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Healing Outcome (healing + outcome)

Distribution by Scientific Domains

Medical Sciences	92%

Selected Abstracts

An evidence-based assessment of the clinical guidelines for replanted avulsed teeth.

DENTAL TRAUMATOLOGY, Issue 2 2009
Part II: prescription of systemic antibiotics
The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO question: (P) for a replanted avulsed permanent tooth, (I) is prescribing SAT, (C) compared with not prescribing SAT, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation? Materials and methods:, A literature search was performed across four internet databases (Ovid Medline, Cochrane Library, PubMed, ISI Web of Science), for relevant citations (n = 35 702). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14 742) that were sieved according to evidence-based dentistry principles. Relevant titles were selected for abstract assessment (n = 782), identifying papers for examination (n = 74). Inclusion criteria were applied and three papers (326 total teeth) met the final criteria for meta-analysis. Results:, Meta-analyses found no statistically significant difference between prescribing or not prescribing antibiotics for acceptable periodontal healing without progressive root resorption (common odds ratio = 0.90, SE = 0.29, 95% confidence intervals = 0.51,1.58). Conclusion:, The evidence for an association between prescribing SAT and an increased likelihood of acceptable periodontal healing outcome is inconclusive. This investigation of antibiotic use as defined in the clinical guidelines indicates there is inconclusive clinical evidence from studies of replanted avulsed human teeth to either contradict or support the guideline. Pending future research to the contrary, dentists are recommended to follow current guidelines in prescribing SAT when replanting avulsed teeth. [source]

An investigation of root-fractured permanent incisor teeth in children

DENTAL TRAUMATOLOGY, Issue 1 2003
Laura Feely
Abstract ,,,The aim of this retrospective study was to determine the type of healing which occurred in root-fractured permanent incisor teeth in children. The objectives were to determine whether gender, age, stage of root development or location of the fracture affected the healing type. The method involved careful scrutiny of clinical records and radiographs of children who attended a unit of paediatric dentistry in a dental hospital. Relevant information was entered onto a data collection sheet. The results were tabulated and analysed by the ,2 -tests using the SPSS statistical package. The results are based on 34 root-fractured teeth in 33 children aged 8,15 years. Root development was incomplete in 27 of the root-fractured teeth and complete in seven teeth. A good healing outcome was seen in 27 (79.4%) of the teeth and poor healing in 7 (20.6%). The only factor which was found to be statistically significantly related to healing was the stage of root development. It can be concluded that root-fractured teeth with immature roots have a better chance of showing good healing than teeth with mature roots. [source]

Healing of 208 intraalveolar root fractures in patients aged 7,17 years

DENTAL TRAUMATOLOGY, Issue 2 2001
Miomir Cvek
Abstract , This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7,17 years) treated in the period 1959,1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies. [source]

Immediate implants at fresh extraction sockets: an experimental study in the beagle dog comparing four different implant systems.

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010
Soft tissue findings
de Sanctis M, Vignoletti F, Discepoli N, Muñoz F, Sanz M. Immediate implants at fresh extraction sockets: an experimental study in the beagle dog comparing four different implant systems. Soft tissue findings. J Clin Periodontol 2010; 37: 769-776 doi: 10.1111/j.1600-051X.2010.01570.x. Abstract Objectives: To evaluate whether different implants placed immediately upon tooth extraction may affect the dimension and composition of the peri-implant soft tissues. Material and Methods: Eight beagle dogs received implants randomly installed into the distal socket of 3P3 and 4P4. Four commercially available implant systems were evaluated: 3i Osseotite Certain straight; Astra MicroThreadÔ -OsseoSpeedÔ; Thommen SPI Element®; and Straumann ITI standard. Each animal provided four test implant sites. All animals were sacrificed 6 weeks after implant placement, providing specimens for the evaluation of the soft tissue dimensions by histometric analysis. Results: The biological width at 6 weeks after implant placement consisted of a junctional epithelium measuring between 2 and 2.7 mm and a connective tissue component between 1 and 1.8 mm with no statistical differences among the four implant systems. Conclusion: This study failed to demonstrate differences in the soft tissue healing outcome when placing four different implant systems into fresh extraction sockets. Nevertheless, the length of the epithelium achieved with the four implant systems is longer than what has been reported when placing implants in healed-ridge experimental models. [source]

Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2003
A. Stavropoulos
Abstract Objectives: To evaluate whether Bio-Oss® used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss® with gentamicin may have an added effect. Material and methods: Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss® impregnated with saline (DBB,), a resorbable membrane in combination with Bio-Oss® impregnated with gentamicin (DBB+), or with flap surgery (RBF). Results: All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss® did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss® with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. Conclusion: The results failed to demonstrate an added effect of Bio-Oss® implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant. Zusammenfassung Von Proteinen befreiter boviner Knochen und Gentamycin als Adjuvans der GTR bei der Behandlung von infraalveolären Knochentaschen. Eine randomisierte kontrollierte klinische Studie. Ziele: Die Evaluation ob, Bio-Oss® welches als Adjuvans zur GTR verwendet wird, die Heilung von 1- oder 2-wandigen Knochentaschen im Vergleich zu alleiniger GTR verbessert. Sowie die Untersuchung, ob die Imprägnierung von Bio-Oss® mit Gentamycin einen zusätzlichen Effekt haben könnte. Material und Methoden: 60 mit wenigstens einer approximalen Knochentasche mit Sondierungstiefe (PPD) ,7 mm und röntgenologischem Nachweis einer infraalveolären Komponente (IC) von ,4 mm, wurden randomisiert entweder mit einer resorbierbaren Membran (GTR), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Kochsalzlösung imprägniert war (DBB-), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Gentamycin imprägniert war (DBB+) oder mit Lappen-OP (RPF) behandelt. Ergebnisse: Nach einem Jahr hatten alle Behandlungsweisen eine statistisch signifikante klinische Verbesserung zum Ergebnis. Defekte, die mit alleiniger GTR behandelt wurden zeigten einen Gewinn an klinischem Attachmentniveau (PAL) von 2,9 mm, einer PPD (PPD12) von 4,9 mm, einem Gewinn an röntgenologischem Knochenniveau (RBL) von 3,1 mm und einer IC (IC12) von 2,7 mm. GTR in Kombination mit Bio-Oss® verbesserte das Ergebnis der Heilung nicht (PAL Gewinn: 2,5 mm; PPD12: 4,9; RBL Gewinn: 2,8 mm; IC12: 3,3 mm). Die Imprägnierung von Bio-Oss® mit Gentamycin 2% mg/ml hatte klinische Verbesserungen zum Ergebnis (PAL Gewinn: 3,8 mm; PPD12: 4,2 mm; RBL Gewinn: 4,7 mm; IC12: 2,1 mm), die größer waren als die der anderen Behandlungsweisen, jedoch waren die Unterschiede nicht statistisch signifikant. Defekte, die nur mit Lappen-OP behandelt wurden zeigten das schlechteste klinische Ergebnis von allen Gruppen (PAL Gewinn: 1,5 mm; PPD12: 5,1 mm; RBL Gewinn: 1,2 mm; IC12: 4,2 mm). Schlussfolgerung: Die Ergebnisse konnten im Vergleich mit alleiniger GTR keinen zusätzlichen Effekt der Bio-Oss®-Implantation in Kombination mit GTR hinsichtlich der Heilung von tiefen approximalen 1- oder 2-wandigen oder kombinierten 1- oder 2-wandigen Knochentaschen aufzeigen. Auf der anderen Seite verbessert die lokale Applikation von Gentamycin das Behandlungsergebnis, jedoch war das Ausmaß nicht statistisch signifikant. Résumé Os bovin déprotéiné et gentamicine comme adjuvant à la RTG pour le traitement des lésions intra-osseuses. Une étude clinique contrôlée et randomisée. Objectifs: Evaluer si Bio-Oss® utilisé comme adjuvant de la RTG améliore la cicatrisation des lésions intra-osseuses par rapport à la RTG seule et examiner si l'imprégnation de Bio-Oss® avec de la gentamicine pourrait avoir un effet supplémentaire. Matériels et Méthodes: 60 patients, présentant au moins une lésion intra-osseuse interproximale avec une profondeur de poche au sondage (PPD) ,7 mm et la présence avérée radiologiquement d'une composante intra-osseuse (IC) ,4 mm, ont été traités au hasard avec soit une membrane résorbable (GTR), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de solution saline (DBB-), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de gentamicine (DBB+), ou par chirurgie à lambeau (RBF). Résultats: Toutes les modalités de traitement entraînaient des améliorations cliniques significatives statistiquement après un an. Les lésions traitées par RTG seule présentaient un gain d'attache de 2.9 mm, une PPD résiduelle (PPD12) de 4.9 mm, un gain de niveau osseux radiographique (RBL) de 3.1 mm, et un IC résiduel (IC12) de 2.7 mm. La RTG combinée avec le Bio-Oss® n'améliorait pas le devenir de la cicatrisation. (gain de PAL: 2.5 mm; PPD12: 4.9; gain de RBL: 2.8 mm; IC12: 3.3 mm). L'imprégnation du Bio-Oss®avec la gentamicine (2% mg/ml) apportait des améliorations cliniques (gain de PAL: 3.8 mm; PPD12: 4.2 mm; gain de RBL: 4.7 mm; IC12: 2.1 mm), supérieurs à ceux des autres modalités de traitement, mais la différence n'était pas significative. Le traitement des lésions par lambeaux seulement entraînait la réponse clinique la moins bonne (gain de PAL: 1.5 mm; PPD12: 5.1 mm; gain de RBL: 1.2 mm; IC12: 4.2 mm). Conclusion: Ces résultats ne pouvaient démontrer un effet supplémentaire, sur la cicatrisation de lésions profondes interproximales avec une ou deux parois, de l'implantation de Bio-Oss® en combinaison avec la RTG par rapport à la RTG seule. L'application locale de gentamicine, par contre, améliorait le devenir du traitement mais pas suffisamment pour être statistiquement significatif. [source]

Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2003
A controlled clinical trial
Abstract Objectives: The purpose of the present parallel-design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non-smokers. Materials and Methods: After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (,10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non-smokers. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v-CAL), and horizontal clinical attachment level (h-CAL) were assessed immediately before and 6 months following surgery. Results: Overall, statistically significant v-CAL gain was observed in smokers (1.0 ± 1.3 mm) and non-smokers (1.3±1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v-CAL gain amounted to 2.3±0.7 mm in non-smokers as compared to 1.0±1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non-smokers presented a greater h-CAL gain (1.3±1.1 mm) than smokers (0.6±1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4±1.0 versus 0.8±0.8 mm) and proximal furcation defects (1.2±1.3 versus 0.5±1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non-smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non-smokers. Conclusions: The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v-CAL gain, and h-CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v-CAL and h-CAL gain. Zusammenfassung Ziele: Der Zweck der vorliegenden kontrollierten klinischen Studie mit einem parallelen Design war die Überprüfung des Behandlungsergebnisses bei parodontalen Furkationsdefekten nach Wurzelreinigung und ,glättung bei Lappenoperationen (FDS) bei Zigarettenrauchern und Nichtrauchern. Material und Methoden: Nach der initialen Therapie wurden 31 systemisch gesunde Personen mit moderater bis schwerer Parodontitis, die mindestens einen Klasse I oder Klasse II Furkationsdefekt aufwiesen, ausgesucht. 19 Patienten (mittleres Alter 40,3 Jahre, 15 Männer) waren Raucher (,10 Zigaretten/Tag), 12 Patienten (mittleres Alter 44,8 Jahre, 3 Männer) waren Nichtraucher. Der Plaqueindex (FMPS) und die Provokationsblutung (FMBS) im gesamten Mund, die Sondierungstiefen (PPD), die vertikalen klinischen Befestigungsniveaus (v-CAL) und die horizontalen klinischen Befestigungsniveaus (h-CAL) wurden unmittelbar vor und 6 Monate nach der Operation erhoben. Ergebnisse: Insgesamt wurde ein statistisch signifikanter v-CAL Gewinn bei Rauchern (1,0±1,3 mm) und Nichtrauchern (1,3±1,1 mm) beobachtet, die Differenz wischen den Gruppen war statistisch signifikant (p=0,0003). Bei den approximalen Furkationsdefekten betrug der v-CAL Gewinn bei Nichtrauchern 2,3±0,7 mm verglichen zu den Rauchern mit 1,0±1,1 mm (p=0,0013). 