Implant Placement in Patients under Treatment with Rivaroxaban: A Retrospective Clinical Study.

The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient's physician.

Clinical efficacy of a Ginkgo biloba extract in the topical treatment of allergic conjunctivitis.

PURPOSE: To investigate the clinical efficacy of a Ginkgo biloba extract associated with hyaluronic acid ophthalmic solution (GB-HA, Trium, SOOFT, Italy), compared to hyaluronic acid ophthalmic solution (HA) alone, in seasonal allergic conjunctivitis (AC). METHODS: A total of 60 patients with symptomatic AC were enrolled and randomly assigned to the two treatment regimens. After a washout period of 15 days, the treatment with GB-HA eyedrops or HA ophthalmic solution alone was initiated and continued for 1 month. The clinical symptoms such as conjunctival hyperemia, conjunctival discharge, and chemosis, and subjective signs as itching, photophobia, stinging, and lacrimation, were evaluated before and after the treatment. A 0-4 score was used by an independent clinical observer to quantify the above parameters. RESULTS: Patients treated with GB-HA, compared to patients treated with HA alone, showed a significant decrease in the appearance of conjunctival hyperemia, conjunctival discharge, and chemosis. Furthermore, all patients treated with GB-HA showed a significant improvement of subjective symptoms, compared to HA patients. Compared to their baseline values, patients treated with HA alone showed a small but not significant improvement in only some of the clinical and subjective symptoms. CONCLUSIONS: The results suggest that Ginkgo biloba extract may exert therapeutic activity in the treatment of seasonal allergic conjunctivitis. Hyaluronic acid did not exert any valuable effect on this pathology.

Er:YAG laser in defocused mode for scaling of periodontally involved root surfaces: an in vitro pilot study.

BACKGROUND: The Er:YAG laser may be used on periodontally involved teeth in combination with conventional periodontal therapy in order to improve the efficacy of root instrumentation. The aim of this study was to compare the effect of hand instrumentation on root surfaces of periodontally involved teeth with Er:YAG laser application. METHODS: Thirty freshly extracted, non-carious, single-rooted, periodontally diseased human teeth from adult humans with advanced periodontal disease were used in this study. The teeth were divided into three groups of 10 specimens each. Group A was treated with scaling and root planing (SRP) with curets only (control). In group B, the root surfaces were scaled with curets and then lased with an Er:YAG laser (wavelength 2.94 microm). A handpiece with a water spray was used in non-contact mode (defocused) at a distance of 1 cm from root surface. Laser parameters were set at energy of 100 to 200 mJ/pulse, with 10 Hz of frequency. In group C, the root surfaces were lased only with power settings 250 to 300 mJ/pulse and 10 Hz frequency. An epon-araldite plastic embedding technique was used for light microscopic investigation. RESULTS: Histologic findings showed significant differences between the test and control sites. In control sites, after hand instrumentation, the surface was smooth, without a cementum layer, and the dentin layer presented opened tubules. Defects on the dentin layer were also present along root surfaces. In the test sites (B, C) root surfaces revealed no thermal damage; no cracking or tissue carbonization were observed. The superficial layers of lased surfaces appeared smooth and melted without alterations. CONCLUSION: Based on these findings, it appears that it may be feasible to use the Er:YAG laser for root instrumentation without prior root planing if the proper parameters are followed.

Endocardite por estreptococo do grupo D (S. bovis e S. faecalis) e tumor de colon. Apresentação de dois casos / Endocarditis due to group D Streptococcus (Sbovis and S faecalis) and tumor of the colon.Report of 2 cases

Sao relatados 2 casos de pacientes com endocardite infecciosa e tumor de tubo digestivo. No primeiro caso, um paciente de 50 anos, o agente etiologico foi o Steptococcus bovis e foram identificados multiplos adenomas vilosos a partir do enema opaco, realizado por ser este o agente etiologico. No outro caso, um paciente de 55 anos de idade apresentou endocardite por S. faecalis e insuficiencia cardiaca severa, necessitando de implante de bioprotese mitral e aortica.A persistencia de anemia prolongada apos a operacao levou a realizacao de enema opaco identificando-se falha de enchimento no angulo hepatico de colon, sendo o paciente submetido a hemicolectomia direita por adenocarminoma tubular, bem diferenciado. Os autores sublinham a necessidade de identificar os estreptococos ate a especie e a necessidade de investigacao do tubo digestivo no caso de identificacao de Streptococcus bovis, mesmo na ausencia de sintomas do tubo digestivo