Quantification of training in educational methodology among teachers on the degree course in medicine: a pilot study.

BACKGROUND: Medical education has undergone significant changes over the last decades. Scientific and technological progress alongside contemporary society's changing requirements have driven demand for highly trained, competent doctors. In response to this need, university faculties of medicine have sought innovative forms of teaching and evaluating the students on their degree courses. The aim of this study was to quantify the characteristics and extent of academic training in teaching methods, of participation in innovative teaching initiatives, and training in simulation and debriefing among the teaching personnel on the degree course in medicine at the University of Granada (Spain). METHODS: This transversal descriptive study was conducted among a population of 121 educators teaching on the medical degree course at the University of Granada, Spain. All responded to a specially designed CoRe-Content Representation questionnaire. This consisted of various parts: (a) demographic data; (b) teaching experience and qualifications; (c) specific information about training in teaching skills received. The Fisher test was applied whenever the dependent variable had two values (dichotomous) and the Chi-square test when it had more than two values (polytomic). Statistical significance was established with an alpha error of 5%. RESULTS: The results showed that 87.60% of the educators had received no training in debriefing. There was a notable gender gap, whereby women held fewer management posts, fewer were engaged in clinical activity, and fewer had undergone training in clinical simulation. Teachers with degrees in medicine had undergone less regulated training than educators with other degree qualifications. CONCLUSION: The main areas of medical training that require improvement (and so present challenges to be met in the years to come) are as follows: a definitive solution to the existing gender gap, general implementation of new educational models and methods (especially learning based on clinical problem-solving and simulation), closing generation gaps, and improved training processes for educators with clinical attachment.

Magnetic detection of sentinel nodes in oral squamous cell carcinoma by means of superparamagnetic iron oxide contrast.

The aim was to evaluate sentinel node detection capacity by means of a magnetic probe in 11 patients with oral squamous cell carcinoma at stages T1-T2 received submucosal injections of a superparamagnetic iron oxide contrast agent (SPIO). A magnetic probe was used for sentinel node biopsy. The use of SPIO and magnetic probes in the early stages of oral cancer may offer an alternative to conventional radioisotope techniques and/or elective neck dissection.

Correction to: Influence of surface treatment on osseointegration of dental implants: histological, histomorphometric and radiological analysis in vivo.

Dear Professor Dr. Matthias Hannig. Editor-in-Chief Clinical Oral Investigations. Following the publication of our paper by Calvo Guirado et al, 2015 [1] in Clinical Oral Investigations, it came to light that a certain part of the text at the materials and methods and results sections were similar.

Dental implant surgery in patients in treatment by dabigatran.

OBJECTIVES: The aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the oral anticoagulant dabigatran following a specific protocol. MATERIAL AND METHODS: Seventy-one patients were divided into two groups: 29 had been taking dabigatran for over 6 months (150 mg orally every 12 h) before implant surgery (dabigatran group) and a control group consisting of 42 healthy subjects. Patients were treated in an outpatient setting. All subjects received dental implants in different positions, dabigatran group patients 12 h after the last dose of dabigatran. Nonabsorbable sutures were used and patients were given gauzes impregnated with tranexamic acid 5% to bite on for 30-60 min. Dabigatran patients resumed medication 8 h after the procedure, resuming usual dosage (every 12 h) the day after surgery. RESULTS: Two dabigatran patients and two control patients presented slight bleeding the day after surgery. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P = 0.542) were found in relation to bleeding episodes between the groups, with a relative risk of 0.675 based on the pooled groups and a 95% confidence interval of 0.090-5.088. CONCLUSIONS: Dental implant surgery in patients taking dabigatran can be performed safely providing 12 h have passed since the last dose and local hemostatic measures are applied. Normal dosage can be resumed 8 h after implant surgery.

The antibiotic of choice determined by antibiogram in maxillary sinus elevation surgery: a clinical study.

OBJECTIVES: This study set out to make antibiograms of positive bacteria cultures in samples collected when performing maxillary sinus elevations to determine a specific and effective antibiotic in each case. MATERIAL AND METHODS: A total of 174 patients (90 women and 84 men) with a mean age of 55.92 years underwent 227 sinus elevations. As the membrane was lifted, a sample was collected from the maxillary sinus floor with a cotton swab and placed on a blood agar and chocolate agar culture to incubate for 48 h at 37°; the samples then underwent microbiological analysis. Antibiograms were made for each positive culture to identify the most sensitive antibiotic, which were regrouped according to their mechanism of action as: beta-lactam (penicillins), beta-lactam (cephalosporins), macrolides, quinolones, fosfomycin, aminoglycosides, or trimethoprim-sulfamethoxazole. RESULTS: Of 227 cultures, 18.1% were bacteria-positive. Of the germs, 45% were of the Streptococcus genus, most of which belonged to the Streptococcus viridans group (61.1%). The germs studied showed greater resistance to macrolides and greater sensitivity to penicillins, cephalosporins, and ciprofloxacin. The antibiotics that showed the greatest efficacy were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. CONCLUSIONS: On the basis of antibiograms of positive cultures, the antibiotics presenting the greatest efficacy against possible complications were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. Clinically, the antibiograms proved useful as they allowed the prescription of specific antibiotics to resolve possible postoperative sinus infections.

Biological effects of compressive forces exerted on particulate bone grafts during socket preservation: animal study.

OBJECTIVES: To compare different compressive forces exerted on a particulate graft material during socket preservation and their effects on bone regeneration. MATERIAL AND METHODS: Six male dogs were used. The second, third, and fourth premolars, and the first molar were extracted bilaterally at the lower jaws. A particulate synthetic biphasic grafting material (60% HA and 40% ß-tricalcium phosphate) was used. Three different standardized compressive forces were applied randomly during the socket preservation. The sample was divided into four experimental groups Test A (10 g), Test B (50 g), Test C (200 g), and Control (empty sockets). Collagen membranes were placed, and primary closure was obtained. Two months after the surgery the animals were sacrificed, and histomorphometric analysis of non-decalcified samples was performed at the coronal, middle, and apical thirds. RESULTS: Grafted sockets resulted in higher bony contour (3 ± 0.43 mm2 ; P < 0.05). The particles penetrated up to the apical third in the group C but not in the other test groups and controls (P < 0.05). The percentage of new bone were higher at the coronal and apical thirds for Controls and group C compared to A and B groups (P < 0.05). The residual graft was higher for group C (53 ± 1.4%), followed by group B (45 ± 3.1%) and group A (35 ± 1.9%; P < 0.05). The percentages of connective tissue were higher at the middle third without differences between groups (P > 0.05). CONCLUSIONS: Within the limitations of this experimental animal study, it might be concluded that grafted sockets compressed with 200 g force will have higher bony contours; higher compressive forces facilitate the penetration of the particulate graft material into the apical area of the socket and results in more bone formation at the coronal, middle, and apical thirds.

Role of mechanical compression on bone regeneration around a particulate bone graft material: an experimental study in rabbit calvaria.

PURPOSE: This experimental study was designed to analyze the effect of different compressive forces on the bone regeneration around a particulate bone graft material. MATERIAL AND METHODS: Eighty 6-mm-diameter defects were created in the calvaria of 20 New Zealand rabbits (4 defects per rabbit calvaria). All the defects were filled with particles of synthetic bone. Two standardized compressive forces were then applied, 4.1 g to half the defects (Test A) and 8.2 g to the other half (Test B), all for 1 min. The graft sites were allowed to heal for 6 weeks, after which the rabbits were euthanized. The calvarium vault of each animal was extracted, radiographed, and prepared for histomorphometric analysis. The percentage of defect fill, bone density, new bone formation, and residual bone graft material were recorded, and the results were subjected to statistical analysis. RESULTS: Histological evaluation found that defect closure among the Test A (lower compression) group ranged from 38.34 (95% lower CI) to 55.8 (95% upper CI) (mean 47 ± 8.5%), while among the Test B group (higher compression), it ranged from 81.26 (95% lower CI) to 95.32 (mean 88 ± 7.3%). Significantly more closure was achieved for the Test B group (P < 0.05). Histomorphometric comparison of the two groups found significantly more new bone formation, higher bone density, and a higher percentage of defect fill in the defects subjected to the higher compression level (P < 0.05). CONCLUSIONS: Increasing the compressive force applied to bone graft particulate used to fill small defects created in rabbit calvaria appears to be beneficial.

Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part B: a comparative study with biphasic synthetic biomaterials.

