Risedronate therapy for neurofibromatosis Type 1-related low bone mass: A stitch in time saves nine

PubMedID: 25338093Neurofibromatosis Type 1 (NF1) is a common hereditary disease characterized by disorders regarding the skin, neural, and skeletal systems. Osteoporosis is one of the skeletal manifestations of NF1, which is associated with increased fracture risk. The management of NF1-related low bone mass has been less studied in the literature. We present a 19-year-old patient with severe low bone mass complicating NF1. The patient received 1-year course of 35 mg risedronate sodium once per week along with a daily regimen of 1200 mg calcium and 800 IU vitamin D. Significant improvement with regard to the Z-scores and bone mineral density values was achieved. Besides, rapid favourable biochemical response was obtained. The patient experienced 24.4 and 15.0% improvements in bone mineral density at the lumbar site and hip, respectively, at the first year of therapy. No adverse effect was observed. Since increased bone turnover is the primary contributor of osteoporosis in NF1, antiresorptive agents such as bisphosphonates can be considered for treatment. Despite the lack of consensus on the treatment of osteoporosis in NF1, risedronate may hold a promise as a potential therapy for osteoporosis complicating NF1. This is the first report of risedronate therapy in a case with NF1-associated low bone mass in the literature. © Acta Clinica Belgica 2015

Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

PubMedID: 26216348The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton’s scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0% (n=51) and 20.0% (n=15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p=0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p=0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95% confidence interval (CI) 1.1–70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP. © International League of Associations for Rheumatology (ILAR) 2015

Placement of implants in the mandible reconstructed with free vascularized fibula flap: comparison of 2 cases

PubMedID: 18280944The reconstruction of mandibular continuity defects after tumor resection with free vascularized bone flaps is considered to be a treatment option. Although the fibula flap presents many advantages, it does not offer sufficient bone height to restore the alveolar arch when reconstruction involves a dentate mandible. In this report, 2 patients who were referred to our clinic with reconstructed mandibles with diagnosis of amelablastoma are presented and compared. The mandibles of these patients were reconstructed with free vascularized fibula flaps. Whereas one of the reconstructed mandibles was vertically distracted before implant placement, distraction procedure was not carried out for the other patient. Increasing height of the fibula flap by distraction osteogenesis before implant placement in dentate mandible is desirable from a functional and esthetic point of view. © 2008 Mosby, Inc. All rights reserved

A histomorphometric evaluation of the effects of plateletrich fibrin and rifamycin in combination with an allograft on bone augmentation with simultaneous implant placement in rabbit tibia

Objective: To evaluate the potential of platelet-rich fibrin (PRF) and rifamycin to enhance guided bone augmentation with simultaneous high-profile dental implant placement in a rabbit tibia model. Materials and Methods: Dental implants protruding 2 mm were covered with dome-shaped stiff occlusive titanium barriers filled with demineralized freeze-dried bone allograft (DFDBA)+saline (7 rabbits), DFDBA + rifamycin (8 rabbits), or DFDB +PRF (8 rabbits). After 4 weeks, the animals were sacrificed, and undecalcified histomorphometric examination with toluidine blue staining was performed. Results: The bone-to-implant contact (BIC) was 58.43 ± 1.92% in the saline group, 68.3 ±20.37% in the rifamycin group, and 80.70±2.55% in the PRF group, and the percentage of new bone formation was 36.90 ± 0.94%, 45.26±0.60%, and 51.82±0.82%, respectively. Conclusions: Both PRF and rifamycin have potential to enhance GBA, and using DFDBA + PRF or DFDBA+rifamycin beneath a stiff occlusive titanium barrier next to a high-profile implant may enhance both BIC and new bone formation. © 2017 Cumhuriyet University Faculty of Dentistry.DİŞ-129Acknowledgements: This work was supported by the Scientific Research Project Fund of Cumhuriyet University under project number DİŞ-129

Management of a case of human bite complicated by myonecrosis and compartment syndrome

PubMedID: 19331260Case reports concerning rare complications of human bite injuries are uncommon in the literature. Further, rehabilitation of the resultant dysfunction is also hardly reported. A 41-year-old housewife who had had a human bite during an altercation 6 months ago was referred to the rehabilitation department with a nonfunctioning right hand. Twelve days after the injury she developed a compartment syndrome with complicating myonecrosis, which required fasciotomy and resulted in amputation of the fifth digit on the 17th day. Soft-tissue defects were reconstructed with skin grafts. Unfortunately, the patient did not attend follow- up visits, and 6 months after the initial injury she had to be admitted to the rehabilitation department with a nonfunctional hand. She had marked limitations of range of motion of the wrist and almost all finger joints. A rehabilitation program was initiated to improve the functional limitations of her hand. After the rehabilitation program, she was able to use her right hand in her daily routine activities. Rehabilitation can still be useful in order to avoid permanent disability even in late and complicated cases of bite injuries

Direct current electric stimulation in implant osseointegration: An experimental animal study with sheep

PubMedID: 22103684In an effort to obtain a high-quality bone-implant interface, several methods involving alteration of surface morphological, physicochemical, and biochemical properties are being investigated. The aim of our study was to increase the osseointegration rate and quality and decrease the waiting period of dental implants before loading by using a microelectric implant stimulator device. It imitates microelectrical signals, which occur in bone fractures described in terms of piezoelectric theory. A single dental implant (Zimmer Dental), 3.7 mm in diameter, was inserted into the tibia of sheep bilaterally. Twenty-four dental implants were inserted into 12 sheep. Implant on the tibia of each sheep was stimulated with 7.5 µA direct current (DC), while the other side did not receive any stimulation and served as a control. Animals were sacrificed 1, 2, and 3 months after implantation. Bone segments with implants were processed with unclassified method. The determination of new bone formation and osseointegration around the dental implants was investigated by means of undecalcified method, histomorphologically. No statistically significant difference in bone-to-implant contact (BIC) ratio, osteoblastic activity, and new bone formation was found between the stimulation group and the control group at the late phase of healing (4, 8, and 12 weeks). No evidence was found that electric stimulation with implanted 7.5 µA DC is effective at late phase implant osseointegration on a sheep experimental model

Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?

PubMedID: 29053656Background: The number of patients using direct oral anticoagulants (DOACs) instead of vitamin K antagonists (VKA) is increasing and there is limited data on the safety of tooth extractions in patients taking DOACs. The aim of this study was to compare the amount of bleeding (AOB) and postoperative complications after tooth extractions between patients taking VKAs and patients taking DOACs without altering the anticoaguation therapy. Material and Methods: The study consisted of four groups: Direct thrombin inhibitor group, factor Xa inhibitor group, warfarin group and a control group. A single tooth was extracted in each patient and routine coagulation test values were recorded prior to extraction. AOB was measured for 20 minutes after tooth extraction. The patients were evaluated on 2nd and 7th days after extraction for bleeding. Status of bleeding was classified as no bleeding, mild bleeding controlled by gauze pads, moderate bleeding controlled by hemostatic agents and severe bleeding required hospitalization. Analysis of variance, chi square test and correlation analysis were used for statistical analysis of data. Results: A total of 84 patients (48 male, 36 female) were included in this study. The mean age of patients was 57 (38-87) years. Mean AOB was 1388.6±913.0, 1909.29±1063.1, 3673±1415.4, 1593.33±672.5 mg for direct thrombin inhibitor, factor Xa inhibitor, warfarin and control groups respectively. Mean AOB was significantly higher for warfarin group, compared to other groups (p<0.05). The number of patients showing mild and moderate bleeding was significantly higher in warfarin group compared to other groups on the 2nd postextraction day (p=0.001). No bleeding was occurred in control group on 2nd and 7th postextraction days and no bleeding was occurred in direct thrombin inhibitor group on 7th postextraction day. The number of bleeding events among groups was not statistically significant on 7th postextraction day (p=0.251). Conclusions: Patients taking warfarin had more bleeding compared to patients taking direct oral anticoagulants after tooth extractions. In patients taking direct oral anticoagulants simple tooth extractions can be safely carried out without altering the anticaogulant regimen with the use of local hemostatic agents. © Medicina Oral S. L. C.I.F

Effects Of Bovine Lactoferrin In Surgically Created Bone Defects On Bone Regeneration Around Implants

The aim of this experimental study was to evaluate the effect of bovine lactoferrin (bLF)-loaded gelatin microspheres (GM) used in combination with anorganic bovine bone on bone regeneration in surgically created bone defects around tooth implants. Twenty-four uniform bone defects were created in the frontal bone via an extraoral approach in 12 domestic pigs. Twenty-four implants were placed at the center of the defects. In eight animals one of these defects was filled with 0.3 mL anorganic bovine bone while the other was left empty. In four animals, all defects were filled with 3 mg/defect bLF-loaded GM and anorganic bovine bone. All the defects were covered with collagen membranes. All animals were sacrificed after 10 weeks of healing, and the implants with the surrounding bone defects were removed en bloc. Undecalcified sections were prepared for histomorphometric analysis. The mean total area of hard tissue was 26.9 +/- 6.0% in the empty defect group, 31.8 +/- 8.4% in the graft group, and 47.6 +/- 5.0% in the lactoferrin group (P < 0.001). The mean area of newly formed bone was 26.9 +/- 6.0% in the empty defect group, 22.4 +/- 8.2% in the graft group, and 46.1 +/- 5.1% in the lactoferrin group (P < 0.001). The mean residual graft area was 9.4 +/- 3.2% in the graft group and 1.5 +/- 0.6% in the lactoferrin group (P < 0.001). The mean proportion of bone-implant contact in the defect region was 21.9 +/- 8.4% in the empty defect group, 26.9 +/- 10.1% in the graft group and 29.9 +/- 10.3% in the lactoferrin group (P = 0.143). These data indicate that a combination of 3 mg bLF-loaded GM and bovine-derived HA promotes bone regeneration in defects around implants.WoSScopu

Effects of systemic zoledronic acid administration on osseointegration of hydroxyapatite-coated and resorbable blast material surface implants in rabbit models

PubMedID: 23189295Purpose: It is unknown whether zoledronic acid (ZA) interferes with initial bone healing at implant sites. The goal of this study was to examine the effects of systemic zoledronic acid administration on osseintegration of hydroxyapatite (HA)-coated and resorbable blast material surface (RBM) implants in rabbit models. Materials and Methods: Twenty-eight male New Zealand rabbits (aged 6 to 12 months) were used in this study. Rabbits were randomly assigned to four groups. In group A, HA-coated implants were placed in the right tibia of seven rabbits. In group B, RBM-surface implants were placed in the right tibia of seven rabbits. In group C, HA-coated implants were placed in seven rabbits with intravenous (IV) administration of ZA. Finally, in group D, RBM-surface implants were placed in seven rabbits with IV administration of ZA. For groups C and D, IV zoledronic acid (0.1 mg/kg) was performed monthly during the entire osseointegration period. All of the rabbits were sacrificed 12 weeks after the implantation, and tibial specimens were harvested. Histomorphometric boneto- implant contact (BIC) analysis and the data were statistically analyzed. Results: The highest BIC percentage was detected in group D, with a mean value of 56.73% ± 1.85%, as compared with 45.80% ± 3.77% in group C, 35.11% ± 0.76% in group B, and 31.14% ± 1.04% in group A. Conclusions: Histomorphometric analyses showed significant improvement in the osseointegration of implants in the RBM-surface ZA group compared with the HA-coated ZA group. The results of this study suggest that systemic ZA administration may improve osseointegration of titanium implants in bone. © 2012 by Quintessence Publishing Co Inc