Preservación alveolar post extracción en zona estética: decisiones clinicas predecibles en sitio severamente afectado / Alveolar ridge preservation in the esthesic zone: predictable decisions in a severly affected site

INTRODUCCIÓN: La valoración particular de sitios severamente comprometidos, involucra considerar los tiempos necesarios de cicatrización, así como evidencia actual en términos de biomateriales y técnicas quirúrgicas con el fin de lograr un tratamiento exitoso. MATERIAL Y MÉTODO: Paciente sexo femenino, 28 años, asiste por dolor e infección en diente 2.1 al Postítulo de Periodoncia UDD. Se observa defecto extenso y lesión que compromete tanto las tablas óseas vestibular como palatina. El tratamiento consistió en: exodoncia y regeneración ósea, instalación del implante 6 meses después de la exodoncia y cirugía de conexión 7 meses después más injerto de tejidos blandos. RESULTADOS: El tratamiento de defectos combinados (tejidos duros y blandos), asociados a procesos infecciosos de larga data, mediante rehabilitación implanto soportada puede ser muy predecible y exitoso en la medida que se respeten los tiempos de regeneración de diferentes estructuras.

INTRODUCTION: The specific assessment of a severely compromised sites involves: the consideration of healing time according to the different kinds of tissues involved and the knowledge of the evidence available concerning biomaterials and surgical techniques. MATERIAL AND METHODS: Female patient attends the postgraduate school of periodontics, UDD University in Santiago de Chile, because of pain and chronic infection compromising tooth 2.1. At clinical evaluation, the site has an extensive defect, with active fistula that compromises the buccal and palatal bone plates. The treatment consisted of exodontia and guided bone regeneration, implantation six months after initial exodontia and abutment connection surgery seven months after implant insertion. RESULTS: the treatment of combined defects associated with a long-standing infectious process can be very predictable and successful, only if the measures of time and tissue handling are considered and applied.

Influence of three-wall osseous defects on periodontal ligament stress with three-dimensional finite element analysis / 华西口腔医学杂志

OBJECTIVE@#This study aims to explore the influence of three-wall osseous defects on periodontal ligament stress under normal occlusal forces.@*METHODS@#A finite element model for mandibular total dentition, periodontal ligament and alveolar bone was created based on cone beam computed tomography (CBCT) DICOM images. Mesial or distal proximal three-wall osseous defects at varying depths (namely, 1/3, 2/3 and 3/3 of the root) were simulated by modifying the elastic modulus of elements within the defects area. Occlusal forces with an angle of 45° to the long axis of the tooth were applied to the finite element model. In addition, the equivalent stresses of the periodontal ligament were analysed.@*RESULTS@#In the case of no bone defect, the mean value of the periodontal ligament equivalent stress of 14 teeth was 5.71 MPa. The equivalent stresses of the periodontal ligament at different depths (namely, 1/3, 2/3 and 3/3 of the root) were 6.61, 7.14 and 7.42 MPa, respectively. With increasing depth of the osseous defects, stress on the periodontal ligament increased considerably, and the initial stress increment was greater than that of a later stage. Periodontal ligament stresses with mesial proximal three-wall osseous defects (at depths of 1/3, 2/3 and 3/3 of the root) were 6.62, 7.19 and 7.51 MPa respectively. Periodontal ligament stresses with distal proximal three-wall osseous defects (at depths of 1/3, 2/3 and 3/3 of the root) were 6.60, 7.10 and 7.33 MPa, respectively. For three-wall osseous defects located in the mesial surface and distal surface, a significant difference in periodontal ligament stress was lacking. In the case of the same absorption depth, the size relationship of periodontal ligament stress was in the following order: premolars>molars>incisors>canines.@*CONCLUSIONS@#Shallow three-wall osseous defects will likely cause a notable loss in strength of the periodontal ligament. Therefore, teeth with three-wall osseous defects should become the focus of clinical research. Treatment for these teeth should be administered as early as possible.

The effects of bone graft combined with enamel matrix derivative in the treatment of periodontal osseous defects compared with that of bone graft alone: A meta-analysis / 实用口腔医学杂志

Objective: To analyze the efficacy of enamel matrix derivative (EMD) combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis. Methods: The randomized controlled trials(RCTs) about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,PubMed,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS) evaluation tool. Revman 5. 3 was used for the Meta-analysis. Results: 5 RCTs articles with 145 cases were included. Meta-analysis showed that: at 6 months of follow-up, PD reduction and CAL gain was found more in test group than in control group(WMD = 0. 40,95％ CI =[0. 01,0. 79],P ＜ 0. 05) and (WMD = 0. 50,95％ CI =[0. 12,0. 88],P ＜ 0. 05) respectively. At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments. Conclusion: The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.

Pseudoartrosis no viable de tercio distal del cúbito / A Case Report on Nonviable pseudoarthrosis of the distal third of the ulna

Paciente masculino de 57 años de edad que presentó pseudoartrosis no viable del tercio distal de cúbito, con defecto óseo final de 6 centímetros. Se realizó tratamiento quirúrgico y se le reconstruyó el cúbito con injerto autólogo de peroné de 8 cm. El paciente fue atendido en el Hospital Militar de Holguín. Se logró la consolidación ósea a los 5 meses de operado.

A 57-year-old male patient presented nonviable pseudoarthrosis of the distal third of the ulna, with a final bone defect of 6 centimeters. Surgical treatment was performed and the ulna was reconstructed with an 8 cm fibular autologous graft. The patient was treated at the Military Hospital of Holguín. Bone consolidation was achieved 5 months after surgery.

Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: clinical and patient-centered outcomes

This case series evaluated the clinical performance and patient-centered outcomes after a minimally invasive surgical technique (MIST) associated with enamel matrix protein derivative (EMD), for the treatment of intra-bony defects. Twelve patients presenting teeth with probing depth >5 mm and bleeding on probing associated with radiographic evidence of intra-bony defect were treated by MIST associated with EMD. Clinical parameters were measured at baseline, 3 and 6 months. Patient perception during the intraoperative period and during the first postoperative week was evaluated. The use of MIST with EDM promoted significant improvements in clinical parameters, minimal pain/discomfort and maximum esthetics satisfaction. Within of limits of the present study, it could be shown that MIST combined with EMD for the treatment of intra-bony defects promotes satisfactory clinical and patient-centered outcomes.

O objetivo deste estudo foi avaliar os resultados clínicos e centrados no paciente após abordagem cirúrgica minimamente invasiva (CMI) associada à aplicação das proteínas derivadas da matriz do esmalte (PDE) no tratamento de defeitos infra-ósseos. Doze pacientes apresentando um sítio com profundidade de sondagem >5 mm e sangramento à sondagem , associado à evidência radiográfica de defeito infra-ósseo, foram tratados com CMI e aplicação das PDE. Os parâmetros clínicos foram avaliados imediatamente antes do procedimento e após 3 e 6 meses. A percepção de dor e desconforto do paciente durante o período trans-cirúrgico e ao longo da primeira semana de pós-operatório, bem como a satisfação estética 6 meses após o tratamento, foram avaliadas por meio de questionários. Os resultados mostraram que o uso da CMI associada à aplicação de PDE promoveu melhoras estatisticamente significantes nos parâmetros clínicos, mínima dor e desconforto e máxima satisfação estética aos pacientes. Dentro dos limites do estudo, foi demonstrado que a associação de CMI e PDE, no tratamento de defeitos infra-ósseos, é capaz de promover satisfatórios resultados clínicos e centrados no paciente.

Análise das lesões intra-articulares na instabilidade anterior do ombro / Analysis of intra-articular lesions in anterior shoulder instability

Introdução: Instabilidade anterior do ombro é uma afecção frequente, na qual uma de suas consequências é o surgimento de lesões labrais, ósseas e do manguito rotador. Estas lesões que, muitas vezes, estão associadas, variam no seu tamanho de acordo com a causa e número de episódios de luxações. Objetivo: Descrever as alterações intra-articulares encontradas nos pacientes submetidos ao tratamento artroscópico para instabilidade anterior do ombro e correlacionar os achados com a causa da luxação e o número de episódios até o tratamento. Material e métodos: Entre agosto de 2006 e julho de 2007, 60 cirurgias para instabilidade anterior do ombro foram realizadas no Instituto Nacional de Traumatologia e Ortopedia (INTO). Protocolo pré-operatório específico identificando-se: idade, sexo, mecanismo do primeiro episódio de luxação (traumática ou atraumática) e número de luxações foi preenchido em todos os casos. Ao final do procedimento cirúrgico foi preenchido um protocolo descrevendo a eventual presença das seguintes lesões: Bankart, Hill-Sachs, SLAP, ALPSA, HAGL, ruptura do manguito rotador e lesão óssea da glenoide. As lesões da glenoide foram divididas em três tipos: lesão condral sem defeito ósseo, lesões com perda óssea menor e maior que 27%. Resultados: Dos 60 pacientes, 42 eram do sexo masculino e 18 do feminino. A média de idade foi de 30 anos (16-54), 45 casos traumáticos e 15 atraumáticos e a média de luxações foi de 20 episódios (1-100). A lesão de Bankart esteve presente em 57 pacientes (95%), Hill-Sachs em 53 (88%), a do manguito rotador em três casos (5%), SLAP em 11 (18%) e a lesão ALPSA em três (5%). Conclusão: Todos os casos traumáticos e a maioria dos atraumáticos apresentaram lesão do labrum anterior. Não houve associação entre o número de luxações e lesão óssea na glenoide ou entre o mecanismo do primeiro episódio e presença de lesão óssea.

Membranas no reabsorbibles: Una revision de la literatura

La regeneración tisular guiada (RTG) ha sido utilizada por más de una década para regenerar el tejido periodontal perdido como consecuencia de la Enfermedad Periodontal y constituye una de las formas de tratamiento mejor documentado en la literatura. Una serie de biomateriales han sido probados clínicamente para este propósito, sin embargo, las membranas de politetrafluoretileno expandido (e-PTFE) han sido ampliamente consideradas en la literatura como las de elección para los procedimientos de RTG.

Guided tissue regeneration (GTR) has been used for more than a decade to regenerate periodontal tissue lost as a result of periodontal disease and is the best documented regenerative approach. Several biomaterials have been clinically tested for guided tissue regeneration applications; however, the expanded polytetrafluoroethylene (e-PTFE) barriers are widely regarded in the literature as the membrane of choice for GTR procedures.

Histomorphological observation of PerioGlas implanted in muscle and osseous defects / 实用口腔医学杂志

0.05). In bone defects PeroGlas granales bond to bone and new bone formation were observed 4 weeks after operation. The bone defects were repa ired by new bone 12 weeks after PerioGlas implantation. Conclusion: PerioGlas may induce new bone formation in osseous defects.