Diaphragmatic ultrasound evaluation in acute heart failure: clinical and functional associations.

Heart failure patients often experience respiratory symptoms due to diaphragmatic involvement, but the diaphragmatic motion in heart failure remains understudied. This research aimed to investigate the correlation between ultrasonographically assessed diaphragmatic motion and thickness with cardiac performance indexes in an emergency setting. Seventy-two acutely decompensated heart failure patients and 100 non-heart failure individuals were enrolled. Diaphragmatic motion and thickness were assessed via ultrasound. Cardiac and respiratory parameters were recorded, and regression analysis was performed. Heart failure patients exhibited reduced diaphragmatic motion at total lung capacity compared to controls, and an inverse association was found between motion and heart failure severity (NYHA stage). Diaphragmatic thickness was also higher in heart failure patients at tidal volume and total lung capacity. Notably, diaphragmatic motion inversely correlated with systolic pulmonary artery pressure. The study highlights diaphragmatic dysfunction in acutely decompensated heart failure, with reduced motion and increased thickness. These changes were associated with cardio-respiratory parameters, specifically systolic pulmonary artery pressure. Monitoring diaphragmatic motion via ultrasound may aid in evaluating heart failure severity and prognosis in emergency settings. Additionally, interventions targeting diaphragmatic function could improve heart failure management. Further research is warranted to enhance heart failure management and patient outcomes.

Automated Good Manufacturing Practice-Compatible CRISPR-Cas9 Editing of Hematopoietic Stem and Progenitor Cells for Clinical Treatment of ß-Hemoglobinopathies.

Cellular therapies hold enormous potential for the cure of severe hematological and oncological disorders. The forefront of innovative gene therapy approaches including therapeutic gene editing and hematopoietic stem cell transplantation needs to be processed by good manufacturing practice to ensure safe application in patients. In the present study, an effective transfection protocol for automated clinical-scale production of genetically modified hematopoietic stem and progenitor cells (HSPCs) using the CliniMACS Prodigy® system including the CliniMACS Electroporator (Miltenyi Biotec) was established. As a proof-of-concept, the enhancer of the BCL11A gene, clustered regularly interspaced short palindromic repeat (CRISPR) target in ongoing clinical trials for ß-thalassemia and sickle-cell disease treatment, was disrupted by the CRISPR-Cas9 system simulating a large-scale clinical scenario, yielding 100 million HSPCs with high editing efficiency. In vitro erythroid differentiation and high-performance liquid chromatography analyses corroborated fetal hemoglobin resurgence in edited samples, supporting the feasibility of running the complete process of HSPC gene editing in an automated closed system.

Long peripheral cannula in COVID-19 patients: 769 catheter days experience from a semi-intensive respiratory COVID unit.

BACKGROUND: In the daily management of peripheral venous access, the health emergency linked to the COVID-19 pandemic led to re-examining the criteria for choosing, positioning and maintaining the different types of peripheral venous access. OBJECTIVES: This study aimed to observe the dwell time of long peripheral cannula (LPC, also known as mini-midline) in patients affected by COVID 19 related pneumonia. The secondary objective is to study any complications due to mini-midline insertion. MATERIALS AND METHODS: We conducted a prospective observational study on COVID19 patients who arrived at our Semi-Intensive Respiratory Unit from territorial ED between January and April 2021, to whom were positioned an LPC at the time of admission following the SIPUA protocol (Safe Insertion of Peripheral Ultrasound-guided Access). We used Vygon™ Leader-Cath© 18G in polyethylene and 8 cm long catheter. RESULTS: We enrolled 53 consecutive patients, reaching 769 catheter days. The procedure was performed without immediate complications in 37 patients out of 53 (69.8%). In 14 patients (26.4%), we observed a local hematoma (no one led to a failure or early removal of the device) and in two patients (3.7%) was not possible to draw blood. The average catheter dwell time was 14.5 days, from 3 to 41 days. In 42 patients (79.2%), the device was removed at the end of use. In 11 patients out of 53 (20.8%), the device was removed early due to complications: seven accidental removals, one obstruction, two vein thrombosis, and one superficial thrombophlebitis. CONCLUSIONS: The ultrasound-guided implantation of an 18G LPC in COVID19 patients, regardless of the state of their venous heritage, would seem to be an excellent strategy for these patients, reducing the number of venipunctures and CVC implantation, as well as allowing multiple and high pressure (contrast) infusions.

