Uso de membrana de colágeno y placa de protección mecánica como instrumento de conservación alveolar / Use of collagen membrane and mechanical protective plate as an instrument for alveolar preservation

Luego de una extracción dental ocurren inevitablemente procesos de reabsorción y remodelación ósea, donde la dimensión y morfología de la cresta alveolar se ve modificada, representando un problema para la rehabilitación de la zona. Estudios clínicos han documentado un promedio de 4,0 a 4,5 mm de reabsorción ósea horizontal luego de una exodoncia, como así también cambios dimensionales significativos en los alrededores del hueso alveolar. El propósito fue evaluar y comparar clínica y tomográficamente los procesos de reparación y conservación del reborde alveolar post-extracción de paredes intactas, con y sin la utilización de esponjas de colágeno intraalveolar como relleno y placa termoformada como barrera física, durante el proceso de cicatrización. Se seleccionaron pacientes con indicación de exodoncia de elementos dentarios normalmente implantados y clínicamente aceptables, aplicando los criterios de exclusión, se realiza toma de impresión del terreno para la confección de una placa de protección rígida 0,8 termoformada para ser colocada posterior a la extracción durante la masticación por un período de 30 días. Se indica tomografía cone-beam post operatoria inmediata y a los tres meses para analizar, medir y comparar alto y ancho de crestas alveolares residuales. En la evaluación clínica y tomográfica de los casos estudiados, el grupo control donde se usó únicamente placa de protección alveolar arrojó mejores resultados que el grupo donde se colocaron esponja de colágeno en el interior del alvéolo. Palabras clave: Regeneración ósea, esponja de colágeno, cicatrización ósea, alvéolo postextracción, placa de protección alveolar (AU)

After a tooth extraction, bone resorption and remodeling processes inevitably occurs, where size and morphology of the alveolar crest is modified, representing a problem for the rehabilitation of the area. Clinical studies have documented an average of 4.0 to 4.5 mm of horizontal bone resorption after an extraction, us well us substantial dimensional changes around the alveolar bone. The purpose was to evaluate and compare clinical and tomographically both repair and preservation of post extraction alveolar ridge of intact walls processes, with and without the use of intraalveolar collagen sponges as filler and a thermoformed protective plaque, us physica? barrier, during healing process. Patients with normally implanted and clinically acceptable tooth with extraction indication were selected, applying the exclusion criteria, impression of the field is taken to build a 0.8 rigid thermoformed protective plaque in order to be placed after extraction and used during chewing for a period of 30 days. Immediate and three months post-operative cone beam tomography are indicated to analyze, measure and compare height and width of residual alveolar crests. In the clinical and tomographic evaluation of the cases treated, control group where only alveolar protective plaque was used, showed better results than the group with intraalveolar collagen sponge (AU)

Ensaio clínico controlado, randomizado e cego, para avaliar a preservação alveolar, utilizando biomaterial de colágeno: resultados preliminares / Controlled, randomized and blind clinical trial to evaluate alveolar preservation using collagen biomaterial: preliminary results

Foi proposito desse trabalho analisar a eficiência na manutenção óssea alveolar após extração dentária pelo biomateral xenógeno (Hemospon®) por meio de imagens tomográficas pré e pósoperatórias de 1 mês e 18 meses de acompanhamento. Trata-se de um estudo clínico controlado, randomizado e cego, onde foram realizadas 18 exodontias, e os alvéolos dentários tratados foram selecionados de forma randomizada e divididos em dois grupos. O grupo 1, grupo teste (G1) foi inserido esponja de colágeno xenógena (porco) e o grupo controle (G2), foi mantido apenas o coágulo sanguíneo local. Os alvéolos foram analisados nos sentidos horizontais e verticais e os resultados foram avaliados através dos testes de Wilcoxon e Mann-Whitney, assumindo uma significância estatística de p<0,05. Além das análises tomográficas os pacientes foram acompanhados diariamente na primeira semana para verificar se os tecidos locais apresentavam possíveis complicações, como a presença de infecção, fistulas e dor persistente. Os resultados iniciais (1 mês) constataram que numa análise em conjunto avaliando altura (p<,0,863), comprimento total (p<1,000) e espessura total do alvéolo (p<0,222), não foram observadas diferenças significativas entre os grupos teste e controle, respectivamente. Na análise de 18 meses, observa-se diferença estatística (p < 0,05) em relação a espessura total do alvéolo, porém em relação ao comprimento total do alvéolo e a altura alveolar não foram observados diferenças estatisticamente significativas (p = 0,36; p = 0,674 ­ respectivamente). Quando de compara-se o G1 em momentos diferentes 1 mês e 18 meses em relação as variáveis observa-se diferenças estatísticas significativas no comprimento total do alvéolo e na espessura (p<0,05), porém não houve signicancia em relação à altura do alvéolo (p=0,575). Analisando em separado cada variável em relação aos grupos G1 e G2 não houve diferença estatística numa análise após 18 meses (p = 0,773 ­ altura alveolar e espessura alveolar; p = 1 ­ comprimento total do alvéolo). Durante o acompanhamento clínico em ambos os grupos não houve diferença no padrão do processo de reparo tecidual, sendo possível reabilitação oral dos pacientes. Mediante os dados preliminares apresentados, a pesquisa demonstrou que os alvéolos tratados com esponja de colágeno porcina (Hemospon®) tiveram perdas ósseas menores, principalmente em relação a espessura, podendo-se inferir que há indícios de uma manutenção alveolar com o uso do biomaterial, podendo ser um biomaterial em potencial e de baixo custo para preservação alveolar, sem aumentar os índices de complicações, porém sugere-se uma análise de uma amostra maior para uma melhor análise estatística (AU).

The purpose of this work was to analyze the efficiency of alveolar bone maintenance after tooth extraction by xenogenous biomaterial (Hemospon®) by means of pre and postoperative tomographic images of 1 month and 18 months of follow-up. This is a controlled, randomized, blinded, clinical study, in which 18 extractions were performed, and the treated dental alveolo were randomly select and devided into two groups. Group 1 test group (G1) a xenogen collagen sponge (pig) was inserted and the control grouop (G2), only the local blood clot was maintained. The alveoli were analyzed in the horizontal and vertical directions and the results were evaluated using the Wilcoxon and Mann ­ Whitney tests assumig a statistical significance of p<0,05. In addition to tomographic analyzes, patients were followed up daily in the first week to check whether local tissues had possible complications such as the presence of infection fistulas and persistent pain. The initial results (1 month) found that in a joint analysis evaluanting height (p<0,863) total length (p<1,00) and total thickness of the socket (p<0,222), no significant differences were observed between the test groups and control respectively. When G1 is compared at different times 1 month and 18 months in relation to the variables there are statistically significant differences in the total length of the alveolus and in the thickness (p<0,05) but there was no significance in relation to the height of the alveolus (p = 0,575). Analyzing each variable separately in relation to groups G1 and G2 there was no statistical difference in an analysis after 18 months (p=0,773 ­ alveolar height and alveolar thickness; p = 1 ­ total alveolar length). During clinical follow-up in both groups there was no difference in the pattern of the tissue repair process with patients oral rehabilitation being possible. Through the preliminary data presented the research demonstrated that the alveoli treated with porcine collagen sponge (Hemospon®) had smaller bone losses mainly in relation to thickness and it can be inferred that there are signs of alveolar maintenance with the use of biomaterial it can be a potential and low-cost biomaterial for alveolar preservation without increasing the complication rates however an analysis of a larger sample is suggested for a better statistical analysis (AU).

Plasma rico en fibrina e injerto conectivo en la instalación de un implante dental / Fibrin-rich plasma and connective tissue graft in dental implant installation

Introducción: Combinar tratamientos regenerativos con injertos de tejido blando impide que el tejido periimplantario se atrofie y altere la estética. Los resultados de esta combinación son discutidos en la literatura actual cuando se trata de implantes inmediatos. Objetivo: Describir el tratamiento regenerativo combinando plasma rico en fibrina e injerto conectivo en la instalación de un implante dental en el sector anterosuperior. Presentación del caso: El paciente fue un varón de 40 años de edad sin antecedentes de enfermedades sistémicas, con trauma facial. Al examen clínico se observó una corona de porcelana fracturada a nivel cervical vestibular, secreción purulenta en proceso de cicatrización y contorno gingival alterado. En el examen radiográfico se evidenció una lesión periapical con aparente reabsorción radicular. Se extrajo el diente, se colocó plasma rico en fibrina para mejorar la cicatrización, se esperaron 6 semanas y se colocó un implante. Al cabo de 4 meses se realizó la segunda fase con un injerto de tejido conectivo y colocación del cicatrizal, se esperaron dos semanas y se colocó una corona de porcelana. Conclusiones: En el presente caso, la combinación de plasma rico en fibrina e injerto conectivo favoreció el aspecto estético periimplantario sin evidenciarse complicaciones durante el posoperatorio(AU)

Introduction: Combining regenerative treatments with soft tissue grafts prevents atrophy of the peri-implant tissue and alterations in esthetics. The results of this combination are discussed in the current literature. Objective: To describe the regenerative treatment, combining Fibrin-rich plasma and connective tissue graft in the installation of a dental implant in the upper anterior sector. Case presentation: Forty-year-old male patient with facial trauma. He has no history of systemic diseases. On clinical examination, a fractured porcelain crown was found at the vestibular cervical level. There was purulent discharge in the healing process and altered gingival contour. Radiographic examination revealed a periapical lesion with apparent root resorption. The tooth was extracted; fibrin-rich plasma was placed to improve healing. Six weeks after, an implant was placed. After the first four months, the second phase was performed with a connective tissue graft and placement of the scar tissue; two weeks after, a porcelain crown was placed. Conclusions: In the present case, the combination of Fibrin-rich plasma and connective tissue graft favored the peri-implant esthetic appearance without evidence of complications during the postoperative period(AU)

Adipose Tissue and Bone Marrow-Derived Mesenchymal Stem Cells Role in Regeneration of Cleft Alveolus in Dogs

Aim: This study was designed to evaluate the therapeutic potential of adipose tissue-derived mesenchymal stem cells (ATMSCs) compared to bone marrow-derived mesenchymal stem cells (BM-MSCs) on the regeneration of surgically createdcleft alveolus in dogs. Methods: Split mouth experimental study was performed on twelve healthy mongrel dogs. The dogswere divided into two groups (A and B): Ingroup A, the surgically created alveolus was transplanted with AT-MSCs,scaffold and growth factors at the experimental side (right side of the maxilla). Ingroup B, the surgically created alveoluswas transplanted with BM-MSCs, scaffold and growth factors at the experimental side (right side of the maxilla). In thecontrol side (left side of the maxilla), the surgically created alveolus was transplanted with scaffold and growth factors only.The flaps were replaced and sutured with resorbable sutures. Bone regeneration was evaluated clinically andradiographically after 1.5 and 3 months following dogs’ scarification. The data were evaluated with descriptive and t-testmethods (p=0.05). Results: Stem cells whether AT-MSCs or BM-MSCs accelerate the healing and regeneration of thedefected area by increasing the bone width and surface area; providing the bone quantity and quality as early as 1.5 and 3months. Conclusions: AT-MSCs and BM-MSCs are attractive tools in bone regeneration. AT-MSCs in experimental studiesshowed that their effectiveness is comparable to BM-MSCs, in addition to its low cost, ease of harvesting and saferprocedure to obtain stem cells as well as less risk of infection.

Estudio histológico y radiográfico de la preservación alveolar post-exodoncia con sulfato de calcio y xenoinjerto en cobayos / Estudo histológico e radiográfico da preservação alveolar pós-extracção com sulfato de cálcio e xenoinjerto em cobaias / Histological and radiographical study of the alveolar post-extractionpreservation with calcium sulfate and xenoinjerto in guinea pigs

Después de realizar una exodoncia inicia un proceso de remodelación ósea, dejando como consecuencia un volumen óseo disminuido que puede impedir la colocación de un implante dental en óptimas condiciones. Objetivo: Evaluar la preser-vación alveolar post-exodoncia utilizando sulfato de calcio oxenoinjerto en cobayos en comparación con la cicatrización espontánea. Materiales y Métodos: Se utilizaron 30 cobayos machos, de cuatro meses de edad, asignados en tres grupos de 10 cobayos cada uno: G1 Sulfato de calcio, G2 Xenoinjerto (bovino) G3 control negativo (sin sustituto óseo). Se realizó la exodoncia del incisivo central inferior derecho se cureteó y lavó con suero fisiológico, el grupo G1 y G2 se rellenaron con el biomaterial correspondiente, el grupo G3 no recibió ningún biomaterial. La sutura fue punto en X con Vicryl (4/0). Se tomó radiografías estandarizadas en el pos operatorio inmediato y a los 40 dias,se medió la cresta alveolar en mesial, distal y coronal. A los 40 días los cobayos fueron sacrificados, obteniendo el segmento de hueso alveolar para el análisis histológico del alvéolo. Los datos fueron analizados mediante el test de Kruskal Wallis y chi cuadrado con un nivel de significancia del 5%. Resultados: Fue observada la preservación de la cresta alveolar en mesial 2,92 (p= 0,025) y cervical 0,92 (p=0,043). En el análisis histológico los espacios en la región fibrosa en la parte media del alvéolo fue 26,00 para el sulfato de calcio y 23,80 para el xenoinjerto (p = 0,011), en apical 16,20para el sulfato de calcio y 20,60para el xenoinjerto (p= 0,020), espacios vacíos en coronal (p= 0,003), tejido fibroso (p=0,010), regeneración ósea (p= 0,019), áreas hialinas (p= 0,010).Conclusión: Se preservan mejor los alvéolos postextracción usando Sulfato de Calcio y Xenoinjerto en compa-ración con la cicatrización espontánea en cobayos.

After performing an extraction, a process of bone remodeling begins, leaving as a consequence a decreased osseous volume that can prevent the placement of a dental implant in optimal conditions. Objective: To evaluate post-exodontia alveolar preservation using calcium sulfate or xenograft in guinea pigs compared to spontaneous healing. Materials and Methods:30 male guinea pigs, four months old, assigned in three groups of 10 guinea pigs each were used: G1 Calcium sulphate, G2 Xenograft (bovine) G3 Negative control (without bone substitute). Exodontia of the lower right central incisor was curetted and washed with physiological serum, group G1 and G2 were filled with the corresponding biomaterial, group G3 did not receive any biomaterial. The suture was point in X with Vicryl (4/0). Standardized radiographs were taken in the imme-diate postoperative period and after 40 days, the alveolar crest was measured mesially, distally and coronally. At 40 days the guinea pigs were sacrificed, obtaining the segment of alveolar bone for the histological analysis of the alveolus. The data were analyzed through of the Kruskal Wallis test and chi square test with a level of significance of 5%. Results: The preservation of the alveolar crest was observed in mesial 2.92 (p = 0.025) and cervical 0.92 (p = 0.043). In the histological analysis, the spaces in the fibrous region in the middle part of the alveolus were 26.00 for calcium sulphate and 23.80 for xenograft (p = 0.011), apical 16.20 for calcium sulphate and 20 , 60 for the xenograft (p = 0.020), empty coronal spaces (p = 0.003), fibrous tissue (p = 0.010), bone regeneration (p = 0.019), hyaline areas (p = 0.010). Conclusion: Post-extraction alveoli are better preserved using Calcium Sulphate and Xenograft compared to spontaneous wound healing in guinea pigs.

Após a realização de uma extração, inicia-se um processo de remodelação óssea, deixando como conseqüência um volume ósseo diminuído que pode impedir a colocação de um implante dentário em condições ótimas. Objetivo: Avaliar a preservação alveolar pós- pós extração com sulfato de cálcio ou xenoenxerto em cobaias em comparação com a cicatrização espontânea. Materiais e Métodos: Foram utilizadas 30 cobaias machos de quatro meses de idade, distribuídos em três grupos de 10 cobaias cada. G1 Sulfato de cálcio, G2 Xenoenxerto (bovino) G3 Controle negativo (sem substituto ósseo). A exodontia do incisivo central inferior direito foi curetada e lavada com soro fisiológico, o grupo G1 e G2 foram preenchidos com o biomaterial correspondente, o grupo G3 não recebeu nenhum biomaterial. A sutura foi ponto em X com Vicryl (4/0). Radiografias padronizadas foram realizadas no pós-operatório imediato e, após 40 dias, a crista alveolar foi medida mesial, distal e coronária. Aos 40 dias as cobaias foram sacrificadas, obtendo-se o segmento de osso alveolar para a análise histológica do alvéolo. Os dados foram analisados por meio do teste de Kruskal Wallis e teste do qui-quadrado com nível de significância de 5%. Resultados: A preservação da crista alveolar foi observada em mesial 2,92 (p = 0,025) e cervical 0,92 (p = 0,043). espaços análise histológica da região fibroso no meio do alvéolo foi 26,00 para o sulfato de cálcio e de 23,80 para o xenoenxerto (p = 0,011), em apical 16,20 para o sulfato de cálcio e 20 , 60 para o xenoenxerto (p = 0,020), em espaços vazios coronal (p = 0,003), o tecido fibroso (p = 0,010), a regeneração óssea (p = 0,019), as áreas hialinas (p = 0,010). Conclusão: Os alvéolos pós-extração são melhor preservados usando Sulfato de Cálcio e Xenoenxerto em comparação com a cicatrização espontânea em cobaias.

Bone healing of dental alveoli in smokers with platelet-rich plasma obtained using single or double centrifugation

Introduction: the habit of smoking alters the bone healing process, a problem to consider in oral surgery. objective: to evaluate the bone healing of dental alveoli with PRP obtained using single or double centrifugation in smokers. methodology: extraction of mandibular third molars was performed in a study population divided into smoking group (A), which had PRP applied with the protocol using a single centrifugation step (P1C) in the alveolus of tooth 38 and the protocol of double centrifugation (P2C) in alveolus of tooth 48; a smoking group(B), to whom no PRP was applied; and a non-smokers group (C) to whom PRP was applied obtained using P1C and P2C protocol. radiographic examination was performed at 8, 30 and 60 days post procedure. results: thirty patients met the criteria, 57 percent were female. when evaluating bone healing between the group of smokers and non-smokers, statistically significant differences were observed in the non-smoking group at 30 and 60 days, showing better results with the P2C protocol (p<0.005). statistically significant differences were found at 30 and 60 days (p<0.005), both with the P1C and P2C when comparing bone healing of group A and B. conclusions: bone healing in the alveoli of mandibular third molars that which PRP applied was higher in non-smoking patients, compared with the group of smokers. bone healing was better in patients smokers to whom PRP was applied than those without PRP treatment. regarding the method of obtaining PRP, bone healing was better when a double centrifugation protocol (P2C) was applied.

Utilización de sulfato de calcio hemihidratado como material de relleno y barrera en un alveolo post-exodoncia: Una observación clínica, tomográfica e histológica comparativa a 4 meses antes de la colocación de implantes / Use of calcium sulfate hemihydrate as a filler and barrier in a post-extraction alveolus. A clinical, tomographic and histological comparative observation to 4 months before implant placement

Evaluar y comparar de forma clínica, tomográfica e histológica el proceso de reparación ósea y la conservación del reborde alveolar en dos alveolos post-extracción de paredes intactas, con y sin la utilización de un material sustituto óseo regenerativo a base de sulfato de calcio hemihidratado como relleno y barrera, antes de la colocación de implantes a cuatro meses.

To evaluate and compare clinically, tomographic and histological the bone repair process and the preservation of the alveolar walls of two sockets intact, with and without the use of a bone substitute material based regenerative calcium sulfate hemihydrate as a filler and barrier before implant placement to four months.

Comportamento dos tecidos peri-implantares no implante imediato com provisionalização: revisão de literatura / Behavior of peri-implant tissues inimmediate implant with provisionalization:A literature review

Introdução: a Implantodontia alcançou um patamar onde apenas a osseointegração já não é o bastante para se considerar sucesso o resultado do tratamento. Hoje, além de devolver função, o implante deve estar associado a restaurações estéticas similares à dentição natural, harmoniosas com os dentes vizinhos e com as outras estruturas peri-implantares. O processo cicatricial, após a perda dentária, é desfavorável aos tecidos moles, que acompanham a remodelação óssea comprometendo a estética. A utilização de implantes imediatos e provisionalização possibilita uma abordagem de tratamento que visa a manutenção dos tecidos peri-implantares, em substituição ao tratamento das sequelas da atrofia pós-extração. Objetivo: identificar e discutir os determinantes do comportamento morfo-estético-funcional do tecido peri-implantar no procedimento de implante imediato com provisionalização. Métodos: utilizou-se como fonte de pesquisa a base de dados do PubMed no período de 2003 a 2012. Resultados: dentro dos limites dessa revisão, foi possível concluir que o resultado estético na terapia com implantes sofre influência do biótipo tecidual, especialmente nos níveis da mucosa peri-implantar vestibular. O biótipo fino apresentou maior suscetibilidade a recessão gengival. Por outro lado, o biótipo tecidual demonstrou pouca influência na altura da papila interproximal. O preenchimento do gap com um substituto ósseo ou enxerto autógeno contribuiu para a manutenção das estruturas ao redor do implante, mas não se pode afirmar a existência de superioridade entre os materiais de enxerto. Conclusão: o enxerto de tecido conjuntivo subepitelial parece beneficiar o nível da mucosa marginal vestibular.

