ZAGA Double Pedicle Palatal Flap for Soft Tissue Management in Zygomatic Surgery.

Oral rehabilitation of the atrophic maxilla using prostheses anchored on zygomatic implants is a well-documented process. To prevent the risk of sinusitis and or oro-antral communications, the placement of zygomatic implants with an externalized path has been proposed. In these cases where the sealing of the implant neck depends exclusively on a hemidesmosomal junction, there is a risk of dehiscence of the soft tissue. This can lead to esthetic problems, bone resorption, oro antral communication, cellulitis, and even orbital infection. To avoid soft tissue recession when implants are placed in a buccal position to the remaining ridge, different procedures have been proposed, the simplest being a good buccal coverage of the implant by keratinized tissue. In this technical note, we propose the use of a double pedicle palatal flap to increase the keratinized tissue buccal to the implant and, at the same time, to facilitate the incision closure by initial intention.

A modified Delphi consensus for rehabilitations anchored to zygomatic implants.

BACKGROUND: Studies on different surgical approaches have been published with excellent success rates for zygomatic implants. The same publications offer different results regarding the complications associated with the use of such implants. A consensus protocol on zygomatic implant interventions has yet to be documented. PURPOSE: To seek to establish a consensus at each step of treatment consisting of oral rehabilitation using zygomatic implant-anchored restorations, and to share the outcome of the process to serve as a basis for practitioners and researchers. MATERIALS AND METHODS: A wide variety of protocols were identified based on the results of a literature review conducted previously. All participants received the results of the systematic literature search. A modified Delphi process was used to establish a consensus protocol. Six sections were defined: Diagnosis and indications, Planning, Medication, Surgery, Prosthesis, and Follow-up. The first round of 17 open-ended questions was shared with 63 participants, all of whom were experts in zygomatic implant rehabilitation and part of the ZAGA Centers network. A total of 77 follow-up questions were then generated after analysis of the responses to the first 17 questions. RESULTS: Of the 63 experts enrolled, 48 responded to both rounds of questions. Consensus was determined based on the percentage of agreement: < 70% was considered "no consensus" and ≥ 70% was considered "consensus". A high level of consensus was reached. The sections with the lowest percentage of agreement were Medication and Surgery, where a consensus was reached for 67% of the questions. Of the questions included in the Follow-up section in both rounds, a consensus was reached for 80%. Overall, agreement was obtained on 71% of the topics. CONCLUSIONS: Use of the modified Delphi process led to the creation of the first consensus protocol for oral restorations anchored to zygomatic implants.

ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes.

OBJECTIVES: The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants. MATERIALS AND METHODS: Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds. RESULTS: A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants. CONCLUSIONS: Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.

Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review.

PURPOSE: To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae. METHODS: Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared. RESULTS: Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3-100% in OST and 90.4-100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis. CONCLUSIONS: Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST.

Educational Data Virtual Lab: Connecting the Dots Between Data Visualization and Analysis.

Educational Data Virtual Lab (EDVL) is an open-source platform for data exploration and analysis that combines the power of a coding environment, the convenience of an interactive visualization engine, and the infrastructure needed to handle the complete data lifecycle. Based on the building blocks of the FIWARE European platform and Apache Zeppelin, this tool allows domain experts to become acquainted with data science methods using the data available within their own organization, ensuring that the skills they acquire are relevant to their field and driven by their own professional goals. We used EDVL in a pilot study in which we carried out a focus group within a multinational company to gain insight into potential users' perceptions of EDVL, both from the educational and operational points of view. The results of our evaluation suggest that EDVL holds a great potential to train the workforce in data science skills and to enable collaboration among professionals with different levels of expertise.

Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review.

Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years.

Rate matching, probability matching, and optimization in concurrent ratio schedules.

