Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening

Background

Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this retrospective study was to evaluate the outcomes of dental implant placement in sinus-augmented areas with preexisting sinus mucosal thickening.

Methods

This study involved the review of cone-beam computed tomographic (CBCT) scans taken on patients that underwent both maxillary sinus elevation with grafting and implant placement at the University of Michigan School of Dentistry from 2004 to 2014. Cases with documented radiographic and clinical follow-up were included. The data analyses revealed the following.

Results

A total of 29 CBCT scans met the inclusion criteria for evaluation, and 93.1% of them had maxillary sinus mucosal/tissue thickening. Specifically, 6.9% of cases exhibited no thickening, 6.9% had minimal thickening (1–2 mm), 20.7% of cases had moderate thickening (2–5 mm), and 65.5% had severe thickening (>5 mm). We propose these categorical measurements of tissue thickening as a new “mucosal thickening index.” The tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening (p = 0.0043). These data indicate that there is high implant and grafting success rate (100%) in the maxillary sinus despite large and varied physiologic sinus mucosal/tissue thickening.

Conclusions

Based on study findings, this research will help guide dental practitioners regarding cases that exhibit mucosal thickening. These data support the concept that physiologic mucosal thickening in varied ranges is not associated with implant or grafting failure in the maxillary sinus.

Incidental Findings From Cone-Beam Computed Tomography During Implant Therapy

INTRODUCTION

This report reviews relevant literature on foreign bodies identified with cone-beam computed tomography (CBCT) and documents a rare case of a foreign body that was serendipitously identified during routine implant treatment planning.

CASE PRESENTATION

The literature shows a frequent occurrence of incidental findings with CBCT. This case documents incidental findings in the maxillary sinus and external auditory canal that were identified during routine CBCT used for implant treatment planning. The finding in the maxillary sinus was diagnosed as a mucous retention pseudocyst that did not require treatment. The finding in the external auditory canal was diagnosed as a foreign body (remnant of a cotton swab). Removal of the foreign body was prompted because of its presumed association with chronic headaches that were unresolved. Removal of the foreign body alleviated the chronic headaches, and implant placement proceeded uneventfully.

CONCLUSIONS

This review and case underscore the importance of a thorough review of the entire tomographic image volume. Using advanced technology for treatment creates new responsibilities and places more liability on providers not to overlook findings that may be significant to the patient's health.

The frequency of follicle stimulating hormone receptor gene polymorphisms in Iranian infertile men with azoospermia

BACKGROUND

Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. Follicle stimulating hormone (FSH) is a member of the glycoprotein hormone family that plays an important role in human reproduction because of its essential role in normal spermatogenesis. Various Single Nucleotide Polymorphisms (SNPs) have been reported within FSH receptor (FSHR) gene that may affect the receptor function.

OBJECTIVE

The present study aimed to investigate the correlation between two FSHR SNPs at positions A919G, A2039G, and susceptibility to azoospermia in a group of Iranian azoospermic men. The association between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated.

MATERIALS AND METHODS

This case control study was performed on 212 men with azoospermia (126 non-obstructive and 86 obstructive) and 200 healthy Iranian men. Two FSHR gene SNPs were genotyped using PCR-RFLP method. The relationship between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated.

RESULTS

Statistical analysis indicated that at A919G position, AA genotype and A allele were more frequent in obstructive azoospermia cases compared to non-obstructive or normal men (p=0.001). Regarding A2039G polymorphisms, no significant difference was observed between both azoospermia groups and the controls. The mean level of serum FSH was higher in the non-obstructive men compared to the obstructive patients (23.8 versus 13.8, respectively, p= 0.04).

CONCLUSION

The results of the present study indicated that the genetic polymorphisms in the FSHR gene might increase the susceptibility to azoospermia in Iranian men.

