Explantación de implante mal posicionado en sector estético y regeneración posterior con injerto en bloque. Caso clínico / Explantation of a malpositioned implant in the aesthetic sector and regeneration with bone block grafting. Clinical case

La realización de una explantación en el sector estético produce un defecto óseo que en muchas ocasiones deja un área para la rehabilitación con implantes que debe ser regenerado a través de diferen tes procedimientos. El injerto en bloque puede ser una alternativa en los casos donde se precise regeneración ósea ver tical y horizontal de forma simultánea. En el presente caso clínico se muestra la explantación de un implante mal posicio nado en el sector estético, de imposible rehabilitación que debe ser retirado, regenerándose posteriormente el defecto para poder posicionar un nuevo implante, esta vez en una situación que permita una rehabilitación predecible y estéticamente satisfactoria (AU)

Performing an explantation in the aesthetic sector produces a defect that often leaves a bone loss that must be regenerated through different procedures. Bone block grafting can be an alternative in cases where simultaneous vertical and horizontal bone regeneration is required. In this clinical case we show the explantation of a poorly positioned implant in the aesthetic sector, impossible to rehabilitate, which must be explanted and the defect subsequently regenerated so that a new implant can be positioned, this time in a situation that allows us a predictable and aesthetically satisfactory rehabilitation (AU)

Does orthognathic surgery have an incidentally beneficial effect on mild or asymptomatic sleep apnoea?

A prospective study was performed to assess the effect of orthognathic surgery on mild obstructive sleep apnoea (OSA) in patients with an underlying dentofacial deformity treated for occlusal and/or aesthetic reasons. As the main outcome variables, changes in upper airway volume and apnoea-hypopnoea index (AHI) were evaluated at 1 and 12 months of follow-up, in patients undergoing orthognathic surgery with widening movements of the maxillomandibular complex. Descriptive, bivariate, and correlation analyses were performed; significance was set at P < 0.05. Eighteen patients diagnosed with mild OSA were enroled (mean age 39.8 ± 10.0 years). An overall upper airway volume widening of 46.7% after orthognathic surgery was observed at 12 months of follow-up. The AHI decreased significantly from a median 7.7 events/hour preoperatively to 5.0 events/h at 12 months postoperative (P = 0.045), and the Epworth Sleepiness Scale score decreased from a median 9.5 preoperatively to 7 at 12 months postoperative (P = 0.009). A cure rate of 50% was obtained at 12 months of follow-up (P = 0.009). Despite the limited sample size, this study provides evidence that in patients with an underlying retrusive dentofacial deformity and mild OSA, a slight decrease in AHI is obtained after orthognathic surgery due to upper airway enlargement, which could be added as a beneficial effect of orthognathic surgery.

Injerto en bloque en combinacióncon la técnica de split en dosfases para la rehabilitación deun caso de gran reabsorción óseadel maxilar en anchura / Block grafting in combination with the two-stage split technique for the rehabilitation of a case with severe bone resorption in width

El uso de diferentes técnicas quirúrgicas para lograr la resolución de los casos con atrofia más complejos es de vital importancia. Cada vez tenemos en la consulta casos con edentulismos de mayor duración que demandan tratamiento implantológico con prótesis fija, lo que supone un reto a la hora de planificar y llevar a cabo los tratamientos. Para ello, podemos utilizar diferentes técnicas que nos permitan ganar anchura y altura, así como implantes de distintas longitudes y diámetros que nos permitan adaptarnos a cada situación. En el presente caso clínico mostramos una rehabilitación que combina diferentes técnicas quirúrgicas para lograr el resultado buscado (AU)

The use of different surgical techniques to achieve the resolution of the most complex cases with atrophy is of vital importance. We have more and more cases with edentulism of longer duration that require implant treatment with fixed prosthesis, which is a challenge when it comes to planning and carrying out the treatments. For this, we can use different techniques that allow us to gain width and height as well as implants of different lengths and diameters that allow us to adapt to each situation. In this clinical case we show a rehabilitation that combines different surgical techniques to achieve the desired result (AU)

Progress in the use of plasma rich in growth factors in ophthalmology: from ocular surface to ocular fundus.

INTRODUCTION: The use of blood derivatives and especially Plasma rich in growth factors (PRGF), for regenerative purposes has been a common trend along the last decades in the field of oral surgery, dermatology, orthopedics, and more recently in ophthalmology. AREAS COVERED: PRGF is a type of platelet-rich plasma that is being explored for the treatment of ocular injuries. The present review article highlights 50 ophthalmology-related publications about the application of PRGF in the treatment of acute and chronic pathologies in ophthalmology as well as most relevant challenges and future prospects. EXPERT OPINION: PRGF technology provides a wide range of formulations that can be used therapeutically in many different acute and chronic ocular pathologies. In addition to eye drops enriched with autologous growth factors, PRGF enables the preparation of both immunologically safe and fibrin-based formulations. Recent advances in the field have promoted PRGF storage for 12 months under freezing conditions, its daily use for 7 days at room temperature and the freeze-dried formulation. The thermally treated immunosafe formulation has shown promising clinical results for the treatment of several diseases such as Sjögren syndrome, graft versus host disease or cicatrizing conjunctivitis. In addition, several fibrin formulations have been preclinically evaluated and clinically incorporated as an adjuvant to ocular surface or glaucoma surgeries, dermal fat graft procedures, limbal stem cell expansion and retinal surgeries. The present review explores the latest scientific and clinical data, current challenges, and main prospects of this technology for the treatment of several ocular injuries.

Are mucous retention cysts and pseudocysts in the maxillary sinus a risk factor for dental implants? A systematic review.

BACKGROUND: Mucous retention cysts and pseudocysts of the maxillary sinus are benign lesions present in up to 13% of adult patients. Different surgical approaches for sinus lift and dental implant placement in the presence of these lesions have been proposed. MATERIAL AND METHODS: A systematic review was performed following the PRISMA statement recommendations to answer the PICO question: Does the aspiration or removal of mucous retention cysts/pseudocysts before or during sinus lifting and dental implant placing, affect the survival of the implants? The study was pre-registered in PROSPERO (CRD42020185528). Included articles quality was assessed using the "NIH quality assessment tool" and "The Newcastle-Ottawa scale". RESULTS: Previous literature in this field is scarce and with a low level of evidence. There are no randomized prospective studies. Only 19 studies were identified, being composed of 2 cohort studies and 17 case series/reports. These studies involved 182 patients with a previous history of mucous retention cyst or pseudocyst in 195 maxillary sinuses where 233 implants were placed. The mean age of the patients was 45.5 (range: 12-80 years); 122 (67%) were male patients and 60 (33%) were female patients. The mean follow-up of the patients was 17.6 (range: 4-90 months). Only two fail was reported. No differences were identified in relation to the surgical approach or in relation to the removal/aspiration of the sinus lesion (prior to or simultaneous to sinus grafting) or not. CONCLUSIONS: The level of evidence was grade 4 according to the CEBM and further studies are needed to confirm this observations, but with the available data, dental implants placement after sinus lift procedure in patients with mucous retention cysts and pseudocysts seems to be safe and present high survival regardless on the removal of the lesion or not.

Short dental implants in patients with oral lichen planus: a long-term follow-up.

Oral lichen planus is associated with the Koebner phenomenon, and trauma may exacerbate oral lesions. Short dental implants, as alternatives to bony augmentation, would reduce the number of interventions and their morbidity. However, we know of no studies that have analysed the long-term outcomes of short implants in patients with oral lichen planus. We have therefore designed a retrospective study of such patients treated with short implants (≤8.5mm long), with survival of implants as the main outcome. The secondary outcomes were marginal bone loss and the development of complications. We calculated the implants' survival and compared the outcomes statistically between erosive and reticular oral lichen planus. Sixty-six short implants were placed in 23 patients with a mean (SD) age of 58 (7) years. The mean (SD) peri-implant bone loss was 0.96 (0.89) mm mesially and 0.99 (1.1) mm distally. Sixty-five of the 66 implants survived with a mean (SD) follow-up of 68 (32) months, and there were no significant differences between erosive and reticular disease. Stable long-term outcomes can be expected for short implants placed in patients with oral lichen planus, and graftless rehabilitation of missing teeth could be possible in these patients if short implants were used.

