Computer-guided implant placement associated with computer-aided bone regeneration in the treatment of atrophied partially edentulous alveolar ridges: A proof-of-concept study

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O MÚLTIPLO E O DIVERSO EM "VÍCIOS E VIRTUDES"

The Helder Macedo's narrative presents us the writer who meets a friend, also writer, and listens from him the story of his loves. The text inside the text leads us, in a spiral movement, from the author to the character, from the present to the past, from the contingent to the history. The present work aims to reflect on the games of masks formulated by Macedo from the overlapping of registers and narrative plans that is presented in his novel.A narrativa de Helder Macedo conta-nos do escritor que encontra o amigo, também escritor, e ouve desse a história de seus amores. O texto dentro do texto vai nos levando, em espiral, do autor à personagem, do presente ao passado, do contingente ao  histórico.  Este  trabalho  pretende  refletir  sobre  os  jogos  de  máscaras  e  fingimentos formulados por Macedo a partir da sobreposição de registros e de planos narrativos que este seu livro apresenta

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Multidisciplinary Oral Rehabilitation of a Severely Compromised Dentition

The decision-making process of complex clinical cases should involve multiple specialists to obtain a predictable result on a long-term basis. In view of the above, the present report is aimed at describing the multidisciplinary management of a partially edentulous female patient presenting with a severely compromised residual dentition. To improve function and aesthetics, the treatment combined multiple extractions, temporary rehabilitation with a complete removable denture, guided bone regeneration and implant insertion, soft tissue management, tooth alignment, and restorative dentistry. Thus, several dental branches were embraced during the treatment phases, including oral surgery and implantology, periodontology, orthodontics, and prosthodontics. The involvement of different specialists ensured the achievement of a good result from biological, functional, and aesthetic aspects. The patient was satisfied with the final outcome. In conclusion, to meet the patient’s expectations particularly in complex clinical situations, the interdisciplinary approach becomes essential from the early phases in order to identify the ideal treatment plan with the correct time sequence

Autogenous Chin Block Grafts in the Aesthetic Zone: A 20-Year Follow-Up Case Report

The successful use of osseointegrated implants in the treatment of partial or complete edentulism requires a sufficient bone support. Whenever rehabilitation in atrophic edentulous areas is needed, bone augmentation procedures are recommended. The aim is to provide adequate amount of supporting bone to achieve a prosthetically guided implant placement. This in turn leads to functional and aesthetic improvements that can be maintained on the long term. Bone grafting of the atrophic site can be performed either prior to implant placement or at the time of implantation. Irrespective of the timing, bone augmentation by means of autogenous bone grafts is a reliable technique, as confirmed by several studies. On the other hand, long-term evidence on the use of autogenous chin block grafts in preprosthetic implant surgery is still scarce. Thus, the purpose of the present case is to report the 20-year clinical and radiological outcome of autogenous chin block grafts used to augment a bilateral defect due to agenesis of the upper lateral incisors for implant placement purposes

Full Digital Model-Free Maxillary Prosthetic Rehabilitation by Means of One-Piece Implants: A Proof of Concept Clinical Report with Three-Years Follow Up

Implant rehabilitation is a daily practice in dentistry, and patients often have heightened expectations regarding both the functional and the aesthetic outcome. Implant–abutment connection (IAC) is involved in the long-term aesthetic quality of the rehabilitation. The use of one-piece implants for fixing dentures may prevent the mechanical and biological implication of the implant–abutment interface, resulting in a better quality of hard and soft tissue maintenance. In this case report, we present a novel one-piece implant in a maxillary rehabilitation with a full model-free digital approach

Evaluation of Breaking Force of Different Suture Materials Used in Dentistry: An In Vitro Mechanical Comparison

