Creation of a Zone of Immobile Connective Tissue with Acellular Dermal Matrix Allografts.

Acellular dermal matrix allografts (ADMs) have been hypothesized to create a zone of immobile connective tissue (ICT) extending apical to the mucogingival junction (MGJ). This 12-month prospective randomized trial investigated the presence of ICT after the use of two commercially available ADMs with coronally advanced flaps in the treatment of Miller Class I and II recession defects. This study demonstrated that the use of either type of ADM resulted in predictable root coverage and a zone of ICT extending apical to the MGJ by 1.

Optimizing Connective Tissue Integration on Laser-Ablated Implant Abutments.

Focused Clinical Question: The integration of connective tissue (CT) to a laser-ablated abutment with a microgrooved surface at the apical millimeter (LL) has been documented in both animal and human studies. How should the healing be influenced to optimize the CT integration on abutment surfaces? Summary: When smooth machined titanium (ST) abutments were placed, epithelial attachment was found on abutments, but no CT integration was noted. On LL abutments, a zone of epithelial attachment and CT integration was noted.

A Randomized Clinical Trial Evaluating rh-FGF-2/β-TCP in Periodontal Defects.

Biological mediators have been used to enhance periodontal regeneration. The aim of this prospective randomized controlled study was to evaluate the safety and effectiveness of 3 doses of fibroblast growth factor 2 (FGF-2) when combined with a β-tricalcium phosphate (β-TCP) scaffold carrier placed in vertical infrabony periodontal defects in adult patients. In this double-blinded, dose-verification, externally monitored clinical study, 88 patients who required surgical intervention to treat a qualifying infrabony periodontal defect were randomized to 1 of 4 treatment groups-β-TCP alone (control) and 0.

Is Laser Disinfection an Effective Adjunctive Treatment to Bone Augmentation for Peri-Implantitis? A Review of Current Evidence.

Focused Clinical Question: In patients with endosseous dental implants that demonstrate peri-implantitis, does surgical bone augmentation with adjunctive laser implant surface disinfection have an effect on implant survival rates, and do these rates differ based on laser treatment modality? Clinical Scenario: A 55-year-old female presents 10 years after implant placement at sites #18 and #20 (Fig. 1). She demonstrates a 9-mm probing depth mesially and distally at implant #20.

Clinical assessment of bone quality of human extraction sockets after conversion with growth factors.

Purpose: The study was conducted to evaluate the effect of mineralized freeze-dried bone allograft (FDBA), alone or in combination with growth factors in extraction sockets, on subjective assessment of bone quality during implant placement.

Materials And Methods: Forty-one patients whose treatment plan involved extraction of anterior or premolar teeth were randomized into four groups: Group 1, collagen plug (control); Group 2, FDBA/β-tricalcium phosphate (β-TCP)/collagen plug; Group 3, FDBA/β-TCP/platelet-rich plasma (PRP)/collagen plug; Group 4, FDBA/β-TCP/recombinant human platelet-derived growth factor BB (rhPDGF-BB)/collagen plug. After 8 weeks of healing, implants were placed.

Effect of intensive oral hygiene regimen during pregnancy on periodontal health, cytokine levels, and pregnancy outcomes: a pilot study.

Background: Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes.

Methods: A clinical trial was conducted on 120 community-dwelling, 16- to 35-year-old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate-to-severe gingivitis.

Using growth factors in human extraction sockets: a histologic and histomorphometric evaluation of short-term healing.

Purpose: Ridge preservation protocols reduce crestal remodeling after tooth extraction. There is insufficient evidence on bone grafting in combination with platelet-rich plasma (PRP) or recombinant human platelet-derived growth factor (rhPDGF-BB). The aim of this study is to evaluate healing of grafted and nongrafted sockets and the effect of PRP and rhPDGF-BB on early remodeling.

Oral health education and therapy reduces gingivitis during pregnancy.

Background: Pregnant women demonstrate increases in gingivitis despite similar plaque levels to non-pregnant counterparts.

Aim: To evaluate an intensive protocol aimed at reducing gingivitis in pregnant women and provide pilot data for large-scale randomized controlled trials investigating oral hygiene measures to reduce pregnancy gingivitis and alter maternity outcomes.

Materials And Methods: One hundred and twenty participants between 16 and 24 weeks gestation with Gingival Index (GI) scores ≥2 at ≥50% of tooth sites were enrolled.

Intravenous Bisphosphonates for Osteoporosis and Implant Placement.

Focused Clinical Question In a patient receiving intravenous infusion of nitrogen containing bisphosphonates for management of osteoporosis, is surgical implant treatment contraindicated because of the risk of impaired bony wound healing and osteonecrosis of the jaw? Clinical Scenario A 64-year-old postmenopausal woman who leads a busy life and works full time as a business executive presents with a fracture of her maxillary central incisors teeth #8 and #9. She has been a periodontal maintenance patient for the past 20 years with excellent oral hygiene. One month earlier, she experienced trauma to her anterior teeth by walking into a closed patio door.

Efficacy of micronized acellular dermal graft for use in interproximal papillae regeneration.

The aim of this study was to evaluate interdental papillary reconstruction based on a micronized acellular dermal matrix allograft technique. Thirty-eight papillae in 12 patients with esthetic complaints of insufficient papillae were evaluated. Decreased gingival recession values were found postoperatively (P < .

Host Modulation for Smokers Undergoing Periodontal Maintenance: A Review of Current Evidence.

Focused Clinical Question In patients presenting with generalized moderate to severe chronic periodontitis and continuing to smoke, does host modulation improve the maintenance of alveolar bone support and clinical attachment level? Clinical Scenario A 45-year-old woman with a 25-pack-year history of smoking presents for comprehensive periodontal therapy including four quadrants of regenerative surgery and is now receiving supportive care at 3-month intervals. Clinical examination reveals excellent oral hygiene, and the patient resists a referral for smoking cessation. The patient is anxious about the potential for tooth loss.

Hazardous medical waste generation in Greece: case studies from medical facilities in Attica and from a small insular hospital.

The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.

Soft tissue considerations in implant site development.

Healthy soft tissue surrounding a dental implant is essential for health, function, and esthetics. The development of the tooth includes the formation of a biologic connection between the living tissues that has to be created during the healing process after placement of the implant. The success of dental implants is dependent on the establishment of a soft-tissue barrier that is able to shelter the underlying osseous structures and the osseointegration surrounding the implant body.

Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas.

Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma (HCC) associated with direct invasion to the stomach and pancreas. The patient presented with gastric outlet obstruction, upper abdominal pain and a history of chronic liver disease due to hepatitis B virus (HBV) infection. Upper gastrointestinal (GI) endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen.

Solitary fibrous tumor of the liver expressing CD34 and vimentin: a case report.

A case of a successfully treated solitary fibrous tumor (SFT) of the liver is reported. An 82-year-old female presented with left upper abdominal discomfort, a firm mass on palpation, and imaging studies revealed a large tumor, 15 cm in diameter, arising from the left lobe of the liver. A formal left hepatectomy was performed.

Gemcitabine as palliative treatment in patients with unresectable pancreatic cancer previously treated with placement of a covered metal stent. A randomized controlled trial.

Purpose: To evaluate the efficacy of gemcitabine as palliative treatment in patients with advanced pancreatic cancer (PC) previously treated with placement of a covered metal biliary stent, taking into account survival and quality of life (QoL).

Patients And Methods: Forty-nine patients with unresectable PC and obstructive jaundice, previously treated with the placement of a covered metal biliary endoprosthesis, were randomized to receive gemcitabine (group A: 9 males, 7 females) or to be followed without any anticancer intervention (group B: 18 males, 15 females). Gemcitabine was administered weekly as intravenous (i.

Primary malignant melanoma of the duodenum: aggressive management and long-term survival of an unusual oncologic entity.

Primary malignant melanoma originating in the small bowel is extremely rare. We report the case of a 55-year-old man who presented with a preoperative bleeding duodenal tumor. A standard pancreaticoduodenectomy was performed.

Clinical and histologic assessment of lateral alveolar ridge augmentation using a synthetic long-term bioabsorbable membrane and an allograft.

Background: Guided bone regeneration (GBR) is a widely used procedure for augmenting alveolar ridge width prior to placement of endosseous implants. Various graft materials and barrier membranes (non-resorbable and bioabsorbable) have been used in GBR. The aim of this study was to assess the performance of a new bioabsorbable, synthetic polyglycolic acid/trimethylene carbonate (PGA/TMC) barrier membrane with an increased absorption time in conjunction with a combination of assayed demineralized bone matrix and cortical cancellous chips uniformly dispersed in a thermoplastic biologic carrier.

Reconstruction of the chest wall.

Chest wall reconstructions can be a complex and challenging procedure and may require a multidisciplinary approach. The most common indications for chest wall reconstruction are repair of defects due to tumor resection, infection, radiation necrosis, congenital deformities or trauma. The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon.

Melanoma of the head and neck: a review.

Melanoma of the head and neck and its treatment are complex issues. The behavior of head and neck melanoma is aggressive, and it has an overall poorer prognosis than that of other skin sites. Current understanding of the behavior of head and neck melanoma is reviewed and treatment strategies are presented.

Merkel cell carcinoma: clinicopathological aspects of an unusual neoplasm.

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous cancer that predominately affects elderly Caucasians with fair skin and has a propensity for local recurrence and regional lymph node metastases. It can occur on the face, the trunk, the genitalia, and the perianal region. The median age of the patients is 69 years, but it may occur earlier and more frequently in immunosuppressed patients.

Dermatofibrosarcoma protuberans: clinicopathological aspects of an unusual cutaneous tumor.

Dermatofibrosarcoma protuberans is a rare cutaneous tumor with particular characteristics and a high frequency of recurrence after inadequate primary treatment. Its histopathological diagnosis might be difficult. Dermatofibrosarcoma protuberans can be safely distinguished from other similar neoplasms of mesenchymal origin based on the immunohistochemical expression of CD34 antigen and the genetic presence of specific chromosomal translocations.

Ovarian fibrothecoma associated with Meigs' syndrome and elevated serum CA 125.

Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 in postmenopausal women with a solid adnexal mass, ascites and pleural effusion is highly suggestive of a malignant ovarian tumor. We report on an unusual case of a benign fibrothecoma of the ovary associated with Meigs' syndrome and elevated CA 125 level in an 62-year-old white female.

Short-term preoperative radiotherapy in locally advanced rectal cancer does not increase postoperative complications and improves the rate of sphincter-preserving surgery.

Purpose: The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (RT) (5x5 Gy) not only reduces the risk for local recurrence, but also improves the overall survival rate. However, an increase in postoperative mortality and morbidity has also been observed. We, therefore, evaluated the early postoperative complications in patients treated with neoadjuvant RT for locally advanced rectal adenocarcinoma.