Accuracy of vertical height measurements on direct digital panoramic radiographs using posterior mandibular implants and metal balls as reference objects.

OBJECTIVES: Conventional panoramic radiography, a widely used radiographic examination tool in implant treatment planning, allows evaluation of the available bone height before inserting posterior mandibular implants. Image distortion and vertical magnification due to projection geometry is well described for rotational panoramic radiographs. To assess the accuracy of vertical height measurements on direct digital panoramic radiographs, implants and metal balls positioned in the posterior mandible were used as radio-opaque reference objects. The reproducibility of the measuring method was assessed by the inter- and intraobserver agreements. METHODS: Direct digital panoramic radiographs, performed using a Kodak 8000C (Eastman Kodak Company, Rochester, NY), of 17 partially edentulous patients (10 females, 7 males, mean age 65 years) were selected from an X-ray database gathered during routine clinical evaluation of implant sites. Proprietary software and a mouse-driven calliper were used to measure the radiological length of 25 implants and 18 metal reference balls, positioned in mandibular posterior segments. The distortion ratio (DR) was calculated by dividing the radiological implant length by the implant's real length and the radiological ball height by the ball's real height. RESULTS: Mean vertical DR was 0.99 for implants and 0.97 for balls, and was unrelated to mandibular sites, side, age, gender or observer. Inter- and intraobserver agreements were acceptable for both reference objects. CONCLUSIONS: Vertical measurements had acceptable accuracy and reproducibility when a software-based calibrated measurement tool was used, confirming that digital panoramic radiography can be reliably utilized to determine the pre-operative implant length in premolar and molar mandibular segments.

Microbicidal properties of Leukocyte- and Platelet-Rich Plasma/Fibrin (L-PRP/L-PRF): new perspectives.

Platelets, as main actors of the first stage of the healing process, play an important role in tissue repair. Their granules contain many active substances, particularly over 30 growth factors with significant effects on the resident cells at the site of injury, such as mesenchymal stem cells, chondrocytes, fibroblasts, osteoblasts. This potential may be increased by the concentration of the platelets, using platelet-rich plasma/fibrin products. In the four families of platelet concentrates, 2 families contain also significant concentrations of leukocytes: L-PRP (Leukocyte- and Platelet-Rich Plasma) and L-PRF (Leukocyte- and Platelet-Rich Fibrin). Inductive properties of platelet concentrates were widely described. However, they present also antimicrobial effects. The antibacterial effects of L-PRP were highlighted in only a few in vitro studies. Strong activity comparable to gentamicin and oxacillin for L-PRP against methicillin susceptible Staphylococcus aureus (MSSA) was already demonstrated. L-PRP also inhibited the growth of methicillin resistant Staphylococcus aureus (MRSA) and Escherichia coli. Some authors also reported clinical observations about the reduction of infections and the induction of healing processes after the use of platelet concentrates in cardiac, orthopaedic, oral and maxillofacial surgery. However, very little is yet known about the antibacterial effects of these concentrates. In this manuscript, the current data about the antimicrobial agents and cells present in the platelet-rich plasma/fibrin are highlighted and discussed, in order to introduce this new key chapter of the platelet concentrate technology history.

[Mouthwash solutions containing microencapsulated natural extracts: Clinical results on dental plaque and gingivitis]. / Bains de bouche aux extraits naturels microencapsulés : résultats cliniques sur la plaque dentaire et la gingivite.

INTRODUCTION: New mouthwash solutions containing microencapsulated natural extracts have been developed. Besides antiseptic activity, these solutions have antioxidant and immunoregulatory properties on oral tissues. The objective of this preliminary clinical study was to assess the efficiency of a mouthwash containing microencapsulated natural extracts (GingiNat, LoB5 Foundation, Paris, France) on gingivitis. PATIENTS AND METHODS: Twenty volunteers (37 + or - 2 years) with significant gingivitis (bleeding when tooth-brushing) used a 6% GingiNat mouthwash solution, two to three times per day (according to oral hygiene habits) for 21 days in addition to their usual oral care. Each volunteer was examined at day 0, 4, 7 and 21. The Löe and Silness Plaque Index, the Russel Periodontal Index, a breath index (halitosis), and oral tissue tolerance were assessed. Finally, each volunteer filled in a daily follow-up form and answered a questionnaire on tolerance and acceptability. RESULTS: A significant decrease of the dental plaque index was observed on day 4, 7, and 21, in respectively 29, 48 and 71% of volunteers. This decrease reached 18% on day 4 (p=0.014), 32% on day 7 (p=0.002), and 47% on day 21 (p<0.001). A significant decrease of the periodental index was observed on day 4, 7 and 21, in respectively 52, 81 and 95% of volunteers. This decrease reached 30% (p=0.001) on day 4, 49% (p<0.001) on day 7, and 78% (p<0.001) on day 21. A significant improvement of the breath index was noted on day 4, 7, and 21, in respectively 43, 52 and 48% of volunteers. This improvement reached 29% (p=0.004) on day 4, 35% (p=0.001) on day 7, and 32% (p=0.002) on day 21. The mouthwash was well tolerated. The patients liked its effectiveness and organoleptic properties. All patients expressed the wish to continue using this solution. DISCUSSION: The GingiNat mouthwash solution at 6% had a significant efficiency on plaque, gingivitis, and halitosis after 21 days of use. This makes it a good complementary treatment for gingivitis. Tolerance and acceptability were good despite the long and repeated use. Further studies are needed to have a detailed analysis of its efficiency in the long run and on patients presenting with various forms of periodontitis.

