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OBJECTIVES: The aim of this study is to analyze the effectiveness of screencast training videos for users from different professional backgrounds on the basis of the quality and quantity of virtual 3D implant planning as evaluated using assessment software. METHODS: Participants in the study were dental students (n = 21), dental technicians (n = 16), or practicing dentists (n = 16) with no knowledge of the implant planning software CoDiagnostiX or any experience in virtual implant planning. They were randomly divided into 2 groups: The participants of the control group were presented training videos on CBCT (cone beam computed tomography) and implant planning, additional to the traditional software manual. The participants of the experimental group received, additionally, a training video on the planning software, produced in the form of a screencast. Then 3 implant planning procedures were performed by all participants. The quality of implant planning was assessed using the Treatment Evaluation Tool software, and time for planning was measured. RESULTS: Paired sample tests showed significantly shorter planning times for the experimental groups consisting of dentists and students (P < 0.001). A comparison of the results of the individual groups reveals that students and dental technicians who had not received prior screencast training were significantly less precise in their planning (P < 0.001). CONCLUSION: This study suggests a promising outcome for the future use of screencasts in the acquisition of software skills for dental software. There is a need for tools for objective self-assessment of effectiveness in software training.
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Implantación Dental Endoósea , Imagenología Tridimensional , Tomografía Computarizada de Haz Cónico , Humanos , Planificación de Atención al Paciente , Programas InformáticosRESUMEN
OBJECTIVES: Alveolar ridge and vertical augmentations are challenging procedures in dental implantology. Even material blocks with an interconnecting porous system are never completely resorbed. Shell techniques combined with autologous bone chips are therefore the gold standard. Using biopolymers for these techniques is well documented. We applied three-dimensional (3-D) techniques to create an individualized bending model for the adjustment of a plane biopolymer membrane made of polylactide. STUDY DESIGN: Two cases with a vertical alveolar ridge defect in the maxilla were chosen. The cone beam computed tomography data were processed with a 3-D slicer and the Autodesk Meshmixer to generate data about the desired augmentation result. STL data were used to print a bending model. A 0.2-mm poly-D, L-lactic acid membrane (KLS Matin Inc., Tuttlingen, Germany) was bended accordingly and placed into the defect via a tunnel approach in both cases. A mesh graft of autologous bone chips and hydroxylapatite material was augmented beneath the shell, which was fixed with osteosynthesis screws. RESULTS: The operative procedure was fast and without peri- or postoperative complications or complaints. The panoramic x-ray showed correct fitting of the material in the location. Bone quality at the time of implant placement was type II, resulting in good primary stability. CONCLUSIONS: A custom-made 3-D model for bending confectioned biomaterial pieces is an appropriate method for individualized adjustment in shell techniques. The advantages over direct printing of the biomaterial shell and products on the market, such as the Xyoss shell (Reoss Inc., Germany), include cost-efficiency and avoidance of regulatory issues.
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Aumento de la Cresta Alveolar/métodos , Implantes Dentales , Impresión Tridimensional , Materiales Biocompatibles , Tornillos Óseos , Trasplante Óseo/métodos , Tomografía Computarizada de Haz Cónico , Durapatita , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Membranas Artificiales , Persona de Mediana Edad , Poliésteres , Radiografía Panorámica , Trasplante AutólogoRESUMEN
OBJECTIVES: We assessed the influence of a simulated diving environment on the interfacial microleakage and retentive forces of different post types in root-canal-filled teeth. MATERIALS AND METHODS: One-hundred-and-twenty extracted, single-rooted teeth were endodontically treated and were randomly divided into three groups according to the post and cement used: ER Post/Harvard cement (Titanium), CeraPost/DentinBuild Evo (Zirconia), DT Light Post/Calibra (FRC). Each group was randomly divided into two equal subgroups, a control group, and an experimental group, subjected to simulated dives to 456 kPa in a diving chamber. For 10 specimens of each subgroup the pull-out strength and the coronal microleakage were measured. RESULTS: Significant differences in the linear coronal penetration were observed between the Titanium and FRC groups (experimental group P ≤ 0.001; control group P = 0.02). Diving simulation had no significant impact on the microleakage for the three post types. The FRC groups showed significantly higher retentive strength values compared to the Titanium and Zirconia groups before and after simulated diving. The pull-out strength of the titanium experimental group was significantly less than the control group (P = 0.008). CONCLUSIONS: Following root canal treatment the combination of fibre-reinforced posts and resin cement should be preferred for patients requiring retention for tooth restorations using posts that are likely to be exposed to hyperbaric conditions.
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Presión del Aire , Cementos Dentales , Filtración Dental , Buceo , Técnica de Perno Muñón , Obturación del Conducto Radicular , Aire Comprimido , Humanos , Distribución Aleatoria , Cementos de Resina , Preparación del Conducto Radicular/métodos , Titanio , Cemento de Fosfato de Zinc , CirconioRESUMEN
OBJECTIVES: Vertical bone augmentation in dental implantology is an indication for cancellous allogeneic bone blocks (ABB). However, these materials may lead to adverse reactions, which are known well in orthopedics but rarely published. Therefore, in this study, we performed an evaluation of the use of ABB in vertical bone augmentation in clinical dental implantology. STUDY DESIGN: The prospective clinical study included 20 cases with vertical augmentation using ABB and subsequent or simultaneous placement of implants in the lateral maxilla and mandible. Follow-up included panoramic radiography, tissue healing, and peri-implantitis. Because of the limited number of patients, the report was planned to be descriptive only. Loss of ABB or peri-implantitis of more than 30% of the intraosseous implant length was deemed to indicate failure. RESULTS: The study was cancelled after six cases because of an unexpectedly high number of complications (5 of 6; 83%). The average surveillance time was 1460 days. Three types of unsatisfying outcome were observed: type I, early complete loss of the augmentation with soft tissue defects after 3 to 8 weeks (n = 2); type II, early soft tissue maceration (up to 8 weeks) without loss of coverage and complete early bone healing with later peri-implantitis and bone loss after prosthetic loading (6 months or later; n = 2); and type III, complication-free bone healing with subsequent peri-implantitis after prosthetic loading (6 months or later; n = 1). CONCLUSIONS: Complications were observed in vertical augmentation with ABB and implant placement. After careful consideration, literature data were found to support these results and also suggest that tissue level implants may be advantageous in vertical bone augmentation with ABB.
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Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Hueso Esponjoso/trasplante , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Sustitutos de Huesos , Implantación Dental Endoósea/métodos , Fracaso de la Restauración Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía Panorámica , Factores de Riesgo , Trasplante Homólogo/efectos adversosRESUMEN
OBJECTIVES: The purpose of this retrospective study was to compare the clinical significance of panoramic radiography (orthopantomography [OPTG]) and cone beam computed tomography (CBCT) for therapy planning of bisphosphonate-related osteonecrosis of the jaw (BRONJ) by surgeons. STUDY DESIGN: Using standardized questionnaire, eight maxillofacial surgeons evaluated intraoral photographs of the clinical situation of 14 patients with BRONJ as well as the corresponding radiographic images (OPTG, CBCT). The presence of five typical BRONJ signs (bone-remodeling, periosteal reaction, osteosclerosis, sequestra, and continuity of cortical bone) was evaluated with OPTG and CBCT. The influence of radiologic information on therapy decision was examined as well. RESULTS: On the basis of the information from intraoral photographs only, seven of the eight surgeons indicated that an additional radiographic examination was necessary for further therapy planning. For evaluation of the five radiographic BRONJ signs, CBCT provided significantly better values compared with OPTG (all P < .05). A before-and-after comparison showed that four of the eight surgeons changed their therapy concept after having three-dimensional CBCT information. The majority (6 of 8) of the surgeons considered that an additional CBCT was required for therapy planning, even after having studied the clinical photographs and OPTG images. CONCLUSION: These data demonstrate a significant advantage of CBCT over OPTG for surgeons with regard to therapeutic planning for BRONJ.
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Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Tomografía Computarizada de Haz Cónico , Planificación de Atención al Paciente , Radiografía Panorámica , Anciano , Anciano de 80 o más Años , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The aim of the present study was to evaluate the trend of dental practitioners in the federal state of Saarland in Germany in regard to restoring endodontically treated teeth using a Web-based survey. MATERIALS AND METHODS: An interactive Web-based survey instrument was developed, including seven clinical scenarios, presented by photographs of natural incisor and premolar with different types of cavities. Following a decision tree adapted to the clinical treatment, questions on different aspects of the post-endodontic treatment were asked. All 615 members of the Saarland Dental Association (SDA) were asked to participate in the survey. RESULTS: A total of 33 % completed the survey. The majority of the participants believed in the reinforcement effect of the ferrule design, as well as the post placement. The vast majority of the responding practitioners (92 %) adapted their treatment strategies to a high extent to the destruction degree of the endodontically treated tooth. Fiber-reinforced composite (FRC) posts are the most popular prefabricated post type, regardless of the cavity size and tooth localization. Significant differences between the dentists according to the degree of experience were detected only for the use of glass-ionomer cements as core buildup material. CONCLUSIONS: The predominant post-endodontic treatment strategies of German dental practitioners are only partly in agreement with the current literature. There is a clear trend toward the increasing use of metal-free post and core materials. CLINICAL SIGNIFICANCE: Although the participants showed a general adoption of modern materials and techniques, different patterns of post-endodontic treatment were revealed that were not consistent with approaches supported by the literature.
