Removal of Inflammatory Tissue/Product by Sinus Membrane Puncturing during Lateral Sinus Augmentation in Asymptomatic Patients with Severely Opacified Sinuses: A Case Series

It is generally recommended that severe sinus membrane (SM) thickening should be treated prior to maxillary sinus augmentation (MSA), but during lateral MSA, inflammatory tissue/product may be removed by puncturing the SM. The present case report demonstrates surgical experience of lateral MSA with simultaneous inflammatory tissue/product removal for sinuses with severe opacification. In three patients requiring dental implant placement in the posterior maxilla, severe SM thickening was observed, but they were asymptomatic. The SM was gently elevated, followed by puncturing the SM, removing inflammatory tissue via the punctured site, draining, and thorough saline irrigation. Then, bone grafting and implant placement were performed with extra care not to spread bone substitute material into the punctured area. The postoperative pain following this procedure was more severe as compared to conventional MSA. Nasal bleeding was reported for 2–3 days. All implants were successfully integrated and demonstrated adequate function. Tissue samples retrieved during the surgery showed advanced inflammatory cell infiltration. The follow-up cone-beam computed tomographic scans revealed a significant reduction in SM thickening. In conclusion, inflammatory tissue/product removal by puncturing the SM can be applied during lateral MSA. However, more data should be needed due to the empirical nature of the present outcomes.

Where Stool is a Drug: International Approaches to Regulating the use of Fecal Microbiota for Transplantation

Regulatory agencies vary widely in their classification of FMT, with significant impact on patient access. This article conducts a global survey of national regulations and collates existing FMT classification statuses, ultimately suggesting that the human cell and tissue product designation best fits FMT's characteristics and that definitional objectives to that classification may be overcome.

Amniotic Tissue Modulation of Knee Pain—A Focus on Osteoarthritis

The use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and medicinal signaling cells for osteoarthritis (OA) is rapidly evolving. Amnion, chorion, amniotic fluid, and the umbilical cord are distinct placental tissues that have been investigated for use in OA. Amniotic membrane (AM) synthesizes a variety of growth factors, cytokines, and vasoactive peptides that modulate inflammation. In addition, they contain amniotic epithelial cells and amniotic mononuclear undifferentiated stromal cells, which have chondrogenic and osteogenic differentiation capacity. AMs are also rich sources of hyaluronic acid and proteoglycans, which could play a role in the potential therapeutic relief of OA. Currently, there are several commercially available formulations of AM that differ based on content as well as how they were preserved. Understanding the processing of amniotic tissue is important because of their distinct mechanical and biologic effects of preservation on AM grafts. To date, there have been two preclinical and only one clinical study on the use of AM for OA, which show promising results. Many high level of evidence clinical trials are currently underway investigating the use of AM of OA. Future basic science and clinical research is warranted to better understand the anti-inflammatory and chondroregenerative properties of amniotic tissue and to determine clinically what amniotic tissue product is most efficacious for symptomatic OA.