Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits

Objective To compare the effects of decompressive surgery (DSX), electroacupuncture (EAP), and DSX followed by EAP (DSX + EAP) for the treatment of thoracolumbar intervertebral disk disease (IVDD) in dogs with severe neurologic deficits of > 48 hours' duration.Design Retrospective case series and prospective clinical trial.Animals-40 dogs between 3 and 6 yEAPs old and weighing between 10 and 20 kg (22 and 44 lb) with long-standing (>48 hours) clinical signs of severe neurologic disease attributable to thoracolumbar IVDD.Procedures Thoracolumbar medullar injury was classified on the basis of neurologic signs by use of a scale ranging from 1 (least severe) to 5 (most severe). The DSX dogs (n = 10) were retrospectively selected from those that underwent DSX for the treatment of thoracolumbar IVDD. In addition, 19 dogs received EAP alone and 11 dogs underwent DSX followed by EAP (DSX + EAP). Outcome was considered a clinical success when a dog initially classified as grade 4 or 5 was classified as grade 1 or 2 within 6 months after the end of treatment.Results The proportion of dogs with clinical success was significantly higher for dogs that underwent EAP (15/19) than for dogs that underwent DSX (4/10); the proportion of dogs with clinical success for dogs that underwent DSX + EAP was intermediate (8/11).Conclusions and Clinical Relevance EAP was more effective than DSX for recovery of ambulation and improvement in neurologic deficits in dogs with long-standing severe deficits attributable to thoracolumbar IVDD. (J Am Vet Med Assoc 2010;236:1225-1229)

Poda apical, densidade de plantas e cobertura plástica do solo na produtividade do tomateiro em cultivo protegido

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alveolar bone healing process in spontaneously hypertensive rats (SHR). A radiographic densitometry study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys

Aim: To describe the early healing processes around the implants installed after elevation of the sinus mucosa applying the lateral access technique without the use of grafting material.Material and methods: Immediately after the elevation of the maxillary sinus Schneiderian membrane by the lateral approach in eight monkeys, implants were installed without the use of grafting material. The healing of the tissue around the implants was evaluated after 4, 10, 20 and 30 days. Ground sections were prepared and analyzed histologically.Results: After 4 days of healing, the formation of coagulum and provisional matrix was documented within the elevated area. At 10-day interval, sprouts of woven bone were in continuity with the parent bone, and partly in contact with the implant surface at the base of the augmented area. While bone-to-implant contact increased after 20 and 30 days, the area underneath the Schneiderian membrane appeared reduced in volume and condensed toward the apex of the implants. The sinus mucosa was to some extent collapsed onto the implant surface and on the newly formed bone.Conclusions: The void initially occupied by the coagulum after sinus membrane elevation shrank substantially during the observation period. A lack of influence of the Schneiderian membrane in bone formation apical to implants was documented in the early phase of healing.

Periodontal tissue response to coverage of root cavities restored with resin materials: A histomorphometric study in dogs

Background: the purpose of this study was to histomorphometrically evaluate the response of periodontal tissues covering Class V resin restorations in dogs.Methods: After raising a mucoperiosteal flap, bony defects measuring 5 x 5 mm were created on the buccal aspect of the canines of five dogs followed by cavity preparations on the root surface measuring 3 x 3 x 1 mm. Before repositioning the flap to cover the bone defect, the cavities were restored with composite resin (CR) or resin-modified glass ionomer cement (RMGIC) or were left unrestored as control (C). The dogs were euthanized 90 days after surgery. Specimens comprising the tooth and periodontal tissues were removed, processed routinely, cut into longitudinal serial sections in the bucco-lingual direction, and stained with hematoxylin and eosin (H&E) or Masson's trichrome. The most central sections were selected for histomorphometric analysis.Results: Histomorphometric analysis revealed apical migration of epithelial tissue onto the restorative materials (RMGIC and CR). The C group presented significantly longer connective tissue attachment (P < 0.05) than the RMGIC and CR groups and significantly higher bone regeneration (P < 0.05) compared to the RMGIC group. Histologically, the cervical third (CT) of all groups had the most marked chronic inflammatory infiltrate.Conclusions: Within the limits of this study, it can be concluded that the restorative materials used exhibit biocompatibility; however, both materials interfered with the development of new bone and the connective tissue attachment process.

Photoelastic Analysis of Stress Distribution in Different Retention Systems for Facial Prosthesis

The aim of this study was to assess the behavior and stress distribution of 3 retention systems associated with implant for facial prosthesis by using the photoelasticity method. A photoelastic model was made from the replica of the orbital region on the left side of a dry skull with two 4-mm implants fixed in the superior orbital region. Three facial prosthetic retention systems were made for this study: O'ring, bar-clip, and magnets. The set (model/retention systems/prosthesis) was placed in a polariscope, and then traction began to be applied to the retention systems. The limit values for removal of the retention system were obtained by tests performed in an EMIC Universal test machine. The results were obtained by observation during the experiments and by photographic record of the stress behavior in the photoelastic model, resulting from the traction of the retention systems. In the magnet system, a lowest formation of fringes was verified both around and between the implants; in the O'ring system, the formation of photoelastic fringes was noted between the implants in the apical region; and in the bar-clip system, there was a greater concentration of colored fringes in the regions between the implants and cervical area. Based on the results obtained, it was concluded that the retention systems produced different stress distribution characteristics that, in general, were concentrated in the area around the implants, and the highest concentration of fringes, in increasing order, occurred ill the retention systems of the magnets, O'ring, and bar-clip.

