Minimally invasive transcrestal sinus floor elevation with graft biomaterials. A randomized clinical trial.

OBJECTIVES: The present study was performed to comparatively evaluate the effectiveness and post-operative morbidity of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of two graft biomaterials. METHODS: Thirty sites in 30 patients were randomly assigned to tSFE in association with either deproteinized bovine bone mineral (DBBM) (n = 15) or synthetic hydroxyapatite in a collagen matrix (S-HA) (n = 15). In both groups, the extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. Surgical and post-surgical complications as well post-surgical pain and discomfort were also assessed. RESULTS: The results of the study indicated that (i) immediately post-surgery, both DBBM and S-HA resulted in substantial SL and aGH, which were maintained at 6 months, (ii) greater aGH and SL were observed in S-HA group compared with DBBM group at 6 months post-surgery and (iii) limited surgical complications and post-operative pain/discomfort were associated with the use of both graft biomaterials. CONCLUSIONS: The Smart Lift technique in conjunction with the additional use of either S-HA or DBBM may provide a predictable elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort. SL and aGH were significantly greater at 6 months for S-HA than DBBM.

Minimally invasive technique for transcrestal sinus floor elevation: a case report.

The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant.

Transcrestal sinus floor elevation with a minimally invasive technique.

BACKGROUND: Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique. METHODS: Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery. RESULTS: The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 +/- 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 +/- 13.4 and 17.0 +/- 22.2, respectively. The 7-day VAS score for pain was 2.1 +/- 4.9. No complications were observed during or after the surgical procedure. Six months after surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases. CONCLUSION: The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

Clear-cell myoepithelial carcinoma of the salivary glands: a clinicopathologic, immunohistochemical, and ultrastructural study of two cases involving the submandibular gland with review of the literature.

Myoepithelial carcinoma (MC) is an uncommon neoplasm of the salivary glands, and cases of the clear-cell (CC) variant are extremely rare. Two cases of MC of the CC variant arising in the left submandibular gland are described herein. Both cases, which involved elderly women, almost exclusively consisted of large glycogen-rich CCs. Both cases were immunopositive for several epithelial and myoepithelial markers, and electron microscopy (EM) demonstrated hybrid epithelial and myoid differentiation in both. Case 1 arose in a pre-existing pleomorphic adenoma ("ex mixed tumor MC"), while Case 2 was a "de novo MC". CC-MC is an aggressive tumor with frequent recurrence, lymph node, and systemic metastases. A total of 14 cases of this type of neoplasm have been reported so far in the salivary glands, two arising from the submandibular gland. To date, only four cases have been studied using EM. The cases of CC-MC presented here are the third and fourth ones, respectively, originating from the submandibular glands, and the first two cases arising from this location, in which EM investigation succeeded in demonstrating myoepithelial differentiation. CC-MC needs to be distinguished from diverse primary and secondary CC neoplasms.

Hepatitis C virus chronic infection and oral lichen planus: an Italian case-control study.

OBJECTIVE: The aim of the study was to investigate the possible epidemiological relationship between hepatitis C virus (HCV) chronic infection and oral lichen planus (OLP) in centre-south Italy. METHODS: In a case-control study three groups of patients were investigated: group 1 (82 patients): patients with histologically confirmed OLP were tested for HCV infection; group 2 (165 patients): patients with chronic HCV infection were examined for OLP; group 3 (466 participants): control group: healthy individuals who had been hospitalized in the Trauma-Orthopaedic Ward and had been tested for HCV. RESULTS: In group 1, 11.4% of the participants were HCV-positive and HCV was found in 10.8% of the patients above 50 years of age. Eight participants (5.5%) of group 2 showed lesions possibly related to OLP: only two had a histology consistent with OLP. In group 3, 5.4% participants had chronic HCV infection, but HCV was found in 10% of the participants of 50 years and above. A weak overall association between HCV and OLP (odds ratio 2.27; 95% confidence interval 0.94, 5.35; P<0.05) was seen and the result was not statistically significant in participants aged 50 years and above (odds ratio 1.08; 95% confidence interval 0.39, 2.88; P=0.86). CONCLUSION: Our data suggest that no clear association exists between OLP and chronic HCV disease. It is possible that the association is mainly due to the frequency of each disease in the population.