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INTRODUCTION: Periapical surgery is the last resort in the arsenal of an endodontist to effectively deal with periapical lesions that result from necrosis of the pulp. Bone grafts, growth factors and membranes form an array of regenerative materials that influence the healing outcome of periapical surgery. PRESENTATION OF CASE: The main purpose of the two cases reported here was to assess the potential benefits of a combination of bone graft, platelet-rich fibrin (PRF) and amnion membrane in terms of reduced post-operative discomfort, radiographic evidence of accelerated periapical bone healing and present a novel therapeutic option in the management of large periapical lesions. Two cases of radicular cysts were treated through a combined regenerative approachof Bio-Gen mix®, PRF and amnion membrane. The patients were assessed for discomfort immediate post-operatively and after a week. The patients were recalled every month for the next 6 months for radiographic assessment of the periapical healing. DISCUSSION: Literature is replete with articles that have substantiated the role of demineralized bone matrix comprising a mixture of cancellous and cortical bone graft particles in enhancing regeneration. To the best of our knowledge, there has been no evidence related to the application of a human placental membrane in periapical surgery. Hence, the rationale of using a combined approach of Bio-Gen mix®, PRF and amnion membrane was to combine the individual advantages of these materials to enhance clinical and radiographic healing outcomes. Our present case reports provide an insight into this novel therapeutic option. CONCLUSION: The results of this case seriessubstantiatesthe credibility of using a combination ofamnion membrane with a bone graft and PRF to enhance radiographic healing outcome with decreased post-operative discomfort and present a viable regenerative treatment modality in periapical surgery.
RESUMO
The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- x 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.
