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Biomedical subjects

M Nevins

Publications and source records attributed to M Nevins.

At least 19 recordsLinked to original sources
PubMed2001

The piezoelectric bony window osteotomy and sinus membrane elevation: introduction of a new technique for simplification of the sinus augmentation procedure.

All of the surgical techniques to elevate the maxillary sinus present the possibility of perforating the schneiderian membrane. This complication can occur during the osteotomy, which is performed with burs, or during the elevation of the membrane using manual elevators. The purpose of this article is to present a new surgical technique that radically simplifies maxillary sinus surgery, thus avoiding perforating the membrane. The piezoelectric bony window osteotomy easily cuts mineralized tissue without damaging the soft tissue, and the piezoelectric sinus membrane elevation separates the schneiderian membrane without causing perforations. The elevation of the membrane from the sinus floor is performed using both piezoelectric elevators and the force of a physiologic solution subjected to piezoelectric cavitation. Twenty-one piezoelectric bony window osteotomy and piezoelectric sinus membrane elevations were performed on 15 patients using the appropriate surgical device (Mectron Piezosurgery System). Only one perforation occurred during the osteotomy at the site of an underwood septa, resulting in a 95% success rate. The average length of the window was 14 mm; its height was 6 mm, and its thickness was 1.4 mm. The average time necessary for the piezoelectric bony window osteotomy was approximately 3 minutes, while the piezoelectric sinus membrane elevation required approximately 5 minutes.

Adult↗
PubMed2001

Periodontal regeneration with an autogenous bone-Bio-Oss composite graft and a Bio-Gide membrane.

This study evaluated the clinical, radiographic, and histologic response to the composite use of Bio-Oss porous bone mineral and autogenous bone in combination with a Bio-Gide bilayer collagen membrane to achieve regeneration when treating human periodontal bone defects. Preoperative recordings for four treatment areas included radiographs, clinical probing depths, and attachment levels; these recordings were repeated at 9 months. Histologic evaluation revealed new cementum with inserting collagen fibers and new bone formation on the surface of both types of graft materials. This grafting combination not only compared favorably with the previous use of Bio-Oss and Bio-Gide, but exceeded that result with almost complete periodontal regeneration. This human histologic study demonstrates that autogenous bone in combination with porous bone mineral matrix, together with the Bio-Gide collagen membrane, has the capacity to stimulate substantial new bone and cementum formation with Sharpey's fiber attachment.

Alveolar Bone Loss↗
PubMed2000

Treatment of Class II furcations with autogenous bone grafts and e-PTFE membranes.

This article reports a successful clinical regimen of treatment for the Class II furcation defect. Twenty-eight patients with molar teeth demonstrating Class II furcations were treated with regenerative therapy with the goal of regenerating lost interradicular periodontium. The treatment selected included scaling and root planing, surgical flap design that would enable the flap to completely cover the surgical site, complete enucleation of granulation tissue, tetracycline root conditioning, a particulate autogenous bone graft, and an expanded polytetrafluoroethylene (e-PTFE) membrane. Of the twenty-eight consecutive patients treated, twenty-five demonstrated no postoperative clinical evidence of furcation invasion, for a success rate of 89%. Eleven sites were reopened 8 to 9 months postsurgical and presented complete furcation fill with a hard, bone-like tissue. Three teeth were judged to be failures because clinical assessment revealed persistent furcation invasion. The absence of histologic evidence precludes the presumption that complete periodontal regeneration occurred.

Anti-Bacterial Agents↗
PubMed2000

A retrospective study of dental implants in diabetic patients.

The efficacious placement of dental implants in diabetic patients remains controversial. Definitive guidelines with objective criteria, including the type of diabetes, age of onset, and level of long-term control, have not been determined. In addition, few relevant literature citations assess the survival rate of implants in diabetic patients. Therefore, it is the purpose of this study to assess the success and survival rates of dental implants in diabetic patients. In this retrospective analysis, 215 implants placed in 40 patients at 2 clinical centers were evaluated. Chart reviews and interviews provided medical and implant data. From the analysis, 31 failures occurred, for an overall success rate of 85.6%. Of these failures, 24 occurred within the first year of functional loading. The mean time of functional load was 4.05 +/- 2.6 years. When the success rate was analyzed by implant location, success rates for the maxilla and mandible were 85.5% and 85.7%, respectively. For the anterior and posterior regions, success rates were 83.5% and 85.6%, respectively. The lifetable analysis revealed a cumulative success rate of 85.7% after 6.5 years of function. Based on the data, the survival rate of dental implants in controlled diabetic patients is lower than that documented for the general population, but there is still a reasonable success rate. The increase in failure rate occurs during the first year following prosthetic loading.

