In vivo efficacy proof of concept of a large-size bioprinted dermo-epidermal substitute for permanent wound coverage

Introduction: An autologous split-thickness skin graft (STSG) is a standard treatment for coverage of full-thickness skin defects. However, this technique has two major drawbacks: the use of general anesthesia for skin harvesting and scar sequelae on the donor site. In order to reduce morbidity associated with STSG harvesting, researchers have developed autologous dermo-epidermal substitutes (DESs) using cell culture, tissue engineering, and, more recently, bioprinting approaches. This study assessed the manufacturing reliability and in vivo efficacy of a large-size good manufacturing practice (GMP)-compatible bio-printed human DES, named Poieskin®, for acute wound healing treatment. Methods: Two batches (40 cm2 each) of Poieskin® were produced, and their reliability and homogeneity were assessed using histological scoring. Immunosuppressed mice received either samples of Poieskin® (n = 8) or human STSG (n = 8) immediately after longitudinal acute full-thickness excision of size 1 × 1.5 cm, applied on the skeletal muscle plane. The engraftment rate was assessed through standardized photographs on day 16 of the follow-up. Moreover, wound contraction, superficial vascularization, and local inflammation were evaluated via standardized photographs, laser Doppler imaging, and PET imaging, respectively. Histological analysis was finally performed after euthanasia. Results: Histological scoring reached 75% ± 8% and 73% ± 12%, respectively, displaying a robust and homogeneous construct. Engraftment was comparable for both groups: 91.8% (SD = 0.1152) for the Poieskin® group versus 100% (SD = 0) for the human STSG group. We did not record differences in either graft perfusion, PET imaging, or histological scoring on day 16. Conclusion: Poieskin® presents consistent bioengineering manufacturing characteristics to treat full-thickness cutaneous defects as an alternative to STSG in clinical applications. Manufacturing of Poieskin® is reliable and homogeneous, leading to a clinically satisfying rate of graft take compared to the reference human STSG in a mouse model. These results encourage the use of Poieskin® in phase I clinical trials as its manufacturing procedure is compatible with pharmaceutical guidelines.

Immediate Proximal Row Carpectomy for Severe Perilunate Dislocation Injuries: A Minimum 5-Year Follow-Up

Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).

Adipose tissue-derived stromal vascular fraction for treating hands of patients with systemic sclerosis: a multicentre randomized trial

OBJECTIVE

To assess the superiority of adipose tissue-derived stromal vascular fraction (AD-SVF) injection into the fingers vs placebo in reducing hand disability in systemic sclerosis (SSc) patients.

METHODS

We performed a double-blind, multicentre, phase II trial from October 2015 to January 2018 in France. SSc patients with a Cochin Hand Function Scale (CHFS) ≥20/90 were randomized 1:1 to receive injection of AD-SVF or placebo. AD-SVF was obtained using the automated processing Celution®800/CRS system. The placebo was lactated Ringer's solution. The primary efficacy end point was the change of the CHFS score from baseline to 3 months. Secondary efficacy endpoints included the CHFS score at 6 months, hands function, vasculopathy, hands pain, skin fibrosis, sensitivity of the finger' pulps, Scleroderma Health Assessment Questionnaire, patients and physician satisfaction and the safety.

RESULTS

40 patients were randomized. The AD-SVF and placebo groups were comparable for age, sex ratio, disease duration, skin fibrosis of the hands and main cause of hand disability. After 3 month-follow-up, hand function significantly improved in both groups with no between-group difference of CHFS (mean change of -9.2 ± 12.2 in the AD-SVF group vs -7.6 ± 13.2 in the placebo group). At 6 months, hand function improved in both groups.

CONCLUSION

This study showed an improvement of hand function in both groups other time, with no superiority of the AD-SVF. Considering the limits of this trial, studies on a larger population of patients with homogeneous phenotype and hand handicap, should be encouraged to accurately assess the benefit of AD-SVF therapy.

TRIAL REGISTRATION

ClinicalTrials.gov, https://clinicaltrials.gov, NCT02558543. Registered on September 24, 2015.

EURADOS STRATEGIC RESEARCH AGENDA 2020: VISION FOR THE DOSIMETRY OF IONISING RADIATION

Since 2012, the European Radiation Dosimetry Group (EURADOS) has developed its Strategic Research Agenda (SRA), which contributes to the identification of future research needs in radiation dosimetry in Europe. Continued scientific developments in this field necessitate regular updates and, consequently, this paper summarises the latest revision of the SRA, with input regarding the state of the art and vision for the future contributed by EURADOS Working Groups and through a stakeholder workshop. Five visions define key issues in dosimetry research that are considered important over at least the next decade. They include scientific objectives and developments in (i) updated fundamental dose concepts and quantities, (ii) improved radiation risk estimates deduced from epidemiological cohorts, (iii) efficient dose assessment for radiological emergencies, (iv) integrated personalised dosimetry in medical applications and (v) improved radiation protection of workers and the public. This SRA will be used as a guideline for future activities of EURADOS Working Groups but can also be used as guidance for research in radiation dosimetry by the wider community. It will also be used as input for a general European research roadmap for radiation protection, following similar previous contributions to the European Joint Programme for the Integration of Radiation Protection Research, under the Horizon 2020 programme (CONCERT). The full version of the SRA is available as a EURADOS report (www.eurados.org).

Use of Formal and Informal Food Resources by Food Insecure Families in Lima, Peru: A Mixed-Methods Analysis

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use – FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.

Epidemiology of odontogenic sinusitis: an old, underestimated disease, even today. A narrative literature review

Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses resulting from dental pathology. The aim of this study is to provide an overview of the current literature on the dimensions of the phenomenon, quality of life, economic considerations, and approaches to odontogenic sinusitis. A narrative review was conducted following the methodology proposed by Green et al. (2006). There appears to have been an increase in the incidence over the last decade. Nowadays, evidence in the literature reports that 10-12% up to 40% of all sinusitis cases are associated with odontogenic infections. The iatrogenia was by far the leading cause of odontogenic sinusitis (55.97%) while the first and second molars were the most affected teeth with an incidence of 35.6% and 22%. If not properly diagnosed and treated, these infections may lead to a rapid spread, giving rise to potentially life-threatening complications with a significant general health-related Quality of Life detriment. The proper management of patients in a pre-implant logical setting leads to substantial savings, ranging from €38 million to €152 million, for the Italian National Health Service. Odontogenic sinusitis management should involve shared decisionmaking between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and endoscopic sinus surgery are discussed.

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.

Evaluation of the periodontal healing of the second mandibular molar distal site following insertion of PRF in the third molar post extraction alveolus

The aim of this study was to evaluate the periodontal healing of the distal sites of the mandibular second molars, comparing the extraction therapy of the third molar with and without PRF adjunct into the postextraction alveolus. The study sample was composed by 40 consecutive patients who underwent extraction of mandibular third molars. Patients were divided in two groups: the last 20 participants who have only been subjected to extraction (spontaneous healing group, SHG) and the first 20 patients who had PRF adjunct (PRF group, PG). Healing was evaluated by analyzing the variations in terms of PPD (Probing Pocket Depth), REC (Recession), CAL (Level of Clinical Attachment), BoP (Bleeding on Probing) and GI (Gingival Index) from Baseline to further follow-ups at 1 month and 3 months. The disto-vestibular (DV) and disto-lingual (DL) PPD values of the second mandibular molar were measured at Baseline and after three months in the two groups. Patients of the PG group showed lower PPD values at 1 month and 3 months postoperatively: DV: 3.6±1.09 - DL: 3.5±1.15 and DV: 2.5±0.83 - DL: 2.6±1.09, respectively. Patients belonging to the SHG also showed lower PPD values, reporting respectively the following DV values after 3 months: 2.7±0.86 - DL: 2.75±0. 85. However, there was no statistically significant difference comparing the results obtained in PG and SHG groups at 1 and 3 months (p>0.05). The insertion of PRF inside the post-extraction alveolus of the mandibular third molar leads to limited improvement in terms of periodontal healing, compared to extraction therapy only.

Antimicrobial efficacy of photodynamic therapy (PDT) in periodontitis and peri-implantitis: A systematic review

To systematically review the literature regarding the antimicrobial effects of photodynamic therapy (PDT) on multi-bacterial species in periodontitis and peri-implantitis disease. The addressed focused question was: "Does PDT show antimicrobial efficacy against multi-bacterial species colonization in periodontal pockets and on the surface of dental implants?" Electronic databases including MEDLINE and EMBASE up to and including December 2018 were searched. Of the ninety studied analyzed, seven were included, four for the study of PDT in peri-implantitis disease and three for periodontal disease. All studies reported the multibacterial species outcomes after the application of antimicrobial PDT. All studies showed a significant reduction in the bacterial load, both in studies based on periodontal and peri-implantary disease, with an average reduction of the total amount of bacterial load of 99.3%. Moreover, the change in clinical parameters is equally important, with an average reduction of PPD of 1.01 mm (from 4.92 to 3.49 ± SD with a percentage reduction of 29%); of BoP of 50%; of RCAL of 1.19 mm (from 9.93 to 8.74, with an average percentage reduction of 12%); of PI of 0.3 (from 1 to 0.7 with a percentage reduction of 30%) and of GI of 1.2 (from 1.8 to 0.6 with a percentage reduction of 66.6%). This review demonstrated significant reduction in the bacterial load in periodontal pocket and dental implant surface with the use of PDT. The results of this review should be considered preliminary and further studies with standardized laser parameters are needed to obtain strong conclusions.

Eurados review of retrospective dosimetry techniques for internal exposures to ionising radiation and their applications

This work presents an overview of the applications of retrospective dosimetry techniques in case of incorporation of radionuclides. The fact that internal exposures are characterized by a spatially inhomogeneous irradiation of the body, which is potentially prolonged over large periods and variable over time, is particularly problematic for biological and electron paramagnetic resonance (EPR) dosimetry methods when compared with external exposures. The paper gives initially specific information about internal dosimetry methods, the most common cytogenetic techniques used in biological dosimetry and EPR dosimetry applied to tooth enamel. Based on real-case scenarios, dose estimates obtained from bioassay data as well as with biological and/or EPR dosimetry are compared and critically discussed. In most of the scenarios presented, concomitant external exposures were responsible for the greater portion of the received dose. As no assay is available which can discriminate between radiation of different types and different LETs on the basis of the type of damage induced, it is not possible to infer from these studies specific conclusions valid for incorporated radionuclides alone. The biological dosimetry assays and EPR techniques proved to be most applicable in cases when the radionuclides are almost homogeneously distributed in the body. No compelling evidence was obtained in other cases of extremely inhomogeneous distribution. Retrospective dosimetry needs to be optimized and further developed in order to be able to deal with real exposure cases, where a mixture of both external and internal exposures will be encountered most of the times.

[Total reconstruction of the lower lip: Lip suspension technique by double nasolabial rigging and review of the literature]

BACKGROUND

Total lower lip defect is rare and its reconstruction difficult. The challenges are both aesthetic and functional. Suspension of the lower lip is essential for restoring oral competence. We report an original and simple technique of suspension by double nasolabial rigging.

METHOD

Two upper base orbitonasolabial flaps, extended over several centimeters below the lip commissures are raised. The epidermis is completely removed. Then, the flaps are tunneled under the skin and fixed to the reconstructed lower lip in order to provide it with effective suspension to the maxillary.

RESULTS

In our experience, we used the nasolabial rigging associated with a total reconstruction of the lower lip for three patients. Lip continence is effective in the long term. The review of literature shows that the use of conventional locoregional flaps restores a good labial competence but is limited to subtotal lower lip defect. Distant pedicled flaps or free flaps made without suspension of the lower lip don't restore the labial competence. Several procedures to suspend the lower lip with strips of fascia lata or tendon of palmaris longus, associated or not with a free flap, seem to provide satisfactory oral competence. All these techniques are poorly standardized and technically difficult.

