Material de injerto en elevación de seno de acceso lateral: ¿es necesario? Parte II / Graft material in lateral sinus lift, is it necessary?: Part II

Introducción: Las extracciones dentarias producen una reabsorción del proceso alveolar en sentido horizontal y vertical además de la neumatización del seno. Estos cambios óseos en la zona posterior del maxilar pueden comprometer la colocación de implantes. La técnica convencional o de acceso lateral sigue siendo la técnica más utilizada para realizar elevaciones de seno maxilar. Estas elevaciones se realizan tanto sin injertos óseos como con diferentes biomateriales. Existe cierto debate sobre si es necesario colocar o no injerto. Objetivo: Analizar y comparar la ganancia ósea en elevaciones de seno de acceso lateral con injerto y sin injerto. Material y método: Se realizó una búsqueda electrónica para la actualización del tema en tres bases de datos y una serie de libros relacionados. Resultados: Se obtiene una ganancia de 4,0-6,14 mm cuando no se emplea material de injerto y entre 3,11-13,1 mm cuando se emplean biomateriales. Los estudios reflejan una pérdida ósea marginal entre 1,01-1,9 mm cuando no se emplea material de injerto y 2,3 mm de media cuando se emplean biomateriales. La técnica de elevación de seno de acceso lateral sin empleo de biomaterial presenta unas tasas de supervivencia elevadas pero las tasas de supervivencia son ligeramente superiores cuando se emplean biomateriales. La tasa de complicaciones es baja para ambas técnicas, siendo la más frecuente la perforación de la membrana de Schneider, que no parece suponer un impedimento para la colocación de implantes. Conclusión: la técnica de elevación convencional con relleno obtiene mayor ganancia ósea, pero mayor pérdida ósea marginal y presenta una tasa de supervivencia alta de implantes en comparación con la técnica que no emplea material de injerto, por lo que se debe individualizar cada caso para decidir si es necesario o no la utilización de un sustituto óseo. (AU)

Introduction: dental extractions produce a resorption of the alveolar process, horizontally and vertically in addition to pneumatization of the sinus. These bone changes in the posterior area of the maxilla can compromise implant placement. The conventional or lateral access technique is still the most used technique to perform maxillary sinus elevations. These elevations are performed without bone grafts and with different graft biomaterials where there is some discussion whether or not it is necessary to place a graft. Objective: Analyze and compare bone gain in graft and non-graft lateral access sinus lifts. Material and method: An electronic search was carried out to update the subject in three databases and a series of related books. Results: A gain of 4.0-6.14 mm is obtained when no graft material is used and between 3.11-13.1 mm when biomaterials are used. Studies show a marginal bone loss between 1.01-1.9 mm when no graft material is used and 2.3 mm on average when biomaterials are used. Lateral access sinus elevation technique without the use of biomaterial has high survival rates but survival rates are slightly higher when biomaterials are used. Rate of complications is low for both techniques, the most frequent being the perforation of Schneider’s membrane, which doesn’t seem to be an impediment to the placement of implants. Conclusion: conventional lift technique with filling obtains greater bone gain, but greater marginal bone loss and presents a high implant survival rate compared to the technique that doesn’t use graft material, so each case must be individualized to decide if it’s necessary or not the use of a bone substitute. (AU)

Regeneración ósea con injertos intraorales: rama vs. mentón. Puesta al día / Bone regeneration with intraoral graft: ramus vs. chin. Updating

La utilización de injertos intraorales en bloque es una alternativa de tratamiento válida para la regeneración en anchura de defectos óseos maxilares y mandibulares. Sin embargo, actualmente no hay consenso entre los diferentes autores en la elección del mejor tipo de bloque intraoral a utilizar. Por ende, esta puesta al día busca comparar la ganancia ósea, la tasa de complicaciones postoperatorias y el éxito del injerto entre bloques autólogos de rama mandibular y mentón. La ganancia ósea alcanzada es similar en ambos bloques. No obstante, se podría deducir una mayor ganancia al utilizar bloques de la rama mandibular cuando son evaluados mediante CBCT. Además, la tasa de reabsorción ósea fue menor con los injertos de rama. La supervivencia de los implantes es equiparable con ambos tipos de injertos. Las complicaciones que tienen lugar, en orden de frecuencia, son las alteraciones sensoriales, las necrosis pulpares, dehiscencias y hemorragias; apareciendo con mayor frecuencia en los bloques de mentón. Además, el periodo de recuperación en las zonas de rama mandibular es más lento. De este modo, a la hora de la elección parece razonable individualizar el caso y tener en consideración aspectos como la morbilidad y el acceso a la zona donante. (AU)

