Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. Objective: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. Material and Methods: Four patients presenting deep recession defects at buccal sites (>= 4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. Results: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss

Sinus lift with newly forming bone and inorganic bovine bone: a clinical, histologic and histomorphometric evaluation

O objetivo deste estudo é avaliar a efetividade do enxerto ósseo em neoformação (EONF) no ganho de altura de tecido ósseo em procedimentos de levantamento de seio maxilar. Foram selecionados indivíduos de ambos os sexos com idade entre 25 e 60 anos apresentando perda de um dente na região de pré-molares ou molares superiores com remanescente ósseo de 2 a 9 mm entre a crista do rebordo alveolar e o assoalho do seio maxilar e existência de rebordo desdentado ou pelo menos um dente condenado à extração. Os seios foram tratados por meio de EONF misturado a osso bovino inorgânico OBI (teste; n= 7) ou OBI (controle; n= 6). O volume de tecido ósseo existente foi avaliado por meio de tomografias computadorizadas obtidas no exame inicial e 6 meses após a cirurgia. Após este período, biópsias de tecido duro foram obtidas para análise histológica e histomorfométrica durante a cirurgia de instalação dos implantes osseointegrados. A análise dos resultados das imagens tomográficas por meio do teste t demonstrou que os dois materiais são igualmente efetivos no ganho em altura óssea (teste: 11,22 ± 0,60 mm vs. controle: 11,82 ± 0,69 mm; p= 0,0664). A análise histológica da reação tecidual ao redor e entre as partículas de enxerto mostrou ausência de diferenças estatisticamente significantes entre os grupos, segundo teste de Mann Whitney. A análise histomorfométrica demonstrou maior percentual de osso vital (31,42% ± 11,13% vs. 16,38% ± 10,14%; p= 0,0002), menor percentual de partículas remanescentes (1,32% ± 2,34% vs. 3,15% ± 3,31%; p= 0,0306) e de tecido conjuntivo (27,65% ± 12,34% vs. 35,02 ± 13,16; p= 0,0257) no grupo teste do que no controle. O diâmetro médio das partículas remanescentes foi maior no grupo controle do que no grupo teste, segundo teste t (p= 0,0294), embora não houvesse diferenças estatisticamente significantes entre os grupos em relação à área de contado direto entre o tecido ósseo neoformado e a superfície das partículas. Esses resultados sugerem que EONF é efetivo para o ganho de altura óssea em procedimentos de levantamento de seio maxilar, resultando em formação de maior quantidade de osso vital do que aquela observada com o uso de OBI apenas.The aim of this study is to evaluate the efficacy of newly forming bone graft (NFB) in the gain of bone height in sinus lift procedures. It were recruited for this study individuals 25- 60 years of age, both genders, presenting a missing tooth at an upper premolar or molar region with 2-9 mm of remaining bone between alveolar ridge crest and sinus floor and the existence of an edentulous ridge or at least one tooth condemned to extraction. Sinus were treated by NFB mixed to inorganic bovine bone IBB (test; n= 7) or IBB (control; n= 6). The volume of bone tissue was evaluated by computerized tomography obtained at baseline examination and 6 months after surgery. After this period, biopsies of hard tissue were obtained during implant installation for histologic and histomorphometric analysis. The analysis of data from tomographic images by t test showed that both materials were equally effective in the gain of bone height (test: 11.22 ± 0.60 mm vs. control: 11.82 ± 0.69 mm; p= 0.0664). The histologic analysis of tissue reaction around and between graft particles showed absence of significant differences between groups, according to Mann Whitney. Histomorphometric analysis showed greater percentage of vital bone (31.42% ± 11.13% vs. 16.38% ± 10.14%; p= 0.0002) and lower percentage of remaining particles (1.32% ± 2.34% vs. 3.15% ± 3.31%; p= 0.0306) and connective tissue (27.65% ± 12.34% vs. 35.02 ± 13.16; p= 0.0257) at test than control group. The mean diameter of remaining particles was greater at control than test group, according to t test (p= 0.0294), although no differences were observed between groups related to the area of direct contact between new bone and particles surface. These findings suggest that NFB is effective in the gain of bone height in sinus lift procedures, resulting in the formation of greater amount of vital bone with the use of IBB alone

Recobrimento radicular: avaliação clínica de nova abordagem terapêutica regenerativa em humanos. Acompanhamento longitudinal de 9 meses