[Mouthwash solutions containing microencapsuled natural extracts: In vitro evaluation of antioxidant properties (dental plaque and gingivitis)]. / Bains de bouche aux extraits naturels microencapsulés : évaluation in vitro des propriétés antioxydantes (plaque dentaire et gingivite).

INTRODUCTION: New mouthwash solutions containing microencapsulated natural extracts were developed to provide both antiseptic activity and in depth treatment of oral tissues, due to their antioxidant and immunoregulatory properties. The objective of this study was to quantify the antioxidant action of the GingiNat solution (LoB5 Foundation, Paris, France) in an in vitro cell model. MATERIALS AND METHODS: Diluted GingNat solutions (0.12%, 0.06% and 0.012%) were put in contact with Jurkat type human lymphoid cells in basal radical state (cells at rest) and in provoked oxidative stress conditions (after an UVA+UVB irradiation). The lipid peroxidation was quantified by flow cytometry using a fluorescent probe. RESULTS: The diluted GingNat solutions at 0.12%, 0.06%, and 0.012% showed a significant antioxidant effect with respectively 122.9%, 117.8% and 119.3% on average. The difference was statistically significant compared to controls for the three concentrations without any significant difference among them. This antioxidant effect was even more significant when cells were in oxidative stress with respectively 155.3%, 139.3%, and 132.5% on average. There was a significant difference between the tested concentrations (p<0.01). DISCUSSION: These first in vitro results confirmed the antioxidant properties of the GingiNat solution. These antioxidant properties are significantly higher at stronger concentrations. Further studies are required to analyze the influence of microencapsulation on these results. Clinical trials are needed to confirm these antioxidant properties.

[Mouthwash solutions with microencapsuled natural extracts: Efficiency for dental plaque and gingivitis]. / Bains de bouche aux extraits naturels microencapsulés : effets sur la plaquedentaire et la gingivite.

Mouthwash solutions are mainly used for their antiseptic properties. They currently include synthetic agents (chlorhexidine, triclosan, etc.) or essential oils (especially Listerine). Many natural extracts may also be used. These associate both antiseptic effects and direct action on host response, due to their antioxidant, immunoregulatory, analgesic, buffering, or healing properties. The best known are avocado oil, manuka oil, propolis oil, grapefruit seed extract, pycnogenol, aloe vera, Q10 coenzyme, green tea, and megamin. The development of new technologies, such as microencapsulation (GingiNat concept), may allow an in situ slow release of active ingredients during several hours, and open new perspectives for mouthwash solutions.

[Advantages of combined therapies in cosmetic medicine for the treatment of face aging: botulinum toxin, fillers and mesotherapy]. / Intérêt des thérapies combinées en médecine esthétique pour le traitement du vieillissement du visage: toxine botulique, fillers et mésothérapie.

Non surgical cosmetic medicine procedures for the face are developing considerably, as they deliver good results using simple, non invasive, atraumatic and reproducible techniques. Aesthetic mesotherapy, also known as anti-aging mesotherapy, uses intra-dermal injections of a nutritive and moisturizing solution to improve brightness, skin hydration and tonus, and also smooth out superficial wrinkles. Subcutaneous filler injections enable to fill wrinkles and folds; by using high density products it is also able to provide genuine facial volumetric reconstruction. Finally, botulinum toxin acts by reducing certain muscle contractions to smooth out expression lines and folds induced by facial dynamics. In this article, we explore the concept of combined therapy and describe our experience associating anti-aging mesotherapy (NCTF-135HA, Filorga, Paris, France), hyaluronic acid based fillers (X-HA3 and X-HA-Volume, Filorga, Paris, France) and botulinum toxin (Vistabel, Allergan, Irvine CA, USA). A therapy combining anti-aging mesotherapy, botulinum toxin and filler injections, offers full treatment of the 3 biological levels of the covering tissues. This non-invasive therapeutic strategy brings patient satisfaction through a global approach to facial aging.

[The relevance of Choukroun's Platelet-Rich Fibrin (PRF) during middle ear surgery: preliminary results]. / Place des facteurs de croissance (Platelet-Rich Fibrin de Choukroun) dans la chirurgie de l'oreille moyenne: résultats préliminaires.

