ABSTRACT
[Objective] To explore the similarities and differences between ancient and modern physicians in treating "bone atrophy"so as to provide reference for clinical treatment of renal osteodystrophy, bone tuberculosis and osteoporosis. [Method] Summarizing the similarities and differences between ancient and modern physicians in etiology and pathogenesis and treatment of syndrome differentiation of bone atrophy by consulting the literatures. [Results] Ancient and modern physicians have connections and differences in treatment based on syndrome differentiation of bone atrophy.Ancient physicians who treated bone atrophy whose syndrome was evil invading XiGu, deficiency of spleen and kidney with coordinating meridian of Yangming, getting rid of evil obtained better effects and the syndrome of Qi deficiency and blood stasis, damage of Yin and Yang that treated with enriching Qi and activating blood, nourishing yin and tonifying yang as well. Modern physicians who treated bone atrophy whose syndrome was deficiency of spleen and kidney, dampness and blood stasis with nourishing kidney and spleen, activating blood and draining turbidity obtained certain effects and the syndrome of kidney and essence deficiency, blood and Qi stasis that treated with strengthening bones and essence, promoting flow of qi and blood as well. So as the syndrome of Yang deficiency of kidney, phlegm and blood stasis resisting meridian. [Conclusion] Ancient and modern physicians have certain effects in the treatment of bone atrophy.They both believe that Qi and blood stasis are the factors which lead to bone atrophy, therefore, activating Qi and blood as treatment of bone atrophy are both agreed.The difference is that the ancient physicians believed that the spleen and stomach deficiency was the key to the formation of bone atrophy.Coordinating Yangming meridian as treatment.Modern physicians believe that kidney deficiency and blood stasis is the key to the formation of bone atrophy.Nourishing kidney and activating blood as treatment mainly.
ABSTRACT
Objective @#To establish an animal model that clinically conforms to the characteristics of severe alveolar ridge atrophy. @*Methods @#Beagle dogs were used as experimental subjects. Bilateral fourth premolars and first molars in mandible were extracted. A horizontal groove was made on alveolar ridge which was 8 mm from the cemento-enamal junction of mandible third premolar and second molar. Rongeur was used to remove the alveolar bone above this groove and bone chisel was used to level the bone-free area. A box-shaped defect cavity of the size 25 mm × 8 mm was formed with sterile silicone prosthesis implanted. After careful suture we waited for the subjects to heal naturally. Eight weeks after operation, CBCT examination was performed.@*Results @#Eight weeks after bone remodeling the top of alveolar ridge of operation area appeared to be a circular arc. The average distance from the bottom of the ridge to inferior alveolar nerve canal was 2.5 mm. @*Conclusion @#This study successfully established the Beagle dog animal model for severe alveolar ridge atrophy and laid the foundation for experiments on vertical bone augmentation.
ABSTRACT
Diversas técnicas já foram propostas para viabilizar a reabilitação de pacientes com atrofias severas de maxila, como instalação de implantes zigomáticos, regenerações ósseas utilizando enxertos autógenos com áreas doadoras extrabucais, como osso ilíaco e calota craniana, dentre outras. Porém, todas estas técnicas possuem limitações, baixa previsibilidade e, algumas, grande morbidade para o paciente. Atualmente, alguns trabalhos têm mostrado bons resultados com o uso da técnica de ROG em atrofi as severas de maxila, utilizando telas de titânio associadas ao levantamento de seio maxilar bilateral, empregando como material substituto ósseo a rhBMP-2 (proteína óssea morfogenética humana do tipo 2). Com esta técnica, evita-se a utilização do osso autógeno e suas possíveis complicações, além do fato da rhBMP-2 ser o único biomaterial, além do osso autógeno, com características de osteoindução. O objetivo deste trabalho foi relatar um caso de paciente com atrofia severa de maxila submetida à técnica de ROG com tela de titânio e levantamento de seio maxilar bilateral, utilizando como material de enxertia a rhBMP-2 associada ao material heterógeno inorgânico. Após o período de neoformação óssea, a paciente foi submetida à cirurgia para instalação de sete implantes osseointegráveis convencionais e reabilitada com uma prótese total maxilar do tipo protocolo.
Several techniques have been proposed to rehabilitate patients with severely atrophic maxillae, such as the placement of zygomatic implants, bone regeneration using autogenous grafts with extraoral donor sites from the pelvic bone and skull cap, among others. However, all these techniques have limitations, low predictability and some contribute to high patient morbidity. Currently, some studies have shown positive results regarding the use of the GBR technique for severely atrophic maxilla using titanium meshes associated with bilateral maxillary sinus elevation using rhBMP-2 (recombinant human bone morphogenetic protein-2) as a bone substitute material. This technique does not require the use of autogenous bone and rhBMP-2 is the only bone substitute, which has osteoinduction characteristics. The aim of this study is to report a case of a patient with severely atrophic maxilla submitted to the GBR technique with titanium mesh and bilateral maxillary sinus elevation using rhBMP-2 as the grafting material associated with heterogeneous inorganic material. After new bone formation, the patient underwent surgery for the placement of 7 conventional osseointegrated implants and was rehabilitated with a implantretained maxillary prosthesis.
Subject(s)
Humans , Female , Middle Aged , Biocompatible Materials/therapeutic use , Bone Morphogenetic Proteins , Bone Regeneration , Sinus Floor Augmentation , Surgery, Oral/methods , Titanium/therapeutic useABSTRACT
Ligustri Lucidi Fructus (LLF), which could nourish the liver and kidney, was used for the treatment of bone atrophy in ancient times. The current basic and clinical studies have shown that LLF had a broad application prospect in the treatment of osteoporosis. In this paper, by reviewing the related literature of home and abroad, we summarize the related experimental and clinical research progress of LLF and its compound on the treatment of osteoporosis, and clear their function mechanism, hoping to lay a theoretical foundation for further experimental study and clinical research.
ABSTRACT
The alveolar ridge splitting technique (ARST) has been developed for close to 20 years, demonstrating effectiveness and efficiency in some cases. The aim of this study was to evaluate the behavior of the technique in a series of surgical cases using a piezoelectric system. Eleven patients (ASA I and ASA II) were included in this study. Subjects who smoked or who presented previous implant treatments or reconstructive surgeries in the treatment area were excluded. The surgeries took place under local anesthesia without sedation and consisted of a straight crestal incision and subsequent bone management with 4 different types of inserts mounted on a piezoelectric system, which were used gradually on the alveolar crest, moving down approximately 10 mm. Once the approximately 3 mm expansion had been achieved, the implants were installed under controlled torque and the implant sites and defects present were filled with lyophilized bovine bone. In the splitting technique, there was a fracture of the bone plate in 4 cases, although in each case the implants were installed. A total of 34 implants were installed, of which 27 reached 35 N in installation and the rest between 20 N and 35 N. In the second surgery 2 implants were lost. It can be concluded that the technique is predictable, of low morbidity and with rapid treatment completion, presenting limited intraoperative complications.
La técnica de división de reborde alveolar (DRA) tiene cerca de 20 años de evolución demostrando efectividad y eficiencia en algunos casos. El objetivo de este estudio es evaluar el comportamiento de la técnica en una serie de casos operados con sistema piezoeléctrico. Once pacientes (ASA I y ASA II) fueron incluidos en este estudio; se excluyeron sujetos fumadores o que presentaran tratamientos implantológicos o quirúrgicos reconstructivos previos en el área a tratar; las intervenciones se desarrollaron bajo anestesia local, sin sedación y consistió en una incisión crestal recta y posteriormente el manejo óseo con 4 tipos diferentes de insertos montados en sistema piezoeléctrico los que fueron utilizados gradualmente sobre la cresta alveolar profundizando hasta los 10 mm aproximadamente; una vez obtenida la expansión de 3 mm aproximadamente se procedió a la instalación de implantes bajo torque controlado y relleno con hueso liofilizado bovino de los sitios implantados y defectos presentes. En la técnica de división, en 4 casos existió fractura de la tabla ósea, aunque en todos ellos fueron instalados los implantes. Se instalaron un total de 34 implantes de los cuales 27 consiguieron los 35 N en instalación y el resto presento de entre 20 N y 35 N; en la segunda cirugía se observo una perdida de 2 implantes. Se puede concluir que la técnica es predecible, de baja morbilidad y de rápida finalización de tratamiento, presentando limitadas complicaciones intraoperatorias.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Alveolar Bone Loss/surgery , Dental Implantation, Endosseous/methods , Periodontal Atrophy/surgery , Alveolar Ridge Augmentation/methods , Dental Implants , Bone Transplantation/methods , Alveolar Process/surgery , PiezosurgeryABSTRACT
O propósito deste trabalho foi apresentar aspectos favoráveis ao uso de implantes curtos nas situações de limitações de altura e volume ósseo em mandíbulas atróficas, onde o tratamento com este tipo de implante torna-se viável. Uma paciente que optou pelo tratamento com implantes curtos, depois de uma grande procura para reabilitação de uma mandíbula com significativa perda óssea e grande instabilidade de suas próteses. Depois dos exames clínico e radiográfico, foram instalados seis implantes Titamax CM na região anterior inferior entre 33 a 43, sendo cinco implantes de tamanho 7 mm e um de 8 mm como base para a confecção de uma prótese total fixa tipo protocolo. Depois do período de espera para a osseointegração, realizou-se a reabertura e, através do aparelho Osstell, verificou-se a alta estabilidade dos implantes com o osso, pré-requisito para a garantia do sucesso na reabilitação implantossuportada. Após três meses houve a troca da prótese total convencional superior e a elaboração de uma prótese fixa protocolo inferior. Foram feitos alguns acompanhamentos semestrais e a paciente apresenta excelente resultado clínico há mais de cinco anos...
