Search

Purpose: The aim of this systematic review was to investigate which material is the most effective bone substitute for alveolar bone healing by evaluating histomorphometric outcomes after healing of postextraction sockets in humans. Materials and Methods: A manual and electronic search (PubMed, EMBASE, Cochrane Library) was performed using a search string prepared ad hoc. Data were statistically analyzed by calculating weighted mean percentage of new bone formation (primary outcome) and weighted mean percentage of residual biomaterial, soft/connective tissue, and nonmineralized tissue (secondary outcomes) in the biopsies. A meta-analysis of the included randomized controlled trials (RCTs) was performed. Results: A total of 802 papers were screened. After application of the inclusion and exclusion criteria, a total of 40 articles were included in the quantitative synthesis while 11 were included in the meta-analysis of comparative studies. The evaluation of comparative studies with empty sites as control showed that bovine bone could lead to a lower proportion of new bone formation compared to sites left to heal spontaneously (P < .00001). Magnesium-enriched hydroxyapatite and porcine bone showed a significantly higher percentage of new bone compared to control sites (P < .00001). Grafting with an allograft did not lead to a higher percentage of new bone formation in comparison with control sites (P = .09). Conclusion: There was no evidence for the superiority of a given biomaterial over the others in terms of new bone formation. While calcium sulphate and beta-tricalcium phosphate resorbed faster than other biomaterials, xenografts showed a lower resorption rate than allografts. Comparative studies suggested that bovine bone was related to a lower proportion of new bone volume compared to sites left to heal spontaneously, while porcine bone and magnesium-enriched hydroxyapatite were related to higher new bone volume. Allograft was not related to higher new bone volume than sites healed without any biomaterial. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the long-term outcome of fixed prostheses supported by six implants, two of which were tilted, placed in the maxilla and immediately loaded more than 10 years earlier. Materials and Methods: A retrospective review of implants placed between May 29, 2003 and February 12, 2005 and used to support immediately loaded fixed dental prostheses in the maxilla was conducted. The features of failed implants were analyzed. In the most recent follow-up visits, survival of individual implants and prostheses was verified, and modified Plaque Index as well as modified Sulcular Bleeding Index were assessed. Patients also filled out a questionnaire requiring graded responses from 0 (poor) to 10 (excellent) that was designed to assess their quality of life. Results: A total of 162 implants were placed between May 29, 2003 and February 12, 2005 to support immediately loaded maxillary fixed prostheses of 27 totally edentulous patients (19 female, 8 male). Three patients (1 male, 2 female) dropped out, so 144 implants were followed up. Seven of the 144 original implants failed, corresponding to a survival rate of 95.1% over 10 years. All the failures occurred within 2 years after surgery. Patients' responses to the questionnaire produced an average score of 8.4 to 8.8, showing a relevant degree of satisfaction. Conclusion: Based upon this study of 27 patients who received immediately loaded maxillary full-arch fixed implant-supported prostheses supported by two tilted and four axial implants, it appears that this is a reliable procedure with a high long-term survival rate and a high level of patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present systematic review was to evaluate, in patients with irreversible pulpitis affecting mandibular posterior teeth, if premedication with nonsteroidal anti-inflammatory drugs can increase the efficacy of inferior alveolar nerve block (IANB) if compared to placebo administration; if one anesthetic agent is more effective than another; if 1.8 mL injection is more effective than 3.6 mL injection to increase the efficacy of IANB; and if supplementary buccal injection is able to increase the efficacy of IANB as compared to a negative control/placebo group. Data Sources: Randomized controlled clinical trials investigating different aspects (technique, premedication with anti-inflammatory drugs, different anesthetic agents) were searched. Success of IANB, as defined in the studies, was considered as the primary outcome. A meta-analysis was performed evaluating relative risks (RRs). Electronic databases (Medline, Embase, Cochrane Central) were searched after preparation of an appropriate search string. After application of selection criteria, a total of 37 studies were included; 19 of them were considered in the meta-analysis. There was evidence of a difference in favor of the use of premedication with anti-inflammatory drugs (RR, 1.80; CI 95%, 1.50–2.14; P < .0001). There was no evidence of a difference between articaine and lidocaine (RR, 1.05; CI 95%, 0.91–1.21; P = .94). With regard to the volume of anesthetic infiltrated, the computed RR was 1.17 (CI, 0.73–1.88) without any significant difference between the use of one or two cart ridges (P = .52). The estimated RR for a supplementary buccal infiltration was 1.56 (CI, 1.00–2.42; P = .05). Conclusion: The use of premedication with anti-inflammatory drugs before IANB can increase the efficacy of the IANB. The type of anesthetic agent, the volume of anesthetic, and the use of a supplemental buccal infiltration do not seem to affect the efficacy of anesthesia. [ABSTRACT FROM AUTHOR]

Aims: Zygomatic implants are successful alternatives to conventional dental implants for oral rehabilitation of patients with severely atrophic maxillae; however, the use of unilateral zygomatic implants needs to be studied further to validate their efficacy. The present investigation aimed to evaluate unilateral zygomatic implant placement in the oral rehabilitation of partially edentulous patients with extremely atrophic maxillary bone and/or previous implant failures. Materials and methods: This retrospective clinical study included patients with partially edentulous maxillae who underwent unilateral zygomatic implant insertion. The primary outcome was implant survival. Intraoperative, postoperative and prosthetic complications were also assessed based on patients’ clinical records. Results: A total of 32 patients (34 zygomatic implants) with a mean age of 60.45 ± 8.74 years (range 47 to 78 years) were included in the study. The mean follow-up period was 34.3 ± 25.5 months, and the overall implant survival rate was 100%. No intraoperative or postoperative complications developed in any of the patients, and no prosthesis failures or complications were recorded. Conclusions: The results indicate that unilateral zygomatic implant insertion for oral rehabilitation of patients with partially edentulous posterior maxillae with severely atrophic bone and/or previous implant failures can be considered a successful alternative to use of conventional dental implants associated with advanced bone grafting procedures. [ABSTRACT FROM AUTHOR]

Negrini, Daniela, Anna Candiani, Federica Boschetti, Beatrice Crisafulli, Massimo Del Fabbro, Dario Bettinelli, and Giuseppe Miserocchi. Pulmonary microvascular and perivascular interstitial geometry during development of mild hydraulic edema. Am J Physiol Lung Cell Mol Physiol 281: L1464-L1471, 2001.--To study pulmonary arteriolar vasomotion in control conditions and in the transition to hydraulic edema, changes in subpleural pulmonary arteriolar diameter and perivascular interstitial volume were evaluated in anesthetized spontaneously breathing rabbits. Images of subpleural pulmonary microvessels were recorded in control conditions and for up to 180 min during a 0.5 ml.kg-1.min-1 intravenous saline infusion through an intact parietal pleural window. Images were digitized and analyzed with a semiautomatic procedure to determine vessel diameter and perivascular interstitial thickness from which interstitial fluid volume was derived. In control yessels, the diameter of-30-, -50-, and -80-[mu]m arterioles and the perivascular interstitial thickness were fairly stable. During infusion, the diameter increased maximally by 20% in -30-[mu]m vessels, was unchanged in -50-[mu]m vessels, and decreased by 25% in -80-[mu]m arterioles; the perivascular interstitial volume increased by 54% only around 30-[mu]m microvessels. In papaverine-treated rabbits, all arterioles dilated and a larger increase in perivascular interstitial thickness was observed. The data suggest that the opposite vasomotor behavior of 30- and 80-[mu]m arterioles during development of mild edema may represent a local specific response of the pulmonary microcirculation to reduce capillary pressure in the face of an increased transendothelial fluid filtration, thus counteracting progression toward severe edema. pulmonary arteriolar vasomotion; perivascular interstitial volume; mild interstitial edema