Introduction: Implantodontics has reached a level in which osseointegration alone is no longer enough for treatmentsuccess. Today, in addition to recovering function, the implant must be associated with esthetic restorations that aresimilar to natural dentition, in harmony with surrounding teeth and with other peri-implant structures. The healingprocess after tooth loss is unfavorable to soft tissues that follow bone remodeling, compromising esthetics. The use ofimmediate implants and provisionalization enables a treatment approach that aims at maintaining peri-implant tissues,replacing treatment of atrophy sequelae after extraction. Objective: The aim of this paper is to conduct a literaturereview in order to identify and discuss the determinants of morpho-esthetic-functional tissue peri-implant behavior inimmediate implant placement with provisionalization. Methods: PubMed database was used as a research resourceconsidering the period between 2003 and 2012. Results: Within the limits of this review, it was reasonable to concludethat the esthetic results in implant therapy are influenced by tissue biotype, especially in the peri-implant mucosa.The thin biotype revealed higher susceptibility to gingival recession. Conversely, tissue biotype revealed little influenceover the height of the interproximal papilla. Filling the gap with autogenous bone graft contributed to the maintenanceof the structures around the implant, but we can not affirm the existence of superiority between different graft materials.Conclusion: Subepithelial connective tissue graft seems to positively influence the level of marginal mucosa.

Caracterização radiográfica ex vivo de biomateriais utilizados para regeneração óssea em mandíbulas de porcos / Ex-vivo radiographic characterization of biomaterials used for bone regeneration in pig jaws

Introdução: As características radiográficas, como a densidade, podem influenciar na avaliação dos resultados obtidos com a utilização de biomateriais. Objetivo: O objetivo deste estudo foi avaliar a densidade radiográfica de diferentes biomateriais substitutos ósseos, inseridos em alvéolos dentários e defeitos ósseos, em mandíbulas de porcos, além de verificar a influência de simulador de tecido mole. Material e método: Foram obtidos os defeitos: defeitos ósseos de 2 e 3 mm de profundidade no ramo da mandíbula, e alvéolos originados da extração dos primeiros molares direitos. Foram utilizadas amostras comerciais de cinco diferentes tipos de biomateriais, todos granulados: Hidroxiapatita, Osso Bovino Liofilizado, Biovidro 45S5 (genérico), PerioGlass e ß-Fosfato Tri-Cálcio, que foram comparados com controle positivo (região óssea mandibular sem defeito) e controles negativos (defeitos ósseos e alvéolos vazios). Tomadas radiográficas foram realizadas com e sem simulador de tecido de 10 mm de espessura. Resultado: Os resultados obtidos nos alvéolos não demonstraram diferenças entre o controle negativo e os biomateriais avaliados. Nos defeitos ósseos, a profundidade do defeito mostrou influenciar a densidade tanto nos grupos controle negativo (p< 0,01) como nos grupos de biomateriais (p < 0,05). O simulador de tecidos moles não alterou os resultados. Conclusão: Pode-se concluir que os tipos de defeitos avaliados podem interferir nas características radiográficas apresentadas pelo biomaterial, enquanto que a simulação de tecidos moles não se mostrou relevante estatisticamente.

Introduction: The radiographic characteristics of a biomaterial, such as its density, may influence the evaluation of the results obtained following its clinical use. Objective: The aim of this study was to evaluate the radiographic density of biomaterials used as bone substitutes, inserted into dental sockets and bone defects in created in the jaws of pigs. The influence of a soft tissue simulator on the results was also evaluated. Material and method: Two and three-millimeter-deep bone defects were created in the pigs mandible and the right first molar extraction socket were used. Commercial samples of five biomaterials were tested: Hydroxyapatite, Lyophilized Bovine Bone, 45S5 bioglass (generic), PerioGlass and ß-Tri-Calcium Phosphate, and compared to a positive (mandibular bone) and negative (empty alveolar bone defects) controls. Radiographic images were acquired with and without a 10 mm thick soft-tissue simulator. Result: The results for the extraction sockets showed no differences between the biomaterials and the negative control. For the bone defects, the depth of the defect density influenced the density, both in the negative control (p < 0.01) and biomaterials (p < 0.05) groups. The soft- tissue simulator did not alter the results. Conclusion: The type of the evaluated defect can interfere in the radiographic features presented by each biomaterial, while the simulation of soft tissues was not statistically significant.

Hemorragia alveolar difusa no lúpus sistêmico: adversário duro, não imbatível / Diffuse alveolar hemorrhage in the systemic lupus erythematosus: a hard, but not invincible opponent

Hemorragia alveolar é afecção clínica grave e com alta taxa de mortalidade. Pode ocorrer em indivíduos com lúpus eritematoso sistêmico e a instituição de imunossupressão precoce é medida salvadora. Como é de diagnóstico difícil, sua condução clínica é um desafio. No presente artigo relata-se a experiência recente com dois pacientes e as recomendações de terapêutica, segundo revisão de literatura médica.

