Indications and Frequency for the Use of Cone Beam Computed Tomography for Implant Treatment Planning in a Specialty Clinic

PURPOSE To analyze the indications and frequency for three-dimensional (3D) imaging for implant treatment planning in a pool of patients referred to a specialty clinic over a 3-year period. MATERIALS AND METHODS All patients who received dental implants between 2008 and 2010 at the Department of Oral Surgery and Stomatology at the University of Bern were included in the study. The influence of age, gender, and time of treatment (2008 to 2010) on the frequency of use of two-dimensional (2D) radiographic imaging modalities alone or in combination with 3D cone beam computed tomography (CBCT) scans was analyzed. Furthermore, the influence of the indication, location, and need for bone augmentation on the frequency of use of 2D imaging modalities alone or in combination with CBCT was evaluated. RESULTS In all, 1,568 patients (792 women and 776 men) received 2,279 implants. Overall, 633 patients (40.4%) were analyzed with 2D imaging procedures alone. CBCT was performed in 935 patients (59.6%). There was a statistically significant increase in CBCT between 2008 and 2010. Patients older than 55 years received a CBCT scan in addition to 2D radiographic imaging statistically significantly more often. Additional 3D imaging was most frequently performed in the posterior maxilla, whereas 2D radiographs alone exhibited the highest frequency in the anterior mandible. The combination of 2D with CBCT was used predominantly for implant placement with simultaneous or staged guided bone regeneration or sinus elevation. CONCLUSION Based on these findings from a specialty clinic, the use of additional CBCT imaging for implant treatment planning is influenced by the indication, location, local anatomy (including the need for bone augmentation), and the age of the patient.

The Perceived Prognosis of Endodontic Treatment and Implant Therapy Among Dental Practitioners

Little data concerning the perceived success of implant therapy in comparison with endodontic treatment exists. While the criteria used to measure the outcome of each modality are not the same, it is not clear if this is appreciated by practicing dentists. The purpose of the study was to evaluate the perceived outcome of implant therapy in comparison to endodontic treatment. A 23 question Web-based survey was distributed to 648 dentists who matriculated from the University of Connecticut School Of Dental Medicine over the past 30 years. The response rate was 47%. Sixty-seven percent of respondents were general dentists. Forty-nine percent of respondents did not know different criteria exist in the literature and are used to evaluate implant and root canal treatment. Fifty-four percent of dentists felt the prognosis of implant therapy was the same as or better than endodontic treatment of teeth with vital pulps. Thirty percent of responders thought root canal treatment of teeth with necrotic pulp was superior to implants and only 16% thought retreatment was preferable. Treatment planning for implant placement vs. retreatment of a restorable tooth was 46% and 32%, respectively. A third of the respondents felt that the role of endodontics will decline in the future. Dentists’ primary source of information regarding implant therapy was continuing education; however, their primary source of information regarding endodontic treatment was their dental program. Dentists felt the prognosis of implant therapy was as good or superior to endodontic treatment of teeth with vital, necrotic or previously treated pulps.

Fibrilación auricular y terapéutica anticoagulante

La fibrilación auricular es la taquiarritmia más frecuente en la población general. La frecuencia de dicha arritmia aumenta con la edad, presentándose en un 1.5% de los 50 a 59 años a 8-10% de los 80 a 89 años. La fibrilación auricular incrementa el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico en 5 veces y causa el 15% de todos los accidentes cerebrovasculares isquémicos. El manejo de la fibrilación auricular se enfoca, principalmente, en la prevención de los fenómenos tromboembólicos y en el control de la frecuencia y ritmo cardiaco. La anticoagulación, ha demostrado ser la principal herramienta en la prevención de eventos cardioembólicos. Aunque las complicaciones hemorrágicas por el tratamiento son esperables, y aumentan con la edad, sobrepasa por mucho, el beneficio de usar anticoagulación, al riesgo de sangrados. Precisamente debido a la heterogeneidad clínica de esta arritmia y a la dificultad de establecer un tratamiento adecuado para cada caso en particular, el American College of Cardiology, la American Heart Association, la European Society of Cardiology y el American College of Chest Physicians han establecido unas guías para mejorar el manejo de los pacientes. La revisión de esta patología y de estas directrices propuestas pueden facilitar y mejorar notablemente el tratamiento de los pacientes con fibrilación auricular.

Fixed Mydriatic Pupil Associated with an Intraocular Pressure Rise as a Complication of the Implant of a Phakic Refractive Lens (PRL)

We describe a case report of a patient that was implanted with a posterior chamber phakic intraocular lens (Phakic Refractive Lens, PRL) for the correction of moderate myopia and who developed postoperatively a fixed mydriasis compatible with an Urrets-Zavalia Syndrome (UZS). Specifically, a sudden acute increase of IOP in the left eye was observed in the immediate postoperative period. After IOP stabilization, the refractive result was good, but a fixed and mydriatic pupil appeared. This condition led the patient to experience visual discomfort, halos, and glare associated with high levels of higher-order aberrations in spite of the good visual result. A tinted-contact lens was fitted in order to minimize those symptoms. The UZS should be considered as a possible complication after implantation of posterior chamber phakic intraocular lenses.

Os inibidores orais do fator Xa na prevenção de eventos cerebrovasculares em doentes com fibrilhação auricular não-reumática

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Applying scanning electron microscopy for the ultrastructural and clinical analysis of periprosthetic capsules in implant-based breast reconstruction

La reconstruction en deux étapes par expanseur et implant est la technique la plus répandue pour la reconstruction mammmaire post mastectomie. La formation d’une capsule périprothétique est une réponse physiologique universelle à tout corps étranger présent dans le corps humain; par contre, la formation d’une capsule pathologique mène souvent à des complications et par conséquent à des résultats esthétiques sous-optimaux. Le microscope électronique à balayage (MEB) est un outil puissant qui permet d’effectuer une évaluation sans pareille de la topographie ultrastructurelle de spécimens. Le premier objectif de cette thèse est de comparer le MEB conventionnel (Hi-Vac) à une technologie plus récente, soit le MEB environnemental (ESEM), afin de déterminer si cette dernière mène à une évaluation supérieure des tissus capsulaires du sein. Le deuxième objectif est d‘appliquer la modalité de MEB supérieure et d’étudier les modifications ultrastructurelles des capsules périprothétiques chez les femmes subissant différents protocoles d’expansion de tissus dans le contexte de reconstruction mammaire prothétique. Deux études prospectives ont été réalisées afin de répondre à nos objectifs de recherche. Dix patientes ont été incluses dans la première, et 48 dans la seconde. La modalité Hi-Vac s’est avérée supérieure pour l’analyse compréhensive de tissus capsulaires mammaires. En employant le mode Hi-Vac dans notre protocole de recherche établi, un relief 3-D plus prononcé à été observé autour des expanseurs BIOCELL® dans le groupe d’approche d’intervention retardée (6 semaines). Des changements significatifs n’ont pas été observés au niveau des capsules SILTEX® dans les groupes d’approche d’intervention précoce (2 semaines) ni retardée.

Does immediate loading affect clinical and patient-centered outcomes of mandibular 2-unsplinted-implant overdenture? : a 2-year within-case analysis

Objective To provide 2-year clinical- and patient-oriented data with regard to mandibular overdenture assisted by 2 immediately loaded unsplinted implants. Material and methods In this pre-post design, Phase-I clinical trial, 18 edentate individuals (62.4 ± 7.7 years) received a new set of complete denture. Then, following standard procedures, 3 threaded implants (OsseoSpeed TX™, Dentsply Implants, Mölndal, Sweden) were placed in the mandible in each patient, and locator abutments (Zest Anchors LLC, Escondido, U.S.A.) were inserted on the right and left side implants. The midline implant served as a control for within-patient comparison. The immediate loading was conducted within 24 h of surgery. Data were collected at baseline (T0), 12 (T1) and 24 (T2) months after immediate loading. The clinical outcomes included implant survival rate, crestal bone level changes and implant stability. These criteria were assessed through clinical and radiographic examinations as well as resonance frequency analysis. Patient-centered outcomes included patient satisfaction and oral health-related quality of life measured using validated questionnaires. Brunner-Langer approach was used for statistical analysis. Results Implant survival rate for immediate loaded implants was 91.7% at 2-year follow-up. None of the unloaded implants failed. There was no statistically significant difference at baseline and follow-ups with regard to clinical outcomes between loaded and unloaded implants. Patient satisfaction and quality of life improved (p < 0.0001) from baseline to 2-year follow-up. Conclusion Immediate loading protocol did not negatively affect clinical outcomes, satisfaction and quality of life of patients wearing 2-unsplinted-implant mandibular overdenture for 2 years. This conclusion requires confirmation by randomized control trials. Clinical significance statement Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

Oral bacterial microflora associated with total acrylic dentures: implant supported vs mucus supported

Poster presented at the 1st International Congress of CiiEM - From Basic Sciences to Clinical Research. 27-28 November 2015, Egas Moniz, Caparica, Portugal.

Oral fungal microflora associated with implant-supported VS. mucous-supported dentures

Poster presented at the 1st International Congress of CiiEM - From Basic Sciences to Clinical Research, 27-28 November 2015, Egas Moniz, Caparica, Portugal.

Benefícios clínicos da terapia de ressincronização cardíaca em pacientes com insuficiência cardíaca e fibrilhação auricular

Objetivo: Verificar se os benefícios da TRC nos pacientes em FA são semelhantes aos benefícios nos pacientes em RS. População e Métodos: Estudaram-se 397 pacientes (137 em FA e 260 em RS), com ICC refratária à terapêutica médica, nos quais foi implantado um sistema para TRC, em 4 centros distintos. Incluíram-se os pacientes que, antes do procedimento, apresentavam FEVE ≤ 35% e perturbação da condução, com um QRS≥ 120ms e estivessem em Classe NYHA II a IV. Foram recolhidos os dados relativos às diversas características clínicas, eletrocardiográficas e ecocardiográficas dos pacientes antes da implantação e após o período de seguimento. Registaram-se ainda o número de internamentos por descompensação de IC, mortes e de MACE, ocorridos no período de seguimento. Avaliou-se a ocorrência de resposta ecocardiográfica e clínica (melhoria ≥ 1 classe NYHA). Resultados: Ambos os grupos apresentaram melhorias significativas e comparáveis a nível ecocardiográfico na remodelagem inversa e função ventricular e a nível clínico na classe funcional NYHA. Os pacientes com RS apresentaram redução significativa nos internamentos e maior sobrevida. Nos pacientes em FA, observou-se uma maior ocorrência de MACE. Quando se procedeu a ablação NAV nos pacientes em FA, obteve-se uma sobrevida para mortalidade total comparável à do RS. Por análise univariada, a presença de FA, a ausência de ablação NAV, género masculino, história familiar de morte súbita são preditores de mortalidade total e MACE. A história familiar de morte súbita e a HTP foram preditores de morte cardíaca. Na análise multivariada, apenas a idade, presença de FA, FEVE e NYHA pós-TRC foram preditores de mortalidade total. Os preditores de mortalidade cardíaca foram a FEVE, NYHA e diâmetro TD do VE pós-TRC. A FEVE e o diâmetro e volumes telesistólicos após a TRC revelaram-se capazes de predizer a resposta clínica pela melhoria da classe funcional NYHA Conclusão: Os pacientes em FA submetidos a TRC têm uma sobrevida semelhante aos pacientes em RS, se forem submetidos a ablação NAV. Porém, os benefícios na capacidade funcional e a nível ecocardiográfico são semelhantes aos pacientes em RS, independentemente da preseça da ablação NAV.