Evaluation of masticatory efficiency and OHRQoL in implant-retained overdenture with different numbers of implant in the edentulous mandible: a one-year follow-up prospective study.

PURPOSE: The aim of this article is to evaluate to the masticatory function performance and Oral Health-related Quality of Life (OHRQoL) in implant-retained overdenture compared with different implant number placements in the edentulous mandible. METHODS: From 2013 to 2015, each patients received 3 implants (iSy-Implant, Camlog, Wimsheim, Germany) in intraforaminal mandible (34, 41/31, 44). After operation, inserted implants were gradually loaded and incorporated into an overdenture with a self-aligning attachment system (Locator abutments) in 3 + 3 + 3 months. Five checked points were performed chewing cycle test with multicolored chewing gum and OHIP-G14 questionnaire and a sum score questionnaire as following: pre-operation, one implant load (41/31), two implants loaded (33,43), three implants loaded and 1-year follow up. RESULT: A total of 10 patients with 30 implants were placed, the survival rate of the implants was 100% within 1-year follow-up. Regarding the masticatory function analysis, for the higher number of chewing cycles, the higher mixing rate was observed. After 1 year, the inter-mixing rate without significant changes was found compared to the time after three implants were loaded with attachment system. The mean value of OHIP-G14 was 30.4 preoperatively, 21.1 after loading the first locator, 10.7 after loading two locator abutments, and 3.2 after loading all three locator abutments. After 1 year, OHIP-G14 was 2.6 without significantly changed. The mean of the sum score was 15.5 preoperatively, 27.8 after activation of the first locator, 39.4 after activation of two locators, 46.2 after activation of all three locators, and 47.3 after 1 year. An increase of 0.7 sum score units per time point was observed. No significance was detectable, analogous to OHIP-G14, compared to the time of activation of all three locator setups (p-value = 0.22). CONCLUSIONS: A significant improvement in masticatory function performance and OHRQoL was evaluated with the increasing number of implants with locator attachment in edentulous mandible. With the investigation of the OHIP-G14 and sum score, the results of patient report outcome might be associated with the increase in the number of implants.

Prolonged Hourly Neurologic Examinations are Associated with Increased Delirium and No Discernible Benefit in Mild/Moderate Geriatric Traumatic Brain Injury.

BACKGROUND: Serial neurologic examinations (NE) are routinely recommended in the ICU within the first 24 hours following a TBI. There are currently no widely accepted guidelines for the frequency of NE. Disruptions to the sleep-wake cycles increase the delirium rate. We aimed to evaluate whether there is a correlation between prolonged Q1-NE and development of delirium and to determine if this practice reduces the likelihood of missing the detection of a process requiring emergent intervention. METHODS: Retrospective analysis of patients with mild/moderate TBI, admitted to the ICU with serial-NE. Cohorts were stratified by the duration of exposure to Q1-NE, into Prolonged(≥24 h) and Not Prolonged(<24 h). Our primary outcomes of interest was delirium, evaluated using the Confusion Assessment Method (CAM-ICU), radiological progression from baseline images, neurological deterioration (focal neurological deficit, abnormal pupillary exam, or GCS decrease >2), and neurosurgical procedures. RESULTS: A total of 522 patients were included. No significant differences were found in demographics. Patients in the Prolonged Q1-NE group (26.1%) had higher ISS with similar AIS Head, and significantly higher delirium rate [59% vs 35%, p < .001], and a longer Hospital/ICU length of stay when compared to the Not Prolonged Q1-NE group. No neurosurgical interventions were found to be performed emergently as a result of findings on NE. Multivariate analysis demonstrated that Prolonged Q1-NE was the only independent risk factor associated with a 2.5-fold increase in delirium rate. The Number Needed to Harm for prolonged Q1-NE was 4. CONCLUSIONS: Geriatric patients with mild/moderate TBI exposed to Q1-NE for periods longer than 24 h had nearly a 3-fold increase in ICU-Delirium rate. One out of five patients exposed to prolonged Q1-NE is harmed by the development of delirium. No patients were found to directly benefit as a result of more frequent neurological examinations.

Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria?

Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.