As diferentes técnicas cirúrgicas propostas para tratamento das recessões mostram resultados variáveis, especialmente em áreas de recessão profunda. O objetivo deste estudo é avaliar a efetividade da técnica de enxerto ósseo em neoformação (EONF) como uma alternativa de tratamento em recessões classe I ou II de Miller. Para tanto, foram selecionados indivíduos de ambos os sexos com idade entre 18 e 45 anos apresentando pelo menos um sítio com recessão >4mm e que apresentassem ao menos um dente condenado ou rebordo desdentado que possibilitasse confecção de alvéolo cirúrgico, (grupo teste). Os pacientes foram divididos em dois grupos, de acordo com o tratamento: teste (n=35)- técnica de EONF e controle (n=30)- enxerto de tecido conjuntivo subepitelial (ETCS). O exame clínico foi realizado por examinador único na visita inicial e 1, 3, 6 e 9 meses pós-operatórios, de acordo com as medidas de profundidade de sondagem (PS), nível de inserção clínica (NIC), recessão da margem gengival (R), sangramento à sondagem (SS), índice de placa (IPl) e quantidade de gengiva ceratinizada (GC). Os resultados obtidos demonstraram que as duas técnicas cirúrgicas são igualmente efetivas, segundo o teste t, na diminuição da recessão (-2,77±0,16 x -3,20±0,24; p=0,14). O EONF foi mais efetivo na redução da PS (-0,85±0,10 x 0,24±0,12; p4 mm and one condemned tooth or edentulous ridge allowing the surgical creation of an alveolus (test group) were selected. The sample was divided into two groups, according to the root coverage procedure: test (n=35) - NFB and control (n=30)- subepithelial connective tissue graft (SCTG). Clinical examinations were performed by a single trained examiner at baseline and 1, 3, 6 and 9 months after surgery according to probing depth (PD), clinical attachment level (CAL), recession (R), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KG). The analysis by t test have shown that both techniques are effective in the reduction of recession (-2,77±0,16 x - 3,20±0,24; p=0,14). The NFB technique was more effective in the reduction of PD (-0,85±0,10 x 0,24±0,12; p<0,0001), BOP (-0,65±0,21 x 0,00±0,13; p=0,01), PI (-1,57±0,25 x 0,43±0,31; p<0,0001) and gain of CAL (-3,74±0,26 x - 2,95±0,19; p=0,024), but less effective in the increase of KG width (0,48±0,13 x 1,43±0,17, p<0,0001). Intra-group analysis showed a significant improvement of all clinical parameters (p<0,05; ANOVA) for both groups, except for PI (p=0,4267), BOP (p=2,19) and PD (p=1,05) in control group. These results suggest that the NFB technique is effective to the treatment of large recession defects, allowing the reduction of recession and, possibly, regeneration of periodontal tissues

Glycolipid Metabolic Disorders, Metainflammation, Oxidative Stress, and Cardiovascular Diseases: Unraveling Pathways

Glycolipid metabolic disorders (GLMDs) are various metabolic disorders resulting from dysregulation in glycolipid levels, consequently leading to an increased risk of obesity, diabetes, liver dysfunction, neuromuscular complications, and cardiorenal vascular diseases (CRVDs). In patients with GLMDs, excess caloric intake and a lack of physical activity may contribute to oxidative stress (OxS) and systemic inflammation. This study aimed to review the connection between GLMD, OxS, metainflammation, and the onset of CRVD. GLMD is due to various metabolic disorders causing dysfunction in the synthesis, breakdown, and absorption of glucose and lipids in the body, resulting in excessive ectopic accumulation of these molecules. This is mainly due to neuroendocrine dysregulation, insulin resistance, OxS, and metainflammation. In GLMD, many inflammatory markers and defense cells play a vital role in related tissues and organs, such as blood vessels, pancreatic islets, the liver, muscle, the kidneys, and adipocytes, promoting inflammatory lesions that affect various interconnected organs through their signaling pathways. Advanced glycation end products, ATP-binding cassette transporter 1, Glucagon-like peptide-1, Toll-like receptor-4, and sphingosine-1-phosphate (S1P) play a crucial role in GLMD since they are related to glucolipid metabolism. The consequences of this is system organ damage and increased morbidity and mortality