Retrospective study on the treatment outcome of surgical closure of oroantral communications.

PURPOSE: A retrospective cohort study concerning the surgical closure of oroantral communications (OACs) was carried out to facilitate a comparison between treatment outcomes of conventional surgical treatment and new strategies for closure of OACs. Data were statistically analyzed to gather insight into possible predictor variables of recurrent OAC. PATIENTS AND METHODS: A cohort of patients treated for an OAC from 2004 through 2008 was reviewed. Recorded data included patient age and gender, location and duration of OAC, method of removal of the (pre)molar, presence of maxillary sinusitis, disturbed wound healing, and surgical treatment method. Data analysis included descriptive and multivariate logistic regression analyses with recurrence of OAC as the outcome variable. RESULTS: In total, 308 patients were included in the sample, of which 28 patients (9.1%) required a second intervention to repair an OAC. Of these 28 patients, 4 patients needed a third intervention, making the total number of recurrent OACs 32 (10.4%). In most cases (60.7%), a buccal advancement flap according to the method of Rehrmann was used to close the perforation. Multivariate regression analysis showed a 15 times higher risk of recurrence with maxillary sinusitis at follow-up. CONCLUSIONS: Overall results of the study showed that OACs recur in about 1 of 10 patients and requires a second intervention after surgical closure. New strategies should therefore result in an equal or better treatment outcome to be considered a suitable treatment option. Furthermore, it was demonstrated that the presence of maxillary sinusitis at follow-up is an important determinant of the treatment outcome of OAC repair.

In vitro analysis of polyurethane foam as a topical hemostatic agent.

Topical hemostatic agents can be used to treat problematic bleedings in patients who undergo surgery. Widely used are the collagen- and gelatin-based hemostats. This study aimed to develop a fully synthetic, biodegradable hemostatic agent to avoid exposure to animal antigens. In this in vitro study the suitability of different newly developed polyurethane-based foams as a hemostatic agent has been evaluated and compared to commonly used agents. An experimental in vitro test model was used in which human blood flowed through the test material. Different modified polyurethane foams were compared to collagen and gelatin. The best coagulation was achieved with collagen. The results of the polyurethane foam improved significantly by increasing the amount of polyethylene glycol. Therefore, the increase of the PEG concentration seems a promising approach. Additional in vivo studies will have to be implemented to assess the application of polyurethane foam as a topical hemostatic agent.

Feasibility of conical biodegradable polyurethane foam for closure of oroantral communications.

PURPOSE: To assess the feasibility of a conically shaped biodegradable polyurethane (PU) foam for closure of oroantral communications (OACs). PATIENTS AND METHODS: In 10 consecutive patients, fresh OACs (present for <24 hours) were closed with PU foam. Standardized evaluations were performed at 2 and 8 weeks after closure of the OAC. Success was considered permanent closure of the OAC. RESULTS: No complications were observed in 7 of the 10 patients. Of the other 3 patients, 1 developed a maxillary sinusitis that was successfully managed with antibiotics and the OAC recurred in 2 patients. CONCLUSIONS: Permanent closure of the OAC using PU foam was accomplished in 8 of 10 patients. The results obtained in the present study were more favorable than in a previous feasibility study. Therefore, the alterations in the treatment protocol were maintained for additional research of this new and straightforward treatment strategy. In general, closure of OACs with biodegradable PU foam is feasible and has the potential to make surgical treatment unnecessary for a large number of patients with OACs.

Closure of oroantral communications using biodegradable polyurethane foam: a feasibility study.

PURPOSE: The aim of this study was to assess the feasibility of biodegradable polyurethane (PU) foam for closure of oroantral communications (OACs). PATIENTS AND METHODS: Ten consecutive patients with OACs (existing <24 hours) were treated with PU foam. Standardized evaluations were performed at 2 weeks and 8 weeks after closure of the OAC. RESULTS: In 5 patients, the OACs were closed successfully without complications. Three patients developed sinusitis, which was conservatively managed with antibiotics in 2 cases. In 1 case the sinus was reopened for irrigation, after which a buccal flap procedure was performed. In 2 patients the OAC recurred and was surgically closed with a buccal flap after thorough irrigation. CONCLUSION: In this feasibility study, closure was achieved in 7 of the 10 patients without further surgical intervention. Complications of the procedure using PU foam may be related to the fit of the foam in the socket and the size of the perforation. In general, closure of OACs with biodegradable polyurethane foam is feasible and has the potential to spare a large number of patients with OACs a surgical procedure. Furthermore, in case the treatment with PU foam fails to close the OAC, the attending physician can always fall back on the standard surgical procedure.

Closure of oroantral communications using biodegradable polyurethane foam: a long term study in rabbits.

An oroantral communication (OAC) is an open connection between the oral cavity and maxillary sinus. Closure of OACs is commonly performed with a surgical procedure using a mucoperiosteal flap. An alternative technique using synthetic biodegradable polyurethane (PU) foam for closure of OACs is presented. This PU foam is composed of hard urethane segments, and soft segments made of D/L lactide (50/50), epsilon-caprolactone, and 5% polyethyleneglycol (PEG). To evaluate the use of PU foam for this application, OACs were created in the edentulous part of the maxilla in 21 rabbits, after which PU foams were fitted in the defects. Results showed complete healing of the oral mucosa after 4-10 weeks, healing of the antral mucosal lining after 6 months and complete bony regeneration after 1 year. No reopening of the defects occurred and no maxillary sinusitis was observed. Degradation of the PU foam had not yet reached completion 1 year after implantation. In conclusion, PU foam with 5% PEG provides adequate closure of an OAC in the rabbit model to support healing of the oral and maxillary sinus mucosa. Longer time intervals are needed to assess the complete degradation of the PU foam.

Role of energy systems in two intermittent field tests in women field hockey players.

The energetics of 2 field tests that reflect physical performance in intermittent sports (i.e., the Interval Shuttle Sprint Test [ISST] and the Interval Shuttle Run Test [ISRT]) were examined in 21 women field hockey players. The ISST required the players to perform 10 shuttle sprints starting every 20 seconds. During the ISRT, players alternately ran 20-m shuttles for 30 seconds and walked for 15 seconds with increasing speed. Anaerobic and aerobic power tests included Wingate cycle sprints and a .V(O2)max cycle test, respectively. Based on correlation and regression analyses, it was concluded that for the ISST, anaerobic energetic pathways contribute mainly to energy supply for peak sprint time, while aerobic energetic pathways also contribute to energy supply for total sprint time. Energy during the ISRT is supplied mainly by the aerobic energy system. Depending on the aspect of physical performance a coach wants to determine, the ISST or ISRT can be used.