The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model

Background: The repair of large bone defects is a major orthopedic challenge because autologous bone grafts are not available in large amounts and because harvesting is often associated with donor-site morbidity. Considering that bone marrow stromal cells (BMSC) are responsible for the maintenance of bone turnover throughout life, we investigated bone repair at a site of a critically sized segmental defect in sheep tibia treated with BMSCs loaded onto allografts. The defect was created in the mid-portion of the tibial diaphysis of eight adult sheep, and the sheep were treated with ex-vivo expanded autologous BMSCs isolated from marrow aspirates and loaded onto cortical allografts (n = 4). The treated sheep were compared with control sheep that had been treated with cell-free allografts (n = 4) obtained from donors of the same breed as the receptor sheep. Results: The healing response was monitored by radiographs monthly and by computed tomography and histology at six, ten, fourteen, and eighteen weeks after surgery. For the cell-loaded allografts, union was established more rapidly at the interface between the host bone and the allograft, and the healing process was more conspicuous. Remodeling of the allograft was complete at 18 weeks in the cell-treated animals. Histologically, the marrow cavity was reestablished, with intertrabecular spaces being filled with adipose marrow and with evidence of focal hematopoiesis. Conclusions: Allografts cellularized with AOCs (allografts of osteoprogenitor cells) can generate great clinical outcomes to noncellularized allografts to consolidate, reshape, structurally and morphologically reconstruct bone and bone marrow in a relatively short period of time. These features make this strategy very attractive for clinical use in orthopedic bioengineering

Compressão pneumática intermitente na prevenção de trombose venosa profunda em pacientes cirúrgicos: revisão sistemática e metanálise

Introdução: Trombose Venosa Profunda (TVP) é o resultado de inúmeros fatores, incluindo estase venosa, injuria endotelial e hipercoagulação do sangue. O embolismo pulmonar é a maior complicação da TVP e ocorre quando um trombo ou um coágulo sangüíneo desloca-se em direção aos pulmões. O tromboembolismo é um sério problema de saúde e é responsável por um considerável número de mortes súbitas e por significantes custos de hospitalizações em todo o mundo. Entre os métodos profiláticos usados na prevenção da TVP, há os classificados como mecânicos e os farmacológicos. Ambos são efetivos e podem ser usados sempre que necessário, tendo sido recomendados por consenso internacional. Objetivos: Avaliar a incidência da TVP em pacientes cirúrgicos através da Compressão pneumática Intermitente CPI (coxa/perna ou perna/pé) contra nenhuma forma de profilaxia ou contra fármacos. Métodos: Revisão sistemática de ensaios clínicos randomizados, utilizando a metodologia Cochrane, através de buscas eletrônica e manual. Foram incluídos pacientes cirúrgicos, de ambos os sexos, cuja intervenção foi o uso de aparelhos de compressão pneumática intermitente. Resultados: 4269 pacientes cirúrgicos investigados por 31 ensaios submetidos a um número de intervenções cirúrgicas, incluindo cirurgia ortopédica (joelho e quadris), geral, ginecológica, urológica e neurológica. Dados combinados demonstraram efeitos de tratamento virtualmente iguais entre CPI e abordagens farmacológicas [0.95 (95%CI 0.82, 1.10)], em relação à incidência de TVP. Entretanto, o risco de hemorragia foi maior e estatisticamente significante em pacientes tratados com intervenções farmacológicas [0.37(95%CI 0.20, 0.69)]. Conclusão: Comparações entre as estratégias farmacológicas e mecânicas indicam que ambas são similares na prevenção de trombose venosa profunda. Entretantio, a evidência atual suportaria a escolha das abordagens mecâncias, uma vez que o risco de eventos hemorrágicos favorece os métodos mecânicos.

Late Infiltration of Post-orthodontic White Spot Lesions

White spot lesion (WSL) infiltration has been recommended immediately after debonding of orthodontic brackets. It is however not clear if established inactive WSLs can also be masked through infiltrationOrthodontic treatment of a 19-year-old patient had to be terminated prematurely due to development of multiple WSLs of varying severity. Three months after debonding, the patient presented for lesion infiltration. After etching with 15% HCl gel and re-wetting of the dried surfaces it seemed that a good outcome could be expected. Lesion infiltration led to complete masking of less severe WSLs. The visual appearance of moderate and severe WSLs was improved but they were still visible after treatment.Inactive WSLs may not represent an increased caries risk, but patients are often bothered esthetically. Infiltration by repeated etching might be a viable approach even for inactive WSLs. Controlled clinical trials are needed to investigate the long-term performance of this technique.

