of the predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality in patients with endoprosthesis after hip fracture.

In this research, we aimed to investigate the predictive value of the systemic immune inflammation index and prognostic nutritional index on mortality among patients with an endoprosthesis after a hip fracture. In this retrospective, cross-sectional study, a total of 915 patient files applied to our hospital between 2020 and 2023 with an endoprosthesis after a hip fracture were subjected to the study. The patients were divided into 2 groups: alive (n = 396; 43.3%) and deceased (n = 519; 56.7%). The eosinophil-to-lymphocyte ratio, hemoglobin-to-red cell distribution width ratio (HRR), mean platelet volume-to-platelet ratio (MPVPR), neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, monocyte-to-eosinophil ratio (MER), neutrophile-to-monocyte ratio, systemic inflammation index (SII), and prognostic nutritional index (PNI) parameters of the patients were evaluated. The mortality rate was higher among male patients, with a statistically significant difference (P < .05). The follow-up duration, albumin, HGB, eosinophil, lymphocyte, eosinophil %, eosinophil-to-lymphocyte ratio, HRR, and PNI means were significantly higher in the living group (P < .05). Age, MPV, MPVPR, neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, MER, and systemic inflammation index were significantly higher in the deceased group (P < .05). The predictive value of gender (B = -0.362; P < .01), age (B = 0.036; P < .01), HRR (B = -1.100; P < .01), MPVPR (B = 8.209; P < .01), MER (B = 0.006; P < .01), and PNI (B = -0.078; P < .01) were statistically significant at the multivariate level. The time of death was significantly predicted by gender (B = 0.10; P < .05), age (B = -0.02; P < 0 = 1), HRR (B = 0.61; P < .01), MPVPR (r = -4.16; P < .01), MER (B = -0.01; P < .05), and PNI (B = 0.03; P < .01). The predictive value of PNI for the 30-day mortality rate was statistically significant (AUC: 0.643; P < .01). For a PNI cutoff value of 34.475, sensitivity was 69.7%, and specificity was 51.1%. The PNI has predictive value both in estimating overall mortality and in predicting the 30-day mortality rates among patients undergoing endoprosthesis after a hip fracture.

Effectiveness of gonarthrosis treatment via intra-articular injections of linear vs. cross-linked hyaluronic acids.

OBJECTIVES: The study aimed to compare the outcomes of single-dose cross-linked hyaluronic acid and the linear regimen of three doses of HA knee injections among patients with gonarthrosis. PATIENTS AND METHODS: This single-center, retrospective study was conducted with 60 patients (47 females, 13 males; mean age: 57.9±4.29 years; range, 50 to 65 years) with Kellgren-Lawrence Grade 2 or 3 gonarthrosis between February 2020 and February 2022. Patients were either subjected to intra-articular cross-linked hyaluronic acid (n=30) or linear hyaluronic acid (n=30) injection treatments. Comprehensive assessments of the patients were conducted prior to the injections, as well as at three and six months after injection. The two injection groups were compared regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score. RESULTS: Both injections showed a statistically significant improvement from baseline in both WOMAC and Oxford Knee Score at three and six months (p<0.001). There was no notable distinction in the alteration of WOMAC knee scores between the two injection types. However, a notable discrepancy was observed in the elevation of Oxford Knee Score among patients who received cross-linked knee injections compared to those who underwent linear hyaluronic acid knee injections, signifying a significant increase in the former group (p<0.001). CONCLUSION: The advantage of a single-dose administration of cross-linked HA knee injections, as opposed to the three-dose regimen required for linear hyaluronic acid, translates into reduced time and cost for the injection process. Moreover, this approach minimizes injection-associated discomfort for patients due to the singular dose administration.

Zingerone attenuates sciatic nerve damage caused by sodium arsenite by inhibiting NF-κB, caspase-3, and ATF-6/CHOP pathways and activating the Akt2/FOXO1 pathway.

Objectives: In the present study, the potential protective effects of zingerone (ZNG) against sciatic nerve damage caused by sodium arsenite (SA), a common environmental pollutant, were evaluated by various biochemical, molecular, and histological methods. Materials and Methods: In the study, SA and ZNG were given to 35 male Sprague Dawley rats for 14 days. At the end of the period, the sciatic nerve tissues were taken and the markers involved in oxidative stress, endoplasmic reticulum stress, inflammation, and apoptosis were analyzed. Results: The data obtained showed that SA decreased glutathione (GSH) levels and increased malondialdehyde (MDA) levels in the sciatic nerve tissue. However, it was determined that these markers approached the control group levels due to the anti-oxidant properties of ZNG. While SA triggered endoplasmic reticulum stress and apoptosis pathways, ZNG suppressed them. Moreover, SA up-regulated inflammatory markers such as nuclear factor kappa-B (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin-1-beta (IL-1ß), and neuronal nitric oxide synthases (nNOS) in the sciatic nerves and caused neuro-inflammation and inhibited cell survival by suppressing serine/threonine-protein kinase 2 (Akt2) and forkhead box protein O1 (FOXO1) genes. It has also been shown histopathologically that SA causes degeneration in the sciatic nerves. In contrast, ZNG suppressed neuro-inflammation, activated Akt2/FOXO1 signaling, and repaired histological irregularities. Conclusion: In general, SA caused oxidative stress, inflammation, ER stress, and apoptosis in the sciatic nerves of rats, causing damage to the tissues, however, ZNG suppressed these pathways and protected the sciatic nerves from the destructive effect of SA.

Use of blood parameters for the prediction of mortality in patients with below­knee amputation.

The present retrospective study aimed to investigate the value of blood parameters in predicting mortality in patients with below-knee amputation (BKA). A total of 178 patients with BKA were included in the present study. The patients were divided into two groups, namely the exitus group (n=136; 76.4%) and the survivors group (n=42; 23.6%). Patients in the exitus group were further divided into three subgroups: i) Those who experienced mortality in <1 month (n=55; 40.4%); ii) those who experienced mortality between 1-12 months (n=48; 35.3%); and iii) those who experienced mortality in >12 months after surgery (n=33; 24.3%). Binary logistic regression and a generalized linear model were used for relational analysis, and a receiver operator characteristic curve was used for diagnostic tests. It was found that the parameters of age (B=0.061; P=0.01), eosinophil-to-lymphocyte ratio (ELR) (B=-2.861; P<0.05), C-reactive protein (CRP)/albumin ratio (B=0.027; P<0.01) and mean platelet volume (MPV)/lymphocyte ratio (B=0.310; P<0.01) had a significant effect on mortality at the multivariate level. Moreover, regression coefficients showed that the effect of age, CRP/albumin and MPV/lymphocyte ratios on mortality were positive, whereas the effect of the ELR was negative. The mortality predictive values of age [area under the curve (AUC)=0.681; P=0.01], ELR (AUC=0.630; P=0.01), CRP/albumin ratio (AUC=0.746; P=0.01) and MPV/lymphocyte ratio (AUC=0.676; P<0.01) were also found to be statistically significant. For the 27.51 CRP/albumin cut-off value, the sensitivity was found to be 80.1%, whereas the specificity was 54.8%. For the 36.93 CRP/albumin cut-off value, the sensitivity was 71.3%, and the specificity was 73.8%. Furthermore, MPV (B=-0.37; P<0.01) and hemoglobin/red-blood-cell distribution width (RDW) ratio (B=5.20; P<0.01) were found to have a significant effect on the time to death at the multivariate level. The parameters MPV (AUC=0.648; P<0.01) and hemoglobin/RDW (AUC=0.673; P=0.01) had predictive value in terms of the time to death. The predictive value for MPV was found to be 64.8%, whereas that for the hemoglobin/RDW ratio was 67.3%. For the 0.54 cut-off value for hemoglobin/RDW, the sensitivity was 74.5%, and the specificity was 11.1%. By contrast, for the 0.84 cut-off value for the hemoglobin/RDW ratio, the sensitivity was 10.9% and the specificity was 81.5%. In conclusion, the CRP/albumin ratio was identified as a significant mortality parameter, whereas the hemoglobin/RDW ratio was a significant time to death predictor, according to the results of the present analysis. These results may guide clinical practices and further research in terms of predicting mortality in patients with BKA.

Photodynamic therapy in dentistry: a literature review.

OBJECTIVES: The purpose of this review was to summarize recent developments regarding photodynamic therapy (PDT) in the field of dentistry. MATERIALS AND METHODS: A review of pertinent literature was carried out in PubMED to determine the current position of PDT applications in dentistry. One hundred thirteen relevant articles were retrieved from PubMED by inserting the keywords "photodynamic therapy", "dentistry", "periodontology", "oral surgery", and "endodontics". It is anticipated that this overview will create a specific picture in the practitioner's mind regarding the current status and use of PDT. RESULTS: In spite of different results and suggestions brought about by different researchers, PDT can be considered as a promising and less invasive technique in dentistry. CONCLUSION: PDT seems to be an effective tool in the treatment of localized and superficial infections. Within the limitations of the present review, it can be concluded that although PDT cannot replace antimicrobial therapy at its current stage, it may be used as an adjunctive tool for facilitating the treatment of oral infections. CLINICAL RELEVANCE: Oral infections (such as mucosal and endodontic infections, periodontal diseases, caries, and peri-implantitis) are among the specific targets where PDT can be applied. Further long-term clinical studies are necessary in establishing a more specific place of the technique in the field of dentistry.

Predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality after below-knee amputation.

This retrospective cross-sectional study aimed to evaluate the predictive value of SII (Systemic Immune Inflammation Index) and PNI (Prognostic Nutritional Index) with blood ratios on mortality in diabetic foot patients who underwent below-knee amputation. A total of 231 living (n = 71; 30.7%) and exitus (n = 160; 69.3%) patients were evaluated. The mortality group was divided into 3 groups: 30-day mortality (n = 62; 38.8%), 1-year mortality (n = 62; 38.8%), and over-1-year mortality (n = 36; 22.5%). The hemogram, SII, and PNI parameters of the patients were evaluated. Age, some blood count parameters and SII were significantly higher in the exitus group (P < .05). The lymphocyte, monocyte, eosinophil, albumin, and PNI levels were significantly higher in the living group (P < .05). Mortality was significantly predicted by age (B [regression coefficient] = 0.026, P < .05), NLR (neutrophil lymphocyte ratio) (B = -0.065, P < .05), PNI (B = -0.100, P < .01), and SII (B = 0.00000024, P < .01). The predictive values of CAR (C reactive protein albumin ratio), PNI, and SII were 77.3%, 77.0%, and 76.1%, respectively. For CAR of 30.88 cutoff value, the sensitivity and specificity were 79.4% and 64.8%, respectively. For the PNI 22.0143 cutoff value, the sensitivity and specificity were 66.9% and 5.6%, respectively. For the SII 732249.2481 cutoff value, the sensitivity and specificity were 91.9% and 31.0%, respectively. The predictive value of the PNI was significant for mortality time (B = 0.058; P < .01). The predictive value of PNI for 30-day mortality was significant (AUC (area under curve):0.632; P < .01), whereas its predictive value for 1-year mortality and over-1-year mortality after below-knee amputation was statistically insignificant (P > .05). Both the SII and PNI may be evaluated and used to predict mortality after below-knee amputation. The SII had a significant predictive value for 30-day mortality after below-knee amputation.

The Length of Incision in Unicondylar Knee Arthroplasty Is More Affected by the Patient's Height Than Their Weight.

Objective Obesity leads to osteoarthritis due to increased loading forces on joint cartilage and inflammatory agents released from adipose tissue. In patients with a high body mass index (BMI), during hip and total knee arthroplasty, surgical technical challenges such as longer incisions and wider exposure are encountered, resulting in increased postoperative complications (wound healing problems and infection, venous thromboembolism (VTE)- pulmonary embolism (PE), dislocation, early implant failure) and ultimately decreased patient satisfaction and implant survival. This study investigates whether BMI, height, weight, and patient age are associated with longer incisions in patients undergoing unicondylar knee prosthesis (UKP) placement. Method Between January 2017 and December 2018, 30 patients (29 females and 1 male) who underwent UKP surgery due to medial gonarthrosis were included in the study. The UKP used in the procedures was the Oxford Knee Phase III by Biomet Ltd., UK. The study comprised 43 knees, 13 being bilateral cases, 8 on the right, and 9 on the left. Data regarding the patient's height, weight, BMI, age, and the operated side were collected and compiled. The relationships between these variables and the surgical incision length were statistically analyzed. Results The average age of the patients was 66.3 years, with an average weight and height of 77.6 kg (ranging from 62 to 98 kg) and 167 cm (ranging from 150 to 184 cm), respectively. The lengths of the surgical incisions ranged from 70 mm to 160 mm, with an average length of 124.5 mm. When comparing the incision lengths between the right and left sides, it was observed that the incisions on the left side were longer. The average incision length on the right side was 122.09 mm, while on the left, it was 126.86 mm. Moreover, in the 13 patients who underwent bilateral surgery, this difference in incision length was even more pronounced. The average incision length on the right side was 117.15 mm, whereas on the left, it was 124.23 mm. Bivariate correlation analyses were performed to examine the relationship between the length of the incision and BMI and age. However, no significant relationship was found between the incision length and BMI or age. On the other hand, there was a correlation between the patient's weight values and the incision length (p < 0.05, correlation 0.335). Furthermore, a higher correlation was observed between the patient's height and the incision length (p < 0.01, correlation 0.595). Conclusion The latest advances in surgical techniques and instrumentation have enabled surgeons to perform the procedure using a reliable mini-incision approach. Mid-term evaluation of UKP with mini-incision shows faster recovery and lower morbidity. The findings show that in UKP, the length of the surgical incision is more strongly related to the patient's height than their weight.

Primary Angiosarcomas Of The Bone: An Evaluation Of 4 Cases.

Angiosarcoma is a rare mesenchymal neoplasm that may arise from vascular or lymphatic tissue. Angiosarcoma of bone is a rare high-grade malignant vascular tumour, representing less than 1% of all angiosarcomas. The most common locations of unifocal tumour are the long and short tubular bones, followed by the pelvis, and trunk. The literature regarding treatment and outcome of patients with this tumour is limited. We performed a retrospective study to analyse treatment and survival of four patients with angiosarcoma of bone.

Regenerative treatment with platelet-rich plasma combined with a bovine-derived xenograft in smokers and non-smokers: 12-month clinical and radiographic results.

AIM: The purpose of this study was to assess the healing response of intrabony defects following regenerative treatment with platelet-rich plasma (PRP) combined with a bovine-derived xenograft (BDX) in smokers and non-smokers. MATERIALS AND METHODS: A total of 24 advanced chronic periodontitis patients, 12 smokers and 12 non-smokers, with 113 intrabony defects with an intrabony component of or /=3 mm were included in this study. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession, probing and radiographic bone levels. RESULTS: Considering the soft tissue measurements, smokers and non-smokers presented a mean PD reduction of 3.97 +/- 0.76 and 4.63 +/- 0.52 mm, recession of 0.76 +/- 0.44 and 0.50 +/- 0.12 mm and attachment gain of 3.26 +/- 0.42 and 4.06 +/- 0.40 mm, respectively. Evaluation of the hard tissue findings revealed that the mean clinical and radiographic bone gains in smokers and non-smokers were 2.83 +/- 0.47 and 3.63 +/- 0.38 mm, 2.98 +/- 0.38 and 3.67 +/- 0.48 mm, respectively. Inter-group differences for PD reduction (p<0.05), attachment (p<0.001), clinical (p<0.001) and radiographic bone gains (p<0.001) were found to be significant between smokers and non-smokers. CONCLUSIONS: Within the limits of this study, the results indicate that treatment outcome following PRP/BDX application in intrabony defects is impaired with smoking.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of deep intrabony periodontal defects: a report of 20 consecutively treated patients.

There is currently great interest concerning the use of platelet-rich plasma (PRP) in combination with bone grafts for predictably obtaining periodontal regeneration. The aim of the present study was to investigate the effectiveness of PRP and bovine derived xenograft (BDX) combination in the treatment of deep intrabony defects with an emphasis on the evaluation of early wound healing. A total of 85 intrabony defects with an intrabony component of > or =3 mm were selected in 20 advanced chronic periodontitis patients. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession (REC), probing bone and radiographic bone levels. Postoperative healing was evaluated by an early healing index at 1 and 2 weeks after surgery. At 12 months, all clinical and radiographic parameters were improved (p < 0.0001). The mean changes at 12 months were: PD reduction of 4.78 +/- 1.20 mm, attachment gain of 4.24 +/- 1.03 mm, REC of 0.54 +/- 0.34 mm, clinical bone gain of 3.75 +/- 0.97 mm, and radiographic bone gain of 3.79 +/- 1.02 mm, respectively. Two weeks after surgery, primary closure was maintained in 95% of the defect sites. Treatment with a combination of PRP and BDX leads to a significantly favorable clinical and radiographic improvement in deep intrabony periodontal defects.

