Contemporary concepts on periodontal complications from prosthetic and restorative therapies.

The clinical outcome of every prosthetic and restorative procedure depends on the maintenance of a healthy periodontium. It is, therefore, important that the prosthodontist and restorative dentist cause no harm or permanent damage to the underlying hard and soft tissues when performing clinical procedures necessary to carry out the planned treatment. Several factors involved in these procedures have been described to have an impact on gingival health. For the present article, a selection of four of these factors are presented with the goal of evaluating the current trends and their influence on periodontal structures: (1) tooth preparation configuration and apical extension, (2) gingival tissue sulcular expansion/retraction, (3) prosthetic contours, and (4) prosthesis marginal adaptation and the consequences of excess cement remnants. Based on the available scientific evidence and clinical experience, recommendations for the practitioner are given.

A comprehensive approach to assigning periodontal prognosis.

AIM: The purpose of this retrospective case series study was to evaluate the usefulness and performance of a comprehensive approach to assigning periodontal prognosis by assessing the risk of tooth loss due to periodontal disease (TLPD) and estimate the survival time (ST) of periodontally compromised teeth (PCT). MATERIAL AND METHODS: The Long-Term Outcome (LTO) index was utilized to assess the risk of TLPD, at baseline, in 100 patients following periodontal maintenance for a mean 24.7 year (±2.4). A TLPD prediction model was utilized to assign ST to PCT. The performance of the TLPD prediction based on both parameters was assessed. RESULTS: The mean TLPD rate increased as the LTO index increased (Kruskal-Wallis p < .001). The percentage of TLPD increased as the ST decreased, with significantly differences between the LTO categories <4 and ≥4 for all ST intervals (Mann-Whitney p < .001 to p .021). Only 21% of PCT were lost. This percentage was 58% for teeth assigned the shortest ST and increased to 71% and 88% for these teeth in LTO ≥4 patients. CONCLUSIONS: This approach might be useful to predict TLPD in patients with an initial higher risk of TLPD while it was not useful in patients with lower risk of TLPD.

Corticosteroids and other immunosuppressants for immune-related adverse events and checkpoint inhibitor effectiveness in melanoma.

BACKGROUND: Recent studies indicate an association between immunosuppression for immune-related adverse events (irAEs) and impaired survival in patients who received immune checkpoint inhibitors. Whether this is related to corticosteroids or second-line immunosuppressants is unknown. In the largest cohort thus far, we assessed the association of immunosuppressant type and dose with survival in melanoma patients with irAEs. METHODS: Patients with advanced melanoma who received immunosuppressants for irAEs induced by first-line anti-PD-1 ± anti-CTLA-4 were included from 18 hospitals worldwide. Associations of cumulative and peak dose corticosteroids and use of second-line immunosuppression with survival from start of immunosuppression were assessed using multivariable Cox proportional hazard regression. RESULTS: Among 606 patients, 404 had anti-PD-1 + anti-CTLA-4-related irAEs and 202 had anti-PD-1-related irAEs. 425 patients (70 %) received corticosteroids only; 181 patients (30 %) additionally received second-line immunosuppressants. Median PFS and OS from starting immunosuppression were 4.5 (95 %CI 3.4-8.1) and 31 (95 %CI 15-not reached) months in patients who received second-line immunosuppressants, and 11 (95 %CI 9.4-14) and 55 (95 %CI 41-not reached) months in patients who did not. High corticosteroid peak dose was associated with worse PFS and OS (HRadj 1.14; 95 %CI 1.01-1.29; HRadj 1.29; 95 %CI 1.12-1.49 for 80vs40mg), while cumulative dose was not. Second-line immunosuppression was associated with worse PFS (HRadj 1.32; 95 %CI 1.02-1.72) and OS (HRadj 1.34; 95 %CI 0.99-1.82) compared with corticosteroids alone. CONCLUSIONS: High corticosteroid peak dose and second-line immunosuppressants to treat irAEs are both associated with impaired survival. While immunosuppression is indispensable for treatment of severe irAEs, clinicians should weigh possible detrimental effects on survival against potential disadvantages of undertreatment.

Anti-dsDNA B-Cell ELISpot as a Monitoring and Flare Prediction Tool in SLE Patients.

