Necrotizing Sialometaplasia and Bulimia: A Case Report.

Bulimia is an eating disorder with a great prevalence in young women. Due to its multifactor ethiology, bulimia has systemic consequences. In the literature, necrotising sialometaplasia is seldom associated with bulimia. Its etiopathogenesis is discussed by several authors; nevertheless, the consensus does not consider the relevance of local trauma associated with induced vomiting. A case of necrotising sialomethaplasia, presented with a single hard palatal ulcer in a bulimic woman is described in the present report. The patient did not present significant systemic laboratorial values, nor physical weight variations, which highlights the relevance of performing a complete medical clinical history when diagnosing this rare pathology.

Excess Mortality Estimation During the COVID-19 Pandemic: Preliminary Data from Portugal.

INTRODUCTION: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-cause mortality during the early COVID-19 pandemic period. MATERIAL AND METHODS: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. RESULTS: An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65) [corrected]. DISCUSSION: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. CONCLUSION: Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths [corrected].

Introdução: Desde março 2020, Portugal tem sofrido os efeitos da pandemia COVID-19. A mortalidade por todas as causas aumentou em março e abril de 2020 comparativamente a anos anteriores, mas este aumento não é explicado pelas mortes reportadas de COVID-19. O objetivo deste estudo foi analisar e considerar outros critérios para estimar o excesso de mortalidade durante a pandemia COVID-19. Material e Métodos: Utilizaram-se bases de dados públicas para estimar o excesso de mortalidade por idade e região entre 1 de março e 22 de abril, propondo níveis basais ajustados ao período de estado de emergência em vigor. Resultados: Apesar da incerteza inerente, é seguro assumir um excesso de mortalidade observada de 2400 a 4000 mortes. O excesso de mortalidade encontra-se associado aos grupos etários mais idosos (idade superior a 65 anos). Discussão: Os dados sugerem uma explicação tripartida para o excesso de mortalidade: COVID-19, COVID-19 não identificado e diminuição do acesso a cuidados de saúde. As estimativas efetuadas possuem implicações ao nível da comunicação de acções não farmacológicas, da investigação científica e dos profissionais de saúde. Conclusão: Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.

A Prognostic Model for the Outcome of Nobel Biocare Dental Implants with Peri-Implant Disease after One Year.

BACKGROUND: This investigation, based on a 1-year retrospective cohort study, aimed to estimate and validate a prognostic model for ailing and failing implants due to peri-implant disease. METHODS: A total of 240 patients (male: 97; female: 143; average age of 57.3 years) with at least one ailing or failing implant were included: 120 patients for model derivation and 120 patients for model validation. The primary outcome measure was the implant status: success, defined as the arrest of the disease, or failure defined as implant extraction, prevalence or re-incidence of peri-implant disease). Potential prognostic risk indicators were collected at the baseline evaluation. The relative risk (RR) was estimated for the predictors through logistic regression and the c-statistic (95% confidence interval) was calculated for both derivation and validation sets. The significance level was set at 5%. RESULTS: The risk model retrieved the prognostic factors age (RR = 1.04), history of Periodontitis (RR = 3.13), severe peri-implant disease status (RR = 3.26), implant length (RR = 3.52), early disease development (RR = 3.99), with good discrimination in both the derivation set (0.763 [0.679; 0.847]) and validation set (0.709 [0.616; 0.803]). CONCLUSIONS: A prognostic risk model for estimating the outcome of implants with peri-implant disease is available, with a good performance considering the c-statistic evaluation.

Risk Score to Predict Dental Caries in Adult Patients for Use in the Clinical Setting.

BACKGROUND: There is a need for risk prediction tools in caries research. This investigation aimed to estimate and evaluate a risk score for prediction of dental caries. MATERIALS AND METHODS: This case-cohort study included a random sample of 177 cases (with dental caries) and 220 controls (randomly sampled from the study population at baseline), followed for 3 years. The risk ratio (RR) for each potential predictor was estimated using a logistic regression model. The level of significance was 5%. RESULTS: The risk model for dental caries included the predictors: "presence of bacterial plaque/calculus" (RR = 4.1), "restorations with more than 5 years" (RR = 2.3), ">8 teeth restored" (RR = 2.0), "history/active periodontitis" (RR = 1.7) and "presence of systemic condition" (RR = 1.4). The risk model discrimination (95% confidence interval) was 0.78 (0.73; 0.82) (p < 0.001, C-statistic). Patients were distributed into three risk groups based on the pre-analysis risk (54%): low risk (

Seven mm long dental implants in posterior jaws: 3-year report of an ongoing prospective single cohort study.

PURPOSE: To report on the outcome of 7 mm long implants in the rehabilitation of posterior areas of atrophic jaws 3 years after loading. MATERIALS AND METHODS: This prospective study included 127 patients treated with 217 implants supporting 165 fixed prostheses. Final abutments were delivered at surgery stage and in the large majority of patients (n = 116) the implants (n = 199) were loaded after 4 months. Primary outcome measures were implant success and prosthetic success calculated at patient level; secondary outcome measures were complications, and marginal bone level changes calculated at patient level. RESULTS: Thirteen patients with 21 implants dropped out of the study after 3 years. Implant losses occurred in 10 of the 127 patients and 14 of the 217 implants placed failed, giving a cumulative success rate of 93.7% at 3 years, using the patient as unit of analysis. Eight prosthetic failures occurred in six patients, rendering a prosthetic success rate 95.3% at patient level. The average (standard deviation) marginal bone resorption after 3 years of follow-up was 1.46 mm (0.78 mm). Complications occurred in 13 patients (10.2%) and 15 implants (6.9%). CONCLUSIONS: Within the limitations of this study, 7 mm long implants in posterior atrophic jaws can be a viable treatment option given the good prosthetic and implant success rates, low marginal bone loss and low incidence of complications. Nevertheless, longer follow-ups are needed to validate the long-term outcome. Conflict-of-interest statement: This study was funded by grant no. 2015-1378 from Nobel Biocare Services. Paulo Maló is currently a consultant for Nobel Biocare. The remaining authors declare no conflicts of interest.

Outcome of dental implants in diabetic patients with and without cardiovascular disease: A 5-year post-loading retrospective study.

PURPOSE: To investigate the outcome of immediate function of dental implant rehabilitations in diabetic patients with and without coexisting cardiovascular diseases (CVD). MATERIALS AND METHODS: This retrospective study included 70 diabetic patients (33 females and 37 males, average age: 59 years old), rehabilitated with 352 implants and divided into two groups (CVD: 38 patients; non-CVD: 32 patients). Diabetes mellitus was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) or 2 h plasma glucose ≥ 11.1mmol/l (200 mg/dl). The data was retrieved from patient records. Primary outcome measures were prosthesis and implant survival; secondary outcome measures were marginal bone loss and complications (biological or mechanical). The follow-up was 5 years after loading for all patients. RESULTS: Seven patients (10%) were lost to follow-up (one patient in the CVD group; and six patients in the non-CVD group). One prosthesis failed in the non-CVD group, rendering a 97.4% survival rate, compared to 100% in the CVD group (non-significant difference between groups; P = 0.359). Ten implants failed in 7 patients: CVD group with eight implant failures in 5 patients (86.7% cumulative survival rate) versus two implants in 2 patients in the non-CVD group (93.8% cumulative survival rate) with a non-significant difference between both groups (P = 0.365). The average (95% confidence interval) marginal bone loss at 1- and 5-years was 0.95 mm (0.66 mm; 1.23 mm) and 1.52 mm (1.20 mm; 1.88 mm), respectively in the CVD group; and 0.78 mm (0.40 mm; 1.16 mm) and 1.54 mm (0.86 mm; 2.31 mm), respectively for the non-CVD group; with no significant differences between groups at 1 year (P = 0.979) and 5 years (P = 0.300). Complications occurred in 38 patients (CVD group: 21 patients; non-CVD group: 16 patients); with a non-significant difference between both groups (P = 0.660). CONCLUSIONS: Implant rehabilitations represent a valid treatment for diabetic patients with or without coexisting CVD, with a good risk/benefit ratio.

Five-year outcome of a retrospective cohort study on the rehabilitation of completely edentulous atrophic maxillae with immediately loaded zygomatic implants placed extra-maxillary.

