International consensus for a dissection room quality system (DRQS): A Delphi panel study.

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered "essential" or "important" by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

Timing of umbilical cord occlusion, delayed vs early, in preterm babies: A randomized controlled trial (CODE-P Trial).

INTRODUCTION: Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30-60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. MATERIAL AND METHODS: A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group. RESULTS: Our study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis. CONCLUSION: The primary and secondary outcomes of our study were not achieved. Therefore, more meta-analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth.

Comparison of two different lingual flap advancement techniques and vascular structure identification: a human cadaver study.

BACKGROUND: One of the most frequent complications in guided bone regeneration (GBR) is wound dehiscence, which compromises treatment outcomes. Thus, primary tension-free suture is essential to avoid wound dehiscence. The purpose of this study was to compare the extension of 2 different mandibular flaps in human cadaveric specimens, and to measure the size of the supraperiosteal blood vessels. MATERIAL AND METHODS: Five freshly unfrozen human cadaveric specimens were used. Arteries and veins were marked and bilateral classical lingual flaps (extending from the second premolar to the retromolar area) were prepared. In one side, the mylohyoid muscle was detached to increase the coronal extension of the flap. An implant drill was used to measure the extension of the flap after exerting 30 g of traction, before and after detaching the mylohyoid muscle. The size of the largest vascular structures of the flap was measured using a periodontal probe. RESULTS: The classical flap extension was 5.99 mm (95% confidence interval (CI): 5.08 to 6.90), while the coronally advanced flap extension with mylohyoid muscle detachment was 14.96 mm (95%CI: 10.81 - 19.11). A statistically significant difference was found between the 2 groups (p= 0.0002), with a mean extension difference was 8.97 mm (95%CI: 5.02 to 12.91). The mean largest artery had 0.20 mm of diameter (95%CI: 0.15 - 0.26). CONCLUSIONS: The detachment of the mylohyoid muscle from the lingual flap allows to significantly increase its extension by 2.5 times. The superficial arteries found in the lingual flap have a small diameter (around 0.2mm).

Prematurity and ADHD in Childhood: An Observational Register-Based Study in Catalonia.

Objective: To evaluate the association between prematurity (by the gestational week [gw]) and ADHD during childhood. Method: Observational, matched cohort study using data from children born in a tertiary-level hospital (Hospital Universitari Vall d'Hebron, Catalonia, Spain) during 1995-2007 and data from the Information System for the Development of Research in Primary Health Care (SIDIAP database, Catalonia, Spain). Results: Prevalence of ADHD increases as gestational age decreases, 12.7% for those born ≤28 gw, compared to 3.2% for those born after the 37 gw. The risk of developing ADHD in the non-premature children tends to increase as the gw decreases (35-36 gw, hazard ratio [HR] = 1.70, 95% confidence interval [CI] [1.19, 2.44]; 33-34 gw, HR = 3.38, 95% CI [2.08, 5.50]; 29-32 gw, HR = 2.37, 95% CI [1.54, 3.63]; and ≤28 gw, HR = 5.57, 95% CI [2.49, 12.46]) Conclusion: Being born preterm is associated with a risk of developing ADHD, also in late preterm children (35-36 gw). Attention when taking care of these infants regarding their mental health must be made.

Application of an enhanced homogenization technique to the structural multiscale analysis of a femur bone.

Bone is a complex hierarchical material that can be characterized from the microscale to macroscale. This work demonstrates the application of an enhanced homogenization methodology to the multiscale structural analysis of a femoral bone. The use of this homogenization technique allows to remove subjectivity and reduce the computational cost associated with the iterative process of creating a heterogeneous mesh. Thus, it allows to create simpler homogenized meshes with its mechanical properties defined using information directly from the mesh source: the medical images. Therefore, this methodology is capable to accurately predict bone mechanical behavior in a fraction of the time required by classical approaches. The results show that using the homogenization technique, despite the differences between the used homogeneous and heterogeneous meshes, its mechanical behavior is similar. The proposed homogenization technique is useful for a multiscale modelling and it is computationally efficient.

Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3-year follow-up.

AIM: This case report demonstrates a positive outcome of the adjuvant use of fragile fracture (FF), which is a technique used to harvest dental pulp stem cells (DPSCs), and platelet-rich plasma (PRP) in a mandibular premolar (tooth 44) with a completely formed root that was transplanted into a surgically created socket and which maintained pulp vitality and function. SUMMARY: After virtual surgical planning, a 3D tooth replica of tooth 44 was fabricated. A surgical socket was created in the position of tooth 14; then, tooth 44 was extracted and the root dentine was abraded using a turbine diamond bur 3 mm from the apex until a circular groove was prepared around the outer circumference of the root; and then, an FF was performed without damaging the pulp tissue. PRP was placed in the socket, after which the donor tooth was inserted in the recipient area. At 2 weeks post-treatment, orthodontic traction was applied. At 3-year follow-up, the tooth had adequate alignment and was asymptomatic. Response to pulp testing was positive, and the presence of pulp canal obliteration was observed as a sign of pulpal healing. KEY LEARNING POINTS: Autotransplantation is a good alternative for replacing missing teeth, with repair of tissues and pulp revascularization. Revascularization of an autotransplanted mature tooth using the fragile fracture technique and PRP scaffold is a feasible option and might have positive effects on the long-term outcome of the procedure. Including completely formed teeth as donors in autotransplantation, maintaining vitality and their functions is an option that warrants further study.

In vivo efficiency of antimicrobial inorganic bone grafts in osteomyelitis treatments.

The purpose of the present work was to evaluate in vivo different antimicrobial therapies to eradicate osteomyelitis created in the femoral head of New Zealand rabbits. Five phosphate-based cements were evaluated: calcium phosphate cements (CPC) and calcium phosphate foams (CPF), both in their pristine form and loaded with doxycycline hyclate, and an intrinsic antimicrobial magnesium phosphate cement (MPC; not loaded with an antibiotic). The cements were implanted in a bone previously infected with Staphylococcus aureus to discern the effects of the type of antibiotic administration (systemic vs. local), porosity (microporosity, i.e. <5 µm vs. macroporosity, i.e. >5 µm) and type of antimicrobial mechanism (release of antibiotic vs. intrinsic antimicrobial activity) on the improvement of the health state of the infected animals. A new method was developed, with a more comprehensive composite score that integrates 5 parameters of bone infection, 4 parameters of bone structural integrity and 4 parameters of bone regeneration. This method was used to evaluate the health state of the infected animals, both before and after osteomyelitis treatment. The results showed that the composite score allows to discern statistically significant differences between treatments that individual evaluations were not able to identify. Despite none of the therapies completely eradicated the infection, it was observed that macroporous materials (CPF and CPFd, the latter loaded with doxycycline hyclate) and intrinsic antimicrobial MPC allowed a better containment of the osteomyelitis. This study provides novel insights to understand the effect of different antimicrobial therapies in vivo, and a promising comprehensive methodology to evaluate the health state of the animals was developed. We expect that the implementation of such methodology could improve the criteria to select a proper antimicrobial therapy.

The Graduating European Dentist: Contemporaneous Methods of Teaching, Learning and Assessment in Dental Undergraduate Education.

It is often the case that good teachers just "intuitively" know how to teach. Whilst that may be true, there is now a greater need to understand the various processes that underpin both the ways in which a curriculum is delivered, and the way in which the students engage with learning; curricula need to be designed to meet the changing needs of our new graduates, providing new, and robust learning opportunities, and be communicated effectively to both staff and students. The aim of this document is to draw together robust and contemporaneous methods of teaching, learning and assessment that help to overcome some of the more traditional barriers within dental undergraduate programmes. The methods have been chosen to map specifically to The Graduating European Dentist, and should be considered in parallel with the benchmarking process that educators and institutions employ locally.

The Graduating European Dentist-Domain II: Safe and Effective Clinical Practice.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to Safe and Effective Clinical Practice. Dentists are required to ensure that they are capable of providing appropriate care for their patients, whilst also effectively managing and leading the wider clinical team. The care that is provided should align to a contemporaneous evidence base wherever possible, and the quality of care and the management systems that underpin it should be regularly audited and improved.

The Graduating European Dentist-Domain III: Patient-Centred Care.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to patient-centred care. This approach is becoming increasingly prominent within the literature and within policy documents. Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide. The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient-centred care.

Histological differences in the adherence of connective tissue to laser-treated abutments and standard abutments for dental implants. An experimental pilot study in humans.

BACKGROUND: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments. MATERIAL AND METHODS: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces. RESULTS: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03. CONCLUSIONS: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments.

Antenatal corticosteroids and perinatal outcomes in infants born at 23-25 weeks of gestation.

OBJECTIVES: To evaluate the perinatal results of infants born between 23 and 25.6 weeks of gestation. METHODS: Medical charts of all women giving birth prematurely (23-25.6 w) from January 2005 to December 2011 were retrospectively reviewed. Cases of malformed infants or deliveries elsewhere were excluded. RESULTS: 198 infants were included. Chorioamnionitis occurred in 86 (43.4%) of the whole group: 26 (86.7%) in the 23-week; 35 (53.8%) in the 24-week and 25 (24.3%) in the 25-week groups. Foetal maturation with antenatal corticosteroids was complete in 119 cases (60.1%): 4 (13.3%) in the 23-week; 35 (53.8%) in the 24-week and 80 (77.7%) in the 25-week groups. Foetal death at birth occurred in 22 cases (11%) and 61 newborns (30.8%) died in the neonatal period. Of the 106 survivors with 2 years complete follow-up, 45 infants (42.4%) did not present sequelae; 16 infants (15.1%) had severe sequelae. A 66.6% (4) of infants born at 23 weeks of gestation did not present sequelae compared with a 32.3% (11) at 24 weeks and 45.4% (30) at 25 weeks. CONCLUSIONS: The chorioamnionitis rate was higher when gestational age was lower. The foetal maturation rate was higher when gestational age was higher. A low severe sequelae rate was observed in the whole series, particularly in the 23-week group where the rate was lower than expected; however, these results could have been influenced by the small size of the 23-week group.

"In vivo" bone tibial response to the application of mineral trioxide aggregate (MTA). Study in New Zealand white rabbit.

Short Communication selected from the Oral Presentations of the 56th Congress of the Groupèment International pour la Recherche Scientifique en Stomatologie et Odontologie, Peñafiel (Portugal) May 2012. ";Prix du GIRSO"; 2012.

Morfología de los conductos radiculares de premolares superiores e inferiores / Anatomic mrphology of both upper and lower root canal premolars

El propósito de este estudio fue caracterizar la anatomía de los conductos radiculares de dientes premolares superiores e inferiores provenientes de pacientes espaoles. Fueron seleccionados 200 dientes premlares permanetes sometidos a diafanización. Para el estudio de los conductos radiculares se empleó la clasificacion de Vertucci. La incicia de conducto tipo I (un conducto) para los primeros premolares superiores fue de 5,88%, mientres que un 88,22% presentó dos conductos (de tipo II a tipo VI). Sólo el 5,88% de los primeros premolares superiores fueron tipos VIII (tres conductos). En los segundos premolares superiores, la incidencia de un conduto (tipo I) fue de 39, 65% y el 60,31• presentaron dos conductos ( de tipo II a tipo VII). La incidencia e un conducto (tipo I) fue de 68,18% para los primeros premolares inferiores y un 31,8%) presentó dos conductos (de tipo II a tipo V). En los segundos premolares inferiores, la incidencia de tipo I (un conducto) fue de 73,91%, mientras que el 26,08% presentó dos conductos (de tipo IV a V). Salvo en el caso del segundo premolar inferir, nuestros resultados coincidieron con los detrabajos previos hechos en otras poblaciones (AU)

