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Biomedical subjects

M Peled

Publications and source records attributed to M Peled.

At least 37 records · Page 2Linked to original sources
PubMed2001

Periodontal changes in liver cirrhosis and post-transplantation patients. I: clinical findings.

BACKGROUND: Cyclosporin A (CsA) is widely used to prevent liver transplantation failure. CsA-induced gingival overgrowth is a common side effect. However, the effect of cirrhotic liver disease, liver transplantation, and immunosuppressive therapy on the periodontium is yet unclear. The aim of the present cross-sectional study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy on the periodontium. METHODS: The experimental group (LC) consisted of 13 liver cirrhosis patients. A second experimental group (PT) included 24 patients, post-liver transplantation, receiving immunosuppressive therapy. Seventeen healthy subjects formed a control group. The Ramfjord index teeth were recorded for plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO). RESULTS: Mean PI and mean GI for the LC, PT, and C groups were not statistically different (P >0.05). Mean PD for the LC (3.32+/-0.24 mm) and PT group (3.41+/-0.13 mm) was significantly higher (P = 0.0001, ANOVA) compared to the C group (2.45+/-0.16 mm). Likewise, CAL for the LC (4.89+/-0.47 mm) and PT group (4.68+/-0.47 mm) was significantly higher (P = 0.001, ANOVA) than the C group (2.78+/-0.23 mm). Patients in the PT group exhibited the greatest mean GO scores (0.88+/-0.09) compared to the LC group (0.37+/-0.07) and the C group (0.09+/-0.02). All 3 groups were significantly different from each other (P = 0.0001) despite great variability within the groups. GO in the CsA-treated patients (1.1+/-0.09) was significantly higher (P = 0.0001) than in those treated with tacrolimus (0.57+/-0.1). CONCLUSIONS: Liver cirrhosis patients demonstrated greater pocketing and attachment loss compared to healthy matched controls. These same differences were observed in patients post-transplantation. Gingival overgrowth occurred as a result of the immunosuppressive therapy with CsA, while to a lesser degree with tacrolimus. Replacement of CsA by tacrolimus in patients manifesting gingival overgrowth might be recommended whenever possible to overcome this problem.

Analysis of Variance↗
PubMed2001

[Vertical alveolar ridge augmentation using distraction osteogenesis].

Alveolar ridge atrophy can be acquired or congenital. Alveolar ridge augmentation can be performed using bone grafting but a donor site morbidity is unavoidable and some resorption of the grafted bone occurs. Distraction osteogenesis offers an alternative method for bone reconstruction without donor site morbidity and sufficient stability of the final results. In order to place implants, vertical alveolar augmentation using Distraction Osteogenesis has been applied to 14 patients aged 17 to 55 years old with edentulous alveolar ridge, 8 in the mandible and 6 in the maxilla. Vertical alveolar bone distraction was started by performing a segmental alveolar osteotomy followed by insertion of a central distraction device--Lead System (Endosseous alveolar distraction system, Leibinger). After three days of latency period, the distraction was started in a rate of 0.8 mm per day for 9 to 16 days as needed. The retention period for the new bone maturation was twice as long as the active distraction period. After removal of the device, 23 cylindrical threaded implants were inserted. The results revealed increase of the alveolar bone height with new bone formation that was observed radiographically and clinically at the removal of the distraction device. The amount of elevation was 7-13 mm. In follow-up of 6-14 months, failure of only one implant was noted, due to inadequate transported bone stability. The advantages of alveolar bone distraction are: Increase of the alveolar bone height with new bone formation, minimal resorption of bone without the bone graft disadvantages. A long term follow up after the bone height achieved and implant anchorage should be performed in the future.

Adolescent↗
PubMed2001

[Inferior alveolar nerve repositioning in implant surgery].

Severe resorption of the posterior mandible possesses one of the most difficult restorative challenges to the implant surgery today. This resorption may prevent the placement of dental implants without the potentially damage to the inferior alveolar nerve. To create the opportunity of insertion dental implants of adequately length in those cases, the technique of nerve repositioning has been advocated. The purpose of this article is to describe two cases of nerve repositioning combined with placement of dental implants. Both cases showed appropriate postoperative healing without damage to the inferior alveolar nerve. The inferior alveolar nerve repositioning technique seems to be an acceptable alternative to augmentation procedure prior to dental implants placement in cases exhibiting atrophic posterior mandibular ridges.

