Performance of Ultrasound for Identifying Morphological Characteristics and Thickness of Cutaneous Basal Cell Carcinoma: A Systematic Review.

Advances in ultrasound technology and non-surgical treatments of basal cell carcinomas (BCCs) have raised the need to study the performance of high-frequency ultrasound (HFUS) in BCCs. We aimed to assess the performance of HFUS in the evaluation of BCCs to formulate recommendations for its uses and conducted a systematic review of the literature to do so. A search of Central, Medline, Embase, CINHAL, and Web of Science was performed using key/MESH terms "ultrasonography" and "basal cell carcinoma" (January 2005-December 2020). We included primary studies reporting biopsy-confirmed BCCs for which the target intervention was ultrasound assessment at 15 MHz or higher frequency. Thirty articles were included, studying a total of 1,203 biopsy-confirmed BCCs. HFUS provides accurate depth measurements, especially for BCCs >1 mm. The definition of lateral margins in vivo needs further studies; however, ex vivo margin assessment seems convincing. There is a diagnostic role for HFUS in identifying higher recurrence risk BCC subtypes, which can help in risk stratification. Performance of HFUS is significant in BCC management. Pre-surgical scans may support case selection for Mohs. HFUS can improve safety when used to plan brachytherapy treatments, help with case selection and adjunct treatment choice pre-photodynamic therapy. Finally, HFUS can help follow lesions after intervention, particularly non-surgical management, and support the decision to observe or re-intervene. HFUS can enhance clinical practice by providing useful information that cannot be deducted from the clinical examination. It would be recommended to evaluate the extent, mainly depth, and detect the aggressiveness of the BCCs.

Apremilast in dermatology: A review of literature.

Apremilast is an orally administered small molecule that specifically inhibits the phosphodiesterase-4 enzyme and modulates the immune system by increasing the levels of intracellular cyclic adenosine monophosphate (cAMP) and inhibiting IL-2 & 8, interferon-γ and tumor necrosis factor (TNF) production. It is FDA approved for the treatment of psoriasis, psoriatic arthritis, and oral ulcers of Behcet's disease. More recently, apremilast has been used off-label to treat varied dermatological diseases where systemic corticosteroids or immunosuppressive agents were not effective. We review the efficacy and safety of apremilast in the treatment of aphthous stomatitis, Behçet's disease, chronic actinic dermatitis, atopic dermatitis, cutaneous sarcoidosis, hidradenitis suppurativa, lichen planus, and discoid lupus erythematosus in cases where standard treatment has failed.

Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II.

Introduction: Since its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear. Objective: We aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST). Materials and Methods: A literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared. Results: AGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50-96); stakeholder involvement, 54% (28-85); rigor of development, 39% (21-63); clarity of presentation, 85% (69-100); applicability, 27% (6-51); and editorial independence, 76% (42-100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG. Conclusion and Relevance: Dupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.

Prevalence of Hidradenitis Suppurativa: A Systematic Review and Meta-regression Analysis.

IMPORTANCE: Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by occlusion of hair follicles as a primary pathogenic factor. There are scarce data regarding the prevalence of HS. OBJECTIVE: To estimate overall HS prevalence. DATA SOURCES: This review and meta-regression analysis was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. The academic search included PubMed, Cochrane registry, ClinicalTrials.gov, and evidence by NHS UK and Trip databases from inception through May 2020. To analyze HS prevalence, only cross-sectional studies or baseline assessments of longitudinal cohorts using census-based surveys or probabilistic and nonprobabilistic epidemiologic methods were considered. The search terms were (prevalence OR incidence OR epidemiology) AND (hidradenitis suppurativa OR acne inversa OR Verneuil's disease). No language restriction was applied. STUDY SELECTION: Original investigations that reported HS prevalence were included. After exclusion criteria were applied, 17 studies qualified for qualitative analysis, but only 16 studies were quantitatively assessed. DATA EXTRACTION AND MEASURES: Two reviewers extracted data by age, diagnostic criteria, presence of any comorbidity, sample sizes, continent/location, sex, and other characteristics. Assessment of bias risk used the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data using random-effects models to synthesize available evidence. MAIN OUTCOMES AND MEASURES: Hidradenitis suppurativa prevalence (with 95% CI) among the overall population and among subgroups. Between-study heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). RESULTS: In 16 quantitatively assessed studies included, prevalence estimates were reported only from Western European and Scandinavian countries, the US, and Australia. Meta-analysis with random effects, after adjusting for publication bias in the prevalence estimates, revealed a 0.40% prevalence (95% CI, 0.26%-0.63%) for HS. Studies based on clinical samples revealed a higher pooled prevalence of HS (1.7%) than population-based studies (0.3%). CONCLUSIONS AND RELEVANCE: The findings of this systematic review and meta-regression analysis may help facilitate policy formulation, channeling funding and guiding principles for better disease diagnosis using universal valid tools and management.