Negative Pressure Wound Therapy With and Without Instillation in Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTIs) are rare but deadly infections that require early and often extensive surgical debridement. After debridement, patients frequently have substantial morbidity because of large, open wounds. Hypothesis: Negative pressure wound therapy with instillation (NPWTi) results in higher wound closure rates compared with traditional negative pressure wound therapy (NPWT) or wet to dry dressings (moist wound care dressing). Patients and Methods: A prospectively maintained Acute and Critical Care Surgery database spanning 2008-2018 was queried for patients with a diagnosis of necrotizing fasciitis, Fournier gangrene, or gas gangrene. Data were collected on patient comorbidities, operative management, and clinical outcomes. Patients were stratified by use of moist wound care dressing, traditional NPWT, or NPWTi. Data were analyzed using analysis of variance (ANOVA), χ2, and logistic regression. Results: During the 10-year study period, patients were treated for NSTI; 173 were managed with moist wound care dressing, 150 with NPWT, and 48 with NPWTi. Patients were similar in terms of demographics, body mass index (BMI), diabetes mellitus, and smoking rates. Overall, complication rates were not substantially different, but mortality was higher in the moist wound care dressing group (16.2% vs. 10.7% NPWT vs. 2.1% NPWTi; p = 0.02). In the moist wound care dressing group, 81.5% of patients had an open wound at discharge compared with 52.7% of the NPWT group and only 14.6% of the NPWTi group (p < 0.001). On multivariable regression, NPWTi was associated with closure rates five times higher than the NPWT group (odds ratio [OR], 5.28; 95% confidence interval [CI], 2.40-11.61; p < 0.001) after controlling for smoking status, intravenous drug use, number of operations, and involvement of the most common region of the body. Conclusions: Negative pressure wound therapy with instillation is associated with higher rates of wound closure without increasing complication rates in patients with NSTI compared with traditional NPWT or moist wound care dressing. Although prospective studies are needed, this indicates the potential to improve patient quality of life through reduced pain and outpatient home health needs.

Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic.

Background: Ludwig's angina (LA) is a diffuse cellulitis of the submandibular space and adjacent tissues. During the coronavirus disease 2019 (COVID-19) pandemic, odontogenic treatments were often delayed because of the implementation of safety measures to avoid the spread of the virus. We hypothesized that delayed odontogenic treatments associated with the onset of the COVID-19 pandemic would be associated with an increase in the incidence of LA and worse outcomes related to these infections. Patients and Methods: Patients from June 2018 to June 2022 with computed tomography images suggestive of LA and confirmed by ear, nose, throat (ENT) consult were included. We abstracted demographics, outcomes, clinical management, and microbiology. Patients were stratified into pre-COVID and COVID-onset. Our primary outcome, incidence of LA, was defined as: (new LA cases) ÷ (ED evaluations of oral or dental infections × 1.5 years). Results: In the pre-COVID group, we identified 32 of 1,301 patients with LA for an incidence of 0.02 per year. The COVID-onset group consisted of 41 of 641 patients, with an incidence of 0.04 per year. In the COVID-onset group, progression to necrotizing fasciitis was more likely (0% vs. 15%; p < 0.024), and they returned to the operating room for repeated debridement (3% vs. 22%; p < 0.020). Likewise, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were higher (4.3 ± 3.5 vs. 9.5 ± 11.3; 1.1 ± 1.2 vs. 9.5 ± 7.1; 0.3 ± 1 vs. 3.6 ± 7.1; p < 0.001). Conclusions: Although the prognosis for dental infections diagnosed early is generally favorable, we observed a notable increase in the incidence of LA after the onset of the COVID-19 pandemic. Moreover, complications stemming from these infections became more severe in the COVID-onset era. Specifically, the likelihood of necrotizing fasciitis showed a substantial increase, accompanied by an increased risk of respiratory failure and mediastinitis.

The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. METHODS: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. RESULTS: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34-2.29) at the entry point and 2.95 mm (95% CI: 1.66-4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04-4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83-1.54) at the entry point and 1.80 mm (95% CI: 1.10-2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43-2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69-2.39) at the entry point and 3.23 mm (95% CI: 2.34-4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86-5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. CONCLUSION: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Short implants compared to regular dental implants after bone augmentation in the atrophic posterior mandible: umbrella review and meta-analysis of success outcomes.

