Effect of Novel Low-intensity Pulsed Ultrasound Stimulation on Accelerated Implant Osteointegration in Canine.

AIM: To evaluate the effect of low-intensity pulsed ultrasound (LIPU) application on dental implant accelerated osseointegration in the two-stage implant protocol. MATERIALS AND METHODS: A total of 20 implants were placed in 10 mature mongrel dogs, two implants for each dog replacing the lower 3rd premolars bilaterally. After 3 months of extraction, implants were placed. After 24 hours of implantation, the right sides received LIPU for 20 mins/day, continuously for 20 days. The left sides didn't receive LIPU (control). Standardized radiographs were taken before LIPU and after 10 and 20 days for both sides. After 20 days of LIPU application, second-stage surgery was performed and provisional crowns were placed on each implant. Implants were subjected to functional occlusal loading for 4 weeks. Standardized radiographs were taken after 2 and 4 weeks of loading and analyzed to assess the peri-implant bone density changes. All data were collected, tabulated, and statistically analyzed. RESULTS: All tissues appeared clinically normal, with the absence of inflammation and peri-implant radiolucency. The survival rate was 100%. The LIPU group showed a statistically significantly higher percentage increase in mean bone density after 10 LIPU sessions, 20 LIPU sessions, and 2 and 4 weeks of loading, than a control group. CONCLUSION: The LIPU stimulation radiographically increased the bone density around implant area and accelerated osseointegration in the two-stage implant protocol. CLINICAL SIGNIFICANCE: Low-intensity pulsed ultrasound stimulation could be beneficial in accelerating osseointegration and thus shortening the waiting period for final prosthetic delivery.

Clinical Impact on Dental Implant Survival in Patients Taking Antiresorptive Medications: A Systematic Review and Meta-Analysis.

Dental implants are a predictable option to replace missing teeth. Patients on antiresorptive medications used to treat disorders associated with bone resorption may need dental implants to replace missing teeth. The data on implant failure in patients on antiresorptive medication requiring dental implants, is conflicting and limited. This systematic review aims to investigate if antiresorptive medications have any clinical impact on dental implant survival. Electronic databases were searched until May 2020. The focus question (PICOS): Participants: humans, Interventions: implant placement surgery in patients on antiresorptive medication, Comparisons: patients on antiresorptive medication vs control (patients not on antiresorptive medication), Outcomes: implant survival, and Study design: clinical studies. The protocol of this systematic review was registered in PROSPERO (CRD42020209083). Fourteen nonrandomized studies were selected for data extraction and risk of bias assessment using the ROBINS-1 tool. Only studies with a control were included for the meta-analysis, 8 articles were included in the meta-analysis using implant-level data, and 5 articles were included in the meta-analysis using patient-level data. There was no statistical significance between the 2 groups at the patient level based on 265 patients. However, there was a statistically significant difference at the implant level based on 2697 implants. Therefore, antiresorptive medications, mainly bisphosphonates (BPs), may significantly contribute to implant failure. Antiresorptive medications, especially BPs may reduce implant survival and impair the osseointegration of dental implants. Failed implants in patients on BPs may not lead to osteonecrosis and may be replaced with success.

Abu Dhabi Neural Mapping (ADNM) during Minimally Invasive Thyroidectomy Enables the Early Identification of Non-Recurrent Laryngeal Nerve and Prevents Voice Dysfunction.

The aim of this study was to evaluate the diagnostic accuracy of a neuromonitoring protocol-the Abu Dhabi Neural Mapping protocol (ADNM)-using a new device, Nim-Vital™, during minimally invasive thyroidectomy in the early identification of non-recurrent laryngeal nerve (n-RLN) problems and the preservation of its function. METHOD: Patients with thyroid disorders that required thyroid resection, who were admitted to the Department of Surgery at Burjeel Hospital, Abu Dhabi, between January and July 2022, were included in the study. The data were extracted from a prospective database and were analyzed retrospectively. All nerves at risk were identified and exposed at seven precisely defined anatomical points, with strict adherence to the intraoperative technical steps of neuromonitoring. These were sequentially applied to the vagal nerve (VN), the superior laryngeal nerve (SLN), and the recurrent laryngeal nerve (RLN). In the next step after the creation of the skin-platysma flap, the strap muscle's lateral border was moved from the medial limb of the sternocleidomastoid without using any electrical device and without any manipulation of the thyroid gland. The VN was exposed in the carotid sheath and then stimulated using a monopolar probe at a precisely defined point above the clavicle, using anatomical landmarks. RESULTS: In total, 136 women with a mean age of 40 years (range 18-74) and 36 men with a mean age of 42 (range 21-66), demonstrating 270 nerves at risk, were included in the analysis. Indications for surgery were malignancy in 70 cases, toxic goiter/Graves in 23 cases, retrosternal goiter in 21, and symptomatic multinodular goiter in 64 cases. Of these, 100 patients received a total thyroidectomy, 46 received a right lobectomy, and 24 received a left lobectomy only. For a total thyroidectomy, the median skin-to-skin surgery duration was 52 min (range 24-104 min) and the median hospital stay was 2 days (range 1-4 days). In 4 cases (4/146; 2.74%) the pre-dissection stimulation of the vagal nerve (VN1) at the ADNM's precisely defined point did not create any signal or proper EMG-curve that indicated the existence of the non-RLN. Proximal dissection of the right VN at a precisely defined point by the ADNM's level of incisura of the larynx created a positive signal. The separation point of the right non-RLN from the VN was discovered in all four patients. The postoperative video-laryngoscopy confirmed bilateral mobile vocal cords in all cases. CONCLUSIONS: Following the ADNM protocol during thyroid surgery minimizes the risk of a non-laryngeal nerve injury and prevents voice dysfunction.

Effect-directed analysis by high-performance thin-layer chromatography for bioactive metabolites tracking in Primula veris flower and Primula boveana leaf extracts.

The genus Primula (Primulaceae) comprises species with high medicinal as well as ornamental values. Plants belonging to this genus are well recognized for their richness in bioactive constituents. The huge variety of secondary metabolites make their complete analysis impossible. In order to cope with this challenge, effect-directed analysis (EDA) via HPTLC coupled to structure elucidation techniques was applied on Primula species for the first time. As straightforward non-target bioanalytical technique, HPTLC-UV/Vis/FLD-EDA-ESI-HRMS hyphenates three different orthogonal dimensions, i.e. chromatography with spectrometric detection, biological/enzymatic assays and HRMS. The bioactive metabolites were determined in the middle polar extracts of two Primula species, P. veris (flower) and P. boveana (leaf). The bioactivity profiling comprised the antibacterial activity against Aliivibrio fischeri and Bacillus subtilis bacterial strains and acetyl-/butyrylcholinesterase (AChE/BChE) inhibition assays. The compounds were characterized and identified via their recorded spectral data (HRMS and 1H NMR). The results showed that linoleic and linolenic acids were the principle bioactive compounds present in the studied P. veris flower extract. In the P. boveana leaf extract, flavone, 2'-methoxy-, 2'-hydroxy- and 5,6,2',6'-tetramethoxyflavone (zapotin) were determined as active metabolites. The identification of zapotin, which was previously undescribed in the investigated plant, was considered as the strength of the straightforward non-target bioanalytical technique. Flavone turned out to be the highest potent metabolite, and at the same time, a multipotent compound referring to its various bioactivities discovered. An equivalency calculation of the HPTLC-AChE inhibition by flavone was performed with reference to the well-known inhibitor rivastigmine. As a result, the amount of flavone contained in 10.0 µg dry powder of P. boveana (corresponding to 0.1 µL extract) inhibited as strong as 4.5 µg rivastigmine. In other words, the flavone contained in P. boveana leaf extract powder turned out to be half as strong as the well-known AChE inhibitor rivastigmine.

Prospective randomized evaluation of open preperitoneal versus preaponeurotic primary elective mesh repair for paraumbilical hernias.

PURPOSE: The aim of this study was to compare the preperitoneal versus the preaponeurotic mesh positioning in open paraumbilical hernia repair. METHODS: During the period from January 2011 until July 2012, 60 adult patients were randomly assigned to two equal groups. The patients in group A were treated by preperitoneal mesh repair and those in group B underwent preaponeurotic mesh repair. Both groups were assessed and compared. RESULTS: There were no significant differences between the two groups in the demographics, hernia characteristics, risk factors, type of anesthesia, American Society of Anesthesiologists score or the mean follow-up period. The length of the operation was significantly shorter in group B than in group A (P value = 0.01). There were no significant differences in the early postoperative complications except for the development of a seroma, which developed only in group B (P value = 0. 044). The postoperative pain was significantly lower in group A than in group B (P value = 0.01). The time of return to normal daily activities was significantly shorter in group A than in group B (P value = 0.001). CONCLUSION: The preperitoneal mesh placement during the repair of paraumbilical hernias is superior to the preaponeurotic placement, because it is associated with fewer complications, less pain and a shorter time of return to normal daily activities.

Influence of selective immunosuppressive drugs on the healing of exposed dogs' dental pulp capped with mineral trioxide aggregate.

INTRODUCTION: Immunosuppressive drugs are used in clinical medicine for a variety of disorders, but their effects on the reparative capacity of the dental pulp are unknown. This study evaluated the influence of selected immunosuppressive drugs on pulpal tissue healing after direct pulp capping of mechanically exposed dog's teeth with mineral trioxide aggregate (MTA). METHODS: Ten healthy male dogs were assigned into 5 experimental groups: a control group in which no drug was received and 4 experimental groups in which the immunosuppressive drugs prednisone, mycophenolate mofetil, sirolimus, and cyclosporine A were administered 45 days before the operative procedures and until the dogs were killed. Class V cavities were prepared on the buccal surfaces of 12 teeth in each dog. In each cavity, the pulp was exposed and capped with MTA. The pulpal tissue responses to capping material were assessed 65 days postoperatively. RESULTS: Compared with the control group, variable responses was recorded in the groups treated with mycophenolate mofetil, sirolimus, and cyclosporine A, which were characterized by moderate to severe inflammatory reactions, tissue necrosis, and total absence of hard tissue bridging. Pulpal tissue responses in the group treated with prednisone were characterized by inflammatory cell infiltration, limited tissue necrosis, as well as partial to complete hard tissue bridging. CONCLUSIONS: From these findings, it seemed evident that acceptable repair of the dentin-pulp complex, eg, wound healing with hard tissue formation after capping with MTA, is unlikely with mycophenolate mofetil, sirolimus, or cyclosporine A immunosuppressive drug therapy.