Clinical features and management of oral lichen planus (OLP) with emphasis on the management of hepatitis C virus (HCV)-related OLP

Oral lichen planus (OLP) is a chronic inflammatory disease characterized by the occurrence of multiple, symmetrical lesions in the oral cavity. Hepatitis C virus (HCV) infection has been suggested as an etiological factor in OLP. The purpose of this review was to summarize the current literature regarding the treatment of OLP in patients with HCV infection. An electronic search of the PubMed database was conducted until January 2018, using the following keywords: OLP, HCV, corticosteroids, retinoids, immunomodulatory agents, surgical interventions, photochemotherapy, laser therapy, interferon, ribavirin, and direct-acting antivirals. We selected the articles focusing on the clinical features and treatment management of OLP in patients with/without HCV infection. Topical corticosteroids are considered the first-line treatment in OLP. Calcineurin inhibitors or retinoids can be beneficial for recalcitrant OLP lesions. Systemic therapy should be used in the case of extensive and refractory lesions that involve extraoral sites. Surgical intervention is recommended for isolated lesions. In patients with HCV, monotherapy with interferon (IFN)-α may either improve, aggravate or trigger OLP lesions, while combined IFN-α and ribavirin therapy does not significantly influence the progression of lesions. Direct-acting antiviral (DAA) therapy appears to be a promising approach in patients with HCV-related OLP, as it can improve symptoms of both liver disease and OLP, with fewer side effects. Nevertheless, for clinical utility of DAAs in OLP patients, further studies with larger sample sizes, adequate treatment duration, and long term follow-up are required

Enhancement of bone consolidation using high-frequency pulsed electromagnetic fields (HF-PEMFs): An experimental study on rats

In vitro studies showed that high-frequency pulsed electromagnetic fields (HF-PEMFs) increase the activity/expression of early and late osteogenic markers and enhance bone mineralization. The main aim of this study was to investigate the in vivo effects of HF-PEMFs on fracture healing using a rat model. A femur fracture was established by surgery in 20 male Wistar rats. Titanium nails were implanted to reduce and stabilize the fracture. After surgery, 20 rats were equally divided into untreated control and treated group (from the first postoperative day HF-PEMFs at 400 pulses/sec [pps] were applied for 10 minutes/day, for two weeks). Quantitative and qualitative assessment of bone formation was made at two and eight weeks following surgery and included morphological and histological analysis, serological analysis by ELISA, micro-computed tomography (micro-CT), and three-point bending test. At two weeks in HF-PEMF group, soft callus was at a more advanced fibrocartilaginous stage and the bone volume/total tissue volume (BV/TV) ratio in the callus area was significantly higher compared to control group (p = 0.047). Serum concentration of alkaline phosphatase (ALP) and osteocalcin (OC) was significantly higher in HF-PEMF group (ALP p = 0.026, OC p = 0.006) as well as the mechanical strength of femurs (p = 0.03). At eight weeks, femurs from HF-PEMF group had a completely formed woven bone with dense trabeculae, active bone marrow, and had a significantly higher BV/TV ratio compared to control (p = 0.01). HF-PEMFs applied from the first postoperative day, 10 minutes/day for two weeks, enhance bone consolidation in rats, especially in the early phase of fracture healing

Alendronate Prevents Early Periprosthetic Bone Loss in Cementless Total Hip Arthroplasty Better Than Simvastatin

Background and Objectives: Cementless total hip arthroplasty leads to an early periprosthetic bone loss, which can impair the osseointegration process and lead to a femoral implant migration during early weight-bearing. An altered osseointegration process can lead to aseptic loosening, which is the most frequent late complication in these surgical procedures. The objective of this study was to compare the effect of alendronate and simvastatin in the prevention of early periprosthetic bone loss found in osteoporotic patients. This can lead to earlier weight-bearing in patients, as well as reduce the rate of aseptic loosening. Materials and Methods: Forty-five patients undergoing cementless total hip arthroplasty were equally distributed into three groups: group I (alendronate), group II (simvastatin), and group III (control). The alendronate group received 5 mg of alendronate postoperatively, daily for 8 weeks, and the simvastatin group received 20 mg daily for 4 weeks postoperatively, followed by 40 mg daily for 4 weeks. We determined bone mineral density (BMD), as well as bone serum markers beta cross-laps (β-CTx) and alkaline phosphatase (ALPL) preoperatively, 4 weeks postoperatively, and 8 weeks postoperatively. All patients were not allowed to fully bear weight for 6 weeks postoperatively. Results: Alendronate statistically significantly increases the BMD at one month postoperatively compared to the control group in Gruen zones 5 and 6 (p = 0.042 and p = 0.039). Overall, the BMD was higher in the alendronate group compared to the control group at one month postoperatively (p = 0.043). Alendronate decreased β-CTx bone serum marker compared to control at one month and two months (p = 0.024 and p = 0.012). Moreover, alendronate showed a higher decrease in β-CTx compared to simvastatin at both timelines (p = 0.028 and p = 0.03, respectively). Conclusions: The study shows that alendronate administration following cementless total hip arthroplasty offers better protection against periprosthetic bone loss compared to simvastatin