OBJECTIVE: The aim of this study was to compare the influence of the physical-chemical properties of synthetic hydroxyapatite (HA) and biphasic commercial materials on the biological behavior of study materials through material characterization and SEM analysis before and after application in rabbit tibias. MATERIALS AND METHODS: Two defects were performed in each tibiae for a total of 180 defects: Group I HA granules (2000-4000 µm), Group II HA granules (1000-2000 µm), Group III HA granules (600-1000 µm), Group IV Ossceram® nano (Bredent medical GmbH & Co. KG, Senden, Germany), Group V 4Bone® granules (MIS Implants Technologies Ltd, Shlomi, Israel), and Group VI: empty defect acted as control. Comparison was performed by mean of material characterization, SEM, and EDX. RESULTS: 4Bone: Pores between 300 µm and 100 µm with intra- and interparticle spaces. Ossceram show also interparticle and intraparticle pores, between 100 µm and 26 µm, but the proportion of interparticles in the 4Bone is clearly minor than in the Ossceram. Related with pure HA, Group III has the greatest porosity (69.3%). For Group I, the intraparticle pores (0.71 µm) are about 8 times larger than those of the other two samples. The analysis of the images of in vivo SEM shown as biphasic groups has presented a more gradual resorption of the material. CONCLUSION: HA-based biomaterials, both pure and biphasic, are an effective means for bone regeneration processes; of these, materials with higher initial and secondary porosimetry allow greater cell colonization and therefore more effective substitution by new bone. The two-phase materials have a higher ion release to the environment in the early stages and thus allow greater colonization by collagen fibers that can be matured into new bone.

Effects on the osseointegration of titanium implants incorporating calcium-magnesium: a resonance frequency and histomorphometric analysis in rabbit tibia.

OBJECTIVE: This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface. MATERIAL AND METHODS: The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05. RESULTS: Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times. CONCLUSION: Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact.

Piezosurgery for Treatment of Large Recurrent Mandibular Osteoma.

BACKGROUND: Osteomas are infrequent benign bone tumors of uncertain etiology. They are usually situated at extremities and their occurrence in the jaws is relatively rare. There are 3 types of osteoma: central, peripheral, and extraskeletal. Preoperative presumptive diagnosis is performed by means of radiography using orthopantomographs, computerized tomographs, or cone beam scans. Treatment is surgical and consists of careful exeresis and curettage of the adjacent tissue. In recent years, piezoelectric surgery has been used to treat bone pathologies in the maxillofacial area, orthopedic surgery, and neurosurgery. When used for the exeresis of a bone lesion, the device minimizes risks and eliminates possible complications arising from affectation of the vascular and nerve structures close to the lesion. OBJECTIVE: This clinical report describes a peripheral mandibular osteoma situated in the left mandibular basilar which recurred 45 years after surgical treatment at another center. METHODS: For resection, the surgical approach followed the scar remaining from the earlier surgery and was performed using piezoelectric surgery. Surgery did not cause hemorrhagic complications, affect the sensitivity of the left labial menton, or cause paralysis of the lower lip. CONCLUSIONS: Based on the present patient, it may be concluded that mandibular osteoma treatment by means of piezoelectric surgery makes precise exeresis possible with less affectation of the important surrounding structures such as the inferior alveolar nerve and the marginal mandibular branch of the facial nerve.

Polymethyl Methacrylate Custom-Made Prosthesis: A Novel Three-Dimension Printing-Aided Fabrication Technique for Cranial and/or Orbital Reconstruction.

BACKGROUND: Over the years, many materials have been used in orbital reconstruction and cranioplasty. Among the materials in current use, polymethyl methacrylate (PMMA) offers a high degree of compatibility with human tissue. OBJECTIVE: This work describes a new, custom-made, 3D printing-aided, prosthetic fabrication process for orbital and/or cranial reconstruction using PMMA. METHODS: On the basis of information obtained from computerized tomography scanning processed in Digital Imaging and Communication in Medicine format and exported to treatment planning software, a 3D prosthesis master model was designed and digitally printed. This was then used to create an injection mold from which the prosthesis was cast in PMMA and implanted in the patient. Five patients with cranial and/or orbital defects of tumoral or traumatic etiology were treated by this method. After 5 to 7 years follow-up, no complications occurred to cause the removal of the prostheses. CONCLUSION: This novel method makes it possible to produce customized PMMA prostheses to treat orbital and/or cranial defects that are cost-effective and individualized to each case.

Reconstruction of Liposarcoma Resection Defect With a Made-to-Measure Polyethylene Prosthesis Using Three-Dimensional Digital Technology.

BACKGROUND: Liposarcoma is considered one of the most frequently occurring tumors of the soft tissues, representing 17% to 30% of all mesenchymal cell tumors. It is less common in the head and neck representing <10% of tumors in this region. The reconstruction of defects derived from resection of these tumors presents a surgical challenge. New three-dimensional digital technologies allow more exact surgery, cause less morbidity, and achieve adequate aesthetic outcomes. OBJECTIVE: The aim of this article was to describe the complex reconstruction of a defect caused by the resection of a liposarcoma in the temporal region. METHODS: Three-dimensional technology allowed patient planning and a reconstruction that was as exact as possible. A made-to-measure polymethyl methacrylate prosthesis was used to correct the defect in the zygomatic arch. The temporal fossa was covered with a standard porous polyethylene prosthesis. CONCLUSIONS: Satisfactory esthetic and functional results were achieved using three-dimensional digital technology for treatment planning and to fabricate a made-to-measure polyethylene prosthesis and surgical guide.

Reconstruction of a Compound Oromandibular Defect by Means of Chimeric Scapular-Parascapular Free Flap Assisted by Virtual Surgical Planning.

BACKGROUND: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. OBJECTIVE: This article reports a complex patient with a composite oromandibular defect. METHODS: The patient had undergone multiple surgeries with bad results. She presented an orostoma of 5 cm in diameter, osteoradionecrosis and fracture of the left mandibular body, and relapse in the ipsilateral posterior maxilla. Reconstruction was performed by means of a scapular/parascapular chimeric free flap. A customized reconstruction plate was designed virtually based on the mirror image of the contralateral mandibular body. Surgery and the postoperative phase passed without incident. The patient recovered vocal, swallowing, and respiratory function without any problems. At the end of a 1-year follow-up, no complications or tumor relapse had occurred. CONCLUSIONS: Composite defects are a surgical challenge in which free flap reconstruction is an evolution that has facilitated treatment and led to improved outcomes. Virtual treatment planning produces more exact results and greater control of surgical techniques.

Effects of Surface Treatment Modification and Implant Design in Implants Placed Crestal and Subcrestally Applying Delayed Loading Protocol.

OBJECTIVES: The aim of this study is to evaluate the effect of the surface modification and cervical implant design on the bone remodeling in implants installed at the crestal and subcrestal bone level. METHODS: Ten American Fox Hound of approximately 1 year of age, each weighing approximately 14 to 15 kg, were used for this study. Two different dental implant macrodesign were used: cylindric-conical with 3.5 mm of diameter and 9 in length (implant A) and conical with 2.9 mm of diameter and 9 mm in length (implant B). Two surfaces were used: sandblasting and acid etching (surface 1) and sandblasting and acid etching, then maintained in an isotonic solution of 0.9% sodium chloride (surface 2). Four groups were performed (n = 20 implants): Group A1 (implant A with the surface 1), Group A2 (implant A with surface 2), Group B1 (implant B with surface 1), and Group B2 (implant B with surface 2). The mandibular premolars and molars (P1, P2, P3, M1) were removed and, after 2 months of healing, implants were inserted at the crestal and 2 mm subcrestal position related to the buccal bone level. Analysis was performed at 4 and 8 weeks. Histomorphometry with longitudinal measurements and bone implant contact, bone remodeling and implant stability quotient analysis were realized. RESULTS: The surface 2 showed to get more close contact between implant and new bone formed after implant placement and more stability surrounding platform both at 4 and 8 weeks. Surface 2 groups and subrestally placed showed to have better results in terms of linear measurements, with less bone loss and soft tissue distance to the IS. The data showed significant differences among the groups (P < 0.001). CONCLUSIONS: Surface modification (surface 2) has shown to be an effective alternative to conventional surface with better results in situations placed subcrestally and combined with implant design.

Manual versus sonic powered toothbrushing in patients with intellectual disability: a cluster-randomized clinical trial.

