The 360-degree continuous mattress suture in dental implant surgery: A case series

The necessity of an ‘adequate’ keratinized mucosa at the emergence profile of dental implants is a controversial and debated topic. But, in recent years, research suggests that a minimum of at least 2mm of keratinized mucosa is recommended for the maintenance of peri-implant health. The latest systematic reviews on this topic are largely in favor of keratinized mucosa, as are the recommendations of some expert panels. The present paper presents a novel technique for peri-implant flap suturing that can be used in combination with soft tissue augmentation procedures, such as laterally positioned flaps, roll-flaps, and decellularized dermal matrix xenografts. The technique stabilizes the flap on the buccal surface of the healing screw or the emergence profile of the tissue-level implant with a circumferential continuous mattress design that is anchored on the buccal margins and/or periosteum with a final knot. The technique is carried out with a sterile 6/0 synthetic absorbable glyconate monofilament surgical suture (Monosyn, Bbraun, B. Braun Milano S. p.A., Via Vincenzo da Seregno, 14, 20,161 Milan, Italy). This type of suture is ideal, as it slides smoothly through the tissues and allows for the ideal adjustment of the tension and the position of the flap margins until the final knot is positioned. Furthermore, these augmentative procedures make use of second-intention healing and mattress sutures are always ideal to stabilize flap margins without excess tension in such cases. This case series involves patients with a reduced band of keratinized mucosa and, as such, in need of augmentative flap procedures

Comparison of Marginal Bone Loss Around Axial and Tilted Implants: A Retrospective CBCT Analysis of Up to 24 Months

This clinical study retrospectively analyzed cone beam computed tomography (CBCT) images to determine the potential influence of implant inclination on peri-implant marginal bone loss after 18 to 24 months of functional loading. Twenty-five consecutive patients presenting with an edentulous or partially edentulous maxilla or mandible and an adequate bone volume for receiving oral implants were selected for analysis of the marginal bone loss around tilted and/or axial implants. The study population included patients rehabilitated with Toronto bridges (TBs), fixed partial dentures (FPDs), or single crowns (SCs) on axial and/or tilted implants. The primary outcome was the CBCT analysis of peri-implant marginal bone level change, depending on inclination of implants and type of prostheses. The secondary outcome was analysis of survival and success rates of tilted and axial implants. A significant difference was observed for peri-implant buccal bone loss (mean of axials 0.42 \ub1 0.06; mean of tilted 0.70 \ub1 0.09) (P = .009). The difference in peri-implant lingual/palatal/mesial/distal bone loss was not significant between axial and tilted implants (P > .05). No significant difference was observed between the marginal bone level and the type of prostheses for both tilted and axial implants in all the assessed sites (P > .05). The success rate for both tilted and axial implants was 100%, and no complications were observed for all the prosthetic rehabilitations, with a 100% survival rate. Compared to axial implants, tilted implants showed a significant statistical difference for peri-implant buccal bone loss, but no other differences were observed for peri-implant bone loss or for implant survival and success rate. Fixed partial or total rehabilitation using tilted or axial implants, or with tilted and axial implants, could be a reliable technique with advantages to patients and operators

Volumetric Evaluations of Full-Arch Implant Supported Restorations and Their Role on Patients' Quality of Life: A Mixed-Model Analysis

Introduction. Full-arch, implant-supported hybrid restorations, employing tilted implants, can offer an efficient way of treating edentulous patients. Several factors, such as the timing of implant placement and the inclination of the fixture, can have a detrimental effect on their stability. This retrospective study is aimed at discerning the role played by those factors. Materials and Methods. Patients treated with full-arch, implant supported restorations were selected for this study; cone-beam computed tomography (CBCT) images, taken 3 months and 3 years after delivery of the final restoration, as well as peri-implant values, were obtained and compared; bone loss was measured on four sites for each implant and then averaged. These patients were recalled, and the OHIP-5 questionnaire was administered. Results. 21 patients, with a mean age of 53 years, were included in the present analysis. 108 implants were placed, and 25 Toronto prostheses were delivered. According to a mixed-model analysis, tilted implants (0.51, p < 0.001) had a higher rate of bone loss, while implants placed in a healed ridge suffered less bone loss than immediate implants (-0.21, p < 0.001). Patient-level variables have a significant effect on this variable, as implants coming from the same subject share a similar risk of bone loss. The mean response to the self-administered OHIP-5 questionnaire was 1.53 +/- 0.29; other variables did not have a statistically significant effect on this outcome. Discussion/Conclusions. The results of the present study show that Toronto bridges prostheses are an efficient procedure for treating edentulous patients, as their oral-related quality of life is reported as satisfactory even 7 years after delivery of the restoration. Tilted and immediate implants are more at risk of bone loss. Implants coming from the same subject share a similar risk of bone loss

Preparation and characterization of Chilean propolis coprecipitates using Supercritical Assisted Atomization

Propolis is a natural resinous material with antimicrobial, anti-inflammatory, antioxidant, antibiotic and anti-carcinogenic properties. Propolis coprecipitation was attempted by Supercritical Assisted Atomization (SAA) using two carriers: hydroxypropyl-β-cyclodextrin (HPβCD) and polyvinylpyrrolidone (PVP), with the aim to protect propolis bioactivity against oxidation and to improve its bioavailability. Propolis/carrier ratio and overall solute concentration were investigated to understand their effect on the success of coprecipitation as solid dispersion of propolis in the carrier matrix and on particle morphology and particle size distribution. The results confirmed the efficiency of SAA process: spherical amorphous particles were obtained in which propolis and carrier were coprecipitated, with a mean diameter ranging between about 0.20 and 0.37 μm for HPβCD coprecipitates and between about 0.23 and 0.50 μm for PVP coprecipitates. SAA particles showed a polyphenol loading efficiency up to 100% for HPβCD coprecipitates and up to 96% for PVP coprecipitates, with a half inhibition concentration of DPPH radical up to (17.2 ± 2.8) μg/mL and (17.3 ± 1.0) μg/mL, respectively. These particles rich in bioactive compounds can be used as functional component in formulations of new food or pharmaceutical products

Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial.

OBJECTIVE: To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients. DESIGN AND SETTING: Randomized multicenter trial in two weaning centers in northern Italy. PATIENTS AND PARTICIPANTS: 46 tracheostomized patients (age 70 +/- 7 years, 28 men, arterial blood pH 7.436 +/- 0.06, PaO(2)/FIO(2) 238 +/- 46) weaned from mechanical ventilation. INTERVENTIONS: Patients were assigned to two treatment groups performing chest physiotherapy (control), or percussive ventilation (IMP2 Breas, Sweden) 10 min twice/day in addition to chest physiotherapy (intervention). MEASUREMENTS AND RESULTS: Arterial blood gases, PaO(2)/FIO(2) ratio, and maximal expiratory pressure were assessed every 5th day for 15 day. Treatment complications that showed up in 1 month of follow-up were recorded. At 15 days the intervention group had a significantly better PaO(2)/FIO(2) ratio and higher maximal expiratory pressure; after follow-up this group also had a lower incidence of pneumonia. CONCLUSIONS: The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia