Implant failure : etiology and complications

The possible occurrence of implant failure is a major concern for implantologists and knowledge in such unavoidable fact is clinically essential. Periimplantitis is an inflammatory response in which there is a loss of the bony support of the implant. Diagnosis is based on the clinical signs of infection such as hyperplastic soft tissues, suppuration, colour changes of the marginal peri-implant tissues and gradual bone loss. This site-specific infection may have many features in common with chronic adult periodontitis. Surgical trauma, micromotion and overload are also considered to be associated with implant failures. The lack of osseointegration is generally distinguished by implant mobility and radiological radiolucency. Here, the implant is considered to be failed . Progressive marginal bone loss without marked mobility is referring to a failing implant. The purpose of this concise review was to discuss the implant complications and failure by highlighting the major etiologic factors as well as the parameters used for evaluating such failure

Neurological Characteristics of Allgrove Syndrome: A Case Series

Purpose Allgrove syndrome, also known as “triple A” syndrome, is characterized by adrenal insufficiency, achalasia, and alacrimia. When neurological signs are also present, the condition is referred to as “4 A” syndrome. Methods We conducted a retrospective analysis of three patients with 4 A syndrome confirmed genetically. A complete neurological exam was carried out by an experimented neurologist. Results Herein, we describe the neurological characteristics often associated with this condition, through the clinical and electrophysiological analysis of three patients. All patients exhibited a mutation in AAAS, the gene coding for ALADIN. While these individuals presented with the classic features of triple-A syndrome, neurological symptoms were not prominent. Conclusion The neurological manifestations of Allgrove syndrome have historically been overlooked and inadequately explored. Due to the condition’s rarity and substantial phenotypic heterogeneity, only recently have a variety of symptoms been recognized and described

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Student feedback on team-based learning in a preclinical oral surgery course: A pilot study

الملخص: أهداف البحث: التعلم القائم على الفريق هو طريقة تركز على الطالب حيث يمكن تعزيز وتسهيل التعلم من خلال تحويل المحاضرة التقليدية إلى عملية حل مشكلات نشطة وديناميكية وأكثر جاذبية. هدفت الدراسة الحالية إلى تقييم تجربة التعلم ورضا الطلاب باستخدام طريقة التعلم القائم على الفريق في دورة جراحة الفم قبل السريرية. طرق البحث: تم تصميم اثنتي عشرة جلسة تعلم قائمة على الفريق لطلاب السنة الثانية في طب الأسنان. تم إجراء ست جلسات من ثلاث ساعات في الفصل الدراسي الأول وست جلسات من ساعتين في الفصل الدراسي الثاني مع مواضيع مختلفة قبل السريرية. تم تضمين أنشطة تعليمية مثل الاختبارات والمناقشات الجماعية في الجلسات. استهدفت الاستبانة التي تم توزيعها بعد الجلسة الأخيرة معرفة آراء الطلاب ورضاهم لتقييم أربعة معايير تتعلق باكتساب المعرفة، وتعزيز المهارات الشخصية، وبيئة التعلم، وعلاقات المعلم بالطالب. النتائج: توافق معظم متوسطات الدرجات الخاصة بالردود مع العبارات المتعلقة بالمعايير الأربعة. كشفت نتائج اختبار ارتباط بيرسون عن وجود علاقة ذات دلالة إحصائية (معامل الارتباط يساوي 0.735 وقيمة الاحتمال أقل من 0.05) بين معايير الجلسات التي استمرت لثلاث ساعات وتلك التي استمرت لساعتين. الاستنتاجات: أظهرت طريقة التعلم القائم على الفريق مستويات عالية من الرضا، والتي قد تعزى إلى التنفيذ السليم لمنهجية التعلم القائم على الفريق من قبل المعلم والطلاب. Abstract: Objectives: Team-based learning (TBL) is a student-centered method where learning can be promoted and facilitated by changing the traditional teaching lecture into an active, dynamic, and more engaging problem-solving process. The present study evaluated the student's learning experience and satisfaction using a TBL method in a preclinical oral surgery course. Methods: Twelve TBL sessions were designed for second-year dental students. Six 3-h and 2-h sessions with various preclinical topics were conducted in academic Terms 1 and 2, respectively. Teaching activities such as tests and group discussions were included in the sessions. The last post-session questionnaire sought students' feedback and satisfaction to assess four parameters related to students’ knowledge acquirement, interpersonal skills enhancement, learning environment, and teacher–student relationships. Results: Most average scores of the responses agreed with the related statements in the four parameters. The results of the Pearson's correlation test revealed that there was a significant relationship (r = 0.735; P < 0.05) between the parameters of the 3-h and 2-h sessions. Conclusion: The TBL method yielded positive and high levels of satisfaction, which may be attributed to the proper implementation of TBL methodology by the teacher and students

Immunohistochemical characteristics of the Implant-Hosted Bon : preliminary findings of 9 mandibular cores

Objectives: The aims of this study were to investigate the biochemical topography of collagen types I and III and to describe the histological structure at the implant placement site to determine the clinical significance of the findings and their possible interaction with bone healing around dental implants. Material and Methods: Bone cores from 9 mandibles were taken from the site of placement of dental implants. The reliable technique for rapid preparation of fresh-frozen undecalcified bone sections and the indirect immunofluorescent technique as an immunohistochemical procedure were applied. All sections were viewed under U.V light. For comparative purposes the tissue blocks remaining were used for general histology examination. Results: A homogenous distribution of collagen type I throughout the sections of all cores was evident. Whereas, the distribution of collagen type III throughout the sections of all cores was heterogeneous with different staining patterns. On the other hand, seven cores of the general histology study showed a structure of lamellar mature bone and two cores showed a structure of less mature woven bone. Conclusion: The biochemical and histological structures of the hosted bone may have an impact on the speed of bone healing around dental implants

Morphology of root canals in lower human premolars

Background The knowledge of the root canal morphology and the possible anatomical variations of mandibular premolars are important for the successful endodontic treatment of such cases. The aim of this study was to investigate the presence of two or three root canals in extracted first and second mandibular premolars which were collected from health centers in Syria. Materials and Methods: One hundred and ten human mandibular premolars (70 first premolars and 40 second premolars) with fully developed roots were investigated. After access the cavity of the teeth, the root canals were explored and radiographs were taken. Results: Premolars with one canal were found in 87% of cases (53% first premolar and 34% second premolar) and premolars with two canals were found in 12% of cases (10% first premolar and 2% second premolar). There was just one case (1%) where a first premolar had three canals. These differences were statistically significant with P 0.05. Conclusion: Clinicians should be aware of the anatomical variation in the mandibular premolars and be able to apply this knowledge in radiographical and clinical interpretation.Keywords: Morphology, endodontic, premolarsNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201