Vagifem is superior to vaginal Premarin in induction of endometrial thickness in the frozen-thawed cycle patients with refractory endometria: A randomized clinical trial

BACKGROUND

Embryo transfer to a developed endometrium is an important prognostic factor in frozen-thawed embryo transfer cycle outcome. Vaginal estrogen, such as Vagifem vaginal tablets and Premarin vaginal cream, is a regimen used for the patients with refractive endometria.

OBJECTIVE

Our objective was to compare the effects of Vagifem and Premarin on the endometrial thickness of the patients with refractive endometria.

MATERIALS AND METHODS

In this randomized clinical trial, 30 patients with refractive endometria in frozen-thawed embryo transfer cycles received Vagifem vaginal tablets and 30 women received Premarin vaginal cream. Endometrial thickness was measured on the 14th day of drug administration.

RESULTS

Comparing the endometrial thicknesses of the two groups showed that the endometria of the Vagifem group was significantly thicker than that of the Premarin group (5.93±0.38 vs. 6.74±0.32; p<0.001).

CONCLUSION

Vagifem is superior to Premarin in induction of endometrial thickness in frozen-thawed embryo transfer cycles in the patients with refractive endometria.

The effect of HLA-DRB1 sharing between the couples with recurrent pregnancy loss on the pregnancy outcome after leukocyte therapy

BACKGROUND

Miscarriage is a common phenomenon complicating more than half of pregnancies. Recurrent Pregnancy Loss (RPL) is defined as three or more pregnancies lost before the twentieth week of gestation. It is believed that abnormality in maternal immune reaction to fetus and sharing of HLA antigens might be associated with RPL.

OBJECTIVE

To investigate the effect of HLA-DRB1 sharing between the couples with recurrent pregnancy loss on the pregnancy outcome after leukocyte therapy.

METHODS

Sixty primary RPL women who were immunized and followed after therapy (30 successful and 30 unsuccessful) and their husbands formed the cases of this study. In addition, one hundred healthy women were considered as the controls. HLA-DRB1 genotypes of all the cases and controls were checked by PCR-SSP method.

RESULTS

HLA typing indicated that the prevalence of HLA-DRB1 sharing (defined as at least one allele sharing) between the couples with unsuccessful outcomes was significantly higher compared to those with successful outcomes (63.3% vs. 23.3%, p<0.004). Moreover, HLA DRB1*07:01 allelic group was significantly more frequent in the patients with unsuccessful outcome compared to the controls (18.3% vs. 8%, p<0.04).

CONCLUSION

Our results confirmed the role of HLA sharing in RPL and revealed that HLA-DRB1 typing may be a valuable prognostic factor for the leukocyte therapy outcome.

Double versus single cervical cerclage for patients with recurrent pregnancy loss: a randomized clinical trial

AIM

To compare the effectiveness of the double cervical cerclage method versus the single method in women with recurrent second-trimester delivery.

METHOD

In this randomized clinical trial, we included 33 singleton pregnancies suffering from recurrent second-trimester pregnancy loss (≥2 consecutive fetal loss during second-trimester or with a history of unsuccessful procedures utilizing the McDonald method), due to cervical incompetence. Patients were randomly assigned to undergo either the classic McDonald method (n = 14) or the double cerclage method (n = 19). The successful pregnancy rate and gestational age at delivery was also compared between the two groups.

RESULTS

The two study groups were comparable regarding their baseline characteristics. The successful pregnancy rate did not differ significantly between those who underwent the double cerclage method or the classic McDonald cerclage method (100% vs 85.7%; P = 0.172). In the same way, the preterm delivery rate (<34 weeks of gestation) was comparable between the two study groups (10.5% vs 35.7%; P = 0.106). Those undergoing the double cerclage method had longer gestational duration (37.2 ± 2.6 vs 34.3 ± 3.8 weeks; P = 0.016).

CONCLUSION

The double cervical cerclage method seems to provide better cervical support, as compared with the classic McDonald cerclage method, in those suffering from recurrent pregnancy loss, due to cervical incompetence.