Comparison between two bone substitutes for alveolar ridge preservation after tooth extraction: Cone-beam computed tomography results of a non-inferiority randomized controlled trial

AIM To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to DBBM with 10% collagen (DBBM-C) for maintenance of bone volume after tooth extraction in the anterior maxilla. MATERIALS AND METHODS Sixty-six patients were randomly treated with DBBM or DBBM-C, both of which were covered with a collagen matrix for ridge preservation in the anterior maxilla. Cone-beam computed tomographic analysis was performed immediately and 4 months after treatment. The primary outcome, for which non-inferiority of DBBM was tested, was change in the horizontal ridge width 1 mm below the buccal alveolar crest (HW-1) 4 months after extraction. RESULTS Four months after extraction, HW-1 measured -1.60 mm ± 0.82 mm for DBBM-C, while the DBBM group showed a mean loss of -1.37 mm ± 0.84 mm (p = 0.28, 0.23 [95% CI: -0.19; 0.64]). The horizontal ridge width at 3 mm (HW-3) showed -0.98 mm (±0.67 mm) for DBBM-C and -0.84 mm (±0.62 mm) for DBBM (p = 0.40, 0.12 [95% CI: -0.19; 0.45]), and the horizontal ridge width at 5 mm (HW-5) showed -0.67 mm (±0.47 mm) for DBBM-C and -0.56 mm (±0.48 mm) for DBBM (p = 0.36, 0.11 [95% CI: -0.13; 0.34]). CONCLUSIONS The present clinical trial demonstrated non-inferiority of DBBM compared to DBBM-C for maintenance of alveolar bone volume 4 months after tooth extraction in the anterior maxilla

Thrombocytopenia in malaria: who cares?

Despite not being a criterion for severe malaria, thrombocytopenia is one of the most common complications of both Plasmodium vivax and Plasmodium falciparum malaria. In a systematic review of the literature, platelet counts under 150,000/mm³ ranged from 24-94% in patients with acute malaria and this frequency was not different between the two major species that affected humans. Minor bleeding is mentioned in case reports of patients with P. vivax infection and may be explained by medullary compensation with the release of mega platelets in the peripheral circulation by megakaryocytes, thus maintaining a good primary haemostasis. The speculated mechanisms leading to thrombocytopenia are: coagulation disturbances, splenomegaly, bone marrow alterations, antibody-mediated platelet destruction, oxidative stress and the role of platelets as cofactors in triggering severe malaria. Data from experimental models are presented and, despite not being rare, there is no clear recommendation on the adequate management of this haematological complication. In most cases, a conservative approach is adopted and platelet counts usually revert to normal ranges a few days after efficacious antimalarial treatment. More studies are needed to specifically clarify if thrombocytopenia is the cause or consequence of the clinical disease spectrum

Deproteinized bovine bone mineral is non-inferior to deproteinized bovine bone mineral with 10% collagen in maintaining the soft tissue contour post-extraction: A randomised trial

OBJECTIVES To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to demineralized bovine bone mineral with 10% collagen (DBBM-C) for the maintenance of the soft tissue contour after tooth extraction in the esthetic zone. MATERIAL AND METHODS Sixty-five patients randomly received ridge preservation at a single site in the anterior maxilla with DBBM or DBBM-C. Both, DBBM and DBBM-C were covered with a collagen matrix. Profilometric analyses were performed at baseline (BL), immediately after treatment (PO) and at 4 months (FU; day of implant placement). The main outcome was the horizontal mean change (HC) at the buccal aspect. The measurements also included changes of the estimated soft tissue thickness (eTT) at 1mm, 3mm and 5mm below the buccal gingival margin. Descriptive analysis was performed and differences between groups were analyzed using independent samples t-test. The non-inferiority test was performed for HC. RESULTS At 4 months, the horizontal mean change (HC) was -1.43mm (±0.53mm) (DBBM-C) and -1.32mm (±0.53mm) (DBBM). Change of the estimated soft tissue thickness (eTT) between baseline (BL) and four months of follow-up (FU) at 1mm, 3mm and 5mm amounted to -4.58mm (±2.02mm), -2.40mm (±0.97mm) and -1.37mm (±0.78mm) for DBBM-C and to -4.12mm (±1.80mm), -2.09mm (±0.91mm) and -1.23mm (±0.72mm) for DBBM. The differences between the groups were not statistically significantly for any of the outcome measures (p > .05). CONCLUSIONS DBBM is non-inferior to DBBM-C for the maintenance of the soft tissue contour 4 months after tooth extraction

Secondary Atrophic Rhinitis: Autoimmune and Granulomatous Forms

Atrophic rhinitis is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Among diseases responsible of secondary atrophic rhinitis, infective- and noninfective-granulomatous and autoimmune diseases may be advocated, even if they represent less than 1% of etiologies. This group of pathologies should be considered especially in patients without medical history of nasal surgery or radiation and in presence of systemic symptoms, such as low-grade fever, weight loss, and arthralgias. The most frequent autoimmune diseases resulting in atrophic rhinitis are granulomatosis with polyangiitis, sarcoidosis, and mucous membrane pemphigoid [1]. Among granulomatous infections, tuberculosis and syphilis are the leading reported causes of this group of rhinosinusitis [1]. An accurate anamnesis may highlight current or past unexplained skin lesions, arthritis, shortness of breath, or neurologic symptoms. In addition, history of travel in foreign countries and sexual promiscuity should be checked. Routine laboratory tests may underline high ESR and CRP values, anemia, and renal abnormalities, such as unexplained renal failure, proteinuria, and red cell casts. All patients with secondary atrophic rhinitis should undergo a Chest X-ray to rule out lung infiltrations or cavities and mediastinal lymphadenopathies. Presence of ANCA antibodies and QuantiFERON TB-test positivity should be checked; in presence of a suggestive history also VDRL, TPHA and HIV-test may be considered. A nasal biopsy aimed to perform histology and microbiological tests is usually required to confirm the diagnosis