Estudio prospectivo de implantes inmediatos postextracción en zonas infectadas y no infectadas, restaurados con coronas cementadas: 3 años de seguimiento.

Falta palabras claveObjetivo: Comparar el éxito de implantes inmediatos colocados en alveolos postextracción infectados y no infectados restaurados con coronas cementadas. Método: Se colocaron 36 implantes inmediatos en total, 18 implantes en alveolos no infectados (grupo control GC n=18) y 18 implantes en alveolos infectados (grupo estudio GE n=18) que han sido desbridados y cureteados con peróxido de hidrogeno al 3%, irradiado con laser yttrium– scandium–gallium–garnet (Er,Cr:YSGG) e irrigado con solución estéril. Se realizó regeneración ósea guiada bajo cobertura antibiótica. La ostectomia para los implantes se extendió tres/cuatro milímetros en apical para asegurar la estabilidad primaria de los implantes. La fase protésica se llevó a cabo cuatro meses y medio después de la cirugía. Los criterios de éxito fueron: Presencia de estabilidad primaria de los implantes, presencia de zona radiolúcida alrededor de los implantes, ausencia de supuración y ausencia de dolor. El seguimiento se realizó al comienzo del estudio, a los 12, 24 y 36 meses. Resultados: Todos los implantes se osteointegraron tres meses después de la cirugía. El rango de éxito fue de 94.44% para el grupo de estudio y del 100% para el grupo control. Las variables clínicas y radiográficas evaluadas arrojaron diferencias significativas entre los grupos a los 36 meses. Conclusiones: Bajo las condiciones evaluadas, la colocación de implantes unmediatos puede ser considerada una opción de tratamiento predecible para la restauración de alveolos infectados postextracción. Significancia clínica: Los implantes inmediatos pueden ser indicados para reemplazar dientes perdidos debido a lesiones periapicales crónicas con la historia de fracaso endodontico cuando se tienen procedimientos preoperatorios apropiados para limpiar y descontaminar las zonas quirúrgicas.Objectives: To compare the survival of immediate implants placed in postextraction infected and non-infected sites, restored with cemented crowns. Methods: Thirty-six implants were immediately placed in non-infected sockets (control group (CG), n = 18), and in infected alveoli (test group (TG), n= 18) that had been debrided, curetted, cleaned with 3% hydrogen peroxide, irradiated with yttrium scandium gallium garnet (Er,Cr:YSGG) laser, and irrigated with a sterile solution. Guided bone regeneration was performed under antibiotic coverture. All study patients had both a CG and a TG site. The implant osteotomy sites were extended 3–4 mm beyond the apical extent of the sockets to achieve primary stability for the implants. The prosthetic phase occurred 4.5 months after surgery. Success criteria were accepted as the presence of implant stability, absence of a radiolucent zone around the implants, absence of mucosal suppuration, and lack of pain. Clinical evaluations were performed at baseline, and at 12, 24, and 36 months of follow-up. Results: All of the implants were osseointegrated 3 months after surgery. The 3-year survival rate was 94.44% for TG, and 100% for CG. The clinical and radiographic variables tested yielded no significant differences among groups at 36 months. Conclusions: Under the tested conditions, immediate implant placement can be considered a predictable treatment option for the restoration of fresh postextraction infected sockets. Clinical significance: Immediate implants may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history when appropriate preoperative procedures are taken to clean and decontaminate the surgical sites

Métodos de valoración de la interfase hueso-implante: análisis de la producción científica (1997-2007

Objetivos: Realizar un análisis estadístico descriptivo y bibliométrico de las fuentes bibliográficas periódicas relacionadas con los métodos de valoración de la interfase hueso-implante publicadas entre los años 1997 y 2007. Diseño del estudio: Se obtuvo una muestra de 224 artículos como resultado de la consulta de diez repertorios, nacionales e internacionales, accesibles desde los recursos electrónicos de la biblioteca de la Universidad de Sevilla. El análisis de los datos obtenidos se llevó a cabo en función de la base de datos, en la que se encontró, el año de su publicación, país de origen e idioma. Se comprobó la validez de las leyes de Price, Lotka y Bradford sobre esta muestra. Resultados: Señalamos la importancia de EE. UU. como principal país productor de artículos sobre métodos de valoración de la interfase hueso-implante, aunque si agrupamos los países por zonas geográficas, Europa occidental es la de mayor producción. Conclusiones: Las leyes de Lotka y Bradford sí se cumplen en nuestra muestra (coeficiente de correlación de 1 y 0,99), mientras que la ley de Price no (coeficiente de correlación, 0,20), lo que se traduce en un estancamiento de la producción científica en esta área en el periodo estudiado

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care