Maxillary Sinus Floor Elevation Surgery With BioOss Mixed With Enamel Matrix Derivative: A Human Randomized Controlled Clinical and Histologic Study.

Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.

Treatment of multiple maxillary adjacent class I and II gingival recessions with modified coronally advanced tunnel and a new xenogeneic acellular dermal matrix.

OBJECTIVE: To evaluate the treatment of maxillary Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique (MCAT) combined with a new porcine acellular dermal matrix (PADM). MATERIALS AND METHODS: Twelve patients exhibiting at least six adjacent maxillary Miller Class I and II gingival recessions were consecutively treated by means of MCAT and a PADM. Recession depth (RD), recession width (RW), probing pocket depth (PD), keratinized tissue height (KT), clinical attachment level (CAL), mean root coverage (RC), and complete root coverage (CRC) were recorded. RESULTS: At 12 months, CRC was obtained in 43% of the 100 gingival recessions, while the mean RC measured 84.35%. Mean RD reduction was 3.16 ± 0.75 mm (P < 0.001), mean RW reduction was 1.73 ± 0.65 mm (P < 0.001), while the gain of CAL was 3.26 ± 1.33 mm (P < 0.001). All patients were satisfied with the esthetic appearance and would undergo the same surgery again. CONCLUSION: Within their limits, the present results indicate that treatment of Miller Class I and II multiple gingival recessions using PADM in conjunction with the MCAT could be successfully used as an alternative to connective tissue grafts, with the advantage of avoiding the discomfort and morbidity of connective tissue harvesting. CLINICAL SIGNIFICANCE: The modified coronally advanced tunnel technique using the new porcine acellular dermal matrix represents a clinically and esthetically satisfactory treatment of multiple Miller Class 1 and 2 recession defects.

Community-based behavior change promoting child health care: a response to socio-economic disparity.

BACKGROUND: Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger. METHODS: A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers. RESULTS: The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9). CONCLUSIONS: A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.

Modified Tunnel Technique Combined with Enamel Matrix Derivative: A Minimally Invasive Treatment for Single or Multiple Class I Recession Defects.

PURPOSE: Gingival recession is a significant problem in the esthetic zone. Connective tissue grafts have been considered the gold standard, but they need a donor site that increases morbidity and discomfort for the patient.The purpose of the present study was to evaluate the clinical results of a modified tunnel technique that consists of replacing the connective tissue graft by enamel matrix derivative, in the treatment of Miller Class I recession defects. MATERIALS AND METHODS: Twenty-six teeth in 14 subjects with Miller Class I recessions were treated using the tunnel procedure plus enamel matrix derivative. The gingival recession, probing depth, clinical attachment level, and the width of the keratinized gingival tissue were recorded. RESULTS: There was a statistically significant reduction in gingival recession (88% of root coverage) and a gain in clinical attachment level (3.1 mm) between baseline and 24 months post-operatively, whereas the change in width of keratinized tissue and in probing depth was not statistically significant. All patients were satisfied with the esthetic appearance and would undergo the same surgery again. CONCLUSION: This technique could be successfully used as an alternative to connective tissue grafts, with the advantage of avoiding the discomfort and morbidity of connective tissue harvesting. CLINICAL SIGNIFICANCE: This modified tunnel technique using enamel matrix derivative potentially represents a clinically and esthetically satisfactory treatment of Miller Class I recession defects.

EBV infection is common in gingival epithelial cells of the periodontium and worsens during chronic periodontitis.

An amplifying role for oral epithelial cells (ECs) in Epstein-Barr Virus (EBV) infection has been postulated to explain oral viral shedding. However, while lytic or latent EBV infections of oro/nasopharyngeal ECs are commonly detected under pathological conditions, detection of EBV-infected ECs in healthy conditions is very rare. In this study, a simple non-surgical tissue sampling procedure was used to investigate EBV infection in the periodontal epithelium that surrounds and attaches teeth to the gingiva. Surprisingly, we observed that the gingival ECs of the periodontium (pECs) are commonly infected with EBV and may serve as an important oral reservoir of latently EBV-infected cells. We also found that the basal level of epithelial EBV-infection is significantly increased in chronic periodontitis, a common inflammatory disease that undermines the integrity of tooth-supporting tissues. Moreover, the level of EBV infection was found to correlate with disease severity. In inflamed tissues, EBV-infected pECs appear to be prone to apoptosis and to produce larger amounts of CCL20, a pivotal inflammatory chemokine that controls tissue infiltration by immune cells. Our discovery that the periodontal epithelium is a major site of latent EBV infection sheds a new light on EBV persistence in healthy carriers and on the role of this ubiquitous virus in periodontitis. Moreover, the identification of this easily accessible site of latent infection may encourage new approaches to investigate and monitor other EBV-associated disorders.

Toward a comprehensive demography: rethinking the research agenda on change and response.

This essay drafts a new interdisciplinary agenda for research on population and development. Starting from Kingsley Davis's 1963 formulation of change and response, Davis's analytical categories are broadened to include inertia as well as change and to encompass both demographic and non-demographic responses at the micro, meso, and macro levels. On that basis the essay proposes what can be called a comprehensive demography, an approach drawing principally on micro-level methodologies like those employed in anthropological demography. Like anthropological demography, comprehensive demography questions the rationality of actors, emphasizes cultural infuences, and stops short of the postmodernist extremes of anthropology. But it also takes explicit account of higher-level social, economic, and political factors bearing on demographic behavior and outcomes. The conclusion raises some epistemological issues. Illustrative examples are offered throughout to demonstrate the feasibility of the approach, mainly referring to sub-Saharan africa and the Caribbean and often drawn from the authors' own fieldwork.