PURPOSE: To assess the body of evidence of short versus regular implants after bone augmentation (BA) in the atrophic posterior mandible in the context of implant treatment success outcomes. METHODS: Seven databases, two registries, and reference lists were searched for systematic reviews and meta-analysis (SR/MA), randomized controlled trials (RCTs) and longitudinal studies published in English, Spanish or German since 2012. Confidence in the SR/MA methodology was evaluated using AMSTAR-2 and the risk of bias of primary studies using Cochrane's RoB 2.0 and ROBINS-I. A random-effects meta-analysis and a meta-regression were performed for continuous and dichotomous outcomes. GRADE approach was used to assess the certainty of the evidence. RESULTS: Eighteen SRs/MAs, most of them "critically low" and "low" confidence with substantial overlap, included 14 relevant RCTs with a high risk of bias. A cohort study with moderate risk of bias was added. Quantitative synthesis of 595 implants and 281 hemiarches/patients indicates that the use of short implants (< 10 mm) compared to regular implants and BA may reduce implant failure at 1-year follow-up, and marginal bone loss (MBL) at 3-, 5-, and 8-year follow-up; is likely to reduce the risk of biological complications at 1-, 3-, 5-, and 8-year follow-up; and may be the patient's preferred alternative. There is a correlation between bone height, MBL and biological complications. CONCLUSIONS: The available evidence partially suggests that the use of short implants could decrease implant failure, MBL, and biological complications, and increase patient satisfaction. However, given the need for further RCTs and real-world evidence to fully evaluate short- and long-term outcomes, it would be prudent for clinicians to carefully consider the individual needs and circumstances of the patients before deciding whether to use short implants. Trial registration PROSPERO CRD42022333526.

Correlation between periodontal phenotype and sinus membrane thickness: A systematic review.

AIM: To assess the correlation between the periodontal phenotype (PP) and sinus membrane thickness (SMT) in humans. METHODS: This review was conducted according to the PRISMA guidelines. Two reviewers independently carried out electronic and manual literature searches of studies published in English, German, and Spanish, from 1970 to September 2022 in four electronic databases, PubMed/Medline, Scopus, Cochrane Library, and Web of Science, in addition to gray literature. Studies that assessed the correlation between PP and SMT in adults (aged 18 years) were included. Methodological quality was evaluated using the Appraisal Tool for Cross-Sectional Studies (AXIS) for articles that met the eligibility criteria. RESULTS: Six studies, including 510 patients, were considered for qualitative analysis. All included studies were cross-sectional, and the correlation between the PP and SMT was evaluated, finding a positive and high correlation in 83.3% of them, based on a value of ≥0.7. All the included studies were assessed with a high overall risk of bias. CONCLUSIONS: Periodontal phenotype and sinus membrane thickness are likely correlated. Nevertheless, further standardized studies are required to draw definitive conclusions.

The feasibility of ultrasonography for the measurement of periodontal and peri-implant phenotype: A systematic review and meta-analysis.

BACKGROUND: Screening ultrasonography was proposed for monitoring periodontal soft tissues in the early 1960s, owing to its nonionizing, real-time, and cost-effective properties. Studies have provided convincing preliminary evidence for the use of ultrasound (US) in implant dentistry. PURPOSE: To assess the feasibility of ultrasonography (US) for measuring the buccal thickness of periodontal and peri-implant tissues. The secondary objective was to evaluate the reliability of US measurements compared to classic techniques, such as CBCT and directly measurements. MATERIALS AND METHODS: An electronic literature search was conducted by three independent reviewers through February 2023. The inclusion criteria were articles investigating at least five patients/cadavers with US measurements in periodontal or peri-implant buccal tissues. Compliance with methodological reporting standards and risk of bias was assessed using EULAR and QUADAS-C tools, respectively. Random-effects meta-analysis was conducted, using Bland-Altman analysis. Certainty of the evidence was assessed using GRADE. RESULTS: The final selection included 12 studies examining 458 patients and 13 cadavers, with a total of 226 implants, 1958 teeth and 60 edentulous sites. The body of evidence was assessed as partially compliant with methodological reporting standards for US studies and had an unclear to high risk of bias. Meta-analysis of five comparative studies showed no evidence of clinically significant bias between US and direct measurements (very low certainty), and between US and CBCT (very low certainty) for soft-tissue thickness. Likewise, for bone thickness, there is no evidence of clinically significant bias between US and CBCT (low certainty). CONCLUSIONS: Compared to the CBCT and direct measurements, ultrasonography might be a reliable approach for monitoring on periodontal and peri-implant phenotype. However, there is uncertainty about estimates of the actual effect, so further standardized and larger sample size of clinical research is needed.

Minimally Invasive Navigation-Guided Quad Zygomatic Implant Placement: A Comparative In Vitro Study.

Purpose: Zygomatic implants (ZIs) have been considered a reliable alternative treatment for patients with maxillary atrophy and/or maxillary defects. The use of a navigation system for assisting ZI placement could be a reliable approach for enhancing accuracy and safety. The purpose of this in vitro study was to evaluate the accuracy of a new dynamic surgical navigation system with its minimally invasive registration guide for quad zygomatic implant placement in comparison with a gold standard navigation approach. Materials and Methods: A total of 40 zygomatic implants were placed in 10 3D-printed models based on the CBCT scans of edentulous patients. For registration, a surgical registration guide with a quick response plate was used for the test group, and five hemispheric cavities as registered miniscrews in the intraoral area were used for the control group. In each model, a split-mouth approach was employed (two ZIs in bilateral zygomata) to test both systems. After ZI placement, a CBCT scan was performed and merged with pre-interventional planning. The deviations between planned and placed implants were calculated as offset basis, offset apical, and angular deviation and compared between the systems. Results: The offset basis, offset apical, and angular deviation were 1.43 ± 0.55 mm, 1.81 ± 0.68 mm, and 2.32 ± 1.59 degrees in the test group, respectively. For the control group, values of 1.48 ± 0.57 mm, 1.76 ± 0.62 mm, and 2.57 ± 1.51 degrees were measured without significant differences between groups (all P < .05). The accuracy of ZI positions (anterior and posterior) were measured without significant differences between groups. Conclusion: Two navigation systems with different registration techniques seem to achieve comparable acceptable accuracy for dynamic navigation of zygomatic implant placement. With the test group system, additional pre-interventional radiologic imaging and invasive fiducial marker insertion could be avoided.

Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault.

Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.

Evidence of SARS-CoV-2 infection in postmortem lung, kidney, and liver samples, revealing cellular targets involved in COVID-19 pathogenesis.

There is an urgent need to understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-host interactions involved in virus spread and pathogenesis, which might contribute to the identification of new therapeutic targets. In this study, we investigated the presence of SARS-CoV-2 in postmortem lung, kidney, and liver samples of patients who died with coronavirus disease (COVID-19) and its relationship with host factors involved in virus spread and pathogenesis, using microscopy-based methods. The cases analyzed showed advanced stages of diffuse acute alveolar damage and fibrosis. We identified the SARS-CoV-2 nucleocapsid (NC) in a variety of cells, colocalizing with mitochondrial proteins, lipid droplets (LDs), and key host proteins that have been implicated in inflammation, tissue repair, and the SARS-CoV-2 life cycle (vimentin, NLRP3, fibronectin, LC3B, DDX3X, and PPARγ), pointing to vimentin and LDs as platforms involved not only in the viral life cycle but also in inflammation and pathogenesis. SARS-CoV-2 isolated from a patient´s nasal swab was grown in cell culture and used to infect hamsters. Target cells identified in human tissue samples included lung epithelial and endothelial cells; lipogenic fibroblast-like cells (FLCs) showing features of lipofibroblasts such as activated PPARγ signaling and LDs; lung FLCs expressing fibronectin and vimentin and macrophages, both with evidence of NLRP3- and IL1ß-induced responses; regulatory cells expressing immune-checkpoint proteins involved in lung repair responses and contributing to inflammatory responses in the lung; CD34+ liver endothelial cells and hepatocytes expressing vimentin; renal interstitial cells; and the juxtaglomerular apparatus. This suggests that SARS-CoV-2 may directly interfere with critical lung, renal, and liver functions involved in COVID-19-pathogenesis.

Acute Sheehan's Syndrome Presenting with Hyponatremia Followed by a Spontaneous Pregnancy.

Background: Acute Sheehan's syndrome is rare, as well as hyponatremia as its initial manifestation. In addition, spontaneous pregnancy in patients after Sheehan's syndrome is unusual. To our knowledge, no cases of spontaneous pregnancy after acute Sheehan's syndrome have been reported. We describe a case of Sheehan's syndrome that presented with acute hyponatremia and a spontaneous pregnancy. Case: A 34-year-old female developed blood loss during delivery, which required a blood transfusion. On day seven postpartum, she presented with headaches, lethargy, and difficulty in breastfeeding. The workup showed hyponatremia (118 mEq/l), secondary hypothyroidism, and low prolactin levels. Magnetic resonance imaging showed pituitary necrosis. She was treated with NaCl, hydrocortisone (cortisol results were not available), and levothyroxine. Laboratory tests six weeks after discharge showed low IGF-1 and 8 AM cortisol and normal FT4, LH, FSH, and PRL levels. She was able to partially breastfeed until 4 months postpartum. Regular menstrual cycles started three months later. She became spontaneously pregnant one year later. Conclusion: Acute Sheehan's syndrome should be considered in the evaluation of postpartum patients with suggestive symptoms. Physicians should be aware that hyponatremia could be an initial manifestation of Sheehan's syndrome, which requires a high index of suspicion for diagnosis. Spontaneous pregnancy can occur after acute Sheehan's syndrome.

Does vitamin D have an effect on osseointegration of dental implants? A systematic review.

PURPOSE: The aim of this study was to systematically review the available evidence to evaluate the efficacy of vitamin D supplementation or vitamin D depletion on the osseointegration of implants in animals and humans. METHODS: The focus questions addressed were "Do vitamin D deficient subjects treated with (dental) implants have an inferior osseointegration than subjects with adequate serum vitamin D level?" and "Do vitamin D supplemented subjects treated with (dental) implants have a superior osseointegration than subjects with adequate serum vitamin D level?" Humans and animals were considered as subjects in this study. Databases were searched from 1969 up to and including March 2021 using different combination of the following terms: "implant", "bone to implant contact", "vitamin D" and "osseointegration". Letters to the editor, historic reviews, commentaries and articles published in languages other than English and German were excluded. The pattern of the present systematic review was customize to primarily summarize the pertinent data. RESULTS: Thirteen experimental studies with animals as subject, two clinical studies and three case reports, with humans as subjects, were included. The amount of inserted titanium implants ranged between 24 and 1740. Results from three animal studies showed that vitamin D deficiency has a negative effect on new bone formation and/or bone to implant contact (BIC). Eight animal studies showed that vitamin D supplementation has a enhancing effect on BIC and/or new bone formation around implants. Furthermore, enhancing the impact of vitamin D supplementation on the osseointegration of implants in subjects with diabetes mellitus, osteoporosis and chronic kidney disease (CKD) were assessed. Studies and case reports involving human subjects showed that patients with a low serum vitamin D level have a higher tendency to exhibit an early dental implant failure. When supplemented with vitamin D the osseointegration was successful in the case reports and a beneficial impact on the changes in the bone level during the osseointegration were determined. CONCLUSIONS: Vitamin D deficiency seems to have a negative effect on the osseointegration of implants in animals. The supplementation of vitamin D appears to improve the osseointegration in animals with systemic diseases, such as vitamin D deficiency, diabetes mellitus, osteoporosis, and CKD. Slight evidence supports the hypothesis that humans similarly benefit from vitamin D supplementation in terms of osseointegration. Further investigation is required to maintain these assumptions.

Teledentistry protocol for the elderly in the context of the covid-19 pandemic through a web platform/mobile app: approach from the general dentist / Protocolo de teleodontología para adultos mayores en el contexto de la pandemia de covid-19 a través de una plataforma web/aplicación móvil: abordaje desde el odontólogo general

Objective: To generate teledentistry protocols for urgent and priority dental care for the elderly population through a technological web platform and mobile application in the context of the COVID-19 pandemic. Material and Methods: Teledentistry protocols were developed in five sequential steps: Staff training, Patient recruitment, Patient admission, Patient reception and Patient care. Reasons for admission were categorized in urgencies and priority dental treatment. Results: The most prevalent reasons for consultation were prosthesis mismatch (18.37%), dental pain (16.33%) and fractured teeth (14.29%). In urgencies by need for treatment: due to infection or pain (24.44%) or to avoid pulp involvement (26.67%). The rest of the care did not require immediate attention. Regarding the OHIP-14Sp survey prior to care, in which patients were consulted for problems with their teeth, mouth or prosthesis, two questions were answered per dimension, for each dimension the following values were obtained: functional limitation (71.30% and 50.44%), physical pain (68.97% and 70.18%), psychological discomfort (75.00% and 74.14%), physical disability (57.39% and 46.09%), psychological disability (37.72% and 53.91%), social disability (33.91% and 30.97%) and handicap (27.83% and 25.86%). Conclusion: A teledentistry protocol for urgent and priority dental care of the elderly in the context of the COVID-19 pandemic with a focus on a general dentist remotely supported specialists was a useful tool to effectively systematize the care of elderly patients, reducing risk of exposure to COVID-19 and solving dental urgencies in this population

Objetivo: Generar protocolos de teleodontología para la atención odontológica urgente y prioritaria de la población adulta mayor a través de una plataforma web tecnológica y aplicación móvil en el contexto de la pandemia del COVID-19. Material y Métodos: Los protocolos de teleodontología se desarrollaron en cinco pasos secuenciales: capacitación del personal, reclutamiento de pacientes, admisión de pacientes, recepción de pacientes y atención al paciente. Los motivos de ingreso se categorizaron en urgencias y tratamiento odontológico prioritario. Resultados: Los motivos de consulta más prevalentes fueron desajuste de prótesis (18,37%), dolor dental (16,33%) y dientes fracturados (14,29%). En urgencias por necesidad de tratamiento por infección o dolor (24,44%) o para evitar afectación pulpar (26,67%). El resto de los cuidados no requirieron atención inmediata. En cuanto a la encuesta OHIP-14Sp previa a la atención, en la que se consultaba a los pacientes por problemas en sus dientes, boca o prótesis, se respondieron dos preguntas por dimensión, para cada dimensión se obtuvieron los siguientes valores: limitación funcional (71,30% y 50,44%), dolor físico (68,97% y 70,18%), malestar psicológico (75,00% y 74,14%), discapacidad física (57,39% y 46,09%), discapacidad psicológica (37,72% y 53,91%), discapacidad social (33,91% y 30,97%) y handicap (27,83% y 25,86%). Conclusión: Un protocolo de teleodontología para la atención odontológica urgente y prioritaria del adulto mayor, en el contexto de la pandemia de COVID-19 con un enfoque en un odontólogo general con especialistas apoyados de forma remota, fue una herramienta útil para sistematizar de manera efectiva la atención de los pacientes adultos mayores, reduciendo el riesgo de exposición al COVID-19 y resolviendo las urgencias odontológicas en esta población.

The microglial NLRP3 inflammasome is involved in human SARS-CoV-2 cerebral pathogenicity: A report of three post-mortem cases.

We herein report, by using confocal immunofluorescence, the colocalization of the SARS-CoV-2 nucleocapsid within neurons, astrocytes, oligodendrocytes and microglia in three deceased COVID-19 cases, of between 78 and 85 years of age at death. The viral nucleocapsid was detected together with its ACE2 cell entry receptor, as well as the NLRP3 inflammasome in cerebral cortical tissues. It is noteworthy that NLRP3 was colocalized with CD68 + macrophages in the brain and lung of the deceased, suggesting the critical role of this type of inflammasome in SARS-CoV-2 lesions of the nervous system/lungs and supporting its potential role as a therapeutic target.

Potencial de transformación maligna de las lesiones blanquecinas bucales / Potential for malignant transformation of whitish oral lesions

Introducción: Las lesiones blanquecinas bucales con potencial maligno, son un grupo reconocible de enfermedades de las mucosas, que preceden a la aparición de cánceres invasivos de la cavidad bucal. Objetivo: Determinar el potencial de transformación maligna de las lesiones blanquecinas de la cavidad bucal. Métodos: Se realizó un estudio observacional, descriptivo y transversal, de enero del año 2016 hasta enero de 2020, de todos los pacientes que acudieron al servicio de Cirugía Maxilofacial, con lesiones blanquecinas bucales. Las variables utilizadas fueron: edad, sexo, factores de riesgo, tiempo de evolución, sitio de la lesión, diagnóstico histológico y potencial de transformación maligna. Se exploró asociación mediante ji cuadrado. Resultados: Se encontraron lesiones con potencial de transformación maligna en el 24 por ciento de los mayores de 50 años, en el 24,3 por ciento de los hombres y en el 40 por ciento de pacientes con queilitis actínicas. El 83,3 por ciento fueron leucoplasias y entre ellas, el 20 por ciento con potencial de transformación maligna. Conclusiones: La leucoplasia es el diagnóstico histológico más común. Las lesiones con potencial de transformación maligna aumentan con la edad, son mayores en los hombres y en pacientes con queilitis actínicas. Los sitios anatómicos en que más aparecen son: paladar blando y labio superior; entre los factores de riesgo de mayor asociación está la exposición al sol(AU)