Immediate fixed rehabilitation supported by pterygoid implants for participants with severe maxillary atrophy: 1-Year postloading results from a prospective cohort study.

STATEMENT OF PROBLEM: Few investigations concerning the use of pterygoid implants have reported reproducible and consistent data, making survival data controversial. PURPOSE: The purpose of this clinical study was to investigate the 1-year survival and success rates of pterygoid implants and prostheses in participants affected by severe atrophy of the posterior maxilla requiring a complete-arch immediate fixed prosthesis. MATERIAL AND METHODS: Fifteen participants, either completely edentulous or with failing dentition in the maxillary arch and with severe atrophy of the posterior maxilla, were enrolled in the study. All participants underwent prosthodontic rehabilitation after implant placement in both the anterior maxilla areas and the pterygoid regions. The survival data of the implants were evaluated at the time of abutment connection by means of a mobility test for each implant. After placement of the prostheses, survival was assessed by means of marginal bone maintenance as assessed by panoramic radiographs and the absence of pain or symptoms of infection. The t test was used for evaluating the difference in age between men and women (α=.05). Correlations between categorical variables (Fisher exact test) were used to evaluate the possible association between the number of implants and both the age and presence of comorbidities (α=.05). RESULTS: During the 1-year follow-up, high prosthesis stability and no implant loss were observed for all participants. In addition, participants did not report any pain or paresthesia. No peri-implant radiolucency was detected in the panoramic radiographs. Survival and success rates in the follow-up period were 100%. CONCLUSIONS: The present study supports the conclusion that pterygoid implants have a high success rate with minimal or no complications.

Rehabilitation of the Completely Edentulous Mandible by All-on-Four Treatment Concept: A Retrospective Cohort Study with Up to 10 Years Follow-Up.

(1) Background and Objectives. Currently, there are no definitive long-term data about clinically significant difference in the failure of prosthesis and implant or marginal bone loss related to the rehabilitation of the completely edentulous mandible by all-on-four treatment concept. The main aim of present investigation was to report the long-term outcomes (10-years follow-up) of complete-arch mandibular rehabilitations based on the all-on-four concept. (2) Materials and Methods. Patients in need of extractions of teeth due to the occurrence of caries and/or severe periodontal disease and patients presented with edentulous mandibles were enrolled to the study. A total of 96 participants (mean follow-up period after intervention of 3185.2 days) were enrolled in the study. Participants were evaluated at the first visit, 10 days after intervention and every year after the intervention. Implant and prosthesis survival, bone loss and both local biological and mechanical complications were evaluated during the follow-up period. (3) Results. An implants' survival rate of 97.9% was observed at the end of the follow-up period. Biological complications were reported in 19.8% of patients, whereas mechanical complications were reported in 27.1% of cases. The average marginal bone level at baseline was -0.03 mm. A significant marginal bone loss was observed after 10-years follow-up (2.5 mm). Binary logistic regression analysis showed significant association between smoke and both marginal bone loss and local biological complications. Lastly, a significant association was observed between bruxism and mechanical complications. (4) Conclusions. The high implant and prosthesis survival rate and the moderate incidence of biological and mechanical complications observed in present investigation can be associated to several factors such as high implant primary stability, prosthetic design, and control of the occlusal forces.

Extrasinus Zygomatic Implants for the Immediate Rehabilitation of the Atrophic Maxilla: 1-Year Postloading Results From a Multicenter Prospective Cohort Study.

PURPOSE: The use of zygomatic implants is an alternative to major grafting procedures for the treatment of the atrophic posterior maxilla. However, only few studies reported solid and correct data about the use of extrasinus zygomatic implants. Starting from these considerations, this study aims to investigate the 1-year survival and success rates of extrasinus zygomatic implants immediately loaded in patients with severe atrophy of the posterior maxilla. METHODS: Twenty-three consecutive patients fully edentoulus or with failing dentition in the upper arch and with a severe atrophy of the posterior maxilla were enrolled. All patients underwent prosthodontic rehabilitation with the application of implants in both anterior maxilla areas and zygomatic bone. All the zygomatic implants were inserted with an extrasinus path. Primary outcomes were prosthesis and implant failures. Secondary outcomes were complications, bleeding scores, probing pocket depths, and peri-implant marginal bone-level changes. A total of 98 implants were inserted. RESULTS: During the 1-year follow-up, no implant failure was reported as well as no pain and/or no sinusitis were detected. No other significant events were reported, except for minor soft tissue and technical problems. A maxillary sinus membrane rupture occurred during the surgical phase in 4 (17.4%) patients, but healing was not compromised. Peri-implant mucositis was observed in 2 (8.7%) patients. Twelve months after surgery, average bone loss around conventional implants was 1.11 ± 0.23 mm. In addition, no peri-implant radiolucency was observed around zygomatic implants. Within the limits of this study, preliminary short-term data (1-year after loading) suggested that extrasinus zygomatic implants represent a predictable treatment option for the atrophic maxilla. Further follow-up data (≥5 years) are needed to confirm these results. CONCLUSIONS: The present study supports the conclusion that extrasinus zygomatic implants for the immediate rehabilitation of the atrophic maxilla have high success rate with minimal or no complications.

Immediate fixed rehabilitation of severe maxillary atrophies using trans-sinus tilted implants with or without sinus bone grafting: One-year results from a randomised controlled trial.

BACKGROUND: To compare the clinical outcomes between tilted trans-sinus implants inserted without simultaneous bone grafting versus sinus elevation procedures with bone grafting to support immediately loaded prostheses for the rehabilitation of the atrophic maxilla. MATERIALS AND METHODS: Thirty-two subjects were selected to receive an immediately loaded fixed restoration supported by four or six implants and randomised to receive at least one trans-sinus implant without simultaneous bone grafting (group 1, n = 16) or at least one trans-sinus implant with sinus elevation procedures and bone grafting (group 2, n = 16). Primary outcomes were prosthesis and implant failures. Secondary outcomes were complications and peri-implant marginal bone level changes. RESULTS: Forty-one trans-sinus implants (23 trans-sinus implants without simultaneous bone-grafting and 18 trans-sinus implants with sinus elevation procedures), 23 conventional tilted implants and 84 axial implants were inserted. No drop-outs occurred. At 1 year after loading no prosthesis was lost. One patient treated with sinus graft lost one implant (0.0% vs. 6.3%, difference 6.3%; 95% CI: -4.7 to 17.3; P = 0.99). There were no statistically significant differences in implant failures between the two groups. Complications occurred in eight patients in the group without bone grafting and in nine patients in the group with sinus elevation and bone augmentation. No statistically significant differences were found in complications (50.0% vs. 56.3%, difference 6.3%; 95% CI: -12.7 to 25.3; P = 0.99), and in peri-implant marginal bone level changes (difference 0.05 mm; 95% CI: -0.24 to 0.34; P = 0.604). CONCLUSIONS: In this study, no statistically significant differences were observed between subjects treated with tilted trans-sinus implants without simultaneous bone-grafting or with sinus elevation procedures supporting cross-arch immediately loaded fixed prostheses in atrophic maxillae. Longer follow-ups are needed and alternative procedures such us short implants or crestal sinus elevation procedures should be compared since they could be less invasive.

Narrow implants (2.75 and 3.25 mm diameter) supporting a fixed splinted prostheses in posterior regions of mandible: one-year results from a prospective cohort study.

BACKGROUND: Can multiple splinted narrow-diameter implants be used as definitive implants in patients with insufficient bone ridge thickness in posterior regions of the mandible? With this aim, we evaluated their outcomes in this set up to 1 year after loading. METHODS: Forty-two patients with a mean age of 61.3 years old (range 49-73) in need of fixed prosthetic implant-supported rehabilitations in the posterior region of the mandible, presenting a thin alveolar crest, were selected. One hundred twenty-four narrow-diameter implants (2.75 and 3.25 mm diameter) were placed and splinted with a bridge. One implant for each missing tooth was requested to be inserted. Outcomes measured were implant survival, complications, and marginal bone level changes up to 1 year after loading. RESULTS: At the 12-month follow-up, three implants failed. Two 2.75 mm diameter implants and one 3.2 mm diameter implant failed. The implant survival rate was 97.6%. Peri-implant bone resorption was 0.20 mm (CI 95% 0.14: 0.26) after 6 months and 0.47 mm (CI 95% 0.29; 0.65) after 12 months of loading, not different between 2.75 and 3.25 mm diameter groups (p = 0.786). Of the 42 cases, three had an episode of peri-implant mucositis (7.1%). CONCLUSIONS: Within the limits of this study, preliminary short-term data (1 year post-loading) suggested that narrow-diameter implants (2.75 to 3.25 mm) can be successfully used as a minimally invasive alternative to horizontal bone augmentation in the posterior mandible. However, larger and longer follow-ups of 5 years or more are needed.

A comparison of two implants with conical vs internal hex connections: 1-year post-loading results from a multicentre, randomised controlled trial.

PURPOSE: To compare the clinical and radiological outcomes of identical implants with conical or internal hex connections. METHODS: A total of 90 patients with partial edentulism requiring one implant-supported prosthesis were randomly allocated in two equal groups (n = 45) to receive either implants with a conical connection or implants of the same type, but with an internal hex connection at three centres. Patients were followed for 1 year after loading. Outcome measures were implant failures, any complication and marginal bone level changes. RESULTS: One patient (2.2%) belonging to the internal hex group dropped out. One implant (2.2%) failed in the conical group. There were no statistically significant differences in implant failures between the two groups (2.2% vs. 0%, difference 2.2; 95% CI: -1.3; 5.7; P = 0.315). Two complications occurred in the conical group and two in the internal hex group (P = 1.000, difference 0.00, 95% CI: -3.1; 3.1). The 12-month peri-implant bone resorption was similar in both groups: 0.56 ±â€…0.53 mm (95% CI 0.03; 1.09) in the conical group and 0.60 ±â€…0.62 mm (95% CI 0.02; 1.22) in the internal hex group (difference = 0.04 ±â€…0.55, 95% CI: -0.51; 0.59, P = 0.745). CONCLUSIONS: Within the limitation of this study, preliminary short-term data (1 year post-loading) did not show any statistical differences between the two internal connection types, therefore clinicians could choose whichever connection they prefer. Conflict of interest statement: Tommaso Grandi serves as consultant for J Dental Care, Modena, Italy. This study was completely self-financed and no funding was sought or obtained, not even in the form of free materials.

Implant site preparation using a single bur versus multiple drilling steps: 4-month post-loading results of a multicenter randomised controlled trial.

PURPOSE: To compare the clinical outcome of implants inserted in sites prepared with a simplified protocol consisting of one single drill versus multiple conventional drilling steps. MATERIALS AND METHODS: In two private clinics, 40 patients, requiring one single implant and having a residual bone height of at least 10 mm and a thickness of at least 5 mm measured on computerised tomography (CT) scans, were randomised after flap elevation to have the implant site prepared using a single drilling step with a newly designed tapered-cylinder drill (1-drill group) or a conventional procedure with multiple drills (multiple-drill group). Implants were left to heal non-submerged for 3 months and then they were loaded with a final metal-ceramic crown. Outcome measures were: implant failure; any complications; peri-implant marginal bone level changes assessed by a blinded outcome assessor; operation time; operator preference and post-surgical pain, swelling and analgesic consumption. All patients were followed up to 4 months after implant loading. RESULTS: Twenty patients were randomised to the 1-drill group and 20 patients to the multiple-drill group. No implant failed and no complications occurred. Four months after loading, implants in the 1-drill group lost 0.54 mm of peri-implant bone versus 0.41 mm for the implants in the multiple-drill group. There were no statistically significant differences for marginal bone level changes between the two groups (difference 0.13 mm, 95% CI -0.21; 0.47, P = 0.108). Less time which was statistically significant (3.66 mins, 95% CI 2.69; 4.63, P < 0.0001) was required to place the implant with the single bur. Both operators always preferred the single bur technique. Postoperatively, patients in the 1-drill group vs patients in the multiple-drill group reported statistically significant differences for pain level (difference 27.5, 95% CI 3.3; 51.7, P < 0.0001), number of days in which the swelling persisted (difference 3.4, 95% CI 2.4; 4.4, P < 0.0001) and the number of analgesic drugs taken (difference 2.8, 95% CI 1.4; 4.2, P < 0.0001) CONCLUSIONS: Within the limits of this trial, both drilling techniques produced successful results over a 4-month post-loading follow-up period, but the single bur procedure required less surgical time and lead to less postoperative morbidity.

Immediate, early (3 weeks) and conventional loading (4 months) of single implants: Preliminary data at 1 year after loading from a pragmatic multicenter randomised controlled trial.

PURPOSE: To compare the clinical outcome of single implants which underwent immediate nonocclusal loading with implants subjected to early non-occlusal loading at 3 weeks, and implants conventionally loaded at 4 months. MATERIALS AND METHODS: One hundred and five patients in five private practices requiring a single implant-supported crown were randomised to immediate loading (35 patients), early loading (35 patients) and conventional loading (35 patients) groups. To be immediately or early loaded, implants had to be inserted with a torque superior to 45 Ncm. Immediately and early loaded implants received non-occluding temporary crows, whereas conventionally loaded implants were directly restored with definitive crowns. Temporary crowns were replaced by definitive ones after 4 months. Outcome measures were crown and implant failures, complications and peri-implant marginal bone level changes recorded by a blinded assessor. RESULTS: Two patients dropped out from the immediate loading group up to 1-year post-loading. Two implants failed, one in the immediately loaded and one in the early loaded group (P=0.601). One immediately loaded implant and two early loaded implants were affected by one complication each (P=0.162). Mean peri-implant marginal bone loss after 1 year was -0.120±0.230 mm (95% CI -0.35, 0.10) for immediate, -0.390±0.840 mm (95% CI -1.23, 0.45) for early and -0.201±0.306 mm (95% CI -0.51; 0.11) for conventionally loaded implants. There were no statistically significant differences for any of the outcome measures between the three loading strategies up to 1-year post-loading. CONCLUSIONS: No major clinical differences were observed with regard to implant survival, complications and marginal bone level changes when loading single implants immediately, early or conventionally.

G-Protein ß3-Subunit Gene C825T Polymorphism and Cardiovascular Risk: An Updated Review.

Hypertension is a common disorder of multifactorial origin that constitutes a major risk factor for cardiovascular events such as stroke and myocardial infarction. The subunits of the heterotrimeric G proteins are attractive candidate gene products for susceptibility to hypertension, obesity and insulin resistance syndrome. A polymorphism (825C/T) in exon 10 of the GNB3 gene, encoding for the Gß3 subunit, has been described. The 825T allele is associated with alternative splicing of the gene and formation of a truncated but functionally active ß3 subunit. Many studies have investigated whether carriers of the 825T allele are at increased risk for hypertension, obesity, insulin-resistance and left ventricular hypertrophy with apparently conflicting results. The present review demonstrates that GNB3 825T allele is a useful genetic marker for better defining the risk profile of hypertensive patients, as it is associated with increased risk of stroke and myocardial infarction in longitudinal studies in Caucasians.

One abutment-one time versus a provisional abutment in immediately loaded post-extractive single implants: a 1-year follow-up of a multicentre randomised controlled trial.

PURPOSE: To compare immediately loaded post-extractive single implants using a definitive abutment versus provisional abutment later replaced by custom-made abutment. MATERIALS AND METHODS: In two private clinics, 28 patients in need of one single post-extractive implant in the maxilla or mandible from the left second premolar to the right second premolar area were randomised shortly before tooth extraction to provisional abutment (PA) and definitive abutment (DA) groups. Three patients had to be excluded for buccal wall fracture after tooth extraction. In the PA group, implants were immediately restored using a platform-switched provisional titanium abutment and definitive platform-switched titanium abutments were used in the DA group. In both groups, a non-occluding provisional single crown was provided. Implants were definitively restored after 4 months. In the PA group, the abutment was removed and the impression was made directly on the implant platform. In the DA group an impression of the abutment was made using a retraction cord. Outcome measures were: implant failures; complications; and marginal peri-implant bone level changes. Patients were followed up to 1 year after loading. RESULTS: Twelve patients were randomised to the DA group and 13 patients to the PA group. At the 12-month follow-up, no implant failed. One biological complication occurred in the DA group and one mechanical complication occurred in the PA group. All complications were successfully treated. One year after loading, implants in the DA group lost an average of 0.11 mm (SD: 0.06) of periimplant bone and implants in PA group about 0.58 mm (SD: 0.11). At the 12-month follow-up, there was a statistically significant difference in bone level change between groups (mean difference: 0.48 mm, CI 95% 0.40; 0.55, P < 0.0001). CONCLUSIONS: Within the limits of this study, the non-removal of abutments placed at the time of surgery resulted in the maintenance of 0.5 mm more bone levels around immediately restored postextractive single implants than repeated abutment removal, although this amount of bone maintenance may not have a clinical impact. Conflicts of interest notification: Dr Tommaso Grandi and Dr Paolo Guazzi serve as consultants for JDentalCare. This study was completely self-financed and no funding was sought or obtained, not even in the form of free materials.

Creation of autogenous radial cephalic direct wrist access for hemodialysis in the elderly using microsurgery.

PURPOSE: Guidelines recommend autogenous radial-cephalic AV fistula (RCAVF) as the first choice for hemodialysis. Concern has been raised that this is not suitable in the elderly. We assessed the results of microsurgery for RCAVF creation comparatively in patients older and younger than 70 years. METHODS: We prospectively followed 126 patients for three years. After systematic clinical and ultrasound assessment, a RCAVF was created using a surgical microscope. Patency was assessed immediately, at one week, one month and one year. Outcomes were recorded and stratified into two groups: <70y and >70y. RESULTS: RCAVF was created in 75.4% and 70.8% of the <70y and >70y groups, respectively. Incidence of early failure was 11% (<70y) and 13% (>70y). Primary and secondary patency at one year was 67% and 84% (<70y) versus 63% and 80% (>70y). CONCLUSIONS: Microsurgery enabled the creation of RCAVF in >70y with acceptable risk of failure and slight differences by comparison with <70y. Older age should not preclude RCAVF creation.

A 3-year report from a multicentre randomised controlled trial: immediately versus early loaded implants in partially edentulous patients.

PURPOSE: To compare implant failure, prosthesis failure and radiographic bone level changes of immediate non-occlusal loading versus early loading in partially edentulous patients 3 years after implant placement. MATERIALS AND METHODS: A total of 80 patients with partial edentulism were selected for a two implant-supported immediate restoration and randomised to immediate loading (test group) or early loading (control group) after 2 months, 40 patients for each group. To be included in the study, implants had to be inserted with a torque ≥ 30 Ncm. In the test group, implants were provided with non-occluding temporary restorations. In the control group, healing abutments were attached and implants were left to heal nonsubmerged. Definitive prostheses were delivered 2 months after surgery with full occlusal contacts. The outcome variables were implant failure, prosthesis failure, complications and radiographic bone level changes at implants 3 years after loading. The assessor was blinded to group assignment. RESULTS: Eighty-one implants were immediately loaded and 80 were early loaded. Two immediately loaded patients and 1 early loaded patient dropped out at 3 years. No implant failed. Two complications occurred in the immediate loading group and 1 in the early loading group. There were no significant differences in bone levels changes at 36 months between the two groups (P = 0.67; difference 0.2 mm; 95% CI -0.23, 0.63). Immediately loaded implants lost 0.90 mm (95% CI 0.63, 1.17) and early loaded implants 1.10 mm (95% CI 0.81, 1.39). CONCLUSION: If adequate primary stability was achieved, no statistically significant difference in failure rates, complications or bone level changes between implants loaded immediately or early were observed 3 years after placement in partially edentulous patients.

