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Plastic and Reconstructive Surgery May 2019Bone morphogenetic proteins (BMPs) have played a central role in the regenerative therapies for bone reconstruction, including alveolar cleft and craniofacial surgery....
BACKGROUND
Bone morphogenetic proteins (BMPs) have played a central role in the regenerative therapies for bone reconstruction, including alveolar cleft and craniofacial surgery. However, the high cost and significant adverse effect of BMPs limit their broad application. Hydroxycholesterols, naturally occurring products of cholesterol oxidation, are a promising alternative to BMPs. The authors studied the osteogenic capability of hydroxycholesterols on human mesenchymal stem cells and the impact of hydroxycholesterols on a rodent alveolar cleft model.
METHODS
Human mesenchymal stem cells were treated with control medium or osteogenic medium with or without hydroxycholesterols. Evaluation of cellular osteogenic activity was performed. A critical-size alveolar cleft was created and one of the following treatment options was assigned randomly to each defect: collagen sponge incorporated with hydroxycholesterols, BMP-2, or no treatment. Bone regeneration was assessed by means of radiologic and histologic analyses and local inflammation in the cleft evaluated. Moreover, the role of the hedgehog signaling pathway in hydroxycholesterol-mediated osteogenesis was examined.
RESULTS
All cellular osteogenic activities were significantly increased on human mesenchymal stem cells treated with hydroxycholesterols relative to others. The alveolar cleft treated with collagen sponge with hydroxycholesterols and BMP-2 demonstrated robust bone regeneration. The hydroxycholesterol group revealed histologically complete bridging of the alveolar defect with architecturally mature new bone. The inflammatory responses were less in the hydroxycholesterol group compared with the BMP-2 group. Induction of hydroxycholesterol-mediated in vitro osteogenesis and in vivo bone regeneration were attenuated by hedgehog signaling inhibitor, implicating involvement of the hedgehog signaling pathway.
CONCLUSION
Hydroxycholesterols may represent a viable alternative to BMP-2 in bone tissue engineering for alveolar cleft.
Topics: Alveolar Process; Alveoloplasty; Animals; Bone Morphogenetic Protein 2; Bone Regeneration; Cell Culture Techniques; Cell Line; Culture Media; Humans; Hydroxycholesterols; Male; Mesenchymal Stem Cells; Models, Animal; Osteogenesis; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Tissue Scaffolds; Transforming Growth Factor beta
PubMed: 30789479
DOI: 10.1097/PRS.0000000000005528 -
Annals of Maxillofacial Surgery 2018Conventional alveoloplasty procedure using manual instruments results in higher resorption of the residual alveolar ridge, which is unsuitable for denture construction....
PURPOSE
Conventional alveoloplasty procedure using manual instruments results in higher resorption of the residual alveolar ridge, which is unsuitable for denture construction. The purpose of this study was to evaluate the effect of piezosurgery-assisted alveoloplasty using minimally invasive technique compared to that of the conventional technique.
MATERIALS AND METHODS
This was a comparative study. The study sample consisted of 35 edentulous patients with bilateral bony spicules requiring alveoloplasty. The primary outcome variables assessed were time required for alveoloplasty, postoperative pain using visual analogue scale (VAS), and postoperative healing using Landry, Turnbull, and Howley healing index. The differences between the outcome variables were statistically analyzed using paired -test.
RESULTS
The participants consisted of 35 patients (25 men and 10 women; age range: 38-83 years) diagnosed with bilateral bony spicules on the edentulous alveolar ridge. There was a statistically highly significant difference between both groups with respect to the outcome variables such as time required, VAS at 2 day, and healing index at 7 day with higher mean of time required (in sec), higher mean of VAS, and lower healing index for conventional group as compared to piezo group ( < 0.05).
CONCLUSION
Alveoloplasty done using piezosurgery not only reduces patient's postoperative discomfort but also maintains the alveolar bone integrity by not disturbing the soft-tissue and hard-tissue architecture, allowing faster healing of tissues, which makes the future prosthesis replacement easier.
PubMed: 30693229
DOI: 10.4103/ams.ams_162_18 -
Journal of Prosthodontics : Official... Jul 2019Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality...
PURPOSE
Systematic monitoring of important clinical outcomes is increasingly important for health-care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions.
MATERIALS AND METHODS
The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post-implantation, summarized as hazard ratio (HR) (95% confidence interval [CI]).
RESULTS
Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first-year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02-2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33-5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11-4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17-0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10-22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement.
CONCLUSIONS
These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants.
Topics: Adult; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Humans; Proportional Hazards Models; Retrospective Studies
PubMed: 30350385
DOI: 10.1111/jopr.12978 -
The Cleft Palate-craniofacial Journal :... Apr 2019Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to...
OBJECTIVE
Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique.
MATERIAL AND METHODS
A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate.
INTERVENTIONS
An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability.
CONCLUSIONS
Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.
Topics: Alveoloplasty; Child; Cleft Lip; Cleft Palate; Humans; Male; Maxilla; Nose
PubMed: 30068230
DOI: 10.1177/1055665618791706 -
The Journal of Craniofacial Surgery Sep 2018Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic...
Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors' protocol is: orthodontic devices, phonoaudiology, and surgical procedures.The authors' cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8-18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors' protocol.Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.
Topics: Adolescent; Alveoloplasty; Child; Cleft Lip; Cleft Palate; Clinical Protocols; Cord Blood Stem Cell Transplantation; Female; Follow-Up Studies; Humans; Infant; Male; Outcome Assessment, Health Care; Palate, Hard; Palate, Soft; Plastic Surgery Procedures; Rhinoplasty; Time-to-Treatment
PubMed: 30067525
DOI: 10.1097/SCS.0000000000004766 -
Periodontology 2000 Jun 2018Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered... (Review)
Review
Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin?
Topics: Alveolectomy; Alveoloplasty; Crown Lengthening; Dental Restoration, Temporary; Esthetics, Dental; Humans; Surgical Flaps; Wound Healing
PubMed: 29493814
DOI: 10.1111/prd.12208 -
Oral Diseases Mar 2018To examine the effects of direct oral anticoagulants (DOACs) on bleeding complications following dental surgeries.
OBJECTIVE
To examine the effects of direct oral anticoagulants (DOACs) on bleeding complications following dental surgeries.
SUBJECTS AND METHODS
This 6-year retrospective study collected data from records of patients undergoing oral surgical procedures within a university setting. An electronic health record database was searched using current procedural terminology codes for oral surgical procedures. Information regarding patient, procedural factors, and postoperative complications were extracted. Data were analyzed by Fisher's exact test.
RESULTS
Of patients who had a procedural code associated with oral surgery, only 0.11% (12/11,320) took a DOAC. Twelve patients (10 males, age ranging from 44 to 90 years) underwent 17 surgeries by nine different practitioners involving 98 extractions, 14 alveoloplasties, two tuberosity reductions, and two tori removals. In nine cases, the DOAC was discontinued a mean of 52.5 hrs prior to surgery (range 12-120 hrs). Bleeding complications were not reported for patients whose drug was discontinued or continued. Documentation of drug continuation/discontinuation was poor.
CONCLUSIONS
Bleeding was not observed with direct oral anticoagulation use in this oral surgery cohort. Drug discontinuation/continuation was not a factor in bleeding outcomes, and direct oral anticoagulation interruption was variable and poorly documented.
Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Documentation; Female; Humans; Male; Middle Aged; Oral Surgical Procedures; Postoperative Hemorrhage; Retrospective Studies; Withholding Treatment
PubMed: 29480605
DOI: 10.1111/odi.12698 -
Special Care in Dentistry : Official... Nov 2017Primary surgical repair of the bilateral cleft lip and palate (BCLP) deformity is challenging. Infant Orthopedic (IO) procedures are often used to assist surgical...
BACKGROUND
Primary surgical repair of the bilateral cleft lip and palate (BCLP) deformity is challenging. Infant Orthopedic (IO) procedures are often used to assist surgical reconstruction of normal anatomy. Nasoalveolar molding (NAM) is a presurgical infant orthopedic procedure that attempts to reduce the cleft nasal deformity, in addition to the lip and alveolus, leading to an esthetic primary surgical repair.
OBJECTIVE
NAM provides the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus.
METHOD
Infant nasal cartilages are amenable to correction with NAM in the first few weeks of infancy when they retain their plasticity. NAM-assisted surgical repair of a complete BCLP infant is discussed. Postoperatively nasal stents were used to retain results and minimize relapse.
RESULTS
NAM helped correct premaxillary deviation and protrusion, reduce alveolar cleft width and improve the nasal morphology prior to surgery in the BCLP infant.
CONCLUSIONS
NAM helped reduce the severity of the cleft deformity in the BCLP infant and facilitated an easier and esthetic single stage primary surgical repair.
Topics: Alveolar Process; Alveoloplasty; Cleft Lip; Cleft Palate; Esthetics; Humans; Infant, Newborn; Nose; Orthopedic Procedures; Preoperative Care; Stents
PubMed: 29194721
DOI: 10.1111/scd.12252 -
Journal of Cranio-maxillo-facial... Sep 2017The aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques. (Comparative Study)
Comparative Study
Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study.
PURPOSE
The aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques.
MATERIALS AND METHODS
In posterior mandibles, alveolar ridges were treated either with interpositional equine cancellous bone block (inlay group) or with onlay autogenous bone block (onlay group). Bone volumes at baseline and at 4 months after surgery were measured by computed tomography.
RESULTS
A total of 20 subjects were enrolled in the present study: 10 in the inlay group and 10 in the onlay group. After surgery, atrophic posterior mandibles showed a mean vertical augmentation height of 6.0 mm in the inlay group and 7.4 mm in the onlay group. No significant differences were recorded between the two groups regarding volume loss of the grafted bone or decrease in vertical bone height of the augmented site (29% and 1.9 mm for the onlay group, and 35% and 1.7 mm for the inlay group) during healing. Two complications (1 wound dehiscence and 1 mandibular fracture) occurred postoperatively in the inlay group; on the other hand, the onlay group had three complications (wound dehiscence). A total of 80 dental implants were placed in augmented areas: 46 in the inlay group with a peri-implant marginal bone loss of 0.8 mm, and 34 in the onlay group with a peri-implant marginal bone loss of 1.3 mm (p = 0.0006).
CONCLUSIONS
Inlay xenogeneic grafts showed volumetric bone remodeling similar to that recorded for onlay autogenous bone. The success of the autogenous onlay blocks (82.4%) appeared to be lower than that registered for the inlay group (93.8%), but the difference was not significant.
Topics: Adult; Aged; Alveolar Bone Loss; Alveolar Ridge Augmentation; Animals; Bone Remodeling; Bone Transplantation; Female; Heterografts; Horses; Humans; Image Processing, Computer-Assisted; Male; Mandible; Mandibular Diseases; Middle Aged; Retrospective Studies; Smoking; Tomography, X-Ray Computed
PubMed: 28705523
DOI: 10.1016/j.jcms.2017.01.018 -
Journal of Clinical Periodontology Feb 2017To evaluate and compare clinical and histological changes after ridge preservation procedures with those of spontaneous healing. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To evaluate and compare clinical and histological changes after ridge preservation procedures with those of spontaneous healing.
MATERIALS AND METHODS
Ninety patients were enrolled in the present randomized controlled clinical trial and underwent single-tooth extraction in the premolar/molar areas. Thirty sites were grafted with collagenated cortico-cancellous (coll), 30 sites with cortical (cort) porcine bone and 30 sites underwent natural healing. Primary (vertical and horizontal bone changes after 3 months) and secondary outcomes (histomorphometric after 3 months) were evaluated at implant placement.
RESULTS
The vertical bone changes at the grafted sockets were significantly (p < 0.0001) lower (0.30 mm for cort group and 0.57 mm for coll group) when compared to non-grafted sockets (2.10 mm for nat group). Moreover, the width reduction of the coll (0.93 mm) and cort (1.33 mm) groups was significantly lower (p < 0.0001) than the non-grafted group (3.60 mm). The analysis of subgroups attested that when premolar and molar sites were compared, the buccal bone loss appeared to be dependent both on tooth position and grafting material employed.
CONCLUSION
The ridge preservation procedures had significantly better outcomes when compared to natural healing. The biomaterials did not differ for maintenance of bone width; even though, the bone height seemed to be better preserved with the cortical porcine bone.
Topics: Adult; Aged; Alveolar Bone Loss; Female; Follow-Up Studies; Heterografts; Humans; Male; Middle Aged; Surgical Wound; Time Factors; Tooth Extraction; Tooth Socket; Wound Healing
PubMed: 27883211
DOI: 10.1111/jcpe.12655