Dental implants in patients with ectodermal dysplasia: a computer guided quad zygomatic case report and literature review / Implantes dentales en pacientes con displasia ectodérmica: Reporte de caso y revisión de literatura

Abstract Ectodermal dysplasia (ED) is a genetic disorder affecting anatomical structures with an ectodermal origin. The consequent alveolar bone anomalies and lack of teeth require a multidisciplinary approach to rehabilitate patients function and esthetics. To avoid bone grafting procedures the application of zygomatic implants was suggested for the upper jaw treatment. The advancements in three-dimensional (3D) radiology and the introduction of digital implant planning software could enhance the approach to zygomatic implants in ED patients. The present case report describes the quad zygomatic implant treatment of the edentulous maxilla of an ED patient by means of computer guided implant surgery. The patient reported previous failure of bone grafting procedures in the upper jaw. The implants were immediately loaded with a screw-retained complete-arch resin prosthesis. The patient was followed up for 1 year with no biological nor mechanical complications reported, but a slight bone resorption in the anterior zone was observed. Zygomatic implants could be a potential alternative treatment to bone grafting in upper jaw and the digital implant planning could enhance the surgical procedure.

Resumen La displasia ectodérmica (DE) es una enfermedad genética que afecta las estructuras anatómicas de origen ectodérmico. Las consiguientes anomalías del hueso alveolar y la anodoncia requieren un planteamiento multidisciplinario para rehabilitar la función y la estética de los pacientes. Para evitar procedimientos de injerto óseo se sugirió la aplicación de implantes cigomáticos para el tratamiento del maxilar superior. Los avances en radiología tridimensional (3D) y la introducción de software de planificación de implantes digitales podrían mejorar el enfoque de los implantes cigomáticos en los pacientes con displasia ectodérmica. El presente reporte de caso describe el tratamiento con implantes cigomáticos en el maxilar superior edéntulo de un paciente con displasia ectodérmica mediante cirugía de implantes guiada por ordenador. El paciente refirió fracaso de procedimientos de injerto óseo en el maxilar superior. Los implantes se cargaron inmediatamente con una prótesis de resina de arcada completa. El paciente ha sido incluido en un programa de control postoperatorio por 1 año, sin reportarse complicaciones ni biológicas ni mecánicas, siendo el único problema encontrado una ligera reabsorción ósea en la zona anterior. Los implantes cigomáticos podrían ser un posible tratamiento alternativo al injerto óseo en el maxilar superior y la planificación de implantes digitales podría mejorar el procedimiento quirúrgico.

COVID-19 Vaccine Hesitancy among Unvaccinated Adults: A Cross-Sectional Exploratory Analysis of Vaccination Intentions in Italy Related to Fear of Infection.

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36-1.62); it was highest in the 50-59 and 40-49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46-0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46-4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics.

Upper First and Second Molar Pulp Chamber Endodontic Anatomy Evaluation According to a Recent Classification: A Cone Beam Computed Tomography Study.

(1) The possibility of knowing information about the anatomy in advance, in particular the arrangement of the endodontic system, is crucial for successful treatment and for avoiding complications during endodontic therapy; the aim was to find a correlation between a minimally invasive and less stressful endodontic access on Ni-Ti rotary instruments, but which allows correct vision and identification of anatomical reference points, simplifying the typologies based on the shape of the pulp chamber in coronal three-dimensional exam views. (2) Based on the inclusion criteria, 104 maxillary molars (52 maxillary first molars and 52 maxillary second molars) were included in the study after 26 Cone Beam Computed Tomography (CBCT) acquisitions (from 15 males and 11 females). And linear measurements were taken with the CBCT-dedicated software for subsequent analysis. (3) The results of the present study show data similar to those already published about this topic. Pawar and Singh's simplified classification actually seems to offer a schematic way of classification that includes almost all of the cases that have been analyzed. (4) The use of a diagnostic examination with a wide Field of View (FOV) and low radiation dose represents an exam capable of obtaining a lot of clinical information for endodontic treatment. Nevertheless, the endodontic anatomy of the upper second molar represents a major challenge for the clinician due to its complexity both in canal shape and in ramification.

The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study

BACKGROUND: The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. MATERIAL AND METHODS: 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. RESULTS: The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. CONCLUSIONS: In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized

Use of 3D cartilage scaffolds for the stabilization of implants and bone regeneration with the fit-lock technique

Los procedimientos quirúrgicos para la aplicación de los implantes en los sectores latero superiores, están condicionadas por la neumatización del seno y la disponibilidad del huesoresidual. En estos casos el injerto de hueso autólogo permanece como lamejor opción, pero a causa de la morbilidad asociada al sitio donante y a las complicaciones post quirúrgicas, se pusieron a disposición diversas alternativas de sustitutos óseos, que implican sin embargo un aumento de los costos económicos y con limitadas propiedades osteoinductivas. Tales defectos pueden ser compensados con nuevas estrategias de regeneración biológica y mecánica de los tejidos a loscuales fue dirigida la ingeniería biológica y mecánica en los últimos años.Se presenta una nueva posibilidad terapéutica en la aplicación de los implantes en el maxilar superior con disponibilidad ósea inferior a los 4 mm, mediante la utilización de andamios 3D confeccionados en cartilago de cerdo libre de antígenos obtenido según la tecnica Fit-Lock. Se realizo un estudio longitudinal en 18 casos consecutivosevidenciando al cabo de un año de la carga implantológica, un éxito del 95,2 por ciento. Las ventajas en esta nueva técnica son: 1)La recuperación funcionaly anatómica del antro del maxilar 2).La aplicación inmediata de los implantes; 3)Reducción de los tiempos quirúrgicos; 4) Ausencia de morbilidad para el paciente; 5) Uso de anestesia local; 6)Uso de implantes con diámetros superiores a los 4 mm

Use of 3D cartilage scaffolds for the stabilization of implants and bone regeneration with the fit-lock technique. / Use of 3D cartilage scaffolds for the stabilization of implants and bone regeneration with the fit-lock technique.

The surgical procedures for implant applications on the lateral-upper areas depend on sinus pneumatization and availability of the residual bone. In these cases, autologous bone grafting remains the gold standard. Nevertheless, because of the morbidity associated to the donor site and the post-surgical complications, several alternative bone substitutes have been introduced, which, however, imply additional costs and show limited osteoinductive properties. Such limitations can be compensated with new regeneration strategies for biological and mechanical tissue restoration, a subject which has been addressed by tissue engineering in recent years. The authors present a new therapeutic option for implant application in the upper maxilla with bone availability less than 4 mm by using 3D scaffolds obtained from antigen-free porcine cartilage in the fit-lock technique. A longitudinal study on 18 consecutive cases was performed, with a 95.2

success rate one year after the implant. The advantages of this new technique are: 1) Functional and anatomical recovery of the maxillary antrum, 2) Immediate application of the implants; 3) Reduction of surgical times; 4) Absence of patient morbidity; 5) Local anesthesia; 6) Use of implants with a diameter > 4 mm.

Self-bone graft and simultaneous application of implants in the upper jawbone (fit lock technique)

La rehabilitación implanto soportada de los sectores posterosuperiores resulta, a veces, condicionada por la neumatizaciòndel seno maxilar, reduciendo la posibilidad de la aplicación delos implantes cuando la disponibilidad ósea es inferior a los 4 mm. (Condición Límite para la estabilidad primaria).El levantamiento del seno maxilar y la aplicación simultánea de los implantes es con seguridad la condición que mejorgarantiza el éxito, respecto a la sola aplicación del material de relleno. Muchas son las técnicas quirúrgicas desarrolladas en la utililizaciòn del hueso autòlogo (cresta iliaca, calota craneana, peroné) y la aplicación de los implantes. En este artículo se presenta una nueva técnica para reducir almínimo la invasividad de la toma del material óseo de injerto autólogo y la morbilidad del paciente. Se ha realizado un estudio longitudinal sobre 21 casos consecutivos, mostrando un éxito del 94,5 por ciento. Las ventajas de esta técnica son: 1) Recuperación funcional y anatómica del seno maxilar. 2) Aplicación inmediata de los implantes con un espesor residuo de hueso de piso de seno menor a los 4 mm. 3) Reducciónde los tiempos quirúrgicos. 4) Menor Morbilidad del paciente. 5) Anestesia loco regional.