Graft Stability Research Articles

THE ONE-STAGE PREMAXILLARY REPOSITIONING AND BONE GRAFT ALVEOLOPLASTY IN BILATERAL ALVEOLAR CLEFT; A PRELIMINARY STUDY

Background: The bilateral alveolar cleft associated with markedly prominent premaxillary segment always possessed a surgical challenge because of the paucity of local flaps for watertight closure and high bone graft alveoloplasty failure rate. The orthodontic workup alone to mold unrestricted growing premaxillary segment could not optimize its position with the unfavorable functional and aesthetic outcome. In addition, the repeated surgical intervention may add burden on patient suffering and affect maxillary growth rate.Objective: Evaluation of the premaxillary viability, position, bone graft stability, and early growth after simultaneous premaxillary repositioning and alveolar bone grafting in alveolar cleft patients. Patients & Methods: Seven patients aged between 6 and 11 years were subjected to perioperative orthodontic workups to optimize the position of the premaxilla for its surgical correction before bone grafting. Then, the simultaneous premaxillary repositioning and bone graft alveoloplasty technique was done. Surgical indications, contraindications with orthodontic role were evaluated and discussed. Results: This prospective clinical study presents the outcome of seven consecutive pediatric patients who complained of alveolar clefts with severe premaxillary segment protrusion. It was conducted during the period between 2014 and 2020 in the Plastic Surgery Department-Aswan University Hospitals. The results were assessed by clinical examination and cephalometric tracing for at least two years for evaluating the premaxillary position, functional outcome, upper jaw stability, and early growth affection. Conclusion This technique proved to be a safe procedure in appropriately selected patients. It can produce an early stable maxillary arch with good aesthetic results besides less surgical interventions. No relapse or significant complications were documented. Clinical relevance The treatment of wide bilateral cleft alveolus patients is still based on experience and expert opinions. This preliminary study deals with markedly protruded premaxilla with bilateral alveolar cleft by combined orthodontic and one-stage premaxillary repositioning with bone graft alveoloplasty. An extended study period assessment for midfacial and maxillary growth is necessary to continue until adulthood or beyond.

To compare conjunctival autografting with autologous serum against fibrin glue in pterygium excision

The study included 60 eyes having all nasal primary pterygium. Simple excision was performed followed by closure of the bare sclera by conjunctival autograft by the known method of fibrin glue in 30 eyes (Group A) versus autologous serum (Group B). During follow-up of 3 months, the eyes were assessed in comprehensive manner on postop day one, one month and third month. Outcome measures were assessed by cosmesis, operative time, postoperative recovery, graft inflammation, sub-conjunctival haemorrhage [SCH], Graft stability and recurrence. Average operative time in group A and group B were 18 minutes and 27 minutes respectively. Postoperative findings like graft oedema in conjunctival inflammation were more or less similar in both groups. In terms of graft stability, there were 1 (3.3%) graft loss in group A versus 2 (6.7%) graft loss. 2 (6.7%) partial displacements seen in group A whereas 4 (13.3%) partial displacements in group B. Most common finding in group B was SCH which made poor cosmesis but it lasted 2-3 weeks. There was one granuloma in group A. Both groups had same recurrence rate of 6.7%. Also graft retraction seen in 2 eyes each in either group. Autologous serum glue method is safe, efficacious and cost effective yet not commonly performed. As per our study, this method is associated with less postoperative discomfort with success rates that are comparable to fibrin glue.

Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Single-Stage Anterior Cruciate Ligament Revision Reconstruction Using an Allograft Bone Dowel for a Malpositioned and Widened Femoral Tunnel

Tunnel widening, osteolysis, and/or malposition can be a cause of anterior cruciate ligament (ACL) reconstruction failure and a challenging problem to treat when performing revision ACL reconstruction (RACLR). Traditionally, problematic tunnels that interfere with bony stability and incorporation of the new graft at the time of revision have been treated with staged procedures—bone grafting first, followed by a return several months later for the revision reconstruction after bony incorporation has occurred. Multiple staged procedures increase the level of risk the patient may encounter and increase cost and resource utilization. In addition, they prolong the recovery period for the patient. In recent years, several studies have evaluated the clinical outcomes of performing bone grafting of tunnels and concomitant RACLR in a single-stage setting in an effort to mitigate these issues. We describe a technique by which a malpositioned and widened femoral tunnel from a primary ACL failure is treated with bone grafting using an allograft dowel, as well as immediate RACLR using a bone–patellar tendon–bone allograft.

Osseointegration of Dental Implants in Ridges with Insufficient Bones Using Different Membranes for Guided Bone Regeneration

Background:The use of membrane with the guided bone regeneration (GBR) has been a controversial aspect of the implant placement, which helps achieve the primary graft stabilization and inhibit early graft loss.Objectives:The present clinical trial was aimed to determine the results of GBR with nonresorbable (expanded polytetrafluoroethylene [e-PTFE]) and resorbable (collagen) membrane both clinically and radiographically for 2 years with dental implant placement.Materials and Methods:16 subjects having 32 sites for implant placement in a split-mouth pattern were included in the study. The sites for implant was prepared and grafted with the autogenous graft procured from the mandibular ramus area followed by graft coverage with either e-PTFE or collagen membrane. Various radiographic and clinical parameters were assessed for 2 years at an interval of 6 months each. The collected data were recorded for each study subject for all the implant sites and were statistically analyzed.Results:The mean values for periodontal probing depth at 6 months, 12 months, 18 months, and 24 months were 2.25 ± 0.17, 2.67 ± 1.84, 2.64 ± 1.21, and 3.01 ± 0.52, respectively, for the e-PTFE group. For the collagen group, the probing depth mean values at 6 months, 12 months, 18 months, and 24 months were 2.30 ± 0.14, 2.59 ± 1.76, 2.62 ± 1.30, and 2.98 ± 0.81, respectively. The corresponding clinical and radiographic parameters at all time intervals were nonsignificant on the intergroup comparison.Conclusion:Dental implants placed with simultaneous GBR have an acceptable survival rate at the end of 2 years irrespective of the resorbable or non-resorbable membrane used.

Polymer brush grafted antimicrobial peptide on hydroxyapatite nanorods for highly effective antibacterial performance

Serious bacterial infection induces the failure of artificial implants. Covalent bonding of antimicrobial peptides (AMPs) on implant surfaces can avoid the main shortcoming (blast releasing) by physisorption, but the low grafting yield, mobility, and stability of bonded AMPs limit their antibacterial efficiency. In this study, hydroxyapatite (HA) nanorods co-doped with Fe and Si were fabricated on Ti based on previous work, and the antimicrobial peptide HHC-36 was chemically bonded on the nanorods with and without polymer brushes as a spacer. The microstructures and physicochemical properties of coating surfaces were observed; Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), and hFOB1.19 behaviours in the presence of in vitro antibacterial activity, and the immunization response in vivo on various surfaces were evaluated. The results show that the grafting of polymer brushes and HHC-36 did not substantially change the microstructure of the nanorods, but the brushes efficiently increased the load and stability of the HHC-36. The HA nanorods did not kill bacteria, but with the assistance of HHC-36, physical puncturing by nanorods worked efficiently in killing S. aureus. In contrast with Ti, in phosphate-buffered saline and suppressed biofilm formation in a nutrient-rich medium, HA nanorods with polymer-brush-grafted HHC-36 killed 99.5% of S. aureus and 99.9% of E. coli. This outstanding antibacterial activity was attributed to the synergistic effect of AMP-derived destruction and the physical puncturing by HA nanorods. Also, HA nanorods with polymer-brush-grafted HHC-36 showed cytocompatibility in vitro, and in vivo they inhibited bacterial infection and reduced the inflammatory response, indicating that polymer-brush-grafted HHC-36 on HA nanorods has great potential application in surface modification of Ti implants, especially in infected cases.

An experimental simulation model to assess wear of the porcine patellofemoral joint.

A range of surgical techniques and osteochondral interventions have been developed for early stage chondral/osteochondral repair interventions in the knee however, methods for functional, pre-clinical assessment of these therapies are limited. In this study, a method for simulating physiological loading and motion in the porcine patellofemoral joint was developed using a 6-axis simulator. As an example of how the method can be used, the influence of surgical positioning of osteochondral allografts in the patella on cartilage wear, deformation and damage and graft stability was investigated in this porcine patellofemoral joint model. The functional performance of allografts implanted either optimally (flush with the cartilage surface) or 1 mm proud of the cartilage surface was compared to a positive control (stainless steel pin implanted 1 mm proud of the cartilage surface), a negative control (no intervention) and a defect model. Allografts implanted flush with the surrounding cartilage could restore the articulating surface of the patella resulting in low wear, damage and deformation of the opposing cartilage surface, similar to that of the negative control group. Implanting the graft proud of the patella surface resulted in cartilage lesions on the femoral trochlea (ICRS grade 2) and a cartilage volume difference of 2.0 ± 3.9 mm3; the positive controls resulted in more severe lesions, a higher volume difference (14.2 ± 7.4 mm3) which in some cases exposed subchondral bone (ICRS grade 4). Defects in the patella caused deformation of the opposing cartilage surface. All grafts implanted in the patella subsided over the duration of the study. This study demonstrated a method that can be used to evaluate osteochondral repair strategies in the patellofemoral joint applying physiological loading and motions.

Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Compared with a Composite Grafting Material or Bone Substitute Alone: a Systematic Review and Meta-Analysis Assessing Volumetric Stability of the Grafting Material.

ABSTRACTObjectivesTest the hypothesis of no difference in the volumetric stability of the grafting material following maxillary sinus floor augmentation with autogenous bone graft compared with composite grafting material or bone substitute alone applying the lateral window technique.Material and MethodsMEDLINE (PubMed), Embase, Cochrane library and hand-search of relevant journals were conducted. Human studies published in English until the 9th of October 2020 were included. Outcome measures included three-dimensional volumetric changes of the grafting material and potential predictive parameters. Volumetric changes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval.ResultsElectronic search and hand-searching resulted in 102 entries. Four randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. The volumetric stability of the grafting material was significantly improved by mixing autogenous bone graft with a non-resorbable xenograft compared with autogenous bone graft. Meta-analyses assessing absolute and relative volumetric changes demonstrated no significant differences between autogenous bone graft compared with allogeneic bone graft, synthetic biomaterials combined with autogenous bone graft or used alone. Association between volumetric changes of the grafting material and potential predictive parameters were not assessed in the included studies.ConclusionsVolumetric reduction of the augmented area seems inevitable following maxillary sinus floor augmentation regardless of the grafting material. The volumetric stability of autogenous bone graft is improved with addition of xenograft compared with autogenous bone graft. However, conclusions drawn from this systematic review should be interpreted with caution since only four studies using three-dimensional radiographic measurements were included.

A Comparative Study To Evaluate The Outcome Of Sutures Versus Fibrin Glue In Conjunctival Autograft Technique For Primary Pterygium Excision

Background: Pterygium is degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue and is characterized by formation of a triangular fold of conjunctiva encroaching on the cornea leading to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Now, Fibrin glue is being tried since few years to secure grafts in place of the sutures. The objective of this study was to compare duration of surgery, immediate postoperative complications which includes an inflammation, subconjunctival hemorrhage, patient comfort, graft stability between the uses of fibrin glue versus sutures. Methods: A total of 40 patients having primary pterygium were included in the study. 20 patients were underwent pterygium excision surgery and conjunctival autografting using absorbable vicryl 8-0 suture and 20 patients underwent pterygium excision surgery and conjunctival autografting using fibrin glue. These 2 groups were compared in terms of duration of the surgery, inflammation, degree of postoperative discomfort, subconjunctival haemorrhage and graft stability at postoperative day 1. Results: The mean surgery time in fibrin glue group was 15 minutes and mean surgery time in suture group was 28 minutes (p=0.000). Fibrin glue group had significantly lesser inflammation (p=0.001) as well as postoperative discomfort (p=0.000) compared to suture group at postoperative day 1. There was no significant difference found in the degree of subconjunctival haemorrhage between the fibrin glue versus sutures groups (p=0.887 and p=0.797 at day 1). The grafts secured with fibrin glue were as stable as those secured with the sutures (p=0.745, 0.644 at day 1). Conclusion: The fibrin glue group in conjuctival autografting had significantly less surgery time, which also produces significantly less postoperative discomfort as well as inflammation with grafts being as stable as those secured with sutures. Fibrin glue can be used regularly if patients can be pooled together and operated on, by making it cost effective procedure.