6 Monate post operationem zeigten die Nichtraucher einen größeren h-CAL Gewinn (1,3±1,1 mm) verglichen mit den Rauchern (0,6±1,0 mm) mit einer statistischen Signifikanz zwischen den Gruppen (p=0,0089). Dieser Trend wurde sowohl bei den fazialen/lingualen Defekten (1,4±1,0 mm vs. 0,8±0,8 mm) und bei den approximalen Furkationsdefekten (1,2 v 1,3 mm vs. 0,5±1,2 mm) bestätigt. Das Verhältnis von Klasse II Furkationen, die post operationem eine Verbesserung zu Klasse I Furkationsdefekten zeigten, war bei Rauchern 27,6 % und 38,5 % bei Nichtrauchern. Nach 6 Monaten zeigten 3,4 % der Klasse I Furkationsdefekte bei Rauchern einen kompletten Verschluss verglichen mit 27,8 % bei Nichtrauchern. Zusammenfassung: Die Ergebnisse der vorliegenden Studie zeigten, dass 1) FDS eine klinische und statistisch signifikante PPD Reduktion, einen v-CAL Gewinn und h-CAL Gewinn bei Klasse I/II Molaren Furkationsdefekten erbringt; 2) Zigarettenraucher weniger gute Heilungsergebnisse nach Operationen sowohl bei v-CAL als auch bei h-CAL zeigten. Résumé Objectifs: cette étude clinique contrôlée en parallèle se proposait d'évaluer l'issue du trai-tement des lésions des furcations par un lam-beau de débridement (FDS) chez des fumeurs de cigarette par rapport à des non-fumeurs. Matériel et méthodes: Après un traitement initial, 31 sujets en bonne santé atteints de parodontite modérée à avancée et présentant au moins une lésion inter-radiculaire de classe I ou II sur une molaire, furent sélectionnés. 19 patients (d'âge moyen: 40.3 ans, 15 hommes) étaient fumeurs (,10 cigarettes/jour), 12 patients (d'âge moyen: 44.8 ans, 3 hommes) étaient non-fumeurs. Le score de plaque de toute la bouche (FMPS) et le score de saignement (FMBS), la profondeur de poche au sondage (PPD), le niveau clinique d'attache vertical (v-CAL), et horizontal (h-CAL) furent estimés immédiatement avant et 6 mois après la chirurgie. Résultats: D'une façon générale, un gain de v-CAL statistiquement significatif gain était observé chez les fumeurs (1.0±1.3 mm) et chez les non-fumeurs (1.3±1.1 mm), la différence entre les groupes étant statistiquement significative (p=0.0003). Pour les lésions des furcations proximales, le gain de v-CAL atteignait 2.3±0.7 mm chez les non-fumeurs et seulement 1.0±1.1 mm chez les fumeurs (p=0.0013). 6 mois après la chirurgie, les non-fumeurs présentaient un gain de h-CAL gain plus important (1.3±1.1 mm) que les fumeurs(0.6±1.0 mm), avec une différence statistiquement significative entre les groupes (p=0.0089). Cette tendance était confirmée à la fois sur les lésions des furcations vestibulo-linguales (1.4±1.0 mm vs 0.8±0.8 mm) et proximales (1.2±1.3 mm vs 0.5±1.2 mm). La proportion de furcations de Classe II s'améliorant après chirurgie en Classe I était de 27.6% chez les fumeurs et 38.5% chez les non-fumeurs. Après 6 mois, 3.4% des furcations initialement de Classe I étaient complètement fermées contre 27.8% chez les non-fumeurs. Conclusions: Les résultats de cette étude indiquent que: 1) FDS produit une réduction cliniquement et statistiquement significative de PPD, un gain de v-CAL et de h-CAL gain sur les lésions de furcations molaires de Classe I/II; 2) Les fumeurs de cigarette ont une cicatrisation moins favorable après chirurgie en terme de gain de v-CAL et de h-CAL. [source]

