Microvascularisation of lips in ageing edentulous subjects

Flap and incision design in implant surgery: clinical and anatomical study

OBJECTIVES

The protection of microcircular support which is essential for healing gains importance if implant surgery is considered to affect the blood flow. The aim of the study is to establish the artery territories supplying the blood into the oral mucosa in the cadavers and to demonstrate the mucosal delivery pattern and to evaluate the effects of different incision types on the healing in the patients having the implant application.

MATERIALS AND METHODS

The study was planned in two stages as cadaver and clinical investigations. In cadaver investigation, all intra oral vascular territories were shown in ten specimens. The arterial structure and mucosal vascularity of the area were assessed microscopically and macroscopically. With the obtained data, the clinic results were established by making the crestal incision only for Group 1 (n = 30); both crestal and vertical releasing incisions for Group 2 (n = 30) were planned.

RESULTS

The results were established anatomically and clinically. In all cases, vascular territories of the mucosa in the maxilla and mandible were evaluated. In stereo microscopic assessment, although vestibule and oral mucosa had rich anastomoses, the crestal line had avascular features. There was no complication in the soft tissues of the cases, performed the vertical releasing incision during the healing period after 8-week follow-up.

CONCLUSION

The vascular richness of the oral mucosal area enables the sufficient healing in the areas of applied flap. According to the alveolar anatomical pattern and the amount of the soft tissue over it, the incisions may be applied horizontally and/or vertically.

Bicyclic monoterpene diols stimulate release of nitric oxide from skin cells, increase microcirculation, and elevate skin temperature

Bicyclic monoterpene diols (BMTd) stimulate nitric oxide synthesis in melanoma and neuronal cells, representing cell types arising from embryonic neural crest tissue. This study shows that an equimolar mixture of the BMTd's 2,3-cis/exo-pinanediol and 2,3-cis/exo-camphanediol stimulates nitric oxide synthesis in epithelial cells of the skin, specifically normal human epidermal keratinocytes (NHEK) and normal human microvascular endothelial cells (HMVEC). A 1 mM mixture increased nitric oxide 3-fold in HMVEC in the first 24 h after treatment, and a 2 mM mixture produced an equivalent increase in NHEK. We hypothesized that an increase in nitric oxide in skin would lead to an increase in microcirculation, thereby increasing skin temperature. We found that twice daily application of 1mM BMTd lotion significantly increased arm skin temperature by 0.5 degrees C in 14 days compared to placebo, while a 2 mM mixture significantly increased skin temperature by 0.3 degrees C in 7 days (P < or = 0.05; ANOVA). A single application of a 2 mM BMTd mixture applied 30 min before a 30 min cold challenge (6 degrees C), maintained facial skin temperature 1.4 degrees C above untreated control sites (P < or = 0.05; ANOVA). We also tested whether BMTd treatment would benefit people with dark circles under their eyes. Twenty-six panelists with dark undereye circles completed 2-week, twice daily application of a lotion containing the 1mM mixture to one eye while the other eye was untreated. Seven of 26 subjects showed a reduction of darkness of undereye circles (P < or = 0.05; paired t test). Application of 2 mM BMTd lotion to lips resulted in a significant increase in their redness, as measured by the erythema index (P < or = 0.05; ANOVA). These results show that a mixture of BMTd's increases nitric oxide, and application to skin increases microcirculation and skin temperature.

Palatine Mucosa of Aging and Experimentally Induced Diabetic Aging Rabbits: Light-Microscopic, Scanning Electron Microscopic and Transmission Electron Microscopic Qualitative Study

BACKGROUND

Data associating palatine mucosa, microvascular architecture, aging and diabetes mellitus are few, so the aim of the present study was to examine these conditions structurally and ultrastructurally.

METHODS

We used 18 female rabbits, aged about 2 years at the beginning of the experiment, distributed into 2 groups: aging diabetic and aging animals, prepared by three different methodologies: light microscopy, scanning electron microscopy and transmission electron microscopy. The samples were stained with hematoxylin-eosin for light microscopy, and for scanning electron microscopy, we used Mercox Cl-2B vascular corrosion casts. For transmission electron microscopy, the specimens were fixed and embedded in Epon 812 resin.

RESULTS

Under light microscopy, we noted small amounts of underdeveloped connective papillae and significant flattened areas through the epithelium-connective tissue interface in the aging diabetic group. Larger blood vessels were deeply located in the palatine mucosa, branching off in the direction of the epithelium-connective tissue interface. Capillaries followed the interface contour. In both groups, vascular corrosion casts revealed capillaries sprouting out in disorganized rows but parallel between themselves. 'Hair-pin' capillary loops and convoluted capillary loops were noted.

CONCLUSION

The aging diabetic group showed rarefying microvasculature areas with complex tortuous capillary loops. Transmission electron microscopy results showed that the aging diabetic group presented small cytoplasmatic projections directed to the vessel lumen and micropinocytic vesicle, i.e. caveolas. Epithelium-connective tissue interface, connective papillae, microangioarchitecture, and information about endothelial cells alterations were observed in the aging diabetic and aging animals.

[Blood supply of the lips]

An important study of lips arterial supply was enabled using multiple sources of information: anatomical dissection, cadaver and "in vivo" arteriography and phlebography. Literature was a great help, especially a recent analysis of lips microvascularisation done by H. Sick. The classical figure of labial circular artery was found out to be quite seldom, whereas an important number of anatomical variations where shown. Also there was a total independence between inferior and superior lip venous drainage, for embryological reasons. Finally lymph drainage was studied by anatomical dissection with the use of Gerota mass and the G. Hidden's work. It appeared that cutaneous and mucosal drainage were separate, since the nodes were different. All these information have been useful and confirmed during more than a thousand surgical procedures performed in our maxillo-facial surgery unit of Besançon medical school.