Immediate provisionalisation of single post-extractive implants versus implants placed in healed sites in the anterior maxilla: 1-year results from a multicentre controlled cohort study.

PURPOSE: The purpose of the study was to compare the clinical and aesthetic outcome of single post-extractive implants versus implants placed in a preserved socket after 4 months of healing in the anterior maxilla. All of the implants were immediately non-occlusally loaded. MATERIALS AND METHODS: A total of 50 patients were treated in the two groups of study. The Delayed Group had a maxillary tooth (premolar, canine, lateral or central incisor) removed, with immediate socket grafting, followed by implant placement and provisionalisation 4 months later. The Immediate Group had immediate implant placement and provisionalisation. Outcome measures were implant failures, biological and biomechanical complications, peri-implant radiographic bone level changes, and gingival aesthetics. RESULTS: At the 12-month follow-up, two implants failed in the Immediate Group (8%) versus one in the Delayed Group (4%), with a comparable rate of implant failure (P = 0.55). No complications occurred for either group. The 12-month peri-implant bone resorption was similar in both groups (P = 0.23): 0.71 mm (95% CI 0.45, 0.97) in the Immediate Group versus 0.60 mm (95% CI 0.38, 0.82) in the Delayed Group. The mean difference in bone resorption was 0.13 mm (95% CI -0.21, 0.47). An ideal gingival marginal level was reached most frequently in the Delayed Group (83.3% versus 52.1%, P = 0.04). Rates of full closure of the papilla were similar between the two groups (82.6% for the Immediate Group versus 62.5% for the Delayed Group, P = 0.12). CONCLUSIONS: Given the limitation that this was not a randomised controlled trial, there were no differences in complications or crestal bone response at immediate post-extractive implants when compared to delayed implants. A delayed protocol might be considered in the aesthetic zone due to the gingival recession that occurs after post-extractive implant placement.

Immediate loading of four (all-on-4) post-extractive implants supporting mandibular cross-arch fixed prostheses: 18-month follow-up from a multicentre prospective cohort study.

AIM: To evaluate the outcome of immediately loaded mandibular cross-arch prostheses according to the 'all-on-4' concept supported by implants placed in fresh extraction sockets up to 18 months after loading. MATERIALS AND METHODS: In total, 47 patients with a mean age of 62.3 years (range 52 to 78) were rehabilitated with an immediately loaded fixed cross-arch prosthesis supported by four post-extractive implants. A total of 188 implants were inserted. Patients received a provisional fixed dental prosthesis with a metal framework within 48 hours after surgery and a permanent one 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 6-, 12- and 18-month follow-up examinations. RESULTS: At the 18-month follow-up, no implant failed and all restorations were stable. Peri-implant bone levels amounted to 0.31 ± 0.12 mm after 6 months, 0.58 ± 0.112 mm after 12 months and 0.7 ± 0.107 mm after 18 months. No significant differences in bone loss were found between axially placed and tilted implants at the 6-month (0.06 mm; P = 0.115), the 12-month (0.12 mm; P = 0.062) and the 18-month follow-up (0.08 mm; P = 0.146). Three patients had a fracture of the provisional restoration, but all of the definitive prostheses remained stable throughout the study period without any complications. CONCLUSIONS: Within the limits of this study, it can be suggested that immediately loaded mandibular cross-arch fixed dental prostheses can be supported by four post-extractive implants, however larger and longer follow-ups are needed.

Immediate positioning of definitive abutments versus repeated abutment replacements in immediately loaded implants: effects on bone healing at the 1-year follow-up of a multicentre randomised controlled trial.

