A new heparan sulfate from the mollusk Nodipecten nodosus inhibits merozoite invasion and disrupts rosetting and cytoadherence of Plasmodium falciparum

BACKGROUND

Despite treatment with effective antimalarial drugs, the mortality rate is still high in severe cases of the disease, highlighting the need to find adjunct therapies that can inhibit the adhesion of Plasmodium falciparum-infected erythrocytes (Pf-iEs).

OBJECTIVES

In this context, we evaluated a new heparan sulfate (HS) from Nodipecten nodosus for antimalarial activity and inhibition of P. falciparum cytoadhesion and rosetting.

METHODS

Parasite inhibition was measured by SYBR green using a cytometer. HS was assessed in rosetting and cytoadhesion assays under static and flow conditions using Chinese hamster ovary (CHO) and human lymphatic endothelial cell (HLEC) cells expressing intercellular adhesion molecule-1 (ICAM1) and chondroitin sulfate A (CSA), respectively.

FINDINGS

This HS inhibited merozoite invasion similar to heparin. Moreover, mollusk HS decreased cytoadherence of P. falciparum to CSA and ICAM-1 on the surface of endothelial cells under static and flow conditions. In addition, this glycan efficiently disrupted rosettes.

CONCLUSIONS

These findings support a potential use for mollusk HS as adjunct therapy for severe malaria.

Maxillary sagittal and vertical displacement induced by surgically assisted rapid palatal expansion

The purpose of this study was to investigate the sagittal and vertical effects on the maxilla induced by surgically assisted rapid palatal expansion. Twenty patients (average age, 25.6 years) who required a surgically assisted rapid palatal expansion procedure were available for this study. Each patient was banded with a Haas-type palatal expander, maxillary surgery was performed, and the expander was activated. Presurgical and postexpansion lateral cephalograms were taken for each patient. The measurements of SNA, Frankfort horizontal-nasion-A point, sella-nasion-palatal plane, A-point-nasion-perpendicular (in millimeters), 1-nasion-A-point, 1-sella-nasion, 1-nasion-perpendicular (in millimeters) were made on each cephalogram, and the presurgical and postexpansion tracings were superimposed on the cranial base to determine the changes in the anterior nasal spine and posterior nasal spine positions. Results showed that from the presurgical cephalogram to the postexpansion cephalogram SNA, Frankfort horizontal-nasion-A point and A-point-nasion-perpendicular had a mean increase of 0.60 degrees (P <.05), 0.65 degrees (P <.05), and 0.55 mm (P <.05), respectively; 1-nasion-A-point decreased 2.18 degrees (P <.05) and 1-sella-nasion decreased 1.53 degrees (P <.05). No significant maxillary vertical displacement was noted from the first cephalogram to the second. In conclusion, surgically assisted RPE did not significantly affect the maxilla vertically; however, it did induce a slight forward movement of the maxilla and a slight retroclination of the maxillary incisors sagittally (P <.05).

Preprosthetic surgery for the edentulous patients

Preprosthetic surgery is a rapidly changing area of dentistry. A knowledge of the range, capabilities, and limitations of the commonly used surgical procedures is a must for anyone treating a patient who will receive a complete denture prosthesis. It cannot be overemphasized that the establishment of a clear treatment plan and close coordination of all parties involved in the reconstructive effort are essential to achieve the best overall result.

Diagnosis and treatment of transverse maxillary deficiency

Treatment of skeletally mature patients is often complicated by inadequately treated or undiagnosed transverse skeletal discrepancy. This report emphasizes diagnosis of transverse maxillo-mandibular discrepancy and describes recommendations for treatment. Proper treatment strategy must consider the type and magnitude of transverse deficiency, patient's growth status, dentofacial esthetics, stability factors, and periodontal tissue health. Indications for surgically assisted maxillary expansion are listed, and the recommended surgical technique to improve frontal dentofacial esthetics, provide better stability, and enhance long-term periodontal health is described. Specific modifications in surgical technique to help prevent postoperative complications are included. New recommendations for sequencing, timing, and correction of transverse deficiency are presented.

Multiple central giant cell lesions with a Noonan-like phenotype

A small number of patients with the phenotypic features of Noonan syndrome have also developed giant cell lesions of the jaws similar to those seen in cherubism. This case report describes an individual with the features of the recently described Noonan-like/multiple giant cell lesion syndrome. Previously reported cases and issues relative to diagnosis and management are considered.