Blood Glucose↗
PubMed2000

Human histologic evaluation of bioactive ceramic in the treatment of periodontal osseous defects.

This study examined the healing of intrabony defects around 5 teeth treated with bioactive glass ceramic (PerioGlas). Healing was evaluated by clinical measurements, radiographic observation, and histologic analysis. The protocol included a presurgical phase of scaling and root planing therapy, with measurements obtained immediately prior to the surgical procedures and after 6 months of healing. Following therapy there was a mean of 2.7 mm of probing depth reduction, 2.2 mm of clinical attachment gain, and 0.5 mm of recession. The histologic analysis revealed healing by a long junctional epithelium with minimal new connective tissue attachment to the teeth, except in one case where the intrabony region demonstrated new cementum formation and new connective tissue attachment. Graft particles were found to be biocompatible, as evidenced by being embedded in a stroma of dense connective tissue with minimal inflammatory infiltrate. There was minimal new bone formation limited to the most apical borders of the defects. No signs of periodontal regeneration as defined by new cementum, periodontal ligament, and bone formation on a previously diseased root surface were observed. Although the clinical results are encouraging and radiographs evidenced radiopacities within the defects, histologic analysis revealed that as a periodontal grafting material, bioactive glass ceramic has only limited regenerative properties.

Alveolar Bone Loss↗
PubMed1999

Periodontal pocket--predictable treatment.

Periodontal pocket depths and attachment loss are charted early in treatment to establish a benchmark against which the success of treatment regimens will be measured. They are considered both a measure of past inflammatory disease and a reservoir for periodontal pathogens capable of further destruction. The clinician must strive to identify predictable means of treating pockets. Three nonpharmaceutical approaches can be considered: maintain the present depth and hope for the best when treating a patient who has already demonstrated susceptibility; reduce the pocket by resective treatment, a frequently used and very predictable corrective methodology; reduce the probing depth by accomplishing periodontal regeneration. This last approach is the treatment of choice, but it is often impossible to achieve. This article describes a treatment regimen that recognizes the need for proper diagnosis and an initial nonsurgical debridement regimen before considering surgery. It then evaluates surgical treatment alternatives and concludes with a mandate for a well-constructed periodontal maintenance program. It also provides long-term detailed analysis of patient treatment.

Adult↗
PubMed1999

Formation of the biologic width following crown lengthening in nonhuman primates.

The purpose of this study was to determine if and how the biologic width is reestablished following surgical crown lengthening. Crown-lengthening surgery was performed on the right or left maxillary and mandibular central and lateral incisors of three adult monkeys, with contralateral teeth serving as unoperated controls. Twelve weeks after surgery, tissue blocks were removed for histologic analysis. The results of a histometric evaluation indicate that the biologic width is reestablished following surgical crown lengthening. The junctional epithelium generally migrates to the apical level of root planing. Space for the supracrestal connective tissue fiber groups is created by crestal resorption of alveolar bone.

Animals↗
PubMed1998

Clinical, radiographic, and histologic evaluation of human periodontal defects treated with Bio-Oss and Bio-Gide.

This study evaluated the clinical, radiographic, and histologic response to Bio-Oss porous bone mineral when used alone or in combination with Bio-Gide bilayer collagen membrane in human periodontal defects. Four intrabony periodontal defects were treated: two received Bio-Oss alone and two were treated with a combination of Bio-Oss and Bio-Gide. Radiographs, clinical probing depths and attachment levels were obtained preoperatively and 6 to 9 months postoperative, and teeth and surrounding tissues were biopsied. Both treatments significantly improved clinical probing depths and attachment levels, and the radiographic appearance suggested osseous fill. Histologic evaluation revealed that both treatments produced new cementum with inserting collagen fibers and new bone formation on the surface of the graft particles; this regenerative effect was more pronounced using the Bio-Oss/Bio-Gide combination, which resulted in 7 mm of new cementum and periodontal ligament and extensive new bone incorporating the graft. The membrane was intact at 7 months and partially degraded by 9 months after treatment. This human histologic study demonstrates that the porous bone mineral matrix used has the capacity to stimulate substantial new bone and cementum formation and that this capacity is further increased when the graft is used with a slowly resorbing collagen membrane.

Absorbable Implants↗
PubMed1998

Implants in regenerated bone: long-term survival.