Implantes inmediatos post-extracción con carga inmediata en alveolos con infección por periodontitis activa: estudio de cohortes retrospectivo / Immediate post-extraction implants with immediate loading in sockets with active infection: a retrospective cohort study

Objetivo: En este estudio se realiza un seguimiento de implantes inmediatos con carga inmediata en alveolos afectados por periodontitis activa, con el fin de determinar la supervivencia de los mismos, la pérdida ósea y otras variables que puedan suponer el fracaso del tratamiento tanto quirúrgico como protésico. Material y métodos: Fueron seleccionados pacientes a los que se les colocaron implantes inmediatos post-extracción con carga inmediata en zonas afectadas por periodontitis durante 9 años (desde diciembre de 2006 hasta enero 2015). Se recolectó de forma retrospectiva información relativa a los datos demográficos, datos relativos al implante y datos relativos a la evolución del implante a lo largo del tiempo de seguimiento (estabilidad de los tejidos blandos, duros y prótesis). Se calculó la pérdida ósea marginal por implante y la supervivencia de los implantes y prótesis. Fue calculada también por implante la distancia entre el implante estudiado y su implante o diente adyacente y las repercusiones que tuvo esta distancia en el comportamiento del tejido blando peri-implantario y la formación de papila. Resultados: Fueron reclutados 25 pacientes en los que se insertaron 39 implantes post-extracción inmediata con carga inmediata en zonas infectadas por periodontitis. El tiempo medio de seguimiento fue de 6 años (rango 1 a 7 años). únicamente 3 de los implantes incluidos en el estudio no cumplieron con los criterios establecidos para el éxito implantológico y la supervivencia de los implantes fue del 100%. La media de pérdida ósea marginal fue de 1,50 mm (rango 0,61-5,01 mm). No se registró ningún fracaso de prótesis en los ca-sos estudiados aunque si un 6% de incidencias protésicas (aflojamiento de tornillos y fracturas de porcelana). Se encontró una correlación estadísticamente significativa entre la distancia al implante-diente adyacente y la estabilidad del tejido blando tras la cirugía (p=0,038). La media de la distancia entre el implante estudiado y el implante o diente adyacente cuando el tejido blando se mantuvo estable tras el tratamiento fue de 3,10 mm ±1,67 y cuando no se mantuvo estable fue de 2,09 mm ±1,95. La distancia media al diente-implante adyacente cuando se formó papila fue de 2,96 mm ±1,95 mm. Conclusiones: La carga inmediata de implantes post-extracción inmediata en implantes afectados por periodontitis (infección activa en el momento de la inserción del implante) no es un factor de riesgo para la supervivencia de los implantes según los datos obtenidos por este estudio (AU)

Objective: In this study is a follow-up of immediate implants with immediate loading in a post-extraction sockets affected by acute infection was made, in order to determine the survival of the implants, bone loss and survival of the implants and prosthesis. Material and Methods: patients who have implants immediate post-extraction with immediate loading in areas affected by periodontitis during 9 years (from December 2006 until January 2015) were selected. Retrospectively collected information on demographic data, data relating to the implant and data relating to the evolution of the implant over time of follow-up (soft tissue stability, hard and prosthesis). We calculated the marginal bone loss by implant and the survival of the implants and prostheses. The inter-implant distance was calculated by the distance between the implant and implant or adjacent tooth and the repercussions of this distance on the behavior of the peri-implant soft tissue and the papilla formation. Results: Finally 25 patients and 39 implants were included in the study. The mean follow-up time was 6 years (range 1 to 7 years). Only 3 of the implants included in the study did not meet the criteria for implantological success and the survival of the implants and prosthesis was 100%. The mean marginal bone loss was 1.50 mm (range 0.61-5.01 mm). In a 6% of the prosthesis mechanical complications were observed (loosening of screws and porcelain fractures). A statistically significant correlation was found between the distance to the adjacent tooth-implant and the stability of the soft tissue after surgery (p=0.038). The average distance between the implant and the implant or adjacent (AU)

The use of topical corticosteroides in the treatment of oral lichen planus in Spain: A national survey.