The aim of this investigation was to study the root canal anatomy of maxillary and mandibular premolars teeth form Spanish population, 200 extracted permanet premolars were studied using a clearing technique. The exaination of root canal systems of the teeth was based on Vertucci´s clssification. The incidence of type I canal (one canal) for the maxillary first premolars was 5,88% whereas 88,22% of the total samples showed two canals (from type II to type VI), Only 5,88% of maxillary first premolars were type VIII (three canals). In maxillary second premolars, the incidence of type I (one canal) was 39.65%, whreas it was 60,31% for type II to type VII (two canals). Regarding mandibular premlars, the incidece of type I (one canal) for the mandibular first preolars was 68,18% and 31,8% for type II to type V (Two canals). In the mandibular second premolars, the incidence of type I (one canal) was 73,91% and 26,08% for type IV to V (two canals). Except for the second mandibular premolar, our results were in accordance with previous studies referred in the literature (AU)

Técnicas de diafanización: estudio comparativo / No disponible

Las técnicas de diafanización dental, han sido frecuentemente empleadas para evaluar diferentes aspectos anatómicos y endodóncicos, son muy variables y se utilizan principalmente con objetivos docentes. El propósito de éste estudio consistió en comparar la transparencia y dureza de la dentina entre grupos de dientes diafanizados mediante diferentes técnicas y comparar además su eventual idoneidad para realizar técnicas endodóncicas. Las técnicas de diafanización empleadas fueron: la técnica de Okumura-Aprile, Venturi, Robertson y dos modificaciones de esta última. Para el análisis de los datos obtenidos de la transparencia se utilizó un modelo de análisis de varianza (ANOVA) a dos vías y el test Tukey HSD (Tukey Honest Significant Difference). Los datos obtenidos de la dureza fueron analizados mediante el Test de Medicanas y el Test de Mann-Whitney. Nuestro resultados demuestran que la dureza de la dentina de los dientes diafanizados es igual independientemente de la técnica utilizada, mientras que la transparencia de los dientes diafanizados sí difiere de manera significativa en función de la técnica utilizada(AU)

The clearing technique has been proposed to evaluate different anatomical and endodontic aspects, they are very variable and they are used mainly with educational objective. The purpose of this study consisted in to compare the transparency and hardness of the dentin between groups of cleared teeth by different techniques and to compare in addition its possible suitability to make endodontic techniques. The clearing techniques used were: Okumura-Aprile, Venturi, Robertson and two modified Robertson techniques. The resultant data of transparency was analyzed by two-way ANOVA test and HDS (Honest Significant Difference) Turkey test. The Means test and Mann-Whitney test were employed to compare the hardness. It is concluded that that the hardness of the dentin of the cleared teeth is equal independently of the used technique, whereas the transparency of the cleared teeth differs form significant way based on the used technique(AU)

Repercusiones clínicas de la anorexia nerviosa restrictiva en la cavidad oral / Clinical repercussions of restrictive anorexia on the oral cavity

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The role of fibroblast growth factor (FGF) and type beta transforming growth factor (TGF-beta 1-beta 2-beta 3) during rat craniofacial development.

Growth factors seem to be part of a complex cellular signalling language, in which individual growth factors are the equivalents of the letters that compose words. According to this analogy, informational content lies, not in an individual growth factor, but in the entire set of growth factors and others signals to which a cell is exposed. The ways in which growth factors exert their combinatorial effects are becoming clearer as the molecular mechanisms of growth factors actions are being investigated. A number of related extracellular signalling molecules that play widespread roles in regulating development in both invertebrates and vertebrates constitute the Fibroblast Growth Factor (FGF) and type beta Transforming Growth Factor (TGF beta). The latest research literature about the role and fate of these Growth factors and their influence in the craniofacial bone growth ad development is reviewed.