This retrospective multicenter study analyzed 526 implants placed and loaded in regenerated bone. Both autogenous and allogeneic bone grafts were used in combination with a barrier membrane to reconstruct bone using either a simultaneous or staged approach. Implants were followed from 6 to more than 74 months postloading. Eight of the implants were lost, for a success rate of 97.5%. The type of graft material did not affect the clinical success of the implants, nor did the use of submerged versus nonsubmerged implants or a staged versus a simultaneous approach. In conclusion, regenerated bone reacted to implant placement in a manner that was clinically similar to native bone.

Adolescent↗
PubMed1998

Evaluation of a bioabsorbable physical barrier for guided bone regeneration. Part I. Material alone.

This study evaluates a prototype bioabsorbable physical barrier material for guided bone regeneration. Nonspacemaking dehiscence-type defects were surgically created in the right and left mandibles of six adult dogs. Each animal received six root-form threaded titanium implants. The osseous defects were randomized to receive treatment by either the prototype bioabsorbable barrier composed of a copolymer of lactide and glycolide, an expanded polytetrafluoroethylene nonresorbable barrier, or no barrier (control), Clinical and histologic results after 3.5 months of wound healing indicated that exposed threads were covered when treated with the expanded polytetrafluoroethylene barrier. Minimal thread coverage was evident with the bioabsorbable barrier and the control.

Alveolar Bone Loss↗
PubMed1998

Evaluation of a bioabsorbable physical barrier for guided bone regeneration. Part II. Material and a bone replacement graft.

Part I of the evaluation of a prototype bioabsorbable physical barrier composed of a copolymer of lactide and glycolide for treatment of bone defects in the guided bone regeneration procedure indicated that the prototype bioabsorbable physical barrier did not possess sufficient spacemaking characteristics to prevent collapse of the barrier into the defect or against the threads of the titanium implants. The purpose of Part II was to evaluate this bioabsorbable physical barrier in combination with a supporting material to prevent barrier collapse. Posterior mandibular teeth in three dogs were extracted and allowed to heal for 3 months. This produced localized alveolar ridge defects with a narrow buccolingual width. Six titanium threaded implants were placed in the right and left mandibles of each dog so that nonspacemaking dehiscencetype defects were produced. Two defects in each animal were randomly treated with the prototype bioabsorbable physical barrier and decalcified freeze-dried bone allograft; two defects were treated with a nonbioabsorbable expanded polytetrafluoroethylene barrier with decalcified freeze-dried bone allograft; and one defect each was treated with prototype bioabsorbable physical barrier alone or by flap access with no barrier or bone replacement graft. The results demonstrated that both the bioabsorbable and the nonbioabsorbable barrier combined with decalcified freeze-dried bone allograft produce comparable amounts of new bone with percent bone-to-implant contact, height, width, and area. Defects treated with the prototype bioabsorbable physical barrier alone or no barrier demonstrated unfavorable results. It is suggested that a bone replacement graft is indicated when treating defects with a nonspacemaking morphology.

Alveolar Bone Loss↗
PubMed1997

A feasibility study evaluating rhBMP-2/absorbable collagen sponge for maxillary sinus floor augmentation.

This 16-week open-label study assessed the safety and technical feasibility of implanting human recombinant bone morphogenetic protein-2 delivered on an absorbable collagen sponge (rhBMP-2/ACS) for two-stage maxillary floor sinus augmentation. This first use of rhBMP-2/ACS in human clinical maxillary sinus floor augmentation included 12 patients with inadequate bone height in the posterior maxilla. The total delivered dose of rhBMP-2 implanted varied from 1.77 to 3.40 mg per patient. The rhBMP-2/ACS device was easily handled. Significant bone growth was documented by computerized tomographic scans in all evaluable patients (11/12). The overall mean height response for the maxillary sinus floor augmentation was 8.51 mm (95% confidence interval 6.07 to 10.95). There were no serious or unexpected immunologic or adverse effects and no clinically significant changes in complete blood counts, blood chemistries, or urinalysis results. The most frequent adverse effects were facial edema, oral erythema, pain, and rhinitis. Eleven patients have received dental implants and follow-up examinations are still being conducted. Histologic examinations of core bone biopsies obtained at the time of dental implant placement confirmed the quality of the bone induced by rhBMP-2/ACS. These results tend to indicate that rhBMP-2/ACS may provide an acceptable alternative to traditional bone grafts and bone substitutes for maxillary sinus floor augmentation procedures in humans.

Absorbable Implants↗