Cyanoacrylate adhesive for closing sinus membrane perforations during sinus lifts

A comparative study of cyanoacrylate-based tissue adhesive and surgical sutures on marginal flap stability following coronally advanced flap

INTRODUCTION

The present study evaluated the biomechanical characteristics of cyanoacrylate-based tissue adhesive (TA) compared to surgical sutures in coronally advanced flap (CAF) procedures using an ex-vivo model.

MATERIAL AND METHODS

Thirty-six half-pig mandibles were divided into three groups, n=12 each: (I) CAF fixed with sutures (sling and tag suture technique), (II) CAF fixed with TA, and (III) CAF fixed with sutures and TA. At mandibular premolars, gingival recession defects extending 3 mm apical to the cemento-enamel junction (CEJ) were created. CAF procedures were performed using a split-full-split approach, with coronal advancement of the flap to 1 mm above the marked CEJ and stabilization according to the respective groups I-III. Marginal flap stability against pull-of forces (maximum tensile force) was measured with a universal material testing machine until the CEJ became visible.

RESULTS

The comparison between groups I-III demonstrated a significantly increased maximum tensile force for the TA (II) compared to the suture group (I) (p<0.001). A significantly increased maximum tensile force was found for the suture and TA (III) compared to the suture group (I) (p<0.001). There was also a significantly increased maximum tensile force in the suture and TA (III) compared to the TA group (II) (p<0.001).

CONCLUSION

The results suggest that cyanoacrylate-based TA can increase marginal flap stability compared to sutures in CAF procedures.

CLINICAL RELEVANCE

Cyanoacrylate-based TA can be considered a useful and valuable adjunct to conventional suturing techniques in periodontal plastic surgery, especially in cases where high flap stability is required. The results of this ex-vivo study can only be transferred to the clinical situation with limitations. Clinical long-term follow-up data must be generated.

A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study

Background In order to maintain the surgery site's shape, functionality, and aesthetics, closure of the wound is essential for intra-oral and general surgical procedures. Wound closure speeds up healing by reducing the buildup of inflammatory cells. For a wound to heal well, the incision must be precise, the tissue must be handled delicately, the wound must be precisely repositioned, and the closure material must have optimum functional properties and be sterile. Aim This study aims to conduct a clinical comparison of the effectiveness of silk suture versus isoamyl 2-cyanoacrylate (IAC) for intra-oral mucosal incisions. Methodology Fifty patients who needed a minor oral surgical operation under local anesthesia from the Department of Oral and Maxillofacial Surgery were recruited for this prospective clinical trial. Ethical clearance and informed consent were obtained for this study. Two groups were created from the sample of 50 patients in this investigation. An intra-oral mucosal incision was closed in one group using a 3-0 silk suture and in the second using two drops of IAC. An accurate approximation of the incised edges was used to avoid leaving any gaps between them. Parameters such as the time taken for closure, pain, bleeding, swelling, mouth opening, wound dehiscence, wound infection, and local ulceration were evaluated in this study. A visual analog scale (0-10) was used to assess the pain score. Facial swelling was evaluated by the tape method given by Gabka and Matsumura. The measurement was done from tragus to pogonion, tragus to oral commissure, and outer canthus to gonion. The sum of these measurements was calculated. By measuring the distance between the incisal edges of the upper and lower central incisors, the trismus was evaluated using a graduated metal scale. Assessment of bleeding (0-4) was done by asking the patient. Assessment of wound dehiscence and local ulceration was done based on visual inspection and palpation on the first, second, and seventh days postoperatively. All the recorded parameters were tabulated. The statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY). The Chi-square test was used to compare the categorical variables between the study groups. The independent t-test was used to compare the means between the study groups. The statistical significance was kept at a p-value less than 0.05. Results The results showed that there was no statistically significant difference between suture and IAC in terms of incidence of pain and wound dehiscence. But the time taken for wound closure was less with IAC, and the pain score on the seventh day was higher with IAC and statistically significant. Conclusion We observed that IAC was as effective as the gold standard silk suture. The advantages of IAC are its hemostatic and bacteriostatic qualities, and IAC also took less time to complete the procedure.

Plasma Bead Entrapped Liposomes as a Potential Drug Delivery System to Combat Fungal Infections

Fibrin-based systems offer promises in drug and gene delivery as well as tissue engineering. We established earlier a fibrin-based plasma beads (PB) system as an efficient carrier of drugs and antigens. In the present work, attempts were made to further improve its therapeutic efficacy exploiting innovative ideas, including the use of plasma alginate composite matrices, proteolytic inhibitors, cross linkers, and dual entrapment in various liposomal formulations. In vitro efficacy of the different formulations was examined. Pharmacokinetics of the formulations encapsulating Amphotericin B (AmpB), an antifungal compound, were investigated in Swiss albino mice. While administration of the free AmpB led to its rapid elimination (<72 h), PB/liposome-PB systems were significantly effective in sustaining AmpB release in the circulation (>144 h) and its gradual accumulation in the vital organs, also compared to the liposomal formulations alone. Interestingly, the slow release of AmpB from PB was unusual compared to other small molecules in our earlier findings, suggesting strong interaction with plasma proteins. Molecular interaction studies of bovine serum albumin constituting approximately 60% of plasma with AmpB using isothermal titration calorimetry and in silico docking verify these interactions, explaining the slow release of AmpB entrapped in PB alone. The above findings suggest that PB/liposome-PB could be used as safe and effective delivery systems to combat fungal infections in humans.

Which substances loaded onto collagen scaffolds influence oral tissue regeneration?-an overview of the last 15 years

BACKGROUND

Collagen scaffolds are widely used for guided bone or tissue regeneration. Aiming to enhance their regenerative properties, studies have loaded various substances onto these scaffolds. This review aims to provide an overview of existing literature which conducted in vitro, in vivo, and clinical testing of drug-loaded collagen scaffolds and analyze their outcome of promoting oral regeneration.

MATERIALS AND METHODS

PubMed, Scopus, and Ovid Medline® were systematically searched for publications from 2005 to 2019. Journal articles assessing the effect of substances on oral hard or soft tissue regeneration, while using collagen carriers, were screened and qualitatively analyzed. Studies were grouped according to their used substance type-biological medical products, pharmaceuticals, and tissue-, cell-, and matrix-derived products.

RESULTS

A total of 77 publications, applying 36 different substances, were included. Collagen scaffolds were demonstrating favorable adsorption behavior and release kinetics which could even be modified. BMP-2 was investigated most frequently, showing positive effects on oral tissue regeneration. BMP-9 showed comparable results at lower concentrations. Also, FGF2 enhanced bone and periodontal healing. Antibiotics improved the scaffold's anti-microbial activity and reduced the penetrability for bacteria.

CONCLUSION

Growth factors showed promising results for oral tissue regeneration, while other substances were investigated less frequently. Found effects of investigated substances as well as adsorption and release properties of collagen scaffolds should be considered for further investigation.

CLINICAL RELEVANCE

Collagen scaffolds are reliable carriers for any of the applied substances. BMP-2, BMP-9, and FGF2 showed enhanced bone and periodontal healing. Antibiotics improved anti-microbial properties of the scaffolds.

Modified 'Cul-De-Sac' approach for management of a large perforation during maxillary sinus elevation- (A case report)

Dental implants have been in used as a successful mode of rehabilitation of lost dentition for over three decades. Science and techniques have undergone significant progress with time and clinical situations that were deemed unfit for insertion of dental implants due to lack of sufficient bone are now being treated using implants with predictable long term results. Clinicians can now rehabilitate the posterior maxilla with a wide variety of implant-based solutions. There are complications associated with this procedure which may be attributed to diagnostics or the surgical protocol itself and a multitude of management approaches have been suggested in the literature. This report elucidates one such case of management of a large perforation in the Schnederian membrane during elevation using a staged approach.

Debonding Shear Strength of Orthodontic Tubes Bonded to Skeletal Anchorage Miniplates with Different Agents

Introduction:

Most miniplates used for skeletal anchorage lack built-in orthodontic devices. To address this issue, orthodontists must use creative solutions, such as bonding buttons, brackets, or tubes directly to the miniplates, thus making them more versatile devices that provide a wider range of tooth movement possibilities. The purpose of the present study was to ascertain the debonding strength in Megapascals (MPa) of orthodontic accessories bonded to skeletal anchorage miniplates with different bonding agents.

Methods:

Forty specimens were divided into two equal groups by bonding agent: Group 1, resin (Transbond XT®, 3M ESPE); Group 2, cyanoacrylate (Scotchbond®, 3M ESPE). Shear strength testing was performed in an EMIC DL-2000 universal testing machine.

Results:

The results obtained were 2.28 ± 0.44 MPa for Group 1 and 4.90 ± 0.76 MPa for Group 2. The Kolmogorov-Smirnov test was used to assess the normality of data distribution. Student's t-test was used to compare means in the response variable.

Conclusion:

A statistically significant difference was observed between groups. However, both bonding agents provided strength in excess of that needed for secure orthodontic tooth movement.

Evaluation of Regular Market Ethyl Cyanoacrylate Cytotoxicity for Human Gingival Fibroblasts and Osteoblasts

Background: The aim of this study was to evaluate the cytotoxicity of cyanoacrylate adhesives in an indirect contact assay in human gingival fibroblast (FGH) and oral osteoblasts (GO) lineages. Methods: Cover glasses were glued with adhesives following the ISO 10993-2012 protocol. The groups were: C (control with cells and regular Dulbecco Modified Eagle Medium; LC (liquid ethyl-cyanoacrylate); GC (ethyl-cyanoacrylate gel); EGC (easy gel [ethyl-cyanoacrylate]); and D (Dermabond [octyl-cyanoacrylate]). Each cell linage was plated in the sixth passage using 10⁴ cells. Cell viability was measured by the MTT test at 24, 48, 72, and 96 hours. Data were analyzed by two-way analysis of variance complemented by the Tukey test, with p < 0.05 being significant. Results: Dermabond stimulated osteoblast viability at 72 h (p < 0.05). All other groups were similar to the control cells (p > 0.05). For the fibroblasts, there was no difference in the groups, including the control except that EGC was cytotoxic for these cells (p < 0.05). Conclusions: Ethyl-cyanoacrylate gel and liquid forms available on the general chemical market were not cytotoxic for oral osteoblasts and fibroblasts in most cases. However, the easy gel form was cytotoxic for fibroblasts.

Sinus floor elevation in sites with a perforated schneiderian membrane: What is the effect of placing a collagen membrane in a rabbit model?

OBJECTIVE

To investigate the healing following sinus grafting in sites with a perforated schneiderian membrane repaired using a collagen membrane, compared to control sites without membrane perforation.

MATERIALS & METHODS

Following elevation of the sinus membrane in 16 rabbits, each sinus was assigned to one of the following groups: (a) intentional schneiderian membrane perforation, followed by the placement of a collagen membrane and bone grafting (group SMP) and (b) bone grafting without a perforation of the schneiderian membrane and without a collagen membrane placement (control group). At 2 and 4 weeks (n = 8 for each time-point), microcomputed tomographic (micro-CT) and histomorphometric analyses were performed.

RESULTS

Overall new bone formation in group SMP was significantly delayed compared to the control group at 2 and 4 weeks (1.58 ± 1.25% vs. 9.23 ± 2.69% at 2 weeks, 10.43 ± 3.55 vs. 17.86 ± 4.11% at 4 weeks, p < 0.05). At 2 weeks, new bone formation for the areas close to lateral (1.19 ± 2.02%) and medial sinus bone walls (3.17 ± 1.98%) was markedly delayed in group SMP compared to the control group (13.08 ± 6.13% and 12.75 ± 5.63%, respectively, p < 0.05), but there was no statistical difference in those areas at 4 weeks (p > 0.05). The augmented volumes at 2 and 4 weeks were not statistically significantly different in both groups.

CONCLUSION

The perforation of the schneiderian membrane and the repair using a collagen membrane delayed new bone formation in the augmented sinuses. However, the extension of the collagen membrane on the sinus bone walls was also attributable to this delayed bone formation.

Oral Applications of Cyanoacrylate Adhesives: A Literature Review

Cyanoacrylate adhesives have been used in medicine and dentistry with some controversial opinions. The aim of this review was to summarize the relevant literature regarding the use of cyanoacrylate adhesives for oral wounds during dental and surgical procedures, with focus on the applications, indications, advantages, and disadvantages. In conclusion, in vivo and clinical studies have demonstrated in the last few years convincing results regarding the safety, efficacy, ease of application, and feasibility of all types of cyanoacrylate adhesives used in intra- and extraoral procedures.

Biomimetic characteristics of mussel adhesive protein-loaded collagen membrane in guided bone regeneration of rabbit calvarial defects

Purpose

The aim of the present study was to evaluate the biocompatibility and barrier function of mussel adhesive protein (MAP)-loaded collagen membranes in guided bone regeneration (GBR).

Methods

Eight male New Zealand white rabbits were used. Four circular defects (diameter: 8 mm) were created in the calvarium of each animal. The defects were randomly assigned to 1) a negative control group, 2) a cyanoacrylate (CA)-loaded collagen membrane group (the CA group), 3) a MAP-loaded collagen membrane group (the MAP group), and 4) a group that received a polycaprolactone block with MAP-loaded collagen membrane (the MAP-PCL group). Specimens were harvested at 2 weeks (n=4) and 8 weeks (n=4) postoperatively for observational histology and histometric analysis.

Results

In the histologic analysis, MAP was completely absorbed without any byproducts. In contrast, some of the CA adhesive remained, showing an inflammatory reaction, at 8 weeks. In the MAP-PCL group, the MAP-loaded collagen membranes served as a barrier membrane despite their fast degradation in GBR. No significant difference was found in the amount of new bone between the MAP-PCL and MAP groups (1.82±0.86 mm² and 2.60±0.65 mm², respectively).

Conclusions

The MAP-loaded collagen membrane functioned efficiently in this rabbit calvarial GBR model, with excellent biocompatibility. Further research is needed to assess clinical applications in defect types that are more challenging for GBR than those used in the current model.

Pain perception following epithelialized gingival graft harvesting: a randomized clinical trial

OBJECTIVES

The aim of this study was to compare the effects of a hemostatic collagen sponge and a collagen sponge sealed with a bio-adhesive material on the palatal donor sites with the purpose of minimizing postoperative pain after epithelialized gingival graft (EGG) harvesting.

MATERIAL AND METHODS

The present study consisted of 44 EGGs harvested in 44 patients. In the control group, a hemostatic collagen sponge was applied over the palatal wound, while the test group was treated with additional cyanoacrylate. Patients were observed for 14 days, evaluating the pain level by using the visual analogic scale. The consumption of analgesic during the postoperative period, the willingness for retreatment and the characteristic of the graft were also analyzed.

RESULTS

Statistically significant differences in pain perception were found between test and control groups in each of the studied days (p < 0.01). Analgesic consumption was lower in the test group (p < 0.01). Graft width < 14 mm was found to be associated with lower discomfort (p < 0.01).

CONCLUSIONS

Adding an additional layer of cyanoacrylate over a hemostatic collagen sponge on the palatal wound following EGG harvesting was found to be successful in minimizing the postoperative discomfort and the need for analgesics.

CLINICAL RELEVANCE

Postoperative pain after palatal tissue harvesting can be successfully minimized if the donor site open wound is protected with an external layer of cyanoacrylate over a collagen sponge.

Repair of a perforated sinus membrane with an autogenous periosteal graft: a study in 24 patients

We describe a technique for repairing a perforation of the sinus membrane with a periosteal graft. Of 117 patients who had augmentation of the sinus floor, the sinus membrane perforated in 24, and these were repaired with autogenous periosteal grafts. Patients were followed up daily for the first 10days and monthly for the next six months, and clinical and radiographic variables were recorded. Patients had to be free of complications such as wound dehiscence, sinus infections, exposure of the graft, local inflammation, or pain. The radiographs showed correct osseointegration of all implants. Periosteal grafts are an effective alternative for repair of a perforation of the sinus membrane.

Histopathological Effects of Fibrin Glue and Cyanoacrylate on the Maxillary Sinus

Objective

To compare the histopathological effects of fibrin glue (FbGl) and cyanoacrylate (CyAc) on the maxillary sinus mucosa.

Methods

Twenty rabbits were divided into two groups of 10, and surgical defects were created in the maxillary sinuses. The right maxillary sinus was treated with FbGl in one group and with CyAc in the other group. As a control, the left maxillary sinuses of all rabbits were treated with sterile saline solution. One rabbit treated with CyAc died during the study and was excluded. On postoperative day 21, all animals were sacrificed. Maxillary sinus mucosa samples were studied to determine the extent of inflammation and fibrosis, foreign body reaction, cilia loss, increased osteogenesis in bony structures under the mucosa, and loss of serous glands.

Results

The FbGl group differed significantly from the CyAc and control groups in terms of a high degree of inflammation (p<0.001), fibrosis (p<0.001), foreign body reaction (p<0.001), cilia loss (p<0.001), and serous gland loss (p<0.001). In terms of osteogenesis, there were no significant differences between the FbGl and CyAc groups (p=0.650), while there was a significant (p=0.002) difference between these two groups and the control group.

Conclusion

Histopathologically, CyAc had fewer side effects than FbGl. Further clinical studies are needed to demonstrate the validity of these results in humans.

Cyanoacrylate for Intraoral Wound Closure: A Possibility?

Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE) was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

Does cation break the cyano bond? A critical evaluation of nitrile-cation interaction

DFT and G4 results reveal that cations display the following trends in imparting its positive charge to acrylonitrile; H⁺ > Li⁺ > Na⁺ > K⁺ for group I and Be²⁺ > Mg²⁺ > Ca²⁺ for group II. Solvation by water molecules and interaction with cation make the cyano bond more polarized and exhibits ketene-imine character. Bond order in nitrile-cation complexes has been predicted based on the s character of the covalent bond orbitals. Mulliken, CHELPG, and NPA charges are in good agreement in predicting positive charge buildup and GIAO nuclear deshileding on C1. G4 enthalpies show that Mg²⁺ is more strongly bound to acrylonitrile than to acetonitrile by 3 kcal mol⁻¹, and the proton affinity of the former is higher by 0.8 kcal mol⁻¹. G4 enthalpies of reductions support prior experimental observation that metalated conjugated nitriles show enhanced reactivity toward weak nucleophiles to afford Michael addition products.

Demineralization of the contacting surfaces in autologous onlay bone grafts improves bone formation and bone consolidation

BACKGROUND

Autologous bone grafts are usually well consolidated after 4 to 5 months but can be incompletely interlocked with the native bone. This study investigated the effect of acid demineralization of the graft-bed interface on graft consolidation.

METHODS

Onlay bone grafts were performed on the calvaria of 36 guinea pigs. Half of the animals had the graft-bed contacting surfaces demineralized with 50% citric acid (pH 1.0) for 3 minutes (test group). The other half received no demineralization (control group). The bone grafts were immobilized by a resorbable membrane glued to the recipient bed with cyanoacrylate. After 7, 30, and 90 days, specimens (n = 6) were obtained for light microscopy. Data from qualitative analysis and computerized histomorphometry were statistically processed at a significance level of 5%.

RESULTS

Osteogenesis was not seen at the interface after 7 days. After 30 days, the test group showed 34.39% ± 13.4% of the interface area filled with mineralized tissue, compared to 17.14% ± 8.6% in the control group (P = 0.026). After 90 days, the mean percentages of mineralized tissue at the interface in the test and control specimens were 54.00% ± 11.23% and 38.65% ± 7.76% (P = 0.041), respectively. Within groups, a higher percentage of the area filled with mineralized tissue was seen at 90 days compared to 30 days (P = 0.004 for control and 0.041 for test).

CONCLUSIONS

Demineralization of the contacting surfaces between autologous bone graft and bone bed improved new bone formation and bone consolidation. These data need to be confirmed in humans.

The rabbit as experimental model for research in implant dentistry and related tissue regeneration

The use of rabbits for experimental research has a long historical tradition. The aim of this review consists in outlining the use of the rabbit for research in implant dentistry and related tissue regeneration. Rabbits appear as a first-hand choice for fundamental implant design studies because of their size, easy handling, short life span, and economical aspects in purchasing and sustaining. In the following, the various anatomical sites in the rabbit will be summarized to provide an overview of current possibilities and limitations of this model for bone research in oral implantology.

Cyanoacrylate: a handy tissue glue in maxillofacial surgery: our experience in alexandria, egypt

Cyanoacrylate tissue glue has been widely used in different surgical applications. It is easy to apply and can save considerable time and effort. Reports including series of oral and maxillofacial cases are yet to be well documented. We report our experience using cyanoacrylate tissue glue in the head and neck region in 165 patients. We have used it for indications including orbital floor graft fixation, cleft lip and palate repair, oral dressing, skin graft fixation, nasal splinting, immobilisation of traumatised teeth, management of chyle leak during neck dissection and wound closure. We have not had any complications from using cyanoacrylate. It is found to be safe and effective in different indications it is used for without undue hazards. The role of cyanoacrylate in oral and maxillofacial surgery needs further research.

Comparison of octyl-2-cyanoacrylate and conventional sutures in facial skin closure

INTRODUCTION

Closure of wounds to achieve an esthetically pleasing result has always been a challenge. Since time immemorial, surgeons have strived to produce "invisible scars". This, however, has always been elusive. The introduction of tissue adhesives heralded the era of suture free closures which led to better results.

AIMS AND OBJECTIVES

The aim of this study is to compare the efficacy of octyl- 2-cyanoacrylate with that of the conventional sutures, in facial skin closure.

RESULTS AND CONCLUSION

The use of octyl-2-cyanoacrylate offers many advantages such as rapidity and ease of application and superior results.

In vitro and in vivo studies on the use of Histoacryl(®) as a soft tissue glue

The skin adhesive Histoacryl(®) consists of n-butyl-2-cyanoacrylate which polymerises in contact with moisture. It is not fully biodegradable, produces heat during polymerisation and releases products which are toxic and inhibit cell growth. Clinical application is exclusively approved to glue skin. However, there are also clinical studies and case reports in the scientific literature, which discuss the application of Histoacryl(®) as a soft tissue adhesive. In parallel to an analysis of the literature which discusses the usage of Histoacryl(®) in head and neck surgery, we performed in vitro and in vivo investigations with this adhesive. In vitro, the vitality of cultured cell lines which where treated with extracts of Histoacryl(®) was determined with a viability assay. In addition, Histoacryl(®) was examined by fixing defined mucous membrane of the nasal septum in an animal study in rabbits. The analysis of the literature shows both positive and negative results for the application of Histoacryl(®) as a soft tissue adhesive depending on the manner and place of the application as well as the applied amount of glue. Our own results confirm a negative influence of Histoacryl(®) on the viability of cultured cells and soft tissue. The histological examination showed that a better biocompatibility is achieved if the glue is used in small amounts. Both the literature study as well as the in vitro and in vivo examinations showed that the usage of Histoacryl(®) as a soft tissue glue may be arguable. Critical factors are the moisture at the application area and the applied amount of glue.

