Open surgical wounds: how does Aquacel compare with wet-to-dry gauze?

OBJECTIVE: To compare the healing rates of a hydrofibre dressing (Aquacel) and normal wet-to-dry gauze in the treatment of open surgical wounds. METHOD: Fifty patients with open surgical wounds were randomized to receive either saline-moistened gauze or Aquacel. The rate of wound healing was measured as ml/day (deep wounds) or cm2/day (superficial wounds) at each dressing change until an investigator blinded to the patient group diagnosed the wounds as having healed or the patient was withdrawn from the study. RESULTS: Of the 50 patients, seven were withdrawn from the study after the first evaluation. Of the remaining 43 patients, 21 had been randomly allocated to the gauze group and 22 to the Aquacel group. For deep wounds, a mean change in the wound healing rate of 1.9 +/- 1.3 cm3/day was reported for the gauze group and 2.9 +/- 2.3 cm3/day for the Aquacel group. These results approach statistical significance (p = 0.082). For superficial wounds, the mean change in the healing rate was 1.6 +/- 1.5 cm2/day for the gauze group and 1.9 +/- 2.2 cm2/day for the Aquacel group, but this was not statistically significant. CONCLUSION: Aquacel appears to be at least as effective as wet-to-dry gauze in the healing of open surgical wounds.

The use of a soft tissue expander in an alveolar bone ridge augmentation for implant placement.

A narrow mandibular posterior alveolar ridge was modified by the use of a soft tissue expander to generate adequate tissue for graft coverage. The principles of osteoperiosteal flaps were combined with guided bone regeneration techniques for an optimum amount of bone at the site.

Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption.

The aim of this study was to study sugar maldigestion/malabsorption in patients with functional dyspepsia using H2 breath testing. End-expiratory breath H2 after separate challenges with lactose (25 g), fructose (25 g), and sorbitol (5 g) were used to determine malabsorption, as well as small bowel transit time (SBTT). Five hundred twenty patients with functional dyspepsia received all three challenges. Smaller groups were also tested after lactulose (10 g, N = 36) and glucose (50 g, N = 90) challenges. Fructose and sorbitol were closely linked with respect to absorption and malabsorption status. Only in the case of lactose maldigestion/malabsorption was there a greater than random prevalence of malabsorption (P < 0.001) for fructose and sorbitol. In contrast to lactose, ethnic origin did not influence fructose or sorbitol malabsorption, and females predominated among fructose and sorbitol malabsorbers. In Jews, the prevalence of lactose maldigestion/malabsorption decreased in the age group of 25-55 and subsequently rose after 55, while fructose and sorbitol malabsorption decreased progressively with advancing age. With respect to small bowel transit time (SBTT), in the case of sorbitol and lactulose, it was significantly greater (P < 0.05) than those for fructose and lactose. Multiple sugar malabsorptions are common when lactose maldigestion/malabsorption is present.

Guided tissue regeneration using a biodegradable barrier membrane for new attachment: a clinical, histologic, and histometric study in dogs.

Although nonbiodegradable barrier membranes have proven partially successful in achieving regeneration of lost periodontium through the principles of guided tissue regeneration, their use requires a second surgical procedure for their removal. The results of a study, in which a biodegradable collagen membrane was used to treat dehiscence defects in dogs, are presented. The membrane was an effective barrier to the downgrowth of gingival epithelium during the early stages of healing and tended to increase the regeneration of new cementum and connective tissue attachment. It was also biocompatible and biodegradable.

Guided tissue regeneration with and without decalcified freeze-dried bone in mandibular Class II furcation invasions.

The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.

Decision making with pregnant patients: a policy born of experience.

One hospital has developed an institutional policy to guide decision making between physicians and pregnant patients. Read the policy and a description of how it was developed by the ethics committee at the George Washington University Hospital.

The effectiveness of the Titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical comparison of the effect on the gingiva of the Prophy-Jet and the rubber cup and paste techniques.

This clinical trial compared the effect on the gingiva of the Prophy-Jet and the rubber cup and paste techniques of stain and supragingival plaque removal. Twenty-one human subjects with healthy gingiva or slight gingivitis participated. A split mouth design was used. The Prophy-Jet caused a statistically significant increase (P less than 0.05) in gingival irritation immediately posttreatment, but the differences were not deemed clinically significant. There were no statistically significant (P less than 0.05) or clinically significant differences in the effect on the gingiva between the two techniques at 7 and 21 days posttreatment. There was no lasting difference in gingival trauma between the two methods of stain and supragingival plaque removal in subjects with healthy gingiva or slight gingivitis.

The laterally positioned odontogenic keratocyst. A case report.

An odontogenic keratocyst which was in a lateral periodontal location is reported. The histology of the odontogenic keratocyst is compared with that of the lateral periodontal cyst. The importance of correctly diagnosing the odontogenic keratocyst is stressed, especially in view of its high recurrence rate and its possible association with the basal cell nevus syndrome.