BACKGROUND: Explore the treatment of oral lichen planus with topical corticosteroids by the healthcare professionals in Spain. MATERIAL AND METHODS: A questionnaire targeted health professionals who treat OLP, in particular maxillofacial surgeons, dermatologist and dentist. The dissemination of the questionnaires was conducted through professional associations and dental and medical societies. The questionnaire was previously evaluated by means of a cognitive pre-test procedure to ensure that the questions were opportune and appropriate, understandable and accep-table among the professionals. RESULTS: Of the 890 questionnaires sent a total of 190 questionnaires were answered by 90 dentists, 60 dermatologists and 40 by maxillofacial surgeons. The most frequent treatment was 0.1%triamcinolone acetonide in orobase 3 times a day. The effectiveness of the topical corticosteroid treatment was 6.68 (SD= 2.26) in a scale of 1 to 10. The 30% of the dentists and 10.49% of maxillofacial surgeons combined treatment with other drugs. The most frequent one (80%) was nystatin (100,000 IU per millimetre). Dermatologists did not use other treatments in combination with corticosteroids Conclusions: There is a need for national guidelines in treatment for oral lichen planus (treatment criteria, drug, dose, treatment time and method of application of corticosteroid) that can be applied by all professionals who treat this disease.

Autologous method for ex vivo expansion of human limbal epithelial progenitor cells based on plasma rich in growth factors technology.

PURPOSE: Develop an autologous culture method for ex vivo expansion of human limbal epithelial progenitor cells (LEPCs) using Plasma Rich in Growth Factors (PRGF) as a growth supplement and as a scaffold for the culture of LEPCs. METHODS: LEPCs were cultivated in different media supplemented with 10% fetal bovine serum (FBS) or 10% PRGF. The outgrowths, total number of cells, colony forming efficiency (CFE), morphology and immunocytochemistry against p63- α and cytokeratins 3 and 12 (CK3-CK12) were analyzed. PRGF was also used to elaborate a fibrin membrane. The effects of the scaffold on the preservation of stemness and the phenotypic characterization of LEPCs were investigated through analysis of CK3-CK12, ABCG-2 and p63. RESULTS: LEPCs cultivated with PRGF showed a significantly higher growth area than FBS cultures. Moreover, the number of cells were also higher in PRGF than FBS, while displaying a better morphology overall. CFE was found to be also higher in PRGF groups compared to FBS, and the p63-α expression also differed between groups. LEPCs cultivated on PRGF membranes appeared as a confluent monolayer of cells and still retained p63 and ABCG-2 expression, being negative for CK3-CK12. CONCLUSIONS: PRGF can be used in corneal tissue engineering, supplementing the culture media, even in a basal media without any other additives, as well as providing a scaffold for the culture.

Ultrasound-guided plasma rich in growth factors injections and scaffolds hasten motor nerve functional recovery in an ovine model of nerve crush injury.

In the present study we evaluated the motor recovery process of peripheral nerve injury (PNI), based on electrophysiological and histomorphometric criteria, after treatment with plasma rich in growth factors (PRGF) injections and scaffolds in an ovine model. Three groups of sheep underwent a nerve crush lesion: the first group (n = 3) was left to recover spontaneously (SR); the second group was administered saline injections (SI; n = 5) and a third group (n = 6) received PRGF injections and scaffolds immediately after the crush injury. At post-intervention week 8, 70% of sheep in the PRGF group were CMAP-positive, with no electrophysiological response in the rest of the groups. Histomorphometric analysis 12 weeks after the surgical intervention revealed that the average axonal density of the SR (1184 ± 864 axons/µm2 ) and SI (3109 ± 2450 axons/µm2 ) groups was significantly inferior to the control (8427 ± 2433 axons/µm2 ) and also inferior to the PRGF group (5276 ± 4148 axons/µm2 ), showing no significant differences between the control and PRGF groups. The axonal size of the SR and SI groups was significantly smaller compared with the control group (18 ± 4 µm2 ), whereas the axonal size of the PRGF group (6 ± 5 µm2 ) did not show statistical differences from the control. Morphometry of the target muscles indicated that the PRGF group had the lowest percentage volume reduction 12 weeks after the crush injury. The PRGF group had larger muscle fibre areas than the SI and SR groups, although the differences did not reach statistical significance. Overall, these data suggest that the PRGF injections and scaffolds hastened functional axon recovery and dampened atrophy of the target muscles in an ovine model. Copyright © 2015 John Wiley & Sons, Ltd.

Plasma rich in growth factors promotes dermal fibroblast proliferation, migration and biosynthetic activity.

OBJECTIVE: The use of plasma rich in growth factors (PRGF) has gained importance in many medical fields due to its regenerative potential. The aim of this study is to evaluate the effects of PRGF on primary skin fibroblasts assessing cell proliferation, migration and secretion of growth factors. The age of the patients from who PRGF was prepared was also studied to determine whether it influenced the outcomes. METHOD: Human dermal fibroblasts were isolated from three healthy volunteers. Using PRGF-Endoret technology, PRGF was prepared from two groups of different ages (18-35 years and 50+ years). The effects of increasing concentration of PRGF (5%, 10% and 20%) on cell proliferation and migration was evaluated. Biosynthetic behaviour of cells was also analysed measuring vascular endothelial growth factor (VEGF), transforming growth factor b1 (TGFb1) and pro-collagen type I secreted levels with or without PRGF treatment. RESULTS: Mean platelet enrichment reached 2.4X and 2X in 18-35 and 50+ groups respectively. A dose-dependent response was observed in proliferation assays achieving the highest levels with 20% PRGF. Migration was also promoted in cells but not in a dose-dependent manner. Cell proliferation and migration outcomes obtained with PRGF (from both groups) were significantly higher compared to non-stimulated groups (p<0.05), with no statistical significances were observed between the different age groups. Production of VEGF, TGFb and procollagen type I was significantly increased by cells treated with PRGF, however, with the exception of VEGF, no statistical significances were observed between the different age groups. CONCLUSION: Results from this study concluded that PRGF is safe and effective in stimulating skin regeneration by enhancing proliferation, migration and expression of pivotal bioactive molecules involved in wound healing and haemostasis.

PRGF exerts more potent proliferative and anti-inflammatory effects than autologous serum on a cell culture inflammatory model.

Ocular graft versus host disease (oGVHD) is part of a systemic inflammatory disease that usually affects ocular surface tissues manifesting as a dry eye syndrome. Current treatments provide unsatisfactory results. Blood-derived products, like plasma rich in growth factors (PRGF) emerge as a potential therapy for this disease. The purpose of this study was to evaluate the tissue regeneration and anti-inflammatory capability of PRGF, an autologous platelet enriched plasma eye-drop, compared to autologous serum (AS) obtained from oGVHD patients on ocular surface cells cultured in a pro-inflammatory environment. PRGF and AS were obtained from four GVHD patients. Cell proliferation and inflammation markers, intercellular adhesion molecule-1 (ICAM-1) and cyclooxygenase-2 (COX-2), were measured in corneal and conjunctival fibroblastic cells cultured under pro-inflammatory conditions and after treatment with PRGF or AS eye drops. Moreover, cell proliferation increased after treatment with PRGF and AS, though this enhancement in the case of keratocytes was significantly higher with PRGF. PRGF eye drops showed a significant reduction of both inflammatory markers with respect to the initial inflammatory situation and to the AS treatment. Our results concluded that PRGF exerts more potent regenerative and anti-inflammatory effects than autologous serum on ocular surface fibroblasts treated with pro-inflammatory IL-1ß and TNFα.

Benefits of plasma rich in growth factors (PRGF) in skin photodamage: clinical response and histological assessment.

Skin ageing is characterized by small and fine wrinkles, roughness, laxity, and pigmentation as a result of epidermal thinning, collagen degradation, dermal atrophy, and fewer fibroblasts. Plasma rich in growth factors (PRGF) is an autologous plasma preparation enriched in proteins obtained from patient's own blood aimed at accelerating tissue repair and regeneration. To evaluate the benefits of PRGF in skin photodamage, 10 healthy volunteers were treated with three consecutive intradermal injections of PRGF in the facial area. Clinical outcomes and histological analysis were performed. A statistically significant increase in the epidermis and papillary dermis thickness was seen after PRGF treatment (p < 0.001). Skin thickening was observed in all patients studied, being more intense in the group of patients with photodamage (p < 0.001). After PRGF treatment, a reduction of the average area fraction of solar elastosis was observed in patients with clinical and histological signs of skin photodamage (p < 0.05).No changeswere observed in the number of CD31, XIIIa factor, cKit, CD10, nor p53-positive cells. The improvement score after PRGF use was 0.75 (9/12) for the group of patients with signs of skin photodamage. Intradermal PRGF infiltration appears to be an effective treatment for the photodamaged skin.