Introduction: Potentially malignant whitish oral lesions are a recognizable group of mucosal diseases that precede the appearance of invasive cancers of the oral cavity. Objective: To determine the potential malignant transformation of whitish lesions in the oral cavity. Methods: An observational, descriptive and cross-sectional study was carried, from January 2016 to January 2020, of all patients who attended the Maxillofacial Surgery service with whitish oral lesions. The variables used were: age, sex, risk factors, time of evolution, and site of the lesion, histological diagnosis and potential for malignant transformation. To explore the association between categorical variables, the Chi square distribution was used. Results: Lesions with the potential for malignant transformation were found in 24 percent of those over 50 years of age, in 24,3 percent of men and in 40 percent of patients with actinic cheilitis. 83,3 percent were leukoplakia, and among them 20 percent with the potential for malignant transformation. Conclusions: Leukoplakia was the most common histological diagnosis. Lesions with the potential for malignant transformation increased with age, were greater in men and in actinic cheilitis patients. The anatomical sites in which they appeared most were on the soft palate and upper lip and among the risk factors with the greatest association was sun exposure(AU)

Infecciones bacterianas asociadas a la COVID-19 en pacientes de una unidad de cuidados intensivos / Bacterial infections associated with COVID-19 in patients of the Intensive Care Unit

Introducción: Los primeros informes de China sugirieron que la coinfección con otros patógenos en la COVID-19 era anómala, las últimas evidencias han demostrado que pueden aparecer otras infecciones, sobre todo en pacientes graves. Objetivo: Describir las infecciones bacterianas asociadas a la COVID-19, en pacientes de una unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo en el período comprendido de marzo 24 a mayo 24 del año 2020, en la unidad de cuidados intensivos del Hospital Militar "Comandante Manuel Fajardo Rivero". La población de estudio estuvo constituida por 13 pacientes de 49 a 91 años, quienes permanecieron hospitalizados en esa sala, con diagnóstico confirmado, por la prueba de reacción en cadena de la transcriptasa inversa - polimerasa en tiempo real, para el SARS-CoV-2. Las variables de estudio fueron: edad, sexo, confección, antecedentes patológicos personales, estado al egreso, microorganismos aislados y susceptibilidad antimicrobiana. Resultados: El 61,5 por ciento de los pacientes fueron del sexo femenino, la edad media fue de 78,8 años, el 61,5 por ciento falleció y entre estos, el 44,4 por ciento presentó coinfección. El 66,7 por ciento y el 55,6 por ciento de los que padecían hipertensión arterial y cardiopatía isquémica respectivamente, desarrollaron una coinfección. La Escherichia coli fue el microorganismo que se aisló con mayor frecuencia. Conclusiones: En la serie estudiada predominaron las féminas, la mortalidad fue alta, se evidenció un porcentaje elevado de confección bacteriana y de comorbilidades. Más de la mitad de los pacientes falleció. Fueron las bacterias gramnegativas los microorganismos que más se aislaron. Los niveles de resistencia a los antimicrobianos fueron elevados(AU)

Introduction: The first reports from China suggested that coinfection with other pathogens in COVID-19 was abnormal, the latest evidence has shown that other infections may appear, especially in severe patients. Objective: To describe the bacterial infections associated with COVID-19, in patients in an intensive care unit. Methods: A descriptive study was carried out in the period from March 24 to May 24, 2020, in the intensive care unit of the Military Hospital "Comandante Manuel Fajardo Rivero". The study population consisted of 13 patients from 49 to 91 years, those who remained hospitalized in that room, with a confirmed diagnosis, by the real-time reverse transcriptase-polymerase chain reaction test for SARS-CoV-2. The study variables were: age, sex, clothing, personal pathological history, status at discharge, isolated microorganisms and antimicrobial susceptibility. Results: 61.5 percent of the patients were female, the mean age was 78.8 years, 61.5 percent died, and among these, 44.4 percent had coinfection. 66.7 percent and 55.6 percent of those with high blood pressure and ischemic heart disease, respectively, developed a coinfection. Escherichia coli was the most frequently isolated microorganism. Conclusions: Females predominated in the series studied, mortality was high, a high percentage of bacterial preparation and comorbidities was evident. More than half of the patients died. Gram-negative bacteria were the microorganisms that were most isolated. Antimicrobial resistance levels were high(AU)

