Translucent Customized Cranial Implants Made of Clear Polymethylmethacrylate: An Early Outcome Analysis of 55 Consecutive Cranioplasty Cases.

BACKGROUND: Large skull reconstruction, with the use of customized cranial implants, restores cerebral protection, physiologic homeostasis, and one's preoperative appearance. Cranial implants may be composed of either bone or a myriad of alloplastic biomaterials. Recently, patient-specific cranial implants have been fabricated using clear polymethylmethacrylate (PMMA), a visually transparent and sonolucent variant of standard opaque PMMA. Given the new enhanced diagnostic and therapeutic applications of clear PMMA, we present here a study evaluating all outcomes and complications in a consecutive patient series. METHODS: A single-surgeon, retrospective, 3-year study was conducted on all consecutive patients undergoing large cranioplasty with clear PMMA implants (2016-2019). Patients who received clear PMMA implants with embedded neurotechnologies were excluded due to confounding variables. All outcomes were analyzed in detail and compared with previous studies utilizing similar alloplastic implant materials. RESULTS: Fifty-five patients underwent cranioplasty with customized clear PMMA implants. Twenty-one (38%) were performed using a single-stage cranioplasty method (ie, craniectomy and cranioplasty performed during the same operation utilizing a prefabricated, oversized design and labor-intense, manual modification), whereas the remaining 34 (62%) underwent a standard, 2-stage reconstruction (craniectomy with a delayed surgery for cranioplasty and minimal-to-no implant modification necessary). The mean cranial defect size was 101.8 cm. The mean follow-up time was 9 months (range, 1.5-39). Major complications requiring additional surgery occurred in 7 patients (13%) consisting of 2 (4%) cerebrospinal fluid leaks, 2 (4%) epidural hematomas, and 3 (4%) infections. In addition, 3 patients developed self-limiting or nonoperative complications including 2 (4%) with new onset seizures and 1 (2%) with delayed scalp healing. CONCLUSIONS: This is the first reported consecutive case series of cranioplasty reconstruction using customized clear PMMA implants, demonstrating excellent results with regard to ease of use, safety, and complication rates well below published rates when compared with other alloplastic materials. Clear PMMA also provides additional benefits, such as visual transparency and sonolucency, which is material specific and unavailable with autologous bone. Although these early results are promising, further studies with multicenter investigations are well justified to evaluate long-term outcomes.

Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease.

AIM: Investigate short-term effects of power brushing following experimental induction of biofilm overgrowth in periodontal disease states. MATERIALS AND METHODS: Overall, 175 subjects representing each of five biofilm-gingival interface (BGI) periodontal groups were enrolled in a single-blind, randomized study. After stent-induced biofilm overgrowth for 21 days subjects received either a manual or a power toothbrush to use during a 4 weeks resolution phase. At baseline and during induction and resolution, standard clinical parameters were measured. Subclinical parameters included multikine analysis of 13 salivary biomarkers and 16s Human Oral Microbe Identification Microarray (HOMIM) probe analysis of subgingival plaque samples. RESULTS: All groups exhibited significantly greater reductions in bleeding on probing (BOP) (p = 0.002), gingival index (GI) (p = 0.0007), pocket depth (PD) (p = 0.04) and plaque index (p = 0.001) with power brushing compared to manual. When BGI groups were combined to form a shallow PD (PD ≤ 3 mm) and a deep PD group (PD > 4 mm) power brushing reduced BOP and GI in subjects with both pocket depths. Power brushing significantly reduced IL-1ß levels at resolution while changes in bacterial levels showed non-significant trends between both brushing modalities. CONCLUSIONS: Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states.

What are the local and systemic implications of third molar retention?

PURPOSE: To establish a relationship between visible third molars (M3s) and increased periodontal probing depths on teeth other than M3s and to examine the hypothesis that the presence of M3s and/or increased probing depths and local inflammation associated with M3s was associated with increased levels of serum inflammatory markers. PATIENTS AND METHODS: The data from three previous population studies (Dental Atherosclerosis Risk In Communities [DARIC], Oral Conditions and Pregnancy [OCAP], and National Health and Nutrition Estimates Study [NHANES III]) and the third molar clinical trials of young adults (White et al) are summarized. A secondary analysis determined whether the presence or absence of visible M3s was associated with an increased prevalence of clinical signs of periodontal disease using adjusted logistic regression models. In addition, serum samples collected from the OCAP, DARIC, and White studies were used to measure the markers of systemic inflammation, C-reactive protein, interleukin-6, and soluble intracellular adhesion molecule-1. RESULTS: In young adults, asymptomatic M3s were associated with an increase in periodontal probing depths of at least 4 mm on second molars and an increase in probing depth of at least 2 mm in 24% of subjects after 2 years. Retention of asymptomatic M3s for 6 years led to a significant increase in the number of subjects with a probing depth of 4 mm or more in non-M3 regions of the mouth. Findings from the DARIC, OCAP, and NHANES III further confirmed the association between the M3 probing depth and periodontal inflammation on non-M3s. Retention of M3s in the presence of periodontal inflammation was associated with significant increases in the serum interleukin-6, soluble intracellular adhesion molecule-1, and C-reactive protein levels. CONCLUSION: Patients deciding to retain M3s should consider the potential long-term effects on their periodontal status and the potential for the retained M3s to serve as a chronic source of inflammation that stresses their systemic health.

[Periodontal diseases and treatment needs in diabetes type 2]. / Necesidad de tratamiento periodontal en diabetes tipo 2.

OBJECTIVE: to determine the prevalence of periodontal disease and the needs for treatment in patients with diabetes mellitus type 2 (DM2) in a rural population. METHODS: a transversal descriptive study with bivariate analysis was carried out. Gender, age, smoking habit and blood glucose levels were obtained from the clinical files in 94 cases. A periodontal examination was carried out by the Periodontal Index of Community Treatment Needs. RESULTS: the ratio woman-man was 3:1. Age rate was from 35 to 75 years, with a mean of 53.4. Fifty two percent of the subjects had been diagnosed in the last five years; 78 percent of the subjects were moderately and badly controlled on diabetes parameters; 96.8 percent of the individuals had moderate to severe periodontal disease with the need for specialized periodontal treatment. CONCLUSIONS: the chronic mouth infections should be seriously considered for an adequate metabolic control of diabetic patients.

Correlación entre nivel de conocimientos sobre posturas odontológicas ergonómicas, posturas de trabajo y dolor postural según zonas de respuesta, durante las prácticas clínicas de estudiantes en una Facultad de Estomatología / Correlation between knowledge on dental ergonomics postures, positions of work and postural pain according to response of anatomic zones during clinical practices of dental students

En el presente estudio se investigaron los aspectos ergonómicos y dolor postural aplicados a la actividad odontológica, además de proporcionar información en busca de una buena calidad de vida y capacidad productiva en el campo de la salud ocupacional del Odontólogo. El objetivo fue determinar la correlación entre nivel de conocimientos sobre posturas odontológicas ergonómicas, posturas de trabajo y presencia de dolor postural según zonas anatómicas de respuesta durante las prácticas clínicas del estudiante del quinto año de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia. Se utilizaron: cuestionario de conocimientos en relación a posturas de trabajo ergonómicas, lista de verificación postural que comprobó la postura de trabajo clínico del estudiante, apoyada por fotografías digitales analizadas por medio de los programas de computación Autocad y Corel Draw. La Escala Analógica Visual (EAV) de percepción e intensidad del dolor postural según zonas anatómicas de respuesta. Para el análisis estadístico se utilizó el coeficiente de correlación de rangos de Spearman. En cuanto a las observaciones posturales de trabajo odontológico, sólo el 22,3 por ciento fueron correctas. Del universo de preguntas sobre posturas odontológicas, sólo 90 (37,5 por ciento) fueron respondidas correctamente. La percepción de dolor postural fue mayor en la zona cervical (75 por ciento) y menor en antebrazos (15 por ciento). Se encontró correlación entre nivel de conocimientos sobre posturas odontológicas ergonómicas y la aplicación de posturas de trabajo odontológico. Se concluye que existe relación directa entre las variables estudiadas.

Mucormicosis: diagnóstico y tratamiento / Mucormicosis: diagnosis and processing

Reportamos 1 caso de una patología infrecuentemente diagnosticada, en un varón de 57 años de edad, diabéticos, procedente de Iquitos, que inicia con una enfermedad de 1 mes de evolución caracterizada por tos productiva y esputo hemoptoico, fiebre, edema de miembros inferiores e ictericia de piel y mucosas, además de pérdida de 10 kilos de peso. Recibió tratamiento antibiótico diverso sin resultados favorables. Paciente mal estado general. Rx Tórax una consolidación cavitada de tercio medio de hemitórax derecho. Velocidad sedimentación 51 mm/h. glucosa 118. BK esputo (-). Cultivo de hongos negativo: Prueba de función respiratoria: severo defecto restrictivo. Rx senos paranasales: opacidad circunscrita en seno maxilar derecho. Broncofibroscopía: traquea desviada a la derecha y signos inflamatorios crónicos del lóbulo superior derecho. Biopsia transbronquial informada por patología como Mucormicosis. Tratamiento Anfotericina más cirugía. Pronóstico malo.