Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus percutaneous surgery. / [Artículo traducido] Utilidad del índice de fragilidad modificado de 5 items para predecir complicaciones y reoperaciones después de la cirugía percutánea de hallux valgus.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: 1) non-frail: patients without any of the 5 comorbidities, 2) pre-frail: patients with one comorbidity and 3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct HV deformity, 551 patients were included with a median age of 60 (IQR 48-70). Three hundred eighty-nine patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (P=.11). Frailty patients had worse AOFAS scores at final follow up (P=.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus surgery.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: (1) non-frail: patients without any of the 5 comorbidities, (2) pre-frail: patients with one comorbidity and (3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct hallux valgus deformity, 551 patients were included with a median age of 60 (IQR 48-70). 389 patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (p=0.11). Frailty patients had worse AOFAS scores at final follow up (p=0.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Percutaneous hallux valgus surgery: comparison between mini-invasive Chevron and Bosch osteotomies. / Cirugía percutánea para hallux valgus: comparación entre osteotomía en chevron y de Bosch.

BACKGROUND AND OBJECTIVE: Through percutaneous approaches, hallux valgus corrections can be performed with minimal soft tissue injury, less postoperative pain and good cosmetic results. Bosch osteotomy and MICA (Minimally Invasive Chevron Akin) have shown to be effective techniques for the correction of hallux valgus, although there are currently no publications comparing each other. The aim of this study is to compare the radiological and functional results of both techniques. MATERIALS AND METHODS: A retrospective, comparative study was carried out on patients with moderate hallux valgus. They were divided into two groups according to the percutaneous technique performed: Chevron osteotomy and Bosch osteotomy with screw fixation. The metatarsophalangeal, intermetatarsal, and distal articular veneer declination angles of the first metatarsal and the bone consolidation time were evaluated radiologically. The American Orthopaedic Foot and Ankle Surgery (AOFAS) score was used for functional assessment. Complications were registered during the first year. RESULTS: Thirty-eight patients in each group were included for the study. In each of the groups, the radiological angles were compared preoperatively and at final follow-up, showing statistically significant changes in the three variables considered; but no differences were obtained by comparing them with each other. The time of consolidation was also similar in both groups. As for the AOFAS scale, an improvement was obtained with both techniques, but the difference was not significant when comparing them. CONCLUSIONS: Both Bosch and MICA techniques showed comparable results at the end of the follow-up. Further work is needed to determine the advantages of each in the immediate postoperative time.

Talus Bipartitus: A Rare Anatomical Variant Presenting as an Entrapment Neuropathy of the Tibial Nerve within the Tarsal Tunnel.

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve within the tarsal tunnel that lies beneath the retinaculum on the medial side of the ankle. It is often underdiagnosed. Talus bipartitus is a rare anatomical variant; only a few cases have been described in medical literature. We report a case of a 36-year-old female with tarsal tunnel syndrome secondary to a talus bipartitus undergoing surgical treatment with good clinical outcome. To our knowledge, talus bipartitus presenting as tarsal tunnel syndrome has no previous reports. Image studies and physical examination are crucial to reach precise diagnosis.

Prevalence, extent and severity of peri-implant diseases. A cross-sectional study based on a university setting in Brazil.

