The influence of implant depth, abutment height and mucosal phenotype on peri­implant bone levels: A 2-year clinical trial.

OBJECTIVES: To evaluate the bone changes around equicrestal and subcrestal implants, analyzing the effect of abutment height [short abutments (SA < 2 mm) and long abutments (LA > 2 mm)] and the three components of the peri­implant soft-tissue phenotype. METHODS: Twenty-six patients received 71 implants that were placed according to supracrestal tissue height (STH) in an equicrestal (n = 17), shallow subcrestal ≈1 mm (n = 33), or deep subcrestal ≈2 mm (n = 21) position. After 3 months of healing, rehabilitation was completed using metal-ceramic crowns on multi-unit abutments of 1.5 mm, 2.5 mm, or 3.5 mm in height, depending on the prosthetic space and STH. Longitudinal clinical parameters (STH, mucosal thickness, and keratinized mucosa width) and radiographic data [bone remodelling and marginal bone loss (MBL)] were collected at 3, 6, 12, and 24 months postsurgery. RESULTS: The gain in STH was significantly greater around the implants placed in a subcrestal ≈2 mm position. After 2 years, the mean change in bone remodelling in the SA group was significantly greater than in the LA group. According to the multiple linear regression, bone remodelling depends primarily on abutment height (ß = -0.43), followed by crestal position (ß = 0.34), and keratinized mucosa width (ß = -0.22), while MBL depends on abutment height (ß = -0.37), and the patient's age (ß = -0.36). CONCLUSIONS: Implants placed in an equicrestal or subcrestal ≈1 mm position with LA undergo less bone remodelling, while the lowest level of MBL occurs in subcrestal ≈2 mm implants with LA. Differing soft-tissue thicknesses combined with the use of either SA or LA produced significant intergroup differences in bone remodelling and MBL. CLINICAL SIGNIFICANCE: Abutment height is the most powerful predictor variable affecting bone remodelling and MBL. Depending on the dimensions of the peri­implant soft-tissue phenotype, placing the implants subcrestally may also be a viable option to decrease bone remodelling and, consequently, reduce MBL. CLINICAL TRIAL REGISTRATION: identification number: NCT05670340.

Using the Modified Apical Access Technique to Treat Peri-Implant Mucosa Defects: Description of the Technique and Three-Dimensional Quantitative Measurement of Buccal Augmented Tissue.

The importance of augmenting the peri-implant soft- and hard-tissue architecture is now widely accepted. However, while most contemporary research supports this premise, clinicians are encountering peri-implant soft tissue defects with increasing frequency, which they are therefore required to reconstruct. These complications can result from the difficulty of establishing an appropriate diagnosis and treatment plan or from suboptimal clinical situations (implant malposition, insufficient vestibular alveolar bone thickness or inadequate mucosal thickness). In this context, it is the peri-implant soft-tissue phenotype that most influences esthetic and health-related results in the short and long term. This article describes two clinical cases in which a modification of the apical access technique is presented that may be useful in clinical scenarios requiring large gains in mucosal thickness. Use of the modified bilaminar apical access with de-epithelialized free gingival graft technique showed promising results, with a significant increase in mucosal thickness and satisfactory outcomes in esthetics and peri-implant health.

From the mathematical model to the patient: The scientific and human aspects of artificial intelligence in gastrointestinal surgery.

Recent medical literature shows that the application of artificial intelligence (AI) models in gastrointestinal pathology is an exponentially growing field, with promising models that show very high performances. Regarding inflammatory bowel disease (IBD), recent reviews demonstrate promising diagnostic and prognostic AI models. However, studies are generally at high risk of bias (especially in AI models that are image-based). The creation of specific AI models that improve diagnostic performance and allow the establishment of a general prognostic forecast in IBD is of great interest, as it may allow the stratification of patients into subgroups and, in turn, allow the creation of different diagnostic and therapeutic protocols for these patients. Regarding surgical models, predictive models of postoperative complications have shown great potential in large-scale studies. In this work, the authors present the development of a predictive algorithm for early post-surgical complications in Crohn's disease based on a Random Forest model with exceptional predictive ability for complications within the cohort. The present work, based on logical and reasoned, clinical, and applicable aspects, lays a solid foundation for future prospective work to further develop post-surgical prognostic tools for IBD. The next step is to develop in a prospective and multicenter way, a collaborative path to optimize this line of research and make it applicable to our patients.

The Role of Neutrophyl-to-Lymphocyte Ratio as a Predictor of Ovarian Torsion in Children: Results of a Multicentric Study.

INTRODUCTION: Pediatric ovarian torsion (OT) is an emergency condition that remains challenging to diagnose because of its overall unspecific clinical presentation. The aim of this study was to determine the diagnostic value of clinical, ultrasound, and inflammatory laboratory markers in pediatric OT. METHODS: We performed a retrospective multicentric case-control study in patients with clinical and ultrasound suspicion of OT, in whom surgical examination was performed between 2016-2022 in seven pediatric hospitals. Patients were divided into two groups according to intraoperative findings: OT group (ovarian torsion), defined as torsion of the ovarian axis at least 360°, and non-OT group (no torsion). Demographics, clinical, ultrasound, and laboratory features at admission were analyzed. The diagnostic yield analysis was performed using logistic regression models, and the results were represented by ROC curves. RESULTS: We included a total of 110 patients (75 in OT group; 35 in non-OT group), with no demographic or clinical differences between them. OT-group patients had shorter time from symptom onset (8 vs. 12 h; p = 0.023), higher ultrasound median ovarian volume (63 vs. 51 mL; p = 0.013), and a significant increase in inflammatory markers (leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, C-reactive protein) when compared to the non-OT group. In the ROC curve analysis, the neutrophil-to-lymphocyte ratio (NLR) presented the highest AUC (0.918), with maximum sensitivity (92.4%) and specificity (90.1%) at the cut-off point NLR = 2.57. CONCLUSIONS: NLR can be considered as a useful predictor of pediatric OT in cases with clinical and ultrasound suspicion. Values above 2.57 may help to anticipate urgent surgical treatment in these patients.

Utility of thiol/disulphide homeostasis as a biomarker for acute appendicitis: a systematic review and meta-analysis.

The aim of this study was to analyze the role of thiol/disulfide homeostasis (TDH) parameters as an indicator of oxidative stress in acute appendicitis (AA). PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched. Studies reporting on TDH in AA (both complicated and uncomplicated cases) were included. The comparator group were healthy controls. The TDH domain was compared between the groups using anti-oxidant parameters, namely native thiol and total thiol levels, and native thiol/total thiol ratio; and oxidant parameters, namely disulfide level, disulfide/native thiol ratio, and disulfide/total thiol ratio. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa scale. Eleven studies with a total of 926 subjects, comprising 457 patients with uncomplicated appendicitis, 147 with complicated appendicitis, and 322 healthy controls were included. Our study demonstrated significantly increased oxidative stress in AA as compared to healthy controls in all TDH parameters and significantly lower total thiol levels in complicated AA as compared to uncomplicated AA. Due to a poor methodological quality in five out of eleven studies, future prospective studies with adequate power are essential to validate these observations and refine the diagnostic approaches to AA.

Emotional Intelligence and Personality Traits of University Students in Dentistry, Medicine and Pharmacy Degrees.

BACKGROUND: This study aimed to characterize dentistry, medicine and pharmacy students in terms of emotional intelligence (EI) and personality traits (PTs). It also sought to identify whether differences existed according to gender and degree program and the relationship between them. METHODS: Students enrolled in dentistry (115), medicine (85) and pharmacy (57) degree programs participated voluntarily in the research, including 59 men and 198 women. The following questionnaires were used: (1) the Trait Meta-Mood Scale (TMMS-24) to evaluate EI; (2) the NEO Five-Factor Inventory (NEO-FFI) to assess PT. The Qualtrics XM platform was used for data collection. RESULTS: There were no statistically significant differences between three components of EI, either according to gender or degree program. The only difference in PTs was found in neuroticism, where women scored higher than men. There were statistically significant differences between students on different degree programs in openness to experience and responsibility. The five PTs correlated significantly with the three components of EI, except responsibility and emotional attention. The strongest associations were found between neuroticism and emotional repair (-0.439). CONCLUSIONS: High percentages of the student population were observed to have weaknesses in emotional clarity and emotional repair. Neuroticism is a personality trait that seems to occur more frequently in women.