Influence of Implant Angulation With Different Crowns on Stress Distribution

The aim of this study was to perform a photoelastic analysis of stress distribution on straight and angulated implants with different crowns (screwed and cemented). Three models were made of photoelastic resin PL-2: model 1: external hexagon implant 3.75 x 10.00 mm at 0 degrees; model 2: external hexagon implant 3.75 x 10.00 mm at 17 degrees; model 3: external hexagon implant 3.75 x 10.00 mm at 30 degrees. Axial and oblique (45 degrees) load (100 N) was applied with a universal testing machine. The photoelastic fringes on the models were recorded with a digital camera and visualized in a graphic software for qualitative analysis. The axial loading generated the same pattern of stress distribution. The highest stresses were concentrated between medium and apical thirds. The oblique loading generated a similar pattern of stress distribution in the models with similar implant angulation; the highest stress was located on the cervical region opposite to implant angulation and on the apical third. It was concluded that the higher the implant angulation, the higher the stress value, independent of crown type. The screwed prostheses exhibited the highest stress concentration. The oblique load generated higher stress value and concentration than the axial load.

Integrated treatment to resolve a horizontal root fracture

Root fractures are defined as those that involve cement, dentin and pulp, comprising from 0.5 to 7% of injuries in permanent dentition. Diagnosis is made through clinical and radiographic exams, the latter frequently being limited by the position of the fracture. Treatment varies according to the displacement and vitality of the fragments. The authors present a clinical case of recurrent trauma of tooth 21 causing a horizontal root fracture in the middle third. After several attempts at endodontic treatment, the option was to remove the apical fragment by surgery. The postoperative period of 4 years shows very satisfactory results with regard to wound repair and tooth mobility, or implantation of the coronal segment.

Anterior Tooth Rehabilitation With Frozen Homogenous Bone Graft and Immediately Loaded Titanium Implant Using Computer-Guided Surgery

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

Comparative study of 2 software programs for predicting profile changes in Class III patients having double-jaw orthognathic surgery

Introduction: Computer software can be used to predict orthognathic surgery outcomes. The aim of this study was to subjectively compare the soft-tissue surgical simulations of 2 software programs. Methods: Standard profile pictures were taken of 10 patients with a Class III malocclusion and a concave facial profile who were scheduled for double-jaw orthognathic surgery. The patients had horizontal maxillary deficiency or horizontal mandibular excess. Two software programs (Dentofacial Planner Plus [Dentofacial Software, Toronto, Ontario, Canada] and Dolphin Imaging [version 9.0, Dolphin Imaging Software, Canoga Park, Calif]) were used to predict the postsurgical profiles. The predictive images were compared with the actual final photographs. One hundred one orthodontists, oral-maxillofacial surgeons, and general dentists evaluated the images and were asked whether they would use either software program to plan treatment for, or to educate, their patients. Results: Statistical analyses showed differences between the groups when each point was judged. Dolphin Imaging software had better prediction of nasal tip, chin, and submandibular area. Dentofacial Planner Plus software was better in predicting nasolabial angle, and upper and lower lips. The total profile comparison showed no statistical difference between the softwares. Conclusions: The 2 types of software are similar for obtaining 2-dimensional predictive profile images of patients with Class III malocclusion treated with orthognathic surgery. (Am J Orthod Dentofacial Orthop 2010; 137: 452.e1-452.e5)

Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Occurrence of Odontogenic Infections in Patients Treated in a Postgraduation Program on Maxillofacial Surgery and Traumatology

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Aracatuba Dental School, São Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.

A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible.Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure's stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis.Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period.Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Computer-Guided Surgery in Implantology: Review of Basic Concepts

The aim of the present study was to conduct a critical literature review about the technique of computer-guided surgery in implantology to highlight the indications, purposes, immediate loading of implants and complications, protocol of fabrication, and functioning of virtual planning software. This literature review was based on OLDMEDLINE and MEDLINE databases from 2002 to 2010 using the key words "computer-guided surgery" and "implant-supported prosthesis." Thirty-four studies regarding this topic were found. According to the literature review, it was concluded that the computer-assisted surgery is an excellent treatment alternative for patients with appropriate bone quantity for implant insertion in complete and partially edentulous arches. The Procera Nobel Guide software (Nobel Biocare) was the most common software used by the authors. In addition, the flapless surgery is advantageous for positioning of implants but with accurate indication. Although the computer-guided surgery may be helpful for virtual planning of cases with severe bone resorption, the conventional surgical technique is more appropriate. The surgical guide is important for insertion of the implants regardless of the surgical technique, and the success of immediate loading after computer-guided surgery depends on the accuracy of clinical and/or laboratorial steps.