Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study.

OBJECTIVE: To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS: Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS: At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS: This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE: A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.

Periodontal health in a population with Parkinson's disease in Spain: a cross-sectional study.

BACKGROUND: The aim of this research is to evaluate the periodontal health of patients with Parkinson Disease (PD) in a Spanish cohort. MATERIAL AND METHODS: A cross-sectional study was performed on 104 patients with PD (mean age: 66.19+9.3 years) and 106 controls (mean age: 59.26+14.11 years). A pre-designed clinical protocol was implemented, which included a standardized epidemiological index for periodontal disease (CPITN), clinical attachment loss (CAL), tooth-loss, full mouth plaque index (FMPI), and oral hygienic habits. Univariate descriptions and comparative analysis were performed. RESULTS: The majority of PD patients presented good oral hygienic habits. There were no significant differences in relation to CPITN, periodontitis, gingival recessions and tooth loss. However, moderate/severe CAL (p=0.027) and FMPI (p=0.003) was higher in the PD group. CONCLUSIONS: There were no differences on periodontitis and tooth loss between both groups. The higher number of advanced CAL and presence of biofilm in the PD group could be related to the difficulties to perform an effective tooth brushing due to this neurological disorder.

Marginal bone loss around implants placed in maxillary native bone or grafted sinuses: a retrospective cohort study.

OBJECTIVES: To assess differences in marginal bone loss around implants placed in maxillary pristine bone and implants placed following maxillary sinus augmentation over a period of 3 years after functional loading. MATERIAL AND METHODS: Two cohorts of subjects (Group 1: Subjects who received sinus augmentation with simultaneous implant placement; Group 2: Subjects who underwent conventional implant placement in posterior maxillary pristine bone) were included in this retrospective study. Radiographic marginal bone loss was measured around one implant per patient on digitized panoramic radiographs that were obtained at the time of prosthesis delivery (baseline) and 12, 24, and 36 months later. The influence of age, gender, smoking habits, history of periodontal disease, and type of prosthetic connection (internal or external) on marginal bone loss was analyzed in function of the type of osseous support (previously grafted or pristine). RESULTS: A total of 105 subjects were included in this study. Cumulative radiographic marginal bone loss ranged from 0 mm to 3.9 mm after 36 months of functional loading. There were statistically significant differences in marginal bone loss between implants placed in grafted and pristine bone at the 12-month assessment, but not in the subsequent progression rate. External prosthetic connection, smoking, and history of periodontitis negatively influenced peri-implant bone maintenance, regardless of the type of osseous substrate. CONCLUSIONS: Implants placed in sites that received maxillary sinus augmentation exhibited more marginal bone loss than implants placed in pristine bone, although marginal bone loss mainly occurred during the first 12 months after functional loading. Implants with external implant connection were strongly associated with increased marginal bone loss overtime.

[To go in-depth in the knowledge of the device to control fecal elimination in the critical patient]. / Profundizando en el conocimiento sobre el manejo del dispositivo para control de la eliminación fecal en el paciente crítico.

OBJECTIVE: To describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. MATERIAL AND METHODS: An analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal(®) carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P<.05. RESULTS: Twenty-one patients were included, 52% male, aged 54±17 with 30 insertion episodes, Flexi-Seal-Signal(®) 33%, 10±8 days permanency, main indication 33% «diarrhea and injured skin¼," 30% device removal «intolerance and/or spontaneous expulsion¼. Median (Me) PGR =40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal(®), MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4(1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal(®) conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. CONCLUSIONS: Monitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume.

Portland Versus Alkaline Cement: Continuity or Clean Break: "A Key Decision for Global Sustainability".

This review undertakes rigorous analysis of much of the copious literature available to the scientific community on the use of alkali-activated binders (AABs) in construction. The authors' main intention is to categorically refute arguments of that part of the scientific community underestimating or even dismissing the actual potential of AABs as alternatives to Portland cement (PC). The main premise invoked in support of those arguments is a presumed lack of material resources for precursors that would make AAB industrial-scale production unfeasible anywhere on the planet (a substantial number of scientific papers show that the raw materials required for AAB manufacture are in abundance worldwide). The review also analyses the role of alkaline activators in the chemistry of AABs; it is important to clarify and highlight that alkaline activators are not, by any means, confined to the two synthetic products (caustic soda and waterglass) mostly employed by researchers; other sustainable and efficient products are widely available. Finally, the review deals with the versatility of AAB production processes. The technologies required for the large scale manufacturing of AABs are mostly already in place in PC factories; actually no huge investment is required to transform a PC plant in a AAB factory; and quality and compositional uniformity of Alkaline Cements (binders produced through an industrial process) would be guaranteed. The last conclusions extracted from this review-paper are related with: i) the low carbon footprint of one-part AABs and ii) the urgent need of exploring standardization formulas allowing the commercial development of (sustainable) binders different from PC.

Stabilization/solidification of hazardous and radioactive wastes with alkali-activated cements.

This paper reviews progresses on the use of alkali-activated cements for stabilization/solidification of hazardous and radioactive wastes. Alkali-activated cements consist of an alkaline activator and cementing components, such as blast furnace slag, coal fly ash, phosphorus slag, steel slag, metakaolin, etc., or a combination of two or more of them. Properly designed alkali-activated cements can exhibit both higher early and later strengths than conventional portland cement. The main hydration product of alkali-activated cements is calcium silicate hydrate (CSH) with low Ca/Si ratios or aluminosilicate gel at room temperature; CSH, tobmorite, xonotlite and/or zeolites under hydrothermal condition, no metastable crystalline compounds such as Ca(OH)(2) and calcium sulphoaluminates exist. Alkali-activated cements also exhibit excellent resistance to corrosive environments. The leachability of contaminants from alkali-activated cement stabilized hazardous and radioactive wastes is lower than that from hardened portland cement stabilized wastes. From all these aspects, it is concluded that alkali-activated cements are better matrix for solidification/stabilization of hazardous and radioactive wastes than Portland cement.

Profundizando en el conocimiento sobre el manejo del dispositivo para control de la eliminación fecal en el paciente crítico / To go in-depth in the knowledge of the device to control fecal elimination in the critical patient

OBJETIVO: Describir las características generales del paciente y del uso del dispositivo. Conocer presión del globo de retención (PGR) y factores relacionados. Identificar incidencia de fuga, recolocación y lesión perineal asociada al dispositivo (LAD) y factores relacionados. MATERIAL Y MÉTODOS: Estudio observacional analítico longitudinal realizado en UCI polivalente, de junio a diciembre de 2010. La muestra incluyó portadores de Flexi-Seal ®. Se valoraron: características de pacientes y de uso del dispositivo, PGR, fuga y cantidad, recolocación y motivo, LAD, sedoanalgesia en perfusión(SAP), relajación en perfusión, posición, tipo sonda, modalidad ventilatoria(MV), presión intraabdominal(PIA), presión media intratorácica(PMI), PEEP, Glasgow, color-aspecto, consistencia y volumen de heces. Significación p < 0,05. RESULTADOS: Se incluyeron 21 pacientes, 52% varones, edad 54 ± 17años con 30 episodios de inserción, Flexi-Seal-Signal ® un 33%, permanencia 10 ± 8días, principal indicacion «diarrea más lesión piel» en un 33%, retirada «intolerancia y/o expulsión espontánea» en un 30%. PGR mediana (Me) = 40; RI (61-19) cmH2O. Factores asociados significativamente a mayor PGR: ausencia de SAP, decúbito prono, fuga, recolocación, Flexi-Seal ® convencional, MV, menor PEEP y PMI, color-aspecto y mayor PIA. Densidad de incidencia de fuga, recolocación y LAD 43, 30 y 2 casos/100días de sonda, respectivamente. Factores de riesgo de fuga y recolocación: mayor PGR, Glasgow y volumen de heces, menor PIA, MV, modalidad asistida-espontánea OR 2,5; IC (1,6-3,8) y OR 1,7 (1,1-2,7), ausencia SAP OR 3,3 (2,2-5,1) y OR 2,4 (1,5-3,8), relajación en perfusión OR 2,4 (1,4-3,9) y OR 1,8 (1,1-3,1), Flexi-Seal ® convencional OR 2,7 (1,7-4,1) y OR 2 (1,2-3,3), respectivamente. Factores de riesgo de fuga: color-aspecto, decúbito supino, menor PMI y PEEP. CONCLUSIONES: Monitorizar la PGR puede alertar sobre la aparición de fuga y necesidad de recolocación. Conocer los factores asociados a la PGR, fuga y recolocación permitirá desarrollar estrategias para descender su elevada incidencia, como puede ser la disminución de la PGR reduciendo el volumen de hinchado

OBJECTIVE: To describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. MATERIAL AND METHODS: An analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal ® carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P < .05. RESULTS: Twenty-one patients were included, 52% male, aged 54 ± 17 with 30 insertion episodes, Flexi-Seal-Signal ® 33%, 10 ± 8 days permanency, main indication 33% «diarrhea and injured skin»," 30% device removal «intolerance and/or spontaneous expulsion». Median (Me) PGR = 40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal ®, MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4 (1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal® conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. CONCLUSIONS: Monitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume