The experience of the rigid lockdown in the dental emergency room and urgency care during COVID-19 pandemic: a transnational multicenter observational study

OBJECTIVE

The COVID-19 pandemic had a major impact on our lives all over the world. Changes have occurred in daily life as well as in all medical services. The aim of the present study was to evaluate the emergency accesses in four universities' emergency services during the lockdown period from March to June 2020 during the COVID-19 pandemic.

SUBJECTS AND METHODS

A cross-sectional study was carried out on 44,787 patients to evaluate the emergency services of university centers. The medical data of Medical Emergency Service Data (MESD) were assessed by five independent operators considering the epidemiological findings for statistics methods.

RESULTS

A lower level of emergency access was reported in March-July compared to the pre-COVID period. The epidemiological data confirmed that female pathologies were more frequent compared to male patients. A fluctuation for almost all urgent healthcare centers was detected, showing one/two peaks per year during the years 2017-2019. The COVID-19 pandemic period did not influence the variety of pathology detected.

CONCLUSIONS

After the lockdown period, the emergency services slowly increased in cases. The pre-COVID period showed an overlapping of the most frequent pathologies compared to the post-COVID period: periodontitis (Bari and Tirana), dental fractures (Bari and Bucharest), odontogenic abscess (Bari, Cluj and Tirana).

Immediate postoperative complications after lateral ridge augmentation - a clinical comparison between bone shell technique and sticky bone

Nowadays, implant dentistry is strongly interconnected to bone augmentation procedures. Lateral ridge augmentation is often an imperative treatment stage for successful, prosthetic-driven implant placement. This study aimed to comparatively analyze the immediate postoperative complications of two horizontal bone grafting procedures: sticky bone and bone shell technique. Records of patients with lateral ridge augmentation were analyzed to identify immediate postoperative complications. The study group included 80 patients divided into 40 control (bone-shell technique - BS) and 40 tests (sticky bone -SB). More patients reported moderate and severe pain in the BS - group (11 patients - 27.5%) than in the SB group (6 patients - 15%). In the BS group, the incidence of severe and moderate trismus, neurosensory disturbances, and important hematoma was higher. There was an increased inflammatory response following the bone shell technique, while the sticky bone technique proved reduced surgical morbidity. There was no difference between the two groups in the risk of dehiscence or infection.

Bending Fracture of Different Zirconia-Based Bioceramics for Dental Applications: A Comparative Study

The fabrication of fixed dental prostheses using aesthetic materials has become routine in today’s dentistry. In the present study, three-unit full zirconia fixed prosthetic restorations obtained by computer-aided design/computer-aided manufacturing (CAD/CAM) technology were tested by bending trials. The prostheses were intended to replace the first mandibular left molar and were manufactured from four different types of zirconia bioceramics (KatanaTM Zirconia HTML and KatanaTM Zirconia STML/Kuraray Noritake Dental Inc.; NOVAZir^® Fusion float^® ml/NOVADENT/Dentaltechnik; and 3D PRO Zirconia/Bloomden Bioceramics). In total, sixteen samples were manufactured—four samples per zirconia material. Additionally, the morphology, grain size area distribution, and elemental composition were analyzed in parallelepiped samples made from the selected types of zirconia in three different areas, noted as the upper, middle, and lower areas. The scanning electron microscope (SEM) analysis highlighted that the grain size area varies with respect to the researched area and the type of material. Defects such as microcracks and pores were also noted to a smaller extent. In terms of grain size area, it was observed that most of the particles in all samples were under 0.5 μm², while the chemical composition of the investigated materials did not vary significantly. The results obtained after performing the bending tests showed that a zirconia material with fewer structural defects and an increased percentage of grain size area under 0.5 µm², ranging from ~44% in the upper area to ~74% in the lower area, exhibited enhanced mechanical behavior. Overall, the resulting values of all investigated parameters confirm that the tested materials are suitable for clinical use.

PRF-Solution in Large Sinus Membrane Perforation with Simultaneous Implant Placement-Micro CT and Histological Analysis

Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.

Experimental Studies Regarding the Distribution of the Masticatory Pressures According to the Turn�s Length of the Dental Implants

In order to study comparatively the behaviour of the bone-implant interface at mechanical stresses depending on the length of the implant turns, we chose a complex case, a total bimaxillary edentate. 7 implants were virtually inserted into the maxilla (2 pterigoid implants in the lateral regions and 3 implants in the frontal region), and 4 implants were inserted into the mandible (two in the premolar regions and two corresponding to the canines). The FEA analyzes were performed separately for the maxilla and for the mandible, applying a force of 200N on each type of implant. The critical areas, in which the extreme values of the strains develop, are located into the bone on the neck-implant level, and its apex level, regardless of the type of implant and regardless of the maxillary or mandibular area where the implants were virtually inserted. Implants with small turns induce lower stresses and deformations, compared to implants with large turns.

Management of Schneiderian Membrane Perforations during Sinus Augmentation Procedures: A Preliminary Comparison of Two Different Approaches

BACKGROUND

The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach.

METHODS

A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage.

RESULTS

Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed.

CONCLUSIONS

Both surgical techniques yielded therapeutic success.

Deficiencies in Silicone Impression for Crowns and Bridges

There are many steps in fabrication of dental crowns and bridges at which an error can occur, and a technician can only fabricate a quality restoration if the impression itself is of adequate quality. All dental practitioners should have the ability to evaluate the quality of dental impression before sending to the laboratory. Elastomeric silicones (polysiloxane) are the most utilised impression materials in dental practice. The present study deal with the deficiencies of silicones dental impressions sent to commercial dental laboratories for fabrication of single crowns and bridges.

Study on Chemical Composition of Urinary and Salivary Gland Stones in Relationship with Laboratory Parameters and Lifestyle Habits of Patients with Lithiasis

Lithiasis is a disease with increasing incidence, may occur in the urinary tract, salivary glands and bile ducts. Genetic susceptibility, diet, low fluid intake, endocrine disorders, infections and other factors can influence the development of the disease and its recurrences. The aim of the study was to reveal the relationship between chemical composition of the stones, lifestyle and dietary habits and the results of laboratory analysis in patients with urinary tract and salivary gland lithiasis. The data of 258 patients with urinary tract and salivary gland lithiasis collected between September 2009 � May 2016 were studied. The subjects were from the Urology and Oral Surgery Hospital, and from the Marmed and Procardia medical units in Tirgu Mures. We evaluated the lifestyle habits using a questionnaire, microscopical examination, size measurement and chemical analysis of the stones were made and we processed the results of urinary strip analysis and sediment. In a subgroup of patients (48 samples) calciuria, phosphaturia, serum uric acid, calcium, phosphate, alkaline phosphatase and parathormone (PTH) levels were determined; in case of pathological values calcitonin measurement and endocrinology consultation were performed. The most frequent composition was the combination of calcium oxalate and phosphate in case of both urinary and salivary gland stones, in several uroliths we detected uric acid/xanthine crystals, rarely cystine and carbonate were found. The incidence of hematuria and leukocyturia exceeded 70%. Excessive calcium intake was observed in the diet of the several patients having calcium oxalate stones. In the subgroup tested for biochemical and hormonal analyses we found increased serum PTH concentration in 20.83% of the patients. Some of the subjects had pathological serum calcium, uric acid and alkaline phosphatase results, or the elimination of minerals in the urine was out of the normal range. We found pathological laboratory results in several patients suffering from lithiasis. Proper diet and medical treatment in many cases could prevent the recurrences of stone formation, but first a complex investigation of the patients is necessary to adapt the treatment plan to individual requirements.

Pharmacodynamic Modulation of Motility by Glycine Administration in Dugesia Dorotocephala

The glycinergic neurotransmission system is a potential pharmacological target for pain and muscle spasm relief therapy. Planarians are attractive model organisms for neuropharmacological research, due to their simplicity and neurotransmitters shared with mammals. In this study, planarians were exposed to glycine, caffeine, midazolam and ondansetron separately and to successive associations of glycine/caffeine, glycine/midazolam and glycine/ondansetron. Effects on motility were examined by a grid crossing assay. Results showed a dose-dependent reduction of motility by glycine, partially reversed by caffeine and midazolam, but not by ondansetron. Midazolam caused an intense decrease of motility, but not significantly lower than glycine. Ondansetron-treated planarians showed decrease motility compared with controls, but not with glycine or midazolam. These results are consistent with data obtained from higher organisms, showing that planarians can be used as model organisms for glycinergic pharmacological research.

A modified surgical technique for inferior alveolar nerve repositioning on severely atrophic mandibles: case series of 11 consecutive surgical procedures

BACKGROUND

To emphasize the characteristics and possible pitfalls of nerve reposition in cases of severe bone resorption in the posterior mandibular area, and to modify hard- and soft-tissue manipulation accordingly.

METHODS

We analyzed retrospectively, 7 patients in which we performed full arch lower jaw rehabilitation. The patients presented for oral rehabilitation having a minimal residual bone above the mandibular canal and had undergone inferioral veolar nerve (IAN) displacement with modified surgical technique for fixed prosthetic rehabilitation.

RESULTS

Eleven procedures of nerve repositioning were performed on severely atrophic mandibles. The average age of the patients was 43.29 years (12.37 SD). Residual bone above the mental foramen ranged between 0.5 mm and 1.5 mm, with an average of 0.93 mm (0.35 SD). In total, 32 dental implants were inserted into the area simultaneously with nerve displacement. The average follow-up time was 35.71 months(41.75 SD), ranging between 7 and 120 months.

CONCLUSIONS

Severe atrophic cases require special attention due to the loss of keratinized tissue around the crestal area.The use of a modified surgical approach and specific surgical instruments provides a safer working environment for the operator and ensures optimal results.

Correlations between cyto-histopathological tissue changes at the dental implant interface and the degree of surface processing

The bone tissue is a specialized connective tissue adapted for support and protection. The bone physiology is balanced by the interaction between mechanical and metabolic factors. Current research focuses on the bone remodeling process after the insertion of dental implants, because, after the primary healing of the wound caused by the creation of the new alveolus, the proliferation and differentiation of the osteoblasts and fibroblasts will tip the balance of the healing pattern toward bone regeneration or fibrous encapsulation. Knowing and identifying the components of the connective and bone tissue prior to implant placement, researchers are investigating the quality and quantity of the bone matrix and the physiological stages of bone generation and resorption to improve the bone-implant interface. Our research included nine dental implant failures, without prosthetic supra-structures, immediately loaded or loaded after osseointegration. The analyzed samples were from the BIOMAT Research Center, Politehnica University of Bucharest, Romania, and experienced different modalities of surface preparation. Comparative analysis of the tissue at the bone-implant interface was investigated by scanning electron microscopy.