An in vitro model to evaluate the accuracy of guided surgery systems.

PURPOSE: An in vitro model was developed and tested to evaluate the precision of guided implant systems. The accuracy of dental implants placed with a flapless technique was analyzed using a stereolithographic template in vitro. Differences between the virtual and actual positions of the implants were measured. MATERIALS AND METHODS: Six polyurethane mandibles with artificial silicone gums were fabricated, and each was fitted with an individual computed tomography (CT) guide. Stereolithographic guides were created using computer-aided design/computer-assisted manufacturing technology and virtual planning software. All stereolithographic guides had four holes for stabilization pins and three holes for cylindric implants. After implant placement, the mandibles were subjected to another CT scan to compare the actual implant positions with the planned positions. The pre- and postimplantation CT images were superimposed using digital processing image software to evaluate the linear and angular deviations between the virtual planning data and the surgical results. RESULTS: The mean angular discrepancy between the virtual and actual positions of the 18 placed implants was 2.16 ± 0.92 degrees. Among the placed implants, 66.7% were situated a mean of 0.38 ± 0.03 mm apical to the planned vertical position, and 33.3% were situated 0.39 ± 0.03 mm coronal to the planned position. CONCLUSIONS: Within the limitations of the present study, this tool showed promising accuracy in virtual implant placement.

Evaluation of implant-abutment microgap and bacterial leakage in five external-hex implant systems: an in vitro study.

PURPOSE: The aim of the present study was to verify the presence of a microgap between implants and prosthetic abutments on their external surfaces in five different external-hex implant systems and to determine whether bacterial leakage occurs through the implant-abutment (I-A) interface. MATERIALS AND METHODS: Ten samples of each implant system were used. Eight samples of each implant system were inoculated with 0.3 µL of a suspension of Escherichia coli for bacterial leakage evaluation. Two other samples were used as controls. Sample analysis was accomplished at 24 and 48 hours and on the 5th, 7th, and 14th day after inoculation. After microbiologic analysis, all samples were prepared for I-A interface evaluation by scanning electron microscopy. The mean of the microgap misfit was obtained from six points at x1,000 and x3,000 magnifications. RESULTS: The Neodent implant system (0.51 ± 0.39 µm) showed the closest adaptation, followed by Dentoflex (1.44 ± 0.73 µm), Titanium Fix (1.88 ± 1.28 µm), SIN (2.46 ± 3.38 µm), and Conexão (2.68 ± 3.02 Μm). Twenty-five percent of the Dentoflex samples showed bacterial leakage through the I-A interface; no other implant system presented bacterial leakage. CONCLUSION: The width of the microgap at the I-A interface was less than 3 µm in all systems. A direct correlation between bacterial leakage and I-A interface misfit was not observed.

Histomorphometric analyses of bone interface with titanium-aluminum-vanadium and hydroxyapatite-coated implants by biomimetic process.

PURPOSE: The surface properties of dental implants have been considered directly related to the success of the osseointegrated interface. Hydroxyapatite (HA)-coated implants promote a bioactive surface because they facilitate cellular migration and bone growth, resulting in a faster osseointegration. MATERIALS AND METHODS: This study analyzed and compared 2 different implant surfaces: a group composed of titanium implants and another group coated with HA. The HA coating was produced by the biomimetic process to reduce costs. RESULTS AND CONCLUSIONS: After histomorphometric analyses it was possible to demonstrate that there were no statistically significant differences between the groups.

Cirurgia mucogengival em Implantodontia / Mucogingival surgery in implant therapy

O objetivo deste trabalho foi discutir algumas técnicas de cirurgia mucogengival usadas em Implantodontia, suas indicações e o melhor momento para serem empregadas. Foram identificados quatro momentos de importância clínica na manipulação dos tecidos mucosos e suas principais técnicas cirúrgicas correspondentes: 1) antes da instalação do implante: enxerto gengival livre, e enxerto de tecido conjuntivo (para minimizar as complicações nas cirurgias de primeiro e segundo estágios); 2) durante a instalação do implante: selamento do alvéolo modificado, enxerto pediculado de tecido conjuntivo (para fechar o alvéolo), reposicionamento coronal (que pode diminuir a profundidade do vestíbulo), o reposicionamento lateral do retalho (podendo causar recessão no sítio doador), retalho palatino de espessura dividida (que evita as desvantagens das outras técnicas), e o enxerto de tecido conjuntivo subepitelial (para aumentar e manter a espessura da mucosa vestibular favorecendo a estética); 3) durante a conexão do pilar protético: retalho palatino ou incisão circular, incisão em H (que são conservadoras), retalho reposicionado apicalmente (que aumenta a gengiva queratinizada vestibular), enxerto da tuberosidade, retalho em rolo (que mantem a cor a textura, mas possui sitio doador limitado); e 4) após a conexão do pilar protético: enxertos onlay/inlay, enxerto conjuntivo envelopado, e as técnicas de recontorno gengival. Embora o cirurgião possa valer-se das técnicas de cirurgia mucogengival a qualquer tempo, uma abordagem criteriosa antes da instalação do implante ou mesmo durante sua instalação pode eliminar a necessidade de procedimentos cirúrgicos adicionais, reduzindo o custo e tempo de tratamento.

The aim of this study was to discuss some mucogingival surgery techniques for implant dentistry, their indications, and best moments for application. Four stages of clinical importance regarding mucosal tissue management were identified with their main corresponding surgical techniques: 1) before implant placement: free gingival graft and the connective tissue graft (to minimize complications in the first and second surgical stages); 2) during implant placement: modified socket seal, the pedicle connective tissue graft (to close the alveolus), coronal flap positioning (which can reduce the vestibular depth), the lateral flap positioning (which may cause recession in donor site), split-thickness palatal flap (which avoids the disadvantages of other techniques), and the subepithelial connective tissue graft (to augment and maintain the thickness of the buccal mucosa favoring aesthetics); 3) during abutment connection: palatal flap or circular incision, H-type incision (which is more conservative), the apically positioned flap (which increases the keratinized buccal gingiva), the tuberosity graft, the palatal roll flap (which keeps color and texture, but has limited donor site availability); and 4) after abutment connection: inlay/onlay grafts, the envelop connective tissue graft, and techniques for gingival recontouring. Although the surgeon can use all those mucogingival surgical techniques at any time, a careful approach before implant placement or even during its installation can eliminate the need for additional surgical procedures, reducing treatment time and costs.

Existe associação entre o ângulo formado pelo terço inferior das paredes medial e lateral do seio maxilar e o risco de perfuração da membrana? Um estudo transversal / Is there association between the angle of medial and lateral maxillary sinus walls at the inferior third and the risk of membrane perforation? A cross-sectional study

Objetivo: avaliar a prevalência das medidas dos ângulos formados entre a parede medial e lateral do seio maxilar em seu terço inferior, e verificar a correlação entre os ângulos medidos e sua localização anatômica específica em áreas de dentes posteriores. Material e métodos: foram selecionados 64 cortes parasagitais em 25 exames tomográficos de uma amostra de pacientes uni ou bilateralmente desdentados, registrados para atendimento na Clínica de Implantologia Oral da Universidade do Grande Rio entre 1998 e 2004. Depois, os cortes foram digitalizados por um único operador, com cobertura transparente e em resolução 4.800 dpi. Os ângulos dos assoalhos dos seios maxilares (θ) foram medidos traçando-se linhas retas tangenciais às paredes medial e lateral, e separando sua distribuição por sítios posteriores (primeiros pré-molares, segundo pré-molares, primeiro molares e segundos molares), proporcionando três grupos: grupo 1 (θ ≤ 30º); grupo 2 (30º≤ θ ≤ 60º) e grupo 3 (> 60º). O teste qui-quadrado foi usado para avaliar a prevalência dos ângulos medidos e sua correlação com a localização anatômica, e o teste Anova para avaliar a correlação entre as médias dos ângulos mensurados e a localização anatômica. Resultados: os ângulos obtusos (grupo3) prevaleceram significativamente em 65,6% dos cortes parassagitais avaliados (p<0,01)...

Imageologia associada ao planejamento cirúrgico para implantoterapia / Imageology associated to the surgical planning for implant therapy

Para o sucesso e satisfação do paciente no tratamento com implantes, além da necessária e rigorosa avaliação médica e clínica, deve-se prestar especial atenção a alguns aspectos diretamente relacionados ao procedimento cirúrgico na cavidade oral. Fatores como a avaliação da densidade óssea, do volume vestíbulo-lingual/palatino e da altura óssea do sítio selecionado, a localização de estruturas anatômicas nobres, principalmente o canal mandibular e o seio maxilar, são fundamentais para o aprimoramento do diagnóstico. Para essa avaliação, algumas técnicas radiográficas têm sido indicadas. Cabe ao cirurgião-dentista adquirir conhecimento e experiência clínica para a seleção do método mais eficaz, levando em consideração o custo financeiro, a dose de radiação absorvida pelo paciente e a eficácia da informação obtida. O objetivo deste estudo é contribuir para o entendimento das técnicas radiográficas normalmente utilizadas, apresentando suas indicações, vantagens e limitações.