Alveolar Bone Loss↗
PubMed2001

[Parapharyngeal and peritonsillar infection following mandibular third molar extraction].

Numerous complications following impacted third molar extractions have been described previously. Among these are swelling, infection, subdermal hematomas, nerve injuries, injuries to adjacent teeth and mandibular fractures. The parapharyngeal space is a funnel-shaped space with its base located at the base of the skull and its apex near the hyoid bone. It is bounded medially by the superior constrictor muscle and the tonsillar fossa and laterally by the medial pterygoid muscle, the mandibular ramus, the deep lobe of the parotid gland and the posterior belly of the digastric muscle. The junction of the buccinator and superior constrictor muscles at the pterygomandibular raphe forms the anterior border. The posterior border is formed by the vertebral column and the prevertebral muscles. Infratemporal and peritonsillar space infections following third molar extractions are relatively rare because of anatomical barriers that exist in that area, but complications of such infections are considered to be highly severe and sometimes even life threatening. These complications include septic thrombophlebitis of the internal jugular vein, septic aneurysms of the internal carotid artery and mediastinitis. This article presents a parapharyngeal and peritonsillar space abscess resulting from a third molar extraction. Several articles reviewed in this paper revealed similar signs and symptoms in parapharyngeal abscesses. The main radiological finding was soft tissue swelling in the prevertebral area. Cultures have demonstrated Klebsiella pneumoniae as the dominant microorganism in these infections. Early identification and correct diagnosis of parapharyngeal and peritonsillar abscesses are necessary to avoid life-threatening complications that may accompany such infections. Airway control should receive top priority in treatment, followed by extensive surgical drainage and administration of high dose organism-specific antibiotics as well as removal of the source of infection.

Adult↗
PubMed2000

Carcinoma of the dorsum of the tongue.

BACKGROUND: Squamous cell carcinoma (SCC) of the anterior two thirds of the tongue is the second most common oral cancer, with the lateral border being the most common location. Squamous cell carcinoma of the dorsum of the tongue is exceedingly rare and has been described in the past as a myth or misdiagnosis. The clinical diagnosis of SCC on the dorsum of the tongue is difficult because it may be mimicked by a wide variety of benign and premalignant lesions, including granular cell myoblastoma, erosive lichen planus, medial rhomboid glossitis, and amyloidosis. In this study we re-evaluate the entity of SCC of the dorsum of the tongue. METHODS: We reviewed 5 large series of carcinoma of the tongue, which include accurate documentation of the topographic location of the carcinoma. We also describe 5 cases of SCC of the dorsum of the tongue from our own series of 99 patients with carcinoma of the tongue. RESULTS: In all 6 series, carcinoma of the dorsum of the tongue was present in 3 to 5% of the carcinomas of the tongue. CONCLUSION: Although rare, SCC of the dorsum of the tongue exists and may be mimicked by benign conditions, thus SCC should be suspected when diagnosing lesions of this area of the tongue.

Adult↗
PubMed2000

Social behavior and off-target verbosity in elderly people.

This study investigated social behavior in older adults with varying levels of off-target verbosity (OTV). After screening 455 adults in Phase 1, 198 individuals were selected to participate in both a get-acquainted conversation and an experimental cues situation and to complete social and cognitive measures. Higher OTV participants had lower cognitive inhibitory scores, talked more, were less interested in their partners, and focused more on themselves. Their conversational partners were less satisfied. Age and cognitive functioning were not related to OTV scores or conversational style for low- and mid-range participants. Although high-OTV individuals talked less when exposed to social cues signalling boredom, they spoke more relative to other participants. Self-reported social behavior had little relation with OTV and conversational style, but higher OTV individuals were less accurate in judging videotaped social interactions. Gender differences in conversational behavior are also discussed.

Aged↗
PubMed2000

Orbital infection arising from a primary tooth: a case report.

Odontogenic infections may spread to the orbit by one or more of several paths. Such extension is potentially dangerous and may lead to loss of vision. A case of infection from a primary tooth, which extended to the retrobulbar area is presented in this report. Treatment included surgical drainage of the resulting subperiosteal orbital abscess through a Caldwell-Luc approach as well as aggressive antibiotic therapy. The importance of early suspicion of this entity and its potential sequelae are discussed.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2000

Extraoral vs. intraoral distraction osteogenesis in the treatment of hemifacial microsomia.

During hemifacial microsomia (HMF), an important phase of the treatment is elongation of the hypoplastic mandible, mainly the ramus, at an early stage. Twenty-two patients with HFM were treated with distraction osteogenesis: 12 with an extraoral device (10 unidirectional and 2 multidirectional) and 10 with an intraoral device. The mean elongation with the extraoral device was 21 mm, and with the intraoral device was 17 mm, resulting in a more symmetrical facial appearance. The advantages and disadvantages of both methods are presented, based on the authors' experience and a review of the literature. The extraoral device permits elongation of a greater distance, enables extraoral control of the vector of elongation, and conserves the gonial angle by working in many directions. The main disadvantages of the extraoral device are the social inconvenience to the patient and the extraoral cutaneous scars. Conversely, the intraoral device is much more socially convenient to the patient and avoids residual scarring. However, in 2 patients treated with an intraoral device, an undesired contralateral open bite appeared as a result of reduced vector control. The intraoral method should always be considered first because of its previously mentioned advantages. However, in severely hypoplastic patients, when three-dimensional correction and gonial angle control are necessary, or when there is a limited space along the planned distracted bone, the extraoral device has an advantage over the intraoral device.

Adolescent↗
PubMed2000

Does low-dose aspirin therapy complicate oral surgical procedures?

BACKGROUND: The fear of uncontrolled bleeding often prompts medical practitioners to stop aspirin intake for seven to 10 days before any surgical procedure. The authors initiated this study to evaluate the effect of aspirin on bleeding in patients undergoing oral surgery. METHODS: The study group consisted of 39 patients who were scheduled to undergo dental extractions. All patients were receiving 100 milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test. In addition, the amount of bleeding during the procedure was measured. RESULTS: The mean (+/- standard deviation) bleeding time was 1.8 +/- 0.47 minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.1 +/- 0.65 minutes. The difference was statistically significant (P = .004). However, both groups were within the normal bleeding time range, and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intraoperative or postoperative bleeding were noted. CONCLUSION: Low-dose aspirin therapy should not be stopped before oral surgery. Local hemostasis is sufficient to control bleeding. CLINICAL IMPLICATIONS: Patients receiving aspirin therapy to prevent blood clot formation may be subject to emboli formation if the treatment is stopped. The results of this study show that aspirin therapy should be continued throughout oral surgical procedures. Local measures are sufficient to control any bleeding during surgery.

Adult↗
PubMed2000

Primary gingival malignant melanoma. Report of 3 cases.

BACKGROUND: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma. METHODS: Three cases are presented. One case was in the right mandibular molar area; the second in the right maxillary canine-premolar area; and the third in the left mandibular canine-premolar region. All patients were treated surgically, with postoperative radiotherapy. RESULTS: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow-up after 18 months. CONCLUSION: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the prognosis for these patients.

Adult↗
PubMed2000

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study.

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.

Amines↗
PubMed2000

Cyclosporine A-induced gingival hyperplasia pemphigus vulgaris: literature review and report of a case.

Gingival hyperplasia appears in 8% to 85% of patients treated with cyclosporine. Most studies show an association between oral hygiene status and the prevalence and severity of this gingival overgrowth. Thus, besides attempting to substitute this drug with another whenever possible, treatment usually involves maintenance of strict oral hygiene coupled with scaling and root planing and removal of iatrogenic factors. Sometimes a second treatment phase involving periodontal surgery is necessary. Cyclosporine-induced gingival overgrowth has been mainly described in post-organ transplant patients. The present case describes, for the first time, a severe form of cyclosporine-induced gingival overgrowth arising in a 15 year-old male with pemphigus vulgaris. Periodontal treatment included oral hygiene and scaling and root planing under local anesthesia. There was a significant reduction in gingival enlargement, as well as a reduction in plaque levels and inflammation. Cessation of drug administration, combined with continuous periodontal treatment, brought further improvement. This successful conservative treatment of cyclosporine-induced gingival overgrowth in a pemphigus vulgaris patient suggests that early diagnosis and comprehensive treatment of these lesions may yield good response and reduce the need for periodontal surgery.

