Antimicrobial Activity of Glycine Air Polishing: A Clinical Split- Mouth Study on Full-Arch Implant-Supported Rehabilitations.

PURPOSE: To investigate the possible antimicrobial activity of glycine air polishing by comparing peri-implant microbiota before and after treatment. MATERIALS AND METHODS: A total of 15 patients who received implant-supported full-arch fixed rehabilitations were included. After prosthesis removal (T0), Plaque Index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded. In each hemiarch, the implant with the highest PD score was selected for microbiologic sample collection from the peri-implant sulcus (T0). All patients received two different hygienic protocols (randomly administered, one per each hemiarch): glycine air-polishing (G) and cleansing with cotton pellets soaked in saline (C). At 7 days (T1) and 3 months (T2) after the intervention, PI and BOP were recorded, and new microbiologic samples were taken. Traditional polymerase chain reaction (PCR) and quantitative PCR real-time were employed for microbiologic analysis to investigate how the presence of different bacterial species varied according to the hygienic treatment performed. RESULTS: Treatment G provided a significantly higher PI score reduction around implants compared to treatment C (P = .015). No statistical difference was found in the microbial population around G and C implant sites, with Tannerella forsythia being the most commonly detected bacterial species in both G and C groups. No statistical differences were found between the antimicrobial activity of treatments C and G. CONCLUSIONS: Glycine powder air polishing is a valid method for professional hygienic care of implants and was more effective in PI reduction compared to the control treatment. However, its antimicrobial efficacy cannot be confirmed by the outcomes of the present study.

Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study.

INTRODUCTION: Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments. OBJECTIVE: The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet. METHODOLOGY: A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills. RESULTS: With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46). CONCLUSIONS: Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.

Tissue-level versus bone-level single implants in the anterior area rehabilitated with feather-edge crowns on conical implant abutments: An up to 5-year retrospective study.

STATEMENT OF PROBLEM: Limited information is available on the differences between tissue-level implants with an ultrathin threaded microsurface conical transmucosal portion and bone-level implants rehabilitated with conical custom abutments. PURPOSE: The purpose of this retrospective study was to assess the outcomes of crowns designed as per the biologically oriented preparation technique (BOPT) cemented on conical titanium abutments on tissue-level and bone-level implants. MATERIAL AND METHODS: Patients consecutively rehabilitated with a delayed loading protocol with anterior implant-supported single crowns with a feather-edge margin, in function for at least 4 years, were recruited and divided into 2 groups based on the implant type they had received: tissue-level implants with a conical transmucosal portion or bone-level implants rehabilitated with a conical abutment by following the platform switching concept. Bone resorption, pink esthetic score (PES), and white esthetic score (WES) were collected and analyzed. The nonparametric Mann-Whitney test was performed to analyze all parameters (α=.05 for all tests). RESULTS: A total of 43 participants (48 implants) were included in the present study. The mean follow-up period was 4.5 years (range 52-64 months). A statistically significant difference (P=.004) was found in the mean ±standard deviation bone resorption between tissue-level implants (0.38 ±0.46 mm) and bone-level implants (0.83 ±0.58 mm). Higher values for both PES and WES were obtained in the tissue-level implant group. CONCLUSIONS: Within the limitations of the present retrospective study, tissue-level implants with a conical transmucosal portion seem to provide a suitable alternative to bone-level implants in the anterior area.

pH Evaluation over a Period of 6 months of Two-bottle Water-based Self-etching Primers: An In Vitro Study.

AIM AND OBJECTIVE: The objective of this study was to monitor the pH stability over a period of 6 months of two-bottle self-etching (SE) primers. MATERIALS AND METHODS: Four commercially available two-bottle SE primer solutions, Adhese SE (Ivoclar Vivadent; Schaan, Liechtenstein), Clearfil SE (Kuraray; Tokyo, Japan), Contax Primer (DMG; Hamburg, Germany), and Enabond SE (Micerium; Avegno (Ge), Italy), containing water as the main solvent were selected. The pH values during a 6-month storage period at intermittent temperature were daily measured by means of a microprocessor-based pH/temperature meter and hence recorded, tabulated, and analyzed. RESULTS: The mean values of overall pH measurements and standard deviation for Adhese SE, Clearfil SE, Contax Primer, and Enabond SE are, respectively, 1.70 (±0.01), 1.72 (±0.01), 1.20 (±0.01), 1.80 (±0.01). One-way ANOVA did not detect any significant change of the mean pH values of all measurements over time. CONCLUSION: The conventional 6-months storage did not affect the pH values of the water-containing primers of two-bottle SE adhesives. CLINICAL SIGNIFICANCE: This study provides evidence that conventional storage under adequate conditions did not affect the pH values of the water-containing primers of two-bottle SE adhesives with different monomer formulations. Clinicians may rely on the known pH value of the selected SE adhesive during shelf-life.