Long-Term Outcomes of Early Experience in Donation After Circulatory Death Liver Transplantation: Outcomes at 10 Years.

BackgroundDonation after circulatory death (DCD) livers remain an underutilized pool of transplantable organs due to concerns of inferior long-term patient survival (PS) and graft survival (GS), which factors greatly into clinician decision-making and patient expectations.Material/MethodsThis retrospective study used SRTR data to assess 33 429 deceased-donor liver transplants (LT) and compared outcomes between DCD and donation after brain death (DBD) LT recipients in the United States. Data were collected from 2002 to 2008 to obtain 10 years of follow-up (2012–2018) in the era of MELD implementation. Propensity scores for donor type (DCD vs DBD) were estimated using logistic regression, and the association of donor type with 10-year outcomes was evaluated after adjustment using stabilized inverse probability of treatment weights.ResultsAfter adjusting for confounders, patient survival for DBD recipients at 10 years was 60.7% versus 57.5% for DCD recipients (P=0.24). Incorporating retransplants, 10-year adjusted patient survival was 60.2% for DBD recipients versus 55.5% for DCD recipients (P=0.07). Adjusted 10-year graft survival for DBD recipients was 56.4% versus 45.4% for DCD recipients (P<0.001). Surprisingly, however, 1 year after LT, DBD and DCD graft failure rates converged to 7.5% over the remaining 9 years.ConclusionsThese data reveal inferior 10-year DCD graft survival, but only in the first year after LT, and similar 10-year patient survival in DCD LT recipients compared to DBD recipients. Our results show the stability and longevity of DCD grafts, which should encourage the increased utilization of these livers for transplantation.

Pterygium Excision with Sutureless, Glueless Conjunctival Autograft

Introduction: Pterygium is a common condition and various surgical techniques have been described for its excision, of which autografting is seen to have very less recurrence. Graft fixation with fibrin glue is gaining popularity, but autologous serum might be a cheaper alternative. This study was planned to explore the efficacy of autologous serum as a stabilising agent for graft surgery in pterygium.&#x0D; Methods: The hospital data of patients who underwent pterygium surgery with autografting using autologous serum in the Department of Ophthalmology of Shree Birendra Hospital, Chhauni, Kathmandu, Nepal between Oct 2015 to Sept 2017 were retrospectively analysed. The graft stability post-surgery was studied.&#x0D; Results: 46 eyes of 46 patients underwent pterygium surgery with autograft using autologous serum. The male to female ratio was 1.08:1, and the mean age was 45 years. All the pterygium were nasal sided. Post-operatively the graft was stable in all of the cases.&#x0D; Conclusions: Autologous serum is a good stabilising agent for graft surgery in pterygium.

Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a step-by-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome.

Evaluation of Cyclosporine and Tacrolimus Dose Changes During Post-transplantation Period and Their Association with Endomyocardial Biopsy Grading

Background: Changes in the dosage of immunosuppressive drugs following organ transplantation, especially the heart, can be a potential predictor of long-term post-transplant outcomes. It may also be related to the degree of histopathological involvement of endomyocardium. Objectives: We aimed to evaluate cyclosporine and tacrolimus dose changes during post-transplantation biopsies and their association with endomyocardial biopsy grades. Methods: This retrospective study was performed on 100 cardiac transplant patients who underwent endomyocardial biopsies to assess graft stability. In the present study, the patients were divided into two groups receiving cyclosporine (13 cases) and tacrolimus (87 cases). The data was collected by reviewing the recorded files. Results: Regarding the administration of cyclosporine, at different times after biopsy, there was no significant relationship between the plasma level of the drug and the grade of biopsy. Concerning tacrolimus, there was a significant reverse association between serum concentration and biopsy grade at the first biopsy after transplantation (about one month after transplantation), although this relationship was not observed in the subsequent steps of biopsy. Also, the Quilty effect frequency was not significantly associated with biopsy grade in different biopsies for both drugs. Conclusions: There is a lack of association between endocardial biopsy grade in the heart and the serum level of cyclosporine after transplantation. However there is a significant reverse relationship between endomyocardial biopsy grade and serum Tacrolimus concentration in the first weeks after transplantation and thus monitoring serum Tacrolimus after transplantation may play an important role in predicting acute rejection.