Alveolar hemorrhage is a severe clinical disease with high rate of mortality. It can affect individuals with systemic lupus erythematosus, and early immunosuppression is a life-saving measure. However, the difficulty of diagnosis is a challenge for clinical handling of the disease. This paper reports on a recent experience with two patients, and provides treatment recommendations drawing on a review of the literature.

Phalange metastasis from carcinoma of alveolus.

Metastatic involvement of a phalanx by head and neck cancers is rare. We report a case of a 66-year-old man with squamous cell carcinoma of the alveolus who had no residual disease or local recurrence after treatment but presented with metastasis to the middle phalanx of the middle finger.

Incidencia de la alveolitis / Incidence of the alveolitis

Fundamento: La alveolitis es un estado de infección localizado, donde el alveolo está deshabitado o contiene restos de coágulo necrótico y la asocian con mayor frecuencia a las extracciones difíciles y traumáticas, exceso de anestesia local, estado general, factores bacterianos y otras. Objetivo: Determinar la incidencia de la aveolitis en la clínica Las Margaritas. Método: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en la clínica Las Margaritas, municipio Carirubana, estado Falcón, Venezuela desde enero de 2005 a agosto de 2006. El universo del estudio estuvo constituido por la totalidad de los pacientes a los que se les realizaron exodoncias y la muestra por 76 pacientes que se presentaron con alveolitis y cumplieron los criterios de inclusión y exclusión. Las variables estudiadas en la investigación fueron la edad y el sexo, zonas afectadas, tipo de alveolitis y tiempo de aparición. Resultados: El sexo más afectado fue el femenino con 46 pacientes para el 60,5 %, y los masculinos con 39,5 por ciento. En cuanto a la edad esta afección prevaleció más en el grupo de de 35 a 44 años de los cuales 19 pertenecieron al sexo femenino, en el masculino predominó el grupo de 45 a 54 años con 13 enfermos. Conclusiones: La zona dentaria con mayor incidencia fue la mandíbula, en la zona de molares con 37 casos, seguida de la de premolares con 20 alveolitis, en la arcada superior solo se presentaron 17 pacientes, en los incisivos y caninos no se encontró gran incidencia de esta infección.

Background: The alveolitis is a located infection state, where the alveolus is uninhabited or it contains remains of necrotic coagulum and associate it with more frequency to the difficult and traumatic extractions, excess of local anesthesia, general state, bacterial factors and others. Objective: To determine the incidence of the aveolitis in Las Margaritas clinic. Method: An observational, descriptive, longitudinal and prospective study in Las Margaritas clinic, Carirubana municipality, Falcon state, Venezuela was performed, from January 2005 to August 2006. The universe of the study was constituted by the totality of patients to whom exodontias were carried out and the sample by 76 patients that showed up alveolitis and completed the inclusion and exclusion criteria. The studied variables in the investigation were age and sex, affected areas, type of alveolitis and apparition time. Results: The female sex was the most affected with 46 patients for a 60,5 percent , and the masculine one with 39,5 percent. Regarding age this affection prevailed more in the group from 35 to 44 years of which 19 belonged to the female sex, in the masculine one prevailed the group from 45 to 54 years with 13 sick persons. Conclusions: The dental area with more incidence was the mandible, in the molars area with 37 cases, followed by premolars with 20 alveolitis, in the superior arch just 17 patients showed up, in the incisor and canine tooth it was not found great incidence of this infection.

Influence of local tetracycline on the microbiota of alveolar osteitis in rats

The aim of the present study was to evaluate the effects of local tetracycline on the occurrence of alveolar osteitis in rats, and on the microbiota associated to this infection. Forty Wistar rats were randomly assigned to 4 groups (n=10): I - the rats had the maxillary right incisor extracted and the alveolar wound did not receive any treatment; II - adrenaline and Ringer-PRAS were introduced into the alveolar wound; III - the alveolar wound was irrigated with sterile saline; and IV - the alveolar wound was irrigated with an aqueous solution of tetracycline. Microbial samples from the alveolar wounds were collected 2 days after surgery and inoculated on blood agar (with and without 8 µg/mL of tetracycline) and other selective media, and were incubated in either aerobiosis or anaerobiosis at 37ºC, for 2 to 14 days. It was verified that tetracycline reduced the occurrence of alveolar osteitis in the rats and caused significant changes in the microbiota of the surgical sites, decreasing the number of anaerobes and increasing the participation of tetracycline-resistant and multi-resistant microorganisms.

O objetivo do presente estudo foi avaliar os efeitos do uso tópico de tetraciclina sobre a ocorrência de alveolite em ratos e sobre a microbiota a ela associada. Quarenta ratos foram divididos, ao acaso, em 4 grupos (n=10): grupo I, realizou-se somente a extração do incisivo superior direito e a ferida alveolar não recebeu nenhum tratamento; grupo II, além da extração dental, soluções de adrenalina e Ringer-PRAS foram introduzidas no interior do alvéolo; grupo III, a ferida alveolar foi irrigada com solução salina estéril; grupo IV, a ferida alveolar foi irrigada com solução aquosa de cloridrato de tetraciclina a 10 por cento. As amostras dos alvéolos para processamento microbiológico foram coletadas dois dias após a realização das cirurgias e foram inoculadas em ágar sangue com ou sem 8 µg/mL de tetraciclina e em outros meios de cultura seletivos, incubadas em aerobiose ou anaerobiose, a 37ºC, de 2 a 14 dias. Verificou-se que a tetraciclina reduziu a ocorrência de alveolite e provocou uma modificação significativa na microbiota do sítio cirúrgico, levando a uma redução nas proporções ocupadas pelos microrganismos anaeróbios e uma elevação da participação de microrganismos resistentes à tetraciclina e outros antimicrobianos.

Alveolus-capillary permeability on both normal and HIV seroreactive individuals

The aim of this study was to evaluate the alveolus-capillary permeability by the lung clearance rate of 99mTc-DTPA(Technetium99m-diethylene triamine penta-acetate), (LCR-DTPA), both in normal and in asymptomatic HIV seroreactive patients. Thirty individuals were studied, 21 seronegative normal volunteers and 9 HIV seroreactive patients presenting normal chest radiography and no respiratory infection symptoms. LCR-DTPA was determined by inhaling 99mTc-DTPA and obtaining images in a gamma camera. The 99mTc-DTPA clearance rate in normal individuals was 0.99±0.15 percent.min-1 and in patients 2.31±1.25 percent.min-1. There was a significant statistical difference between the two groups (p< 0.05). Two patients who presented LCR-DTPA higher than 4.3 percent.min-1 presented pneumocystis pneumonia one month later. Seroreactive AIDS patients, previously asymptomatic that presented pneumonia later showed higher LCR-DTPA than the seroreactive who did not develop the illness. These results suggested that LCR-DTPA could be a predictive method for the clinical development of pneumocystis pneumonia in asymptomatic HIV seroreactive patients.

A integridade funcional da barreira alvéolo-capilar pode ser alterada por diversas condições patológicas e por outros fatores como a irritação do epitélio alveolar, provocada pelo fumo etc, levando a um aumento da permeabilidade alvéolo-capilar. O objetivo deste trabalho foi verificar a permeabilidade do epitélio pulmonar através da determinação da taxa de depuração pulmonar do aerossol de 99mTc-DTPA (LCR-DTPA) em indivíduos normais e em pacientes assintomáticos HIV sororreativos. Foram estudados 30 indivíduos, sendo 21 voluntários normais e 9 HIV sororreativos sem sintomas de infecção oportunista, com radiografias de tórax normais ou sem sinais sugestivos de infecção pulmonar. A LCR-DTPA foi determinada após inalação de 99mTc-DTPA sob a forma de aerossóis e contagem externa da radiação, em função do tempo, em gama câmara. A LCR-DTPA dos controles foi de 0.99±0.15 por cento.min-1 e nos pacientes sororreativos,de 2.31±1.15 por cento.min-1 houve diferença significativa entre os dois grupos (p< 0.05). Dois pacientes tiveram LCR-DTPA acima de 4,3 por cento.min-1, estes desenvolveram um mês após o exame. Observou-se que os pacientes sororreativos por Imunodeficiência Adquirida (SIDA), sem sintomas específicos para pneumocistose que posteriormente desenvolveram a doença, a LCR-DTPA foi significativamente maior que a dos outros HIV pneumocistose clínica sororreativos que não desenvolveram a doença (p<0.01). Estes resultados sugerem que a LCR-DTPA pode ser um método preditivo do desenvolvimento clínico da pneumocistose, não invasivo, de fácil realização e cômodo, para o paciente HIV sororreativo assintomático.

Estudio Descriptivo Macro y Mesoscópico de la Irrigación de Piezas Dentarias Superiores en Perro (Canis familiaris) Mediante Repleción con Tinta China / Macro and Mesoscopical Study About the Irrigation of the Upper Teeth in Dogs (Canis familiaris) through Repletion With Chinese Ink

Se describe macro y mesoscópicamente la irrigación de piezas dentarias superiores en su tercio rostral (incisivos y canino) en perro, mediante repleción con tinta china. Se utilizaron 30 cabezas de cadáveres de perro, divididas en tres grupos de igual número. El grupo I fue inyectado con tinta china azul vía arteria facial, el grupo II con tinta amarilla vía arteria maxilar y el grupo III con tinta azul y amarilla vía arteria facial y arteria maxilar respectivamente y en forma simultánea. En las cabezas, ya fijadas y conservadas, se analizó macroscópicamente la llegada del color de la tinta china inyectada a nivel de la gíngiva asociada a dientes incisivos y canino superior derecho. Posteriormente, las cabezas se congelaron para realizarles cortes transversales, los que fueron analizados mesoscópicamente, donde se observó la llegada de la tinta china, a nivel de los alvéolos y cavidad pulpar de las piezas dentarias en estudio. La presente investigación demostró que la arteria facial se distribuye hacia tejidos profundos como gíngiva, alvéolos y pulpa de los dientes incisivos y canino superior derecho en perro, por lo tanto, estaría aportando a su irrigación complementaria; se reafirmó la participación de ramas de la arteria maxilar en la irrigación de estos mismos tejidos y finalmente se demostró que ramas de las arterias facial y maxilar se anastomosan para irrigar tejidos en común, como los ya mencionados. Estos resultados permiten conocer el origen de la revascularización de piezas dentarias superiores y periodonto en perro, luego de procedimientos quirúrgicos que pudiesen dañar ramas de la arteria maxilar. Debido a la similitud anatómica de la cavidad oral entre el perro y el humano, los resultados descritos se podrían utilizar como referencia para explicar el origen de la revascularización de piezas dentarias superiores y periodonto, luego de la cirugía ortognática.

