Management of soft tissue ridge deformities with acellular dermal matrix. Clinical approach and outcome after 6 months of treatment.

BACKGROUND: Soft tissue ridge defects often hamper ideally shaped artificial crowns and are basically treated using autogenous soft tissue grafts or alloplastic materials. These approaches present disadvantages such as the necessity of creating additional surgical fields to harvest the graft and the requirement of primary closure, which may reduce ridge height. This investigation evaluated the use of acellular dermal matrix (ADM) in the treatment of soft tissue ridge defects. METHODS: Eight patients, non-smokers with non-contributory medical history, provided 18 sites corresponding to missing teeth in the anterior maxillary arch. The ideal horizontal gain (desired gain) was waxed up in study casts, which served as templates for construction of modified acrylic stents with orthodontic wires. These stents served as references for ideal horizontal gain and also as fixed reference points for further evaluation. The distance from the orthodontic wire to the buccal plate of the defect also represented its baseline horizontal component. Vertical variations were evaluated with another stent and, in this case, no desired gain was considered. After raising partial-thickness flaps, the ADM material was rehydrated and folded to fill the defect and reproduce the desired gain. Flaps were sutured with no tension, and part of the material was intentionally left exposed to avoid pressure on the incision line and prevent height loss. Patients used local and systemic antimicrobials, and the sutures were removed at 7 days. RESULTS: Evaluations were carried out at 30 days, and 3 and 6 months, and all sites healed uneventfully. Neither infection nor significant pain was reported by the patients, and the material was covered by tissue at about 21 days. Mean horizontal gain of 1.72 +/- 0.59 mm (58.5%) at 6 months and mean shrinkage of 1.22 +/- 0.46 mm (41.4%) were observed. There was a mean improvement in vertical gain of only 0.61 +/- 0. 77 mm, although 66. 7% of the treated sites showed a 1 to 2 mm gain. Clinically, the total gain in the subjects was very effective and matched the receptor tissues nicely. CONCLUSIONS: ADM may be a suitable material for the treatment of soft tissue ridge deformities due to its biocompatibility, color matching, and horizontal gain. Additional controlled, comparative trials are necessary to establish its advantages and potential compared to autogenous soft tissue techniques.

Managing soft tissue fenestrations in bone grafting surgery with an acellular dermal matrix: a case report.

The success of bone grafting procedures depends largely on the management and integrity of the gingival flaps. Soft tissues aid in the protection of the bone graft, participate in the revascularization of the newly formed hard tissues, and play an important role in the esthetic outcome of the reconstructive phase. Acellular dermal matrix (ADM) is a material obtained from human skin and used in plastic and reconstructive surgery as an allograft. It acts as a bioactive substrate for cell attachment and proliferation. The outcome of the use of ADM as a dressing material to treat flap fenestrations in bone grafting surgery is presented.

Use of bovine-derived anorganic bone associated with guided tissue regeneration in intrabony defects. Six-month evaluation at re-entry.

BACKGROUND: Different filling materials have been associated with guided tissue regeneration (GTR) in order to improve its regenerative potential and predictability. Anorganic bovine bone (ABB) has demonstrated biocompatibility and osteoconductive properties; however, there are limited data regarding its performance in the treatment of intrabony defects. This investigation aimed to evaluate the clinical outcome of the association of anorganic bovine bone with cellulose membranes in intrabony defects after 6 months. METHODS: Twenty-six paired intrabony defects were selected from 11 non-smoking patients with no relevant medical history. The defects were similar regarding the number of bony walls and defect depth, and presented pocket depths > or = 6 mm. Four weeks after completion of basic therapy, probing depth (PD), clinical attachment level (CAL), and gingival margin position (GP) were recorded (baseline values). The defects were then surgically accessed and debrided, and the intrabony component measured to the nearest millimeter with periodontal probes and customized acrylic stents (distance from the stent to the base of the defect and from the stent to the alveolar crest). Each intrabony defect was randomly assigned to receive the membrane alone (control, C) or the membrane with anorganic bovine bone (test, T). The patients were re-evaluated after 6 months, and re-entry procedures were performed. RESULTS: Significant (P <0.01) improvement in all variables was observed: mean pocket reduction of 4.61+/-1.60 mm (C) and 4.46+/-1.50 mm (T) and clinical attachment gain of 2.85+/-1.46 mm (C) and 3.15+/-1.40 mm (T); the difference between groups was not significant (P >0.05). Nevertheless, gingival recession in the control group (1.84+/-0.89 mm) was significantly (P <0.05) more pronounced than that observed in the test group (1.30+/-0.48 mm). Bone measurements indicated a significant resolution of the defects (P <0.01). A mean defect resolution of 2.76+/-0.72 mm (C) and 2.69+/-1.03 mm (T) and crestal resorption of 1.07+/-0.64 mm (C) and 1.30+/-0.85 mm (T) were detected (P >0.05). Stepwise multiple regression analysis indicated that for both groups, the baseline depth of the defects and the alveolar crest resorption accounted for 82% of the variability of bone fill observed in the control group (F = 23.65, P <0.001) and 89% in the test group (F = 41.32, P <0.001). CONCLUSIONS: ABB may be used in conjunction with GTR in the treatment of intrabony defects. Its use, however, did not result in a better outcome than the use of membranes alone. Studies employing more patients would be of interest in order to determine the advantages and indications of the tested approaches on a more predictable basis.

Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in a prepubescent subject: clinical findings and response to intravenous immunoglobulin treatment.

Common variable immunodeficiency (CVID) is a rare multifactorial congenital disease of genetic origin caused by an impairment in the secretion of specific immunoglobulins. It manifests systemically through recurrent respiratory infections, gastrointestinal disorders and autoimmune diseases. Oral manifestations may include gingivitis and lichenoid lesions with Wickham's striae. The treatment for CVID is supported by using intravenous infusion of immunoglobulins (IVIG) that allows for control of the disease and avoidance of recurrent opportunistic infections. This report presents a case of necrotizing ulcerative periodontitis (NUP) in a young patient with CVID, and correlates his periodontal status with systemic conditions before and after IVIG administration during 1 year of evaluation.

[Residual histoplasmosis of the lung and bronchopulmonary lymph nodes in autopsies carried out in Uberaba, MG]. / Histoplasmose residual dos pulmões e linfonodos broncopulmonares em necropsias realizadas em uberaba, MG.

Lungs and broncho-pulmonary lymph nodes were studied from 127 sequential adult autopsies done in Uberaba, MG, Brazil through the years 1992 and 1993. Calcified lung nodules and/or calcified lymph nodes were found in 39 (30.7%) cases. For 27 (69.2%) out of those 39 autopsies, fungi morphologically compatible with Histoplasma capsulatum were found within those calcified structures. Fite-Faraco stain for acid-fast bacilli was negative for all cases. It is concluded that the majority of calcified pulmonary nodes and calcified regional lymph nodes found at autopsies in Uberaba are related to infection with H. capsulatum. These findings raise the possibility for this fungal disease to be endemic in Uberaba. Such information might be relevant to the diagnosis of this systemic mycosis.