Marvis Allais

The buccal fat pad graft in the closure of oroantral communications

A male patient aged 51 years was referred for the treatment of a buccosinusal fistula of six months duration after removal of the upper left second molar. The patient complained of pain, a bad taste in the mouth and a feeling of fluid in the nose after drinking any beverage.Examination of the mouth revealed a 1 cm fistula in the bottom of the upper left sulcus, which contained pus. Computed tomographic 3D reconstruction demonstrated the bone defect and its proportion (Figure 1E, 1G).Preoperative antimicrobial therapy was started to control the infection, after which surgery was scheduled.Anesthesia involved a block of the upper posterior and middle alveolar nerves and the greater palatine nerve. An incision was made around the fistula and two other relief incisions were also made (Figure 1A). The bone defect was visualized, the necrotic tissue was removed from the bone rims and abundant irrigation was made with saline and an ampule of rifamycin (Rifocina® 75mg/1.5ml). An incision was made on the periosteum, the tissue was dissected and the buccal adipose body was rotated to the defect, covering it fully with no tension (Figure 1B). The buccal adipose body was sutured to the rim of the palatine and vestibular mucosa with 4/0 chrome catgut (Figure 1C). The mucosal flap was repositioned over the adipose tissue and similarly sutured. (Figure 1D).Postoperative medication included antimicrobials for preventing infection and the usual wound care measures.Seven days later the wound was closed, the adipose tissue was healing, and the patient reported that the symptoms were generally sub-siding. Twenty days after surgery, the mucosa was well positioned over the fully healed area and there was a slight excess fat tissue, which was removed in a second procedure.One year after surgery, computed to-mographic 3D reconstruction showed that the bone defect in the lateral wall of the maxillary sinus had regressed. (Figure 1F, 1H)

Estudio comparativo del uso de la matriz ósea desmineralizada de origen humana y de la poliuretana derivada del aceite de mamona sobre el proceso de regeneración ósea: Estudio histométrico en calota de conejos

espanolObjetivo. Analizar histometricamente el efecto de la matriz osea desmineralizada de origen humana y de la resina poliuretana derivada del aceite de mamona, sobre el proceso de regeneracion osea. Diseno del estudio: fueron utilizados 24 conejos y en cada calota craniana fueron preparadas dos cavidades quirurgicas, siendo una a cada lado de la sutura parietal. Los animales fueron divididos en dos grupos. En el grupo 1 la cavidad experimental (lado derecho) fue rellenada con la poliuretana derivada del aceite de mamona, mientras que en el grupo lila cavidad experimental fue rellenada con la matriz osea desmineralizada de origen humano. Las cavidades de control fueron rellenadas solo con la sangre del animal. Los animales fueron sacrificados en los periodos postoperatorios de 04, 07 y 15 semanas. Resultados. El analisis estadistico, realizado en base de los datos de la histometria, mostro una mayor neoformacion osea de los grupos 1 y II en relacion al grupo control, no existiendo diferencia estadistica cuando los grupos experimentales fueron comparados. Conclusiones. El uso de poliuretana derivada del aceite de mamona y matriz osea desmineralizada de origen humano mejoran el proceso de regeneracion cuando lo comparamos a la regeneracion osea normal resultando que entre ambos materiales tuvieron un comportamiento similar sin diferencias estadisticas significantes entre si. EnglishObjective. The present study was aimed at carrying out a histological and histometric analysis on the effect of human demineralized bone matrix and a polyurethane resin, derived of the castor bean oil, on the bone regeneration process. Design. For this, 24 rabbits were used and in each calvarium two surgical bone defects were prepared, on the right side and another on the left side of the parietal suture. The animals were divided into two groups. In group I the experiment defect (right side) was filled with polyurethane derived from oil of the castor oil plant, while in group II the experimental cavity was filled with demineralized bone matrix of human origin. The control cavities were just filled with the blood of the animal. The animals were sacrificied in the postoperative period at 04, 07 and 15 weeks. Results. The statistical analysis, wich was based on the data of the histometric study, showed larger bone neofromation in groups I and II in relation to the control groups, and there were no statistical differences when the experimental groups were compared. Conclusions. The use of polyurethane resin implants and demineralized human bone matrix helped and optimizied the regeneration process when compared with natural bone regeneration, and similar behavior was obtained without statistical differences in both materials.