International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

ALVEOLAR RIDGE AUGMENTATION WITH TITANIUM MESH AND A COMBINATION OF AUTOGENOUS BONE AND ANORGANIC BOVINE BONE: A 2-YEAR PROSPECTIVE STUDY

Background: Recently, the use of bovine bone mineral (BBM) in combination with autogenous bone for alveolar ridge augmentation before implant placement has increased in favor because of concerns over morbidity associated with extraoral donor sites. The aim of this prospective study was to evaluate the clinical and radiographic parameters of implants placed in augmented ridges using a 70:30 mixture of autogenous bone and BBM in association with micro-mesh over a 2-year period. Methods: Sixteen partially edentulous patients requiring bone augmentation were consecutively treated for 19 reconstructive procedures and delayed implant placement (44 implants) after 8 to 9 months of submerged mesh healing. Clinical examinations were performed and radiographs of the implants were taken 6 months after prosthetic loading and once a year during a 2-year follow-up. Results: Only one (5.3%) of the 19 micro-meshes became exposed after 2 months and was removed. Computed tomography scans of the alveolar ridge pre- and postreconstruction demonstrated mean vertical augmentation of 3.71 +/- 1.24 mm and mean horizontal augmentation of 4.16 +/- 0.59 mm. All of the implants were retained after 2 years, yielding a 100% survival rate. The mean bone resorption around the implants was 1.37 +/- 0.32 mm during the observation period. Only three implants demonstrated bone resorption >2 mm, whereas 41 implants were considered clinically successful, resulting in a success rate of 93.1%. Conclusion: This 2-year prospective study demonstrated that implants placed into augmented bone using this technique exhibited peri-implant stability with high survival (100%) and success (93.1%) rates

Prevention of muscle and nerve damage after a prolonged ischemia/reperfusion syndrome: An experimental animal model

An experimental, rat model, of limb replantation was developed to evaluate and compare the efficacy of SOD and mPEG-SOD (native and modified with polyethylene glycole superoxide dismutase) or PAcM-SOD (polyacriloilmorpholine superoxide dismutase) in preventing ischemia- reperfusion damage. In particular, the current research focused on the technical procedure employed for the study of the newly activated motor end-plates after ischemia/reperfusion injury. The experiment was carried out on CO Wistar rats, randomly divided into four groups, submitted to 4 hours and 30 minutes of ischemia of the left hindlimb, followed by reperfusion. Results showed a better limb survival in the mPEG-SOD group (87%) in comparison to other three groups (p<0.05)

Immediate occlusal loading of immediately placed implants supporting fixed restorations in completely edentulous arches: a 1-year prospective pilot study.

BACKGROUND: The aims of this pilot study were to evaluate the efficacy of treatment consisting of the immediate loading of implants placed immediately after tooth extraction in full-arch restorations and to compare the clinical and radiographic outcomes of implants placed in healed versus postextraction sites in the same group of patients. METHODS: Twenty-three patients who needed full-arch restorations were treated. One hundred forty-four implants were placed: 59 after tooth extraction (test group) and 85 in healed sites (control group). Within 48 to 72 hours of implant placement, nine maxillary and 15 mandibular arches received screw-retained fixed prostheses, consisting of a titanium framework fabricated with a computer-aided design and manufacturing techniques and composite resin teeth. The insertion torque for implants was >or=30 Ncm. Implant stability measurements (ISQ) and radiographs of the marginal bone level (MBL) change were performed at prosthesis delivery and after 1 year. RESULTS: One implant in the test group and one implant in the control group failed, giving a cumulative success rate of 98.6%; the prosthesis survival rate was 100%. At the 1-year follow-up, no statistically significant difference was found between the control and test sites with respect to MBL change (0.47 +/- 0.18 mm versus 0.57 +/- 0.27 mm) or mean ISQ values (62.24 +/- 1.92 versus 61.34 +/- 2.15). CONCLUSION: These preliminary data suggest that immediate loading of implants placed immediately after extraction may be a viable treatment option for edentulous arches when implants are stable at insertion and are rigidly splinted with screw-retained titanium-resin prostheses

INFLUENCE OF IMPLANT-ABUTMENT INTERFACE DESIGN ON BONE AND SOFT TISSUE LEVELS AROUND IMMEDIATELY PLACED AND RESTORED SINGLE-TOOTH IMPLANTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL.

PURPOSE: The purpose of the present study was to compare the clinical and radiographic outcomes of single implants immediately placed and restored with two different implant-abutment connections. MATERIALS AND METHODS: Forty subjects requiring single maxillary premolar replacement were consecutively included in this study and prospectively followed for 12 months. One implant was placed at the time of tooth extraction and immediately restored in each patient. Subjects were randomly selected to receive either prosthetic abutments with a Morse taper connection and a platform switch (test group) or conventional abutments with an internal connection and a matching diameter (control group). A provisional screw-retained crown was positioned and adjusted for nonfunctional loading within 24 hours. Four months later, the definitive crowns were delivered. Periodontal parameters and clinical and radiographic measurements of soft and hard tissue levels were recorded at the moment of prosthesis placement and at 4 and 12 months afterward. Means of the two groups were compared using paired and independent-sample t tests (P = .05). RESULTS: Of the 40 patients recruited, 38 (24 women and 14 men) completed the study. No implants were lost in the control group, whereas one implant failed in the test group. At the 12-month examination, no statistically significant differences were seen between the two groups for periodontal parameters, marginal soft tissue level change, or papilla height (P > .05), but greater marginal bone loss was observed at the control sites (0.51 ± 0.24 mm) compared to the test sites (0.2 ± 0.17 mm) (P = .0004). CONCLUSION: Although the control group demonstrated a slight increase in marginal bone loss compared to the test group, the peri-implant soft tissues were very stable with both types of implant-abutment connection after 12 months of loading

PRELIMINARY 2-YEAR REPORT ON TREATMENT OUTCOMES FOR 6-MM-LONG IMPLANTS IN POSTERIOR ATROPHIC MANDIBLES.

Purpose: The aim of this study was to prospectively evaluate clinical and radiographic outcomes of ultrashort implants (4-mm diameter, 6-mm length) supporting fixed partial dentures in severely atrophic posterior mandibles. Materials and Methods: Twenty-five patients with posterior edentulous mandibular spans and 7- to 8-mm residual bone heights above the mandibular canal were enrolled. In total, 61 submerged implants were placed and loaded 5 to 6 months later. Patients were followed for 2 years after prosthesis connection with clinical, radiographic, and resonance frequency analysis (RFA) examinations. Results: Two implants failed in one patient before loading; all other implants showed favorable clinical and radiographic findings throughout the observation period (2-year survival and success rate: 96.8%). Postoperative pain and swelling were negligible. Mean changes in marginal bone levels were stable (0.40 \ub1 0.23, 0.51 \ub1 0.38, and 0.60 \ub1 0.13 mm after 6 months and 1 and 2 years, respectively) and were unaffected by measured crown-to-implant ratios (range: 1.31 to 3.12). Mean RFA values increased significantly from implant placement (67.35 \ub1 6.67) to 2 years (72.91 \ub1 5.07, P < .0001). Prosthetic complications included two prosthesis decementations, three ceramic veneer chippings, and one prosthesis screw loosening. Conclusion: Within the limitations of the short follow-up period, the use of 6-mm-long implants was a predictable treatment method for patients with atrophic posterior mandibles and increased crown-to-implant ratios

Immediate Fixed Implant Rehabilitation of the Atrophic Edentulous Maxilla after Bilateral Sinus Floor Augmentation: A 12-Month Pilot Study

PURPOSES: The aims of this study were to evaluate a surgical/prosthetic protocol for the immediate rehabilitation of the augmented edentulous maxilla, and to compare the outcomes of implants placed in grafted (test group) versus native (control group) sites in the same patients. MATERIALS AND METHODS: Twenty patients were included in the study. Each patient was treated with a bilateral sinus augmentation procedure using a 50:50 composite graft of autogenous mandibular bone and bovine hydroxyapatite. Four to 5 months later, 155 implants (90 test and 65 control) were placed and restored with screw-retained fixed definitive prostheses supported by titanium frameworks within 1 week. All patients were followed for 1 year. Implant stability quotient (ISQ) measurements and radiographic evaluation of the marginal bone resorption (MBR) were performed. RESULTS: Two test implants failed in two patients, giving a cumulative 1-year success rate of 98.7%; the prostheses success rate was 100%. Insertion torque and ISQ values for test implants were significantly lower than those for control implants (unpaired t-test, p < .0001). The mean MBR around control and test implants at the 1-year evaluation were similar (0.47 \ub1 0.25 mm and 0.43 \ub1 0.21 mm, respectively). CONCLUSIONS: The combination of implants placed in sinus-grafted and native sites can be immediately loaded with a fixed full-arch prosthesis and yield short-term successful outcomes

Maxillary sinus augmentation: Histologic and histomorphometric analysis

PURPOSE: Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and the presence of the maxillary sinus. In these situations, sinus floor lifting and grafting frequently have been proposed as the best treatment. The aim of this study was to compare histologically the use of 100% autogenous bone versus a combination of autogenous bone and corticocancellous pig bone for maxillary sinus augmentation. MATERIALS AND METHODS: Eighteen patients requiring bilateral maxillary sinus augmentation were selected for this study. Bone for grafting was harvested from the iliac crest. Each patient received 100% autogenous bone in 1 randomly selected sinus (control side) and a 1:1 mixture of autogenous bone and corticocancellous pig bone particles in the contralateral sinus (test side). Five months after the augmentation procedure, bone biopsy specimens were taken at the time of implant placement. RESULTS: No complications were observed during the surgical procedures; all patients healed uneventfully. No signs or symptoms of maxillary sinus disease were observed during the 5 months after surgery. No significant differences in bone percentages were observed in the bone biopsies from test and control sides. DISCUSSION AND CONCLUSION: It could be concluded from this study that corticocancellous pig bone particles can be successfully used in a 1:1 mixture with autogenous bone from the iliac crest for maxillary sinus augmentation in cases of severely atrophic maxilla