The success of surgical procedures is strictly related to the biomechanical properties of the suture. Mechanical comparisons are scarcely reported in the literature, so the purpose of the present study was to evaluate and compare the mechanical behavior of different sutures commonly used in oral surgery in terms of traction resistance. Sutures made of eight different materials were analyzed: silk (S), polyglycolide-co-caprolactone (PGCL), polypropylene (PP), rapid polyglycolide (rPGA), standard polyglycolide (PGA), polyamide (PA), polyester (PE), and polyvinylidene fluoride (PVDF). For each material, three different sizes were tested: 3-0, 4-0, and 5-0. The breaking force of each suture was assessed with a uniaxial testing machine after being immersed in artificial saliva at 37 °C. The outcomes analyzed were the breaking force, the needle–thread detachment breaking-point and the node response after forward–reverse–forward (FRF) tying when subjected to a tensile force. The 3-0 rPGA provided the maximum resistance, while the lowest value was recorded for the 5-0 PGCL. In general, 3-0 and 4-0 gauges showed non-statistically significant differences in terms of needle–thread detachment. The highest needle–thread detachment was found for the 3-0 PGA, whereas the lowest value was observed for the 5-0 PGCL. After tying the knot with an FRF configuration, the thread that showed the highest resistance to tension was the 3/0 silk, while the thread with the lowest resistance was the 5/0 silk. These data should be considered so that the operator is aware of as many aspects as possible on the behavior of various materials to ensure successful healing

Buccal Peri-Implant Soft Tissue Augmentation by Means of a Porcine Collagen Matrix: A Proof of Concept Technical Note

The quality and quantity of peri-implant soft tissues at the crestal portion of dental implants are important aspects to consider for a long-term successful implant-supported rehabilitation. Some relevant factors attributed to the implant health include mucosal thickness and keratinization. In this respect, many techniques and materials have been described to augment and improve buccal peri-implant soft tissues. Over the last few years, newly developed xenogeneic collagen matrices have been introduced in peri-implant plastic surgery to replace autogenous soft tissue grafts; however, data remain controversial so far. Thus, the purpose of the present report was to present a novel surgical technique conceived to augment buccal peri-implant soft tissues in combination with a volume-stable porcine collagen matrix. The rationale and the fundamental concepts that led to the use of a xenogeneic matrix to increase soft tissue volumes were also discussed

Data assimilation of radar reflectivity volumes in a LETKF scheme

Quantitative precipitation forecast (QPF) is still a challenge for numerical weather prediction (NWP), despite the continuous improvement of models and data assimilation systems. In this regard, the assimilation of radar reflectivity volumes should be beneficial, since the accuracy of analysis is the element that most affects short-term QPFs. Up to now, few attempts have been made to assimilate these observations in an operational set-up, due to the large amount of computational resources needed and due to several open issues, like the rise of imbalances in the analyses and the estimation of the observational error. In this work, we evaluate the impact of the assimilation of radar reflectivity volumes employing a local ensemble transform Kalman filter (LETKF), implemented for the convection-permitting model of the COnsortium for Small-scale MOdelling (COSMO). A 4-day test case on February 2017 is considered and the verification of QPFs is performed using the fractions skill score (FSS) and the SAL technique, an object-based method which allows one to decompose the error in precipitation fields in terms of structure (S), amplitude (A) and location (L). Results obtained assimilating both conventional data and radar reflectivity volumes are compared to those of the operational system of the Hydro-Meteo-Climate Service of the Emilia-Romagna Region (Arpae-SIMC), in which only conventional observations are employed and latent heat nudging (LHN) is applied using surface rainfall intensity (SRI) estimated from the Italian radar network data. The impact of assimilating reflectivity volumes using LETKF in combination or not with LHN is assessed. Furthermore, some sensitivity tests are performed to evaluate the effects of the length of the assimilation window and of the reflectivity observational error (roe). Moreover, balance issues are assessed in terms of kinetic energy spectra and providing some examples of how these affect prognostic fields. Results show that the assimilation of reflectivity volumes has a positive impact on QPF accuracy in the first few hours of forecast, both when it is combined with LHN or not. The improvement is further slightly enhanced when only observations collected close to the analysis time are assimilated, while the shortening of cycle length worsens QPF accuracy. Finally, the employment of too small a value of roe introduces imbalances into the analyses, resulting in a severe degradation of forecast accuracy, especially when very short assimilation cycles are used