Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study

PURPOSE: Graft maturation in the maxillary sinus requires adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls: the aim of this study was to analyze the correlation between sinus cavity dimensions and new bone formation after transcrestal sinus floor elevation (tSFE). METHODS: Patients needing maxillary sinus augmentation (residual crest height 64 4 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in the implant insertion sites. Buccopalatal sinus width (SW) was evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of linear regression analysis. RESULTS: Eight consecutive patients underwent tSFE procedures: at 6 months, average percentage of newly formed bone resulted 24.2% \ub1 7.9%. Statistical analysis showed a strong inverse correlation between SW and new bone formation (R = 0.88), and a strong direct correlation between the number of exposed bone walls and new bone formation (R = 0.82). CONCLUSION: Within the limitations of this proof-of-concept study, in which a restricted number of patients were analyzed, tSFE showed more predictable results in narrow than in large sinuses, in terms of new bone formation

Parotid Gland Edema After Chlorhexidine Mouthrinse: Case Report and Literature Review

Introduction: Parotid gland swelling, caused by many pathological conditions, has also been reported to be a possible side effect of the use of chlorhexidine mouthwash. This adverse reaction to chlorhexidine mouthwash is, however, extremely rare and very few cases of parotid gland swelling due to chlorhexidine mouthwash have been reported in the literature. Case Description: This report describes the clinical management of unilateral parotid swelling caused by chlorhexidine mouthwash. Methods: A patient presented with left parotid gland swelling after using chlorhexidine mouthwash for three days following sinus augmentation on the contralateral side of the maxilla. Diagnosis of parotid gland swelling due to rinsing with chlorhexidine was formulated after anamnesis, clinical examination, radiographs and ultrasound of the gland excluded other pathological conditions. The patient was subsequently advised to stop rinsing. However, on the evening of the same day, swelling increased and the patient presented to an emergency department where a single intravenous dose of methylprednisolone was administered. Results: After seven days, parotid swelling decreased significantly and after three weeks had completely disappeared. Conclusion: Although unilateral or bilateral parotid gland swelling related to the use of chlorhexidine mouthwash is an uncommon adverse event, it must be suspected after other organic or infective conditions have been excluded. The precise pathogenic mechanism has not yet been determined and further studies should be carried out to better understand the pathophysiology of this uncommon phenomenon

Mercado de Bens Simbólicos do Futebol: A Estratégia Empreendedora da Gestão Andrés Sanchez no Sport Club Corinthians Paulista

O crescimento do mercado de bens simbólicos se tornou realidade em todos os continentes. Particularmente, o futebol, desde a Copa do Mundo de 1990, passou por crescimento financeiro incomum. A exploração da paixão dos torcedores/consumidores pelo futebol e por seus respectivos clubes transformou-se em grande atividade comercial e de prestação de serviços, após o advento da Lei Pelé em março de 1998. Consequentemente, os clubes deixaram de ser meras agremiações esportivas e se tornaram grandes organizações, responsáveis por oferecer um produto atraente e cada vez mais rentável. A estratégia empreendedora da gestão de Andrés Sanchez possibilitou ao Sport Club Corinthians Paulista, em 2012, alcançar o primeiro lugar de empresa no futebol brasileiro e a sexta colocação no cenário mundial. Por meio de pesquisa exploratória de natureza qualitativa, ex-post factum, acompanhada de entrevista em profundidade com gestores participantes do empreendimento e membros da torcida organizada, o objetivo central da pesquisa, na perspectiva fenomenológica, buscou identificar as estratégias empregadas na Gestão Andrés Sanchez para a valorização da marca. Os resultados da pesquisa apontam para a integração das estratégias funcionais com a estratégia dos negócios. Na percepção dos entrevistados, a visão empreendedora permitiu ao clube, em quatro anos (2008-2011), formar a base de seu acelerado crescimento para, posteriormente, alcançar posicionamento diferenciado e, consequentemente, vantagem competitiva sustentável.DOI: 10.5585/podium.v2i1.3

Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study

Objectives: The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs). Materials and methods: Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups. Results: Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425). Conclusions: DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant. Clinical relevance: Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature

Micromorphometric analysis of bone blocks harvested with eight different ultrasonic and sonic devices for osseous surgery

OBJECTIVES: The aim of this study was to analyse in vitro the main features of osteotomies performed by means of different ultrasonic and sonic systems for bone surgery. MATERIALS AND METHODS: Six ultrasonic and two sonic devices for osseous surgery were evaluated during block harvesting on bovine bone. After measuring cutting speed, images of the blocks were acquired by light stereo-microscope and E-SEM, in order to measure the osteotomy thickness and to evaluate the presence of intra-trabecular bone debris and signs of thermal injuries on the bone. Roughness evaluation was performed using a profilometer. RESULTS: All the ultrasonic instruments required a shorter time than sonic systems to perform the block harvesting (p 0.05). K-Bisonic and Variosurg 3 showed the smallest percentage variance between tip thickness and osteotomy width. Intra-trabecular debris was found to occur in inverse proportion with the width of the osteotomy: the tighter the track, the higher the amount of debris. Sonicflex Bone, Piezotome 2 and Sonosurgery showed almost no signs of thermal injuries on the osteotomised surfaces. CONCLUSIONS: No single ultrasonic or sonic device combined all the best features of speed, precision and bone micro-architecture preservation

Ventricular arrhythmias in young competitive athletes: Prevalence, determinants, and underlying substrate

Whether ventricular arrhythmias (VAs) represent a feature of the adaptive changes of the athlete's heart remains elusive. We aimed to assess the prevalence, determinants, and underlying substrates of VAs in young competitive athletes.Background--Whether ventricular arrhythmias (VAs) represent a feature of the adaptive changes of the athlete's heart remains elusive. We aimed to assess the prevalence, determinants, and underlying substrates of VAs in young competitive athletes. Method and Results--We studied 288 competitive athletes (age range, 16-35 years; median age, 21 years) and 144 sedentary individuals matched for age and sex who underwent 12-lead 24-hour ambulatory electrocardiographic monitoring. VAs were evaluated in terms of number, complexity (ie, couplet, triplet, or nonsustained ventricular tachycardia), exercise inducibility, and morphologic features. Twenty-eight athletes (10%) and 13 sedentary individuals (11%) showed > 10 isolated premature ventricular beats (PVBs) or 651 complex VA (P=0.81). Athletes with > 10 isolated PVBs or 651 complex VA were older (median age, 26 versus 20 years; P=0.008) but did not differ with regard to type of sport, hours of training, and years of activity compared with the remaining athletes. All athletes with > 10 isolated PVBs or 651 complex VA had a normal echocardiographic examination; 17 of them showing > 500 isolated PVBs, exercise-induced PVBs, and/or complex VA underwent additional cardiac magnetic resonance, which demonstrated nonischemic left ventricular late gadolinium enhancement in 3 athletes with right bundle branch block PVBs morphologic features. Conclusions--The prevalence of > 10 isolated PVBs or 651 complex VA at 24-hour ambulatory electrocardiographic monitoring did not differ between young competitive athletes and sedentary individuals and was unrelated to type, intensity, and years of sports practice. An underlying myocardial substrate was uncommon and distinctively associated with right bundle branch block VA morphologic features

Aspergillus fumigatus biofilm formation on different bone substitutes used in maxillary sinus augmentation: an in vitro analysis

BACKGROUND: Fungus ball (FB) typically affects healthy adults, and Aspergillus fumigatus is the most frequent etiologic agent: iatrogenic factors represent an important issue in FB pathogenesis. Moreover, a recent study suggested a significant association between the use of anorganic bovine bone as sinus grafting material and subsequent development of FB. The aim of the present investigation is to evaluate in vitro eventual differences in the ability of Aspergillus fumigatus to colonize different bone grafting materials and grow on them as biofilm. FINDINGS: Five different bone substitutes (demineralized bone matrix, anorganic bovine bone, f-tricalcium phosphate, synthetic nano-hydroxyapatite, and synthetic hydroxyapatite), commonly used in sinus floor augmentation procedures, were inoculated with conidia suspensions of A. fumigatus and incubated at 37\u2009\ub0C for 4 and 8\u2009h, in standardized conditions. Biofilm bound to the different materials underwent quantitative and qualitative analysis by confocal and scanning electron microscopy. A. fumigatus proved to be able to adhere and form biofilm on all the tested bone substitutes. The surface plot representation of the samples displayed some differences in the density of the superficial layer, due to the physical characteristics of the biomaterials. Nevertheless, Kruskal-Wallis test showed no significant differences in biomass amount among the five bone substitutes (p\u2009=\u20090.236 and p\u2009=\u20090.55 after 4 and 8\u2009h adhesion, respectively). CONCLUSIONS: All the bone substitutes normally used in sinus floor augmentation represent a favorable substrate for fungal growth, due to their physical and chemical characteristics. During sinus floor elevation procedures, Schneiderian membrane integrity should be maintained in order to avoid the exposure of the grafting material at the respiratory environment, with potential risks of fungal colonization

O Atendimento odontológico do paciente renal terminal submetido a dialise: uma revisão atual da literatura médica vigente.

Chronic renal failure is a progressive disease characterized by a gradual destruction of the nephrons and a consequent reduction in renal function. End-stage kidney disease (ESRD) requires renal replacement therapy such as peritoneal dialysis, hemodialysis or transplantation. Patients affected by ESRD or on hemodialysis are at risk of developing a series of comorbidities, including hypertension, anemia, risk of bleeding, susceptibility to infection, side effects of medications and oral manifestations associated with the disease itself and treatment on hemodialysis. In this context, oral diseases represent a potential and preventable cause of poor health outcomes in people with ESRD due to their relationship with infection, inflammation and malnutrition.A insuficiência renal crônica é uma doença progressiva caracterizada por uma destruição gradual dos néfrons e uma conseqüente redução da função renal. A doença renal em estágio terminal (DRT) requer terapia de substituição renal como diálise peritoneal, hemodiálise ou transplante. Os pacientes afetados pela DRT ou em hemodiálise correm risco de desenvolver uma série de comorbidades, incluindo hipertensão, anemia, risco de sangramento, suscetibilidade à infecção, efeitos colaterais dos medicamentos e manifestações orais associadas à própria doença e ao tratamento em hemodiálise. Nesse contexto, as doenças bucais representam uma causa potencial e evitável de maus resultados de saúde em pessoas com DRT devido à sua relação com infecção, inflamação e desnutrição

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy. http://bit.ly/31SXeB