Análise do levantamento de seio maxilar, pela técnica da janela lateral, para colocação de implantes dentários

Introduction: Edentulism is a condition characterized by the partial or total absence of teeth in a person and this reality is still considered significant in the current Brazilian population. This condition impacts the oral health, quality of life and general well-being of those affected. Oral rehabilitation through dental implants has emerged as an effective option for restoring masticatory function and aesthetics in edentulous patients. There are some situations in which, in order to install implants in the posterior region of the maxilla, it is necessary to lift the maxillary sinus, by creating a lateral opening in its bone wall, thus allowing precise surgical access to elevate the sinus membrane, creating an environment conducive to the safe installation of dental implants. The procedure involves elevating the sinus membrane to a more superior position, allowing the creation of a suitable space for the placement of bone grafts. Objective: This study aims to analyze the clinical applications of the lateral window technique for lifting the maxillary sinus and placing implants, with the aim of highlighting its specific indications, contraindications, and types of grafts used. Methodology: This is a literature review, based on scientific articles found in the PubMed/Medline, Virtual Health Library and SciELO databases. The search for articles was carried out using the descriptors: “Maxillary Sinus Floor Survey”, “Edentulous Maxilla”, “Dental Implants”, and as inclusion criteria original articles, literature reviews and case reports were used, in Portuguese, English and Spanish, published between 2008 and 2023. Results: It was observed that the technique described consists of creating a bone window in the lateral wall of the maxillary sinus, to create a bone height of the alveolar ridge. Within its clinical indications, it presents excellent results. An in-depth understanding of anatomy, combined with surgical skills and the use of advanced biomaterials, contribute to the long-term success of this technique, providing patients with a safe and effective option for oral rehabilitation. Final considerations: Maxillary sinus lifting using the lateral window technique is a valuable tool for bone correction, used in implant dentistry, offering effective solutions for patients with bone loss in the posterior region of the maxilla, requiring the dentist to have a deep knowledge of anatomy.Introdução: O edentulismo é uma condição caracterizada pela ausência parcial ou total de dentes em uma pessoa e essa realidade ainda é considerada significativa na atual população brasileira. Essa condição impacta a saúde bucal, qualidade de vida e o bem-estar geral dos acometidos. A reabilitação oral, por meio de implantes dentários tem se destacado como uma opção eficaz para restaurar a função mastigatória e a estética em pacientes desdentados. Existem algumas situações em que para a instalação de implantes na região posterior da maxila se faz necessário o levantamento do seio maxilar, através da criação de uma abertura lateral na sua parede óssea, permitindo assim um acesso cirúrgico preciso para a elevação da membrana sinusal, criando um ambiente propício para a instalação segura dos implantes dentários. O procedimento envolve a elevação da membrana sinusal para uma posição mais superior, permitindo a criação de um espaço adequado para a colocação de enxertos ósseos. Objetivo: Este estudo tem como objetivo analisar as aplicações clínicas da técnica da janela lateral para levantamento do seio maxilar e colocação de implantes, com o intuito de destacar suas indicações específicas, contraindicações, e tipos de enxertos utilizados. Metodologia: Trata-se de uma revisão de literatura, baseada em artigos científicos encontrados nas bases de dados PubMed/Medline, Biblioteca Virtual em Saúde e SciELO. A busca por artigos foi realizada utilizando os descritores: “Levantamento do Assoalho do Seio Maxilar”, “Maxila Edêntula”, “Implantes Dentários”, e como critérios de inclusão foram utilizados artigos originais, revisões de literatura e relatos de caso, em português, inglês e espanhol, publicados entre 2008 e 2023. Resultados: Observou-se que a técnica descrita consiste na confecção de uma janela óssea na parede lateral do seio maxilar, para confecção de altura óssea do rebordo alveolar. Dentro de suas indicações clínicas, apresenta ótimos resultados. A compreensão aprofundada da anatomia, aliada a habilidades cirúrgicas e o uso de biomateriais avançados, contribuem para o sucesso a longo prazo dessa técnica, proporcionando aos pacientes uma opção segura e eficaz para a reabilitação oral. Considerações finais: O levantamento de seio maxilar pela técnica da janela lateral é uma ferramenta valiosa para correção óssea, utilizada na implantodontia, oferecendo soluções eficazes para pacientes com perda óssea na região posterior da maxila, sendo necessário ao cirurgião-dentista um profundo conhecimento da anatomia. &nbsp

O uso da laserterapia no tratamento de parestesia do nervo alveolar inferior pós extração de terceiros molares

Introdução: A cirurgia de terceiros molares é uma prática comum na rotina clínica do cirurgião dentista, desempenhando um papel crucial na prevenção de alterações associadas à erupção desses dentes. Na intervenção cirúrgica existem riscos potenciais, como a parestesia do nervo alveolar inferior, que se trata de uma alteração da resposta nervosa, causada por uma lesão iatrogênica no nervo, levando o paciente a sentir a sensação de formigamento, calor, frio, dormência ou perda de sensibilidade na área afetada. Visando reverter esse quadro, a utilização da laserterapia tem se destacado como uma abordagem promissora no tratamento da parestesia do nervo alveolar inferior, devido ao seu efeito biomodulador. Esse recurso terapêutico atua como uma abordagem não invasiva, que envolve o uso de luz laser de baixa intensidade para estimular processos biológicos, com o intuito de reduzir a inflamação, promover a regeneração nervosa e melhorar a circulação sanguínea na área afetada, por meio da formação de novos vasos sanguíneos. Objetivo: Este estudo tem como objetivo analisar o uso da laserterapia de baixa intensidade na melhora dos pacientes submetidos a cirurgia de exodontia dos terceiros molares, quanto a sua resposta acentuada na regeneração do nervo alveolar inferior, destacando seus benefícios e aplicabilidade clínica. Metodologia: Trata-se de uma pesquisa bibliográfica exploratória de caráter descritivo realizada por meio das bases de dados PubMed/Medline, Biblioteca Virtual em Saúde e SciELO. A procura por artigos foi realizada fazendo uso dos descritores: “Terapia a Laser”, “Parestesia”, “Nervo Alveolar Inferior” e “Terceiro Molar” e como critérios de inclusão foram selecionados artigos originais, revisões de literatura e relatos de caso, em português, inglês e espanhol, sem levar em consideração os períodos de publicação. Resultados: Observou-se que o uso da luz laser, dentro de suas indicações clinicas e alinhado ao diagnóstico precoce, são determinantes para o prognóstico da lesão. A eficácia da laserterapia no tratamento da parestesia pode variar de acordo com a gravidade da lesão. Com isso, é fundamental a compreensão por parte do cirurgião-dentista a respeito dos pontos de aplicação da luz, tempo de exposição e o comprimento de onda corretos. Esses fatores contribuem para o sucesso do tratamento, proporcionando, aos pacientes uma opção segura e eficaz de intervenção para reparação do nervo afetado. Considerações finais: Apesar da ausência de protocolo para uso da laserterapia, seu uso emerge como uma ferramenta terapêutica promissora no tratamento de parestesia, representando uma abordagem inovadora e eficaz para melhorar a qualidade de vida dos pacientes afetados por essa condição, com recuperação mais rápida aos estímulos sensitivos e mecânicos, sem efeitos adversos ao paciente

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundRegular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.FindingsThe leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.InterpretationLong-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London