A longitudinal three-center study of dental arch relationship in patients with bilateral cleft lip and palate

OBJECTIVE: To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP). DESIGN: Retrospective longitudinal intercenter outcome study. PATIENTS: Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers. SETTING: Three cleft palate centers with different treatment protocols. MAIN OUTCOME MEASURES: Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models. RESULTS: There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p=.027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p=.041) and 12.9% (p=.009), respectively. CONCLUSIONS: Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.

Clinical and microbiological findings at sites treated with orthodontic fixed appliances in adolescents

INTRODUCTION: Fixed orthodontic appliances can alter the subgingival microbiota. Our aim was to compare the subgingival microbiota and clinical parameters in adolescent subjects at sites of teeth treated with orthodontic bands with margins at (OBM) or below the gingival margin (OBSM), or with brackets (OBR). METHODS: Microbial samples were collected from 33 subjects (ages, 12-18 years) in treatment more than 6 months. The microbiota was assessed by the DNA-DNA checkerboard hybridization method. RESULTS: Bacterial samples were taken from 83 OBR,103 OBSM, and 54 OBM sites. Probing pocket depths differed by orthodontic type (P <0.001) with mean values of 2.9 mm (SD, 0.6) at OBSM sites, 2.5 mm (SD, 0.6) at OBM sites, and 2.3 mm (SD, 0.5) at OBR sites. Only Actinomyces israelii (P <0.001) and Actinomyces naeslundii (P <0.001) had higher levels at OBR sites, whereas Neisseria mucosa had higher levels at sites treated with OBSM or OBM (P <0.001). Aggregatibacter actinomycetemcomitans was found in 25% of sites independent of the appliance. CONCLUSIONS: Different types of orthodontic appliances cause minor differences in the subgingival microbiota (A israelii and A naeslundii) and higher levels at sites treated with orthodontic brackets. More sites with bleeding on probing and deeper pockets were found around orthodontic bands.

Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in the long-term follow-up after Perthes disease

Aim of this study was to assess the glycosaminoglycan content in hip joint cartilage in mature hips with a history of Legg-Calvé-Perthes (LCPD) disease using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).

Sample size estimation: an overview with applications to orthodontic clinical trial designs

Proper sample size estimation is an important part of clinical trial methodology and closely related to the precision and power of the trial's results. Trials with sufficient sample sizes are scientifically and ethically justified and more credible compared with trials with insufficient sizes. Planning clinical trials with inadequate sample sizes might be considered as a waste of time and resources, as well as unethical, since patients might be enrolled in a study in which the expected results will not be trusted and are unlikely to have an impact on clinical practice. Because of the low emphasis of sample size calculation in clinical trials in orthodontics, it is the objective of this article to introduce the orthodontic clinician to the importance and the general principles of sample size calculations for randomized controlled trials to serve as guidance for study designs and as a tool for quality assessment when reviewing published clinical trials in our specialty. Examples of calculations are shown for 2-arm parallel trials applicable to orthodontics. The working examples are analyzed, and the implications of design or inherent complexities in each category are discussed.

Comparative assessment of conventional and self-ligating appliances on the effect of mandibular intermolar distance in adolescent nonextraction patients: a single-center randomized controlled trial

Our aim in this study was to compare intermolar widths after alignment of crowded mandibular dental arches in nonextraction adolescent patients between conventional and self-ligating brackets.

Reporting of research quality characteristics of studies published in 6 major clinical dental specialty journals

The objective of this article was to record reporting characteristics related to study quality of research published in major specialty dental journals with the highest impact factor (Journal of Endodontics, Journal of Oral and Maxillofacial Surgery, American Journal of Orthodontics and Dentofacial Orthopedics; Pediatric Dentistry, Journal of Clinical Periodontology, and International Journal of Prosthetic Dentistry). The included articles were classified into the following 3 broad subject categories: (1) cross-sectional (snap-shot), (2) observational, and (3) interventional. Multinomial logistic regression was conducted for effect estimation using the journal as the response and randomization, sample calculation, confounding discussed, multivariate analysis, effect measurement, and confidence intervals as the explanatory variables. The results showed that cross-sectional studies were the dominant design (55%), whereas observational investigations accounted for 13%, and interventions/clinical trials for 32%. Reporting on quality characteristics was low for all variables: random allocation (15%), sample size calculation (7%), confounding issues/possible confounders (38%), effect measurements (16%), and multivariate analysis (21%). Eighty-four percent of the published articles reported a statistically significant main finding and only 13% presented confidence intervals. The Journal of Clinical Periodontology showed the highest probability of including quality characteristics in reporting results among all dental journals.

In-vitro assessment of the forces generated by lingual fixed retainers

The aim of this article was to assess the effect of wire adaptation on the lingual surfaces of mandibular anterior teeth with 3 types of lingual retainers on the development of vertical and labiolingual forces.