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Diente Premolar , Restauración Dental Permanente/métodos , Incisivo , Pautas de la Práctica en Odontología/estadística & datos numéricos , Diente no Vital/terapia , Materiales Dentales , Alemania , Humanos , Internet , Técnica de Perno Muñón , Encuestas y CuestionariosRESUMEN
Biosilica, a biocompatible, natural inorganic polymer that is formed by an enzymatic, silicatein-mediated reaction in siliceous sponges to build up their inorganic skeleton, has been shown to be morphogenetically active and to induce mineralization of human osteoblast-like cells (SaOS-2) in vitro. In the present study, we prepared beads (microspheres) by encapsulation of ß-tricalcium phosphate [ß-TCP], either alone (control) or supplemented with silica or silicatein, into the biodegradable copolymer poly(d,l-lactide-co-glycolide) [PLGA]. Under the conditions used, ≈5% ß-TCP, ≈9% silica, and 0.32µg/mg of silicatein were entrapped into the PLGA microspheres (diameter≈800µm). Determination of the biocompatibility of the ß-TCP microspheres, supplemented with silica or silicatein, revealed no toxicity in the MTT based cell viability assay using SaOS-2 cells. The adherence of SaOS-2 cells to the surface of silica-containing microspheres was higher than for microspheres, containing only ß-TCP. In addition, the silica-containing ß-TCP microspheres and even more pronounced, a 1:1 mixture of microspheres containing ß-TCP and silica, and ß-TCP and silicatein, were found to strongly enhance the mineral deposition by SaOS-2 cells. Using these microspheres, first animal experiments with silica/biosilica were performed in female, adult New Zealand White rabbits to study the effect of the inorganic polymer on bone regeneration in vivo. The microspheres were implanted into 5mm thick holes, drilled into the femur of the animals, applying a bilateral comparison study design (3 test groups with 4-8 animals each). The control implant on one of the two hind legs contained microspheres with only ß-TCP, while the test implant on the corresponding leg consisted either of microspheres containing ß-TCP and silica, or a 1:1 mixture of microspheres, supplemented with ß-TCP and silica, and ß-TCP and silicatein. The results revealed that tissue/bone sections of silica containing implants and implants, composed of a 1:1 mixture of silica-containing microspheres and silicatein-containing microspheres, show an enhanced regeneration of bone tissue around the microspheres, compared to the control implants containing only ß-TCP. The formation of new bone induced by the microspheres is also evident from measurements of the stiffness/reduced Young's modulus of the regenerated bone tissue. The reduced Young's modulus of the regenerating bone tissue around the implants was markedly higher for the silica-containing microspheres (1.1MPa), and even more for the 1:1 mixture of the silica- and silicatein-containing microspheres (1.4MPa), compared to the ß-TCP microsphere controls (0.4MPa). We propose that based on their morphogenetic activity on bone-forming cells in vitro and the results of the animal experiments presented here, silica/biosilica-based scaffolds are promising materials for bone repair/regeneration.
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Materiales Biocompatibles/química , Regeneración Ósea/efectos de los fármacos , Dióxido de Silicio/química , Animales , Materiales Biocompatibles/farmacología , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Femenino , Humanos , Microesferas , ConejosRESUMEN
INTRODUCTION: Low-level laser therapy (LLLT) is used in parodontitis treatment in combination with an antimicrobial photosensitizer. The purpose of this study was to investigate the combination of LLLT with cisplatin and zoledronic acid as potential photosensitizer in-vitro. MATERIALS AND METHODS: Primary human fibroblasts (PHF) and head and neck squamous cell carcinoma cells (HNSCC, exactly UM-SCC-3) were treated with different concentrations of zoledronatic acid and cisplatin and irradiated twice with a diode laser (wavelength 670 nm, 2 min). Cell viability was tested by XTT assay and histomorphological analysis with HE staining. RESULTS: LLLT increased bioviability for both cell lines (p < 0.001). LLLT lowered PHF viability at the highest concentrations of cisplatin (p = 0.027 and p = 0.005) and zoledronic acid (p < 0.001). For HNSCCs, LLLT reduced cell viability at every concentration of cisplatin (all p < 0.05). In cases of incubation with zoledronic acid, similar to fibroblasts, laser therapy lowered cell viability at the highest concentration only (p < 0.001). CONCLUSIONS: Within the limits of this study, it can be concluded that LLLT enhances the effect of cisplatin and zoledronic acid in the discussed cells in order to develop new therapeutic options for cysts in the cranio-maxillofacial region and other appropriate indications.
