Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis.

The aim of this systematic review was to evaluate histomorphometric variables, the amount of new bone (NB), residual graft (RG) particles and soft tissue (ST), related to various grafting materials and assess the effect of graft healing time on different histomorphometric outcomes. Studies that were published before October 2015 were electronically and manually searched in three databases. We included human studies that reported the amount of NB, RG and ST in the biopsies taken from the grafted sinuses. Based on the applied grafting materials, extracted data were categorized into different groups. Furthermore, extracted data were classified into three groups based on healing time: (i) ≤ 4.5 mo; (ii) 4.5-9 mo; and (iii) ≥ 9-13.5 mo. The search provided 791 titles. Full text analysis was performed for 258 articles resulting in 136 studies that met the inclusion criteria. Autogenous bone (AB) resulted in the highest amount of NB and lowest amount of RG compared to other grafting materials. Based on this meta-analysis, a significant difference was noticed in the amount of NB formation in grafts with a healing time of > 4.5 mo when compared to the grafts with less healing time. However, when comparing biopsies taken at 4.5-9 mo of healing (average = 6.22 mo) to the ones taken at ≥ 9-13.5 mo (average = 10.36 mo), no significant difference was noticed in the amount of NB formation of various grafts except allografts that resulted in a significantly higher percentage of NB at 9.5 mo of healing. Based on histomorphometric analysis, AB results in the highest amount of NB formation in comparison to the other grafting materials. Bone substitute materials (allografts, alloplastic materials and xenografts) seem to be good alternatives to autogenous bone and can be considered as grafting materials to avoid disadvantages related to AB, including morbidity rate, limited availability and high volumetric change. Combining AB with alloplastic materials and xenografts brings no significant advantages regarding NB formation.

The influence of cortical bone perforation on guided bone regeneration in humans.

The purpose of this study was to evaluate the effect of cortical bone perforation on angiogenesis and osteogenesis of the augmented ridge in guided bone regeneration. Eighteen patients who had osseous defects in the mandible were selected. In the test group (n=9), alveolar cortical bone in the area of regeneration was perforated. No decortication was performed in the control group (n=9). Subsequently, defects were augmented by guided bone regeneration using resorbable membrane and bovine bone. After a healing period of 7 months, trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. Histomorphometry demonstrated that the amount of newly formed bone in the test group (27.8%) was greater than that in the control group (25.3%), but the difference was not statistically significant (P=0.13). However, the mean number of microvessels in the test group was significantly higher than that in the control group (P=0.01). This study found that cortical bone perforation favourably affects the amount of new bone formation in the grafted sites after 7 months of healing. Cortical bone perforation significantly increase number of new vessels (angiogenesis) of the regenerated bone. Further randomized clinical trials are required to confirm these results.

Paranasal sinuses malignancies: A 12-year review of clinical characteristics.

BACKGROUND: Inadequate epidemiologic investigations of the paranasal sinuses malignancies prompted this retrospective study with special emphasis on a major group of 111 tumors. MATERIAL AND METHODS: Clinical records of 111 patients with histologically confirmed malignant tumors of the paranasal sinuses were investigated retrospectively from April 2000 to January 2012. Collection of data included demographic information, clinical manifestations, treatment plans, and histopathology of the tumor. RESULTS: There were 69 (62.16%) male and 42 (37.83%) female patients (male-to-female ratio of 1.6:1), with a median age of 49±12.2 years (range 21 to 88 years). A high level of occurrence was noticed in the fifth (26.3%) decade of life. The most frequent histological types were squamous cell carcinoma (43.5%) and adenoid cystic carcinoma (19%). Among clinical manifestations, nasal obstruction was the most frequent followed by diplopia, and facial swelling. Fifty three patients (47.74%) were treated with combined approach of surgery and radiation therapy. CONCLUSIONS: Paranasal sinuses malignancies are rare conditions with nonspecific symptoms which make early diagnosis of the lesions more challenging. The optimal therapeutic protocol for patients suffering from these tumors is still a somewhat controversial entity and requires further studies.

Incidence of craniofacial pain of cardiac origin: results from a prospective multicentre study.

BACKGROUND: The aim of this study was to reveal the incidence and distribution pattern of craniofacial pain of cardiac origin. METHODS: We undertook a prospective study of 248 consecutive patients (aged 26 to 88 years) hospitalized with confirmed cardiac ischaemic periods. Digital OPG radiographs were obtained from all patients for radiographic examination of the jaws and dentition. Patients underwent clinical and radiographic examinations, and symptoms were evaluated in detail to determine the prevalence and distribution pattern of craniofacial pain of cardiac origin. RESULTS: Craniofacial pain was the sole symptom of cardiac ischaemia in 13 patients (5.2%); two developed acute myocardial infarction (AMI). Pain in the craniofacial region, chest, shoulders and arms was experienced by 72 patients. The most frequently affected region was the left mandible. In the absence of chest pain, patients most frequently experienced pain in craniofacial structures. Incidence of craniofacial pain was significantly higher in females than males (p = 0.024). CONCLUSIONS: Cardiac pain commonly radiates to the craniofacial structures. Pain of cardiac origin is usually described as pressure and/or a burning sensation that is provoked by physical activity and relieved by rest. Craniofacial pain of cardiac origin usually occurs bilaterally. Dental practitioners can play a crucial role in the diagnosis of craniofacial pain of cardiac origin.