Custom-Made 3D-Printed Prosthesis after Resection of a Voluminous Giant Cell Tumour Recurrence in Pelvis

Abstract: Giant-cell tumours are benign aggressive bone lesions that can affect any part of the skeleton. In early stages, curettage is preferred, but in case of local recurrence or voluminous lesions in the periacetabular region, wide resection and reconstruction are recommended. The purpose of this article is to increase clinicians’ awareness of the importance of the follow-up of these patients and to describe a case of a voluminous recurrence of a giant-cell tumour in the pelvis. We present a 25-year-old female who underwent internal hemipelvectomy assisted by 3D cutting-guides and reconstruction with a custom-made 3D-printed pelvic prosthesis, hip arthroplasty and ilio-sacral arthrodesis. No postoperative complications occurred and, at long-term follow-up, the patient had a stable and painless hip joint, good bone-implant osteointegration, with an excellent functional outcome. In spite of all available reconstructive techniques, in well-selected patients with voluminous pelvic resections, custom-made 3D-printed implants allow patients to have a good mechanical outcome

Custom-Made 3D-Printed Prosthesis after Resection of a Voluminous Giant Cell Tumour Recurrence in Pelvis

Abstract: Giant-cell tumours are benign aggressive bone lesions that can affect any part of the skeleton. In early stages, curettage is preferred, but in case of local recurrence or voluminous lesions in the periacetabular region, wide resection and reconstruction are recommended. The purpose of this article is to increase clinicians’ awareness of the importance of the follow-up of these patients and to describe a case of a voluminous recurrence of a giant-cell tumour in the pelvis. We present a 25-year-old female who underwent internal hemipelvectomy assisted by 3D cutting-guides and reconstruction with a custom-made 3D-printed pelvic prosthesis, hip arthroplasty and ilio-sacral arthrodesis. No postoperative complications occurred and, at long-term follow-up, the patient had a stable and painless hip joint, good bone-implant osteointegration, with an excellent functional outcome. In spite of all available reconstructive techniques, in well-selected patients with voluminous pelvic resections, custom-made 3D-printed implants allow patients to have a good mechanical outcome

Atelo-collagen type I bovine bone substitute and membrane in guided bone regeneration: a series of clinical cases and histopathological assessments

Absorbable atelo-collagen type 1 represents a new approach for guided bone regeneration with several reported advantages such as: osteoblast attachment, proliferation, mineralization potential, absorption of growth factors and inhibition of bacterial pathogen colonization. The aim of this study was to assess the clinical, radiological (preoperative width, re-entry width, gain), Periotest measurements and histologic benefits of atelo-collagen-derived bovine bone grafts (ImploBone) in combination with an atelo-collagen type I barrier membrane (ImploSorb) for guided bone regeneration (GBR) of atrophic alveolar crest in thirteen patients. Eleven patients underwent simultaneous GBR with implant insertion, two had initial GBR procedure followed by implant placement after 6 months of healing. Ridge augmentation was performed using an atelo-collagen membrane (ImploSorb, Bioimplon, Germany) and a combination of 50% ABBM (ImploBone, granule size 0.5-1mm, BioImplon Germany) mixed with 50% autologous bone. It was found that simultaneous GBR with implant placement resulted in a 35% gain at bone defect level (preoperative width 5.03±1.25 mm, re-entry width 6.81±0.98 mm, gain 1.78±1.71 mm). Implant placement performed in a 2 stage surgery 6 months following GBR was linked with a 63.9% gain at bone defect level (preoperative width 3.79±1.10 mm, re-entry width 6.22±1.41 mm, gain 2.43±1.43 mm). The total gain in both groups was 41.9% utilizing these novel biomaterials (preoperative width 4.68±1.32 mm, re-entry width 6.65±1.12 mm, gain 1.96±1.64 mm). This case series study presents a protocol where GBR can be performed either simultaneously to implant placement or delayed with this innovative biomaterial to favor bone regrowth. Future randomized controlled clinical trials are needed to further validate the bonepromoting potential of atelo-collagen-based biomaterials for bone regeneration

