Mouth opening limitation and influence of age and surgical location for static fully guided dental implant placement: an observational, cross-sectional clinical study.

The influence of age and region of the mouth was assessed in regard to mouth opening in fully guided implant placement. Ninety patients were included in this study, 30 in each of three age groups (20-34, 35-55, and >55 years). Maximum passive mouth opening was recorded in three locations: incisal, canine, and molar. The minimum distance required to allow the bone drilling sequence through a static fully guided approach was analysed for four implant systems: Straumann, MIS Dentsply, Astra Tech Dentsply, and Dentium. The mean ± standard deviation maximum mouth opening (all 90 patients) was 46.34 ± 7.70 mm, 36.82 ± 5.92 mm, and 30.99 ± 5.40 mm in the incisal, premolar, and molar region, respectively. No significant difference in mouth opening at any of the three locations was found between the age groups (all P > 0.05). However, a correlation was found between increasing age and decreasing average mouth opening in all three mouth regions; each additional 1 year resulted in a mean reduction of 0.13 mm, 0.09 mm, and 0.08 mm in the incisal, premolar, and molar region, respectively. The minimum required mouth opening was most likely to be met for implant placement in the incisal region (98.9% of all patients) and least likely to be met for placement in the molar region, particularly for older patients (as low as 30% of patients). Mouth opening remains a major limitation in fully guided implant surgery, especially in posterior areas and in older patients. The use of some implant systems in the posterior area may be limited to only one in three patients.

Current state of dynamic surgery. A literature review.

BACKGROUND: Recently, dental implant technology has been widely used for oral reconstruction. Dental implants are the treatment of choice for those patients with dental absences. An optimal implant placement is based on the prosthetic driven concept in order to achieve an aesthetic and functional restoration with a long-term prognosis. There are two types of guided implant surgery that are described in the literature: Static Guided Surgery (SGS) and Dynamic Guided Surgery (DGS). The aim of this study is to be aware of the current state of dynamic surgery and compare in the literature the discrepancies between planning and placement of dental implants. MATERIAL AND METHODS: The study consists of a bibliographic review on the topic. The research has been performed in the Medline/Pubmed of articles published by different professional associations and societies in the international context. RESULTS: Twenty two studies out of 100 articles from the initial search were finally included. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. CONCLUSIONS: Dynamic navigation shows a better accuracy and precision of implant placement. To corroborate the results of this review as well as to evaluate the different variables that could influence the accuracy of this technique, future randomized control trials will be needed.

Immediate implants following tooth extraction. A systematic review.

OBJECTIVES: The aim of this article is to review the current state of immediate implants, with their pros and contras, and the clinical indications and contraindications. MATERIAL AND METHODS: An exhaustive literature search has been carried out in the COCHRANE library and MEDLINE electronic databases from 2004 to November 2009. Randomized clinical trials and clinical trials focused on single implants placed in fresh extraction sockets were included and compared. A meta-analysis could not be performed due to heterogeneity of the data. RESULTS: Twenty studies out of 135 articles from the initial search were finally included, which summed up a total of 1139 immediate implants with at least a 12-month follow-up. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. DISCUSSION: Immediate implants have predictable results with several advantages over delayed implant placement. However, technical complications have been described regarding this technique. Also, biomaterials may be needed when the jumping distance is greater than 1mm or any bone defect is present. CONCLUSIONS: Few studies report on success rates rather than survival rates in the literature reviewed. Short-term clinical results were described and results were comparable to those obtained with delayed implant placement. Further long-term, randomized clinical trials are needed to give scientific evidence on the benefits of immediate implants over delayed implant placement.

The relative responsiveness and construct validity of the Spanish version of the DASH instrument for outcomes assessment in open carpal tunnel release.

The objective of this study was to evaluate the responsiveness and construct validity of the Spanish version of the DASH as outcome measure for carpal tunnel surgery. The study population was 42 patients with the diagnosis of carpal tunnel syndrome (CTS) based on clinical and electrophysiological criteria. The clinical design was a classic Cohort study with measures the day before and 12 weeks after open carpal tunnel release. The Spanish version of the DASH was compared to the physical exam measures as dexterity time, grip and pinch strength, range of motion of the wrist (ROM) and two-point discrimination (2PPD). The responsiveness was evaluated based on the effect size (ES) and the standardised response means (SRM). The Spanish version of the CTS questionnaire (CTQ) and the Spanish version of the 36-item short-form health survey (SF-36) were self-administered to the same study population and followed the same clinical design. The hypothesis that the DASH instrument should present a responsiveness level higher than the SF-36 and lower than the CTQ was established to demonstrate the construct validity. The DASH instrument showed an ES of 0.68 and an SRM of 1.00. Responsiveness of traditional physical exam measures were lower, running from 0.35 (SRM) for dexterity time to 0.00 (ES) for key pinch strength. The SF-36 presented a responsiveness level (range from 0.07 to 0.14) lower that the DASH. The CTQ showed the highest level of responsiveness (ES = 1.41 and 0.7) (SRM = 1.75 and 0.51). In conclusion, The DASH instrument is more sensitive in detecting clinical change than the physical exam measures for use in clinical outcome studies of CTS done at 12 weeks after surgery. The Spanish DASH showed a responsiveness lower than the CTQ and higher than the SF-36 as a proof of a good construct validity.

