Clinical versus Dental Laboratory Survey Regarding Modern Fixed Implant Supported Prosthetic in Romania

(1) Background: The success of prosthetic treatment with implant support depends on the combined effort of the team doctor-technician, each of them being responsible for the validation of execution stages. (2) Methods: we composed an online questionnaire with 18 multiple choice questions, using the Google Forms application. It was filled out by an equal number of prosthodontic specialists and dental technicians. Differences and associations were evaluated by Likelihood Ratio test, Linear by Linear association test, Kruskal-Wallis H test, Pearson Chi-Square test and the Fisher’s Exact test. (3) Results: Differences and similarities were found between the statements of prosthodontic specialists and dental technicians. Years of experience are correlated with the number of restorations, impression techniques and types of restoration (p ≤ 0.05). Similar answers for both groups were registered for preferred screw retained type of prosthetic abutment and most frequently reported complications. (4) Conclusions: The different perspectives of the two members of the prosthodontic team regarding the leading role in the treatment plan, type of abutment, impression technique and prosthetic design of implant fixed restorations has been revealed in our study. Similar education curricula and standards for continuing training courses after graduation are necessary for prosthodontic specialists and technicians in Romania

Clinical versus Dental Laboratory Survey Regarding Modern Fixed Implant Supported Prosthetic in Romania

(1) Background: The success of prosthetic treatment with implant support depends on the combined effort of the team doctor-technician, each of them being responsible for the validation of execution stages. (2) Methods: we composed an online questionnaire with 18 multiple choice questions, using the Google Forms application. It was filled out by an equal number of prosthodontic specialists and dental technicians. Differences and associations were evaluated by Likelihood Ratio test, Linear by Linear association test, Kruskal-Wallis H test, Pearson Chi-Square test and the Fisher’s Exact test. (3) Results: Differences and similarities were found between the statements of prosthodontic specialists and dental technicians. Years of experience are correlated with the number of restorations, impression techniques and types of restoration (p ≤ 0.05). Similar answers for both groups were registered for preferred screw retained type of prosthetic abutment and most frequently reported complications. (4) Conclusions: The different perspectives of the two members of the prosthodontic team regarding the leading role in the treatment plan, type of abutment, impression technique and prosthetic design of implant fixed restorations has been revealed in our study. Similar education curricula and standards for continuing training courses after graduation are necessary for prosthodontic specialists and technicians in Romania

Predictive Model for Occlusal Vertical Dimension Determination and Digital Preservation with Three-Dimensional Facial Scanning

(1) Background: Occlusal vertical dimension (OVD) in the optimal maxillo–mandibular relationship is an important parameter to establish when complex dental rehabilitation has to be done. The optimal method to measure OVD is still a challenge in everyday practice. The aim of the present study was to test the reliability of the correlation between OVD and some anthropometric and cephalometric methods described in the literature. The validity of OVD registration using a facial scanner was also assessed. (2) Materials and Methods: 150 dentate participants, aged 20–25 years, were randomly selected using sealed envelopes. Anthropometric measurements between specific standard points were performed: Subnasion–Prementon (Sn–PM) and Subnasion–Gnation (Sn–Gn) in maximum intercuspation and in the rest mandibular position, right and left pupil to the corresponding chelion. The cephalometric measurements registered were the lower facial angle and the angle between mandibular and Frankfurt planes. The distance Sn–Gn in maximum intercuspation was compared to all other parameters. Facial scanning, with a mobile phone and installed dedicated application, was performed on ten subjects, randomly selected using the same method among the participants, and the obtained 3D files were analyzed. The digital measurements were compared, for validity, to the clinical measurements. Pearson’s correlation coefficient was used, for comparing clinical Sn–Gn in maximum intercuspation position to the other parameters. (3) Results: A strong agreement between all measured anthropometric parameters of the facial scan and clinical contact measurement method was registered. None of the measured parameters could predict the exact OVD. (4) Conclusions: In the limits of our study, the facial scanning could be used for predictable registration of OVD and the stored digital information could be preserved through life and use for oral rehabilitation. However, if OVD needs to be determined, several measurement methods, including cephalometric measurements, need to be used simultaneously to reach a final decision

Additional Prognostic Value of Tissue Doppler Evaluation in Patients with Aortic Stenosis and Left-Ventricular Systolic Dysfunction Undergoing Aortic Valve Replacement

Background and Objectives: Patients with surgical aortic stenosis (AS) show impaired diastolic filling, which is a risk factor for early and late mortality after aortic valve replacement (AVR). There is a paucity of information concerning the impact of restrictive diastolic filling and the evolution of diastolic dysfunction in the early and medium terms post-AVR. We aimed to determine the prognostic value of the presence of a restrictive left-ventricular (LV) diastolic filling pattern (LVDFP) and dilated left atrium (LA) in patients with AS and LV systolic dysfunction (LVEF < 40%) who underwent AVR, and to define the independent predictors for immediate and long-term prognosis and their value for preoperative risk estimation. Materials and Methods: The study was prospective and included 197 patients with surgical AS and LVEF <40% who underwent AVR. Preoperative echocardiographic examinations were repeated at day 10, at 1, 3 and 6 months, and at 1 and 2 years after surgery, with evaluation of LVEF, diastolic function and LA dimension index (mm/m2). Depending on LV systolic performance, patients were classified as Group A (LVEF: 30–40%) or Group B (LVEF < 30%). Results: The main echographic independent parameters for early and late postoperative death were: restrictive LVDFP, significant pulmonary hypertension, LV end-systolic diameter (LVESD) >55 mm and the presence of second-degree mitral regurgitation. Restrictive LVDFP and LA dimension >30 mm/m2 were independent predictors for fatal outcome (p = 0.0017). Conclusions: Assessment of diastolic function and LA dimension are reliable parameters in predicting fatal outcome and hospitalization for heart failure, having an independent and incremental prognostic value in patients with surgical AS. Complete evaluation of LVDFP with all the echographic measurements (including TDI) should routinely be part of the preoperative assessment of patients with LV systolic dysfunction undergoing AVR

Prognostic Value of Melanoma Inhibitory Activity Protein in Localized Cutaneous Malignant Melanoma

Background. Cutaneous malignant melanoma (CMM) is a heterogeneous disease, acknowledged for its lack of predictability regarding clinical evolution. In order to appreciate a patient’s individual prognosis, an attempt is made to find new tumor markers that parallel the disease progression. Objective. To identify if melanoma inhibitory activity (MIA) protein could represent a tool for selecting high risk early stages melanoma patients. Method. Between 2008 and 2013, 155 patients with CMM were treated in our clinic. 84 of them were classified into stages I and II, according to TNM 2009. MIA serum concentration was measured in all patients and 50 healthy donors. A cut-off value of 9.4 ng/ml was established using the ROC curve. Results. All patients were followed up by periodic investigations every 6 months. We have noticed that 66% of patients with MIA serum values at diagnosis greater than 9.4 ng/mL have relapsed, while only 5% of patients with MIA serum concentration below the estimated threshold, recurred during the follow-up period (P=0.000). The death risk was 12 times higher in pathological MIA group of patients (P=0.0001). Conclusions. Our data suggest that MIA is an independent prognostic factor for patients with localized CMM

Challenges for Management of Dilated Cardiomyopathy during COVID-19 Pandemic—A Telemedicine Application

Background and Objectives: The 2019 coronavirus pandemic (COVID-19) represented a significant challenge for the medical community. The first aim of this study was to examine the COVID-19 impact on the follow-up of patients with dilated cardiomyopathy (DCM) and to establish the advantages of multiparametric home monitoring. Also, we tried to establish the main prognostic predictors at 2-years follow-up and the value of LV diastolic filling pattern (LVDFP) in increasing mortality and morbidity. Materials and Methods: We conducted a prospective study of 142 patients with DCM assessed by in-patient visit in the pre-pandemic period and hybrid (face-to-face, online consultation and telemedicine home monitoring with a dedicated application) during the pandemic period. The statistical analysis compared the strategy used in the pre-pandemic with management during the pandemic, in terms of clinical assessment, hospitalizations/emergency room visits due to HF exacerbation and total mortality. Results: We did not observe significant changes in blood pressure (BP), heart rate (FC), weight and symptoms or an increased rate of adverse drug events between the two periods. We successfully titrated HF medications with close monitoring of HF decompensations, which were similar in number, but were mostly managed at home during the pandemic. There was also no statistically significant difference in emergency room visits due to severe decompensated HF. Mortality in the first and second year of follow-up was between 12.0 and 13%, similar in the pre-pandemic and pandemic periods, but significantly higher in patients with restrictive LVDFP. Clinical improvement or stability after 2 years was more frequent in patients with nonrestrictive LVDFP. The main prognostic predictors at 1 and 2-years follow-up were: the restrictive LVDFP, significantly dilated LV, comorbidities (DM, COPD), older age, associated severe mitral regurgitation and pulmonary hypertension. Conclusions: The pandemic restrictions determined a marked decrease of the healthcare use, but no significant change in the clinical status of DCM patients under multiparametric home monitoring. At 2-years follow-up, the presence of the restrictive LVDFP was associated with an increased risk of death and with a worse clinical status in DCM patients