Besides a strict medical and clinical evaluation, implant therapy should contemplate some aspects directly related to the surgical procedures. Factors such as bone density, volume and height at the implant site, the precise position of vital structures, namely mandibular canal and maxillary sinus, are fundamental for diagnostics. Some radiographic techniques have been indicated for these purposes, allowing the clinician to obtain knowledge and clinical experience for the best method, taking into account the costs, the radiation doses taken by patients and the efficacy of the acquired information. The aim of the present study is for contribute to the understanding of the present radiographic methods, their indications, advantages, and limitations.

Análise in vitro da infiltração bacteriana na interface de pilares protéticos e implantes cone-morse / In vitro analysis of bacterial leakage at the interface between Morse taper implant platform and prosthetic abutments

A presença de microfenda entre o implante e o pilar protético pode ser responsável pelo acúmulo do biofilme peri-implantar, composto por várias cepas bacterianas. Quando descrito como fator etiológico de processos inflamatórios, apresentam como consequência a desorganização dos tecidos, podendo interferir na saúde peri-implantar a longo prazo. O objetivo deste estudo foi avaliar se a microfenda existente entre implantes com plataforma cone-morse e pilares protéticos permitiria a ocorrência de infiltração de uma cepa bacteriana específica. Foram utilizados 30 conjuntos implantes/pilares protéticos de dois sistemas de implantes com interface tipo cone-morse comercializados no Brasil. A amostra foi dividida em três grupos com dez corpos de prova cada: implantes Neodent com pilares protéticos Neodent, implantes Ankylos com pilares protéticos Ankylos e implantes Ankylos com pilares protéticos Neodent. O espaço interno dos implantes foi inoculado com 0,1 μl de uma suspensão de Escherichia coli. Em seguida, os pilares foram instalados utilizando-se o torque recomendado pelos fabricantes. Os corpos de prova foram então mergulhados em um meio de cultura MacConkey para análise de turvamento, comprovando a infiltração pela microfenda. A leitura após a inoculação foi realizada em um, dois, cinco, sete e 14 dias. Os resultados demonstraram que nenhum dos corpos de prova apresentou turvamento do meio de cultura, sendo a viabilidade da bactéria comprovada através de teste controle positivo. Concluiu-se que as interfaces tipo cone-morse estudadas, impediram a migração de Escherichia coli entre componentes de prótese e os implantes utilizados.

The presence of microgap between dental implant and prosthetic abutment may be responsible for the accumulation of peri-implant biofilm, composed of several bacterial strains. When described as etiological factor of inflammatory processes they trigger tissue disruption and can interfere with the long-term periimplant health. The aim of this study was to assess whether the microgap between Morse Taper platform implants and prosthetic abutment allow the occurrence of infiltration of a specific bacterial strain. It was used 30 sets implants/prosthetic abutment of two implant systems with Morse Taper interface marketed in Brazil. The sample was divided into 3 groups with 10 samples each: Neodent implants and prosthetic abutments, Ankylos implants with respective prosthetic abutments, and Ankylos implants with Neodent prosthetic abutments. The implant inner chamber was inoculated with 0.1 μl of Escherichia coli suspension, before the abutment recommended tightening by each manufacturer. Samples were then immersed in a culture medium for analysis of MacConkey muddiness for analysis of cloudiness, indicating infiltration at the microgap. Measurements after inoculation were performed at 1, 2, 5, 7, and 14 days. The results showed that none of the samples presented cloudiness in the culture medium, with the viability of the bacteria demonstrated by positive control tests. It was concluded that the Morse Taper interfaces systems studied prevented the migration of E. coli between the prosthetic abutment and implants used.

Superfície dos implantes osseointegrados X resposta biológica / Dental implants surface X biological response: a literature review

Um dos fatores determinantes para que ocorra a osseointegração diz respeito à superfície dos implantes dentários. A resposta biológica está diretamente relacionada às propriedades físico-químicas das superfícies. Atualmente existem diferentes métodos de tratamento de superfície que buscam um aperfeiçoamento destas propriedades e assim uma melhora na resposta tecidual. O presente trabalho tem como objetivo relacionar os métodos de tratamento de superfície com a resposta biológica celular através de uma revisão da literatura.

One of the determining factors for osseointegration is related to the surface of dental implants. The biological response is directly related to the physicochemical properties of the surface. There are different methods of surface treatment that seek the improvement of these properties and its relationship with tissues response. The present study aims to relate the surface treatment methods with the biological response, through a literature review

Carga imediata em implantes instalados em pacientes totalmente edêntulos. Relato de um caso de sobredentadura / Immediate loading in implants placed in totally adentulous patiens. An overdenture case report

A instalação de implantes com carga imediata em pacientes edêntulos é apresentada como uma alteração do protocolo original dos implantes osseointegrados que recomenda um período de reparo tecidual de três a seis meses. O objetivo deste artigo é apresentar um caso clínico onde a resolução terapêutica encontrada foi o emprego de implantes com cargas imediatas e uma prótese em sobredentadura. A racionalidade deste procedimento é discutida