A Paradigm Shift Using Scan Bodies to Record the Position of a Complete Arch of Implants in a Digital Workflow.

The use of conventional scan bodies (SBs) with an intraoral scanner (IOS) to capture the position of a complete arch of dental implants has proven to be challenging. The literature is unclear about the accuracy of intraoral scanning techniques using SBs that are connected vertically to multiunit abutments (MUAs) for numerous adjacent implants in the same arch. Recently, there has been a paradigm shift from vertical SBs to horizontal SBs, which are positioned perpendicular to the long axis of the MUAs. Most IOSs available today can capture these horizontal SBs, called scan gauges (SGs), with better accuracy and consequently acquire the position of multiple adjacent implants using an effective scan path, thus reducing stitching and the number of images. The key to implementing this novel technology is to strategically arrange the SGs to optimize horizontal overlap of multiple adjacent SGs without touching each other. By superimposing two high-resolution intraoral scans of the SGs, an artificial intelligence (AI) algorithm is employed to produce a calibrated digital best-fit model on which a passive complete-arch prosthesis can be designed and fabricated. The advantages and disadvantages of SBs and SGs are discussed, and a case report using a digital workflow is presented.

Full-arch restoration with the NEXUS IOS® system: A retrospective clinical evaluation of 37 restorations after a one year of follow-up.

OBJECTIVES: Report the results with a novel workflow of digital restoration for completely edentulous patients with implant supported full arch fixed dental prostheses (ISFDP). METHODS: This multicenter retrospective clinical study was based on the evaluation from a cohort of 29 patients restored with 37 ISFDP designed and manufactured from the data captured by a direct intraoral scan, using a novel full digital system (NEXUS IOS®, Osteon Medical, a Keystone Dental Group company, Melbourne, Australia). Data was collected over a 3-year period, in six different dental centers. This study reported on the clinical parameters including: precision of marginal fit, functional and aesthetic integration of Nexus ISFDP. All patients were followed for a period of one year post delivery. Implant survival, biologic and prosthetic complications were assessed, at one year. A statistical analysis was conducted. RESULTS: All 37 ISFDP were deemed clinically acceptable on insertion. Implant survival at one year was 100 %. The biologic and prosthetic complications were minimal during the follow-up period. CONCLUSIONS: ISFDP, designed and manufactured using the NEXUS IOS® system, are clinically acceptable, with a low incidence of complications at one year. Long-term clinical studies are needed. STATEMENT OF CLINICAL RELEVANCE: Within the limitations of this study (retrospective design, small patient sample, limited follow-up) the NEXUS IOS® system seems to represent a viable solution for the restoration of completely edentulous patients with ISFDP, in a full digital workflow.

Achieving optimal implant esthetics using a team approach Part 1 a review of evidence-based criteria in implant treatment.

As dental implants have evolved into a universally accepted treatment option, it is essential to identify nuances of the peri-implant complex and their impact on treatment given the increasing evidence of peri-implantitis and implant loss. A thorough knowledge of anatomy and biology, careful treatment planning, correct placement, prosthetic and occlusal design, and proper long-term maintenance all play a role in dental implant therapy. The goal of this part 1 presentation is to review evidence-based criteria in implant treatment including the surgical and restorative parameters, and the desired implant features, with the objective of achieving predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. By following science-based guidelines, implant treatment can be improved and simplified with more predictable results, especially in the esthetic zone, where demands are greater and there is less room for error.

Achieving optimal implant esthetics using a team approach: Part 2 treatment options, treatment coordination, and integration of digital technology.

The second part of this JPD Digital presentation focused on the treatment planning, treatment coordination, and execution of implant therapy. The clinical application of the evidence-based criteria in implant therapy was emphasized including the surgical parameters, restorative parameters, and implant features reviewed in part 1. The objective was to achieve predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. Examples of several clinical scenarios of single tooth replacement treatment in the esthetic zone were reviewed by using options that included immediate placement, immediate loading, and resin-bonded interim restoration. In addition, patients requiring multiple implants, combinations of tooth-supported and implant-supported restorations, and a complete arch prosthesis supported by implants were presented. Many clinically challenging patients can be treated more effectively by using a digital workflow to plan and execute implant therapy.

