Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting

The aim of the present survey was to assess neurosensory disturbances and/or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line

Volume changes of grafted autogenous bone in sinus augmentation procedure

to evaluate associations between the osseous remodelling add 3-dimensional features of both the grafted bone and the recipient site as well as the density of the grafted bone,and to assess the relation between the degree of bone resorption and the type of autogenous bone.grafting procedure or the source(block or particulate bone from iliac crest or block bone from chin

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Tissue Stability of Implants Placed in Fresh Extraction Sockets: A 5-Year Prospective Single-Cohort Study

Background: Several materials have been used for ridge preservation after tooth extraction. This 5-year prospective single-cohort study is aimed at evaluating the success rate, marginal bone level (MBL), soft tissue stability, and subjective patient evaluation of implants placed in fresh extraction sockets with the use of a flapless technique and a xenograft to treat the peri-implant bone defect. Methods: Patients requiring a single implant in fresh extraction sockets were selected. After flapless extraction and implant insertion, the peri-implant bone defect was grafted with porcine bone. Collagen membrane was used to stabilize the graft. Four months later, a second surgery and prosthetic procedures were performed. Clinical parameters (width of keratinized gingiva [WKG], facial soft tissue level [FST], papilla index, plaque index, and bleeding on probing) were measured, and periapical radiographs were taken at the time of implant placement (baseline) and then at 1, 3, and 5 years thereafter. Image analysis software was applied to measure changes in the marginal bone level (Delta MBL). Additionally, patient satisfaction regarding the implant treatment was evaluated. All analyses were collected and measured by an independent, trained observer. Together with descriptive statistics, for each of the outcome variables, pairwise comparisons were performed using the Wilcoxon signed-rank test for matched samples. The level of statistical significance was set at 0.01 for all analyses. Results: Forty-seven consecutive patients were treated, with an implant survival rate at 5 years of 95.7%. Delta MBL showed statistically significant differences: mean values were -0.68 +/- 0.39, -0.94 +/- 0.44, and -1.08 +/- 0.43 mm at the 1, 3, and 5-year follow-up, respectively. Changes in WKG (Delta WKG) and FST (Delta FST) decreased from the 1-year point of the survey (0.80 +/- 0.79 and 0.71 +/- 0.73 mm for Delta WKG and Delta FST, respectively) to the last follow-up check at 5 years (0.67 +/- 0.74 and 0.56 +/- 0.69 mm for Delta WKG and Delta FST, respectively), with no significant differences. The papilla indexes showed significant differences among the baseline and all the other time points. Concerning patient satisfaction, at the last survey time point, 74% +/- 11.8% of patients were satisfied regarding the overall implant treatment, 73.0% +/- 11.1% gave a favorable opinion regarding the appearance of the peri-implant soft tissues, and 80.5% +/- 11.3% judged positively the finished appearance of the implant crown. No significant differences were obtained among the three follow-up times. Conclusions: The data of the present study suggest that the placement of a dental implant by means of a flapless technique in a fresh extraction socket filled with slowly resorbable graft biomaterial and with a delayed prosthetic restoration shows positive final esthetic outcomes. At the 5-year point of the survey, the changes in the bone level were minimal. Moreover, both midfacial tissue and the papillae maintained the early increase recorded before the first year of the follow-up

Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis

Abstract Background Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. Methods PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms “Rigid endoscopy AND Flexible endoscopy AND foreign bod*”. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I 2 index and Cochrane Q test. Results Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48–2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96–8.61; p = 0.06), 1.09 (95% CI 0.38–3.18; p = 0.87), and 1.50 (95% CI 0.53–4.25; p = 0.44), respectively. There was no mortality. Conclusions FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated