[Recommendations on organization, design, characteristics and operation of neonatology services]. / Recomendaciones de organización, diseño, características y funcionamiento de servicios o unidades de neonatología.

Neonatal care has undergone important advances involving the technology for treatment and mo nitoring, the design of care spaces, the incorporation of support professionals, and, especially, the strengthening of an organizational model in networks with centers of different levels of care. Neona tal units should be located in centers with maternity services and, ideally, with pediatric ones of an equivalent level of care. This document defines the admission and transfer criteria according to the level of care and among the different levels, respectively. The evidence recommends an individual room design due to the associated benefits such as decreased occurrence and better control of health care-associated infections, improved breastfeeding, and better interaction with parents. The sugges ted room sizes favor the implementation of the family-centered care model. These recommendations establish the possibility of performing emergency surgical procedures in the neonatal unit and define the safety criteria of the physical plant. In addition, they define the human resources according to the level of care, recognizing the time dedicated to non-direct patient care activities, , and the re quirements of non-medical professionals such as psychologists, physical and respiratory therapists, occupational therapists, speech therapists, pharmacists, dietitians, and social workers. Neonatal care should be led by the neonatologist allowing the participation of general pediatricians with training and demonstrated experience in neonatal care. Midwives and neonatal nurses should have accredited formation in such area. The purpose of this document is to update the "Recommendations on the Organization, Characteristics and Operation of Neonatology Services or Units" to serve as an orien tation and guide for the design and management of neonatal care in public and private health care centers in the country.

Within Our Skin.

From "beauty is only skin deep" to "it takes a thick skin," there are a countless number of skin-related aphorisms that serve as social commentaries on the beauty and resilience of skin. The skin as an interface to society may have diverse psychological implications, but its physiological importance to health is undeniable. As the largest organ in the body, the skin presents a formidable barrier that serves to protect our internal physiology from potentially harmful stimuli of the external environment.

A combined direct dowel and indirect core technique.

The dowel-and-core restoration is indicated when inadequate tooth structure remains to retain an extracoronal restoration. A modified technique for fabricating the dowel and core combines the direct technique of forming the dowel in the actual channel with the indirect technique of creating an ideal core contour in the laboratory. This technique allows the operator to create an accurate and passive fit of the dowel pattern in the canal preparation. The technique also introduces the option of retrieving the dowel portion by utilizing a polyvinyl siloxane cast or liner. Further advantages of the technique are reduced chairside time and the ability to capitalize on the preparation of multiple teeth. The technique focuses efforts on achieving an accurate and passive fit of the dowel clinically while delegating the formation of the core to the laboratory.

A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study.

Previous studies have shown chondroitin sulfate and glucosamine hydrochloride have beneficial effects on symptoms of osteoarthritis of the knee. Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate (CS) taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Forty-five subjects were enrolled in the study and were randomly assigned to either an active medication group or a placebo group. Eleven subjects were lost from the study for various reasons, resulting in fourteen subjects remaining in the active medication group and twenty subjects remaining in the placebo group. Subjects taking CS-GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily over-the-counter medications needed. Subjects taking the placebo medication had improvements in their pains as measured by the visual analog scale and by four indices of the McGill Pain Questionnaire. Additional studies are required to evaluate the clinical effectiveness of CS-GH and to determine the exact mechanism by which CS-GH affects the articular cartilage of synovial joints.

Prescribing nicotine substitutes for tobacco cessation: considerations and contraindications.

This article deals with the topic of nicotine replacement drugs and their use in smoking cessation. Questions frequently arise as to their prescription by dentists. Provided patients are carefully selected on the basis of medical and psychological profiles, there is no ethical or legal contraindication to dentists prescribing these aids. This article reviews the current literature and answers commonly asked questions concerning these effective drugs.

Transferring emergence profile created from the provisional to the definitive restoration.

One primary objective for implant therapy is the achievement of an aesthetic result, and this is significantly dependent upon the condition of the peri-implant soft tissue and the implant emergence profile. The requisite for the configuration of the definitive crown is formulated by the provisional restoration, which transfers the position of the implant and the peri-implant soft tissue to the model utilized in the fabrication process. This article demonstrates the use of a provisionalization stage to precisely replicate the peri-implant tissue in the definitive restoration.

Establishing soft tissue integration with natural tooth-shaped abutments.

The disparity in dimensions between implant fixtures and the exposed extraction sockets has resulted in the development of anatomically shaped abutments. Systems have been recently introduced that facilitate the fabrication of abutments to the configuration of natural teeth in the anterior maxilla. These systems permit development of an aesthetic emergence profile and contours for easy access in maintenance of oral hygiene of maxillary anterior single-tooth implant-supported restorations. The rationale for the development, indications, advantages, and clinical utilization of a recently introduced abutment system is discussed.

Rehabilitation of an edentulous mandible with an implant-supported prosthesis.

The advances in osseointegration have resulted in an increased utilization of implants for restoration of the edentulous jaw. The success of osseointegrated implants supporting full arch prostheses has become more predictable. All implant restorations require a thorough diagnosis and a definitive treatment plan. Following a diagnostic wax-up, an optimal surgical implant template must be fabricated; it serves as a guide or prescription for placement of implants in an optimal anatomic location. The slightest misangulation of an implant may create restorative limitations. In such circumstances, alteration of the restorative design or selection of alternate materials may be required. The learning objective of this article is to review the fabrication of a combined ceramometal and resin-metal fixed/removable implant-supported mandibular hybrid prosthesis. Diagnosis, surgical template fabrication, vertical dimensions, buccal/lingual space limitations, and aesthetics are discussed.

Managing malrelated arches and limited vertical space for implant-supported overdentures: a case report.

Advancements in implant therapy have expanded the prosthetic options available to treat edentulous patients. The dental professional must be able to accurately diagnose the status of the intraoral environmental in order to provide the patient with appropriate treatment and a suitable restorative result. Skeletal relationships, arch malalignment, implant angulation, and ridge morphology must be evaluated during initial treatment planning and incorporated into the definitive prosthetic result. This case report demonstrates the application of an implant-supported prosthesis to address the various complications presented in the treatment of edentulous patients.

Prosthetic considerations in the fabrication of surgical stents for implant placement.

The utilization of surgical stents/templates for implant placement is of significant importance to the success of the definitive prosthesis. However, major conceptual differences exist between surgical stents designed for implant-supported crowns and bridges and those designed for implant overdentures. In addition, various types of surgical stents exist within each group. In either case, optimizing the prosthetic result by customization of the stent should be a major consideration in the fabrication process. The design of the stent must account for several treatment conditions, including position of the implant, the tissue present, and the anticipated prosthesis. The teaching objective of this article is to present the prosthetic considerations in the fabrication and customization of surgical stents. The article compares the two groups and offers specific guidelines for the fabrication of surgical stents for the various types of restorations within each group.

Aesthetic considerations for maxillary obturators retained by implants.

Maxillary obturators are prostheses used to replace maxillary tissues, missing congenitally or removed by trauma or tumor ablative surgery. These prostheses are used to restore function (speech, swallowing, and mastication) and aesthetics. A considerable number of edentulous patients have difficulty in retaining this type of prosthesis. Utilization of osseointegrated dental implants is a significant adjunct in treating these cases, but it must be undertaken with careful planning to ensure predictable aesthetic results. The learning objective of this article is to discuss the technique of designing aesthetic maxillary prostheses supported by osseointegrated dental implants. The discussion includes indications and contraindications, and a postcarcinoma surgery case is used to illustrate the clinical procedure.

Rehabilitation of medically complex ectodermal dysplasia with novel surgical and prosthodontic protocols.

The functional and aesthetic needs of a 17-year-old patient afflicted with ectodermal dysplasia, chronic long-term immunosuppression, cleft palate, velopharyngeal insufficiency, hypernasality, maxillary hypoplasia, and oligodontia were met with a multidisciplinary team approach. Predictable functional and aesthetic outcomes were obtained with a combination of injection augmentation of the soft palate and nasopharynx and rigid fixation maxillary external distraction with immediate placement and immediate load protocols. No biological or prosthetic complications were noted after definitive rehabilitation with a mandibular implant-retained fixed prosthesis and a maxillary implant-retained detachable prosthesis.