The use of intraoral block grafts is a valid treatment alternative for the regeneration of maxillary and mandibular horizontal bone defects. However, there is currently no consensus among different authors on the choice of the best type of intraoral bone block to use. Therefore, this update seeks to compare bone gain, post-operative complication rate and grafting success between autologous mandibular ramus and chin bone block grafts. The bone gain achieved is similar in both block grafts. However, a higher gain can be observed by CBCT when using mandibular ramus blocks. In addition, the rate of bone resorption is lower with ramus grafts. Implant survival is comparable in both types of grafts. The complications that occur, in order of frequency, are sensory alterations, pulp necrosis, dehiscence and bleeding, appearing more frequently in chin blocks. In addition, the recovery period in the mandibular ramus areas is slower. Thus, when choosing, it seems reasonable to individualize the case and take into consideration aspects such as morbidity and access to the donor area. (AU)

Genetic variants in the LPL and GPIHBP1 genes, in patients with severe hypertriglyceridaemia, detected with high resolution melting analysis.

INTRODUCTION: Pathogenic variants in lipoprotein lipase (LPL) and glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) have been described in patients with severe hypertriglyceridaemia. We aimed to optimise high resolution melting (HRM) assays to detect the presence of functional variants in these genes. METHODS: One hundred and sixteen patients with severe hypertriglyceridaemia were studied. HRM assays were optimised to scan exons and splice junctions in LPL and GPIHBP1. Sanger sequencing was the reference method. Next-generation-sequencing (NGS) was performed in five patients, including one with Familial Chylomicronemia syndrome (FCS). RESULTS: We identified 15 different variants in LPL and 6 in GPIHBP1. The variants revealed with NGS were also detected with HRM, including a rare premature stop codon in LPL (p.Trp421*) and two LPL pathogenic variants in the patient with FCS (p.His80Arg + p.Gly215Glu). Having multiple functional variant alleles was associated with pancreatitis onset at younger ages and higher baseline triglycerides. CONCLUSIONS: Our HRM assays detected the presence of functional gene variants that were confirmed with Sanger and NGS sequencing. The presence of multiple functional variant alleles was associated with differences in the clinical profile. Therefore, these assays represent a reliable, cost-effective tool that can be used to complement the NGS approach for gene scanning.

Fractional excretion of phosphorus and vascular calcification in stage 3 chronic kidney disease.

The role of renal excretion of Pi in relation to vascular calcification (VC) in patients in the early stages of chronic kidney disease (CKD) is controversial. Thus, we determine the relation between fractional excretion of phosphorus (FEP) and VC, measured using two methods in a cross-sectional study of patients with stage 3 CKD. We recorded demographic data, anthropometry, comorbidities and active treatment. We measured 24-hour urine FEP and, in serum, measured fibroblast growth factor 23 (FGF23), α-Klotho, intact parathyroid hormone (iPTH), calcium and phosphorus. VC was measured by lateral abdominal radiography (Kauppila index (KI)) and CT of the abdominal aorta (measured in Agatston units). In 57% of subjects, abnormal VC was present when measured using CT, and in only 17% using lateral abdominal radiography. Factors associated with VC using CT were age, cardiovascular risk factors, vascular comorbidity, microalbuminuria and levels of FGF23, phosphorus and calcium x phosphorus product (CaxP); although only age (OR 1.25, 95% CI 1.11 to 1.41), smoking (OR 21.2, CI 4.4 to 100) and CaxP (OR 1.21, CI 1.06 to 1.37) maintained the association in a multivariate analysis. By contrast, only age (OR 1.35, 95% CI 1.07 to 1.74), CaxP (OR 1.14, CI 1.13 to 1.92) and FEP (OR 1.07,95% CI 1004 to 1.14) were associated with abnormal VC in the lateral abdominal radiography. In conclusion, in patients with stage 3 CKD, the detection of VC by abdominal CT is more sensitive than conventional X-rays. Moreover, CaxP is associated with cardiovascular risk factors and vascular comorbidity; quantification of FEPi in these patients provides additional clinical information in advanced VC detected by KI.

Mucormicosis pulmonar en paciente joven con inicio de diabetes mellitus / Pulmonary mucormycosis at onset of diabetes in a young patient

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Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

Peripheral arterial disease, manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus. Several reasons exist for peripheral arterial disease in diabetes. In addition to hyperglycaemia, smoking and hypertension, the dyslipidaemia that accompanies type 2 diabetes and is characterised by increased triglyceride levels and reduced high-density lipoprotein cholesterol concentrations also seems to contribute to this association. Recent years have witnessed an increased interest in postprandial lipidaemia, as a result of various prospective studies showing that non-fasting triglycerides predict the onset of arteriosclerotic cardiovascular disease better than fasting measurements do. Additionally, the use of certain specific postprandial particle markers, such as apolipoprotein B-48, makes it easier and more simple to approach the postprandial phenomenon. Despite this, only a few studies have evaluated the role of postprandial triglycerides in the development of peripheral arterial disease and type 2 diabetes. The purpose of this review is to examine the epidemiology and risk factors of peripheral arterial disease in type 2 diabetes, focusing on the role of postprandial triglycerides and particles.