Efficacy of air-polishing devices without removal of implant-supported full-arch prostheses.

PURPOSE: Long-term success of titanium dental implants is influenced by various factors, including the maintenance of good oral hygiene. The present study aimed to evaluate cleaning effectiveness and patient satisfaction with glycine powder air polishing and traditional professional oral hygiene treatments when applied to implant-supported full-arch restorations without removal of the fixed prosthesis. MATERIALS AND METHODS: A total of 85 patients with 357 implants supporting full-arch fixed restorations were included. After removal of the prosthesis (T0), the following parameters were recorded: Plaque Index, peri-implant spontaneous bleeding, probing depth and bleeding on probing. The prosthesis was then reinserted. The patients were divided into three groups, each of which received two hygiene therapies randomly administered in each hemiarch using a split-mouth design. The possible treatments were glycine powder air polishing and use of sponge floss vs sponge floss only in group 1; glycine powder air polishing vs use of an ultrasonic device with a polyetheretherketone fibre tip coating in group 2; and glycine powder air polishing vs use of carbon fibre curettes and sponge floss in group 3. After instrumentation, the prostheses were removed to assess the Plaque Index and peri-implant spontaneous bleeding. Questionnaires were used to record patients' levels of comfort and satisfaction in relation to the various treatments. RESULTS: Glycine powder air polishing resulted in a significantly higher reduction in plaque around implants compared to control treatments (sponge floss only, ultrasonic device with polyetheretherketone fibre tip coating, and manual scaling with carbon fibre curettes and use of sponge floss) (P = 0.020). Glycine powder air polishing followed by application of sponge floss provided the greatest reduction of plaque deposits on the prosthetic surfaces. On average, 80% of patients rated glycine powder air polishing highest with regard to satisfaction. CONCLUSIONS: Glycine powder air polishing is a highly effective and comfortable treatment to maintain good oral hygiene in clinical practice, and could be used as an alternative to manual and mechanical instrumentation when dealing with implant-supported restorations.

Flapless Surgical Approach to Extract Impacted Inferior Third Molars: A Retrospective Clinical Study.

This study aimed to compare a flapless surgical approach (FSA) with a traditional envelope flap (traditional approach (TA)). Every patient was treated with two approaches: TA and FSA. The primary outcome variables were both the discomfort during the post-operative convalescence and the correct final recovery of the impacted area. The secondary outcome variable was the average duration of the surgery. Post-operative pain and oedema were recorded. The measurements of soft tissue interface toward the distobuccal edge of the second molar were taken by periodontal probe before surgery (baseline) and 8 weeks after surgery. Statistical software was used to evaluate the data; a p-value < 0.05 was considered statistically significant. Twenty-four teeth of 12 patients (six Caucasian males and six Caucasian females, aged 23 ± 4 (17-30) years) with both lower impacted third molars (Ms3) were analysed. Considering an alpha error 0.05 that sample size allows power from 0.80 to 0.90, depending on the variable evaluated. Concerning attached gingiva, oedema and pain, the linear mixed model resulted in a statistically significant difference between the TA and FSA (p = 0.003; p < 0.01; and p = 0.018, respectively). Conversely, the model did not show a difference (p = 0.322) if pocket probing depth was considered. The FSA procedure was faster (p < 0.05) than the TA procedure (17 min and 8 s (±6 s) vs. 28 min and 6 s (±4 s), respectively). The results suggest that the FSA could be a suitable option for improving the surgical removal of lower Ms3. However, additional randomized controlled trial studies are necessary to confirm the reliability of our procedure and to verify its suitability in more complex Ms3 classifications.

Analysis of the Subgingival Microbiota in Implant-Supported Full-Arch Rehabilitations.

BACKGROUND: The etiology of peri-implantitis is multifactorial, and it is not directly linked to the quantitative amount of plaque. The aim of this study was to evaluate the influence of subgingival microbiota around implants supporting full-arch restorations on clinical indexes of peri-implant health. METHOD: 47 patients (54 full-arch fixed rehabilitations) were included. Based on the highest value of probing depth (PD), 47 implants (in the test arch), 40 natural teeth and 7 implants (in the antagonist arch) were selected for microbiological sampling (traditional PCR and real-time PCR). Periodontal indexes (plaque index, PlI; probing depth, PD; bleeding on probing, BOP; peri-implant suppuration, PS) and marginal bone loss were also recorded. RESULTS: Despite abundant plaque accumulation, the peri-implant parameters were within normal limits. No statistical difference was found in the microbial population around the test implants and antagonist natural teeth. Treponema denticola was present in a significantly higher amount around implants with increased PlI. Implants with increased BOP showed a significant increase in Treponema denticola and Tannerella forsythia. A significantly higher presence of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia was identified around the implants affected by peri-implantitis and in smokers. CONCLUSIONS: Peri-implantitis is characterized by a complex and polymicrobial disease, that might be influenced by the qualitative profile of plaque. Smoking might also favor implant biological complications in full-arch fixed prosthesis.

Influence of Implant Thread Morphology on Primary Stability: A Prospective Clinical Study.

OBJECTIVES: The purpose of this study was to evaluate the primary stability of two implants with the same macro- and micromorphology but different thread design and analyze their clinical outcomes over a one-year period. MATERIALS AND METHODS: 14 patients needing a partial rehabilitation with a delayed loading approach (DEL group: 9 patients) or a full-arch rehabilitation treated with immediately loaded fixed prostheses supported by 4 implants following the Columbus Bridge Protocol (CBP) (IL group: 5 patients) were included. In each patient, at least one SY (implant with standard threads) and one SL implant (implant with an augmented depth of the threads) were randomly inserted. Primary outcome measures were the number of threads exposed at a torque of 30 Ncm and 50 Ncm and final insertion torque. Secondary outcome measures were implant and prosthetic failure, peri-implant bone resorption, and periodontal parameters: bleeding on probing (BoP), plaque index (PI), and probing depth (PD) evaluated at 3, 6, and 12 months of healing. RESULTS: Nineteen SY and 19 SL implants were inserted in 14 patients. Twenty implants (10 SL and 10 SY) were inserted in the IL group, while 18 (9 SL and 9 SY) were inserted in the DEL group and followed-up for 12 months. No patients dropped out. No implants and prostheses failed. No biological complications were identified. No significant differences were found between SY and SL implants comparing the number of exposed threads when inserting the implant with a torque insertion of 30 N (T student test p = .142 and U test p = .164). At 50 N, no threads were visible in either groups. Final torque insertion values were higher for SL (mean: 48.42 Ncm) compared to SY implants (mean: 43.42 Ncm) without a statistically significant difference. All the implants showed good clinical outcomes at the 1-year-in-function visit. CONCLUSIONS: After 12 months of function, both implant types provided good clinical outcomes without statistically significant differences between the two groups. A difference in insertion torque (even if not statistically significant) was found with higher insertion torque values for SL implants with a larger thread depth.

Long-term impact of interferon or Glatiramer acetate in multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: In recent years the impact of disease-modifying drugs on long-term progression in multiple sclerosis (MS) was assessed both in observational studies and in extension of randomized controlled trial (RCT). Aim of this work was to quantitatively summarize by a meta-analysis the long-term impact of immunomodulatory drugs (Interferon-Beta (IFN-ß) or Glatiramer Acetate (GA)) in relapsing-remitting (RR) MS patients. METHODS: We collected all published observational studies reporting the long-term efficacy of IFN-ß or GA in RRMS patients. The primary outcome was the treatment effect on progression to a sustained EDSS score of 6 or to the Secondary Progressive (SP) phase. A non-parametric approach was adopted to test the overall treatment effect significance, while a random effect model was used to obtain a pooled quantitative estimate of the treatment benefit, in terms of hazard-ratios (HR) or Relative Risks, with their 95% confidence interval (CI). RESULTS: Fourteen studies, on a total of 13,238 RRMS patients, were included in the meta-analysis. All studies but two reported a consistent effect of immunomodulatory treatment on long-term disease progression; the pooled effect on progression to EDSS 6 or SP was significant (p<0.01) when tested by the non-parametric test. The quantitative estimate of the treatment effect in reducing progression to EDSS 6 in the subset of studies reporting this outcome was HRpooled=0.49 (95% CI: 0.34-0.69), p<0.001. CONCLUSIONS: Treatment with immunomodulators seems to reduce long-term probability of disability progression. Additional well-designed observational studies could help to confirm these findings.