The clinical course of vestibular neuritis from the point of view of the ocular vestibular evoked myogenic potential.

BACKGROUND: Studying otolith functions after unilateral vestibular neuritis using ocular vestibular-evoked myogenic potentials and subjective visual vertical tests could give different results. METHOD: A total of 39 patients underwent a vestibular assessment that included the Dizziness Handicap Inventory and horizontal and vertical semicircular canal function testing with video head impulse testing, ocular vestibular-evoked myogenic potential testing, cervical vestibular-evoked myogenic potentials and subjective visual vertical testing. RESULTS: All patients showed a significant alteration (asymmetry ratio more than 40 per cent) for ocular vestibular-evoked myogenic potentials as well as for subjective visual vertical testing (more than -2° to more than +2°) during the acute phase, whereas after 72 hours from the acute vertigo attack normal values (asymmetry ratio less than 40 per cent) were found in 6 out of 39 patients for ocular vestibular-evoked myogenic potentials and 36 out of 39 for the subjective visual vertical (less than -2° to less than +2°). CONCLUSION: Ocular vestibular-evoked myogenic potentials are the most suitable test to evaluate otolith functions in patients with unilateral vestibular neuritis in the acute and sub-acute phase.

The Frequency of Cranial Base Fractures in Lethal Head Trauma.

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.

Paradoxical embolism with thrombus stuck in a patent foramen ovale: a review of treatment strategies.

OBJECTIVE: Paradoxical embolism represents a rare condition occurring when a thrombus originating from venous system produces pulmonary embolism and systemic embolization through an intracardiac or pulmonary shunt. The evidence of a thrombus entrapped in a patent foramen ovale (PFO) is an even more rare condition. There is uncertainty about the optimal treatment strategy. PATIENTS AND METHODS: A 58-year-old male patient was admitted to our Internal Medicine Unit with the diagnosis of bilateral bronchopneumonia. During hospitalization, the co-occurrence of chest pain and amaurosis led us to hypothesize a paradoxical embolism. RESULTS: Transthoracic echocardiography showed the presence of a thrombus stuck over the interatrial septum. A contrast-enhanced chest CT scan showed multiple pulmonary embolisms and brain CT scan documented a hypodense area, of ischemic significance, in the left occipital lobe near tentorium. In order to prevent further embolization, emergency cardiac surgery (right atriotomy, removal of thrombus and closure of the PFO, pulmonary thrombectomy) was performed without complications. CONCLUSIONS: Although rare, the evidence of a thrombus stuck in a patent foramen ovale represents a clinical emergency. The optimal therapeutic approach is still debated. The surgical correction seems to be a safe and effective option for these patients.

Peptide dose, MHC affinity, and target self-antigen expression are critical for effective immunotherapy of nonobese diabetic mouse prediabetes.

Cross-reactive T cells that recognize both Tep69 (dominant nonobese diabetic (NOD) T cell epitope in ICA69 (islet cell autoantigen of 69 kDa)) and ABBOS (dominant NOD T cell epitope in BSA) are routinely generated during human and NOD mouse prediabetes. Here we analyzed how systemic administration of these mimicry peptides affects progressive autoimmunity in adoptively transferred and cyclophosphamide-accelerated NOD mouse diabetes. These models were chosen to approximate mid to late stage prediabetes, the typical status of probands in human intervention trials. Unexpectedly, high dose (100 microg) i.v. ABBOS prevented, while Tep69 exacerbated, disease in both study models. Peptide effects required cognate recognition of endogenous self-Ag, because both treatments were ineffective in ICA69null NOD congenic mice adoptively transferred with wild-type, diabetic splenocytes. The affinity of ABBOS for NOD I-A(g7) was orders of magnitude higher than that of Tep69. This explained 1) the expansion of the mimicry T cell pool following i.v. Tep69, 2) the long-term unresponsiveness of these cells after i.v. ABBOS, and 3) precipitation of the disease after low dose i.v. ABBOS. Disease precipitation and prevention in mid to late stage prediabetes are thus governed by affinity profiles and doses of therapeutic peptides. ABBOS or ABBOS analogues with even higher MHC affinity may be candidates for experimental intervention strategies in human prediabetes, but the dose translation from NOD mice to humans requires caution.

Synthesis and 5-hydroxytryptamine (5-HT) activity of 2,3,4,4a-tetrahydro-1H-pyrazino[1,2-a]quinoxalin-5-(6H)ones and 2,3,4,4a,5,6-hexahydro-1H-pyrazino[1,2-a]quinoxalines.

A series of 2,3,4,4a-tetrahydro-1H-pyrazino[1,2-a]quinoxalin-5-(6H)ones and 2,3,4,4a,5,6-hexahydro-1H-pyrazino[1,2-a]quinoxalines was shown to exhibit 5-HT2C agonist binding and functional activity. Compound 21R inhibited food intake over 2 h in fasted, male Sprague Dawley rats with ED50 values of 2 mg/kg (i.p.) and 10 mg/kg (p.o.).

Effects of wortmannin on human neutrophil respiratory burst and phagocytosis.

Modulation of neutrophil response to naturally occurring stimuli is important to avoid host tissue injure. Both soluble and particulate stimuli may induce superoxide anion generation in human polymorphonuclear leukocytes. Recently wortannin has been shown to inhibit the N-formyl-methionyl-leucyl-phenylalanine (fMLP) induced activation of respiratory burst via phosphatidylinositol 3-kinase. However no data are available about the effect of the inhibitor on the respiratory burst induced by a particulate stimulus. In this paper we studied the effect of wortmannin on E. coli induced respiratory burst and phagocytosis by flow cytometry, which allows the quantitation of both H2O2 production and ingested bacteria in whole blood samples without the need of purification and concomitant manipulation of the cells. The effects of worthmannin on fMLP-induced chemotaxis was also examined by the under agarose method. Neither the E. coli nor the fMLP-induced responses were blocked by wortmannin, suggesting that PI 3-kinase activity is not required to activate these neutrophil functions. Since it is known that the respiratory burst elicited by fMLP is blocked by wortmannin, our results suggest that the generation of oxygen radicals is controlled via different signal transduction pathways, depending on the agonist used.

HLA-DP2: self peptide sequences and binding properties.

Although self peptides bound to HLA-DQ and, especially, HLA-DR allotypes have been described in some detail, few ligands that bind to HLA-DP have been identified. Toward this aim, naturally processed peptides were isolated from immunoaffinity-purified HLA-DP2 molecules expressed in cultured B lymphocytes. The size distribution of the peptide repertoire is generally similar to those reported for self peptides bound to HLA-DR and HLA-DQ molecules. Twelve peptides representing individual sequences including two nested sets were sequenced by mass spectrometry and/or N-terminal Edman analysis. Source proteins included MHC molecules and other integral membrane proteins as well as secretory and serum proteins. No dominant amino acid markers suggestive of particular enzymatic processing events were detected. Peptide specificity and affinity were examined in binding assays using synthetic peptides and purified HLA-DP and HLA-DR molecules. Anchor residues were tentatively assigned using alanine-substituted analogues of two self peptides. Some structural features of HLA-DP2 that may relate to peptide binding are considered.

[Group of study SIAARTI of anesthesia and recovery for neurosurgery and neurology. Present and future]. / Gruppo di studio SIAARTI di anestesia e rianimazione per la neurochirugia e la neurologia. Presente e futuro.

The authors present the results of a survey of anesthesiologists members of the "SIAARTI (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva) Committee for anesthesia and critical care in neurosurgery and neurology". Among the aims of the survey, was to evaluate when the interest in neuroscience of the members of this group started, and the clinical work dedicated to neuroanesthesia and critical care. At present, the group has grown to 143 members. In the questionnaire 105 members indicated the topic discussed for the medical degree thesis, and 87 indicated the thesis discussed for the board in anesthesia. As emerged from the topic of the thesis discussed for the medical degree, in 47% of the responders the interest in anesthesia began during the college. Of this, 6% chose a topic in neuroanesthesia and critical care. During the residency, the interest in neuroscience increased to 33%, that is 32 out of 97 responders discussed a thesis in neuroanesthesia and critical care. Forty-eight per cent of the members performs clinical work "exclusively" in neuroanesthesia, while 39% does it "mainly", and only 13% works in neurosurgery "fiftfully".

[Competitive new generation myorelaxants in pediatric neuroanesthesia]. / I miorilassanti competitivi di nuova generazione in neuroanestesia pediatrica.

Two groups of 50 children were included in a study to examine the use of atracurium and vecuronium. In both groups, newborns and infants showed a shorter onset time and a longer clinical duration of the first dose of the neuromuscular blocking drug. The duration of subsequent doses in the various age groups was not significantly different. Atracurium and vecuronium both have a short recovery index, good cardiovascular stability and do not interfere with ICP. The Authors emphasise the importance of monitoring the use of neuromuscular blocking drugs.

[New anesthetics and myorelaxants. The behavior of intracranial pressure in pediatrics]. / Nuovi anestetici e miorilassanti. Il comportamento della PIC in pediatria.

The authors, following a report on cerebral physiology in childhood, report their experience of ICP and the administration of new drugs in anaesthesiologic practice. The effects of isoflurane, propofol, atracurium, vecuronium on ICP are reported.

[Psychic disorders. An unknown complication of surgery of the posterior cranial fossa]. / Disturbi psichici. Una complicanza misconosciuta della chirurgia in fossa cranica posteriore.

Psychic trouble is not generally recognised as a possible complication of posterior fossa surgery. Reviewing a series of 63 pediatric patients operated on for posterior fossa intraxial tumors, the Authors found 21 cases of psychic troubles in the post-operative period. The incidence was higher in: a) medulloblastoma; b) rostral vermis location; c) supracerebellar infratentorial and transvermian approach. The neuropathophysiological basis of the phenomenon is discussed.

[Operative posture in pediatric neurosurgery]. / La postura operatoria in neurochirurgia pediatrica.

Proper placement of the pediatric neurosurgical patient is strictly correlated to age (newborn, toddler, infant, juvenile). Each age group is reviewed on the basis of different morphological and pathophysiological aspects of typical neurosurgical positions (prone, supine, sitting, lateral).

[Severe head trauma in the pediatric patient. Our experience]. / Il trauma cranioencefalico grave nel paziente pediatrico. Nostra esperienza.

A retrospective study in a pediatric population of 324 severe head trauma patients hospitalized at Santobone Children's Hospital has been carried out; diagnostic investigations and therapeutic aspects are stressed on the baw of pathophysiological features of such patients.

[Intravenous immunoglobulin in the prevention of infections in high-risk pediatric neurosurgery]. / Immunoglobuline endovena (IgEv) nella prevenzione delle infezioni in neurochirurgia pediatrica ad alto rischio.

Sixty-four children undergoing "high risk" neurosurgery, were submitted in a comparative study performed to investigate the prophilactic effect of IgIv in reducing the risk of postoperative sepsis. Patients were divided in two groups that weren't different as to underlying disease, age and sex. 32 patients received IgIv 0.2 g/kg on day 0, day 2, day 5, day 12 and 32 placebo. IgIv reduced the number of postoperative respiratory and urinary infective events, thus resulting in a marked reduction of the therapeutic use of antibiotics. No side effects of administration of IgIv were observed.

A case of granulomatous hepatitis after intravesical bacillus Calmette-Guerin administration.

A 61-year-old man received intravesical bacillus Calmette-Guerin (BCG) as treatment for superficial bladder carcinoma. High spiking relapsing fevers began 39 days after the initial treatment. A liver biopsy revealed noncaseating granuloma. Deoxyribonucleic acid hybridization of the bone marrow was positive for Mycobacterium tuberculosis complex. Pressure exerted to instill the BCG may have favored dissemination.