Faculty Bibliography

Breast cancer, the most common cancer diagnosed in American women, often necessitates mastectomy. Many studies have demonstrated improved quality of life and well-being after breast reconstruction. Numerous techniques are available for breast reconstruction including tissue expander implants and autologous tissues. Microsurgical tissue transfer involves the use of excess skin and fat (flaps) from a remote location to reconstruct the breast. Most often, tissues are transferred from the abdomen and buttocks. Less commonly, thigh flaps are used. These operations can provide durable, esthetic reconstructions. In addition, advances in microsurgical techniques have improved operative success rates to the range of 99%. The selection of an appropriate flap for microsurgical breast reconstruction is multifactorial and is based on patient and oncologic factors. These factors include patient comorbidities, body habitus/availability of donor tissues, cancer stage, and the need for postoperative adjuvant radiation therapy, as well as the risk of cancer in the contralateral breast. Appropriate choice of flap and surgical technique can minimize the risk of operative complications. Additionally, several large series have established that microsurgical breast reconstruction has no impact on survival, or locoregional/distant recurrence rates.

BACKGROUND: Surface modifications to dental implants have been used in an attempt to accelerate the osseointegration process. The objective of this study was to biomechanically/histomorphometrically evaluate a bioceramic grit-blasted and acid-etched surface (BGB/AA; test) versus a dual acid-etched implant surface (control) in a beagle dog model. METHODS: Control and BGB/AA implants were subjected to a series of physicochemical characterization tools, including scanning electron microscopy (SEM), atomic force microscopy (AFM), and auger photoelectron spectroscopy (APS). The animal model included the placement of 72 implants along the proximal tibiae of six beagle dogs, which remained in place for 2 or 4 weeks. After euthanization, half of the specimens were biomechanically tested (removal torque), and the other half was non-decalcified processed to slides of approximately 30 microm thickness for histomorphologic and histomorphometric (percentage of bone-to-implant contact [%BIC]) evaluation. Analysis of variance at the 95% confidence level and the Tukey post hoc test were used for multiple comparisons. RESULTS: SEM and AFM showed that surface microtextures were qualitatively and quantitatively different and that the BGB/AA surface presented higher submicrometer average roughness values (R(a)) and root mean square (RMS) values compared to control surfaces. Ca and P were detected at the BGB/AA surface by APS. Higher degrees of bone organization were observed along the perimeter of the BGB/AA surface compared to control, despite the non-significant differences in %BIC between the surfaces (P >0.25). Significantly higher removal torque was observed for the BGB/AA implants at both time periods (P <0.0001). CONCLUSION: According to the biomechanical and histomorphologic results, early biomechanical fixation was positively affected by the BGB/AA surface compared to the dual-acid etched surface.

The aim of this study was to qualitatively demonstrate surface micro-morphological changes after the employment of different surface conditioning methods on high-alumina and glassy-matrix dental ceramics. Three disc-shaped high-alumina specimens (In-Ceram Alumina, INC) and 4 glassy-matrix ceramic specimens (Vitadur Alpha, V) (diameter: 5 mm and height: 5 mm) were manufactured. INC specimens were submitted to 3 different surface conditioning methods: INC1--Polishing with silicon carbide papers (SiC); INC2--Chairside air-borne particle abrasion (50 microm Al2O3); INC3 - Chairside silica coating (CoJet; 30 microm SiOx). Vitadur Alpha (V) specimens were subjected to 4 different surface conditioning methods: V1--Polishing with SiC papers; V2 - HF acid etching; V3--Chairside air-borne particle abrasion (50 microm Al2O3); V4--Chairside silica coating (30 microm SiOx). Following completion of the surface conditioning methods, the specimens were analyzed using SEM. After polishing with SiC, the surfaces of V specimens remained relatively smooth while those of INC exhibited topographic irregularities. Chairside air-abrasion with either aluminum oxide or silica particles produced retentive patterns on both INC and V specimens, with smoother patterns observed after silica coating. V specimens etched with HF presented a highly porous surface. Chairside tribochemical silica coating resulted in smoother surfaces with particles embedded on the surface even after air-blasting. Surface conditioning using air-borne particle abrasion with either 50 microm alumina or 30 microm silica particles exhibited qualitatively comparable rough surfaces for both INC and V. HF acid gel created the most micro-retentive surface for the glassy-matrix ceramic tested.