Blastocystis hominis -Associated Acute Appendicular Peritonitis in a 9-Year-Old Boy: A Case Report and a Comprehensive Review of the Literature.

Although Blastocystis sp. has been classically considered a commensal parasite with limited pathogenicity, recent studies suggest that its pathogenic potential is high. We report the case of a 9-year-old Spanish male who presented with peritonitis secondary to acute appendicitis with abundant intra-abdominal turbid-free fluid. A standard appendectomy was performed, and a sample of the fluid was taken for microbiological culture. Multimicrobial flora was isolated in peritoneal fluid culture. The antibiotic resistance study showed that all the microorganisms were sensitive to meropenem. On the 5th postoperative day, a control blood test showed relative eosinophilia and a persistently elevated C-reactive protein. A stool parasitological study showed abundant cysts morphologically compatible with Blastocystis hominis . The hematoxylin & eosin and Giemsa study identified abundant parasitic cysts in the appendix. The patient evolved favorably and is currently asymptomatic and under follow-up. Regarding acute appendicitis, there is only one report in the literature of peritonitis of appendiceal origin associated with Blastocystis sp. In conclusion, although infrequent, parasitosis should be considered as a potential etiological agent of acute appendicitis, even in nonendemic areas. Relative eosinophilia or persistently elevated acute phase reactants despite adequate antibiotic coverage should help to establish diagnostic suspicion.

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis.

This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA). This review was registered in PROSPERO (CRD42023450988). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of serum CA-125 in AA. A search was conducted in PubMed, Web of Science, Scopus, and OVID. Search terms and keywords were: (appendicitis OR appendectomy) AND (CA-125 OR CA125). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS-2 index. A synthesis of the results, standardization of the metrics, and three random-effect meta-analyses were performed. Five studies with data from 533 participants (including 219 patients with a confirmed diagnosis of AA and 107 controls) were included in this review. The random-effect meta-analysis of serum CA-125 (AA vs controls) included 3 articles (125 AA and 70 controls) and resulted in a non-significant mean difference [95% CI] of - 6.80 [- 20.51, 6.92] U/mL (p = 0.33). The meta-analysis by subgroups that included only male patients resulted in a significant mean difference [95% CI] of 3.48 [0.46, 6.49] U/mL (p = 0.02). Although serum CA-125 does not appear to be a good overall marker for the diagnosis of AA, our subgroup analyses show that this marker could be useful for diagnosing AA in males. It also appears to be a potentially useful tool for discriminating complicated and uncomplicated AA. However, the limited number of included studies precludes drawing generalizable conclusions. Future prospective studies focused on males and in its potential ability to discriminate between complicated and uncomplicated AA are required.Registration. PROSPERO (CRD42023450988).

Exploring Digital Gingival Shade Matching in Students.

PURPOSE: To study the degree of accuracy in gingival shade matching of undergraduate students using a computer application. MATERIALS AND METHODS: In total, 76 undergraduate dental students' gingival shade selection abilities were evaluated using an in-house developed computer application. A total of 15 intraoral gingival photographs and 21 pink gingival color porcelain samples were used. The environmental conditions were standardized, and no time limit was set for answering in the computer application. RESULTS: Fourteen gingival color samples (66.6%) were not useful for representing the studied gingival shades. Not all natural gingival colors studied were represented within the 50.50% acceptability limits of the pink samples. There were no statistically significant differences between men and women in terms of "hit" percentages. The highest correlation coefficient (in absolute value) was for the L* coordinate (the darker the gingiva in the picture, the higher the hit rate for choosing the "ideal" shade tab); however, none of the linear correlation coefficients were statistically significant. CONCLUSIONS: Not all colors provided in the pink ceramic system were useful for subjective gingival selection. There were no statistically significant differences between male and female dental students in gingival color perception. The L* coordinate was the only one that influenced the correct perception of gingival color by dental students, and it did so more in women than in men.

