Endodontic surgery with guided tissue regeneration comparison with only flap closure. A Case Report

Aim. Endodontic surgery has for aim to treat bone lesions due to root canal infections. the aim of the present study was to evaluate the periapical healing of apical defects 24 months after periradicular surgery and guided tissue regeneration in a series of consecutively treated patients. Methods. 10 patients were treated with guided-tissue regeneration and 10 without biomaterial and membrane after surgery. Root-end cavities, 2.5 to 3 mm deep, were prepared with piezo-ultrasonic tips. Root-ends were sealed using Super EBA. the choice of using or not GTR associated with deproteinized bovine bone for each patient was made by a computer-generated randomized table. For cases allocated to the GTR group, the defect was filled with anorganic bovine-bone mineral and then covered with a resorbable collagen membrane. The outcome was assessed by clinical and radiographic evaluation at 24 months follow-up. Results. All patients were recalled after 1, 3, 6, 12 and 24 months. At the one-year follow-up all teeth had successfully healed, healing was uncertain for 1 tooth after 24 months and 3 were classified as failure Conclusions. GTR as a complement of periapical surgery is not necessary for four-wall defects. However, it may be an indication for transosseous lesions. Guided tissue regeneration treatment of apicomarginal defects yields good results in terms of periapical and periodontal healing and should be considered as an adjunct to periradicular surgery in such cases

Single visit procedure for root canal treatment and bleaching of a discolored tooth: a case report

Aim. Root canal treatment and bleaching of a discolored tooth is one of the most commonly used procedures in contemporary endodontics and restorative dentistry. A case of a discolored tooth in a maxillary left incisor in an 38 year old woman patient is reported. Methods. The patient came to our attention claiming the presence of a discolored tooth, requiring the immediate possibility of bleaching. Radiograph examination showed an incorrect endodontic treatment and the presence of a separated fragment of an endodontic instrument. The tooth was retreated and the fragment was removed with the use of ultrasonic instruments, the root canal was then shaped and irrigated copiously with 5% NaOCl and EDTA 17%, then a canal obturation was performed with warm gutta-percha. A power bleaching gel 38% Hydrogen peroxide was then used with a chemically activation for 30 minutes, and the tooth was immediately restored with a fiber post. Results. The clinical and radiographic examination at 4-6-12 -24 months showed a good root filling and a good margin seal of the restoration, and the color of the restoration was well integrated with the rest of the tooth. Conclusions. Endodontic retreatment, immediate bleaching, and fiber post cementation might be a viable alternative to conventional treatments

The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in five years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours. RESULTS: 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in four out of five models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death. CONCLUSIONS: Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death

The role of the intensive care unit in real-time surveillance of emerging pandemics: the Italian GiViTI experience

The prompt availability of reliable epidemiological information on emerging pandemics is crucial for public health policy-makers. Early in 2013, a possible new H1N1 epidemic notified by an intensive care unit (ICU) to GiViTI, the Italian ICU network, prompted the re-activation of the real-time monitoring system developed during the 2009-2010 pandemic. Based on data from 216 ICUs, we were able to detect and monitor an outbreak of severe H1N1 infection, and to compare the situation with previous years. The timely and correct assessment of the severity of an epidemic can be obtained by investigating ICU admissions, especially when historical comparisons can be made

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor