Hyaluronic acid as an adjunct to coronally advanced flap procedures for gingival recessions: a systematic review and meta-analysis of randomized clinical trials

: Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future

Morphological characteristics of the facial bone wall related to the tooth position in the alveolar crest in the maxillary anterior

The purpose of this study was to analyze whether the position of the tooth in the alveolar ridge influences the thickness of the facial bone wall and the distance between the cemento-enamel junction (CEJ) and osseous zenith (OZ). Cone-beam computed tomography (CBCT) scans from fifty four dentate patients were included in the study (22 male and 32 female, mean age 41. 5 years). The measurements taken included: (1). The Facial bone thickness at 7 different equidistant levels -measuring levels (ML 1-7) - between OZ and the root apex (A). (2) The CEJ -OZ distance. (3) Facial position of the tooth (FPT) relative to a straight line traced from mesial to distal interproximal depressions of the alveolar plate at the level of the CEJ. The Facial bone wall thickness ranged between 0 mm and 3. 8 mm, with greater values at more apical levels. Mean values were smaller than 1 mm at every level except ML7. The CEJ-OZ distance varied between 0. 5 mm and 6. 9 mm (mean 2. 9 mm). The Mean of FPT value was 0. 6 mm. No statistically significant correlation was found between FPT and the CEJ-OZ distance. Weak negative statistically significant correlations were found between FPT and the thickness of the facial bone wall at MP1 and MP3. Within the limits of this study, no clinically relevant correlation between FPT and facial bone thickness - CEJ-OZ distance was found. More studies should be conducted to evaluate a greater number of teeth, especially those that may present misalignment with greater FPT values.El objetivo del presente estudio fue analizar si la posición de la pieza dentaria en el reborde alveolar influencia el espesor de la tabla ósea vestibular y la distancia entre el limite amelo-cementario (LAC) y el cenit óseo (CO). Tomografías computadas haz de cono (TC) de 54 pacientes dentados fueron incluidas en el estudio (22 hombres y 32 mujeres, edad promedio 41. 5 anos). Las medidas registradas fueron: (1) espesor de la tabla ósea vestibular en 7 diferentes niveles de medición (NM1-7) entre CO y el ápice radicular (AR). (2) La distancia LAC-CO. (3) Posición vestibular de la pieza dentaria (PVD) en relación a una línea recta trazada desde la depresión interproximal mesial a la depresión interproximal distal de la tabla ósea a nivel del LAC. El espesor de la tabla ósea vestibular fue 0-3. 8mm, con valores mayores registrados a nivel más apical. El valor promedio fue menor a 1 mm excepto en NM7. La distancia LAC-CO varió entre 0. 5 y 6. 9mm (promedio 2. 9mm). El promedio de PVD fue de 0. 6mm. No se encontró correlación estadísticamente significativa entre la PVD y la distancia LAC-CO. Se halló una correlación débil negativa estadísticamente significativa entre la PVD y el espesor de la tabla ósea vestibular en NM1 y NM3. Dentro de las limitaciones de este estudio, no se encontró una correlación clínicamente significativa entre PVD y espesor de la tabla ósea vestibular - distancia LAC-CO. Se deben llevar a cabo más estudios para evaluar un mayor número de piezas dentarias, especialmente aquellas que se encuentran desalineadas con valores PVD mayores

In vitro activities of amphotericin B, terbinafine, and azole drugs against clinical and environmental isolates of apergillus terreus Sensu Stricto

The antifungal susceptibilities of 40 clinical and environmental isolates of A. terreus sensu stricto to amphotericin B, terbinafine, itraconazole, and voriconazole were determined in accordance with CLSI document M38-A2. All isolates had itraconazole and voriconazole MICs lower than epidemiologic cutoff values, and 5% of the isolates had amphotericin B MICs higher than epidemiologic cutoff values. Terbinafine showed the lowest MICs. No significant differences were found when MICs of clinical and environmental isolates were compared.Fil: Fernández, Mariana Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Rojas, Florencia Dinorah. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cattana, Maria Emilia. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Sosa, Maria de Los Angeles. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Iovannitti, Cristina A.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones en Microbiología y Parasitología Médica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones en Microbiología y Parasitología Médica; ArgentinaFil: Lass Flörl, Cornelia. Medical University Of Innsbruck; AustriaFil: Giusiano, Gustavo Emilio. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Histological evaluation of subepithelial connective tissue grafts harvested by two different techniques. Preliminary study in humans

Subepithelial connective tissue graft (SCTG) is an essential therapeutic tool in periodontal plastic surgery and implantology. The aim of this preliminary study was to observe and make a histological and histomorphometric comparison of the composition of subepithelial connective tissue grafts (SCTGs) harvested from the palatal mucosa by two different harvesting techniques: mucoperiosteal (lamina propria and complete submucosa including periosteum) and mucosal (lamina propria and a portion of the submucosa). The main hypothesis proposes that SCTG harvested with the mucosal technique contains a greater proportion of connective tissue proper (CTP) and a lower proportion of adipose tissue (AT) than the mucoperiosteal technique. Twenty healthy patients who required SCTG for different purposes were selected and assigned to one of the two following groups: group A (n=10; mucoperiosteal harvesting technique) and group B (n=10, mucosal harvesting technique). The histological sample was obtained by removing a 2 mm thick slice from the most distal portion of the graft. The proportions of adipose tissue (AT), connective tissue proper (CTP) and vascular tissue (VT) were evaluated. In group A, histomorphometric analysis showed that CTP accounted for 58.2% of the graft while AT accounted for 32.64%. In group B, the proportions of CTP and AT were 79.86% and 11.93%, respectively. The differences between groups were statistically significant for both tissues (p< .05). In contrast, no statistically significant difference was observed in the proportion of VT. Within the limitations of this study, the results show that the SCTGs harvested by the mucosal technique contain a greater proportion of CTP and a lower proportion of AT than those obtained by the mucoperiosteal technique, whereas the proportion of VT does not differ. Further long-term clinical and histological studies with more samples are needed to evaluate the clinical implications of SCTG composition.El injerto de tejido conectivo subepitelial (ITCSE) es una herramienta indispensable en la cirugía plástica periodontal y la implantología. El objetivo del presente estudio preliminar fue observar y comparar histológica e histomorfometricamente la composición de los injertos de tejido conectivo subepitelial (ITCSE) obtenidos de la mucosa palatina mediante dos técnicas diferentes: mucoperióstica (lamina propia y submucosa incluyendo el periostio) y mucosa (lámina propia y parte de la submucosa). La principal hipótesis postula que el ITCSE obtenido mediante la técnica mucosa contiene mayor proporción de tejido conectivo propiamente dicho (TCP) y menor proporción de tejido adiposo (TA) que el obtenido mediante la técnica mucoperióstica. El presente estudio incluyó veinte pacientes sanos que requerían ITCSE por diferentes motivos, los cuales fueron distribuidos de forma equitativa en dos grupos: grupo A (n=10; técnica de obtención mucoperióstica) y grupo B (n=10; técnica de obtención mucosa). La muestra histológica se obtuvo removiendo una porción de 2 mm de ancho de la parte más distal del injerto. Se evaluó la proporción (%) de tejido adiposo (TA), tejido conectivo propiamente dicho (TCP) y tejido vascular (TV). En el grupo A, el análisis histomorfométrico mostró que el TCP constituía el 58.2% del tejido mientras que el tejido adiposo constituía el 32.64%. En el grupo B, la proporción de TCP y AT fue 79.86%y 11.93%, respectivamente. Las diferencias observadas entre los grupos fueron estadísticamente significativas para ambos tejidos (p< .05). En cambio, no se observaron diferencias estadísticamente significativas en la proporción de TV. Dentro de las limitaciones del presente estudio, los resultados mostraron que los ITCSE obtenidos mediante la técnica mucosa contienen mayor proporción de TCP y menor proporción de TA que los obtenidos con la técnica mucoperióstica, mientras que el TV permanece estable. Se requieren estudios longitudinales clínicos e histológicos a largo plazo con mayor cantidad de muestras para evaluar las implicancias clínicas de la composición del ITCSE

Alveolar dimensional changes relevant to implant placement after minimally traumatic tooth extraction with primary closure