The purpose of this study is to promote the use of short implants in situations of limited height and bone volume in atrophic mandibles, whereas treatment with this type of implant becomes feasible, showing a patient that has chosen a treatment with short implants, after spending a long time in search for the best possibilities in a mandible with signifi cant bone loss and the instability of her prostheses. After clinical and radiographic examination, six Titamax CM implants were installed in the lower anterior region between 33-43, seeing that five of them were at the size of 7 mm and one of 8 mm serving as foundation for a future fixed total prosthesis. After the waiting period for osseointegration, a high stability was verified with the aid of Osstell, being a prerequisite for ensuring the successful implant-supported rehabilitation. Three months later, a conventional total prosthesis was placed along with the elaboration of a lower fixed prosthesis. Regular follow-ups were made at each six months and the clinical results are excellent after 5 years...
Subject(s)
Humans , Female , Middle Aged , Dental Arch , Dental Implants , Mouth Rehabilitation , TomographyABSTRACT
This report describes the case of an edentulous patient with an atrophic maxilla and severe class III malocclusion. Prosthetic rehabilitation was performed using CAD/CAM techniques for manufacturing an implant-supported overdenture with horizontal insertion. A vestibulo-lingual insertion overdenture is a precision prosthesis with a fixation system affording a good fit between the primary and secondary structure. Both structures exhibit passive horizontal adjustment. This treatment option requires the same number of implants as implant-supported fixed dentures. The horizontal assembly system prevents the prosthesis from loosening or moving in response to axial and non-axial forces. The technique was used to rehabilitate a patient presenting an atrophic upper maxilla, with the insertion of 8 implants. No complications were reported at follow-up 3, 6 and 12 months after fitting of the prosthesis. This system offers solutions to the clinical and laboratory complications associated with hybrid prostheses, concealing emergence of the chimneys and improving implant-prosthesis hygiene.
Subject(s)
Humans , Alveolar Bone Loss , Dental Implants , Dental Prosthesis Design , Denture, Overlay , Dentures , Follow-Up Studies , Hygiene , Jaw, Edentulous , Malocclusion , Maxilla , Prostheses and Implants , RehabilitationABSTRACT
La perdida ósea en el sector posterior de maxila ha sido asociada a la perdida dentaria y la presencia del seno maxilar puede generar importantes complicaciones y desafíos en el momento de realizar rehabilitación con implantes dentales. El objetivo de este trabajo es identificar la relación existente entre la perdida dentaria y su influencia en la perdida ósea. Setenta radiografías panorámicas digitales de 70 sujetos fueron estudiadas analizando cada hemimaxila separadamente; se analizo la altura ósea en el primer premolar, segundo premolar, primer molar y segundo molar realizando mediciones verticales en el eje axial de cada diente; cuando no existieron dientes en el area se realizo la medición en el lugar donde debería estar el diente. También se realizo la medición de la distancia vertical y horizontal del seno maxilar en sus lugares intermedios. El análisis de datos se realizo con la prueba Anova y con la prueba Chi cuadrado utilizando un valor de p<0,05 para determinar significancia estadística. Los resultados demostraron ausencia de relación estadística entre la perdida dentaria y la perdida ósea; el sector de primer y segundo molar fueron los que mas presentaron perdida ósea cuando no estaba el diente en estudio; el sexo del paciente no presento influencias sobre la pérdida ósea. Se puede concluir que si bien existe una perdida ósea en el sector de primer molar y segundo molar, no puede atribuirse solamente a la ausencia dentaria en el sector.
The bone loss in the posterior area of the maxilla has been associated to the loss teeth and the maxillary sinus can be cause significant complications and challenge for rehabilitation with dental implants. The aim of this research was to identify the relationship between tooth loss and bone loss. Seventy panoramic radiographs of 70 patients were used in this research analyzing each hemi maxilla separately. Was analyzed the bone height in first molar, second molar, first bicups and second bicusp with vertical measurement made in the long axis of each teeth; if there where no teeth in the area of measurement where conducted at the place where the tooth should be. Also performed measurement in vertical and horizontal dimension for relation with tooth loss. The data analyses was do it with Anova test and Chi-square test using p<0,05 for statistical significance. The result showed no statistical relationship between tooth loss and bone loss; the first and second molar area showed more bone loss when the teeth is not present; sex of patient was not associated to bone loss. Finally, we can conclude that although exist a bone loss in the first and second molar area, it can not be attributed only to the teeth absence in the sector.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Atrophy , Tooth Loss , Maxillary Sinus , Radiography, Panoramic , Maxillary Sinus/anatomy & histologyABSTRACT
La implantología actual ha evolucionado rápidamente diseñando nuevas técnicas para tratar situaciones clínicas criticas; la reabsorción ósea presenta un constante desafío para la instalación de implantes dentales. Se presenta un caso clínico donde se utilizo la técnica de separación alveolar en el sector posterior de mandíbula en conjunto con la instalación de implantes dentales; la cirugía se desarrollo con anestesia local de forma exitosa. Con un seguimiento de 10 meses se presenta de forma optima demostrando la eficiencia de la técnica. Son discutidos aspectos relevantes de la cirugía así como también los elementos que podrían ayudar a optimizar los resultados postquirúrgicos.
Nowadays, dental implantology presents an evolution with new techniques for treatment of critical situation; bone resorption is a challenge for dental implant installation.This paper presents a case with the splint crest technique in the posterior area of mandible with installation of dental implant; the surgery was done with local anesthesia with success of procedure. A 10 month follow-up show good results presenting the efficiency of this technique.We discussed relevant aspects of the technique and other situations to improve surgical options and results.
Subject(s)
Humans , Female , Aged , Jaw, Edentulous, Partially/surgery , Alveolar Ridge Augmentation/methods , Dental Implantation, Endosseous/methods , Atrophy , Bone Resorption , Dental ImplantsABSTRACT
La colocación de implantes dentales osteointegrados y la retención de las prótesis estomatológicas convencionales de acrílico es un grave problema en pacientes con reborde alveolar atrófico. La distracción osteogénica ofrece en la actualidad una solución potencial ante la severa pérdida de tejido óseo alveolar. Este estudio tuvo el propósito de evaluar en nuestro medio la Efectividad y Estabilidad de la osteogénesis alveolar. Se realizó un ensayo clínico Fase II. Fueron tratados 5 pacientes con atrofia del reborde alveolar mandibular o maxilar con distractores alveolares intraorales producidos por Walter Lorenz Surgical, Inc, (ROTT-NELSON-1713-06-04) para inducir osteogénesis. Los pacientes fueron atendidos de forma ambulatoria. El período de latencia fue de 5 días, la tasa de distracción de 1mm diario y el período de contención de 4 semanas . La efectividad de la distracción aplicada fue 76.3% y la estabilidad de 92.0 %. La media de la distracción total obtenida fue 7,25 mm. La Distracción osteogénica resultó ser un método eficaz para lograr incremento de la cresta alveolar en pacientes que presentaron atrofias previas.
The bone integrated dental implants placement and the conventional acrylic estomatological prosthesis is a serious problem in patients with an atrophic alveolar edge. Ostheogenic distraction currently offers a potential solution to the severe loss of alveolar bone tissue. This study had the purpose of evaluate the effectiveness and stability of alveolar ostheogenesis. A Clinical Trial Phase II was conducted. Five patients with an atrophy of the jaw bone or maxillary alveolar edges were treated with intraoral alveolar distracters produced by Walter Lorenz Surgical Inc.(Rott-Nelson-1703-06-04) to induce ostheogenesis. They were all out patients. The latency period was of 1 mm/day and the contention period of 4 weeks. The effectiveness of the applied distraction was of a 76.3% and the stability of a 92.0%. The average of the total distraction obtained was of 7,25 mm. Ostheogenic distraction was an efficacious method to achieve the alveolar dent in patients with previous atrophy.
ABSTRACT
La reconstrucción de rebordes alveolares atróficos por medio de la técnica de distracción osteogénica alveolar (DOA) ofrece un resultado previsible con bajas tasas de morbilidad y una ganancia notable de tejido óseo y tejidos blandos, en comparación con las técnicas tradicionalmente utilizadas. Fue atendido un paciente masculino de 21 años de edad quien presentaba atrofia severa del reborde alveolar en región anterior del maxilar por medio de DOA, utilizando un dispositivo yuxtaoseo (Conexão Implant System® - SP-Brasil). Comenzando la activación del dispositivo a los 7 días posteriores a la instalación, con un patrón de activación de 1 mm. diarios hasta alcanzar la altura ósea deseada, retirándose el distractor y colocando los implantes oseointegrados a las 10 semanas posteriores, pudo comprobarse clínica y radiográficamente el incremento en altura y volumen óseo necesario para la rehabilitación por medio de implantes.
Resumo: A reconstrução dos rebordos alveolares atroficos por meio da técnica de distração osteogênica alveolar (DOA) oferece um resultado previsível com baixas taxas de morbilidade e uma ganância notável de tecido ósseo e tecidos moles, em comparação com as técnicas tradicionalmente utilizadas. Foi atendido um paciente masculino de 21 anos de idade o qual apressentaba afrofia severa do rebordo alveolar na região anterior da maxila por meio de DOA, utilizando um dispositivo yuxtaoseo (Conexão Implant System® - SP-Brasil), começando a ativação do aparelho aos 7 dias após a instalação, com uma padronização de 1mm diários ate lograr os comprimentos ósseos desejado, retirando-se o distrator e colocando-se os implantes osseointegrados às 10 semanas posteriores. Pudo-se comprovar clinica e radiográficamente o incremento em comprimento e volume ósseo necessário para a reabilitação com implantes.
Abstract: The reconstruction of atrophic alveolar ridges by means of the technique of alveolar distraction osteogenesis (ADO) offers a foregone result with small morbidity rates and a remarkable gain of bony and soft tissues, in comparison with the traditionally used techniques. A masculine patient of 21 years old who presented a severe atrophy of alveolar ridge in the region anterior of the maxillary was assisted by means of ADO, using a juxtaosseous device (Connection Implant System® - SP-Brazil), beginning the activation from the device to the 7 days later to the installation, with a pattern of activation 1 mm. per day until reaching the wanted bony height, being carried out the retirement of the distractor and the placement of the implants 10 weeks later. It could be proven clinic and radiographic the gain of the height and necessary bony volume for the rehabilitation by implants.
ABSTRACT
A study was conducted to investigate the mechanism of bone atrophy in various strains of inbred mice under the influence of tail-up suspension. Nine inbred strains of mice (NZB/N, NZW/N, AKR/N, Balb/C, C 57 BL, C 3 H/He, A/J, DBA, CBA/N) aged six weeks were used. Each strain was divided randomly into two groups, a suspension group (SG; n=5) and a control group (CG; n=5) . The suspension group were etherized and suspended with an elastic bandage. After one week, the tibiae were removed and their bone weights were measured using an electric balance (Metler; AE 240) . Their length was also measured with a vernier caliper. In all strains, body weight in the SG was significantly lower than that in the CG. From the bone weight and length in the CG, bone growth in the NZB/N, AKR/N, NZW/N and C3H/He strains was considered to be higher than in the other strains. On the other hand bone growth in the DBA, A/J, Balb/C, and CBA/N strains were lower than in the others. The absolute value of bone weight in the SG was significantly smaller than that in the CG in six strains (NZB/N, C 57 BL, A/J, NZW/N, C 3 H/He, Balb/C) . However in the DBA strain, the absolute value of bone weight in the SG was significantly higher than that in the CG.<BR>From the results of this investigation we suggest that the mechanism of normal bone growth is not the same as the mechanism of bone atrophy induced by tail-up suspension.
ABSTRACT
Human femora obtained from a cadaver of a 70-year-old man were examined by means of bone histometry, image-analysis on X-ray radiographs and a mechanical strength test in order to investigate the effects of disuse on the femora. The patient had been bedfast for seven months until his death because of an amputation of the left lower leg due to a diabetic intractable ulcer on the foot caused by a burn. Other detail records of the medical and the life-style history were also examined.<BR>A marked atrophy of the muscles of the hip and thigh was observed on the amputated side. The macroscopic shape and proportion of the femora were not significantly different between both sides. The results of bending strength test at the mid shaft, disclosed a marked mechanical fragility on the amputated side. The cortical bone area in the shaft showed no significant difference between both sides. However, the degree of bone loss was more pronounced at the anterior region of both shafts. The trabecular bone at the femoral head showed a marked atrophy on the amputated side, especially at the principal compressive group of the trabecular bone. This atrophy was thought to be due to the absence of the compressive stress because of the disuse caused by the amputation. A trabecular bone atrophy was also observed on the normal side and its degree of atrophy was greater than that of agematched values. The multiple systemic factors such as the diabetes and the bedfast condition might had influenced on the bone metabolism in this case, therefore the careful examination of the systemic conditions was required to disclose the effects of local mechanical conditions on the bone metabolism.