Osseous changes following placement of the transmandibular implant system in edentulous mandibles

The transmandibular implant system is designed for the reconstruction and rehabilitation of the endentulous mandible utilizing an extraoral approach. Transmandibular implants were placed in 19 patients and mandibular bony changes were followed using standardized panoramic radiography. Eleven sites were identified on each postoperative radiograph and the percentage of radiographic enlargement was calculated for each site. The true bony changes were then computed for both short-term (9.4 months) and long-term (53.4 months) follow-up. Patients with an average mandibular height in the saddle areas of 3.5 to 8.9 mm showed bilateral bony regeneration in the saddle areas and over the most distal cortical screws of the implants. Most of these bony changes were seen in the first year, but continued beyond that time. Patients with residual bone height of 9.0 to 12.9 mm had little bone change, while patients with bone height of 13.0 to 20.5 mm demonstrated slight resorption. Theories for the observed changes are presented. The transmandibular implant is especially indicated for the severely atrophic mandible because its position within the mandible and the rigid box frame design of the implant promote bilateral bone regeneration distal to the framework of the implant.

The transmandibular implant: implant reconstruction and rehabilitation for the atrophic mandible

The transmandibular implant is specifically designed for the reconstruction and rehabilitation of the severely atrophic mandible utilizing an extraoral approach. The unique design and surgical protocol of the transmandibular system have proven to be predictable and successful. The indications, implant design and materials, surgical technique, advantages, and disadvantages of the transmandibular system are presented in this article.

Evaluation of anterior maxillary alveolar ridge resorption when opposed by the transmandibular implant

Fifteen edentulous patients with complaints regarding denture comfort and/or function were treated with the transmandibular implant. All patients were restored with conventional maxillary dentures opposed by implant-supported removable prostheses. Two to 4 years after surgery, these patients were evaluated for vertical and horizontal maxillary bone loss with a radiographic analysis developed by the authors. With this technique, attention was focused on vertical alveolar ridge resorption in the anterior maxilla. Although the sample size was small, the findings from this study indicate that vertical bone loss in the anterior maxilla does occur when a maxillary denture is opposed by an implant-supported overdenture. Comparison of these results with a previous study that evaluated anterior maxillary resorption when a complete maxillary denture opposed natural mandibular anterior teeth and a distal extension removable partial denture demonstrated no statistically significant difference.

Allogeneic bone for secondary alveolar cleft osteoplasty

The purpose of this retrospective clinical study was to determine the efficacy of allogeneic bone for secondary alveolar cleft osteoplasty. Twenty-four patients with unilateral cleft lip and palate treated with allogeneic bone grafts were examined by a surgeon, orthodontist, and prosthodontist 20 to 47 months after surgery. Radiographic and clinical examination of the periodontal status of the teeth adjacent to the cleft and their antimeres were compared for differences with Student's t test and the Wilcoxon test. Radiographs indicated complete bone bridging in 21 patients. Two of the remaining three patients had a 1-mm radiolucent gap in the cleft site. The third patient had a 6-mm-wide radiolucency and recurrence of an oronasal fistula which was regrafted with autogenous bone. No statistically significant differences between the cleft and noncleft tooth antimeres were found for plaque, gingivitis, bleeding, sulcus depth, or level of attachment. A statistically significant difference in the amount of attached gingiva was found between the cleft and noncleft tooth antimeres. Nine patients with missing lateral incisor teeth avoided prosthetic replacement by orthodontic movement of the canine tooth into the grafted edentulous space. In those cases where the maxillary canine was unerupted at the time of the surgery, eruption into the graft occurred. Stability of the maxillary segments was sufficient to allow prosthodontic restoration with a fixed partial denture in those cases where it was indicated.

Multicenter follow-up study of the transmandibular implant

The purpose of this multicenter study was to review the results of treatment and identify complications in edentulous patients who were treated with the transmandibular implant. A total of 190 patients were treated in four university departments. These patients presented for treatment with mandibular bone heights that ranged from 4 to 18 mm (mean, 10 mm). After postoperative periods that ranged from 3 months to 5 years, 182 of the 190 implants (95.8%) were stable and functional. Three implants were removed due to perioperative fractures in mandibles with 4 to 6 mm of bone height. Five were removed due to infection which occurred within the first 3 months after surgery. Reversible complications that developed in 22.2% of the patients were treated successfully. The 182 implants in function demonstrated no mobility and no infrabony pockets around any of the transmucosal posts. The results of this study demonstrate that the transmandibular implant has acceptable predictability and reliability for reconstruction of patients with severe atrophy of the mandibular alveolar process.

The transmandibular implant: a 2-year prospective study

Thirteen consecutive patients with complaints of dysfunction and pain associated with a mandibular denture were treated with the transmandibular implant. The implant was placed from a submental approach with an atraumatic surgical technique. No load was placed on the implant for 12 weeks. Patients were evaluated for pain, paresthesia, healing of the submental wound, soft tissue response, radiographic change, and mobility of the implant for a period of 2 years. Patient satisfaction was recorded at the 1- and 2-year examinations. The results demonstrate the reliability and reparability of the transmandibular implant system.

A retrospective study of advancement genioplasty

This study examined the immediate and postsurgical changes in the hard and soft tissues of the chin after advancement genioplasty by means of oblique osteotomy of the mandibular symphysis. Twenty-three patients who had undergone this procedure were evaluated cephalometrically for up to 6 months after surgery. The results indicated that the position of the genial segment is stable after advancement. There was a good correlation between the amount of hard versus soft tissue change with surgery in the horizontal direction but a poor correlation in the vertical plane. There was, however, a great amount of variability from one patient to the next in most of the variables examined. Follow-up results were generally very stable.

A study of the utility of measuring mandibular mobility by means of the interincisal dimension

The purpose of this investigation was to determine the reliability of using the interincisal dimension as a measure of mandibular range of motion. Thirty patients who underwent mandibular advancement and 15 patients who underwent mandibular setback were included in this study. Preoperatively, a lateral cephalogram in centric relation and a second cephalogram with the mandible at maximum voluntary gape were obtained. Immediately following surgery, another centric relation cephalogram was obtained. A composite tracing of the two preoperative tracings was made to show how the mandible changed in position from the closed-mouth to the open-mouth radiographs. The proximal segment (ramus) of the postoperative cephalogram was then superimposed on the open-mouth mandibular ramus, and the distal segment of the postoperative mandible was drawn. This composite produced a tracing of what the postoperative maximal gape cephalogram would be if the same amount of condylar rotation and translation as in the preoperative tracing had occurred. The preoperative interincisal dimension was recorded on the composite tracings (factoring in any overbite or openbite) as was the would-be postoperative interincisal dimension. These measures were compared using the paired t test and Pearson's correlations to determine if there were any significant differences between them. The results showed that the interincisal dimension is a fairly reliable measure of mandibular mobility even when the length of the mandible is altered with surgery.

Stability of simultaneous maxillary intrusion and mandibular advancement: a comparison of rigid and nonrigid fixation techniques

This study examines the short-term stability of bimaxillary surgery following Le Fort I impaction with simultaneous bilateral sagittal split osteotomies and mandibular advancement using two standard techniques of postsurgical fixation. Fifteen adults had skeletal plus dental maxillomandibular fixation, and fifteen adults had rigid internal fixation using bone plates in the maxilla and bicortical bone screws between the proximal and distal segments in the mandible. The group with rigid internal fixation did not undergo maxillomandibular fixation. Radiographic cephalograms were analyzed during the postsurgical period to evaluate skeletal and dental stability. There was no statistical difference in postsurgical stability with rigid internal fixation or skeletal plus dental maxillomandibular fixation other than the vertical position of the maxillary molar; the skeletal plus dental maxillomandibular fixation group had a significant amount of postsurgical intrusion of the maxillary molar when compared with the rigid internal fixation group. Although the other measures showed no statistically significant difference between the experimental groups, the amount of variability in postsurgical stability in the group with skeletal plus dental maxillomandibular fixation was greater than that found in the group with rigid internal fixation.

Treatment of chronic drooling: a preliminary report

Chronic drooling can be both psychologically and physically damaging. The technique of sialodochoplasty with sublingual gland resection is a viable treatment modality for this problem. The results of a series of eight patients who underwent the procedure are reported. A short-term success rate of 75% was achieved without morbidity.

The effect of antenatal surgery on postnatal palatal growth in sheep

It has been suggested that repair of skin and mucosal wounds carried out in animals in utero leaves little or no trace of the operative procedure when examined at birth. This study examined the palates of lambs affected surgically in utero postnatally for scarring and transverse palatal growth. Nineteen pregnant sheep were affected at 120 days gestation. Surviving lambs followed for 6 months demonstrated altered palatal morphology.

Particulate allogeneic bone grafts into maxillary alveolar clefts in humans: a preliminary report

The purpose of this study was to determine the ability of particulate allogeneic bone graft to adequately bridge unilateral maxillary alveolar clefts in humans. Twenty patients with unilateral alveolar clefts and oronasal fistula underwent alveolar cleft grafting with a clinically appropriate amount of particulate allogeneic bone. The grafted cleft area was followed radiographically for three to six months postsurgery. Although it was difficult to quantitate, it was both clinically and radiographically apparent at three months that bone bridging and filling of the cleft had occurred in 100% of the cases. From this study, it appears that allogeneic bone is a viable alternative for repairing alveolar clefts and that its use has a significant benefit to the patient by eliminating the morbidity of a second operative site.

Preoperative nutritional supplementation for the orthognathic surgery patient

Orthognathic surgery patients were studied to determine the nutritional adequacy of a high-calorie liquid supplement. The supplements were given for one month before surgery in an attempt to achieve a 5% weight gain and/or for six weeks after surgery to approximate 50% of the estimated caloric requirements of the patients. It was concluded that preoperative supplementation to achieve weight gain before surgery is of no apparent value. However, balanced nutrient intake can be achieved for patients when supplementation is given postoperatively at a level of 50% of estimated caloric requirements, and can result in improved nitrogen retention and protein sparing.

Comparison of the healing and revascularization of onlayed autologous and lyophilized allogeneic rib grafts to the edentulous maxilla

The healing and revascularization of onlayed autologous and lyophilized allogeneic rib grafts to the edentulous maxilla in the Macaca fascicularis monkey were studied using clinical, histologic, and microangiographic methods at varying intervals of up to eight months. Results indicated that healing and revascularization were similar but resorption of the allografts occurred approximately three months later than resorption of the autografts. Both grafting systems appeared to have minimal osteogenic potential. Osteoinduction and the final bony augmentation obtained were less than were seen with comparable autologous and allogeneic interpositional grafts.

Revascularization and healing of onlay particulate allogeneic bone grafts in primates

Particle size of allogeneic bone grafts was investigated to determine its effect on revascularization and healing. Freeze-dried chips of different sizes were placed on the monkey lateral mandibular cortex, and the subsequent healing and revascularization were studied by histologic, autoradiographic, and microangiographic techniques. It appears that allogeneic bone is a reasonable substitute for autologous bone in mandibular ridge augmentation procedures.

Healing of interpositional allogeneic lyophilized bone grafts following total maxillary osteotomy

Healing of allogeneic lyophilized bone grafted to total maxillary osteotomy sites was studied in Macaca fasciularis monkeys using histologic, microangiographic, and autoradiographic methods. Results of the study indicate that allogeneic lyophilized grafts are slowly replaced by host bone. Revascularization around the margins of the graft becomes evident at two weeks and increases until eight weeks; a hypervascular response is still present at six months. The palatal mucosa and facial gingiva provide an adequate nutrient pedicle for interpositional allogeneic grafts.

A retrospective study of alveolar cleft grafting

A surgical technique for the bone graft repair of alveolar clefts is described, and an evaluation of the conditions of 30 patients who have undergone that procedure is reported. Evaluation was made specifically for the preoperative and postoperative presence of oronasal fistula, postoperative eruption of previously unerupted teeth into the graft, soft and hard tissue periodontal status, and radiographic evidence of bone fill in the previous cleft defect resulting in alveolar segmental stabilization.

Mandibular interpositional and onlay bone grafting for treatment of mandibular bony deficiency in the edentulous patient

The development of interpositional and onlay bone grafting techniques for atrophic mandibles is reviewed. A further modification of the visor osteotomy is presented along with follow-up evaluation of the conditions of 16 patients. Results of radiographic measurements show the procedure to be stable, vertical resorption of the augmented mandible in the body regions being 11.2% over a mean follow-up of 8.8 months. Neurosensory evaluation showed altered sensation and dysesthesia as a significant problem in these patients. The results are presented and discussed.