The purpose of this study is to evaluate the dimensional changes that occur in the alveolar ridge after minimally traumatic tooth extraction by means of computed tomography (CT), with special focus on the portion of bone supporting the gingival zenith. Twenty subjects with indication for singlerooted tooth extraction and preserved alveolar walls were selected for this study. After a minimally traumatic extraction, two CT scans were performed; the first within 24 hours postextraction (TC1) and the second 6 months (TC2) later. A radiographic guide with a radiopaque marker was used to obtain references that enabled accurate measurements over time, in both vertical and horizontal directions. The bone crest immediately apical to the gingival zenith was identified and termed "osseous zenith". The displacement of the osseous zenith in horizontal and vertical direction was analyzed and correlated with several alveolar anatomical variables with the aim of identifying possible predictors for bone remodeling. Dimensional changes that occur in postextraction sockets within a 6month period showed significant vertical and horizontal displacement of the osseous zenith (p<0.001). Mean vertical resorption was 2.1 ± 1.7 mm, with a median of 1.9 mm and a range of 0.2 to 7.5 mm. Mean horizontal resorption was 1.8 ± 0.8 mm with a median of 1.7 mm and a range of 0.6 to 4.4 mm. However, no correlation was found between the width of the facial alveolar crest and the displacement of the osseous zenith. The results of the present study showed that if the width of the facial crest at the apicalcoronal midpoint is less than 0.7 mm, a high degree of displacement of the osseous zenith (> 3 mm) should be expected. The present study suggests that the width of the alveolar crest at its midlevel, rather than crestal width, may be correlated with the displacement of the osseous zenith.El objetivo del presente estudio es evaluar los cambios dimen sio nales que ocurren en el reborde alveolar luego de realizar una exodoncia atraumática mediante tomografía computada, con especial atención en el tejido óseo que soporta el cénit gingival. Se seleccionaron 20 sujetos con indicación de exodoncia de piezas unirradiculares y que presentaban las paredes alveolares conservadas. Luego de llevar a cabo una exodoncia atraumática se realizaron dos tomografías computadas (TC); la primera dentro de las 24 hs postexodoncia (TC1) y la segunda a los 6 meses (TC2). Se utilizó una guía radiológica con un marcador radiopaco para obtener medidas precisas en el tiempo, tanto en el plano horizontal como vertical. Se identificó la cresta ósea inmediatamente apical al cénit gingival y se definió como “cénit óseo”. Se realizó un análisis del desplazamiento del cénit óseo en el plano horizontal y vertical y se correlacionó con diferentes variables anatómicas con el objetivo de determinar posibles predictores del remo delado óseo. Los cambios dimensionales que ocurren 6 meses postexodoncia mostraron un desplazamiento significativo del cénit óseo (p<0.001) . La reabsorción vertical promedio fue de 2.1 ± 1.7 mm con una media de 1.9 mm y un rango de 0.2 a 7.5 mm. El promedio de reabsorción horizontal fue de 1.8 ± 0.8 mm con una media de 1.7 mm y un rango de 0.6 a 4.4 mm. No se halló correlación entre el ancho de la cresta vestibular y el desplazamiento del cénit óseo. Los resultados del presente estudio mostraron que si el ancho de la cresta vestibular en el punto medio (en sentido apicocoronal) es menor a 0.7mm se puede esperar un desplazamiento del cénit óseo (>3mm). Este estudio sugiere que el ancho de la cresta alveolar en su punto medio podría predecir el desplazamiento del cénit óseo

Clinical, histological, immunohistochemical and biomolecular analysis of hyaluronic acid in early wound healing of human gingival tissues: a randomized, split‐mouth trial

Background: Hyaluronic acid (HA) exerts a fundamental role in tissue repair. In vitro and animal studies demonstrated its ability to enhance wound healing. Nevertheless, in vivo human studies evaluating mechanisms involved in oral soft tissue repair are lacking. The aim of this study was to evaluate the in vivo effect of HA on early wound healing of human gingival tissues (G). Methods: In the present randomized, split-mouth, double-blind, clinical trial, G biopsies were obtained in eight patients 24 hours after surgery after HA application (treatment group-HA) and compared with those obtained from the same patients without HA application (no treatment group-NT). Clinical response was evaluated through Early Wound Healing Score (EHS). Microvascular density (MVD), collagen content and cellular proliferation were evaluated through Sirius red, Masson trichrome staining and Ki67 immunohistochemistry, respectively. To assess collagen turnover, MMP-1, MMP-2, MMP-9, TGF-β1 protein levels and LOX, MMP-1, TIMP-1, TGF-β1 gene expression were analysed by Western Blot and Real Time PCR. Results: Twenty-four hours after surgery, EHS was significantly higher in HA group. MVD, collagen content and cell proliferation were not affected. LOX mRNA, MMP-1 protein and TIMP-1 gene expression were significantly up-regulated in HA compared to NT group. Conclusions: The additional use of 0.8% HA gel does not modify the new blood vessels growth in the early phase of gingival wound healing. Concerning the secondary outcomes, HA seems to enhance extracellular matrix remodelling and collagen maturation, that could drive the early wound healing of gingival tissues to improve clinical parameters. This article is protected by copyright. All rights reserved

Propuesta para mejorar la gestión del capital humano en empresas citrícolas desde Arquitectura Empresarial

Este trabajo de investigación se centra en el estudio de la metodología de arquitectura empresarial abordada desde un enfoque socio-técnico para el análisis del papel que desempeña el capital humano dentro de una organización y su importancia transversal hacia el marco mencionado. Mediante la recolección de información relevante, de distintos estudios sobre el tema se busca llegar a elaborar una propuesta de diseño, centrándonos tanto en el talento humano como su importancia dentro de una organización enmarcada en una arquitectura empresarial. Mediante el enfoque socio-técnico se considera a la mano de obra como un factor preponderante en el desarrollo de las actividades organizacionales en función del objetivo del negocio empresarial, finalidad última de la arquitectura empresarial.Sociedad Argentina de Informática e Investigación Operativ

Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial.

OBJECTIVES The aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment. MATERIAL AND METHODS Thirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS). RESULTS After 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity. CONCLUSIONS The adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites. CLINICAL RELEVANCE Adjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions

ANALYSIS BY CLUSTERING FACTOR PERFORMANCE BUSINESS INCUBATORS DOI:10.5773/rai.v8i1.390

As incubadoras de empresas tornaram-se um fenômeno onipresente em muitos países e são vistas como importantes para promover a geração e o desenvolvimento empresarial no Brasil e no mundo. Apresenta-se neste artigo uma análise por agrupamento de fatores de desempenho das incubadoras. Neste contexto, o objetivo deste trabalho é desenvolver uma estrutura que sirva para a identificação de medidas que visem ao fortalecimento das incubadoras e suas empresas incubadas, com base em quatro agrupamentos: infraestrutura, gestão, pessoas e marketing. Para tal propósito, a metodologia classifica-se por sua natureza aplicada, é descritiva e realizada por meio de procedimento de pesquisa experimental, com abordagem quantitativa dos dados. Tem-se como resultado dois grupos de empresas, um em que os fatores considerados prioritários à gestão das incubadoras focam a qualificação das equipes internas e a disponibilização de ferramentas de gestão, no outro grupo estão aquelas que focam suas ações em marketing e infraestrutura. Observou-se que o segundo grupo reúne as incubadoras com maiores dificuldades de manutenção, e no outro encontram-se aquelas em melhores condições de atingir a sustentabilidade, em que o grau de maturidade e a taxa de sucesso apontaram para as experiências bem-sucedidas e com maior condição de sobrevivência.Business incubators have become an omnipresent phenomenon all over the world and are of great importance in the creation and development of companies in Brazil. The present article analyses business incubators by grouping incubators according to development factors, specifically, infrastructure, management, people and marketing. The methodology used is descriptive and applied. It employs experimental analyses using quantitative data. Our analyses suggest two groups of companies which vary in terms of their perceptions of critical factors. In the first group the factors considered priority for managing the business incubators focus on the quality of the internal staff and on offering management tools. The companies in the second group focus their attention on infrastructure and marketing. The second group of companies experienced more managerial difficulties while the first group contained those enjoying better performance and therefore more likely to achieve sustainability. Key-words: Business incubators; Performance indicator