Surgical management of primary malignant proximal fibular tumors: Functional and clinical outcomes of 23 patients.

OBJECTIVES: This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula. PATIENTS AND METHODS: This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. The anamnesis or medical history, physical examination, plain chest radiography, lung computed tomography, direct radiograph, and magnetic resonance imaging of the affected extremity and routine laboratory tests of all patients were evaluated. RESULTS: Of the patients, 11 were diagnosed with osteosarcoma (47.8%), nine with Ewing's sarcoma (39.1%), two with chondrosarcoma (8.7%), and one was diagnosed with synovial sarcoma (4.3%). Pain and palpable mass were the most common symptoms. Six patients had lung metastases at the time of diagnosis. Of the patients, eight were performed Malawer type 1 resection (34.8%), nine type 2 resection (39.1%), four above knee amputation (17.4%), and two proximal tibia tumor resection prosthesis (8.6%). Mean follow-up duration was 36 months (range, 12 to 119 months). Local recurrence developed in three patients. Mean Musculoskeletal Tumor Society (MSTS) score of all patients was 62. CONCLUSION: Surgical treatment of primary malignant tumors of the proximal fibula is problematic. In appropriate indications, Malawer type 1 resection should be the treatment of choice due to lower local recurrence rates and higher MSTS scores.

Place of orthopedic surgery in gout.

OBJECTIVE: To evaluate the indications, surgical results, and complications related to tophaceous gout surgery in the orthopedics and traumatology clinic of our hospital. METHODS: A retrospective analysis of all patients who underwent surgery for topical gout in our orthopedics and traumatology clinic between January 2008 and December 2017 was carried out. Their history, physical examination, and radiological and laboratory tests were examined. Surgical indications, surgical results, and complications were analyzed. RESULTS: Total 18 lesions in 15 patients with gout tophi were operated (60% males). The most common lesion was in the elbow (6; 33%). All patients underwent total excision, and the mean mass size was 4.0 cm. Only one patient had a delayed wound healing. All other patients had no complications. CONCLUSION: The results of surgical procedures which were performed to confirm the diagnosis, to reduce mechanical problems due to tophaceous and to alleviate pain were excellent, and complication risk was acceptable. Comorbidities and sepsis were the predictors of surgical complications.

Chondrosarcomas of the phalanges of the hand.

OBJECTIVES: This study aims to evaluate the diagnosis and treatment approaches of the rarely seen chondrosarcomas of the phalanges of the hand. PATIENTS AND METHODS: Fifty-two patients (27 males, 25 females; mean age 41.2 years; range 12 to 70 years) with chondroid lesions localized in hand phalanges who were performed surgical treatment between December 2012 and September 2016 were retrospectively reviewed. The study included 62 phalangeal chondroid lesions. Patients' mean follow-up duration was 60.6 months (range 13 to 165 months). Incisional biopsy was performed for the diagnosis. One patient with bilateral and multiple involvement was performed tru-cut biopsy. Phalangeal chondrosarcoma was diagnosed in five patients (9.6%). RESULTS: Of the chondroid lesions, 37 were localized in proximal phalanges (59.6%), 16 in midphalanges (25.8%), and nine in distal phalanges (14.6%). Chondrosarcoma was detected in 15 phalanges of five patients. Of the two patients with Ollier disease, localization was detected in nine phalanges (four proximal, two mid, three distal phalanges) of one patient and in three phalanges (one proximal, two midphalanges) of the other patient. None of the patients had distant metastasis on diagnosis. Ray amputation was performed in two patients under general anesthesia and amputation was performed in one patient. One patient did not give consent for operation. The other patient with Ollier disease gave consent for amputation of only one finger. No local recurrence was seen. CONCLUSION: The hand localization of chondrosarcomas is rare with scarce information in the literature. Their metastasis potential is low but local recurrence rates are high after insufficient surgery. Amputation or ray amputation is the applicable treatment.