Distributions of calcitonin gene-related peptide and substance P in the human maxillary sinus of Japanese cadavers

BACKGROUND

Substance P (SP) and calcitonin gene-related peptide (CGRP) are released by the nociceptive sensory nerve and are involved in blood flow, pain and inflammation in the nasal mucosa. The purpose of this study was to assess the distribution of the SP and CGRP nerve fibres related to blood supply within human Schneiderian membrane of the maxillary sinus (MS).

MATERIAL AND METHODS

In this study, the MS from Japanese cadavers was examined by whole-mount immunohistochemistry. Human male cadavers (ranging in age from 80 to 90 years) were used in this study.

RESULTS

SP- and CGRP-positive fibres were found around large vessels of the medialis superior alveolar branches and also within the floor region of the MS. The floor region of the MS was composed of complex branches of these fibres.

CONCLUSION

Our results give useful information for surgical sinus floor elevation in this region of the MS. These anatomical features may assist in the execution of a successful surgical procedure.

Dimensional changes in gypsum fragments bonded with cyanoacrylate

PURPOSE

Accidental fractures may occur during manipulation and transportation of plaster casts. In clinical practice, plaster fragments may be bonded without harming the accuracy of the final denture, provided that the bonding agent does not cause dimensional alterations. Cyanoacrylate could be a good material because of its ease of use, quick set, wide availability, and low cost. The aim of this study was to assess the dimensional alteration of Type IV plaster fragments bonded with a cyanoacrylate-based adhesive.

MATERIALS AND METHODS

Ten hexagonal regular prisms were made of Type IV plaster, with two reference marks on one of the faces. The distance between the marks was measured under a comparison microscope. After this, the prisms were fractured so that the fracture line would be between the two reference marks, bonded with a cyanoacrylate-based universal adhesive and measured again.

RESULTS

The mean difference between the measurements performed before and after fracture and bonding of the fragments was 0.0194 mm. At a level of significance of 0.05, there was no statistically significant difference between the measurements before and after fracture and bonding of the dies (p = 0.1582).

CONCLUSION

It may be concluded that bonding of Type IV plaster fragments with a cyanoacrylate-based adhesive did not cause significant dimensional alterations.

A comparative study: efficacy of tissue glue and sutures after impacted mandibular third molar removal

OBJECTIVE

To compare the efficacy of cyanoacrylate (tissue glue) placement after surgical removal of impacted mandibular third molars.

MATERIALS AND METHODS

Thirty patients with bilaterally impacted mandibular third molars were studied in this controlled clinical trial. One side closure after surgical removal of third molar was done with conventional sutures and other side with cyanoacrylate.

RESULTS

The data analysis showed that postoperative bleeding with cyanoacrylate method was less significant than with suturing on the first and second day after surgery. There was no significant difference in the severity of pain between the two methods.

CONCLUSION

This study suggested that the efficacy of both, cyanoacrylate and suturing in wound closure were similar in the severity of pain, but use of cyanoacrylate showed better hemostasis.