Anti-dsDNA autoantibodies quantification and complement levels are widely used to monitor disease activity in systemic lupus erythematosus (SLE). However, better biomarkers are still needed. We hypothesised whether the dsDNA antibody-secreting B-cells could be a complementary biomarker in disease activity and prognosis of SLE patients. Fifty-two SLE patients were enrolled and followed for up to 12 months. Additionally, 39 controls were included. An activity cut-off (comparing active and non-active patients according to clinical SLEDAI-2K) was established for SLE-ELISpot, chemiluminescence and Crithidia luciliae indirect immunofluorescence tests (≥11.24, ≥374.1 and ≥1, respectively). Assays performances together with complement status were compared regarding major organ involvement at the inclusion and flare-up risk prediction after follow-up. SLE-ELISpot showed the best performance in identifying active patients. High SLE-ELISpot results were associated with haematological involvement and, after follow-up, with an increased hazard ratio for disease flare-up (3.4) and especially renal flare (6.5). Additionally, the combination of hypocomplementemia and high SLE-ELISpot results increased those risks up to 5.2 and 32.9, respectively. SLE-ELISpot offers complementary information to anti-dsDNA autoantibodies to evaluate the risk of a flare-up in the following year. In some cases, adding SLE-ELISpot to the current follow-up protocol for SLE patients can improve clinicians' personalised care decisions.

The Influence of Implant Neck Features and Abutment Diameter on Hard and Soft Tissues Around Single Implants Placed in Healed Ridges: Clinical Criteria for Selection.

The clinician's selection of an implant system is influenced by many variables. Ideally, the decision should be based on scientific evidence, but often these decisions are based on economic considerations or influenced by the experience of a trusted peer. The purpose of this paper is to describe the influence of implant neck features (shape and surface) and abutment connection (diameter that matches or is smaller than the implant's platform) on hard and soft tissues around single-tooth implants placed into healed ridges with adequate hard and soft tissue thickness. In an effort to reduce the number of variables, only two-piece implants fully placed at bone level or beneath were taken into consideration. The goal is to provide additional guidance for clinicians on the decision-making and implant-selection processes.

A novel digital approach for fixed full-mouth implant-supported rehabilitations: A case report.

Successful rehabilitation of a patient's entire dentition with implant-supported fixed prostheses requires restoration of function, esthetics and comfort. To achieve this goal, the clinician and laboratory technician must work in concert with one another to navigate the multiple steps from the patient's initial evaluation to delivery of the final prostheses. Key to this is the ability of the clinician to provide the technician with detailed information regarding the patient's extra- and intraoral characteristics in a manner that can be easily and accurately transferred to the lab bench where it then serves as the foundation for reconstruction of the dentition. In recent years, the impressive evolution of digital technology in dentistry has dramatically facilitated this complex process. The aim of this case report is to illustrate how digital profiles of a patient's facial and intraoral features can be merged with one another and used to generate artificial teeth and gingival tissue of a full mouth implant supported rehabilitation via computer-aided design and computer-aided manufacturing (CAD/CAM) technology to successfully rehabilitate a patient that initially presented with a terminal dentition. Key words:Facial scan, Zirconia, Implant-supported rehabilitation, Implant-supported prosthesis, Fixed prosthesis, Oral rehabilitation.

Healed Edentulous Sites: Suitability for Dental Implant Placement, Need for Secondary Procedures, and Contemporary Implant Designs.

PURPOSE: The purpose of this retrospective computed tomography study was to evaluate bone availability for dental implant placement, frequency of bone augmentation procedures, frequency of anatomical structures that compromise implant placement, and frequency of implant dimensions, and to determine which edentulous sites would benefit from the use of a sloped implant versus a traditional flat design. MATERIALS AND METHODS: Recorded parameters included the width of the ridge, the buccal and lingual/palatal alveolar bone height in reference to different anatomical landmarks, determination of implant placement, selection of an implant with a flat or sloped top, and need for a secondary bone augmentation procedure. RESULTS: One thousand three hundred seventy edentulous sites were evaluated in 216 patients. Implants could be placed in 60.6% of the total sites, where the coronal portion would be sloped in 59% of sites and conventionally flat in 41%; 39.4% of sites were not adequate for implant placement, where 56.5% needed additional guided bone regeneration procedures and 43.5% required sinus augmentation procedures. The inferior alveolar canal was the most frequent anatomical structure limiting size and/or placement. CONCLUSION: The study indicates that implants can be placed in slightly over half of edentulous sites without a secondary grafting procedure. The possibility of dental implant placement varied according to the volume and morphology of alveolar bone and related anatomical structures. This decreased from anterior to posterior in both arches. The sloped implant design was beneficial. In addition, the sloped implant design resulted in the placement of a longer implant.

Antiphospholipase 2 receptor antibody levels to predict complete spontaneous remission in primary membranous nephropathy.

BACKGROUND: M-type phospholipase A2 receptor (APLA2R) is considered the major antigen involved in the pathogenesis of adult primary membranous nephropathy (MN), which is the leading cause of non-diabetic nephrotic syndrome. Antibodies to this antigen have been proved to be an excellent biomarker of disease activity in primary MN. In fact, preliminary data suggest that the higher the antibody level the more proteinuria, and that a decrease in antibody level precedes the remission of proteinuria, but more solid evidence is needed. METHODS: The present work aims to characterize the predictive value of the level of antibodies against PLA2R as a biomarker of disease course and treatment response in a well-defined cohort of 62 patients from University Hospitals Clinic of Barcelona and Josep Trueta in Girona. The primary outcome was the appearance of a spontaneous complete remission (CR), defined as induction of a CR without the use of immunosuppressive agents. RESULTS: In common with other reports, this work confirms that spontaneous CR is more frequent in patients with low titre of APLA2R at diagnosis, but strikingly, in this cohort we found that spontaneous CR was achieved in patients with APLA2R levels <40 UI/mL. Furthermore, spontaneous CR were less frequently observed in patients with proteinuria >8 g/day. CONCLUSIONS: In conclusion, these findings point out the important role of APLA2R as a tool to predict the disease course and establish personalized therapeutic options at the moment of diagnosis of primary MN. Specifically, patients with low titre of APLA2R (<40 UI/mL) and proteinuria <4/day could obtain benefit of a longer period of follow-up with conservative treatment after diagnosis.

The Use of Recombinant Human Platelet-Derived Growth Factor for Maxillary Sinus Augmentation.

The maxillary sinus augmentation procedure has become a predictable treatment to regenerate bone for implant placement. The purpose of this study was to evaluate the effect of recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with a deproteinized cancellous bovine bone graft for sinus augmentation. The lateral window approach was used for maxillary sinuses with minimal residual bone. After a healing period of 4 months, dental implants were placed and then restored following a 2-month osseointegration period. The result demonstrated increased bone height and ISQ values and a 100% survival rate. This study indicates that the addition of rhPDGF-BB to deproteinized cancellous bovine bone accelerated the healing period in maxillary sinuses with minimal native bone.

Kinetic analysis of changes in T- and B-lymphocytes after anti-CD20 treatment in renal pathology.

INTRODUCTION: The main objective of this study is to describe qualitatively and quantitatively the different immune lymphocyte phenotypes of patients with renal disease after treatment with anti-CD20. MATERIAL AND METHODS: Two cohorts of transplanted and autoimmune kidney patients were compared: (1) Those who began treatment with Rituximab, matched (for sex, age and general clinical parameters) with (2) Non-treated control kidney patients. Different analyses were performed: (A) B-lymphocyte subpopulations; (B) T-cell subpopulations; (C) serum levels of BAFF, APRIL, Rituximab and anti-Rituximab; (D) rs396991 polymorphism of CD16a and at different time points for each type of analysis: (i) at baseline, (ii) day 15, (iii) at three and (iv) six months post-antiCD20. RESULTS: (A) A depletion of all B cell subsets analysed was observed preferentially decreasing the CD40+memory B-cells, switched memory cells and plasmablasts. (B) A significant decreased percentage of CD4+T-lymphocytes was observed. A significant decrease of the percentage of memory T-cells and an increase in naïve T-cells was also observed. (C) A significant increase for APRIL was observed, as well as a positive correlation between the APRIL levels, and the differential of B-cells. (D) The presence of CD16a Valine-variant induced greater changes in the variations of total T-cell and T-naïve subpopulations. CONCLUSION: Our results highlight that the treatment of renal disease with Rituximab affects T-cells, particularly naïve/memory balance, while APRIL could be also a secondary marker of this treatment. The sequential analysis of phenotypic alterations of B- and T-cells could help patient management, although further studies to identify periods of remission or clinical relapse are warranted.

Enteropatía asociada al uso crónico de olmesartán / Enteropathy associated with chronic use of olmesartan

No disponible