OBJECTIVES: To compare the use of sonic powered or manual toothbrush in patients with intellectual disability (ID) in terms of plaque (PlI) and gingival (GI) indices and adverse effects. MATERIAL AND METHODS: Subjects with ID were recruited for this cluster-randomized, single blinded (examiner), 6-month clinical trial, comparing powered versus manual toothbrushing. Outcome variables included PlI and GI, evaluated at baseline and 3 months after supervised toothbrushing and after 3 additional months of unsupervised used. Clinical outcome variables were analysed by repeated measures ANCOVA considering time and group as factors and respective baseline values as covariates (generalized linear model). RESULTS: Sixty-four patients (34 male, mean age 34.5) in six clusters were included in the study. No statistically significant effect of toothbrushing group was observed for PlI or GI. A significant effect of time was identified (p < 0.001) with mean reductions ranging 0.44-0.45 for PlI and 0.30-0.36 for GI from baseline to 3-6 months. No relevant adverse effect or technical problems were observed. CONCLUSION: The tested sonic powered toothbrush was as effective and safe as the manual toothbrush. The use of powered or manual toothbrushes, together with fluoride toothpaste, may improve plaque and gingivitis levels, in patients with mild to limit ID.

Denosumab and osteonecrosis of the jaw. A systematic analysis of events reported in clinical trials.

OBJECTIVES: The aims of this meta-analysis were (i) to perform a systematic review of the relation between treatment with denosumab and the incidence of osteonecrosis of the jaw (ONJ) and (ii) to obtain information on dosage, first event apparition, and treatment approaches for patients with ONJ related to denosumab. MATERIALS AND METHODS: A systematic review and meta-analysis of relevant literature was performed in the PubMed, MEDLINE, Embase, and Cochrane databases, identifying randomized clinical trials that evaluate the adverse effects of denosumab. The overall incidence rates and 95% confidence intervals (CI) for ONJ were calculated employing fixed- and random-effects models, according to the heterogeneity of the studies included. RESULTS: A total of 8963 patients with a variety of solid tumors reported in seven randomized controlled trials (RCTs) were included in the systematic analysis. The overall incidence of ONJ in patients with cancer receiving denosumab was 1.7% [95% CI: 0.9-3.1%]. The use of denosumab was associated with a significantly increased risk of ONJ in comparison with bisphosphonates (BPs)/placebo treatment (RR 1.61, 95% CI: 1.05-2.48, P = 0.029). Subgroup analysis based on controlled therapies demonstrated an increased risk of ONJ in denosumab therapy, when compared with BPs (RR 1.48, 95% CI: 0.96-2.29, P = 0.078) or placebo (RR 16.28, 95% CI: 1.68-158.05, P = 0.017). Similar results were observed for prostate cancer (RR 3.358, 95% CI: 1.573-7.166, P = 0.002). CONCLUSIONS: Denosumab combined with risk factors such as dental extraction, poor oral hygiene, use of removable apparatus, and chemotherapy may favor the development of ONJ.

Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part A: synthesis, characterization of the materials, and SEM analysis.

OBJECTIVE: The aim of this study was the synthesis and analysis of the tissue reaction to three different Hydroxyapatite (HA)-based bone substitute materials differing only in granule size, porosity, and crystallinity through an animal experimental model at 60 days. MATERIALS AND METHODS: Three different HA-based biomaterials were synthesized and characterized by X-ray diffraction, SEM, and EDS analysis, the resultant product was ground in three particle sizes: Group I (2000-4000 µm), Group II (1000-2000 µm), and Group III (600-1000 µm). Critical size defects were created in both tibias of 15 rabbits. Four defects per rabbit for a total of 60 defects were grafted with the synthesized materials as follows: Group I (15 defects), Group II (15 defects), Group III (15 defects), and empty (15 defects control). After animals sacrifice at 60 days samples were obtained and processed for SEM and EDS evaluation of Ca/P ratios, elemental mapping was performed to determine the chemical degradation process and changes to medullary composition in all the four study groups. RESULTS: The tendency for the density was to increase with the increasing annealing temperature; in this way it was possible to observe that the sample that shows highest crystallinity and crystal size corresponding to that of group I. The SEM morphological examination showed that group III implant showed numerous resorption regions, group II implant presented an average resorption rate of all the implants. The group I displayed smoother surface features, in comparison with the other two implants. CONCLUSION: The data from this study show that changing the size, porosity, and crystallinity of one HA-based bone substitute material can influence the integration of the biomaterials within the implantation site and the new bone formation.