Much research has documented rate matching in concurrent variable-interval schedules, but comparatively little research has examined performance in concurrent variable-ratio schedules, except in discrete-trials procedures that sometimes produce probability matching. One should expect that the two types of schedule would result in different performances, because ratio schedules cannot improve with time the way interval schedules do; ratio schedules lack the temporal dynamics of interval schedules. The present experiment exposed rats to concurrent variable-ratio schedules. Seven unsignaled components were presented in random order within each daily session, with probability ratios ranging from 1:8 to 8:1. Three conditions were studied that varied the overall probability of food while leaving probability ratios the same. Choice appeared to conform to probability matching, because sensitivities in the rate-matching relation were close to 0.5, whereas sensitivities to probability ratio were close to 1.0. The sensitivities alone, however, could not confirm probability matching, because undermatching to rate occurs often. Analyses at smaller time scales supported the interpretation of probability matching. In particular, control by food deliveries was highly local in concurrent variable-ratio schedules, in contrast with concurrent variable-interval schedules, in which control is extended. Activity continued to switch between alternatives throughout components, contradicting optimal sampling theory.

Round and flat zygomatic implants: effectiveness after a 1-year follow-up non-interventional study.

INTRODUCTION: There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). MATERIALS AND METHODS: Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer's instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. RESULTS: Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus-nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund-Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function. CONCLUSIONS: The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol.

Identification of the Pathway and Appropriate Use of Four Zygomatic Implants in the Atrophic Maxilla: A Cross-Sectional Study.

PURPOSE: This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants. MATERIALS AND METHODS: CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomy-guided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established. RESULTS: The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area. The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of the studied sites. Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4, representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively. Approximately 70% of the population presented anatomical intra-individual differences. CONCLUSION: The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications.

Do preceptorship and clinical supervision programmes support the retention of nurses?

BACKGROUND: The reasons for nurse shortages are the ageing healthcare workforce, increasing demand for services, employee dissatisfaction, life-work imbalance and burnout. AIM: To review the literature to find out whether there is evidence to support preceptorship and clinical supervision programmes in retaining nurses, and particularly newly qualified nurses (NQNs), in clinical practice. METHODS: A search of databases, as well as other sources, was carried out, with six studies selected for data analysis. FINDINGS: Thematic analysis was used to synthesise the results and produced seven themes: increase satisfaction, gain competence and feel more confident; competencies of preceptors and supervisors; framework or model required; the challenge to the programmes; intention to stay and staff retention; voluntary withdrawal from the nursing profession; and further support for development. CONCLUSION: Training (preceptorship and clinical supervision programmes) is effective in retaining NQNs, increasing satisfaction, improving skills and competency and staff engagement; however, more support for both preceptors/supervisors and NQNs is needed to maximise the success of these programmes in the future.

Analyzing the magnitude effect in spontaneously hypertensive (SHR) and wistar Kyoto (WKY) rats.

We analyzed the magnitude effect in Spontaneously Hypertensive (SHR) and Wistar Kyoto (WKY) rats choosing between a smaller-sooner (SSF) and a larger-later food (LLF) in the initial link of a concurrent-chains procedure. The SSF was delivered immediately in one terminal link and the LLF delayed 0.01, 5, 10, 20, 40, or 80 s in the other terminal link. An ABABA design varied food amount, 1 vs. 4 and 3 vs. 8 food-pellets in conditions A and B, respectively. The SHRs made more impulsive choices than the WKYs. The hyperbolic-decay model and the Generalized Matching Law fitted the data well. Discounting rate (k) and the area under the discounting curve (AUC) for the choices made by the SHRs in conditions A, were like those in conditions B. For the choices that the individual WKYs made, k was slightly higher and AUC smaller in conditions B than in conditions A. For both strains sensitivity to the immediacy of the LLF (s) was slightly higher in conditions A than in conditions B. Thus, we found no conclusive, compelling evidence either supporting or discarding the magnitude effect in the SHRs and scarce evidence supporting an effect opposite to the magnitude effect in the WKYs.

Interventions to improve inpatients' sleep quality in intensive care units and acute wards: a literature review.

BACKGROUND: Sleep is essential for the physical and psychological restoration of inpatients, and lack of sleep results in sleep deprivation and poor sleep quality, with potentially harmful consequences. AIM: To summarise sleep-promoting interventions in the Intensive care unit (ICU) and acute ward setting. METHOD AND RESULTS: Six databases were searched to obtain studies for review and eight studies were selected, appraised, analysed and produced two themes: sleep-disturbing factors and sleep-promoting strategies. Sleep-disturbing factors included environmental factors (such as light and noise), illness-related factors (such as pain, anxiety and discomfort), clinical care and diagnostics. Sleep-promoting strategies included using pharmacological aids (medication) and non-pharmacological aids (reducing noise and disturbances, eye masks, earplugs and educational and behavioural changes). CONCLUSION: The literature review showed that both ICU and acute ward settings affect patients' sleep and both use similar strategies to improve this. Nevertheless, noise and sleep disturbances remain the most critical sleep-inhibiting factors in both settings. The review recommended future research should focus on behavioural changes among health professionals to reduce noise and improve patients' sleep.

Peptides Mimicking the ß7/ß8 Loop of HIV-1 Reverse Transcriptase p51 as "Hotspot-Targeted" Dimerization Inhibitors.

A conformationally constrained short peptide designed to target a protein-protein interaction hotspot in HIV-1 reverse transcriptase (RT) disrupts p66-p51 interactions and paves the way to the development of novel RT dimerization inhibitors.

Response-reinforcer contiguity versus response-rate-reinforcer-rate covariance in rats' lever pressing: Support for a multiscale view.

The multiscale molar view sees behavior as a flow, like a river, extended in time. Matching theory expresses the way activities compete for time. Relative time taken by any activity depends on relative induction. The present experiment tested matching theory applied to concurrent contingent and noncontingent food. As adjunctive activities that compete with operant activity, we recorded hopper head entries and presses on a lever near the food hopper that had no programmed consequences. Eight naïve rats were first exposed to a variable-time 60 s schedule, which across conditions was gradually transformed into a variable-interval 60 s schedule by increasing the proportion of food that was delivered contingent on pressing a lever far from the hopper. Another group of 4 rats that had been trained to press a lever near a food hopper were introduced in the second condition, in which one food delivery was contingent on far-lever pressing. We found induction following a power function to describe pressing on the far lever (operant activity). Matching theory combined with power-function induction also accounted for adjunctive activity. Results with single contingent food deliveries provided little support for the molecular view that behavior consists of discrete responses "strengthened" by immediately following reinforcers.

ORIS Criteria of Success for the Zygoma-Related Rehabilitation: The (Revisited) Zygoma Success Code.

Zygomatic-related implant rehabilitation differs from traditional implant treatment in biomechanics, clinical procedures, outcomes, and eventual complications such as soft tissue incompetence or recession that may lead to recurrent sinus/soft tissue complications. The extreme maxillary atrophy that indicates the use of zygomatic implants prevents use of conventional criteria to describe implant success/failure. Currently, results and complications of zygomatic implants reported in the literature are inconsistent and lack a standardized systematic review. Moreover, protocols for the rehabilitation of the atrophic maxilla using zygomatic implants have been in continuous evolution. The current zygomatic approach is relatively new, especially if the head of the zygomatic implant is located in an extramaxillary area with interrupted alveolar bone around its perimeter. Specific criteria to describe success/survival of zygomatic implants are necessary, both to write and to read scientific literature related to zygomatic implant-based oral rehabilitations. The aim of this article was to review the criteria of success used for traditional and zygomatic implants and to propose a revisited Zygomatic Success Code describing specific criteria to score the outcome of a rehabilitation anchored on zygomatic implants. The ORIS acronym is used to name four specific criteria to systematically describe the outcome of zygomatic implant rehabilitation: offset measurement as evaluation of prosthetic positioning; rhino-sinus status report based on a comparison of presurgical and postsurgical cone beam computed tomography in addition to a clinical questionnaire; infection permanence as evaluation of soft tissue status; and stability report, accepting as success some mobility until dis-osseointegration signs appear. Based on these criteria, the assessment of five possible conditions when evaluating zygomatic implants is possible.

Zygoma Anatomy-Guided Approach "Scarf Graft" for Prevention of Soft Tissue Dehiscence Around Zygomatic Implants: Technical Note.

Different surgical approaches including the slot and the extrasinus techniques have been described to overcome disadvantages of the original Brånemark technique for the placement of zygomatic implants. A new concern associated with zygomatic implants placed externally to the maxillary wall is the possibility of disturbing buccal soft tissues, ending up with a dehiscence and a potential infective problem. Recently, a new methodology known as the Zygoma Anatomy-Guided Approach (ZAGA) has been described based on the concept of delivering specific therapy for each patient. ZAGA involves a variety of possibilities of implant trajectory from the intrasinus to an eventual extrasinus passage according to variations in patient anatomy. ZAGA methodology includes a rationale of how to prevent most of the reported complications of zygomatic implants. The objective of this technical note is to introduce the "Scarf Graft" as a part of the ZAGA protocol intended to prevent soft tissue dehiscence around extramaxillary zygomatic implants. A pediculated connective tissue graft is placed around the neck of the extramaxillary zygomatic implants. The increased connective tissue thickness consistently gives stable gingival tissue for prevention of recession. Currently, the treatment of soft tissue dehiscence around zygomatic implants does not have predictable results. Protocols for its prevention, such as the proposed ZAGA Scarf Graft, should be incorporated if an eventual dehiscence is foreseen.

Spontaneously hypertensive (SHR) rats choose more impulsively than Wistar-Kyoto (WKY) rats on a delay discounting task.

Indications of Attention Deficit Hyperactivity Disorder (ADHD) in the spontaneously hypertensive rat (SHR) are not consistent across different tests of impulsivity, questioning the SHR's validity as a rodent model of ADHD. This study used a concurrent-chains procedure to examine possible differences in impulsive choice between SHRs and control-normotensive Wistar Kyoto (WKY) rats. The aim was to extend the generality of findings showing regularities between the hyperbolic-decay model and the generalized matching law fitting delay discounting data from nonhuman animals. The objectives were to: (1) examine differences in impulsive choice between SHRs and WKYs; (2) add evidence suggesting that the SHR is a suitable model of ADHD; (3) demonstrate that concurrent-chains procedures requiring locomotion detect differences in impulsive choice between SHRs and WKYs; (4) support the idea that impulsivity in nonhuman animals increases with training. The initial link used two non-independent random interval schedules arranging entries to the terminal links, where one fixed-time (FT) schedule delayed 1-food pellet and the other FT 4-food pellets. The FT delaying the former was kept constant at 0.1s and that delaying the latter changed after every 10 food deliveries, defining six delay components (0.1, 5, 10, 20, 40, and 80s) presented in random order each session. Results showed that the SHRs choose more impulsively than the WKYs, adding to the body of evidence suggesting that the SHR may be a suitable model of ADHD. Both models of choice fitted the impulsive choices of the SHRs and WKYs well; positive correlations between estimates of parameters k and s suggested compatibility between models of choice showing that impulsivity increases with training.

Vertical Bone Regeneration with Synthetic Biomimetic Calcium Phosphate onto the Calvaria of Rats.

IMPACT STATEMENT: This work reports a new bone substitute made of precipitated apatite crystals that resemble in composition and crystallinity to the mineral phase of bone. The bone regeneration capacity of this synthetic biomimetic calcium phosphate (SBCP) was studied by using an original model of vertical bone regeneration with cups on the calvaria of rats. After 4 weeks, a significantly higher bone growth was found with SBCP compared with deproteinized bovine bone matrix and empty controls. This rapid vertical bone regeneration indicated that this new biomaterial is particularly interesting for filling bone defects in oral surgery.