Finite Element Analysis of Different Osseocartilaginous Reconstruction Techniques in Animal Model Knees

Lesions of the articular cartilage are frequent in all age populations and lead to functional impairment. Multiple surgical techniques have failed to provide an effective method for cartilage repair. The aim of our research was to evaluate the effect of two different compression forces on three types of cartilage repair using finite element analysis (FEA). Initially, an in vivo study was performed on sheep. The in vivo study was prepared as following: Case 0—control group, without cartilage lesion; Case 1—cartilage lesion treated with macro-porous collagen implants; Case 2—cartilage lesion treated with collagen implants impregnated with bone marrow concentrate (BMC); Case 3—cartilage lesion treated with collagen implants impregnated with adipose-derived stem cells (ASC). Using the computed tomography (CT) data, virtual femur-cartilage-tibia joints were created for each Case. The study showed better results in bone changes when using porous collagen implants impregnated with BMC or ASC stem cells for the treatment of osseocartilaginous defects compared with untreated macro-porous implant. After 7 months postoperative, the presence of un-resorbed collagen influences the von Mises stress distribution, total deformation, and displacement on the Z axis. The BMC treatment was superior to ASC cells in bone tissue morphology, resembling the biomechanics of the control group in all FEA simulations

How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review

Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention

STATISTICAL STUDY ON THE PREVALENCE OF DENTAL LESIONS OF THE ANTERIOR SEGMENT OF THE DENTAL ARCHES AND THE CALL FOR TREATMENT FOR THESE LESIONS –PART 1

The work performed within Clinical Base of the Gr. T. Popa U.M.P., Faculty of Dental Medicine Iași, has a number of objectives the materialization of which brings forth a new trend of dental medicine, towards a properly coordinated prophylaxis focused on the real needs of the population.The purpose of the study commencement consists in: evaluation of population’s oral health, on categories and age groups; determination of the local factor impact on health; assessment of dental care usage level in Moldova region; provision of statistical data regarding the oral health of the population in Romania; implementation of evaluation systems and of the data processing standard, in order to achieve oral health programs. A clinical record to contain data regarding the following section was created: environmental factors, anthropology, general condition of the body, prophylaxis, dental medicine. The study was conducted on a batch consisting of 646 patients from various social backgrounds and age categories, of which, a batch with age between 18-50 was selected. We deem the presentation of distribution according to age and sex of the whole batch, interesting. For a clearer vision, we considered a 5 to 10 year range. Our purpose, in this study, was to emphasize the extent of damage in the investigated population comprising patients aged between 18 and 50, the batch size and study scale allowing us to conclude that there are well defined clinical entities in the sphere of oral pathology. The clinical circumstance represented by lesions and existing treatments is dominant in the upper front group by the existing fillings and fixed prosthetics

Gradual Drug Release Membranes and Films Used for the Treatment of Periodontal Disease

Periodontitis is an inflammatory disease that, if not treated, can cause a lot of harm to the oral cavity, to the patients’ quality of life, and to the entire community. There is no predictable standardized treatment for periodontitis, but there have been many attempts, using antibiotics, tissue regeneration techniques, dental scaling, or root planning. Due to the limits of the above-mentioned treatment, the future seems to be local drug delivery systems, which could gradually release antibiotics and tissue regeneration inducers at the same time. Local gradual release of antibiotics proved to be more efficient than systemic administration. In this review, we have made a literature search to identify the articles related to this topic and to find out which carriers have been tested for drug release as an adjuvant in the treatment of periodontitis. Considering the inclusion and exclusion criteria, 12 articles were chosen to be part of this review. The selected articles indicated that the drug-releasing carriers in periodontitis treatment were membranes and films fabricated from different types of materials and through various methods. Some of the drugs released by the films and membranes in the selected articles include doxycycline, tetracycline, metronidazole, levofloxacin, and minocycline, all used with good outcome regarding their bactericide effect; BMP-2, Zinc–hydroxyapatite nanoparticles with regenerative effect. The conclusion derived from the selected studies was that gradual drug release in the periodontal pockets is a promising strategy as an adjuvant for the treatment of periodontal disease