Quality of Life of Edentulous Patients with Single Mandibular Implants and Mandibular Overdentures Using Two Different Attachments: A Randomized Clinical Trial.

PURPOSE: To compare the changes in quality of life in edentulous patients with single implants supporting mandibular overdentures with two different attachment types before implant placement and after 6 and 24 months. MATERIALS AND METHODS: Eighty edentulous patients were recruited, and all patients completed the validated Oral Health Impact Profile (OHIP)-EDENT-19 questionnaire before implant surgery. A single implant was placed in the midline of the edentulous mandibles. All implants were allowed to heal for 3 months. After the healing period, randomization into one of two groups was accomplished using sealed envelopes: group A (ball attachment) and group B (locator attachment). The same questionnaire was completed 6 and 24 months postplacement. Mann-Whitney U test for independent samples was used to compare the two groups, while Freidman test was used for comparison within each group. Two-sided P values less than .05 were considered statistically significant. RESULTS: There was an improvement in all domains of the OHIP-EDENT-19 scores at the 6- and 24-month follow-ups for both groups. The social disability domain showed a statistically significant improvement for group A at 6 and 24 months postplacement (P = .004, .005). Within group A, there was a statistically significant improvement within all seven domains (P = .001); while in group B, four domains (functional limitation, physical pain, psychosocial discomfort, and physical disability) and the total score (P = .001) showed a statistically significant improvement. CONCLUSION: Both attachments improved the patients' quality of life at 24 months postplacement. The ball attachment demonstrated a significant improvement regarding the social effects of the prostheses.

Vascular and neurosensory evaluation in relation to lingual canal anatomy after mandibular midline implant installation in edentulous patients.

OBJECTIVES: The aim of this study is to investigate vascular and neurosensory complications in edentulous patients following the installation of mandibular midline single implants in relation to lingual canals. MATERIALS AND METHODS: After performing a cone beam computed tomography scan for the 50 recruited patients, the relationship between the potential implant site and the lingual canals was assessed, and all vascular and neurosensory complications were recorded. RESULTS: Six patients (12%) reported profuse bleeding during implant placement, and 13 (26%) reported transient neurosensory changes, which were resolved after 3 months. According to the virtual implant planning, 44 patients (88%) would have their implants touching the lingual canals, six of them reported vascular changes (14%), and 12 out of 44 patients reported neurosensory changes (27%). For the six patients who would have their implants not touching the lingual canals, one patient reported transient neurosensory changes. CONCLUSIONS: The mandibular lingual canals are constant anatomic landmarks. Injury to the supra-spinosum lingual canals may occur during midline implant placement, depending on the implant length and the bone height. CLINICAL RELEVANCE: Despite that injury to the supra-spinosum lingual canals during implant insertion does not result in permanent vascular or neurosensory complications, caution is required to avoid the perforation of the lingual cortices.

Implant Stability Changes for a Single Implant Mandibular Overdenture.

OBJECTIVES: To compare the changes in implant stability for the nonsubmerged and submerged protocols for a single-implant retained mandibular overdenture using Cendres and Metaux Locator attachment throughout a 24-month follow-up. MATERIALS AND METHODS: Eighty edentulous patients who were seeking to install a single implant in the midline of the completely edentulous mandible. At the day of implant installation, patients were randomized into two groups using sealed envelopes: the nonsubmerged and submerged groups. After 3 months of healing period, randomization using sealed envelopes was performed and patients were randomized to receive the Cendres and Metaux Locator attachment. The periotest readings were recorded using the Periotest M device, every 3 months for the first year and annually in the second year. The scope of this clinical trial focused only on results of the Cendres and Metaux attachment. STATISTICAL ANALYSIS: The Mann-Whitney U-test was used for comparison between study groups for independent samples. Two-sided p-values less than 0.05 were considered statistically significant. RESULTS: There was no statistically significant difference between the mean periotest readings of both groups throughout the 24-month follow-up. Both groups showed an improvement in mean periotest readings with the submerged group tending to show greater stability at 6, 12, and 24-month follow-ups. CONCLUSIONS: The nonsubmerged and the submerged healing protocols resulted in reliable periotest readings with the submerged group showing greater improvement than the nonsubmerged, although this improvement is nonsignificant when using the Cendres and Metaux attachment for a single mandibular overdenture.

Implant Stability Changes for Nonsubmerged and Submerged Protocols for a Single Implant Mandibular Overdenture Using Ball Attachment.

OBJECTIVES: To compare the changes in implant stability for the nonsubmerged (NS) and submerged (S) protocols for the single implant retained mandibular overdenture using ball attachment throughout a 24-month follow-up. MATERIALS AND METHODS: Eighty completely edentulous patients were seeking to improve retention of their lower complete denture by installing a single implant in the midline of the completely edentulous mandible. At the day of implant installation, patients were randomized into 2 groups using sealed envelopes: the nonsubmerged (NS) and submerged (S) group. After a 3-month healing period, all patients were randomized using sealed envelopes into ball attachment and CM-LOC attachment. The Periotest readings (PTV) was recorded using the Periotest M device and was recorded every 3 months for the first year and then annually in the second year. The scope of this clinical trial focused only on results of the ball attachment. The Mann-Whitney U test was used for comparison between study groups for independent samples. Two-sided p values less than 0.05 was considered statistically significant. RESULTS: There was no statistically significant difference in the mean change in PTV reading between the NS and S group at the different follow-up intervals. Initially, at the day of pickup (baseline) and 3-month follow-up, the mean PTV reading for the NS was greater than that of the S group (-4.471 ± 1.489, -4.391 ± 1.4727 (p=0.913)), while the S group has shown a greater improvement in PTV than the NS group after 6-month follow-up and continued throughout the 24-month follow-up (-5.730 ± 1.7804, -50855 ± 1.2581 (p=1)). CONCLUSION: Both the nonsubmerged and the submerged healing protocol have shown reliable Periotest readings using ball attachment for a single implant retained overdenture. The submerged group has resulted in a greater improvement in Periotest readings after the 12- and 24-month follow-up period when compared to the nonsubmerged group although this improvement was not statistically significant.

Masticatory Ability for a Single Implant Mandibular Overdenture Retained by Two Different Attachments: A Randomized Controlled Trial.

OBJECTIVE: The aim of this randomized clinical trial was to compare the masticatory ability subjectively between ball and Cendres+Métaux Locator (CM-LOC) attachment for a single implant retained mandibular overdenture throughout a 24-month follow-up period. MATERIALS AND METHODS: Eighty completely edentulous patients were recruited. All patients received new complete dentures, and masticatory ability was recorded using a questionnaire (baseline record). All patients received a single implant in the midline of the completely edentulous mandible. After 3-month healing period, patients were randomized using sealed envelopes into two groups: ball or CM-LOC attachment. The same masticatory ability questionnaire was used to record masticatory ability for both groups after 2 weeks of pickup and 3-, 6-, 9-, 12-, and 24-month follow-up. Comparison between the study groups was done using Mann-Whitney U test for independent samples. Two-sided P values less than 0.05 were considered statistically significant. RESULTS: The mean masticatory scores improved for both attachments, with no statistically significant difference between them throughout the 24-month follow-up. The CM-LOC attachment group showed a greater improvement change in masticatory ability after 6- and 12-month follow-up (-12.47 ± 12.006, -11.46 ± 14.625; P=0.826), while the ball attachment group showed a slight improvement after the 24-month follow-up (-11.72 ± 12.368, -10.88 ± 11.963; P=0.778). CONCLUSION: Single implant retained mandibular overdenture improved masticatory ability subjectively with no significant difference between both attachments used although the ball attachment showed better masticatory ability scores after 24-month follow-up.

Metal-Bound Methisazone; Novel Drugs Targeting Prophylaxis and Treatment of SARS-CoV-2, a Molecular Docking Study.

SARS-CoV-2 currently lacks effective first-line drug treatment. We present promising data from in silico docking studies of new Methisazone compounds (modified with calcium, Ca; iron, Fe; magnesium, Mg; manganese, Mn; or zinc, Zn) designed to bind more strongly to key proteins involved in replication of SARS-CoV-2. In this in silico molecular docking study, we investigated the inhibiting role of Methisazone and the modified drugs against SARS-CoV-2 proteins: ribonucleic acid (RNA)-dependent RNA polymerase (RdRp), spike protein, papain-like protease (PlPr), and main protease (MPro). We found that the highest binding interactions were found with the spike protein (6VYB), with the highest overall binding being observed with Mn-bound Methisazone at -8.3 kcal/mol, followed by Zn and Ca at -8.0 kcal/mol, and Fe and Mg at -7.9 kcal/mol. We also found that the metal-modified Methisazone had higher affinity for PlPr and MPro. In addition, we identified multiple binding pockets that could be singly or multiply occupied on all proteins tested. The best binding energy was with Mn-Methisazone versus spike protein, and the largest cumulative increases in binding energies were found with PlPr. We suggest that further studies are warranted to identify whether these compounds may be effective for treatment and/or prophylaxis.

The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis.

Background: The world urgently requires surrogate markers to diagnose COVID-19 and predict its progression. The severity is not easily predicted via currently used biomarkers. Critical COVID-19 patients need to be screened for hyperinflammation to improve mortality but expensive cytokine measurement is not routinely conducted in most laboratories. The neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker in patients with various diseases. We evaluated the diagnostic and prognostic accuracy of the NLR in COVID-19 patients.Methods: We searched for relevant articles in seven databases. The quantitative analysis was conducted if at least two studies were evaluating the NLR role in COVID-19.Results: We included 8,120 individuals, including 7,482 COVID-19 patients, from 32 articles. Patients with COVID-19 had significantly higher levels of NLR compared to negative individuals. Advanced COVID-19 stages had significantly higher levels of NLR than earlier stages.Expert Opinion: We found significantly higher levels of NLR in advanced stages compared to earlier stages of COVID-19 with good accuracy to diagnose and predict the disease outcome, especially mortality prediction. A close evaluation of critical SARS-CoV-2 patients and efficient early management are essential measures to decrease mortality. NLR could help in assessing the resource allocation in severe COVID-19 patients even in restricted settings.

Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing Cardiac Surgery With Electroencephalography Monitoring: A Systematic Review and Meta-Analysis.

OBJECTIVE: Cardiac surgery for repair of congenital heart defects poses unique hazards to the developing brain. Deep hypothermic circulatory arrest (DHCA) is a simple and effective method for facilitating a bloodless surgical field during congenital heart defect repair. There are, however, some concerns that prolonged DHCA increases the risk of nervous system injury. The electroencephalogram (EEG) is used in adult and, to a lesser extent, pediatric cardiac procedures as a neuromonitoring method. The present study was performed to assess outcomes following DHCA with EEG monitoring in the pediatric population. DESIGN: In this systematic review and meta-analysis, the PubMed, Cochrane Central Register of Controlled Trials, Scopus, Institute of Science Index, and Embase databases were searched from inception for relevant articles. A fixed- or random-effects model, as appropriate, was used. SETTING: Surgical setting. PARTICIPANTS: Pediatric population (≤18 y old). INTERVENTIONS: DHCA (18°C) with EEG monitoring. MEASUREMENTS AND MAIN RESULTS: Nineteen articles with 1,267 pediatric patients ≤18 years were included. The event rate of clinical and EEG seizures among patients who underwent DHCA was 12.9% and 14.9%, respectively. Mortality was found to have a 6.3% prevalence. A longer duration of DHCA was associated with a higher risk of EEG seizure and neurologic abnormalities. In addition, seizures were associated with increased neurologic abnormalities and neurodevelopmental delay. CONCLUSIONS: EEG and neurologic abnormalities were common after DHCA. A longer duration of DHCA was found to lead to more EEG seizure and neurologic abnormalities. Moreover, EEG seizures were more common than clinical seizures. Seizures were found to be associated with increased neurologic abnormalities and neurodevelopmental delay.

Cost-Effectiveness of CM-LOC Attachment versus Ball Attachment Retaining Single Implant Mandibular Overdentures.

AIM: To investigate the cost-effectiveness of the novel CM-LOC attachment compared to the gold standard ball attachment in single implant mandibular overdenture. MATERIAL AND METHODS: Fifty-two completely edentulous patients (50 to 69 years old) seeking to improve the retention of their complete mandibular dentures by installing a single implant in the midline of the mandible were recruited for this study. The patients were equally divided into two groups. The first group received a ball attachment abutment over the implant and the second group received CM-LOC attachment abutment. The initial cost and aftercare (maintenance) cost were calculated for each attachment and compared to each other. RESULTS: The initial cost of the CM-LOC attachment was 2.2 times that of the traditional ball attachment. The after-care cost of the CM-LOC attachment was 2.39 times more than the ball attachment. The total cost of the CM-LOC attachment was 2.22 times that of the ball attachment. CONCLUSION: The ball attachment system showed better cost-effectiveness compared to the CM-LOC attachment from the beginning of the study and throughout all the treatment period during the first year.

Effects of different dose regimens of magnesium on pharmacodynamics and anesthetic requirements of balanced general anesthesia.

The present double- blind, randomized, placebo-controlled study was designed to assess the effect of two different dose regimens of magnesium sulphate (MgSO4) administration on intraoperative propofol and vecuronium requirements and postoperative fentanyl consumption in patients undergoing hernioraphy. Sixty patients were allocated to three equal groups; two magnesium groups and control group. Magnesium groups received 50 mg kg(-1) of magnesium preoperatively followed by intravenous infusion of magnesium 8 mg kg(-1) h(-1) (Mg1 G) or 16 mg kg(-1) h(-1) (Mg2 G). Patients in control group received the same volume of isotonic solution. Anesthesia was induced and maintained with propofol, fentanyl, and vecuronium. Magnesium Gs required significantly lower propofol (121.0 +/- 4.5, 117.4 +/- 6.3 microg kg(-1) min. (-1) in Mg1 & Mg2 Gs respectively vs. 153.8 +/- 8.4 microg kg(-1) min. (-1) in control G), and vecuronium requirements (0.097 +/- 0.008, 0.0921 +/- 0.006 mg kg(-1) h(-1) in Mg1 & Mg2 Gs respectively vs. 0.124 +/- 0.01 mg kg(-1) h(-1) in control G). Magnesium significantly shortened the onset time of vecuronium (154.0 +/- 25.9, 162.0 +/- 22.4 sec. in Mg1 & Mg2 Gs respectively vs. 227.4 +/- 10.9 sec. in control), prolonged its clinical duration (44.7 +/- 3.2, 46.4 +/- 5.1 min. in Mg1 & Mg2 Gs respectively vs. 26.0 +/- 3.9 min. in control) and prolonged its recovery index which was significantly longest in Mg2 G (25.4 +/- 1.9 min.) compared to Mg1 G (20.1 +/- 2.1 min.) and control (15.3 +/- 1.4 min.). Fentanyl consumption on the first postoperative day was significantly higher in control (1.52 +/- 0.08 microg kg(-1)) than in magnesium Gs (0.96 +/- 0.07, 0.91 +/- 0.08 microg kg(-1) in Mg1 & Mg2 Gs respectively). Postoperative sedation score showed significantly the highest value in Mg2 G compared to Mg1 and control Gs. Mean arterial blood pressure and heart rate were lower in magnesium groups with lowest value in Mg2 G. It is concluded that magnesium 50 mg kg(-1) bolus followed by 8 mg kg(-1) h(-1) leads to significant reductions in intraoperative propofol and vecuronium and postoperative fentanyl consumption. Doubling magnesium infusion rate added minimal benefits on the expense of haemodynamic consequences and delayed recovery.