BACKGROUND AND OBJECTIVE: Peri-implant diseases are a growing concern among clinicians. Epidemiological studies following recently recommended case definitions for peri-implant diseases are emerging worldwide. Although a small number of studies on the prevalence of peri-implant diseases has been conducted in Brazil, no information on the extent and severity of the condition has been made available so far. The objective of this study was to estimate the prevalence, extent and severity of peri-implant diseases in patients treated in a university setting in Brazil. MATERIAL AND METHODS: Patients with dental implants with at least 1 year in function were clinically and radiographically examined and classified according to recently recommended case definitions. A descriptive analysis on the prevalence, extent and severity of the peri-implant status at patient and implant level was performed. Risk indicators for peri-implantitis were also identified with binary logistic regression analysis. RESULTS: Of the 211 participating individuals, 4 (1.9%) presented peri-implant health, 8 (3.8%) clinical stability, 115 (54.5%) mucositis and 84 (39.8%) peri-implantitis. Of the 748 implants analyzed, 47 (6.3%) presented peri-implant health, 30 (4%) clinical stability, 518 (69.2%) mucositis and 153 (20.5%) peri-implantitis. The extent of implants with peri-implantitis and peri-implant mucositis was 41.5% and 90.4%, respectively. Severe peri-implantitis was found in 36 patients (17.1%) and 67 implants (9%). Gender male, number of implants ≥4, implants installed in the maxilla, cemented prosthesis and keratinized mucosa width <2 mm were significantly associated with the event peri-implantitis. CONCLUSION: In the studied population, the prevalence, extent and severity of the peri-implant diseases were similar to those reported elsewhere. Peri-implant diseases were a common finding, with only 5.7% of patients and 10.3% of implants presenting peri-implant health or clinical stability. About 17% of patients studied presented the severe form of peri-implantitis.

One-year follow-up of titanium/zirconium alloy X commercially pure titanium narrow-diameter implants placed in the molar region of the mandible: a randomized controlled trial.

OBJECTIVE: To analyze marginal bone loss (MBL) and clinical parameters around narrow-diameter implants (NDIs - 3.3 mm) made of titanium/zirconium alloy (TiZr) in comparison with commercially pure titanium (cpTi) installed in the molar region of the mandible after 1 year in function. MATERIALS AND METHODS: Ten patients participated in the study. A TiZr and a cpTi NDI were randomly installed in contralateral molar sites of the mandible of each patient in a split-mouth design. Eight weeks after healing, all metal-ceramic single crowns were adapted to the implants and patients were enrolled in a plaque control program. MBL at the mesial and distal aspects of the implants were evaluated by comparing periapical radiographs taken immediately after prosthesis installation (T1) and 1 year after loading (T2). Clinical probing depth, bleeding on probing, suppuration, visible plaque and implant mobility were evaluated to determine implant success and survival rates. RESULTS: Mean MBL at the interproximal aspects of TiZr implant sites was 0.32 ± 0.27 mm, while at cpTi implant sites mean MBL was 0.35 ± 0.24 mm (P = 0.60). Both TiZr and cpTi NDIs presented 100% implant survival and success rates, with no significant differences in the clinical parameters studied (P > 0.05). CONCLUSION: TiZr and cpTi NDIs presented similar outcomes after 1 year in function in the molar region of the mandible. The results suggest that TiZr and cpTi NDIs may be equally used to support single crowns in the posterior area of the mouth. However, further studies with longer follow-up periods are necessary to confirm these findings.

Avaliação da atividade antibacteriana, citotóxica e antioxidante da espécie vegetal Opuntia cochenillifera (L. ) Mill / Evaluation of antibacterial, cytotoxic, and antioxidant activity of the plant species Opuntia cochenillifera (L. ) Mill

RESUMO O presente estudo teve como objetivo avaliar a atividade antibacteriana, antioxidante e citotóxica da espécie Opuntia cochenillifera (L.) Mill. Foi realizada a prospecção fitoquímica e espectroscopia de absorção de infravermelho (IV) dos extratos etanólicos brutos e frações dos cladódios grande e pequeno. A atividade antioxidante foi avaliada pelo método da capacidade sequestradora de radicais livres utilizando o radical sintético 2,2-difenil-1-picrilhidrazila (DPPH). A atividade citotóxica foi obtida através do método colorimétrico do Metiltetrazolium (MTT). Já a atividade antibacteriana foi avaliada pelo método de microdiluição em caldo para determinar a concentração inibitória mínima (CIM) frente às estirpes bacterianas Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa e Escherichia coli. A prospecção fitoquímica revelou principalmente a presença de fenóis, esteroides livres, alcaloides, alcanos, além de outras classes químicas. O IV apresentou grupos funcionais como alcanos, carbonilas, grupos de metila, duplas ligações de carbono, grupamentos alquilamina, entre outros. Sobre a citotoxicidade na concentração de 100 μg/mL, os dois extratos brutos, todas as frações do cladódio grande e as frações de clorofórmio e metanol do cladódio pequeno não apresentaram toxicidade. Os extratos brutos e frações do cladódio grande e pequeno, não demonstraram atividade antibacteriana e nem antioxidante. Esses resultados podem fornecer suporte para pesquisas futuras, visando outras atividades biológicas da presente espécie vegetal.

ABSTRACT The purpose of this study was to evaluate the antibacterial, antioxidant, and cytotoxic activity of Opuntia cochenillifera (L.) Mill. A phytochemical screening and infrared (IR) absorption spectroscopy were performed in the crude ethanolic extracts and fractions of large and small cladodes. The antioxidant activity was evaluated through the qualitative method of free-radical scavenging capacity using the synthetic radical 2,2-diphenyl-1-picrylhydrazyl (DPPH). The cytotoxic activity was obtained by the cell viability assay using methyl thiazolyl tetrazolium (MTT). Antibacterial activity was evaluated by broth microdilution method to determine the minimum inhibitory concentration (MIC) against the bacterial strains Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli. The phytochemical screening mainly revealed the presence of phenols, flavonoids, free steroids, alkaloids, alkanes, and other chemical classes. The IR spectroscopy presented functional groups such as alkanes, carbonyls, methyl groups, carbon double bonds, and alkylamino groups, among others. Regarding cytotoxicity in the concentration of 100 μg/mL, neither the crude extracts, the fractions of the large cladode, nor the chloroform and methanol fractions of small cladode presented toxicity. The crude ethanolic extracts and fractions of large and small cladode showed no antibacterial or antioxidant activity. These results may provide support for future research aimed at other biological activities of this plant species.

Long-term outcomes from implants installed by using split-crest technique in posterior maxillae: 10 years of follow-up.

OBJECTIVE: The aim of the present 10-year retrospective study was to evaluate the success and survival rates of narrow diameter implants (NDIs) placed in combination with a split-crest technique. MATERIALS AND METHODS: Twenty-one healthy individuals who received prosthetic rehabilitation supported by narrow diameter implants (NDIs) installed in atrophic maxillary posterior areas immediately after split-crest procedure were included in the study. Six to eight weeks after implant placement, the prosthetic rehabilitations were delivered. Periapical radiographs were taken at the 6-month and 10-year time interval after implant loading to assess bone marginal level around the implants. In addition, survival and success indexes were also obtained at these time intervals. RESULTS: Forty NDIs were placed in 21 patients. At the end of the 10-year follow-up period, seven patients had dropped out, two implants were lost, and nine prostheses presented some type of deficiency (ceramic fracture or retaining screw fracture). At the 10-year time interval, the implant survival rate was 97% and the success rate was 95%. The marginal bone loss at the 6-month and 10-year time intervals was, respectively, 0.47 (SD 0.91) mm and 1.93 (SD 0.93) mm. CONCLUSION: Narrow diameter implants installed immediately after split-crest procedure may successfully support prosthetic rehabilitations after long-time intervals.

Success and survival rates of narrow diameter implants made of titanium-zirconium alloy in the posterior region of the jaws - results from a 1-year follow-up.

OBJECTIVE: The aim of the present prospective clinical study was to evaluate and to compare the success and survival rates of narrow diameter implants made of titanium-zirconium alloy and commercially pure titanium. MATERIALS AND METHODS: Forty-two healthy adult patients scheduled for implant-supported single restorations were included in the study. In each patient, a titanium-zirconium alloy (Test group) or a commercially pure titanium (Control group) narrow diameter implants was installed in the posterior regions of the jaws. After 8 weeks of healing, all metal-ceramic single crowns were adapted to the implants and the patients enrolled in a plaque control program. The survival and success rates of the implants and the success rate of the implant-supported prosthesis were evaluated following 1 year of loading. Furthermore, mobility (M), suppuration (S), clinical probing depth (CPD), and bleeding on probing (BoP) were measured around the implants at 6 weeks of healing (T1) and 12 months after loading (T2). RESULTS: In T2, survival and success rates for both groups were 95.2%. The corresponding value for the success rate of the implant-supported prosthesis was 100% in both groups. The average CPD was the following: 2.29 (±0.52) and 2.59 (±0.52) (P < 0.05) in the Test and Control groups, respectively, at T1; and 3.0 mm (±0.74) and 3.07 mm (±0.90) (P > 0.05) in the Test and Control groups, respectively, at T2. There was no statistically significant difference between groups concerning about S, M, and BoP at T1 and T2 (P > 0.05). CONCLUSION: The present study suggests that, in a short-term follow-up, narrow diameter implants made of either titanium-zirconium alloy or commercially pure titanium may be used to support single crowns in the posterior portions of the jaws.

Biphasic alloplastic graft used to preserve the dimension of the edentulous ridge: an experimental study in the dog.

BACKGROUND: Loss of teeth results in marked qualitative and quantitative alterations of the alveolar process at the edentulous site. It was observed that a graft comprised of bovine bone mineral placed in the fresh extraction socket delayed tissue modeling, but preserved the dimension of the ridge at edentulous sites. OBJECTIVE: To analyze the influence of a biphasic synthetic graft on tissue modeling and remodeling during healing of extraction wounds. MATERIAL AND METHODS: Five beagle dogs were used. Two premolars in the maxilla and two in the mandible were included. Full thickness flaps were elevated and the distal roots were removed. An alloplastic graft (BPCAP; α-TCP core coated with nanocrystalline biomimetic hydroxyapatite) embedded in porcine collagen was placed to fill the fresh extraction socket of the premolar sites. Flaps were replaced to cover the entrance of the extraction sockets during early healing. The extraction and grafting procedures were scheduled to allow for the study of 1, 2, and 3 months socket healing. The biopsies from the maxillary sites were decalcified, embedded in paraffin, and stained to allow the study of various aspects of hard tissue formation. The biopsies from the mandibular sites were processed for ground sectioning and used to evaluate alterations of ridge dimensions after 3 months of socket healing. RESULTS AND CONCLUSION: It was documented that the biphasic alloplastic graft did not undergo marked resorption during tissue modeling and remodeling, but allowed large amounts of bone to form within the post-extraction site. Grafting the experimental sites with this biomaterial furthermore counteracted ridge resorption that otherwise occurs following tooth extraction.

Clinical and histological evaluation of subepithelial connective tissue after collagen sponge implantation in the human palate.

BACKGROUND AND OBJECTIVE: Successful root-coverage treatment depends on the thickness of the donor tissue. This study aimed to evaluate the thickness of donor tissue after augmentation of the connective tissue in the palatal area by implantation of lyophilized collagen sponge (Hemospon(®) ). MATERIAL AND METHODS: Ten patients with an indication for root coverage, whose palate was deficient in adequate connective tissue, were recruited. The procedure was carried out in two stages. In the first stage, the palatal thickness in the donor site was measured at three standardized points (points 1, 2 and 3), from the distal of the canine to the distal of the first molar, and the lyophilized collagen sponge was inserted. In the second stage, the palatal thickness over the implant was measured (at points 1, 2 and 3), two biopsies of the palatal mucosa were collected - one over the implant (experimental sample) and the other on the contralateral side (control sample) - and then root-coverage treatment was performed. Analyses consisted of clinical assessment of the palatal measurements before and after sponge implantation, and histological assessment of the experimental and control biopsy samples. Data were analyzed using the Wilcoxon test. RESULTS: Both analyses showed a significant increase in mean thickness, of 1.08 mm of neoformed tissue in the clinical analysis (the tissue at point 2 was the thickest of the three points) and of 0.53 mm in the histological analysis. CONCLUSION: The insertion of lyophilized collagen sponge induced a significant increase in the thickness of palatal connective tissue.