Método simplificado para cuantificar el área oseointegrable de implantes dentales / Simplified method to quantify the osseointegration area of dental implants

Introducción: Se han realizado muchas investigaciones sobre los implantes dentales, sin embargo, el área oseointegrable aún es un tema poco tratado en la literatura científica. Objetivo: Diseñar un método para el cálculo del área oseointegrable en la colocación de implantes dentales. Métodos: Las áreas de los implantes se calcularon sobre la base de modelos de implantes de tamaño cuatro veces el real, utilizando las fórmulas conocidas para mantos de cilindro, troncos de cono, círculo (entre otras) y aplicando relaciones lineales para las alturas y para los diámetros al cuadrado (asimilación a teoría de modelos). Se emplearon un calibrador de metales, una lupa y un escalímetro. Los implantes fueron divididos en sectores según su diferente configuración geométrica, la suma de superficies permitió obtener el área total del implante. Las superficies se compararon con el área teórica total de los mismos implantes. Luego se extrapolaron los datos para todos los modelos según sus dimensiones particulares. Resultados: Las áreas obtenidas para implantes tipo tornillo y tipo cónico (diámetro/largo en mm) fueron respectivamente: 3,75/7 = 129 mm2; 3,75/13 = 234 mm2; 3,75/15 = 270 mm2; 4/15 = 306 mm2; 5/7 = 224 mm2 y 3,5/13 = 143 mm2; 4,3/10 = 166 mm2; 4,3/13 = 215 mm2; 4,3/16 = 265 mm2. Conclusiones: La metodología usada en este estudio pareciera ser una buena alternativa para calcular el área final de oseointegración(AU)

Introduction: Many studies have been conducted about dental implants. However, the osseointegration area is a topic not commonly dealt with in the scientific literature. Objective: Design a method to estimate the osseointegration area in the placement of dental implants. Methods: The implant areas were estimated with implant models four times as large as real size, using known formulas for cylinder mantles, cone trunks and circles (among others). Linear relationships were applied for heights and square diameters (assimilation to model theory). Use was made of a metal calibrator, a magnifying glass and a scalimeter. The implants were divided into sectors according to their different geometric configuration. The sum of the surfaces made it possible to obtain the total implant area. The surfaces were compared with the total theoretical area of the same implants. The data were then extrapolated for all the models in keeping with their particular dimensions. Results: The areas obtained for screw and cone implants (diameter / length in mm) were, respectively: 3.75/7 = 129 mm2; 3.75/13 = 234 mm2; 3.75/15 = 270 mm2; 4/15 = 306 mm2; 5/7 = 224 mm2 and 3.5/13 = 143 mm2; 4.3/10 = 166 mm2; 4.3/13 = 215 mm2; 4.3/16 = 265 mm2. Conclusions: The methodology used in the study seems to be a good alternative to estimate the final osseointegration area(AU)

Manejo multidisciplinario de rinosinusitis bacteriana aguda posterior a elevación de seno maxilar: reporte de caso rehabilitado a tres años de seguimiento / Multidisciplinary management of acute bacterial rhinosinusitis after maxillary sinus lift: three years follow-up: case report

La cirugía de elevación de seno maxilar se considera como la técnica de aumento óseo más predecible. Sin embargo, no está exenta de complicaciones las cuales deben ser manejadas adecuadamente. Se presenta un caso clínico rehabilitado, con un seguimiento de 3 años, en el cual se realizó un manejo multidisciplinario y resolutivo de complicaciones asociadas a la técnica quirúrgica de elevación de membrana sinusal vía ventana lateral. Frente a una infección postoperatoria, como la presentada en el caso, hay que considerar iniciar un tratamiento antibiótico en el momento adecuado para impedir el agravamiento del cuadro clínico o un cambio de esquema en caso de resistencia antimicrobiana.

Maxillary sinus lift surgery is considered the most predictable bone augmentation technique. However, this procedure is not without complications, which must be handled properly. We present a rehabilitated clinical case, with a 3-year follow-up, in which a multidisciplinary and resolutive management of complications associated with the surgical technique of sinus lift procedure, using lateral window approach, was performed. In case of postoperative infection, such as the one presented in this report, it is necessary to consider starting an antibiotic treatment at the adequate moment to prevent the aggravation of the illness or change the pharmacological treatment in case of antimicrobial resistance.