Intra-sinus rigid fixation of a resorbable barrier membrane to repair a large perforation of the sinus membrane: a technical note.

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

Radiologic comparative analysis between saline and platelet-rich fibrin filling after hydraulic transcrestal sinus lifting without adjunctive bone graft: A randomized controlled trial.

OBJECTIVES: To evaluate implant survival rate, any complications, and changes in residual alveolar bone height (RABH) using saline or platelet-rich fibrin (PRF) filling after hydraulic transcrestal sinus lifting. METHODS: Dental implants were placed after hydraulic transcrestal sinus lifting and the filling of saline (20 patients) or PRF (20 patients). Outcome measurements were implant survival, any complications, and RABH changes. Cone-beam computed tomography (CBCT) scans were taken and compared preoperatively (T0), immediately postoperatively (T1), at 3 months (T2), 6 months (T3), and 12 months postoperatively (T4), respectively. RESULTS: In a total of 40 patients, 45 implants with a mean length of 10.4 ± 0.8 mm were placed in posterior maxilla of a mean RABH of 6.8 ± 1.1 mm. The increase in RABH peaked at T1, and continuous drooping of the sinus membrane was observed but stabilized at T3. Meanwhile, the gradual increase in the radiopacities was found below the lifted sinus membrane. The PRF filling induced the radiographic intrasinus bone gain of 2.6 ± 1.1 mm, which was significantly more than 1.7 ± 1.0 mm of saline filling at T4 (p < .05). All the implants were in function with no significant complications over the one-year follow-up period. CONCLUSIONS: In this randomized case-control study, the feasibility of hydraulic transcrestal sinus lifting without bone graft was confirmed and PRF might be a better filler to support the elevated sinus membrane. However, adjunctive bone grafting should still be indicated for cases requiring more than 2-3 mm of intrasinus bone gain.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon.

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

Hydraulic Transcrestal Sinus Lift: Different Patterns of Elevation in Pig Sinuses.

PURPOSE: The aim of this study was to evaluate different patterns of sinus membrane elevation in pig jaws. MATERIALS AND METHODS: A total of 30 pig jaws (60 sinuses) were used for the present investigation. The hydraulic Crestal Approach Sinus kit was used to elevate sinus membrane, and different elevation patterns were recorded. RESULTS: There were 4 different scenarios of membrane separation patterns: center dome-shaped elevation, off-center dome-shaped elevation, horizontally spreading membrane elevation, and perforation. The incidence of each different type was 35.0% (n = 21) in center dome-shaped separation, 51.7% (n = 31) in off-center dome-shaped separation, 10.0% (n = 6) in horizontally spreading separation, and 3.3% (n = 2) in membrane perforation. CONCLUSION: Different patterns of membrane elevations are observed in pig sinuses and introduced in this study. The off-center dome-shaped elevation was the most common pattern followed by the center dome-shaped elevation and horizontally spreading elevation, respectively.

Postoperative effects of anterior nasal spine bone harvesting on overall nasal shape.

AIM: Bone harvesting from the anterior nasal spine (ANS) is frequently used to correct peri-implant bone defects, particularly during implant placement in the anterior maxilla. However, many clinicians are concerned about the postoperative effect of removing the ANS on the nasal outline, as the ANS is integral to supporting the nose. This study aimed to describe the technique of ANS bone grafting and to investigate postoperative effects of bone harvesting from the ANS on the overall nasal shape. MATERIAL AND METHODS: Fifteen patients with single maxillary first incisal rehabilitation using dental implant were enrolled in this prospective clinical study. Simply by extending the subperiosteal dissection in the same surgical field without additional local anesthesia, a bone block of about 0.25-0.5 ml could be harvested from the ANS. Nose width (NW), nasolabial angle (NLA), and nasal tip depth (NTD) were measured and analyzed by lateral and frontal photographs taken preoperatively (T0), and at postoperative 1 week (T1), 3 months (T2), and 6 months (T3). Postoperative complications were also recorded. RESULTS: A significant increase in NW and decrease in both NLA and NTD were found at T1 (P < 0.05). At T3, NW, NLA and NTD returned to preoperative measurements at T0 without major complications. CONCLUSIONS: The ANS could be an effective and easily accessible intraoral source for autologous bone. Despite acute soft tissue swelling, the net postoperative effects of removing the ANS on the overall nasal shape, including on nasal tip collapse or widening of the nose base, were negligible.

Assessment of dentists' subjective satisfaction with a newly developed device for maxillary sinus membrane elevation by the crestal approach.

PURPOSE: The purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit. METHODS: Thirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit. RESULTS: A total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation. CONCLUSIONS: From the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

Assessment of antidiabetogenic potential of fermented soybean extracts in streptozotocin-induced diabetic rat.

Most of the available drugs for the treatment of diabetes mellitus (DM) produce detrimental side effects, which has prompted an ongoing search for plant with the antidiabetic potential. The present study investigated the effect of soybean extracts fermented with Bacillus subtilis MORI, fermented soybean extracts (BTD-1) was investigated in streptozotocin (STZ)-induced diabetic rats. The possible effects of BTD-1 against hyperglycemia and free radical-mediated oxidative stress was investigated by assaying the plasma glucose level and the activity of enzymatic antioxidants, such as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), and malondialdehyde (MDA). A significant increase in the levels of both plasma glucose and reactive oxygen species (ROS) was observed in the diabetic rats when compared to normal control group. After administration of BTD-1 (500 and 1000 mg/kg/day), the elevated plasma glucose level was significantly reduced while the plasma insulin level and the activities of SOD, GSH-Px, CAT and MDA were significantly increased. The results suggest that administration of BTD-1 can inhibit hyperglycemia and free radical-mediated oxidative stress. The administration of BTD-1 also inhibited the contractile response by norepinephrine (10(-10)-10(-5) M) in the presence of endothelium, and caused significant relaxation by carbachol (10(-8)-10(-5) M) in rat aorta. These findings indicate that BTD-1 improves vascular functions on STZ-induced diabetic rats. Therefore, subchronic administration of BTD-1 could prevent the functional changes in vascular reactivity in STZ-induced diabetic rats. The collective findings support that administration of BTD-1 may prevent some diabetes-related changes in vascular reactivity directly and/or indirectly due to its hypoglycaemic effect and inhibition of production of ROS.

A multicenter prospective study in type IV bone of a single type of implant.

PURPOSE: To analyze the success and survival rates of the Osstem GSII (Osstem, Busan, Korea) implant in type IV bone. MATERIALS: A prospective, multicenter (5 centers) study was conducted by examining the relationship between implant success and survival rates, and several patient and surgical parameters. The implants were placed in 82 patients who visited several nationwide dental hospitals and clinics between 2007 and 2008, followed by clinical and radiographic analyses. RESULTS: In type IV bone, the implant success and survival rates were 93.23% and 95.83%, respectively. The maxillary premolar and mandibular anterior tooth areas showed success rates of 100%. The most widely used implant diameter and length was 5.0 and 13 mm, respectively, but the diameter and length had no effect on success rates. However, success rates appeared to decrease with age. CONCLUSIONS: The results indicated that the Osstem GSII implant is highly effective in poor-quality type IV bone.

Experimental study of bone response to hydroxyapatite coating implants: bone-implant contact and removal torque test.

OBJECTIVE: The objective of this study was to evaluate the early osseointegration of hydroxyapatite (HA)-coated implant. STUDY DESIGN: Twelve adult male miniature pigs were used in this study. The removal torque of implants placed in the tibia of miniature pigs was measured. For implants placed in the mandible, histomorphometric evaluation was performed for the evaluation of the bone-implant contact (BIC) ratio. RESULTS: After 4, 8, and 12 weeks, removal torque values were increased. Among the 3 groups, the HA-coated group showed the highest values (P < .05). At 4 and 8 weeks, the BIC ratio of HA was significantly higher than that of resorbable blast medium or sand blasted with alumina and acid etched (P < .05). CONCLUSIONS: It was concluded that HA-coated implants are relatively favorable in early loading stages.

Bony window repositioning without using a barrier membrane in the lateral approach for maxillary sinus bone grafts: clinical and radiologic results at 6 months.

PURPOSE: There has been considerable controversy about the placement of barrier membranes over osteotomy and graft sites in sinus bone grafts via the lateral window approach. Particularly when the sinus membrane remains intact, clinicians should consider the benefits and costs of a barrier membrane. This article presents clinical and radiologic findings following repositioning of a detached bony window without a barrier membrane in the lateral approach for maxillary sinus bone grafts. MATERIALS AND METHODS: After a complete 360-degree osteotomy on the lateral maxillary wall, a bony window was outfractured and separated from the sinus membrane by gentle elevation. After the sinus membrane was confirmed to be intact, grafting was carried out and the bony window was repositioned over the graft material without rigid fixation or a barrier membrane. Clinical and radiologic examinations were performed 6 months postoperative. The relationships between the patterns of gap bone healing, number of implants, time of implant placement (simultaneous with grafting or staged), and thickness of the lateral sinus wall were analyzed. The Fisher exact test and Spearman nonparametric correlation coefficient were employed for statistical evaluation. RESULTS: All 23 included patients experienced no complications. Overall external cortical healing and bone regeneration in the gap between the repositioned window and the lateral wall of the sinus were satisfactory. No significant differences in the patterns of gap bone healing were found, with respect to the number of implants placed or time of implant placement. As the lateral sinus wall was thinner, gap bone healing was better. To date, no implants have failed. CONCLUSION: A detached bony window that is repositioned on graft material might function as a barrier membrane in the lateral approach for maxillary sinus bone grafts.

Identification of the genes involved in 1-deoxynojirimycin synthesis in Bacillus subtilis MORI 3K-85.

1-Deoxynojirimycin (DNJ), a D-glucose analogue with a nitrogen atom substituting for the ring oxygen, is a strong inhibitor of intestinal α-glucosidase. DNJ has several promising biological activities, including its antidiabetic, antitumor, and antiviral activities. Nevertheless, only limited amounts of DNJ are available because it can only be extracted from some higher plants, including the mulberry tree, or purified from the culture broth of several types of soil bacteria, such as Streptomyces sp. and Bacillus sp. In our previous study, a DNJ-producing bacterium, Bacillus subtilis MORI, was isolated from the traditional Korean fermented food Chungkookjang. In the present study, we report the identification of the DNJ biosynthetic genes in B. subtilis MORI 3K-85 strain, a DNJ-overproducing derivate of the B. subtilis MORI strain generated by γ-irradiation, xhe genomic DNA library of B. subtilis MORI 3K-85 was constructed in Escherichia coli, and clones showing α-glucosidase inhibition activity were selected. After DNA sequencing and a series of subcloning, we were able to identify a putative Operon which consists of gabT1, yktc1, and gutB1 genes predicted to encode putative transaminase, phosphatase, and oxidoreductase, respectively. When a recombinant plasmid containing this Operon sequence was transformed into an E. coli strain, the resulting transformant was able to produce DNJ into the culture medium. Our results indicate that the gabT1, yktc1, and gutB1 genes are involved in the DNJ biosynthetic pathway in B. subtilis MORI, suggesting the possibility of employing these genes to establish a large-scale microbial DNJ overproduction system through genetic engineering and process optimization.

The value of brachial-ankle pulse wave velocity as a predictor of coronary artery disease in high-risk patients.

BACKGROUND AND OBJECTIVES: Arterial stiffness has been known as an independent contributory factor for coronary artery disease (CAD). Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of our study was to test whether baPWV had predictive value for CAD in the subset of patients with high pretest probability. SUBJECTS AND METHODS: We enrolled 174 consecutive patients who were referred for evaluation of suspected CAD, and who underwent both baPWV measurement and computed tomography (CT) for coronary artery calcium scoring (CACS) as part of a diagnostic work-up. Subsequently, 160 of those patients underwent invasive coronary angiography. The CAD indices consisted of 1) CACS, 2) modified Gensini scoring system, and 3) presence of obstructive CAD and 4) multi-vessel obstructive CAD. RESULTS: baPWV correlated with CACS (r=0.25, p=0.001), but not with modified Gensini scoring (r=0.10, p=0.19). However, after adjustment for factors influencing PWV, baPWV no longer correlated with CACS (r=0.14, p=0.14). By receiver operating characteristic (ROC) curve analysis, baPWV was neither a sensitive nor specific index for predicting the presence of obstructive CAD or multi-vessel obstructive CAD (sensitivity: 53% and 59%; specificity: 50% and 55%, respectively). CONCLUSION: Our findings demonstrated that baPWV is associated with CACS, however, this may be primarily attributed to common risk factors, such as age. Furthermore, baPWV may be of limited value in identifying patients at risk for CAD.

Evaluation of peri-implant tissue in nonsubmerged dental implants: a multicenter retrospective study.

OBJECTIVES: The objective of this study was to evaluate the peri-implant's hard and soft tissue response associated with the 1-stage, nonsubmerged, endosseous dental implant. STUDY DESIGN: A multicenter retrospective clinical evaluation was performed on 339 nonsubmerged implants placed in 108 patients at 5 clinical centers between January 2003 and December 2007. RESULTS: After a mean follow-up period of 30 months, the mean crestal bone resorption in 339 implants was 0.43 mm. The survival and success rates were observed to be 99.1% and 95.1%, respectively. The mean calculus, inflammatory, and plaque indices were 0.13, 0.37, and 0.73, respectively, and the mean width of buccal keratinized mucosa was observed to be 2.43 mm. CONCLUSION: The short- to intermediate-term evaluation of the 1-stage, nonsubmerged, endosseous implant yields relatively high survival and success rates.

Long-term exercise training attenuates age-related diastolic dysfunction: association of myocardial collagen cross-linking.

The incidence of diastolic heart failure increases dramatically with age. We investigated the impact of long-term exercise training on age-related diastolic dysfunction. Old (25-month-old) male Fischer 344 rats were studied after 12 weeks of treadmill exercise training or sedentary cage life (N=7, in each group). We determined cardiac performance using a pressure-volume conductance catheter and magnetic resonance imaging. Collagen volume fraction (CVF) and myocardial collagen solubility by pepsin as an index of advanced glycation end products (AGEs) cross-linked collagen were measured. The maximal slope of systolic pressure increment (+dP/dt) and the slope of end-systolic pressure-volume relation were higher, and end diastolic volume (EDV), Delta EDV (the percentage of the EDV increment-to-baseline EDV) and the slope of end-diastolic pressure-volume relation were lower in training group. The maximal slope of diastolic pressure decrement (-dP/dt) and time constant of LV pressure decay (tau) had no difference. AGEs cross-linked collagen, not CVF was reduced by exercise training. Long-term exercise training appears to attenuate age-related deterioration in cardiac systolic function and myocardial stiffness and could be reduce in pathologic AGEs cross-linked collagen in myocardium.