A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Dentistry in the branch of Maxillofacial and Oral Surgery 31 May 2018. / Aim The aim of this retrospective study was to determine the outcomes of secondary alveolar bone grafts (SABG) in cleft patients treated at the Wits Dental Hospital at the Charlotte Maxeke Johannesburg Academic Hospital. Objectives To record the demographic data of patients who had secondary alveolar bone grafts, and to assess the outcomes of SABG by evaluating clinical variables and the quantity of bone post SABG. Methods Records of 19 patients with a total of 23 clefts were examined to evaluate the amount of bone at the cleft site following secondary alveolar bone graft. Socio-demographic information was collected as well as the clinical variables of the type of graft used, canine eruption, keratinised tissue around teeth close to the cleft, and closure or persistence of any oronasal fistula. The amount of bone at the graft site was measured on CBCT images using the Chelsea scale. Comparisons of Chelsea scale scores and CBCT findings were carried out. SPSS ® 24 was used to analyse the data. All statistical tests were conducted at 5% significance level. Results Most (52%) patients were male, with 57% having left unilateral cleft. The majority of them received autogenous bone grafts from the chin. Most (65.2%) of the patients showed good clinical outcomes, whilst showing evidence of bone resorption in and around the graft site on CBCT images. Fifteen of the patients were considered to have partial alveolar graft resorption. Conclusion In the majority of patients, 3D CBCT images revealed bone resorption in areas that 2D images gave an impression of presence of bone. However, the majority of patients indicated good clinical outcomes despite the poor radiological findings. / LG2018

Orientador: Horácio Faig Leite. / Banca: João Batista César Neto / Banca: Raquel Guedes Fernandes Pires / Banca: Maria Aparecida Neves Jardini / Banca: Warley David Kerbauy / Resumo: O objetivo desse estudo foi avaliar o efeito do uso local de uma solução aquosa de risendronato de sódio (RS) em diferentes concentrações na inibição da perda óssea alveolar decorrente de periodontite experimental induzida em ratas. Os 48 animais foram divididos em 2 grupos constituídos por 24 animais: GD (dupla aplicação) e GU (única aplicação). Os dois grupos foram subdivididos em 8 subgrupos: R1 (duas aplicações de 0,125 mg de RS), R2 (duas aplicações de 0,25 mg de RS), R3 (duas aplicações de 0,5 mg de RS) e A1 (duas aplicações de água destilada); R4 (uma aplicação de 0,125 mg de RS), R5 (uma aplicação de 0,25 mg de RS), R6 (uma aplicação de 0,5 mg de RS) e A2 (uma aplicação de água destilada). Foi induzida a periodontite pela confecção de ligaduras ao redor dos primeiros molares inferiores direitos em todos os animais. Nos grupos A1 e A2, os molares contralaterais serviram de controles negativos (C1 e C2). A medicação foi aplicada aos 5 e 10 dias após indução da periodontite nos animais do GD, e nos animais do GU apenas aos 10 dias. Decorrente 15 dias os animais foram submetidos à eutanásia. Foram feitas análises histológica, histomorfométrica, imuno-histoquímica anti-osteocalcina e enzimo-histoquímica para TRAP (fosfatase ácida tartarato resistente). Os grupos que receberam RS exibiram maior volume trabecular da crista óssea remanescente que o controle significante estatísticamente, mas não foram observados diferenças entre os grupos tratados. A perda óssea alveolar foi menor nos grupos tratados com risendronato comparado com controle e foi dose-dependente. Os grupos que receberam a menor dose (R1 e R4) apresentaram menor perda óssea estatisticamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to evaluate the local use of an aqueous solution of sodium risendronate (RS) at different concentrations on the inhibition of alveolar bone loss caused by experimental periodontitis induced in rats. The 48 animals were divided into two groups consisting of 24 animals: GD (double application) and GU (one application). The two groups were subdivided into eight subgroups: A1 (two applications of 0.125 mg RS), R2 (two applications of 0.25 mg RS), R3 (two applications of 0.5 mg RS) and A1 (two applications of distilled water), and R4 (one application of 0.125 mg RS), R5 (one application of 0.25 mg RS), R6 (one application of 0.5 mg RS) and A2 (one applications with distilled water). Periodontitis was induced in first molars in all animals. In groups A1 and A2, the contralateral molars served as controls (C1 and C2). The medication was applied at 5 and 10 days after induction of periodontitis in animals of GD, and animals of GU only after 10 days. After 15 days the animals were euthanized. Analysis was performed on histological, histomorphometric, immunohistochemical antiosteocalcin and enzimohistochemical for TRAP (tartrate resistant acid phosphatase). The groups that received RS exhibited greater volume of trabecular bone crest that controlling statistically significant, but no differences were observed between treated groups. The alveolar bone loss was lower in treated groups compared with placebo and was dose-dependent. The groups that received the lowest dose (R1 and R4) showed statistically significant less bone loss than the intermediate dose (R2 and R5), which in turn exhibited lower rates compared with higher doses (R3 and R6). The two types of approaches, however, did not show statistical significance. The number of TRAP-positive cells was... (Complete abstract click electronic access below) / Doutor

This retrospective clinical study aimed: (1) to establish and validate a reproducible geometrical measurement strategy in quantifying peri-implant alveolar bone changes based on CBCT images taken before and one year after implantation; (2) to quantify and compare the bone changes of Type 1 and Type 4 implant placement in the patient cohort that requested implant placement at premolar and molar sites; (3) to analyse the bone changes in relation to the two implant protocols in aspects of buccal and lingual, maxilla and mandible, within the cohort and combined cohorts. 3D imaging analysis in this study had used a software package - OnDemand3D. The evaluation of the measurement strategy was based on a simulation model which was made of human dry skull with and without a standard implant (Straumann Standard Plus, Ø3.3 mm diameter, L12 mm) to simulate before and after the implant placement. The recruited cases were 69 (44 Type 1 cases and 25 Type 4 cases); all data sets were provided by Shanghai 9th people's hospital, China. Each case had two CBCT data sets at before and one year after implant placement. With 69 cases, bone grafting was applied to all Type 1 cases, and the flap surgery was applied to Type 1 cases when buccal bone recession greater than 3 mm. The measurements were made in bone height (HL) and bone thickness (L0O0, L1O1, L2O2, L3O) at lingual side, while the same at buccal side (HB, B0O0, B1O1, B2O2, B3O3). The four sections of bone thickness were at 0, 1 mm, 4 mm and 7 mm from the top of the implant. Additionally, six special cases were reported, as they provided extra information. They were two spilt-mouth control cases, three 2-year follow-up cases and one 3-year follow-up case. The evaluation of the measurement strategy showed the error of the measurement strategy was -0.06 mm and the measurement uncertainty was ±0.05 mm. The main measurement outcomes from the clinical cases were as follows: (1) at buccal side, the mean value of bone changes in height was a positive value of +0.18±1.64 mm for Type 1, which was significantly more than +0.01±0.86 mm for Type 4 (p < 0.05). However the standard deviation over the 44 and 25 patient cohorts were as large as 1.64 mm and 0.86 mm; (2) at buccal side, the bone changes in thickness showed significantly more loss at B0O0 (p < 0.01) and B1O1 (p < 0.05) sections in Type 1 (-0.38±1.49 mm and -0.25±1.15 mm) compared with Type 4 (-0.19±0.34 mm and -0.16±0.76 mm); (3) in Type 1 cases, the bone thickness at buccal side showed significantly more absorption at L1O1B1 (p < 0.05), L2O2B2 (p < 0.01), L3O3B3 (p < 0.01) section (-0.25±1.15 mm, -0.19±0.99 mm, -0.12±0.57 mm) compared to lingual side (-0.13±0.85 mm, -0.16±0.28 mm, -0.05±0.28 mm); and the bone height (+0.18±1.64 mm) increased significantly more at buccal side than lingual side (-0.25±0.79 mm) with bone augmentation procedure (p < 0.01). However, within Type 4 cases, no significant difference in bone changes between buccal and lingual sides could be found. In conclusion, the measurement strategy established in this study was reproducible and provided valid quantifiable data of bone changes in relation to implant placement based on 3D CBCT images. The data analysis from these two patient cohorts suggested that Type 1 implant placement protocol could re-build the bone height at buccal side better than Type 4.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Louisville, 1997. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (doctoral)--Umeå University, Sweden, 1994. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (M.S.)--University of Louisville, 1997. / Includes bibliographical references.

Thesis (doctoral)--Umeå University, Sweden, 1994. / Added t.p. with thesis statement inserted. Includes bibliographical references.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / As doenÃas periodontais sÃo as principais causas de perda de dentes em adultos. O fator etiolÃgico preponderante para desencadear a periodontite à o acumulo do biofilme dental com predominÃncia de bactÃrias anaerÃbicas gram negativas. Apesar de ser de origem bacteriana a resposta inflamatÃria induzida a partir de fatores do hospedeiro pode influenciar na progressÃo e nas caracterÃsticas clÃnicas da doenÃa periodontal. A perda Ãssea alveolar à tÃpica na evoluÃÃo desta patologia e dependente da atividade osteoclÃstica. Por sua vez, um dos mecanismos de reabsorÃÃo Ãssea por estas cÃlulas à atravÃs da produÃÃo de prÃtons liberados nos vacÃolos de reabsorÃÃo pela atividade da anidrase carbÃnica. Tem sido relatado que inibidores desta enzima, como acetazolamida, tem aÃÃo supressora sobre osteoclastos. O objetivo deste estudo foi analisar o efeito da acetazolamida (ACTZ) na perda Ãssea induzida no modelo de periodontite experimental em ratos, bem como a dosagem de biomarcadores sÃricos do processo inflamatÃrio periodontal e anÃlise histolÃgica do periodonto. AnÃlises de seguranÃa tambÃm foram realizadas atravÃs de hemograma completo, dosagens de TGP, TGO, gama-GT e histopatologia de ÃrgÃos como: fÃgado, rins, baÃo, coraÃÃo e pulmÃo. Para avaliaÃÃo da perda Ãssea alveolar 50 ratos receberam ligaduras de nylon na regiÃo do segundo molar superior esquerdo. Os animais foram divididos em seis grupos: Grupo veÃculo (propilenoglicol) (n=9), grupo controle positivo (alendronato 0,08 mg/Kg) (n=7), grupo controle negativo (salina) (n=9) e grupos que receberam acetazolamida via I.P. nas doses (8,3, 25 e 75 mg/Kg [grupos ACTZ8,3, ACTZ25 e ACTZ75, respectivamente] n= 7, 9 e 9). ApÃs 11 dias, os ratos foram mortos. A perda Ãssea alveolar foi avaliada macroscopicamente atravÃs da Ãrea de exposiÃÃo de raiz. Em outros quatro grupos, ACTZ25 (n=5) e veÃculo (n=5), o periodonto foi analisado histologicamente apÃs 11 e 17 dias de ligadura por coloraÃÃo em HE. Biomarcadores sÃricos foram dosados (IL-1&#61537;, IL-4, fractalkine, CINC-2, CINC-3, LIX, GM-CSF, &#946;NGF, VEGF e CNTF) atravÃs da tÃcnica de microarray antes e depois da ligadura em trÃs grupos; ACTZ25, Veiculo e Sham (cirurgia simulada). No grupo de ACTZ25 foi realizada a anÃlise de seguranÃa (alpha=5%). Macroscopicamente, o grupo alendronato (controle positivo) apresentou a menor perda Ãssea, seguido do grupo ACTZ75 e ACTZ25 (p<0.05) quando comparados aos controles veÃculo e salina que nÃo diferiram entre si (p>0.05). Histologicamente, o grupo ACTZ apresentou a menor reabsorÃÃo de osso e cemento (p<0,05) apÃs 17 dias de ligadura, nÃo houve diferenÃa entre o grupo ACTZ25 e o veÃculo quanto ao infiltrado inflamatÃrio (P>0,05) . As maiores concentraÃÃes de IL-4 e CNTF foram observadas no grupo ACTZ25 (p< 0,05) quando comparado ao grupo veÃculo. As anÃlises de seguranÃa demonstraram que acetazolamida na dosagem de 25 mg/Kg foi bem tolerada sem alteraÃÃes significativas do hemograma, nas enzimas hepÃticas e histopatologia dos ÃrgÃos pesquisados. ConcluÃmos que a acetazolamida pode proteger o periodonto da reabsorÃÃo Ãssea induzida por ligadura em ratos e pode estar associada a mediadores envolvidos com o reparo, como a IL-4 e CNTF, alÃm de ser bem tolerada. / Periodontal diseases are the main cause of tooth loss in adults. The preponderant etiologic factor for the onset of periodontitis is the accumulation of dental biofilm with predominance of anaerobic gram negative bacteria. In spite of being of bacterial origin, the inflammatory response induced by factors in the host may influence the progression and clinical characteristics of periodontal disease. Alveolar bone is typical in the development of this pathology and is dependent on osteoclastic activity. In turn, one of the mechanisms of bone resorption by these cells is through the production of protons released in the resorption vacuoles by carbonic anhydrase activity. It has been reported that carbonic anhydrase inhibitors, such as acetazolamide, have a suppressive action on osteoclasts. The aim of this study was to analyze the effect of acetazolamide (ACTZ) on bone loss induced in the experimental periodontitis model in rats, as well as the dosage of seric biomarkers in the periodontal inflammatory process and histologic analysis of the periodontium. Safety analyses were also performed by means of a complete hemogram, biochemical tests for TGP, TGO, gama-GT and histopathology of organs such as: the liver, kidneys, spleen, heart and lungs. To evaluate alveolar bone loss, 50 rats received nylon ligatures in the maxillary left second molar region. The animals were divided into six groups: Vehicle Group (propylenoglycol) (n=9), Positive Control Group (alendronate 0.08 V (n=7), Negative Control Group (saline) (n=6) and Groups that received acetazolamide I.P. in the following doses: (8.3, 25 and 75 mg/Kg [Groups ACTZ8,3, ACTZ25 and ACTZ75 respectively] n= 7, 9 and 9). After 11 days, the rats were sacrificed. Alveolar bone loss was macroscopically evaluated by means of the area of root exposure. In another four groups, ACTZ25 (n=5) and vehicle (n=5), the periodontium was histologically analyzed after 11 and 17 days of ligature, by HE staining. Seric biomarkers were dosed (IL-1&#61537;, IL-4, fractalkine, CINC-2, CINC-3, LIX, GM-CSF, &#946;NGF, VEGF and CNTF) by means of the microarray technique before and after ligature in three groups; ACTZ25, Vehicle and Sham (simulated surgery). In the ACTZ25 group, safety analysis was performed (alpha=5%). Macroscopically, the alendronate Group (positive control) presented the lowest bone loss, followed by Groups ACTZ75 and ACTZ25 (p<0.05) when compared with the vehicle and saline controls, which did not differ between them (p>0.05). Histologically, the ACTZ group presented the lowest bone and cement resorption (p<0.05) after 17 days of ligature, and there was no difference between the ACTZ25 and vehicle groups with regard to inflammatory infiltrate (P>0.05). The highest concentrations of IL-4 and CNTF were observed in Group ACTZ25 (p< 0.05) when compared with the vehicle group. The safety analyses demonstrated that acetazolamide at the dose of 25 mg/Kg was well tolerated without significant alterations in the hemogram, hepatic enzymes and histopathology of the researched organ. It was concluded that acetazolamide may protect the periodontium from bone resorption induced by ligature in rats, and may be associated with mediators involved in repair, such as IL-4 and CNTF, in addition to being well tolerated.

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