Normal Course Of Healing Research Articles

Evaluating the Effectiveness of the Original Designs of Immediate-Prostheses after Multiple Tooth Extraction: Clinical Cases

Background. Rehabilitation of patients with chronic periodontal diseases leading to multiple tooth loss can be carried out using the method of immediate prosthetics. However, the likelihood of atrophy of denture-supporting tissues under non-physiological load with removable dental prostheses imposes special requirements for their design features.Case description. Two patients seeking for dental surgical and prosthetic treatment for the diagnosis of chronic generalized periodontitis were treated in the dental clinic of Ryazan State Medical University named after academician I.P. Pavlov. Patient A. was mounted immediate prostheses made using additive technologies with the original design of the drug reservoir. Patient B. was mounted immediate prostheses with bases made of acrylic plastic, border ring of elastic polymer, and a drug reservoir made of polymethyl methacrylate. Patients underwent tooth extraction with immediate prosthetics. Patients were followed for 21 days. Criteria for the effectiveness of treatment included visual and palpatory control of extraction sites with a planimetric wound size analysis, assessment of microcirculation at the extraction site, control of the drug persistence in the reservoirs of prostheses.Conclusion. The observations at the stages of prosthodontic treatment revealed that immediate prostheses made with the help of 3D modeling and printing technologies resulted in a normal course of healing after tooth extraction with the normalization of microcirculatory parameters at the surgical wound sites. When using combined prosthetic structures, healing of postoperative wounds also proceeded favorably, however, congestion in the microcirculatory system was noted.

Achillessehnenruptur – Teil 1: Ätiologie und Diagnostik

The Achilles tendon is the strongest tendon in the human body. Rupture of the Achilles tendon prevents the transmission of forces from the calf muscles to the foot and thus the push-off phase of walking and running is no longer possible. The diagnostics of Achilles tendon rupture are typically based on the symptoms and clinical examination. A palpable gap and the Thompson test are sometimes difficult to evaluate in situations with a large hematoma. Benchmarking for adefinitive rupture is the inability to perform aone leg heel raise. Sonography is used to determine the localization of the Achilles tendon and during the dynamic examination enables detection of a possible adaptation of the tendon ends. Acomplete adaptation of the tendon ends gives the possibility of conservative treatment. Sonographic control examinations after 4 and 8weeks document the course of healing. A visible increase in volume, especially at the rupture site confirms a normal course of healing. Magnetic resonance imaging enables verification of an Achilles tendon rupture and provides more information about the tendon structure.

A dose-response study of a novel method of selective tissue modification of cellular structures in the skin with nanosecond pulsed electric fields.

Background and ObjectivesThis study describes the effects of nanosecond pulsed electric fields (nsPEF) on the epidermis and dermis of normal skin scheduled for excision in a subsequent abdominoplasty. NsPEF therapy applies nanosecond pulses of electrical energy to induce regulated cell death (RCD) in cellular structures, with negligible thermal effects. Prior pre‐clinical studies using nsPEF technology have demonstrated the ability to stimulate a lasting immune response in animal tumor models, including melanoma. This first‐in‐human‐use of nsPEF treatment in a controlled study to evaluate the dose‐response effects on normal skin and subcutaneous structures is intended to establish a safe dose range of energies prior to use in clinical applications using nsPEF for non‐thermal tissue modification.Study Design/Materials and MethodsSeven subjects with healthy tissue planned for abdominoplasty excision were enrolled. Five subjects were evaluated in a longitudinal, 60‐day study of effects with doses of six nsPEF energy levels. A total of 30 squares of spot sizes 25mm2 or less within the planned excision area were treated and then evaluated at 1 day, 5 days, 15 days, 30 days, and 60 days prior to surgery. Photographs were taken over time of each treated area and assessed by three independent and blinded dermatologists for erythema, flaking and crusting using a 5‐point scale (0 = low, 4 = high). Punch biopsies of surgically removed tissue were processed and evaluated for tissue changes using hematoxylin and eosin, trichome, caspase‐3, microphthalmia transcription factor, and elastin stains and evaluated by a dermatopathologist. The skin of two subjects received additional treatments at 2 and 4 hours post‐nsPEF and was evaluated in a similar manner.ResultsMost energy settings exhibited delayed epidermal loss followed by re‐epithelization by day 15 and a normal course of healing. Histologic analysis identified the appearance of activated caspase‐3 at two and four hours after nsPEF treatment, but not at later time points. At the 1‐day time point, a nucleolysis effect was observed in epidermal cells, as evidenced by the lack of nuclear staining while the epidermal plasma membranes were still intact. Cellular structures within the treatment zone such as melanocytes, sebaceous glands, and hair follicles were damaged while acellular structures such as elastic fibers and collagen were largely unaffected except for TL6 which showed signs of dermal damage. Melanocytes reappeared at levels comparable with untreated controls within 1 month of nsPEF treatment.ConclusionsThe selective effect of nsPEF treatment on cellular structures in the epidermal and dermal layers suggests that this non‐thermal mechanism for targeting cellular structures does not affect the integrity of dermal tissue within a range of energy levels. The specificity of effects and a favorable healing response makes nsPEF ideal for treating cellular targets in the epidermal or dermal layers of the skin, including treatment of benign and malignant lesions. NsPEF skin treatments provide a promising, non‐thermal method for treating skin conditions and removing epidermal lesions. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Changes of procollagen type III N-terminal propeptide (PIIINP) concentrations during healing of mandible fractures treated with biodegradable and titanium fixations

The aims of the study were to evaluate procollagen type III N-terminal propeptide (PIIINP) concentrations in blood serum of males in the course of normal healing of mandible fractures, and to determine the correlations between kinetic changes of PIIINP, stages of fracture healing and the applied treatment. We collected blood serum samples from 43 male patients aged between 20 and 30 years, treated for mandible fractures. The patients were divided into 2 groups depending on the type of osteosynthesis used for immobilization of the fragments. Group I (n=10) consisted of patients whose reduced bone fragments were fixed with biodegradable fixations, while group II (n=33) included patients with titanium osteosynthesis devices. The control group (n=25) consisted of healthy males at the same age. PIIINP concentrations were determined with the radioimmunological method (RIA). We found a significant increase in PIIINP concentrations in both study groups (I and II) at defined stages of mandible fracture healing. Differences were noticed in the dynamics of the increase depending on the type of applied osteosynthesis devices. The results point to the fact that the injury and/or mandible fracture increase the collagen type III metabolism and its dynamics depends on the type of the used bone fixation.

Healing of extraction wounds in an experimental model of rat

Introduction: The process of wound healing after tooth extraction has been studied in several animal species under normal and experimental conditions that might interfere with the healing. Chronology of wound healing after tooth extraction (molars and incisors), which consists in several phases, has been examined by histological, radiological, immunohistochemistry, stereology (bone volumetry), and densitometry methods and by using of micro-camera to determine the volume fraction of histological components. The aim of this study is to analyse the process of healing of normal extraction wound and to determine the period of time it takes for the postextraction wound to completely heal. Material and method: The research is based on the literature available in electronic databases Pubmed/Medline, Kobson, Googlescholar. The total of 22 papers which follow the normal course of healing were found; 7 papers met the criteria regarding the complete description of the healing process in the socket after tooth extraction in rats. Results: On the second day after the extraction wound starts with forming epithelium. The first sign of bone tissue has appeared four days after the extraction as subperiostal osteogenesis. On fourth and fifth day, in some fibroblasts differentiation in osteoblasts has already begun. On the fifth day the delicate trabecules of young bone attached to the walls of the socket in its basal part can be seen, and the signs of ossification are clearly indicated by a darker shadow in the central part of the apical third of the socket present in the x ray. The end of the epitelization is on the eighth day, when the lamina dura was slightly less pronounced, while the lower parts of the socket have a pronounced X-ray shadow. In most of the specimens, the socket has been completely filled with reticular bone on day 14. The socket has been filled with young bone after 20 days. Presence of lamelar bone can be seen 60th day after extraction. Remodelation of aveolar ridges lasts until 112th day. Conclusion: The healing of normal extraction wounds in rats begins with the appearance of the epithelium of the second postoperative day, and the end of the epitelization is on the eighth day . Formation of bone begins on the fourth day after the exodontia. The intense bone formation lasts until the twentieth postoperative day when the young r bone fills the socket. Lamellar bone is present on 60th days after extraction. Application of bone morfogenetic protein, low power laser and polarized light had no expected effect on the healing of the extraction wound in experimental rats.

A Case of von Willebrand Disease Discovered during Treatment of a Sacral Pressure Ulcer

A sacral pressure ulcer developed in a patient hospitalized for cerebral infarction. Each time necrotic tissue was debrided from the ulcer, pressure hemostasis was necessary to stop the bleeding. As treatment continued, the pressure required to stop the bleeding caused the ulcer to worsen, leading to a downward spiral in the patient's condition. While trying to determine the cause of this problem, we discovered that the patient had von Willebrand disease. Medication controlled the bleeding, and the pressure ulcer began to heal at the same time. It was clear to us that conservative treatment would lead to a complete cure but that the healing process would take a long time and require continued administration of an expensive drug. We decided, therefore, to close the wound with a fasciocutaneous flap so that the patient could be quickly transferred to a rehabilitation hospital. About 1 month after surgery, epithelialization was complete, we were able to discontinue medication, and the patient was discharged. This experience demonstrates the importance of determining the cause of any deviation from the normal course of healing in pressure ulcers. It also indicates that the use of fasciocutaneous flaps, which involve little intraoperative bleeding in short surgeries, is appropriate in cases like this one.

The role of lymphocytes in human dermal wound healing.

Animal experimental data indicate a requirement for functionally active T lymphocytes to allow optimal healing of dermal wounds. Little evidence exists to confirm that this is the case in humans. Lymphocyte involvement in regulation of healing is probably mediated by release of secreted cytokines/growth factors, and we hypothesize that the cytokine profile requirement will be modulated as healing progresses. As this is likely to be reflected in lymphocyte subset changes over the course of normal healing, we investigated the immunophenotype of lymphocyte subpopulations during wound healing. Sequential biopsies were taken over 42 days from the margin of 12 wounds healing by secondary intention after pilonidal sinus excision. Serial biopsy sections were analysed by immunohistochemistry using lymphocyte-specific monoclonal antibodies, and lymphocytes were counted microscopically. Within 42 days, the mean decrease in wound volume was 87.5%. This was accompanied by significant changes in the wound margin lymphocyte population. Total numbers (mean +/- SEM) of T lymphocytes decreased from 36.8 +/- 9.8 cells per field at inclusion in the study to 25.9 +/- 3.0 immediately prior to wound closure, with a concomitant increase in B lymphocytes from 1 +/- 0.4 to 9.5 +/- 3.6 cells per field. The CD4/CD8 T-lymphocyte ratio fell from an initial level of 3.6 +/- 0.3 to 2.1 +/- 0.3 (mean +/- SEM) prior to closure. These data indicate that human wound-associated lymphocyte populations are modulated during healing; the increase in numbers of CD8+ T-suppressor lymphocytes is in accordance with previous animal data, indicating a role for these cells in downregulating healing as the wound closes. This study also documents an associated increase in B lymphocytes and healing of human wounds, with an as yet undefined role.

DC electrical stimulation for chronic wound healing enhancement. Part 2. Parameter determination by numerical modelling

A three dimensional finite element model of the cutaneous wound stimulated by direct electric current was built by means of the finite element method. As was assumed in part 1 of this article, the endogenous electrical properties of the injured skin are beneficial and necessary for a normal course of healing. Therefore, an attempt was made to determine the parameters of transcutaneous electrical stimulation which would result in an electric field similar to the endogenous one in the wound area. The main goal of the study was to evaluate the influence of the electrodes' shape, size and position on the distribution of electric field in the epidermal layer at the edge of the injured tissue. The wound and the surrounding tissues were modelled as a cylinder with the spherical shaped cut-off representing the wound. 5 layers of the skin and subcutaneous tissues were modelled: epidermis, dermis, subcutis, and deeper lying fat and muscle tissue. In the parametric study performed, the influence of different electrode configurations on the distribution of the electric field was studied. Different sizes and positions of electrodes were examined by applying appropriate boundary conditions. Electric field distributions were calculated for each case and the differences in the resulting electric field were examined. According to the results obtained, some guidelines are given for the selection of the electrodes configuration in the DC electrical stimulation for chronic wound healing enhancement.

Wound healing influenced by thyroxine and thyrotrophic hormone; a tensiometric study.

Studies on the tensile strength of healing wounds in guinea pigs under the influence of thyroxine and thyrotropic hormone are reported. With the Sandblom-Petersen tensiometer the tensile strength of the wounds could be measured in living animals. (1) The wounds of thyroidectomized guinea pigs possess the same tensile strength as those of intact controls. (2) Thyroxine inhibits wound healing in intact as well as in thyroidectomized guinea pigs. (3) Thyrotrophs hormone inhibits wound healing only in intact guinea pigs, whereas it does not appear to alter the normal course of healing in thyroidectomized guinea pigs.

Studies in Cellular Growth

Summary A 0.1 unit/kg dose of antisplenic-tissue-serum (ASTS) accelerates the healing process of experimental wounds in mice. Pretreatment with one dose of ASTS (0.1 unit/kg) did not affect the normal course of healing. A 10 unit/kg dose of antisplenic-tissue-serum (ASTS) did not affect the rate of healing as compared with control treated groups. The presence of anti-mouse red blood cell factors in the antiserum did not modify the action of the ASTS.