Mechanical Negative Pressure Wound Therapy: Real-World Effectiveness in Challenging Patient Presentations

Introduction. When used for wound management, negative pressure wound therapy (NPWT) delivers subatmospheric pressure at the wound site, exerting multiple beneficial effects, including microstrain, macrostrain, edema management, granulation tissue formation, drainage management, and wound stabilization. Comparative effectiveness research has demonstrated similar wound healing and adverse event outcomes between traditional NPWT (tNPWT) and mechanical NPWT (mNPWT). Therefore, considerations for patient selection for mNPWT vs tNPWT are in alignment with current recommendations, including therapeutic goals, wound-related factors, patient satisfaction, quality of life, care setting, economic-related factors, and product design. Case Reports. The 3 complex patient cases in the present report describe the routine use of mNPWT between December 18, 2020, and June 7, 2021, at a community hospital-based outpatient wound center within an academic health system, including 2 dehisced surgical incisions and 1 complicated venous leg ulcer. All patients received local standard of care, including surgical debridement, soap and water cleansing of the wound and extremity, hypochlorous acid 5-minute soak prior to dressing application, non-sting skin barrier periwound protection, smoking cessation and nutrition counseling, and chronic disease management. Case selections for mNPWT included: the need for frequent activity at work, minimal wound depth, lack of undermining, exudate, wound size, wound location allowing for the wound to fit comfortably beneath the mNPWT dressing, need for graft stabilization, protection of the site from repeated trauma, need for granulation tissue formation, and periwound inflammation. Conclusions. Mechanical NPWT is a convenient therapeutic option that appears to deliver healing outcomes comparable to those of tNPWT but with improved wound-related quality of life. These cases reveal the real-world effectiveness of mNPWT in challenging patient presentations and wounds that have stalled. The cases outline common endpoints for using advanced therapy in addition to wound closure, such as granulation tissue formation and quality of life.

Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial

Introduction: Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. Aim: To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. Materials and Methods: It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow- up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. Results: The mean age of patients in group A was 48.32±14.3 years (21-65 years), and in group B was 54.48±15.67 (23-74 years). Mean operating time in group A was 23.21±9.4 minutes and 13.7±4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. Conclusion: This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue.

Evaluation of Long-term Stability of Secondary Alveolar Bone Grafts in Cleft Palate Patients Using Multislice Computed Tomography and Three-Dimensional Printed Models: A Prospective Study.

Aim:Three-dimensional (3D) printed models are contemporary volumetric bone graft assessment technique for secondary alveolar bone grafting (SABG) in cleft lip and palate (CLP) patients. The study aimed at evaluation of long-term stability of iliac autograft in SABG using multislice computed tomography (CT) and 3D-printed model-based volumetric analysis.Materials and Methods:Twenty-eight patients were included in this prospective clinical study. CT image (T1) was taken after orthodontic maxillary expansion, correlating with the presurgical image. Furthermore, 3D-printed model was prepared, and volumetric assessment of graft needed was ascertained with water displacement technique. SABG was carried on with the anterior iliac crest autografting procedure. After 1-year follow-up, postoperative CT analysis (T2) was followed upon.Results:The stability of bone graft at the 1-year postoperative was found to be 43.74% with mean bone loss of 56.26% (95% confidence interval; P < 0.005). The moderate scale of CLP cases has shown statistically significant bone stability compared to that of severe and mild cases. Furthermore, the 3D-printed model has shown a significant difference to that of T1 CT imaging (P < 0.005).Conclusion:Within the limitations of the study, it seems appropriate to conclude that 3D-printed models serves as better reference than CT imaging in the context of planning and execution of precise bone grafting in SABG.

A Comparative Evaluation of Silk Suture and Cyanoacrylate Adhesive in the Stabilization of Free Gingival Graft Harvested with Erbium: Yttrium-Aluminum-Garnet Laser: A Clinical Study.

Background:The most common technique for gingival augmentation is free gingival graft (FGG). The aim of this study is to clinically compare the efficacy of FGG harvested with erbium: yttrium-aluminum-garnet (Er: YAG) laser stabilized with 5-0 silk suture in comparison to N-butyl-2-cyanoacrylate tissue adhesive in increasing the width of keratinized gingiva (WK) for the management of Miller's Class I and II gingival recession.Methodology:Forty-eight gingival recession defects were divided into two Groups I and II. Group I sites were treated with FGG harvested using Er: YAG laser stabilized with 5-0 silk suture and Group II sites were treated with FGG harvested using Er: YAG laser stabilized with N-butyl-2-cyanoacrylate tissue adhesive. Clinical parameters such as gingival recession depth, clinical attachment level (CAL), gain in gingival tissue thickness, and WK were recorded at baseline and 3 and 6 months postoperatively.Results:A significant reduction in gingival recession defects, gain in CAL, increase in WK, and gain in gingival tissue thickness were observed in both the groups. Intergroup comparison of gingival recession defects, CAL, WK, and gingival tissue thickness yielded nonsignificant differences.Conclusion:Within the limits of this study, it can be concluded that both 5-0 silk suture and n-butyl-2-cyanoacrylate were equally efficacious in the stabilization of FGG. N-butyl-2-cyanoacrylate was easy to apply, consumed less operating time, and had no adverse effect. Hence, cyanoacrylate can be used as an alternative to suture in stabilization of FGG.

O uso de membrana de colágeno de pericárdio bovino na regeneração óssea: características e relato de caso

The aim of this article was to describe the use of the bovine pericardium collagen membrane and to present its physical-chemical characteristics through laboratory tests, in addition to a case report proving its clinical performance. Called native collagen membranes from the animal pericardium, this product has ideal characteristics for promoting bone neoformation in grafting procedures for volumetric augmentation. Scanning electron microscopy (SEM) tests showed the organization of collagen fibers, and tensile tests pointed an adequate resistance to the mechanisms of graft stabilization, through sutures, screws or pins. Within the limitations of this article, it was possible to conclude that the bovine pericardium collagen membrane has the appropriate characteristics for use in guided bone regeneration procedures, with efficient handling, stability, and predictability.

Serum creatinine level at 1-month posttransplant can independently predict long-term graft survival and functional status.

BackgroundAfter the year 2000, kidney transplants with high immunologic risk and deceased donors increased rapidly in Korea. At the same time, the medical community developed special pretransplant and early posttransplantation management protocols. Our team evaluated the effect of early graft stabilization on long-term graft survival and functional status using databases from a high-volume kidney transplantation center.MethodsWe included 1,895 kidney transplant patients from a total of 1,976 performed between 2005 and 2018. Early graft failure within 1 month (n=9), loss to follow-up (n=2), pediatric recipient or donor (n=37), and combined organ transplantation (n=33) cases were excluded. We grouped the cases at 1-month posttransplantation by serum creatinine quantiles (1.0 mg%, 1.23 mg%, and 1.52 mg%).ResultsAfter an average of 95 months of follow-up (maximum 189 months), the high-serum creatinine group (4th quantile) showed significantly poorer graft survival than other groups (1st to 3rd quantile) (P<0.05). In multiple Cox regression analysis, a high serum creatinine level (4th quantile) at 1-month posttransplant is an independent risk factor for graft failure with a hazard ratio of 1.799 (P=0.013). The quantile group by serum creatinine shows a persistent, significant difference of functional graft status (glomerular filtration rate by Modification of Diet in Renal Disease method) among quantile groups beyond ten years posttransplant.ConclusionsSerum creatinine level at 1-month posttransplant is a strong independent predictor of graft survival and functional graft status beyond ten years posttransplant.