ANTERIOR MAXILLARY IMMEDIATE IMPLANT AFTER EXTRACTION WITH CLOSE LOADING TEMPORARY CROWN

Immediate implant placement after extraction is a dental implant treatment procedure reported in several case studies with satisfactory results for patients and less crestal bone loss around the implant. This case report describes the method of immediate implant placement after extraction. It directs temporary crown placement in a female patient with failed post-endodontic treatment restoration on the maxillary incisor. The procedure was performed under local anesthesia, preceded by tooth extraction and socket cleaning post-extraction, followed by the implant and bone grafting procedure, then finalized by provisionalization. The immediate implant procedure is a simple and time-saving technique. No second surgery is required, such as delayed implant procedure, but the operator's good analytical, diagnostic, and planning skills in its implementation.

Progress in Microdermal Grafting for Color Regeneration of White Scars

Background Microdermal grafting is used to regenerate color in white (hypopigmented) scars using knife cutting partially de-epithelialized skin for grafting. However, the scalp has more melanocytes, and dermabrasion can preserve more melanocytes than knife cutting during partial de-epithelialization. Our clinics refined the two procedures that we originally reported using dermabrasion, not knife cutting, to partially de-epithelialize skin, and harvesting melanocyte donor sites from the scalp, not the skin. Objectives To evaluate the color regeneration results and complications of various microdermal grafting procedures for white scar color regeneration. Methods We described our use of the two technique refinements of microdermal grafting for white scars and reviewed 65 cases in which different variations of these procedures were used to treat scars on the face and forearms. Results Sixty-five patients (36 forearms; 29 faces) were treated, 40 receiving one session, 23 receiving two sessions and 2 receiving three session treatments. The follow up was 6.5 months (range, 4-16). The use of both technical refinements of the procedures produced approximately 15% better color generation than the original procedures after one session of treatment and approximately 20% better than the original procedures after two sessions. The use of histological immunostaining examination showed that the dermabrasion method could preserve more melanocytes around the epidermal-dermal region. The complication rate was reduced. Conclusions The use of the scalp as the donor site and partial de-epithelialization by dermabrasion can be safely incorporated into this microdermal grafting procedure for better color regeneration of white scars.

A Genetically Modified Skin Graft for Treating Alcohol Use Disorder and/or Polysubstance Abuse With Cocaine

Alcohol use disorder (AUD) is one of the foremost public health problems. Alcohol is also frequently co-abused with cocaine. There is a huge unmet need for the treatment of AUD and/or cocaine co-abuse. We have developed and used a skin stem cell-based gene delivery platform and found that production of the glucagon-like peptide-1 (GLP1) from the grafted genetically modified skin reduced development and reinstatement of alcohol-induced drug-taking and seeking, voluntary oral alcohol consumption and alcohol-induced increase in dopamine (DA) levels in the nucleus accumbens (NAc). Moreover, we have developed a novel co-grafting procedure for both modified human butyrylcholinesterase (hBChE)- and GLP1-expressing cells. Skin grafts-derived hBChE and GLP1 reduced acquisition of drug-taking and toxicity induced by concurrent alcohol and cocaine injections. These results imply that gene delivery through skin transplants may add a new option to treat drug abuse and co-abuse.

Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

Nanostructured Oxide-Based Systems for the pH-Triggered Release of Cinnamaldehyde

Cinnamaldehyde is a natural product with antibacterial, antifungal, and anti-inflammatory properties, poorly stable in environmental conditions. Systems for the controlled release of cinnamaldehyde are of great interest to the food and pharmaceutical industries. Here, a new oxide-based construct for the release of cinnamaldehyde catalyzed by acidic pH was obtained by a facile grafting method based on amino-silane linkers and imine chemistry. The grafting procedure led to a loading of ca. 5 molecules/nm2, determined on oxide powders with CHN and TGA measurements. The covalent grafting of cinnamaldehyde, demonstrated by FTIR analyses, preserved the molecule stability, simplifying storage. Release tests were performed at different pH values (between 5.0 and 7.4). Thanks to imine chemistry, a fast cinnamaldehyde (CIN) release was observed in a pH 5.0 environment. Using 1 mg/mL suspensions, CIN concentrations within the range adopted in the food industry were obtained (12.4 ppm). The grafting procedure was also performed on a porous film based on a photocatalytic oxide, demonstrating the versatility of this method, adaptable to both powders and macroscopic materials. By taking advantage of the photoactivity of the oxide, regeneration of the fouled film was achieved upon UV irradiation for 1 h, opening the door to reusable devices for the controlled release of cinnamaldehyde.

Adipose Tissue as a Useful Material for the Grafting of Tumorigenic Cells and Juvenile Tissues in Mice

Although the aging process expands the adipose tissue habitation in mice and due to its close association with the female reproductive system, it can be easily exposed surgically under anesthesia when reproductive organs (including ovary, oviduct, and part of the uterus) are pulled and exposed onto the dorsal skin. This study aimed to consider the suitability of adipose tissue as a target for manipulation, particularly for the grafting of cells or small-sized tissue sections due to its ease of handling. Subsequently, 1-2 µL trypan blue injections were administered to the tissues using a breath-controlled micropipette under a dissecting microscope for evaluating the adipose tissue’s potential as a suitable grafting material. It was observed that the injected dye remained at the injection site for at least one day after injecting B16 mouse melanoma and P19 embryonal carcinoma cells. It resulted in the generation of solid tumors surrounding the ovary, oviduct, or uterus with 100% efficiency, as reported by an inspection one and a half months after the injections. When the grafting procedure was carried out for one-fourth of the juvenile pancreas (aged 15 days), an enlarged pancreas with normal morphological configuration (including the formation of insulin-synthesizing cells) was generated, which was observed by an inspection one month after the injections, thus successfully validating our approach for adipose tissue manipulation and furthermore, naming this novel technology as “intra-adipose introduction of cells and tissues”.

Utility of 30-Day Readmission Metrics in the Burn Population: Navigating Quality Metric Limitations in Special Populations

Hospital readmission data may be a useful tool in identifying risk factors leading to higher costs of care or poorer overall outcomes. Several studies have emerged utilizing these datasets to examine the trauma and burn population, which have been unable to distinguish planned from unplanned readmissions. The 2014 Nationwide Readmissions Database was queried for 363 burn-specific ICD-9 DX codes and filtered by age and readmission status to capture the adult burn population. Additionally, burn-related excision and grafting procedures were filtered from 25 ICD-9 SG codes to distinguish planned readmissions. A total of 26,719 burn patients were identified with 781 all-cause unscheduled 30-day readmissions. Further filtering by burn-related excision and grafting procedures then identified 468 patients undergoing a burn-related excision and grafting procedure on readmission, reducing the dataset to 313 patients and identifying up to 60% of readmissions as possibly improperly coded planned readmissions. From this dataset, nonoperative management on initial admission was found to have the strongest correlation with readmission (OR 5.00; 3.33–7.14). Notably corrected data, when stratified by annual burn patient admission volume, identified a significant likelihood of readmission (OR 4.57; 2.15–9.70) of centers receiving the lowest annual number of burn patients, which was not identified in the unfiltered dataset. Healthcare performance statistics may be a powerful metric when utilized appropriately; however, these databases must be carefully applied to small and special populations. This study has determined that as many as 60% of burn patient readmissions included in prior studies may be improperly coded planned readmissions.

Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice

Background Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. Objectives This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. Methods A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. Results We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. Conclusions Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. Level of Evidence: 4

Quail-chick grafting experiments corroborate that Tbr1-positive eminential prethalamic neurons migrate along three streams into hypothalamus, subpallium and septocommissural areas

The prethalamic eminence (PThE), a diencephalic caudal neighbor of the telencephalon and alar hypothalamus, is frequently described in mammals and birds as a transient embryonic structure, undetectable in the adult brain. Based on descriptive developmental analysis of Tbr1 gene brain expression in chick embryos, we previously reported that three migratory cellular streams exit the PThE rostralward, targeting multiple sites in the hypothalamus, subpallium and septocommissural area, where eminential cells form distinct nuclei or disperse populations. These conclusions needed experimental corroboration. In this work, we used the homotopic quail-chick chimeric grafting procedure at stages HH10/HH11 to demonstrate by fate-mapping the three predicted tangential migration streams. Some chimeric brains were processed for Tbr1 in situ hybridization, for correlation with our previous approach. Evidence supporting all three postulated migration streams is presented. The results suggested a slight heterochrony among the juxtapeduncular (first), the peripeduncular (next), and the eminentio-septal (last) streams, each of which followed differential routes. A possible effect of such heterochrony on the differential selection of medial to lateral habenular hodologic targets by the migrated neurons is discussed.