Impacto de las alertas de seguridad en la prescripción de terapia hormonal sustitutiva / Impact of safety alerts on prescription of hormone replacement therapy

Objetivo: Evaluar el impacto de evidencias científicas y alertas farmacéuticas (período 2002-2004) sobre la prescripción de la terapia hormonal sustitutiva (THS). Material y método: Estudio observacional retrospectivo donde se han analizado las variaciones en la prescripción de la hormonoterapia realizada por facultativos del servicio de atención primaria (292.000 habitantes). Se ha evaluado la prescripción de la THS según los períodos de las alertas farmacéuticas y se ha estratificado el cambio en la prescripción según períodos preestablecidos. La unidad de medida utilizada fue la dosis diaria definida por 1.000 habitantes/día, en nuestro estudio referida a la población de mujeres (DHDmujeres). Resultados: Se observó una disminución inmediata del 5,5% en la prescripción de THS tras la publicación de la alerta 2002 que llegó al 29,6% al año de su difusión. La nota informativa 2004 produjo una reducción inicial del 29,8%, que llegó al 56,9% al año. En los ginecólogos, observamos una respuesta más tardía y menos intensa a la alerta 2002 (reducción del 6,6% al año), con una respuesta inicial a la alerta 2004 del 39,4 y del 64,3% al año. Conclusiones: La respuesta a las alertas de seguridad en la prescripción de THS fue variable según el período estudiado y el colectivo profesional

Aim: To evaluate the impact of scientific evidence and pharmaceutical safety alerts on prescription of hormone replacement therapy (HRT) from 2002 to 2004. Material and method: An observational retrospective study of prescription of HRT was carried out by physicians from a primary care service (292,000 inhabitants). Variations in HRT prescription were evaluated according to publication of safety alerts between 2002 and 2004 and changes in prescription were stratified by pre-established periods. The unit of measure employed was the defined daily dose per 1,000 inhabitants per day (DID). In this study, the DID referred to the female population (DIDwomen). Results: After the publication of the 2002 alert, HRT prescription immediately decreased by 5.5%. A year after the alert was issued, prescriptions had fallen by 29.6%. After the 2004 safety alert, HRT prescription fell by 29.8 %, reaching a 56.9% decrease after 1 year. Gynecologists showed a later and less intense response to the 2002 alert (6.6% decrease at 1 year) than to the 2004 alert, which produced an initial decrease in prescription of 39.4%, which fell further to 64.3% 1 year later. Conclusions: Response to the publication of safety alerts on HRT prescription was erratic, depending on the period and the professional group studied

[The utilization of anti-infective agents in primary care in La Rioja]. / Utilización de antiinfecciosos en atención primaria en La Rioja.

OBJECTIVE: To analyse the use of drugs to combat infection, prescribed in primary care in the La Rioja area during 1996. DESIGN: A retrospective observational study. SETTING: Primary care. PARTICIPANTS: All the anti-infectious drug prescriptions in primary care during 1996 in our province (450078 units). They are covered by the following therapeutic groups: JO1 (systemic antibiotics), JO3 (systemic chemotherapeutic drugs), JO4A (anti-tubercular), JO5A (antiviral), GO4A (antiseptic and for urinary infections) and RO5C1 (expectorants combining mucolytics and anti-infectious drugs). MEASUREMENTS AND MAIN RESULTS: All the prescriptions for anti-infectious drugs billed in the National Health Service in La Rioja during 1996 were processed. The defined daily dose (DDD) was used as the technical unit of measurement. The DDD per 1000 inhabitants per day (DID) was used as comparative indicator. The DID for the various therapeutic groups was compared with the overall consumption of antibiotics in 1996 in La Rioja. CONCLUSIONS: Non-hospital consumption of anti-infectious drugs during 1996 in La Rioja reached 20.97 DID, which is slightly higher than in other areas. The five therapeutic groups with most prescriptions were: penicillin (8.78 DID), macrolides (4.86 DID), cephalosporins (2.48 DID), quinolones (1.25 DID), antiseptic and urinary anti-infectious drugs (1.11 DID). The new macrolides were used a lot, as were quinolones and third-generation cephalosporins. These last two groups are not first-choice drugs in the empirical treatment of pathologies common in primary care.