CONTEXT: Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. PURPOSE: To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). METHODS: This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings. FINDINGS: Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). CONCLUSIONS: Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success.

INTRODUCTION: Understanding how teeth move in response to mechanical loads is an important aspect of orthodontic treatment. Treatment planning should include consideration of the appliances that will meet the desired loading of the teeth to result in optimized treatment outcomes. The purpose of this study was to evaluate the use of computer simulation to predict the force and the torsion obtained after the activation of tear drop loops of 3 heights. METHODS: Seventy-five retraction loops were divided into 3 groups according to height (6, 7, and 8 mm). The loops were subjected to tensile load through displacements of 0.5, 1.0, 1.5, and 2.0 mm, and the resulting forces and torques were recorded. The loops were designed in AutoCAD software(2005; Autodesk Systems, Alpharetta, GA), and finite element analysis was performed with Ansys software(version 7.0; Swanson Analysis System, Canonsburg, PA). Statistical analysis of the mechanical experiment results was obtained by ANOVA and the Tukey post-hoc test (P < .01). The correlation test and the paired t test (P < .05) were used to compare the computer simulation with the mechanical experiment. RESULTS AND CONCLUSIONS: The computer simulation accurately predicted the experimentally determined mechanical behavior of tear drop loops of different heights and should be considered an alternative for designing orthodontic appliances before treatment.

The objective of this study was to evaluate the in vitro degradation of pellet and powder forms of a poly-L-D-lactic acid material used to produce plates and screws for orthopedic, oral, and maxillofacial applications. MATERIALS AND METHODS: In order to produce the powder form the as-received pellets were milled in a cryogenic chamber. Particles size distribution (PSD) histograms were developed for both forms. The materials were then characterized by Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC), and Thermogravimetric Analysis (TGA) before and after immersion in simulated body fluid for 30, 60, and 90 days. RESULTS: SEM showed that for both forms material degradation started after 30 days of immersion in SBF and evolved until 90 days. Degradation started at the amorphous zones of the polymer and exposed of deeper crystalline layers. The pellet and powder samples PSD showed polydispersed patterns with mean diameters of 673.98 microm and 259.55 microm. Thermal onset degradation temperatures were 365.64 degrees C and 360.30 degrees C, and of 363.49 degrees C and 359.83 degrees C before immersion and after 90 days in SBF for the pellet and powder forms, respectively. The Tg's of the pellets and the powder were approximately 61.5 degrees C and 66 degrees C, and their respective endothermic peaks were observed at approximately 125 degrees C and 120 degrees C. The specific heat (c) was approximately 8.5 J/g and 6.2 J/g for the pellet and powder material, respectively. CONCLUSION: According to the results obtained, cryogenic milling resulted in particle plastic deformation, and alterations in glass transition temperature, melting temperature, and specific heat of the material.

PURPOSE: The purpose of this study was to evaluate the bone healing kinetics around commercially pure titanium implants following inferior alveolar nerve (IAN) lateralization in a rabbit model. MATERIALS AND METHODS: Inferior alveolar nerve lateralization was performed in 16 adult female rabbits (Oryctolagus cuniculus). During the nerve lateralization procedure, 1 implant was placed through the mandibular canal, and the IAN was replaced in direct contact with the implant. During the 8-week healing period, various bone labels were administered for fluorescent microscopy analysis. The animals were euthanized by anesthesia overdose, and the mandibular blocks were exposed by sharp dissection. Nondecalcified samples were prepared for optical light and scanning electron microscopy (SEM) evaluation. RESULTS: SEM evaluation showed bone modeling/remodeling between the IAN and implant surface. Fluorochrome area fraction labeling at different times during the healing period showed that bone apposition mainly occurred during the first 2 weeks after implantation. CONCLUSIONS: The results obtained showed that bone healing/deposition occurred between the alveolar nerves in contact with a commercially pure titanium implant. No interaction between the nerve and the implant was detected after the 8-week healing period. Appositional bone healing occurred around the nerve bundle structure, restoring the mandibular canal integrity and morphology.