Adolescent↗
PubMed2000

[Secondary bone grafting in cleft lip and palate].

Results of reconstruction of residual alveolar bone defects in 52 patients operated between 1990-1998 were evaluated clinically and radiographically in a retrospective study. Ages ranged between 9-37; 30 were males. The donor site of bone grafts in all was particulate cancellous marrow from the anterior iliac crest. 32 had unilateral clefts and 20 bilateral. Total cleft sites treated was 72. Best results were achieved when bone grafting was carried out prior to the eruption of the canine tooth. The cleft space was closed and oro-nasal fistulas were eliminated in 42 (80%). Success rates in unilateral and bilateral cases were significantly different.

Adolescent↗
PubMed1999

Early diagnosis and treatment monitoring roles of tumor markers Cyfra 21-1 and TPS in oral squamous cell carcinoma.

BACKGROUND: Mucosal oral squamous cell carcinoma (SCC) accounts for 3-5% of all reported cancers, with a 5-year survival rate of approximately 50%. Unfortunately, current detection means are of no value in diagnosing lesions early enough for cure, especially when they recur after resection. Postoperative radiotherapy and/or covering the resection site with reconstructive flaps (regional or free vascularized) often makes early diagnosis an impossible task. METHODS: The authors examined the detection and treatment monitoring capacity of two relatively new tumor markers in the serum of SCC patients, comparing their levels with those in patients with other oral/perioral malignancies or benign oral tumors and with disease free, posttreatment SCC patients and healthy controls. RESULTS: Values of sensitivity, specificity, and positive and negative prediction for Cyfra 21-1 were 96%, 87%, 93%, and 53%, respectively, whereas those for tissue polypeptide specific antigen (TPS) were 69%, 87%, 93%, and 54%, respectively. Approximately 2-3 weeks after resection of the SCC lesion, Cyfra 21-1 and TPS levels were reduced by 47% (P < or = 0.003) and 36% (P < or = 0.041), respectively. Cyfra 21-1 levels in SCC patients were significantly greater than those of healthy patients by 73% (P < or = 0.0001), patients with benign tumors by 74% (P < or = 0.0003), and patients in disease remission by 66% (P < or = 0.0002). Similarly, the TPS levels of SCC patients were significantly greater than those of healthy patients by 59% (P < or = 0.0005), patients with benign tumors by 55% (P < or = 0.0001), and patients in disease remission by 59% (P < or = 0.0001). In two patients, a second, new SCC lesion was diagnosed within the follow-up period, with increased tumor markers noted concomitantly with the diagnosis. CONCLUSIONS: The accumulated data point to the suitability of the clinical usage of these two markers, especially Cyfra 21-1, in the early detection of oral SCC lesions (primary, recurrent, or secondary) as well as for treatment monitoring. These results may open new avenues for the diagnosis and follow-up of these patients and hopefully improve their treatment outcome.

Adult↗
PubMed1999

[Ambulatory oral procedures in patients on low-dose aspirin].

Discontinuation of long-term, low-dose aspirin prior to ambulatory oral surgical procedures was assessed in a blind, controlled prospective study. 50 patients on low-dose aspirin who needed dental extractions, periodontal surgery, or other ambulatory oral surgery were randomly divided into test and control groups. The control patients stopped taking aspirin a week before operation, but in the test group aspirin was continued. Before, during and after surgery bleeding time was tested. Although bleeding time was significantly longer when aspirin was continued, in both groups it was within normal limits. Intraoperative hemorrhage was more frequent in those taking aspirin. Hemostasis control posed no problem and there were no postoperative complications in either group. It is concluded that discontinuing low-dose aspirin prior to elective oral surgery is not justified.

Adult↗