Thoracic lipoblastoma in a 6-year-old African male: a case report.

Lipoblastoma is a very infrequent tumor, characteristic of early childhood. The thoracic location is infrequent, with isolated reports to date. We present the case of a 6-year-old male patient with a right thoracic tumor of months of evolution that was surgically removed by right anterolateral thoracotomy and in which the diagnosis of classic well-differentiated lipoblastoma was histologically confirmed. The patient evolved favorably and was discharged. He is currently under follow-up and without recurrence 1 year after surgery. This is, to our knowledge, the first thoracic lipoblastoma reported in an African pediatric patient. The importance of knowing the clinical, semiological, and intraoperative characteristics of this tumor becomes even more important, as in our case, in the context of international cooperation, where in many cases, there is no possibility of performing pre-operative imaging studies or subsequent genetic studies.

El lipoblastoma es un tumor muy infrecuente, característico de la primera infancia. La localización torácica es infrecuente, con reportes aislados hasta la fecha. Presentamos el caso de un paciente varón de 6 años con una tumoración torácica derecha de meses de evolución que fue extirpada quirúrgicamente mediante toracotomía anterolateral derecha y en la que se confirmó histológicamente el diagnóstico de lipoblastoma clásico bien diferenciado. El paciente evolucionó favorablemente y fue dado de alta. Actualmente se encuentra en seguimiento y sin recidiva un año después de la cirugía. Este es, hasta donde sabemos, el primer lipoblastoma torácico reportado en un paciente pediátrico africano. La importancia de conocer las características clínicas, semiológicas e intraoperatorias de este tumor cobra aún más importancia, como en nuestro caso, en el contexto de la cooperación internacional, donde en muchos casos no existe la posibilidad de realizar estudios de imagen preoperatorios ni estudios genéticos posteriores.

Pediatric Rectosigmoid Atypical Juvenile Polyps Presenting With Rectal Prolapse and Acute Bleeding: A Case Report and a Comprehensive Literature Review.

Rectosigmoid solitary juvenile polyps are benign lesions, relatively frequent in childhood. The clinical debut of a pediatric polyp with bleeding is relatively frequent, but there are very few reports of rectal prolapse of polyps. We present the case of a 7-year-old female patient with no previous history who presented with rectal prolapse of a polyp with acute bleeding. An urgent endoscopic examination was performed and 2 rectosigmoid polypoid lesions were found and resected. The anatomopathological study showed that these were 2 hamartomatous polyps with mild dysplasia. The patient is asymptomatic and is being followed up. The literature concerning rectal prolapse of polyps in the pediatric population is scarce. In a pediatric patient with a rectal prolapse, this entity should be considered in the differential diagnosis.

Explaining the colour of natural healthy gingiva.

To examine the differences between natural gingival colour in men and women. To determine the degree of predictability of changes in the gingival colour coordinates recorded for healthy gingiva, according to age, long-term medication, frequency of toothbrushing, and smoking habits. The CIELAB colour coordinates were recorded using a spectrophotometer for 360 Caucasian adult participants (aged 18-92 years), in three zones of the healthy attached gingiva of the maxillary central incisor. Regression models were created for each zone and each sex, taking the L*, a* and b* coordinates as dependent variables and age, frequency of toothbrushing, smoking habits (0-non-smoker; 1-smoker) and whether participants were taking long-term medication (0-no; 1-yes) as independent variables. The statistical analysis was conducted with SPSS version 26.0, using multiple regression models. Statistically significant differences between men and women were found only for colour coordinate b*, in all three zones. The only colour coordinate on which the predictor variables had a significant effect was the L* coordinate. In men, age and long-term medication had the greatest effect as predictors (maximum R2 = 0.149). In women, frequency of toothbrushing was the strongest predictor in the predictive models (maximum R2 = 0.099). The colour of gingiva in men contained a larger amount of blue, given that significantly lower values for colour coordinate b* were recorded in men than women, although this difference lacked clinical implications. For both sexes, the regression models produced had a modest predictive capacity. The L* coordinate was the dependent variable that showed the greatest predictability.

Analyzing Linear and Angular Deviations After Guided Surgery for Dental Implant Placement: A Preliminary Study.

PURPOSE: This study aimed to assess the accuracy and precision of prosthetically-driven implant placement achieved through static computer-aided implant surgery. The primary objective was to analyze the linear and angular deviations of dental implants in patients treated at a university dental clinic. Various types of surgical techniques and templates were utilized to optimize implant positioning. MATERIALS AND METHODS: A total of fiftythree dental implants were included in this study. The implants were positioned using either tooth-supported templates or tooth-tissue-supported templates with fixation pins. Two distinct guided surgery approaches were used, these being pilot drill guided and fully guided. Three-dimensional (3D) data from the implant planning phase was superimposed with the 3D data from the final implant positions using the 'Treatment Evaluation' tool within CoDiagnostix. implant planning software (Straumann AG). This enabled the automatic calculation of deviations in implant placement accuracy. RESULTS: Average angular deviation observed was 3.90 degrees. For linear deviations, the mean 3D deviation at the most coronal point of the implants was 1.04 mm, while at the implant apex it was 1.56 mm. CONCLUSION: This research demonstrates the feasibility of a digital workflow for guided implant surgery, offering a promising treatment option. Nonetheless, it is important to note that deviations do occur, with the apical region of the implant being the most affected area. Care should be taken, particularly in cases of limited bone availability.

How do the dimensions of peri-implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1-year clinical trial.

INTRODUCTION: There is evidence that the apico-coronal implant position and the mucosal phenotype can affect the extent of peri-implant bone loss. This clinical trial analyzes the bone remodeling and marginal bone loss that occur around conical-connection implants placed equicrestally and subcrestally, assessing the effect of the peri-implant soft-tissue phenotype. METHODS: Fifty-one patients received 56 implants of distinct diameters (3.5 mm Ø n = 6; 4.3 mm Ø n = 41; 5 mm Ø n = 9) in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, single metal-ceramic screw-retained implant-supported crowns were placed. Longitudinal measurements of STH, mucosal thickness and keratinized mucosa width (KMW) were made at the time of implant placement (T0), crown placement (T1), and after 3 (T2) and 6 months (T3) of prosthetic loading. At each of these points, a radiographic evaluation of bone remodeling and marginal bone loss was also performed. RESULTS: STH was significantly greater for implants placed >1 mm subcrestally than for those placed 1 mm subcrestally. After 12 months of follow-up, a very significant (p < 0.001) loss of KMW was observed, in addition to a marginal bone loss of 0.08 ± 0.1, 0.15 ± 0.2, and 0.14 ± 0.2 mm in the groups placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, respectively. After the multiple linear regression, marginal bone loss was found to depend primarily on KMW (ß = -0.43), while also being affected by STH (ß = 0.32) and implant diameter (ß = -0.28). CONCLUSIONS: Marginal bone loss may be influenced by the position with respect to the bone crest, as well as the KMW, STH, and implant diameter. However, more well-controlled studies are needed to verify these above-mentioned findings with different implant designs and connections.

From Aviation to Pediatric Surgery.

Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.

Pop-off mechanisms as renoprotective mediators in children with posterior urethral valves: A systematic review and meta-analysis.

