Extracorporeal Shockwave Therapy (ESWT), a Novel Method for Transferring Oral Implant Primary Failures to Final Clinical Success: A Test Case Report Followed up over More than 6 Years.

PURPOSE: To evaluate the feasibility of reversing a primary failure through therapeutic mechanical stimulation induced by transcutaneous application of acoustic waves (ESWT) in the peri-implant tissues. Materials and Μethods: This clinical report evaluates the outcome of a new protocol proposed to treat a primary failure (loosened oral implant); application of three cycles of ESWT, once session per week for 3 consecutive weeks, with an equivalent positive energy of 0,18 mJ/mm² (therapeutic dose: 2000 impulses/ 8Hz/ 4.0 bar). Standardized intraoral radiographs, Cone Beam Computed Tomography (CBCT), Implant Stability Quotient (ISQ) and clinical evaluations were performed. RESULTS: It was possible to verify a progressive increase in the ISQ value after the ESWT protocol; 17 (initial), 46 (after two months) and 68 (after four months), which led to successful implant prosthetic rehabilitation (35 N/cm measured). Our evaluation at 6 years of follow-up confirms that the new bone-implant interface is preserved and ESWT as a safe non-invasive treatment. CONCLUSION: In the context of the new dynamic model of osseointegration, the Foreign Body Equilibrium (FBE), this represents the first report of a host-Implant equilibrium re-established after an early failure process. However, it is necessary to perform studies to determine both the medical device and the most effective therapeutic range for clinical applications of this technology in oral implantology.

Seguimiento a 5 años de prótesis híbrida con subestructura sinterizada. Reporte de caso / Five-year follow-up of hybrid prosthesis with sintered substructure. Case report

RESUMEN: La rehabilitación de rebordes severamente atróficos mediante prótesis híbridas con subestructura cromo-cobalto fabricadas por sinterizado láser asegura el ajuste pasivo, aumentando la estabilidad de los tejidos de soporte a largo plazo. Los controles periódicos y enseñanza de técnicas de higiene son fundamentales para el éxito de rehabilitaciones complejas sobre implantes. El propósito de este reporte de caso es realizar la evaluación clínica y radiográfica a 5 años de prótesis híbridas maxilar y mandibular fabricadas mediante sinterizado láser, encontrándose resultados satisfactorios en la evaluación y seguimiento.

ABSTRACT: Rehabilitation of severely atrophic ridges using hybrid cobalt-chrome substructures manufactured by laser sintering ensures passive fit, increasing support tissue stability. Regular check-ups and the teaching of hygiene techniques are essential for the success of complex implant restorations. The purpose of this case report is to perform a 5-year clinical and radiographic evaluation of hybrid maxillary and mandibular prostheses manufactured using laser sintering, achieving satisfactory results in the evaluation and follow-up.

CD8+ and FoxP3+ T-cell infiltration in actinic cheilitis.

BACKGROUND: Differences in immune profile between actinic cheilitis (AC), a precursor of lip squamous cell carcinoma, and normal lip vermillion (NL) have not been elucidated. OBJECTIVES: To compare density, distribution, and ratios of CD8+ and FoxP3+ cells between AC and NL and assess their associations with clinicopathologic variables. METHODS: Samples of AC and NL obtained between 2001 and 2013 at the College of Dentistry of the University of Concepcion, Chile, were retrospectively analyzed for immunohistochemical detection of CD8+ and FoxP3+ cells. Differences between groups were tested by Mann-Whitney U and Fisher's exact tests. Independent effects of cell densities and CD8/FoxP3 ratio with AC were assessed by multiple logistic regression analysis after adjustment for potential confounding. RESULTS: A total of 62 AC and 24 NL biopsies were included. Densities of CD8+ and FoxP3+ cells in AC were significantly higher than in NL. Conversely, the CD8+/FoxP3+ ratio was significantly lower in AC as compared to NL. After adjustment for sun exposure, age, gender, and smoking status, a stromal FoxP3+ cell density higher than 0.35 cells/field was significantly associated with increased odds of AC (odds ratio [OR] = 5.01, 95% confidence interval [CI]: 1.18-21.31), while a stromal CD8+/FoxP3+ ratio higher than 5.91 was associated with decreased odds of AC (OR = 0.29, 95% CI: 0.08-1.08). CONCLUSIONS: AC is characterized by increased FoxP3+ cell infiltration and a reduced CD8/FoxP3 ratio as compared to NL. Therefore, increased infiltration of FoxP3+ cells relative to CD8+ cells may contribute to the transition from normal to preneoplastic stages in lip carcinogenesis.