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Antineoplásicos/toxicidad , Carcinoma de Células Escamosas/tratamiento farmacológico , Cisplatino/toxicidad , Difosfonatos/toxicidad , Fibroblastos/efectos de los fármacos , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Imidazoles/toxicidad , Terapia por Luz de Baja Intensidad/métodos , Fármacos Fotosensibilizantes/toxicidad , Apoptosis/efectos de los fármacos , Apoptosis/efectos de la radiación , Carcinoma de Células Escamosas/radioterapia , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Proliferación Celular/efectos de la radiación , Forma de la Célula/efectos de los fármacos , Forma de la Célula/efectos de la radiación , Supervivencia Celular/efectos de los fármacos , Supervivencia Celular/efectos de la radiación , Células Cultivadas , Colorantes , Fibroblastos/efectos de la radiación , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Indicadores y Reactivos , Láseres de Semiconductores/uso terapéutico , Fotoquimioterapia/métodos , Sales de Tetrazolio , Ácido ZoledrónicoRESUMEN
INTRODUCTION: Initial platelet activation with subsequent cytokine release at the defect site plays a crucial role in tissue integration. The aim of this study was to evaluate the influence of topographic and biomimetic collagen modifications of a xenogenic bone substitute material (BSM) on in vitro platelet activation and cytokine release. MATERIAL AND METHODS: Three types of xenogenic BSM were used. Two BSM with different levels of granularity (large granule BSM [XBSM/L], small granule BSM [XBSM/S]) and a BSM with collagen (XBSM/C). All three samples were incubated with platelet concentrate of four healthy volunteers at room temperature for 15 min. For all groups, highly thrombogenic collagen type 1 served as a reference and an additional preparation with platelet concentrate only (without XBSM) served as control. Platelet count and cytokine release of VEGF, PDGF, TGF-ß, and IGF into the supernatant were measured. RESULTS: Compared with the control group, XBSM/C showed an increase in platelets consumption (mean 41,000 ± 26,000/ml vs. 471,000 ± 38,000/ml), cytokine release of VEGF (mean 46.8 ± 7.2 pg/ml vs. 18.8 ± 2.7 pg/ml), and PDGF (mean 18,350 ± 795 pg/ml vs. 2726 ± 410 pg/ml) but not IGF (194,728 ± 51,608 pg/ml vs. 1,333,911 ± 35,314 pg/ml). There was also an increase in cytokine release of TGF-ß in XBSM/C compared with XBSM/S (77,188 ± 27,413 pg/ml vs. 38,648 ± 13,191 pg/ml), but no such difference when compared with XBSM/L (77,188 ± 27,413 pg/ml vs. 53,309 ± 29,430 pg/ml). XBSM/L showed higher platelets consumption (301,000 ± 45,000 vs. 415,000 ± 98,000) and a higher cytokine release of PDGF (3511 ± 247 pg/ml vs. 3165 ± 78 pg/ml) compared with XBSM/S. There was no distinct difference in the levels of VEGF, TGF-ß, and IGF between XBSM/L and XBSM/S. CONCLUSIONS: Topographic as well as biomimetic modifications of the xenogenic BSM showed an increased platelet activation and cytokine release in vitro. This effect on the intrinsic healing cascade could result in comparable enhanced soft- and hard-tissue regeneration in vivo.
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Materiales Biomiméticos/farmacología , Sustitutos de Huesos/farmacología , Colágeno/farmacología , Citocinas/metabolismo , Minerales/farmacología , Materiales Biomiméticos/química , Sustitutos de Huesos/química , Colágeno/química , Ensayo de Inmunoadsorción Enzimática , Humanos , Técnicas In Vitro , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/metabolismo , Minerales/química , Activación Plaquetaria , Recuento de Plaquetas , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Bone defects in human, caused by fractures/nonunions or trauma, gain increasing impact and have become a medical challenge in the present-day aging population. Frequently, those fractures require surgical intervention which ideally relies on autografts or suboptimally on allografts. Therefore, it is pressing and likewise challenging to develop bone substitution materials to heal bone defects. During the differentiation of osteoblasts from their mesenchymal progenitor/stem cells and of osteoclasts from their hemopoietic precursor cells, a lineage-specific release of growth factors and a trans-lineage homeostatic cross-talk via signaling molecules take place. Hence, the major hurdle is to fabricate a template that is functioning in a way mimicking the morphogenetic, inductive role(s) of the native extracellular matrix. In the last few years, two naturally occurring polymers that are produced by deep-sea sponges, the biogenic polyphosphate (bio-polyP) and biogenic silica (bio-silica) have also been identified as promoting morphogenetic on both osteoblasts and osteoclasts. These polymers elicit cytokines that affect bone mineralization (hydroxyapatite formation). In this manner, bio-silica and bio-polyP cause an increased release of BMP-2, the key mediator activating the anabolic arm of the hydroxyapatite forming cells, and of RANKL. In addition, bio-polyP inhibits the progression of the pre-osteoclasts to functionally active osteoclasts. Based on these findings, new bioinspired strategies for the fabrication of bone biomimetic templates have been developed applying 3D-printing techniques. Finally, a strategy is outlined by which these two morphogenetically active polymers might be used to develop a novel functionally active polymer.
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Productos Biológicos/química , Huesos/metabolismo , Ingeniería de Tejidos/métodos , Animales , Productos Biológicos/aislamiento & purificación , Materiales Biomiméticos/química , Materiales Biomiméticos/aislamiento & purificación , Huesos/patología , Humanos , Morfogénesis/efectos de los fármacos , Osteoblastos/metabolismo , Osteoclastos/metabolismo , Polifosfatos/química , Dióxido de Silicio/química , Andamios del Tejido/químicaRESUMEN
OBJECTIVES: Fibroblast growth factors consist of receptor tyrosine kinase binding proteins involved in growth, differentiation, and regeneration of a variety of tissues of the head and neck. Their role in the development of teeth has been documented, and their presence in human odontogenic cysts and tumors has previously been investigated. Odontomadysphagia syndrome (OMIM 164330) is a very rare disorder characterized by clustering of teeth as compound odontoma, dysplasia and aplasia of teeth, slight craniofacial abnormalities, and dysphagia. We have followed the clinical course of the disease in a family over more than 30 years and have identified a genetic abnormality segregating with the disorder. MATERIALS AND METHODS: We evaluated clinical data from nine different family members and obtained venous blood probes for genetic studies from three family members (two affected and one unaffected). RESULTS: The present family with five patients in two generations has remained one out of only two known cases with this very rare syndrome. All those affected showed teeth dysplasia, oligodontia, and dysplasia and odontoma of the upper and lower jaw. Additional signs included dysphagia and strictures of the oesophagus. Comorbidity in one patient included aortic stenosis and coronary artery disease, requiring coronary bypasses and aortic valve replacement. Genome-wide SNP array analyses in three family members (two affected and one unaffected) revealed a microduplication of chromosome 11q13.3 spanning 355 kilobases (kb) and including two genes in full length, fibroblast growth factors 3 (FGF3) and 4 (FGF4). CONCLUSION: The microduplication identified in this family represents the most likely cause of the odontomadysphagia syndrome and implies that the syndrome is caused by a gain of function of the FGF3 and FGF4 genes. CLINICAL RELEVANCE: Mutations of FGF receptor genes can cause craniofacial syndromes such as odontomadysphagia syndrome. Following this train of thought, an evaluation of FGF gene family in sporadic odontoma could be worthwhile.
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Trastornos de los Cromosomas/genética , Duplicación Cromosómica/genética , Cromosomas Humanos Par 11/genética , Trastornos de Deglución/genética , Factor 3 de Crecimiento de Fibroblastos/genética , Factor 4 de Crecimiento de Fibroblastos/genética , Odontoma/genética , Anodoncia/genética , Estenosis de la Válvula Aórtica/patología , Emparejamiento Base , Enfermedad de la Arteria Coronaria/patología , Estenosis Esofágica/genética , Femenino , Estudios de Seguimiento , Genoma , Humanos , Masculino , Mutación/genética , Odontodisplasia/genética , Linaje , Polimorfismo de Nucleótido Simple/genética , Estudios Retrospectivos , SíndromeRESUMEN
OBJECTIVES: Combination of scaffolds and growth factors is a promising option for several clinical problems in bone biomaterials. Simplified growth factor loading by adsorption from aqueous solution is one important option for this technology. We evaluated the adsorption followed by PBS rinsing, release and biological effect of transient loading with basic fibroblast growth factor (bFGF) and bone morphogenic protein 2 (BMP-2) on fresh frozen bone, processed bone matrix, collagen, and a ceramic material with immunofluorescence, enzyme-linked immunosorbent assay (ELISA), and qRT-PCR. MATERIALS AND METHODS: The study consisted of three in vitro experiments (immunofluorescence, ELISA, and qRT-PCR) in human osteoblasts (HOB). The first evaluated the adsorption of the growth factors bFGF and BMP-2 to the biomaterials, analyzed by immunofluorescence assays. The second experiment used ELISA to analyze the release of the growth factors from the matrix. The biological effect of the growth factors on HOB was then studied with qRT-PCR experiments as the third step. RESULTS: Strongest sustained release peaks in ELISA were observed in bFGF loading on processed bone matrix (steam-resistant mineralized bone matrix, SMBM) with up to 553 pg/ml medium. BMP-2 loading was less effective in ELISA peak release experiments with up to 257 pg/ml medium in processed bone matrix (SMBM). bFGF showed also higher release peaks in collagen material (192 pg/ml) compared with BMP-2 (101 pg/ml). Cumulative release values 0-72 h were estimated. The expression of runX2, osteocalcin, and alkaline phosphatase as markers for osteoblast activity was correlating. CONCLUSION: The results showed sustained release of BMP-2 and bFGF after transient loading on bone biomaterials with a stronger effect in biological scaffolds. This is interesting for therapeutic growth factor loading as well as insights in natural growth factor matrix deposition during bone healing.
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Materiales Biocompatibles/química , Proteína Morfogenética Ósea 2/farmacocinética , Huesos , Factor 2 de Crecimiento de Fibroblastos/farmacocinética , Osteoblastos/efectos de los fármacos , Andamios del Tejido/química , Adsorción , Fosfatasa Alcalina/análisis , Fosfatasa Alcalina/efectos de los fármacos , Animales , Biomarcadores/análisis , Matriz Ósea/metabolismo , Proteína Morfogenética Ósea 2/farmacología , Técnicas de Cultivo de Célula , Células Cultivadas , Cerámica/química , Colágeno/química , Subunidad alfa 1 del Factor de Unión al Sitio Principal/análisis , Subunidad alfa 1 del Factor de Unión al Sitio Principal/efectos de los fármacos , Preparaciones de Acción Retardada , Durapatita/química , Ensayo de Inmunoadsorción Enzimática , Factor 2 de Crecimiento de Fibroblastos/farmacología , Técnica del Anticuerpo Fluorescente , Humanos , Nanopartículas/química , Osteocalcina/análisis , Osteocalcina/efectos de los fármacos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de TiempoRESUMEN
PURPOSE: The aim of this study was to detect the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in association with osteoporosis in 2009 in the rural district of Marburg-Biedenkopf, Germany. In addition, the therapeutic regimen of dentists in this area was compared to the treatment guidelines of established international associations. METHODOLOGY: A postal survey including 129 dental offices within the named investigation area was conducted. Additionally, the dentists were asked to contribute to this study during a course of retraining. Ultimately, 107 colleagues participated in this study. RESULTS: A total of 37 BRONJ cases were revealed, 37.4 % of those were linked to malignant diseases, 62.6 % to osteoporosis. Noticeably, 30.1 % of the BRONJ cases linked to osteoporosis were connected with intravenous application. In total, 62.6 % of all cases were associated with intravenous and 37.4 % with oral application. Considering the estimated number of 1.014 patients using bisphosphonates for osteoporosis treatment in Marburg-Biedenkopf in 2009, the specific incidence of BRONJ could be narrowed down to about 2.27 %. In proportion to the increasing risk potential of the three patient groups, participants conducted fewer surgical interventions themselves but tended to refer patients to colleagues. CONCLUSION: This study reveals the incidence of BRONJ in association with osteoporosis as being grossly underrated so far, especially in connection with intravenous bisphosphonate treatment. The therapeutic regimen of the dentists who participated correlated with the established guidelines. CLINICAL RELEVANCE: The interface between dentistry and medicine may profit from our study's results which will help to improve interdisciplinary communication. With regard to this, we wish to contribute to an informative discussion since a main focus was to ensure colleagues in their decision making, especially in case of complications after elective dentoalveolar surgery-like implantations. Besides medical there are also economic and political aspects, i.e. the financial responsibility in case of unexpected or inevitable complications, possibly leading to BRONJ, that may become part of future discussions based on this study.
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Osteonecrosis de los Maxilares Asociada a Difosfonatos/tratamiento farmacológico , Difosfonatos/efectos adversos , Osteoporosis/tratamiento farmacológico , Alemania , Humanos , IncidenciaRESUMEN
This study aims to investigate the early outcome of a dental implant with bioactive calcium-phosphate (CaP) coating in the first year of usage in different clinical indications in partially edentulous patients, after early and delayed prosthetic loading. Therefore, in a prospective follow-up study, the cumulative survival and success rate of a conical, self-drilling and self-tapping implant system after 6 months and 1 year post-insertion was evaluated. A total of 311 CaP-coated implants were placed in 124 patients. Seventy-two implants in clinical high-quality bone situation were loaded after 2 weeks post-insertion with the definite restoration; the rest after 6 months. The indication for implant placement was treatment of partial dentate mandible and maxilla. One hundred sixty-three implants were placed in the posterior mandible, 117 in the posterior maxilla. In the frontal maxilla, 25 implants and in the frontal mandible, eight implants were used. In 126 cases (36%), bone augmentation procedures (guided bone regeneration and sinus lift) were performed concomitant with implant placement. The difference between primary and secondary stability (implant stability quotient (ISQ), Periotest, insertion torque), peri-implant clinical parameter as well as survival and success criteria were evaluated. In total, ISQ mean values after 6 months were higher than after implant placement. Periotest values increased in the period of the first 6 months and remained constant afterwards. After 6 months of insertion, the mean bone loss was 0.051 mm. After 12 months, a bone gain with a mean of +0.016 mm was observed; implants in the posterior maxilla showed significant less bone resorption than implants in the posterior mandible (p < 0.0001). In the most of the implants (74%), clinical normal gingival tissue could be observed. In 24%, a mild inflammation was analysed. In 35 implants, a provocation of peri-implant bleeding was possible. In the early loading group, no implant failure was seen. Altogether, one implant in D4 bone has been lost. The cumulative survival rate summed up to 99.7%. In general, implant success assessment analysis according to Albrektsson and Buser displayed success in 99.7% of the implants. With respect to the patient selection including 124 implants with minor and major augmentations as well as early loading prosthetic function, the 1-year clinical use of the studied implant system with CaP coating showed good results, comparable to that of conventional implants without a specific coating. After 1 year, neither special disadvantages nor benefits of CaP-coated implants could be evaluated. Long-term results are further needed.
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Fosfatos de Calcio/química , Materiales Biocompatibles Revestidos/química , Implantes Dentales , Diseño de Prótesis Dental , Arcada Parcialmente Edéntula/cirugía , Adolescente , Adulto , Pérdida de Hueso Alveolar/etiología , Aumento de la Cresta Alveolar/métodos , Densidad Ósea/fisiología , Remodelación Ósea/fisiología , Índice de Placa Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Regeneración Tisular Guiada Periodontal/métodos , Humanos , Carga Inmediata del Implante Dental/métodos , Arcada Parcialmente Edéntula/rehabilitación , Masculino , Persona de Mediana Edad , Oseointegración/fisiología , Índice Periodontal , Estudios Prospectivos , Elevación del Piso del Seno Maxilar/métodos , Propiedades de Superficie , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Ceramic biomaterial blocks like hydroxyl apatite are too brittle for simple simultaneous vertical augmentation and dental implant placement. Biological scaffolds of xenogenic or allogenic origin are known to be advantageous. PURPOSE: The aim of this study was the proof of principle for combined vertical bone augmentation and dental implantation with marginal cuffs made of biological scaffolds with interconnecting porous system and titanium dental implants. MATERIALS AND METHODS: Cylindrical porcine biomaterial rings (processed, mineralized bone matrix) were placed in combination with titanium dental implants in the tibia model using six chinchilla bastard rabbits (n = 12 samples). Histological examination included undecalcified histological examination with toluidine blue staining and fluorescence microscopy. Animals were sacrificed after 30 days. RESULTS: The results showed bony healing in the scaffolds with immature bone tissue ingrowth following the trabecular structure, showing lamellar cancellous bone healing. Fluorescence microscope showed analogous results. CONCLUSION: The biological scaffold proved a biocompatibility in a xenogenic setting. The vertical bone augmentation with simultaneous implantation was successful and proved the feasibility of the concept.