CONCLUSION

The technique of the double nasolabial rigging that we describe seems to be an effective and interesting alternative by its simplicity, its reproducibility and its adaptability. It allows to obtain a perfectly fixed posterior plane, able to receive any reconstruction of the lower lip.

EURADOS education and training activities

This paper provides a summary of the Education and Training (E&T) activities that have been developed and organised by the European Radiation Dosimetry Group (EURADOS) in recent years and in the case of Training Courses over the last decade. These E&T actions include short duration Training Courses on well-established topics organised within the activity of EURADOS Working Groups (WGs), or one-day events integrated in the EURADOS Annual Meeting (workshops, winter schools, the intercomparison participants' sessions and the learning network, among others). Moreover, EURADOS has recently established a Young Scientist Grant and a Young Scientist Award. The Grant supports young scientists by encouraging them to perform research projects at other laboratories of the EURADOS network. The Award is given in recognition of excellent work developed within the WGs' work programme. Additionally, EURADOS supports the dissemination of knowledge in radiation dosimetry by promoting and endorsing conferences such as the individual monitoring (IM) series, the neutron and ion dosimetry symposia (NEUDOS) and contributions to E&T sessions at specific events.

The work programme of EURADOS on internal and external dosimetry

Since the early 1980s, the European Radiation Dosimetry Group (EURADOS) has been maintaining a network of institutions interested in the dosimetry of ionising radiation. As of 2017, this network includes more than 70 institutions (research centres, dosimetry services, university institutes, etc.), and the EURADOS database lists more than 500 scientists who contribute to the EURADOS mission, which is to promote research and technical development in dosimetry and its implementation into practice, and to contribute to harmonisation of dosimetry in Europe and its conformance with international practices. The EURADOS working programme is organised into eight working groups dealing with environmental, computational, internal, and retrospective dosimetry; dosimetry in medical imaging; dosimetry in radiotherapy; dosimetry in high-energy radiation fields; and harmonisation of individual monitoring. Results are published as freely available EURADOS reports and in the peer-reviewed scientific literature. Moreover, EURADOS organises winter schools and training courses on various aspects relevant for radiation dosimetry, and formulates the strategic research needs in dosimetry important for Europe. This paper gives an overview on the most important EURADOS activities. More details can be found at www.eurados.org .

Prototype foamy virus integrase is promiscuous for target choice

Retroviruses have two essential activities: reverse transcription and integration. The viral protein integrase (IN) covalently joins the viral cDNA genome to the host DNA. Prototype foamy virus (PFV) IN has become a model of retroviral intasome structure. However, this retroviral IN has not been well-characterized biochemically. Here we compare PFV IN to previously reported HIV-1 IN activities and discover significant differences. PFV IN is able to utilize the divalent cation calcium during strand transfer while HIV-1 IN is not. HIV-1 IN was shown to completely commit to a target DNA within 1 min, while PFV IN is not fully committed after 60 min. These results suggest that PFV IN is more promiscuous compared to HIV-1 IN in terms of divalent cation and target commitment.

EURADOS work on internal dosimetry

European Radiation Dosimetry Group (EURADOS) Working Group 7 is a network on internal dosimetry that brings together researchers from more than 60 institutions in 21 countries. The work of the group is organised into task groups that focus on different aspects, such as development and implementation of biokinetic models (e.g. for diethylenetriamine penta-acetic acid decorporation therapy), individual monitoring and the dose assessment process, Monte Carlo simulations for internal dosimetry, uncertainties in internal dosimetry, and internal microdosimetry. Several intercomparison exercises and training courses have been organised. The IDEAS guidelines, which describe - based on the International Commission on Radiological Protection's (ICRP) biokinetic models and dose coefficients - a structured approach to the assessment of internal doses from monitoring data, are maintained and updated by the group. In addition, Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides have been elaborated on behalf of the European Commission, DG-ENER (TECHREC Project, 2014-2016, coordinated by EURADOS). Quality assurance of the ICRP biokinetic models by calculation of retention and excretion functions for different scenarios has been performed and feedback was provided to ICRP. An uncertainty study of the recent caesium biokinetic model quantified the overall uncertainties, and identified the sensitive parameters of the model. A report with guidance on the application of ICRP biokinetic models and dose coefficients is being drafted at present. These and other examples of the group's activities, which complement the work of ICRP, are presented.

The use of hyaluronic acid as an adjuvant in the management of mucositis

In recent years, with an increase in the number of implants, there has been a related increase in cases of pathologies related to infections around the implant site and on the implant surface i.e. mucositis and peri-implantitis. The purpose of this pilot study is to evaluate the potential efficacy of nebulized hyaluronic acid in the management of mucositis. The results of the statistical analysis demonstrate that there was no difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days weeks post-treatment). However, the difference between bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, with a slightly greater improvement on the side treated with HA.

The use of hyaluronic acid as an adjuvant in the management of gingivitis

Recently, a specifically designed device was proposed that is able to nebulize particles with a diameter of approximately 16 micrometres to be used mainly in the management of diseases of the upper airway respiratory tract. The purpose of this pilot study is to evaluate the potential efficacy of nebulized hyaluronic acid in the management of gingivitis. The results of the statistical analysis demonstrate that there was no difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days post-treatment). However, the difference between bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, with a slightly greater improvement on the side treated with HA.

The use of hyaluronic acid as a support of two different micronized biomaterials in crestal sinus lift procedures. A report on two case studies with volume comparison

In the context of the trans crestal maxillary sinus lift, a wide variety of biomaterials have been used to fill the sub-antral space over the years. The materials that have a pasty consistency and are smooth and free from lumps are the most suitable to come into contact with the Schneiderian membrane which, if torn, cannot perform its graft containment function. In this study, a micronized heterologous bone in a collagen matrix of two different percentages was used in order to fill the maxillary sinus. Before using biomaterial as filler, a spray form of hyaluronic acid was used to disinfect the surgical site before and after the surgery, along with more consistent and pasty form of gel of hyaluronic acid being used in order to facilitate the detachment of the membrane. The surgical procedures were designed and carried out using computer-planned surgery. The filling volume obtained was measured with a comparative software programme and using an ellissoid formula. This technique allows the surgery to be performed in a way that is both minimally traumatic and invasive, fully careful of the membrane and represents a viable alternative to those surgical techniques for crestal sinus lift currently in use.

The use of hyaluronic acid as an adjuvant in the management of periodontitis

The emollient and restructuring action exerted on the mucous membranes by hyaluronic acid is of particular significance. This is thanks to its reparative (it stimulates angiogenesis) and soothing properties (hyaluronic acid is used in wound care to improve the processes of wound healing), which are effective in treating the symptoms of local inflammation and irritation. The purpose of this clinical trial is to evaluate the potential efficacy of nebulized hyaluronic acid in the management of chronic periodontitis in adults. The results of the statistical analysis demonstrate that there was a slight improvement in the measurement of pocket depth in the side treated with HA at time 0 (pre-treatment) and time 1 (15 days post-treatment). Furthermore, the difference between bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, with a slightly greater improvement on the side treated with HA.

The efficacy of topical hyaluronan in rhinosinusitis: a systematic review

Rhinosinusitis is one of the most common inflammatory conditions of the nasal cavity and paranasal sinuses and is one of the most common causes of absence from work and for visits to the family doctor. The treatment strategy in both acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) is to reduce the severity of the symptoms, minimize the duration of the disease and prevent complications. Topical therapy has become an important tool in otolaryngologists’ armamentarium for rhinosinusitis treatment. Recently, topical hyaluronic acid (HA), the major component of many extracellular matrices that promotes tissue healing, including activation and moderation of the inflammatory responses, cell proliferation, migration and angiogenesis, has been proposed for ARS and CRS adjuvant tool. The aim of the study is to systematically review the published literature regarding all the therapeutic effects of HA on the ARS and CRS. Relevant published studies were found in PubMed, Google Scholar and Ovid, using a combined keyword search or medical subject headings. At the end of our study selection process, 5 relevant publications were included: 2 of them investigated the potential role of HA in reducing symptoms and preventing exacerbations of CRS in adult population, two of them in paediatric patients affected by upper respiratory tract infections and one of them in cystic fibrosis patients with bacterial rhinopharyngitis. Data deriving from the present review of 5 clinical studies showed that the use of topical HA represents a relevant therapeutic advance in rhinosinusitis to minimize symptoms and prevent reacutization with a significant improvement of their quality of life, as it avoids systemic side effects and increases local drug activity. Further studies on larger populations and with new specific nebulization devices for upper airway are needed to confirm these encouraging results.

Post-operative nebulized sodium hyaluronate versus spray after functional endoscopic sinus surgery for chronic rhinosinusitis

We prospectively evaluated the efficacy of nebulized Hyaluronic Acid (HA) as an adjuvant treatment to hasten the improvement of nasal respiration and to minimize patients’ discomfort in the postoperative functional endoscopic sinus surgery (FESS) for chronic rhino-sinusitis (CRS). We enrolled 33 CRS adult patients who underwent endoscopic functional sinus surgery. They were randomly assigned into two groups: Spray-Sol group (18 patients) with HA nebulized with a new nasal device named Spray-Sol and Spray group (15 patients) with a HA nebulized with a common spray. Both groups were treated twice daily for 4 weeks. CRS questionnaire, Visual analogic scale (VAS) and nasal endoscopy were used to assess the outcomes of the treatments during the 1st month of follow up. The mean VAS score of the Spray-Sol group at 2 weeks was significantly lower than the Spray group (5.2±2.1 vs 10.5±3.7; p less than 0.05). The VAS score remained significantly lower in the Spray-Sol group also at the 4 weeks (2.9±0.8 vs 6.1±3.4; p less than 0.05). The CRS score was significantly better at week 2 and 4 in both groups in comparison with baseline values, with better results in the Spray-Sol group. Since the first visit the Spray-Sol group also showed significantly lower crusts, edema and secretions than the Spray group (p less than 0.05). The compliance to treatment was similar in both groups. The results of this prospective study suggest a role nebulized of HA through new device (Spray-sol) as a supportive treatment for faster improvement of nasal respiration, also minimizing patient discomfort, promoting nasal mucosa healing in postoperative FESS for CRS.

Biorevitalization: an in vitro study on gingival fibroblast

Bio-revitalization is a therapy commonly used in aesthetic medicine to improve skin quality by di¬rectly integrating hyaluronic acid alone or added to other molecules (i.e. vitamins) through intradermal injections. These injections are not aimed to fill roughness but to achieve extracellular matrix optimi¬zation. The injective medical devices used in aesthetic medicine differ for hyaluronic acid content and for the presence of additional molecules that characterize the formulation of a particular company. The aim of the present study is to compare HA with different compounds in regard to their effects on cultured fibroblasts over time by using RT-PCR and a panel of genes (ELN, DSP, FN1, FBN1, ITGA1, ITGA2, ITGA5, ITGB1, COL1A1, COL3A1) involved in connective integrity. Bio-revitalization is able to activate genes involved in tissue integrity. The reported data add new insight in the comprehension of molecular mechanism related to BR. These preliminary data have to be developed through additional experiments. However, an injective therapy seems to be effective in gingival fibroblast stimulation.

Systematic review: the efficacy of topical hyaluronic acid on oral ulcers

The management of oral ulcers is a challenge for clinicians. Whilst there is widespread use of topical corticosteroids, antibiotics and antimicrobial, there is only weak evidence for the effectiveness of any of the topical treatments. Hyaluronic Acid (HA) has been recently proposed for topical administration in the treatment of oral ulcers and other painful oral lesions. The aim of the study is to systematically review the published literature regarding all the therapeutic effects of HA on painful oral lesions such as oral ulcers and oral lichen planus. Relevant published studies were found in PubMed, Google Scholar and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 4 relevant publications were included: two regarding oral lichen planus, one Behcet’s Disease and Recurrent Aphthous ulcer and one in oral ulcers in general. Both subjective parameters such as healing period, VAS for pain and objective assessments such as number of ulcers, maximal area of ulcer and inflammatory signs, significantly improved after HA treatment. These data allow us to suggest that HA may play a pivotal role in the treatment of oral ulcers.

The use of hyaluronic acid as an adjuvant in the management of peri-implantitis

It is well known in dentistry that there are numerous chronic conditions that require ongoing and constant management over time, the most noteworthy being periodontal disease, gingivitis and periodontitis. Yet, in recent years, with the increase in the number of implants being placed, mucositis and peri-implantitis have become more and more prevalent pathologies. The results of the statistical analysis demonstrate that there was a slight difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days post-treatment), although the difference was so small as to render it statistically irrelevant. Bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, but with no greater improvement noted on the side treated with HA.

The use of various biomaterials in computer-guided crestal sinus lift procedures. A report on two case studies with volume comparison

PURPOSE

In the context of the transcrestal maxillary sinus lift a wide variety of biomaterials have been used to fill the subantral space over the years. In this study, two types of biomaterials were used in order to fill the maxillary sinus: a nano-crystallized hydroxyapatite in an aqueous solution and a micronized heterologous bone in a collagen matrix.

MATERIALS AND METHODS

The surgical procedures were designed and carried out using computer-guided surgery. The filling volume obtained was measured with a comparative software program.

RESULTS

A ≥ 6 millimeter augmentation of osseous volume was obtained. This result is comparable to those obtained in lifts where conventional techniques were applied. The technique used was very precise and the difference between the projected and clinical outcome of the implant position had an average of less than 0.3 millimeters.

CONCLUSIONS

This technique allows for the surgery to be performed in a way which is both minimally traumatic and invasive, and represents a viable alternative to those surgical techniques for crestal sinus lift currently in use.

Full arch rehabilitation in severe maxillary atrophy with palatal approach implant placement: a case report

PURPOSE

The edentulous severely atrophic maxilla, as consequence of alveolar bone resorption and pneumatisation of the maxillary sinus, represents a serious limitation to the implant rehabilitation. Implants insertion via palatal approach (PA), in combination with relatively minimally invasive techniques aimed at increasing bone volume without the use of autologous bone harvesting is a valid alternative among the options for the rehabilitation of the upper jaw.

CLINICAL CASE

In a 70-year-old female, with a severe maxillary atrophy, 6 spiral taper implants were placed with the PA, combined with the bilateral transcrestal elevation of both the sinus floors and nasal cavities; a further GBR, with resorbable pericardium membrane covering a termoplastic allograft associated to a xenograft, was performed. The second stage was performed after 6 months. Implant prosthetic functionalization was carried out in 4 months by placing the removable prosthesis in direct contact with the healing cup screws. After that period the case was finalized with a hybrid prosthesis. Clinical and radiographic follow-ups were carried out at 6 months and at one year after prosthetic finalization, during which no pathological signs were recorded.

CONCLUSIONS

The PA implant insertion described by the Authors, combined with bone augmentation procedures, performed in the same stage, may represent a valid and reliable solution to rehabilitate maxillary edentulous patients.

[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Navarra, Gipuzkoa and La Rioja]

AIM

To evaluate the effectiveness and safety of fingolimod in clinical practice in Navarra, Gipuzkoa and La Rioja regions.

PATIENTS AND METHODS

We conducted a retrospective multi-centre study with recurrent multiple sclerosis patients treated with fingolimod, following the product data sheet. The following data were evaluated: annualised relapse rate (ARR), percentage of patients free from relapses, disability using the Expanded Disability Status Scale (EDSS) and the percentage of patients without gadolinium-enhancing lesions.

RESULTS

A total of 113 patients were treated with fingolimod: 6% were naive, and 58% and 35% were patients previously treated with an immunomodulator and natalizumab, respectively. Fingolimod lowered the ARR after the first (67%; 1 to 0.3; p < 0.0001) and second (89%; 1 to 0.1; p < 0.0001) years of treatment, and thus the number of patients free from relapses during the treatment increased. The baseline EDSS was 3 and after treatment with fingolimod was 2.5 in both years. The percentage of patients without gadolinium-enhancing lesions after the first year of treatment was 77%. Similar results were observed in naive patients and in those previously treated with an immunomodulator. In patients previously treated with natalizumab no changes were observed following the treatment.

CONCLUSIONS

The use of fingolimod in clinical practice showed an effectiveness similar to that observed in clinical trials. There were no changes in the ARR after changing from natalizumab, and only one patient presented a 'relapse' after withdrawal of natalizumab. Fingolimod acts like a safe drug, with scarce side effects and a low percentage of drop-outs.

LESSONS LEARNED FROM THE EURADOS SURVEY ON INDIVIDUAL MONITORING DATA AND INTERNAL DOSE ASSESSMENTS OF FOREIGNERS EXPOSED IN JAPAN FOLLOWING THE FUKUSHIMA DAIICHI NPP ACCIDENT

European Radiation Dosimetry Group e.V. (EURADOS) survey on individual monitoring data and dose assessment has been carried out for 550 foreigners returning home after being exposed in Japan to intakes of radionuclides (mainly (131)I, (132)I, (132)Te, (134)Cs and (137)Cs) as a consequence of the Fukushima Daiichi NPP accident. In vivo and in vitro measurements were performed in their respective countries at an early stage after that accident. Intakes of radionuclides were detected in 208 persons from Europe and Canada, but the committed effective dose E(50) was below the annual dose limit for the public (<1 mSv) in all the cases. Lessons learned from this EURADOS survey are presented here regarding not only internal dosimetry issues, but also the management of the emergency situation, the perception of the risk of health effects due to radiation and the communication with exposed persons who showed anxiety and lack of trust in monitoring data and dose assessments.