BACKGROUND: Pop-off mechanisms are potential pressure-relieving mediators in patients diagnosed with posterior urethral valves (PUV). This systematic review aimed to synthesize the existing evidence regarding the protective effect of pop-off mechanisms on renal function in children with PUV. METHODS: We conducted a systematic review of the literature that involved an extensive search in the main databases of the medical bibliography. Three independent reviewers selected the relevant articles. Methodological quality was rated using the Newcastle Ottawa Scale index. We used random meta-analyses to compare different outcomes (serum creatine, Nadir serum creatinine, and Chronic Kidney Disease) between children with PUV and pop-off mechanisms and those with PUV without pop-off mechanisms. RESULTS: 10 studies with data from 896 participants were included in this review. Seven articles reported serum creatinine values for each group and 3 of them found significant differences between groups. The random-effects meta-analysis for serum creatinine showed significant lower mean (diff = -52.88 µmol/L [95 % CI -73.65 to -32.11]) in the group of children with pop-off mechanisms, and the random-effects meta-analysis for Nadir serum creatinine showed a marginally significantly lower mean in the group of children with pop-off mechanisms (diff = -12.00 µmol/L [95 % CI -24.04 to 0.04]). The random-effect meta-analysis for Chronic Kidney Disease resulted in a significant risk reduction for the group of children with pop-off mechanisms (odds ratio = 0.48 [95 % CI 0.23 to 0.98]). CONCLUSIONS: Children with PUV and pop-off mechanisms show better renal function and lower risk of Chronic Kidney Disease than those with PUV without pop-off mechanisms suggesting these mechanisms may act as renoprotective mediators. The high heterogeneity between studies in the assessment of renal function and long-term outcomes calls for a cautious interpretation of these findings. Future studies that stratify by different types of pop-off mechanisms and use standardized metrics, such as Nadir creatinine, are needed.

Sea-blue histiocytosis.

A 78-year-old woman with hypertrophic cardiomyopathy underwent a septal myomectomy and valve replacement. In the immediate postoperative period she developed shock of mixed etiology and died. At autopsy, hepatomegaly and splenomegaly were identified, with PAS and Giemsa positive intracellular ceroid granular deposits. Sea-blue histiocytosis is an extremely rare, chronic and benign deposit disease. It is characterized by hepatosplenomegaly, thrombocytopenia and lymphadenopathy. The presence of ceroid substance in granules in PAS and Giemsa stains should establish the diagnosis of suspicion.

Three-dimensional representation of the Vita Toothguide 3D-Master: An in vivo clinical study.

STATEMENT OF PROBLEM: The Vita Toothguide 3D-Master (Vita Zahnfabrik) is considered the dental shade guide in which the three dimensions of color - lightness, hue, and chroma - are most well-ordered in the CIELAB color space. No research has yet explored how well the Vita Toothguide 3D-Master is ordered in the 3D color space by recording color coordinates in vivo. PURPOSE: To evaluate the spatial color distribution of the Vita Toothguide 3D-Master's lightness, chroma, and hue groups and its 26 physical shade tabs. MATERIALS AND METHODS: The dental color (L*, C*, h°, a*, and b* color coordinates) of a healthy maxillary central incisor was recorded for 1361 participants (aged between 18 and 89 years) using a Vita Easyshade Compact spectrophotometer (Vita Zahnfabrik). The R 2.7.2. statistics program was used to create the visual representations. RESULTS: The five lightness levels are those that are best distributed in the color space, in relation to the L* coordinates, followed by the chroma group and, finally, the hue group. The 5M1, 5M2, and 5M3 physical shade tabs are situated at a greater distance apart from the other tabs in the color space. CONCLUSIONS: The Vita Toothguide 3D-Master's 26 physical shade tabs are satisfactorily distributed in three-dimensional space, although strict mathematical criteria are not followed. The natural dental shades that fall lower on the lightness scale are the most poorly represented by the physical shade tabs. CLINICAL IMPLICATIONS: Darker teeth are poorly represented by the Vita Toothguide 3D-Master's physical shade tabs. The spatial distribution of dental shade guides needs to be improved to ensure they provide homogeneous coverage of the entire chromatic spectrum corresponding to natural teeth. This would help reduce the errors inherent to the subjective visual color selection process.