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Aumento de la Cresta Alveolar/métodos , Materiales Biocompatibles , Carga Inmediata del Implante Dental/métodos , Andamios del Tejido , Animales , Matriz Ósea/trasplante , Calcificación Fisiológica/fisiología , Colorantes , Materiales Dentales/química , Femenino , Microscopía Fluorescente , Oseointegración/fisiología , Osteogénesis/fisiología , Porosidad , Conejos , Porcinos , Tibia/patología , Tibia/cirugía , Titanio/química , Cloruro de Tolonio , Trasplante HeterólogoRESUMEN
OBJECTIVES: Short implants have become an interesting alternative to bone augmentation in dental implantology. Design of shorter implants and longer surveillance times are a current research issue. The goal of this study was to show the survival rates of short implants below 9 mm in the partly edentulous mandibular premolar and molar regions with fixed prosthetics. Marginal vertical and 2D bone loss was evaluated additionally. Different implant designs are orientationally evaluated. MATERIAL AND METHODS: A total of 247 dental implants with fixed prosthetics (crowns and bridges) in the premolar and molar region of the mandible were evaluated; 47 implants were 9 mm or shorter. Patient data were evaluated to acquire implant survival rates, implant diameter, gender and age. Panoramic X-rays were analysed for marginal bone loss. RESULTS: Average surveillance time was 1327 days. Cumulative survival rate (CSR) of short implants was 98% (1 implants lost) compared to 94% in the longer implants group without significance. Thirty-five of the short implants were Astratech (0 losses) and 12 were Camlog Screw Line Promote Plus (1 loss). Early vertical and two-dimensional marginal bone loss was not significantly different in short and regular length implant group with an average of 0.6 mm and 0.7 mm(2) in short implants over the observation period. CONCLUSIONS: Within the limitations of this study, we conclude that short implants with a length of 9 mm or less have equal survival rates compared with longer implants over the observation period of 1-3 years.
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Pérdida de Hueso Alveolar/diagnóstico por imagen , Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fracaso de la Restauración Dental , Femenino , Humanos , Arcada Parcialmente Edéntula/cirugía , Masculino , Persona de Mediana Edad , Radiografía Panorámica , Estudios Retrospectivos , Estadísticas no Paramétricas , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical follow-up, particularly with regard to postoperative complications. This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007. Diagnosis and treatment were based on both physical examination and computed tomography scan of the orbit. Patients were retrospectively analyzed for data, such as mechanism of injury, classification of fracture, and complications. The most common cause of injury was physical assault followed by traffic accidents. Surgery was conducted with a mean delay of 2.9 days after the incident. Mid lower eyelid incision was the most common surgical approach to the orbital floor. For orbital floor reconstruction, polydioxanone sheets (70.5%) were mainly used, followed by Ethisorb Dura (23.3%) and titanium mesh (6.2%). There were 19.0% of patients who showed postoperative complications: 5.8% suffered from persisting motility impairment, 3.7% from enophthalmos, 3.2% from consistent diplopia, 2.6% from ectropion, and 0.5% from orbital infection. Intraorbital hematoma (3.2%) represented the most severe complications, one patient suffered lasting impairment of sight and another one, complete blindness of the affected eye. If postoperative impairment of vision becomes evident, immediate surgical intervention is mandatory. Retrobulbar hematoma is more likely to occur in heavily traumatized patients with comminuted fractures and also in patients taking anticoagulative medication. The subciliary approach to the orbit and repeated operations by the same approach are associated with a higher risk of developing ectropion.
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Fijación Interna de Fracturas/métodos , Fracturas Orbitales/cirugía , Implantes Orbitales , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ceguera/etiología , Niño , Diplopía/etiología , Ectropión/etiología , Enoftalmia/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/etiología , Fracturas Orbitales/radioterapia , Polidioxanona , Ácido Poliglicólico , Hemorragia Retrobulbar/etiología , Estudios Retrospectivos , Mallas Quirúrgicas , Titanio , Adulto JovenRESUMEN
BACKGROUND: Bone transplants are mostly prepared with cutting drills, chisels, and rasps. These techniques are difficult for unexperienced surgeons, and the implant interface is less precise due to unstandardized preparation. Cylindrical bone transplants are a known alternative. Current techniques include fixation methods with osteosynthesis screws or the dental implant. PURPOSE: A new bone cylinder transplant technique is presented using a twin-drill principle resulting in a customized pressfit of the transplant without fixation devices and combining this with the superior grinding properties of a diamond coating. MATERIALS AND METHODS: New cylindrical diamond hollow drills are used for customized press fit bone transplants in a case series of five patients for socket reconstruction in the front and molar region of maxilla and mandibula with and without simultaneous implant placement. RESULTS: The technical approach was successful without intra or postoperative complications during the acute healing phase. CONCLUSION: The customized press fit completes a technological trias of bone cylinder transplant techniques adding to the assisted press fit with either osteosynthesis screws or the dental implant itself.