THE CHALLENGE OF CIEMAT INTERNAL DOSIMETRY SERVICE FOR ACCREDITATION ACCORDING TO ISO/IEC 17025 STANDARD, FOR IN VIVO AND IN VITRO MONITORING AND DOSE ASSESSMENT OF INTERNAL EXPOSURES

The accreditation of an Internal Dosimetry Service (IDS) according to ISO/IEC 17025 Standard is a challenge. The aim of this process is to guarantee the technical competence for the monitoring of radionuclides incorporated in the body and for the evaluation of the associated committed effective dose E(50). This publication describes the main accreditation issues addressed by CIEMAT IDS regarding all the procedures involving good practice in internal dosimetry, focussing in the difficulties to ensure the traceability in the whole process, the appropriate calculation of detection limit of measurement techniques, the validation of methods (monitoring and dose assessments), the description of all the uncertainty sources and the interpretation of monitoring data to evaluate the intake and the committed effective dose.

THE EURADOS-KIT TRAINING COURSE ON MONTE CARLO METHODS FOR THE CALIBRATION OF BODY COUNTERS

Monte Carlo (MC) methods are numerical simulation techniques that can be used to extend the scope of calibrations performed in in vivo monitoring laboratories. These methods allow calibrations to be carried out for a much wider range of body shapes and sizes than would be feasible using physical phantoms. Unfortunately, nowadays, this powerful technique is still used mainly in research institutions only. In 2013, EURADOS and the in vivo monitoring laboratory of Karlsruhe Institute of Technology (KIT) organized a 3-d training course to disseminate knowledge on the application of MC methods for in vivo monitoring. It was intended as a hands-on course centered around an exercise which guided the participants step by step through the calibration process using a simplified version of KIT's equipment. Only introductory lectures on in vivo monitoring and voxel models were given. The course was based on MC codes of the MCNP family, widespread in the community. The strong involvement of the participants and the working atmosphere in the classroom as well as the formal evaluation of the course showed that the approach chosen was appropriate. Participants liked the hands-on approach and the extensive course materials on the exercise.

TECHNICAL RECOMMENDATIONS FOR MONITORING INDIVIDUALS FOR OCCUPATIONAL INTAKES OF RADIONUCLIDES

The TECHREC project, funded by the European Commission, will provide Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides It is expected that the document will be published by the European Commission as a report in its Radiation Protection Series during 2016. The project is coordinated by the European Radiation Dosimetry Group (EURADOS) and is being carried out by members of EURADOS Working Group 7 (Internal Dosimetry). This paper describes the aims and purpose of the Technical Recommendations, and explains how the project is organised.

EURADOS-IDEAS GUIDELINES (VERSION 2) FOR THE ESTIMATION OF COMMITTED DOSES FROM INCORPORATION MONITORING DATA

Dose assessment after intakes of radionuclides requires application of biokinetic and dosimetric models and assumptions about factors influencing the final result. In 2006, a document giving guidance for such assessment was published, commonly referred to as the IDEAS Guidelines. Following its publication, a working group within the European networks CONRAD and EURADOS was established to improve and update the IDEAS Guidelines. This work resulted in Version 2 of the IDEAS Guidelines, which was published in 2013 in the form of a EURADOS report. The general structure of the original document was maintained; however, new procedures were included, e.g. the direct dose assessment method for (3)H or special procedure for wound cases applying the NCRP wound model. In addition, information was updated and expanded, e.g. data on dietary excretion of U, Th, Ra and Po for urine and faeces or typical and achievable values for detection limits for different bioassay measurement techniques.

A prospective evaluation of outcomes of two tapered implant systems

The purpose of this prospective clinical study was to evaluate survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around the implant neck) of two tapered implant systems. Both systems were equipped with a tapered connection, one requiring bone-level (BL) placement, while the other required soft-tissue-level (STL) placement. In the period between January 1996 and October 2011, 133 fixtures were inserted, 90 in females and 43 in males, with a mean age of 60±11 years. The mean post-surgical follow-up was 64±38 months. Several clinical parameters were evaluated as potential outcome conditioners. An SPSS program was used for statistical analysis and a Cox analysis was performed. The SVR was 100% since no fixtures were lost. SCR, expressed through the mean marginal bone loss, was 88%. No significant differences were found, for most of the variables investigated with the exception of bone grafting and implant type: STL implants showed a better clinical outcome than BL implants when bone grafting was performed simultaneously with implant placement. Tapered implants are reliable devices for oral rehabilitation of jaws.

Retrospective study on bone-level and soft-tissue-level cylindrical implants

The purpose of this prospective clinical study was to evaluate the survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around implant neck) of two cylindrical implant systems. Both systems were equipped with a tapered connection, one requiring a bone-level (BL) placement, while the other a soft-tissue-level (STL) placement. In the period between January 1996 and October 2011, a total of 150 implants (76 in females and 74 in males, mean age 60±11 years) were inserted. The mean post-surgical follow-up was 84±47 months. Several parameters were evaluated as potential outcome conditioners: age, gender, diabetes, smoking, periodontitis, type of edentulism, replaced tooth, jaw location (i.e. maxilla or mandible), bone graft, immediate loading, post-extractive, type of prosthesis, implant diameter and length. An SPSS program was used for statistical analysis. Only two fixtures were lost, therefore SVR was 98.7%. SCR, expressed through the mean marginal bone loss, was 92%. The mean peri-implant bone loss was 0.121.47 mm for BL implants and 0.041.3 mm for STL implants. None of the studied variables had a statistical significant impact on SVR or SCR. Cylindrical implants are reliable for oral rehabilitation.

Guided bone regeneration in distal mandibular atrophy by means of a preformed titanium foil: a case series

The aim of this case series was to evaluate the clinical outcome of preformed titanium foil (PTF) to perform guided bone regeneration (GBR) in posterior mandibular atrophies. Thirteen patients (4 male; 9 female; mean age 58.85±10.16 years), with class II division C atrophy, according to Misch, were selected to perform GBR by means of PTF, using a moldable allograft paste as graft material. The devices, made of a 0.2mm thick pure titanium foil, were pre-shaped using stereolithographic models obtained from CT-scan of the patients’ recipient sites. In the second stage, performed at 6.35±2.15 months, 23 cylindrical two-piece implants were placed and the devices removed. At four months, the implants were exposed and submitted to progressive prosthetic load for a span of 4 months. The cases were finalized by means of metal-ceramic cementable restorations. The post finalization follow-up was at 12 months. Survival rate (i.e. SVR) was 100% since no fixtures were lost. At the one-year follow up, the clinical appearance of the soft tissues was optimal and no pathological signs on probing were recorded. The success rate (i.e. SCR) was 82.6% and the average peri-implant bone reabsorption was 0.99±0.59 mm. The results suggest good potentialities of this method for bone volume augmentation in distal mandibular atrophies, allowing to maximize the outcome and simplifying the surgical phase.

Clinical outcome of a two-piece implant system with an internal hexagonal connection: a prospective study

The purpose of this prospective clinical study was to evaluate the survival rate (SVR - i.e. fixtures still in place at the end of the observation period) and success rate (SCR - i.e. bone resorption around implant neck) of an implant system characterized by cylindrical and tapered implants, both provided with an internal hexagonal connection. In the period between January 1996 and October 2011, 52 implants with internal hexagonal connection were inserted in 21 females and 31 males, mean age 54±11 years. The mean post-surgical follow-up was 44.6±34.4 months. Several parameters were evaluated as potential outcome conditioners: age, gender, smoking, replaced tooth, periodontal disease, fixture shape (i.e. cylindrical or tapered), jaw location (i.e. maxilla or mandible), bone graft, immediate loading, post-extractive placement, type of prosthesis (i.e. single crown or bridge), edentulism, implant diameter and length. An SPSS statistical program was used and Cox regression analysis performed. SVR was 100% since no fixtures were lost. SCR, expressed through the mean marginal bone loss, was 77%. No significant differences were found, for most of the parameters analyzed, with the exception of prosthetic bridges, where implants supporting this type of rehabilitation showed a worse clinical outcome in comparison to single crown rehabilitations. Internal hexagonal connection is a reliable tool for oral rehabilitation.

Modified connective tissue punch technique to increase the vestibular/buccal keratinized tissue on flapless implant surgery: a case series

The aim of this article is to show a simple and predictable technique to enhance both the vestibular/buccal (V/B) gingival thickness (GT) and keratinized tissue width (KTW) improving the soft-tissue profile after flapless implant placement. The technique proposed was named Modified Connective Tissue Punch (MCTP). Fourteen patients (6 men and 8 women) aged between 35 and 69 years (mean value 48.07±13.023 years) were enrolled in this case series. Seventeen implant sites were submitted to flapless procedure. The connective punch (CP) was harvested with a motor-driven circular tissue punch and then a full-split dissection was executed, in order to create a deep pouch, beyond the mucogingival junction, on the V/B side. In this recipient site the CP was placed. The normal flapless surgical protocol was used; implants were inserted and covered with transgingival healing cap screws. GT and KTW were measured: both immediately before and after surgery; at the time of the prosthetic finalization (3-4months, respectively, for mandible and maxilla); 1 year post surgery follow-up. GT was measured at 1 mm, 2 mm and 5 mm on the V/B side, from the outline of the punch. Both KTW and GT at 1 and 2 mm can be effectively increased, while no significant effects for GT at 5 mm can be expected from this technique. Furthermore, the mean values of KTW and GT at 1 mm and 2 mm show significant increases at 3-4 months post-operative, while no further significant increments are shown at 1 year post-operative follow-up. The Authors recommend the use of the MCTP technique to reduce the number of aesthetic complications and soft tissue defects in flapless implant surgery. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time.

Clinical outcome of 215 transmucosal implants with a conical connection: a retrospective study after 5-year follow-up

The purpose of this retrospective clinical study was to evaluate the survival rate (i.e. SVR – fixtures still in place at the end of the observation period) and success rate (i.e. SCR - bone resorption around implant neck) of an implant system characterized by cylindrical and tapered implants, both types of implant being equipped with a conical connection with an internal octagon (COC), both implant types having a 1.8 mm smooth neck, positioned above the bone crest level. A total of 65 subjects received 215 COCs between January 1996 and October 2011. All COCs were placed and restored by three experienced dental surgeons. The mean follow-up was 84±44 months. The patients involved in the study were both male (30) and female (35), of whom 30 were smokers (less than 20 cigarettes/day) and none was diabetic. The implants differed in terms of diameter and length, and were inserted both in the mandible (97) and in the maxilla (118). Sixty-seven implants were single tooth rehabilitations, and 148 prosthetic bridges. Fourteen had guided bone regeneration (GBR), and 10 were placed in post-extractive sites. Forty of the implants were provided with passing-screw abutments and 175 with full-screw abutments. The data were analyzed using descriptive statistics. None of the implants failed before prosthetic restoration, resulting in an SVR=100% after loading. The radiographic and clinical data revealed well-maintained, hard and soft tissue around the COCs, with an SCR=92.6%. Cox regression analyses did not detect any variables with statistical impact on the clinical outcome. In conclusion, Shiner XT implants are reliable tools for oral rehabilitation.

Maxillary sinus by-pass with tilted implants via tapered-screw bone expanders in low density bone: one year follow -up of a case series

In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors named the procedure: Tilted Implant Expansion Osteotomy (TIEO). Fifteen patients (10 females and 5 males, mean age 47.8±8.15 years) with distal edentulous maxillae were enrolled in this study. For each edentulous site 2 implants were placed, the anterior implant in the area of the most anterior missing tooth while, the posterior implant, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 34 cylindrical two-piece implants were placed, 17 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 4-6 months, the second stage surgery was performed. The cases were finalized by metal-ceramic cementable restorations with a variable number of elements, from 2 to 4, without any cantilever element. The post finalization follow-up was at 12 months. Survival rate was 100% since no fixtures were lost. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for oral rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

Guided bone regeneration by means of a preformed titanium foil: A case of severe atrophy of edentulous posterior mandible

The aim of this case report was to evaluate the potential of preformed titanium foil (PTF) as membrane, used together with a mouldable allograft paste, for guided bone regeneration in a case of severe mandibular posterior atrophy involving the alveolar nerve. In order to create a rigid barrier to the competitive growth of soft tissues and a stable volume for the colonization of the osteoprogenitor cells, a foil of pure titanium was pre-shaped by means of a stereolithographic model, obtained from a CT-scan of the patient. This procedure showed promising results, allowing to maximize the outcome and simplifying the surgical phase.