Comparison of surface integral equation formulations for electromagnetic analysis of plasmonic nanoscatterers.

The performance of most widespread surface integral equation (SIE) formulations with the method of moments (MoM) are studied in the context of plasmonic materials. Although not yet widespread in optics, SIE-MoM approaches bring important advantages for the rigorous analysis of penetrable plasmonic bodies. Criteria such as accuracy in near and far field calculations, iterative convergence and reliability are addressed to assess the suitability of these formulations in the field of plasmonics.

Solution of large-scale plasmonic problems with the multilevel fast multipole algorithm.

A surface integral equation together with the multilevel fast multipole algorithm is successfully applied to fast and accurate resolution of plasmonic problems involving a large number of unknowns. The absorption, scattering, and extinction efficiencies of several plasmonic gold spheres of increasing size are efficiently obtained solving the electric and magnetic current combined-field integral equation. The numerical predictions are compared with reference analytic results to demonstrate the accuracy, suitability, and capabilities of this approach when dealing with large-scale plasmonic problems.

Expression of the chemokine receptor CXCR4 on lymphocytes of leprosy patients

Leprosy is caused by Mycobacterium leprae, which induces chronic granulomatous infection of the skin and peripheral nerves. The disease ranges from the tuberculoid to the lepromatous forms, depending on the cellular immune response of the host. Chemokines are thought to be involved in the immunopathogenesis of leprosy, but few studies have investigated the expression of chemokine receptors on leukocytes of leprosy patients. In the present study, we evaluated 21 leprosy patients (M/F: 16/5) with a new diagnosis from the Dermatology Outpatient Clinic of the University Hospital, Federal University of Minas Gerais. The control group was composed of 20 healthy members (M/F: 15/5) of the community recruited by means of announcements. The expression of CCR2, CCR3, CCR5, and CXCR4 was investigated by flow cytometry on the surface of peripheral blood lymphocytes. There was a decrease in percentage of CD3+CXCR4+ and CD4+CXCR4+ lymphocytes in the peripheral blood of leprosy patients (median [range], 17.6 [2.7-41.9] and 65.3 [3.9-91.9], respectively) compared to the control group (median [range], 43.0 [3.7-61.3] and 77.2 [43.6-93.5], respectively). The percentage of CD4+CXCR4+ was significantly lower in patients with the tuberculoid form (median [range], 45.7 [0.0-83.1]) of the disease, but not in lepromatous patients (median [range], 81.5 [44.9-91.9]). The CXCR4 chemokine receptor may play a role in leprosy immunopathogenesis, probably directing cell migration to tissue lesions in tuberculoid leprosy patients.

Expression of the chemokine receptor CXCR4 on lymphocytes of leprosy patients.

Leprosy is caused by Mycobacterium leprae, which induces chronic granulomatous infection of the skin and peripheral nerves. The disease ranges from the tuberculoid to the lepromatous forms, depending on the cellular immune response of the host. Chemokines are thought to be involved in the immunopathogenesis of leprosy, but few studies have investigated the expression of chemokine receptors on leukocytes of leprosy patients. In the present study, we evaluated 21 leprosy patients (M/F: 16/5) with a new diagnosis from the Dermatology Outpatient Clinic of the University Hospital, Federal University of Minas Gerais. The control group was composed of 20 healthy members (M/F: 15/5) of the community recruited by means of announcements. The expression of CCR2, CCR3, CCR5, and CXCR4 was investigated by flow cytometry on the surface of peripheral blood lymphocytes. There was a decrease in percentage of CD3+CXCR4+ and CD4+CXCR4+ lymphocytes in the peripheral blood of leprosy patients (median [range], 17.6 [2.7-41.9] and 65.3 [3.9-91.9], respectively) compared to the control group (median [range], 43.0 [3.7-61.3] and 77.2 [43.6-93.5], respectively). The percentage of CD4+CXCR4+ was significantly lower in patients with the tuberculoid form (median [range], 45.7 [0.0-83.1]) of the disease, but not in lepromatous patients (median [range], 81.5 [44.9-91.9]). The CXCR4 chemokine receptor may play a role in leprosy immunopathogenesis, probably directing cell migration to tissue lesions in tuberculoid leprosy patients.

Estudo fitoquímico preliminar e bioensaio toxicológico frente a larvas de Artemia salina Leach. de extrato obtido de frutos de Solanum lycocarpum A. St.-Hill (Solanaceae) / Phytochemical screening and toxicological bioassay with brine shrimp larvae (Artemia salina Leach) of an extract obtained from fruits of Solanum lycocarpum A. St-Hill

Neste trabalho, avaliou-se o perfil fitoquímico e a toxicidade preliminar frente a larvas de Artemia salina do extrato etanólico de frutos de Solanum lycocarpum. O extrato foi submetido à análise fitoquímica preliminar para identificação das principais classes de metabolitos secundários presentes e testado frente a larvas de A. salina para obtenção das concentrações letais médias (CL50%). Os testes fitoquímicos demonstraram a presença de fenóis, taninos, saponinas, alcalóides e esteroides livres. O extrato foi fracionado em diferentes solventes para a avaliação da toxicidade frente à A. salina, apresentando considerável citotoxicidade na fração hidroalcoólica (CL50% = 285,546 µg/mL).

The phytochemical profile of ethanolic extract of Solanum lycocarpum fruits was analyzed and preliminary toxicity tests were performed against brine shrimp larvae. The extract was subjected to preliminary phytochemical analysis to identify the main classes of secondary metabolites and tested against the larvae of A. salina to obtain the median lethal concentrations (LC50%). The phytochemical tests showed the presence of phenols, tannins, saponins, alkaloids and free steroids. The extract was fractionated with various solvents for toxicity testing against the larvae and the hydroalcoholic fraction showed considerable cytotoxicity (CL50% = 285.546 µg/mL).

Lateral ridge augmentation by the use of grafts comprised of autologous bone or a biomaterial. An experiment in the dog.

OBJECTIVE: The present investigation was performed to determine if a block of Bio-Oss used as an onlay graft can be used as a scaffold for new bone formation. MATERIAL AND METHODS: Five mongrel dogs were used. The mandibular premolars were extracted. On both sides of the mandible, the buccal bone plate was resected and defects, about 25 mm long, 8 mm high and 5 mm wide, were produced After 3 months of healing, a second surgical procedure was performed. In the left side, a block of Bio-Oss was adjusted to the buccal bone wall. The graft had the shape of a cylinder and was retained with a miniscrew and covered with a collagen membrane. In the contra-lateral side of the mandible, a block biopsy was first obtained from the ascending ramus. This bone graft had the shape of a cylinder that was 8 mm in diameter and 3 mm thick. The graft was transferred to the experimental site, adjusted to the buccal wall, retained with a miniscrew, and covered with a membrane. The flaps were repositioned and closed with sutures to ensure a complete coverage of the experimental sites. After 6 months of healing, the dogs were sacrificed and the experimental sites dissected. The biopsies were processed for ground sectioning. The sections were stained in toluidine blue, examined in the microscope, and a number of histo- and morphometric assessments made. RESULTS: The study demonstrated that cortical bone used as an onlay graft in the lateral aspect of the alveolar ridge, during a 6-month period of healing integrated with the host bone but underwent marked peripheral resorption. Thus, close to 30% of the height and 50% of the length of the graft was replaced with connective tissue. It was further observed that while the dimensions of a graft which contained a scaffold of cancellous bovine bone mineral remained unchanged, only moderate amounts of new bone formed at the base of this graft. CONCLUSION: Grafts of autologous cortical bone, placed on the surface of a one-wall defect, may undergo marked resorption during healing. A similar graft of Bio-Oss may retain its dimension, and limited amounts of new bone will form within the biomaterial.

Cutaneous protothecosis: report of the second Brazilian case.

The present report describes a case of cutaneous protothecosis caused by Prototheca wickerhamii in a non-immunocompromised female from the state of Bahia, Brazil. This is the second case described in Brazil. Dermatological examination revealed diffusely infiltrated erythematous plaques on the flexor aspect of the right arm and forearm. The authors emphasize the pathological aspects that can lead to misdiagnosis this condition. The patient was successfully treated with fluconazole.

Orthodontic movement in bone defects augmented with Bio-Oss. An experimental study in dogs.

OBJECTIVE: To study if it was possible to move, by orthodontic means, a tooth into an area of the jaw that had been augmented with Bio-Oss. MATERIAL AND METHODS: 5 beagle dogs were used. The 1st, 2nd, and 4th mandibular premolars on each side were removed. The defect at the left 4th premolar site was filled with a biomaterial (Bio-Oss) while the corresponding defect in the right side was left for spontaneous healing. 3 months later, an orthodontic device was inserted in each side of the mandible. The device was designed to allow distal, bodily movement of the 3rd premolars. When the experimental teeth had been moved into the extraction sites of the 4th premolars, the animals were sacrificed and biopsies of the premolar-molar regions of the mandible sampled. The tissues were prepared for histological analysis using standard procedures. In the sections, 3 zones were identified: zone A=the bone tissue within the distal portion of the previous extraction site (4th premolar), zone B=the pressure side of the 3rd premolar, zone C=the tension side of the 3rd premolar. The area occupied by mineralized bone, Bio-Oss particles and bone marrow was determined by a point counting procedure. The width of the periodontal ligament as well as the percentage of the root surface (in zone B) that exhibited resorption was determined. RESULTS: The findings demonstrated that it was possible to move a tooth into an area of an alveolar ridge that 3 months previously had been augmented with a biomaterial. It was also demonstrated that 12 months after grafting, Bio-Oss particles remained as inactive filler material in the not utilized part of zone A. The biomaterial was not present in zone C but present in small amounts in zone B. CONCLUSION: During the orthodontic tooth movement the graft material (Bio-Oss) was degraded and eliminated from the part of the alveolar ridge that was utilized for the experiment. In the non-utilized part of the ridge the biomaterial, however, remained as a seemingly inactive filler material.

Resolution of peri-implantitis following treatment. An experimental study in the dog.

The aim of the present experiment was i) to study the effect of anti-microbial therapy of experimentally induced peri-implantitis lesions and ii) to assess features of bone regrowth following treatment. Four beagle dogs were used. Three titanium fixtures (Brånemark System) were installed in each quadrant of the mandible (premolars previously extracted). Abutment connection was performed 5 months later and ligature induced breakdown was initiated. The ligatures were removed when approximately 50% of the initial bone support was lost. A 3-week antibiotic regimen (amoxicillin and metronidazole) was initiated 1 month later. Two days after the start of the antibiotic administration, the experimental implant sites were exposed to local therapy. The abutments were removed and the exposed fixture surfaces were treated with an abrasive (pumice) administered via a rotating brush (left side) or cleaned with cotton pellets soaked in saline (right side). Cover screws were attached to the fixtures and the implants were submerged. Fluorochromes were injected intravenously 2 weeks, 4 weeks and 12 weeks after surgery. The animals were killed 7 months after surgery and block biopsies of each implant site were dissected and prepared for histological analysis. The findings of the examinations disclosed that the inflammatory lesion was resolved and new bone formation had occurred in the previous defect following antimicrobial and local therapy. The amount of "re-osseointegration" that had taken place, however, was small. Indeed, at all experimental implant sites, a thin connective tissue capsule was found to separate the implant surface from the newly formed bone.