Postoperative nutritional supplementation for the orthognathic surgery patient

Twenty-four orthognathic surgery patients were studied to determine the impact of a high-calorie liquid supplement on preventing or minimizing catabolism commonly associated with surgery. The experimental group of 12 subjects, chosen at random, consumed blenderized foods ad libitum and a high-calorie dietary supplement providing a minimum of 50% of energy requirements. The remaining 12 subjects consumed only blenderized foods and served as the control group. The nutritional status of all patients was assessed one day before surgery and on Day 7 of the first, third, and sixth postoperative week. In general, nutrient intake in the experimental group remained similar to that before surgery, whereas intake in the control group decreased significantly, particularly at the one-week postoperative evaluation. It was concluded that the addition of a high-calorie liquid supplement to the dietary regimen of orthognathic surgery patients helped maintain nutrient intake at a level comparable to that before surgery. This resulted in better maintenance of body weight and somatic protein compartments compared with the control group.

Fractures of the mandible: a review of 580 cases

The anatomic distribution of fractures in this study showed more fractures of the condylar and parasymphysis/symphysis regions, with correspondingly fewer body and angle fractures, than in other reported studies. The site of fracture is related to the type of trauma involved. Altercations, in which most force is directed in a single blow to the lateral aspect of the jaw, tend to result more frequently in angle and body fractures and less often in condylar, symphysis, and alveolar fractures. Automobile accidents, which more frequently involve trauma to the anterior mandible, result in more fractures of the symphysis region, alveolus and condyle. Motorcycle accidents produce many more alveolar fractures, suggesting that the traumatic force in this kind of accident is often directed to the alveolus. As might be expected, those individuals involved in motor vehicle accidents had the highest incidence of other injuries in addition to the mandibular fractures. Injuries to the head and neck were most common, but a wide variety of other injuries occurred. Complications are more common in the patient who has sustained multiple trauma. Most fractures were treated by closed reduction. When open reduction was necessary, the most common sites were the angle, body, and symphysis regions.

Multiosseous osteosarcoma involving the mandible: metastatic or multicentric?

A case of multiosseous osteosarcoma in a 15-year-old girl is presented. Neoplastic foci were initially diagnosed in the right ilium and left mandible. The clinical course was complicated by pregnancy and chemotherapeutic side effects. Postmortem examination revealed multiple tumor emboli in the lungs. The literature concerning metastatic and multicentric origins of multiosseous osteosarcomas is reviewed. The case presented probably represents mandibular metastasis from the ilium.

Early pulp changes after anterior maxillary osteotomy

For purposes of examining the pulpal reaction to segmental osteotomy, six adult female Macaca fascicularis monkeys received identical anterior maxillary osteotomies involving the incisors only. The mobilized segment was displaced distally a distance of approximately 2 mm, then splinted in place for a week. The healing and revascularization of the bone proceeded well, with no ischemic areas visible on the microangiograms other than in the animal examined immediately after operation. The osteotomy site was bridged with new bone at three months. The majority of the pulps of the mobilized segment and all teeth examined distal to the segment remained vital. No degenerative change other than the temporary disappearance of sensory nerves was observed in the vital pulps of the segments. By the six-month period, the sensory nerve supply to the dental pulp had regenerated completely.

Cephalometric diagnosis and surgical-orthodontic correction of apertognathia

Nineteen postadolescent white woman with uncorrected Class I molar and/or canine occlusion were compared cephalometrically to thirteen postadolescent white women with skeletal apertognathia that was later corrected by a combination of surgical procedures, the common denominator being maxillary posterior superior repositioning. The cephalometric tracings were compared statistically by evaluating the study group preoperatively, immediately postoperatively, and at a long-term follow-up appointment. The results indicate that there is a statistical difference in certain important measurements between normal persons and preoperative apertognathic patients with the deformity identified in the dentoalveolar complex of the maxilla. Posterior maxillary superior repositioning tends to correct this skeletal deformity, with postoperative measurements approaching the normal values. The correction proved to be stable over a mean follow-up period of 19 months (range, 7 to 30 months).