PURPOSE: To report retrospectively on the 5-year follow-up results of the rehabilitation of complete edentulous atrophied maxillae, using extra-maxillary zygomatic implants alone or in combination with conventional implants. MATERIALS AND METHODS: This retrospective report includes an initial cohort of 39 patients (30 women and 9 men), with a mean age of 53 years, followed for 5 years. The patients were rehabilitated with 39 fixed prostheses and 169 implants (92 zygomatic implants inserted extra-maxillary and 77 conventional dental implants). A provisional prosthesis was manufactured and attached via multiunit abutments secured to the implants on the same day as implant placement. According to patient desires and each clinical situation, either an acrylic resin, a metal-acrylic or metal-ceramic final prosthesis was inserted approximately 6 months after implant placement. Outcome measures were: prosthesis success; implant success; complications; probing pocket depths; marginal bleeding; and marginal bone levels (only for conventional implants). Data were analysed with descriptive statistics. RESULTS: Two patients died after 8 and 30 months of follow-up due to causes unrelated to their oral rehabilitations, and 5 patients dropped out of the study. No prosthesis was lost; one zygomatic implant was removed after 46 months of follow-up, giving cumulative success rates of 97% and 98.8% (patient and implant related, respectively). Twelve complications occurred in 12 patients: 5 sinus infections in 5 patients, all with a previous history of sinusitis and whose sinus membrane was disrupted during surgery; one oroantral communication (leading to removal of the implant), 2 all acrylic resin prostheses fractures, 1 ceramic crown fracture (on a metal-ceramic prosthesis); and 3 screw loosenings. Bleeding on probing was recorded in 6 patients (13 implants). Probing pocket depths >4 mm were present in 13 patients (23 implants) at 5 years of follow-up. The average (standard deviation) marginal bone loss on conventional implants was 1.16 mm (0.77 mm) in those 9 patients having the intraoral radiographs. CONCLUSIONS: The long term outcome (5 years) of rehabilitations performed on patients with completely edentulous, severely atrophic maxillae supported by immediately loaded zygomatic implants alone, or in combination with conventional implants, is satisfactory.

Immediate loading of implants placed in patients with untreated periodontal disease: a 5-year prospective cohort study.

PURPOSE: To report the 5-year outcome of immediately loaded dental implants in patients with untreated periodontal disease. MATERIALS AND METHODS: This prospective cohort study included 103 consecutive patients (51 females and 52 males) with an average age of 52 years (range: 22 to 80 years) who were rehabilitated with 380 implants supporting 145 prostheses in both jaws (40 single; 33 partial and 72 complete rehabilitations). The implants were inserted in patients with active and untreated periodontitis. The patients did not receive any previous periodontal treatment before implant surgery, except for an oral hygiene session immediately before the implant surgery. In maintenance (every 6 months) patients received periodontal treatment as needed. Outcome measures were: prostheses failures; implant failures; complications; and marginal bone level changes. RESULTS: Fifteen patients dropped out of the study (14.6%). Two patients lost two implants (FDI positions nos.12 and 42), rendering a cumulative survival rate of 97.9% and 99.4% at 5 years of followup using the patient and implant as unit of analysis, respectively. The average (standard deviation) marginal bone resorption was 0.71 mm (0.42 mm) at 5 years. Mechanical complications occurred in 14 patients, consisting of prostheses fractures (10 provisional prostheses and 4 definitive prostheses). Thirteen implants (3.9%) in 13 patients (14.8%) presented peri-implant pathology. CONCLUSIONS: Within the limitations of this study, it is possible to conclude that the rehabilitation of patients with untreated periodontitis using immediately loaded dental implants is feasible in the medium-term, when periodontal therapy is provided after rehabilitation and the patients are regularly maintained.

Immediate rehabilitation of completely edentulous arches with a four-implant prosthesis concept in difficult conditions: an open cohort study with a mean follow-up of 2 years.

PURPOSE: There is a growing pressure in implant dentistry to perform implant rehabilitations in difficult conditions, such as fresh extraction sockets, periodontally compromised sites, or sites with low bone density and quantity that imply a high likelihood of dehiscences or fenestrations. The aim of this study was to document complete rehabilitations in both jaws through the so-called All-on-Four concept (ie, four implants with the posterior implants placed at an angle) using immediate function implants inserted in "nonideal" conditions (eg, implants inserted with dehiscences or fenestrations, in periodontally compromised sites, or in fresh extraction sockets). MATERIALS AND METHODS: This prospective cohort study included patients with immediately functioning implants placed in difficult conditions to support fixed full-arch maxillary and mandibular prostheses. RESULTS: One hundred forty-two patients received 227 implants. A total of seven implants failed in six patients (three implants in three patients in the maxilla and four implants in three patients in the mandible), for cumulative patient and implant survival rates of 96.2% and 97.7% for the maxilla and 94.7% and 94.8% for the mandible, respectively, after 2 years (Kaplan-Meier). The average (standard deviation) peri-implant bone resorption after 1 year and 3 years in the maxilla was 1.3 mm (0.4 mm) and 1.6 mm (0.4 mm), respectively; in the mandible, the average (standard deviation) peri-implant bone resorption at 1 year and 5 years was 1.4 mm (0.3 mm) and 1.7 mm (0.6 mm), respectively. CONCLUSIONS: The results support the conclusion that the four-implant ("All-on-Four") immediate-function concept in completely edentulous maxillae and mandibles using implants inserted in difficult conditions is a viable concept in the short term.