Influence of interleukin-1 gene polymorphism on periodontal regeneration in intrabony defects

JOURNAL OF PERIODONTAL RESEARCH, Issue 1 2003
M. Christgau
The aim of this controlled retrospective study was to evaluate the influence of an IL-1 gene polymorphism on the clinical and radiographic healing outcomes of GTR therapy. The study included 47 adult periodontitis patients with 94 deep intrabony defects treated by GTR using different membrane materials. The following clinical parameters were recorded at baseline and 12 months after surgery: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), clinical attachment level (CAL), and the vertical relative attachment gain (V-rAG). Bone changes in the defect regions due to GTR therapy were quantitatively evaluated using digital subtraction radiography (DSR). Polymorphisms of the IL-1A gene at position ,,889 and of the IL-1B gene at position +,3953 were analyzed by PCR. Statistical analysis was performed using the Mann,Whitney-U and the Wilcoxon-Signed-Rank tests (, = 0.05). The study comprised 19 IL-1 genotype positive (IL-1 +) patients and 28 IL-1 genotype negative (IL-1 ,) patients. Twelve months after GTR therapy, both patient groups revealed statistically significant PPD reductions and CAL gain [median (25/75% percentiles)]: ,PPD [IL-1 + : 4.0 (2.5/5.0) mm; IL-1- : 3.8 (3.0/4.9) mm], ,CAL [IL-1 + : 3.5 (3.0/4.8) mm; IL-1 ,: 3.0 (1, 2/4, 5) mm]. V-rAG amounted to 60.0 (47.7/78.6)% in IL-1 + patients and 53.1 (43.4/81.9)% in IL-1 , patients. Both patient groups showed significant bone density gain in 40% (IL-1 +) and 43.6% (IL-1 ,) of the initial defect area due to GTR. Neither the clinical nor the radiographic healing parameters revealed any statistically significant differences in the GTR healing outcome between IL-1 + and IL-1 , patients. In conclusion, these 12-month findings indicate that the IL-1 gene polymorphism has no influence on the clinical and radiographic regeneration results following GTR therapy. [source]

Neutrophil-Derived Metalloproteinase-9 Predicts Healing Quality after Sinus Surgery,

THE LARYNGOSCOPE, Issue 1 2005
J B. Watelet MD
Abstract Background: In a recent study, we have shown that gelatinase-B (metalloproteinase [MMP]-9) in nasal secretions can have both monitoring and predictive value on the healing outcome after functional endoscopic sinus surgery (FESS) to treat chronic rhinosinusitis (CRS) and nasal polyposis (NP). In this work, we aimed to explore the source of MMP-9 and the influence of inflammation on MMP-9 expression and release in nasal tissue and secretions during airway remodelling after surgery. Methods: Biopsies from 23 patients operated by FESS for CRS or NP were collected 1, 3, and 6 months after sinus surgery. MMP-9 expression in the paranasal mucosa was correlated with healing quality, with MMP-9 concentrations in nasal fluid, and with histomorphologic findings (edema, fibrosis, ,smooth muscle actin, CD-68, myeloperoxidase, EG2, and transforming growth factor [TGF]-,1 stainings). Results: MMP-9 concentrations in nasal fluid were paralleled by MMP-9 expression inside the extracellular matrix (ECM) after sinus surgery. MMP-9 expression in ECM was significantly correlated with healing quality (r = 0.378, P = .0181), and poor healers presented significantly more edema (P < .05). The amounts of MMP-9 in nasal fluid were significantly and independently predicted by the number of neutrophils (P = .0224) and macrophages (P = .0497) in the tissue. In contrast, MMP-9 expression was not related to fibrosis, number of myofibroblasts, or TGF-,1 expression in ECM. Conclusions: MMP-9 expression is increased in the ECM during wound healing and parallels concentrations of MMP-9 in nasal fluids. Inflammatory cells represent the major source of increased MMP-9 expression, which is linked to poor healing quality. [source]

Soft tissue dehiscence coverage around endosseous implants: a prospective cohort study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2008
R. Burkhardt
Abstract Aim: To evaluate the healing outcome of soft tissue dehiscence coverage at implant sites. Material and methods: Ten patients with one mucosal recession defect at an implant site and a contralateral unrestored clinical crown without recession were recruited. The soft tissue recessions were surgically covered using a coronally advanced flap in combination with a free connective tissue graft. Healing was studied at 1, 3 and 6 months post-operatively. Results: Soft tissue dehiscences were covered with a coronal overcompensation of the flap margin up to 1.2 mm after the procedure. After 1 month, the coverage shrank to a mean of 75%, after 3 months to 70% and after 6 months to 66%. Conclusions: The implant sites revealed a substantial, clinically significant improvement following coronal mucosal displacement in combination with connective tissue grafting, but in none of the sites, a could complete implant soft tissue dehiscence coverage be achieved. [source]

Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review

DENTAL TRAUMATOLOGY, Issue 2 2009
Susan Elisabeth Hinckfuss
The principles of evidence-based dentistry can be used to assess whether these guidelines are based on currently-available evidence. A qualitative systematic review was conducted of relevant clinical literature to examine the evidence on splinting duration and periodontal healing outcomes. The review was constrained markedly by small sample sizes, retrospective nature of clinical audits, dissimilarities of selected studies in their design, methodology and observation periods, and lack of uniformity in terminology for outcomes. A total of 138 replanted avulsed permanent teeth pooled from four papers each reporting both short-term splinting (14 days or less) and long-term splinting (over 14 days) in accord with current clinical guidelines, were studied. The evidence for an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive. The study found no evidence to contraindicate the current guidelines and suggests that the likelihood of successful periodontal healing after replantation is unaffected by splinting duration. Pending future research to the contrary, it is recommended that dentists continue to use the currently-recommended splinting periods when replanting avulsed permanent teeth. [source]

An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth

DENTAL TRAUMATOLOGY, Issue 1 2008
Bill Kahler
For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the ,Centre of Evidence-based Medicine' categorization (levels 1,5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the design of animal experimentation to correctly simulate some dental injuries. Some of the studies employed rigid splinting techniques, which are not representative of current recommendations. Recommended splinting treatment protocols for teeth that have been luxated, avulsed or root-fractured teeth are formulated on the strength of research evidence. Despite the ranking of these studies in this appraisal as low levels of evidence, these recommendations should be considered ,best practice', a core philosophy of evidence-based dentistry. [source]

Recombinant human platelet-derived growth factor BB (rhPDGF-BB) and beta-tricalcium phosphate/collagen matrix enhance fracture healing in a diabetic rat model

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2009
Loay Al-Zube
Abstract Diabetes mellitus is a common systemic disease that has been associated with poor fracture healing outcomes. The mechanism through which diabetes impairs bone regeneration is unknown. One possible mechanism may be related to either decreased or uncoordinated release of local growth factors at the fracture site. Indeed, previous studies have found reduced platelet-derived growth factor (PDGF) levels in the fracture callus of diabetic rats, suggesting that local application of PDGF may overcome the negative effects of diabetes and promote fracture healing. To test this hypothesis, low (22 µg) and high (75 ug) doses of recombinant human PDGF-BB (rhPDGF-BB) were applied directly to femur fracture sites in BB Wistar diabetic rats that were then compared to untreated or vehicle-treated animals. rhPDGF-BB treatment significantly increased early callus cell proliferation compared to that in control specimens. Low dose rhPDGF-BB treatment significantly increased callus peak torque values (p,<,0.05) at 8 weeks after fracture as compared to controls. High dose rhPDGF-BB treatment increased callus bone area at 12 weeks postfracture. These data indicate that rhPDGF-BB treatment ameliorates the effects of diabetes on fracture healing by promoting early cellular proliferation that ultimately leads to more bone formation. Local application of rhPDGF-BB may be a new therapeutic approach to treat diabetes-impaired fracture healing. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1074,1081, 2009 [source]