Healing of interpositional autologous bone grafts after total maxillary osteotomy

Healing of autologous interpositional bone grafts after total osteotomy in the Macaca fascicularis monkey was studied using clinical, histologic, microangiographic, and autoradiographic methods at varying intervals up to six months. Results indicated that the autologous graft was very osteogenic and incorporated by host bone. Graft revascularization became apparent at two weeks postoperatively, and bone healing time was between two to four weeks. A hypervascular response was present to at least the six-month healing stage. The palatal mucosa plus the facial gingiva provided an adequate nutrient pedicle for total maxillary osteotomies with interpositional bone grafting.

Technetium bone imaging as an adjunct in the management of fibrous dysplasia

The diagnosis of fibrous dysplasia is one that is often made on the basis of biopsy findings and routine radiographs of involved areas. Until the advent of total body scanning, early cases of polyostotic fibrous dysplasia went undiagnosed until swelling, asymmetry, or deformity was noticed in other body parts. More sensitive radiographic techniques, (this is, bone imaging) are now available which offer a means for early detection of polyostotic involvement and more accurate delineation of lesions of the monostotic variety.

Revascularization and healing of onlay particulate autologous bone grafts in primates

Two sizes of bone chips were compared to determine the size that revascularizes faster and what effect this has on the resorption of the graft. To accomplish this, autologous chips of iliac corticocancellous bone of either 2 X 2 X 2 mm or 5 X 5 X 2 mm were placed in the mandibular cortex of monkeys bilaterally. In general, the small-particle graft was quicker to revascularize, showed more osteoclastic activity, and therefore resorbed much more quickly and completely than did the large-particle graft. The resultant net gain in alveolar ridge contour was, therefore, less with the small-particle grafts.

Single arch stabilization devices for segmental orthognathic surgery

Single arch stabilization of segmental osteotomies is desirable because it eliminates intermaxillary fixation while it, in turn, improves oral hygiene and communication and patient comfort, function, and acceptability. Orthodontic appliances with stabilizing arch wires are the method of choice if available. Arch bars modified for segmental stabilization function very well as an alternative to orthodontic appliances. Cast splints are also useful for these cases, although cost and the need for expert laboratory support limit their acceptability. Certain other devices, such as palatal and lingual plates and interocclusal wafers, provide additional support for several of the above-mentioned stabilization systems.

A cephalometric evaluation of American Negro women

A cephalometric study of forty American Negro women with an average age of 24.6 years and a Class I molar and/or canine relationship was performed. When measurements were compared to a control population of twenty Caucasian women, using several standard analyses, significant differences were demonstrated between the sample populations. 1. The maxilla and mandible were more protrusive in the Negro sample. 2. The upper and lower incisors were more proclined and the interincisal angle was more acute in the Negro sample. 3. Middle facial height was shorter and lower facial height was longer in the Negro sample. 4. The projection of the soft-tissue nasal tip was less in the Negro sample. 5. The projection of the upper and lower lips as related to the facial plane was greater in the Negro sample. 6. Lip thickness was approximately the same in the two groups.

Soft tissue changes associated with total maxillary advancement: a preliminary study

A retrospective investigation was performed with use of cephalometric radiographs from eight patients with anterior maxillary advancement. Soft tissue changes associated with hard tissue changes were measured. Statistical description of soft tissue behavior in the upper lip was performed using correlation coefficients, regression functions, and ratios of change in the relationship of soft tissue to hard tissue. Ratios of change in relationship of soft tissue to hard tissue for three parameters of upper lip movement are proposed for clinical use in treatment planning. Further investigation of soft tissue behavior with orthognathic surgical procedures is indicated.

Bone healing and revascularization after total maxillary osteotomy

Adult rhesus monkeys were used as experimental analogues to investigate vascularization, revascularization, and bone healing associated with total maxillary osteotomy. Microangiographic and histologic studies showed minimal transient vascular ischemia, minimal osteonecrosis, and early osseous union. Transection of the greater palatine arteries had no discernible effect on the circulation to the teeth and bone in the maxilla and its enveloping soft tissues. The results of experiments in animals and clinical studies indicate that palatal mucosa and labial-buccal gingiva provide an adequate nutrient pedicle for single-stage total maxillary osteotomies.