PurposeThe aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology.MethodsThe mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry.ResultsDuring the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites.ConclusionsWithin the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing.
Objective To test whether or not topically administered recombinant human epidermal growth factor (rhEGF) accelerates the early healing phase of oral soft tissue wounds. Methods One day following the creation of palatal defects (n = 6/animal), 14 dogs were allocated to one of the following five groups: spontaneous healing (SH), vehicle ointment (V), vehicle ointment + rhEGF at concentrations of 1 μg/g (EGF1), 10 μg/g (EGF10) or 50 μg/g (EGF50). Topical administration of ointments was repeated twice per day until sacrifice at days 8 and 16. Wound area was clinically monitored. Keratinocytes proliferation (Ki67‐immunolabelling), inflammatory response (IR) and areas of collagen (C) and granulation tissue (GT) were histologically measured. Kruskal–Wallis test with Dunnett correction was used for multiple group statistical comparisons. Results Clinically, in comparison with SH, a significantly smaller wound area was observed in groups EGF1 and EGF10 at day 8 (p < 0.05). At day 16, wound closure reached 97.8% in group EGF1 compared to 83.2% in group SH, albeit no statistically different. Histologically, at day 8, significantly more GT was observed in group EGF10 compared to all other groups (p < 0.05). At day 16, in addition to a higher Ki67‐immunolabelling, groups EGF1 and EGF10 demonstrated a significant decrease in GT and IR with more deposition of C compared to the other groups (p < 0.05). Conclusion Application of rhEGF enhanced the early healing of acute oral soft tissue wounds compared to SH, predominantly at concentrations of 1 and 10 μg/g.
Introduction Patient‐, site‐, and procedure‐related factors important for successful periodontal regeneration have been defined in the periodontics literature by insightful clinician‐researchers. Prevention of bacterial contamination of the surgical site through careful wound closure and meticulous postoperative care is a critical procedure‐related factor necessary for periodontal regeneration. Dense polytetrafluoroethylene (dPTFE) is a nonresorbable barrier material that may protect bone replacement grafts (BRG) against bacterial contamination for a short period during early wound healing if membrane exposure occurs. Case Presentation A 35‐year‐old African American female with a deep/narrow infrabony periodontal defect and Hamp degree I furcation involvement at tooth #14 (mesial) underwent combination BRG/guided tissue regeneration (GTR) using a mineralized/demineralized freeze‐dried bone allograft and a dPTFE barrier membrane. Favorable clinical and radiographic outcomes were noted nine months following the procedure. Conclusions Two reports evaluating clinical parameters following use of dPTFE membranes for GTR appear in the literature. The present case provides clinical and radiographic outcome assessments following combination BRG/GTR using a dPTFE membrane. This material may be of interest for periodontal regeneration due to an ability to temporarily limit bacterial influence if membrane exposure occurs.
Introduction Schneiderian membrane perforation (SMP), which is usually readily manageable, is the most common intraoperative complication of sinus elevation surgery. Some evidence suggests that SMP is associated with increased risk for postoperative complications, including maxillary sinusitis. Antral wall discontinuity (AWD) is an acquired condition that may increase SMP likelihood and lead to larger, less‐manageable perforations. Case Presentation A generally healthy patient receiving sinus elevation surgery exhibited an AWD in the palatine process of the maxilla. The osseous defect was isolated intraoperatively, and the Schneiderian membrane was sharply dissected from the palatal connective tissue. Favorable augmentation of the maxillary sinus was noted on cone‐beam computed tomography (CBCT) assessment at postoperative month 34. Conclusions AWD (fusion of the Schneiderian membrane with the periosteum of the maxilla) is a condition identifiable on preoperative CBCT images, which may increase the incidence and severity of SMP during sinus elevation procedures. Careful assessment for integrity of antral osseous walls before surgery is essential. Presence of AWD may obligate modifications to the surgical plan, or in some cases, contraindicate sinus elevation surgery.
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