OBJECTIVES: To evaluate the relevance of Leucocyte- and Platelet-Rich Fibrin (L-PRF, Choukroun's technique) Concentrates during tympanoplasty. MATERIALS AND METHODS: 152 myringoplasties (including 2 cases with bilateral tympanic perforations) were treated by the senior surgeon in 150 patients, 63 women and 87 males aged between 25 and 55-years-old, between december 2004 and june 2008. These patients showed non marginal tympanic perforations, sized from punctiform to subtotal. For the smallest perforations, a PRF cylinder was used alone to fill the perforation without preparing a tympanomeatus flap (Champagne plug technique). For perforations largest than the third of the tympanic surface, temporal aponeurosis graft in underlay was preferred, and optimized by the lateral application of a PRF membrane (hamburger technique). RESULTS: 6 failures were recorded in this case series, with tympans showing residual microperforations, after a minimum follow-up of 6 months. The success rate was thus close to 96%. The mean success rate without PRF is normally 85%. All failures were recorded on large non marginal lesions. CONCLUSION: PRF will never save an inadequate surgical procedure, but it offers both mechanical and inflammatory protection to the tympanic graft and accelerates cell proliferation and matrix remodelling. Moreover, this autologous biomaterial induces no undesirable tissue reaction, is easy, quick and cheap to produce and is easily manipulated during the surgical procedure. It seems a precious help for the otologist, in order to improve tympanic healing. PRF potential applications in the middle-ear surgery seem numerous.

[Medical rhinoplasty: rationale for atraumatic nasal modelling using botulinum toxin and fillers]. / La rhinoplastie médicale : de l'usage de la toxine botulique et des produits de comblement pour un remodelage atraumatique du nez.

OBJECTIVES: To describe the new techniques for medical rhinoplasty, associating fillers and botulinum toxin without invasive surgery, to evaluate their efficiency with a retrospective analysis on 85 patients for 2 years, and to discuss the adequate indications for this new approach. MATERIAL AND METHODS: Between january 2006 and january 2008, 85 patients were treated using a non surgical approach for aesthetic disorders of the nasal pyramid. 62 women and 23 men were included, with different indications: 32 primary rhinoplasties, 53 secondary rhinoplasty corrections. Fillers were used alone in 58 cases, botulinum toxin alone in 12 cases, and both products were used together in 15 cases. Botulinum toxin was always an A-type toxin. For fillers, reticulated hyaluronic acid was used in 56 cases, calcium hydroxyapatite in 11 cases, tricalcium phosphate in 2 cases, L-polylactic acid in 2 cases and polyacrylamid gel in 2 cases. Fillers were injected after application of anaesthetic gel, and placed in depth with osteocartilaginous contact following a retro-tracing movement. At the end of the procedure, the nose was manually modelled in order to improve the product distribution. Botulinum toxin injection was performed without anaesthesia following a specific protocol. Clinical results were evaluated by the patient and the physician immediately after treatment, after 15 days and after 1 month. The satisfaction index was based on 3 answers after 1 month: very satisfactory, satisfactory, insufficient. RESULTS: In this series of 85 cases, the satisfaction index was very high (66/85 patients, very satisfactory result), higher than the classical values obtained after other treatments of face wrinkles and defects (apart from botulinum toxin effects). The complication rate was very low, with only one reversible case in this series (infection of the tip on a multi-operated nose). The durability of results was dependent on the product: 4 months for botulinum toxin, 12 to 14 months after 2 injections for resorbable fillers. CONCLUSION: Medical rhinoplasty provides a large range of therapeutic solutions for minor corrections of nasal morphological or dynamic defects. The benefit/risk ratio for all aesthetic treatments must be high, what implies to reach the best result with the less complex, invasive and brutal protocol. This new approach for rhinoplasty fits in totally with actual patient expectations. The main inconveniences of this approach are the short durability of results and the cost of the procedure repetition.

Relevance of Choukroun's Platelet-Rich Fibrin (PRF) and SMAS flap in primary reconstruction after superficial or subtotal parotidectomy in patients with focal pleiomorphic adenoma: a new technique.

AIM OF THE STUDY: Parotidectomy leaves a retromandibular hollow area in proportion with the amount of gland resected. Many surgeons perform primary reconstruction after superficial or subtotal parotidectomy in patients with exo-facial pleiomorphic focal adenoma. Many techniques have been proposed. We present a new technique of filling of the parotidectomy chamber by a second generation leucocyte and platelet concentrate, Platelet-Rich Fibrin (PRF, Choukroun's method). PATIENTS AND METHODS: 10 patients were included in this preliminary study. Subtotal parotidectomy was performed through classic procedure or lifting procedure. The macroscopic security margin of resection usually allowed performance of a SMAS flap. PRF was prepared following the original Choukroun's method. RESULTS AND DISCUSSION: PRF slow resorption after filling of the exeresis cavity, offers a key aesthetic interest. The fibrin matrix of this biomaterial has many angiogenic and healing properties. Synergetic action of the fibrin and the platelets cytokines within PRF may improve revascularization and postoperative resumption of facial nerve function. The membrane formed by the fibrin dense fibrillary network, as well as the SMAS flap, may help to prevent the Frey's syndrome. CONCLUSION: We propose the use of PRF as a filling, healing and interposition material after parotidectomy for benign parotid tumors. Preliminary results are very encouraging. Longer prospective evaluation of this technique is necessary.