A new approach to rehabilitate the severely atrophic maxilla using extramaxillary anchored implants in immediate function: a pilot study.

STATEMENT OF PROBLEM: There is a need to simplify implant treatment for complete arch rehabilitation of severely atrophic maxillae, as well as a desire to eliminate grafting and provide quality rehabilitation in terms of esthetics, function, and comfort for the patient. PURPOSE: The purpose of this study was to report on the initial results of rehabilitation of complete edentulous atrophied maxillae using a new surgical approach and a newly designed extra long implant, placed externally to the maxillary bone (implant only accommodated in the maxillary bone) and anchored in the zygomatic bone. MATERIAL AND METHODS: The pilot study included 29 patients (21 women and 8 men), with an age range of 32-75 years (mean=52.4 years), followed between 6 and 18 months, with a mean follow-up time of 1 year. The patients presenting severe atrophy in the maxillae (Cawood and Howell classification C-VI and D-V or D-VI) were rehabilitated either by using 1, 2, or 4 extra long implants (30 to 50 mm in length; Nobel Biocare AB) placed in the zygomatic bone in conjunction with standard implants (24 patients): or 4 extra long implants (5 patients), all placed in immediate function. The criteria used to evaluate implant outcome were: implants function as support for reconstruction; implants stable when individually and manually tested; no signs of infection observed; and good esthetic outcome of the rehabilitation. To evaluate the secondary objective of assessing the stability and health of the soft tissue covering the implants, the mucosal seal efficacy evaluation index (MSEE) was used. This index was modified from the probing depth for standard implants and performed with a 0.25-N calibrated plastic periodontal probe measuring the depth (mm) of the space between the implant and the mucosa. Data were analyzed with descriptive and inferential analyses. RESULTS: The cumulative implant survival rate and prosthetic survival rate at 1 year were 98.5% and 100%, respectively. The mean and median values of the MSEE at 2 months (2.9 mm, 3 mm), 4 months (2.5 mm, 2.8 mm), 6 months (2.9 mm, 2.8 mm), and 1 year (2.8 mm, 2.5 mm) are comparable to the values of probing depths assessed for standard implants. CONCLUSIONS: The results indicate that, within the limitations of this preliminary study, the rehabilitation of maxillae with severe atrophy can be performed using extra long implants placed external to the maxilla and anchored only in the zygomatic bone, and placed in immediate function.

A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series.

BACKGROUND: The current investigation focuses on new implant designs for increased predictability in clinically demanding situations. Microtextured implant surfaces create favorable conditions for enhanced osseointegration of dental implants compared to implants with a smooth surface, and the macroscopic implant design may influence implant stability. PURPOSE: The aim of the present study was to retrospectively evaluate the clinical performance of a novel implant design in the rehabilitation of completely edentulous jaws and in combination with an immediate function protocol. MATERIALS AND METHODS: Forty-six consecutive patients received 189 study implants (NobelSpeedy concept implant, Nobel Biocare AB, Göteborg, Sweden) supporting 53 full-arch all-acrylic prostheses (44 maxilla, 9 mandible). The majority (66%) of the reconstructions were supported by four implants, of which the two posterior implants were tilted. All patients were followed for a minimum of 1 year. Radiographic assessment of the marginal bone level was performed. RESULTS: Two implants were lost in two patients, rendering a 1-year cumulative clinical survival rate of 98.9%. The marginal bone level was, on average, situated 1.2 +/- 0.7 mm below the implant-abutment interface after 1 year of loading. Good soft tissue health and overall esthetic outcome was reported. CONCLUSIONS: The results of the present pilot study indicate that fully edentulous jaws with various types of bone can be treated with high success and good esthetics using immediately loaded implants with the presented design, and that favorable marginal bone levels can be maintained.