The irrigation of upper teeth is described macro and mesoscopically in their facial third (incisive and canine teeth) through repletion with Chinese tint. Thirty heads of corpses of dogs were used, which were divided in three equal groups. Group I was injected with blue Chinese ink via facial artery, group II with yellow Chinese ink via maxillary artery, and the group III with blue and yellow Chinese ink via facial and maxillary artery respectively and simultaneously. In the heads, already fixed and conserved, the arrival of the colour of the injected ink was macroscopically analyzed up to the level of the gingiva associated to the upper right incisive and canine teeth; subsequently, the heads were frozen to make them cross sections, which were analyzed mesoscopically, where the arrival of the injected ink was observed up to the level of the alveolus and pulpar cavity of the teeth under study. The present research demonstrated that the facial artery is distributed to deep-lying tissues such as gingiva, alveolus, and pulpar cavity of the upper right incisive and canine teeth in dogs; therefore, it would be contributing to its complementary irrigation, the participation of the branches of the maxillary artery in the irrigation of these tissues, and, finally, it demonstrated that the branches of the facial and maxillary artery anastomose themselves to irrigate tissues they have in common, as the ones that were already mentioned. These results allow us knowing the origin of the revascularization of the upper and periodontal teeth in dogs, after surgical procedures that could damage some branches of maxillary artery. Due to the anatomic similarity of human being's oral cavity and the oral cavity of dogs, the already described results could be used as reference to explain the origin of the revascularization of upper and periodontal teeth, after orthognathic surgery.

New Infants Respiratory Distress Syndrome Treated with Shenfu Decoction and Compound Red Sage Injection in Assistance / 浙江中医药大学学报

[Objective] To observe the clinical effect of Shenfu Decoction and Compound Red Sage Injection on new infants respiratory distress syndrome.[Method] Randomly divide 42 cases into 2 groups,control group(1)take the integrated therapy:CPAP,oxgen,warming,keeping wet and anti-bacterial;the treatment group(1)take the Shenfu Decoction and Compound Red Sage Injection.Compare their cure rates after 7d.[Result] In group 1,survivable rate was 95.23%,cure rate 71.4%;and 80.95% and 47.62% respectively for other group;the clinical symptoms,signs,blood-gas analysis and X-ray result were all better in group 1 than group 2.[Conclusion] Oral taking Shenfu Decoction and Compound Red Sage Injection for vein drip can help relieve infants clinical symptoms and pass alveolus superficial active substance lack period.

Detection of alveolar macrophage apoptosis in patients with chronic obstructive pulmonary disease / 第三军医大学学报

Objective To investigate the apoptosis of alveolar macrophage and its significance in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 11 patients with COPD and 10 healthy controls were enrolled in the study. Alveolar macrophages (AM) were harvested from the BALF (bronchoalveolar lavage fluid). The positive rate of myeloperoxidase (MPO) staining of alveolar macrophages by MPO staining was observed so as to indirectly reflect neutrophil apoptosis and the phagocytosis of apoptotic neutrophils by alveolar macrophages. Apoptosis were detected by the transferase-mediated dUTP nick end labeling (TUNEL) technique. Results The positive rate of alveolar macrophages by MPO staining was lower in COPD group than the control group (P

Septum strut implantation for rhinoplasty simultaneous with cleft alveolar bone grafting in cleft lip and palate patients / 中华医学美学美容杂志

Objective To pursue a more efficient and effective treatment for cleft lip and palate deformities. Methods Patients with unilateral complete cleft lip and palate at their age of 9 years after were chosen for simultaneous cleft alveolar repair and nasal deformity correction. Muco-periosteal pocket and iliacgranular bone was prepared, and bone grafting was performed conventionally. At the same time of iliac cancellous bone harvesting, a cortical plate was taken and sculpted into a strut of 18 mm in length, 6 mm in width, and 1.5 mm in thickness. A flying bird incision was made at the alar ram and across columella in a V-shape. Then the alar cartilage was detached from the overlying skin, a socket was made at the site of anterior nasal spine. The strut was inserted into the socket between the two medial crura of the alar cartilage. The medial crura was lift 3 mm above the superior edge of the strut, and mattress suture technique was used to secure the bilateral medial crura to the strut graft. Results 24 patients were treated by this technique. All the patients healed uneventfully. Depressed alar base, tilted columella and lower nasal tip were corrected satisfactorily. Conclusion There is no interference in simultaneous cleft alveolar bone grafting and rhinoplasty. Septum strut can provide favorable support for tilted nasal structure and satisfactorily correct nasal deformities. Simultaneous with alveolar grafting, it is much easier in harvesting, and the time of anesthesia and operation is also decreased.[

A Surgical Method For The Effective Treatment Of Cleft Alveolus, Especially For The Elevation Of Ala Base

Samsung Medical Center, Sungkyunkwan university, School of Medicine The cleft alveolus is one of three parts in cleft deformity. The purpose of cleft alveolus bone grafting is the recovery of normal esthetics, occlusion and speech. If a bony defect is extended to the nasal floor, especially wide bony defect at the ala base, it is difficult to condense the cancellous bone during bone transplantation and to reconstruct the normal anatomy at the alar base. We treated with above mentioned cleft alveolus patients using the autogenous cortical bone effectively. We report this technique with two cases and the literatures review.

CLINICAL STUDY OF AUTOGENOUS SECONDARY BONE GRAFTING IN CLEFT MAXILLA