PURPOSE: To compare bone resorption around implants immediately loaded and restored using definitive abutments versus provisional abutments later replaced by custom-made abutments up to 12 months after implant placement. MATERIALS AND METHODS: 28 patients with partial edentulism were selected for a two-implant supported immediate restoration and randomised to provisional abutment (PA) and definitive abutment (DA) groups (14 patients for each group). In the PA group, implants were immediately restored using a platform-switched provisional titanium abutment. In the DA group, definitive platform-switched titanium abutments were tightened. In both groups, a provisional restoration was adapted, avoiding occlusal contacts. All implants were definitively restored after 3 months. In the PA group, patients underwent the standard prosthetic protocol: the abutments were removed and impressions were made directly on the implant platform. In the DA group, patients underwent the 'one abutment at one time' protocol: impressions were made of the abutments using a retraction cord. Peri-implant marginal bone levels were assessed immediately after surgery, and at 6- and 12-month follow-up examinations. RESULTS: At the 12-month follow-up no implant failed. In the PA group, peri-implant bone resorption was 0.359 mm after 6 months and 0.435 mm after 12 months. In the DA group, peri-implant bone resorption was 0.065 mm after 6 months and 0.094 mm after 12 months. There were statistically significant differences between the two groups for peri-implant bone level changes at the 6-month (P < 0.001) and the 12-month (P < 0.001) follow-up: 0.294 mm (CI 95% 0.276; 0.312) and 0.341 mm (CI 95% 0.322; 0.36), respectively. CONCLUSIONS: Within the limits of this study, it can be suggested that the non-removal of abutments placed at the time of surgery results in a statistically significant reduction of the crestal bone resorption around the immediately restored implants in cases of partial edentulism, however a difference of 0.3 mm may not have a clinical impact.

Immediate loading of two unsplinted implants retaining the existing complete mandibular denture in elderly edentulous patients: 1-year results from a multicentre prospective cohort study.

PURPOSE: To evaluate the outcome of two freestanding implants immediately loaded retaining an existing mandibular complete denture in elderly edentulous patients up to 1 year after loading. MATERIALS AND METHODS: 42 patients with a mean age of 76.5 years (range 71 to 89) were selected for stabilising their mandibular complete denture with two implants placed mesial to the mandibular canine position bilaterally. Individual ball abutments were connected and torqued at 30 Ncm and the existing complete denture was immediately attached. No postoperative limitations to chewing function were given. The patients were evaluated clinically and radiographically at implant placement and at 6- and 12-month follow-up examinations. RESULTS: At the 12-month follow-up no implant failed. Peri-implant bone resorption was 0.203 mm (CI 95% 0.322; 0.086) after 6 months and 0.298 mm (CI 95% 0.425; 0.173) after 12 months. Of the 42 cases, 3 had major prosthetic complications and 5 patients required minor extra maintenance appointments. CONCLUSIONS: Within the limits of this study, it can be suggested that the immediate loading of two unsplinted implants retaining the existing complete mandibular denture in elderly patients can result in favourable implant survival and peri-implant bone healing, however larger and longer follow-ups of 5 years or more are needed.

Survival and success rates of immediately and early loaded implants: 12-month results from a multicentric randomized clinical study.

Our objective was to compare survival and peri-implant bone levels of immediately nonocclusally vs early loaded implants in partially edentulous patients up to 12 months after implant placement. Eighty patients (inclusion criteria: general good health, good oral hygiene, 30-65 years old; exclusion criteria: head and neck irradiation/cancer, pregnancy, uncontrolled diabetes, substance abuse, bruxism, lack of opposing occluding dentition, smokers >10 cigarettes/day, need for bone augmentation procedures) were selected in 5 Italian study centers and randomized into 2 groups: 40 patients in the immediately loaded group (minimal insertion torque 30 Ncm) and 40 patients in the early loaded group. Immediately loaded implants were provided with nonoccluding temporary restorations. Final restorations were provided 2 months later. Early loaded implants were provided with a definitive restoration after 2 months. Peri-implant bone resorption was evaluated radiographically with software (ImageJ 1.42). No dropout occurred. Both groups gradually lost peri-implant bone. After 12 months, patients of both groups lost an average of 0.4 mm of peri-implant bone. There were no statistically significant differences (evaluated with t test) between the 2 loading strategies for peri-implant bone level changes at 2 (P = .6730), 6 (P = .6613) and 12 (P = .5957) months or for survival rates (100% in both groups). If adequate primary stability is achieved, immediate loading of dental implants can provide similar success rates, survival rates, and peri-implant bone resorption as compared with early loading, as evaluated in the present study.