Mandibular Overdentures Retained by Two Mini-Implants: A Seven-Year Retention and Satisfaction Study.

PURPOSE: Patients with atrophic edentulous ridges generally have problems with retention, therapeutic satisfaction, and comfort with their complete dentures. An alternative treatment to assist in improving retention and stability involves the use of mini-implants. The aim of this study was to evaluate the retention of mandibular overdentures connected to two mini-implants and overall patient satisfaction with them. MATERIALS AND METHODS: Seven patients with atrophic mandibular ridges (Type 4D Misch classification), aged 62 to 74 years old were rehabilitated with complete dentures. In each patient, two mini-implants measuring 15 or 13 mm in length and 1.8 mm in diameter were placed. After 15 days, overdentures were connected to the mini-implants with O-ring attachments. In each patient, retention of the overdentures was measured, and a survey of therapeutic satisfaction before and after connection to the mini-implants was administered. Prosthesis retention was measured with a digital dynamometer at 1 month, 6 months, and 2, 3, 5, and 7 years after mini-implant placement. Patient satisfaction was assessed with a survey. Data were analyzed with Student's t-test (satisfaction survey) and the Friedman test (retention measurements and satisfaction survey). RESULTS: The initial retention values (0.34 to 0.63 N without mini-implants) varied significantly (p ≤ 0.050). These values were less than the subsequent measurements of 3.92 to 9.64 N, taken after placement of the mini-implants and connecting them to the dentures. Satisfaction was good to very good over the 7-year observation period. Mucosa and peri-implant bone showed no pathological changes. CONCLUSIONS: In this limited sample size clinical study the results indicated that after connecting mandibular overdentures to two mini-implants, patient satisfaction significantly increased and retention significantly improved during the 7-year observation period.

Adenomatoid odontogenic tumor concomitant with cystic complex odontoma: case report.

This case report describes a 10-year-old female patient with an adenomatoid odontogenic tumor developing together with a cystic complex odontoma. This occurrence is considered very unusual. Immunohistochemical detection of cytokeratins AE1/AE3, CK5, CK8, CK10, CK14, CK19 and Ki-67 was performed.

Actinic cheilitis: epithelial expression of COX-2 and its association with mast cell tryptase and PAR-2.

Cyclooxygenase-2 (COX-2) is overexpressed in various types of human malignancies, including oral cancers. Recent studies have shown that mast cell-derived protease tryptase can induce COX-2 expression by the cleavage of proteinase-activated receptor-2 (PAR-2). Actinic cheilitis (AC) is a premalignant form of lip cancer characterized by an increased density of tryptase-positive mast cells. To investigate the possible contribution of tryptase to COX-2 overexpression during early lip carcinogenesis, normal lip (n=24) and AC (n=45) biopsies were processed for COX-2, PAR-2 and tryptase detection, using RT-PCR and immunohistochemistry. Expression scores were obtained for each marker and tested for statistical significance using Mann-Whitney and Spearmann's correlation tests as well as multivariate logistic regression analysis. Increased epithelial co-expression of COX-2 and PAR-2, as well as, elevated subepithelial density of tryptase-positive mast cells were found in AC as compared to normal lip (P<0.001). COX-2 overexpression was found to be a significant predictor of AC (P<0.034, forward stepwise, Wald), and to be correlated with both tryptase-positive mast cells and PAR-2 expression (P<0.01). The results suggest that epithelial COX-2 overexpression is a key event in AC, which is associated with increased tryptase-positive mast cells and PAR-2. Therefore, tryptase may contribute to COX-2 up-regulation by epithelial PAR-2 activation during early lip carcinogenesis.

Ultrasonográfia máxilo-facial fetal / Fetal jaw-facial ultrasonography

La experiencia en la detección de malformaciones congénitas máxilo faciales fetales, diagnosticadas por ecografía es presentada