The use of resorbable heterologous cortical lamina as a new sinus lift floor: a technical note

Some graft materials such as a heterologous porcine cortical lamina have an excellent capacity in creating recipient sites that can be filled with cortico-spongious collagenated bone paste that reabsorbs, allowing for the reformation of good-quality bone. In this work a technique is proposed which makes use of resorbable cortical lamina in order to create a new sinus floor that can be filled with cortico-spongious bone paste. The adequate vascularisation of the graft combined with the integration of the lamina, which does not need to be removed, makes it possible to propose this technique as a potential alternative to those used so far.

Endoscopically controlled hydraulic sinus lift in combination with rotary instruments: one-year follow-up of a case series

The aim of this study was to evaluate a sinus lift via crestal approach (SLVCA) case series, performed with rotary instruments and hydraulic pressure, analyzed under endoscopic control. Sixteen patients (11 female, 5 male, mean age 47.13±8.07 years) candidates for SLVCA were enrolled in this study. Twenty-two cylindrical two-piece implants were placed. After a suitable period of time needed for the consolidation of the graft (mean value 5.78±1.49 months), the bone augmentation was assessed by means of intraoral X-ray exams before the surgical procedure of re-entry. After a functional load with temporary acrylic fixed prosthesis, on Peek abutments, for a span of 4 months, the cases were finalized with cemented metal-ceramic prosthesis (10 single crowns, 6 bridges). The post finalization follow-up was at 12 months. During the perforation of the sinus floor via rotary instruments no perforations of the sinus membrane were observed either during the hydraulic detachment or simultaneous filling of the subantral space with the graft material. Survival rate was 94.5% since one fixture was lost, but immediately replaced with a new one. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. The SLVCA performed with rotary instruments and hydraulic pressure is a reliable grafting procedure for oral rehabilitation of maxillary edentulous sites.

The influence of “conical plus octagonal” internal connection on implant survival and success rate: a retrospective study of 66 fixtures

Implant oral rehabilitation has become one of the most successful dentistry techniques over the last 30 years. However, peri-implantitis is the most important complication in implant dentistry. Peri-implantits can be caused by inadequate implant-abutment connections (IAC). The aim of our study is to evaluate the influence of “conical plus octagonal” (i.e. I-Fix connection) on implant survival and success rate. All the implants included in this study were of a completely new type (I-Fix implants and abutments by FMD Falappa Medical Devices S.p.A. Rome, Italy). Sixty-six implants were inserted in males and females. The implants were of different diameters and lengths, inserted both in the mandible and in the maxilla with immediate or delayed loading, with guided bone regeneration (GBR), and post-extractive surgery. All implants were provided with I-Fix connection, 64 abutments using passing screws and 2 using full screws. None of the 66 implants were lost (i.e. survival rate - SVR = 100%). Cox-regression analysis demonstrated that diabetes (p=0.0074), GBR (p=0.0115), maxilla (p=0.0117) and smoking (p=0.0194) have a statistical significant impact on clinical outcome (i.e. greater bone resorption around implant neck). Our data show that I-Fix connection did not influence SVR. This finding demonstrates that I-Fix design seemed to significantly affect the survival rate of the implants in a recent meta-analysis. In spite of the limits of our study, I-Fix connection has been demonstrated to be efficient in closing the gap between implant and abutment and maintaining a good connection over time.

The use of resorbable cortical lamina and micronized collagenated bone in the regeneration of atrophic crestal ridges: a surgical technique. Case series

Some graft materials, such as micronized and collagenated bone, have an excellent capacity to be reabsorbed, allowing for the reformation of good-quality bone, but do not have the mechanical characteristics that would allow for stability in terms of shape and size. In this study, a technique is proposed which makes use of resorbable cortical lamina in order to create recipient sites that can be filled with micronized collagenated bone paste. The adequate vascularization of the graft combined with the integration of the lamina, which does not need to be removed, makes it possible to propose this technique as a potential alternative to those used to date.

Prevention of bacterial leakage at implant-abutment connection level: an in vitro study of the efficacy of three different implant systems

Peri-implantitis is the main cause of implant failures. Peri-implantitis is provoked by the presence of bacterial infiltration around Implant-Abutment Connection (IAC). Reduction of bacterial leakage may be achieved by improving the accuracy and precision of the two pieces of IAC. The aim of the present in vitro study was to evaluate bacterial microleakage from the inside to the outside of the IAC, testing the efficacy of three new designs of internal conical connection (FN - nano-fix -, NQ - uNiQo - and Elisir implant systems by FMD, Rome, Italy). To identify the efficacy of three new IAC, the passage of genetically modified Escherichia coli across IAC was evaluated. A total of 17 implants were used (5 FN, 6 NQ and 6 Elisir). All implants were immerged in a bacterial culture for 48 h and bacteria amount was then measured inside and outside IAC with Real-time PCR. Bacterial quantification was performed by Real-Time Polymerase Chain Reaction using the absolute quantification with the standard curve method. In all the tested implants, bacteria were found in the inner side, with a median percentage of 1.9% FN, 1.4% NQ and 2.6% Elisir. The analysis revealed that in both cases (internally and externally), bacteria grew in the first 48 hours but subsequently started to die, probably due to nutrient consumption. Of the three, the most efficacious connection was NQ. Within the limitations of this study, it was concluded that the best implant connection reducing bacterial leakage al IAC level was NQ (NQ implant system by FMD, Rome, Italy).