Tissue adhesives in otorhinolaryngology

The development of medical tissue adhesives has a long history without finding an all-purpose tissue adhesive for clinical daily routine. This is caused by the specific demands which are made on a tissue adhesive, and the different areas of application. In otorhinolaryngology, on the one hand, this is the mucosal environment as well as the application on bones, cartilage and periphery nerves. On the other hand, there are stressed regions (skin, oral cavity, pharynx, oesophagus, trachea) and unstressed regions (middle ear, nose and paranasal sinuses, cranial bones). But due to the facts that adhesives can have considerable advantages in assuring surgery results, prevention of complications and so reduction of medical costs/treatment expenses, the search for new adhesives for use in otorhinolaryngology will be continued intensively. In parallel, appropriate application systems have to be developed for microscopic and endoscopic use.

Tomographic, histological, and immunohistochemical evidences on the use of N-butyl-2-cyanoacrilate for onlay graft fixation in rabbits

BACKGROUND

The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation.

PURPOSE

The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption.

MATERIALS AND METHODS

Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n = 9) and 6 weeks (n = 9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein.

RESULTS

The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p ≤ 0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and Mann-Whitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group.

CONCLUSION

The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis.

Surface characteristics of biomaterials used for space maintenance in a mandibular defect: a pilot animal study

PURPOSE

The purpose of the present study was to evaluate the effect of implant porosity on wound healing between solid and porous implants placed within a bony mandibular defect with intraoral exposure.

MATERIALS AND METHODS

Solid poly(methyl methacrylate) (PMMA) implants similar to those used currently in clinical space maintenance applications in maxillofacial surgery were compared with poly(propylene fumarate) implants that contained a porous outer surface surrounding a solid core. A 10-mm diameter nonhealing bicortical defect with open communication into the oral cavity was created in the molar mandibular region of 12 adult male New Zealand white rabbits. Of the 12 rabbits, 6 received the hybrid poly(propylene fumarate) implants and 6 received the solid PMMA implants. At 12 weeks, the rabbit mandibles were harvested and sent for histologic staining and sectioning.

RESULTS

Gross inspection and histologic examination showed all 6 poly(propylene fumarate) implants to be intact within the defect site at the termination of the study period, with 3 of the 6 specimens exhibiting a continuous circumferential soft tissue margin. In contrast, 5 of the 6 PMMA-implanted specimens were exposed intraorally with an incomplete cuff of soft tissue around the implant. One of the PMMA-implanted specimens exhibited complete extrusion and subsequent loss of the implant. Fisher's exact test was used to compare the occurrence of oral cavity wound healing between the 2 groups (P = .09).

CONCLUSIONS

Although statistically significant differences between the 2 groups were not seen, our results have indicated that advantages might exist to using porous implants for space maintenance. Additional study is needed to evaluate these findings.

Histological outcomes on the development of new space-making devices for maxillary sinus floor augmentation

BACKGROUND

Previous studies have pointed out that the mere elevation of the maxillary sinus membrane promotes bone formation without the use of augmentation materials.

PURPOSE

This experimental study aimed at evaluating if the two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device in order to increase the bone volume to enable later implant installation with good primary stability.

MATERIALS AND METHODS

Six male tufted capuchin primates (Cebus apella) were subjected to extraction of the three premolars and the first molar on both sides of the maxilla to create an edentulous area. The sinuses were opened using the lateral bone-wall window technique, and the membrane was elevated. One resorbable space-making device was inserted in each maxillary sinus, and the bone window was returned in place. The animals were euthanatized after 6 months, and biopsy blocks containing the whole maxillary sinus and surrounding soft tissues were prepared for ground sections.

RESULTS

The histological examination of the specimens showed bone formation in contact with both the schneiderian membrane and the device in most cases even when the device was displaced. The process of bone formation indicates that this technique is potentially useful for two-stage sinus floor augmentation. The lack of stabilization of the device within the sinus demands further improvement of space-makers for predictable bone augmentation.

CONCLUSIONS

It is concluded that (1) the device used in this study did not trigger any important inflammatory reaction; (2) when the sinus membrane was elevated, bone formation was a constant finding; and (3) an ideal space-making device should be stable and elevate the membrane to ensure a maintained connection between the membrane and the secluded space.