A Surgical Approach to Root Coverage and Correction of Mucogingival Conditions and Deformities in Mandibular Incisors with Isolated Gingival Recession: Free Mucogingival Graft. A Pilot Prospective Cohort Study.

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla.

[The double helix model of DNA: Its impact on biology and medicine 70 years after its initial publication]. / El modelo de la doble hélice del ADN: su impacto en biología y medicina a 70 años de su publicación inicial.

The 70th anniversary of the publication of the double helix model for the structure of deoxyribonucleic acid has oppened the opportunity for reflections and to debate the specific role of each of the original protagonists. Here we review how this discovery has lead to our current medical knowledge and practice, and discuss what we think were the actual contributions of each of these scientists.

El 70 aniversario de la publicación del modelo de doble hélice para la estructura del ácido desoxirribonucleico abre la oportunidad de reflexionar y debatir el papel específico de cada uno de los protagonistas originales. Aquí revisamos las consecuencias de este descubrimiento en nuestro conocimiento y práctica médica actuales, y discutimos lo que creemos que fueron las contribuciones reales de cada uno de estos científicos.

NeuroSuites: An online platform for running neuroscience, statistical, and machine learning tools.

Nowadays, an enormous amount of high dimensional data is available in the field of neuroscience. Handling these data is complex and requires the use of efficient tools to transform them into useful knowledge. In this work we present NeuroSuites, an easy-access web platform with its own architecture. We compare our platform with other software currently available, highlighting its main strengths. Thanks to its defined architecture, it is able to handle large-scale problems common in some neuroscience fields. NeuroSuites has different neuroscience-oriented applications and tools to integrate statistical data analysis and machine learning algorithms commonly used in this field. As future work, we want to further expand the list of available software tools as well as improve the platform interface according to user demands.

Polyoxidovanadates as a pharmacological option against brain aging.

The world population is aging rapidly, and chronic diseases associated are cardiometabolic syndrome, cancer, and neurodegenerative diseases. Oxidative stress and inflammation are typical hallmarks in them. Polyoxidovanadates (POVs) have shown interesting pharmacological actions against chronic diseases. This work aimed to evaluate the POV effect on hippocampal neuroinflammation, redox balance, and recognition memory in the aging of rats. Rats 18 months old were administered a daily dose of sodium metavanadate (MV), decavanadate (DV), Metformin (Metf), or MetfDeca for two months. Results showed that short-term and long-term recognition memory improved by 28 % and 16 % (DV), 19 % and 20 % (Metf), and 21 % and 27 % (MetfDeca). In hippocampi, reactive oxygen species, IL-1ß, and TNF-α, after DV, Metf, and MetfDeca decreased at similar concentrations to young adult control, while lipid peroxidation substantially ameliorated. Additionally, superoxide dismutase and catalase activity increased by 41 % and 42 % (DV), 39 % and 41 % (Metf), and 75 % and 73 % (MetfDeca). POV treatments reduced Nrf2 and GFAP immunoreactivity in CA1 (70-87.5 %), CA3 (60-80 %), and DG (57-89 %). Metformin treatment showed a minor effect, while MV treatment did not improve any parameters. Although DV, Metf, and MetfDeca treatments showed similar results, POVs doses were 16-fold fewer than Metformin. In conclusion, DV and MetfDeca could be pharmacological options to reduce age-related neuronal damage.

Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study.

PURPOSE: The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. METHODS: Twenty patients (stage III-IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. RESULTS: GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. CONCLUSIONS: PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.

Apical approach to the treatment of peri-implantitis in the esthetic zone: nonincised papillae surgical approach (NIPSA). Case reports.

OBJECTIVE: Advanced peri-implantitis treatment is a clinical challenge. Reconstructive surgery is not suggested in defects with limited bony walls and/or in those with a suprabony defect. All studies of peri-implantitis reconstructive surgery have considered a marginal surgical approach. However, in the present case report, a new apical approach is presented for the reconstruction of an advanced peri-implantitis lesion. MATERIALS AND METHOD: First, a non-surgical phase combines prosthetic, mechanical, and chemical strategies. Second, a surgical phase combines the apical nonincised papillae surgical approach (NIPSA) with biomaterials and a connective tissue graft. CONCLUSION: Successful results have been obtained when using a NIPSA for the treatment of peri-implantitis, despite the unfavorable characteristics of the peri-implant defect.

Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial.

OBJECTIVES: This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue. MATERIAL AND METHODS: Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post-surgery, and supra-alveolar attachment gain (SUPRA-AG) was recorded at 1 year post-surgery. RESULTS: At 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05). CONCLUSIONS: NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue. CLINICAL RELEVANCE: NIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT04712630.

Preliminary Results of a Minimally Invasive Microsurgical Approach to Sinus Floor Elevation and Bone Reconstruction Using a Palatal Septum Window.

The aim of this case report was to present the preliminary results of a novel microsurgical approach to sinus floor elevation and bone augmentation. This technique was used to treat four patients in whom an implant could not be placed in the maxillary first molar position because of insufficient bone height. The maxillary first molar was extracted, and a sinus access window was created in the palatal area of the bony interradicular septum. The sinus membrane with the palatal septum fragment was elevated, and the sinus space between and above the roots was filled with xenograft. Alveolar preservation was done with xenograft and a nonresorbable membrane. Bone augmentation was evaluated 6 months after preservation by computed tomography and histology; clinical, radiologic, and histologic bone reconstruction were seen, allowing placement of implants. The novel approach utilized in this study demonstrated positive preliminary results in bone reconstruction with reduced morbidity.

Papilla preservation periodontal surgery in periodontal reconstruction for deep combined intra-suprabony defects. Retrospective analysis of a registry-based cohort.

BACKGROUND: Suprabony defects are the most prevalent defects and there is very little evidence on their treatment. This study aims to assess the effectiveness of papilla preservation periodontal surgery in the periodontal reconstruction of combined deep intra-suprabony defects. MATERIAL AND METHODS: 20 patients with combined intrabony and supra-alveolar deep periodontal defects treated by papilla preservation periodontal surgery were analyzed. Defects were treated with enamel matrix derivate plus xenograft. Clinical recordings made before surgery and at 12 months. RESULTS: Papilla preservation periodontal surgery showed significant PPD reduction (4.4 ± 1.46 mm; p<0.001), clinical attachment gain (3.35 ± 1.6 mm; p<0.001), increased REC (1.05 ± 0.94; p<0.001), papilla apical displacement (0.85 ± 1.31 mm; p<0.005) and KT reduction (0.5 ± 0.76 mm; p<0.05). At one week, there was incomplete wound closure and necrosis in 40% and 30% of the treated sites, respectively. At one year, the intrabony component filling was 73.65 ± 27.6 % and the supra-alveolar attachment gain indicated an incomplete intrabony defect resolution (-0.15 ± 1.56 mm). CONCLUSIONS: Periodontal pocket was significantly reduced and the level of clinical attachment increased. However, there was significant recession of the gingival margin and the papilla and a trend to incomplete resolution of the intrabony component. Key words:Periodontitis, surgical flaps, reconstructive surgery, regeneration.

Laterally rotated flap for soft tissue augmentation around maxillary loaded osseointegrated dental implants: preliminary results of a pilot study.

A minimal width and thickness of keratinized and attached soft tissue is desirable to prevent peri-implant diseases. This report describes the preliminary results of a pilot study of a surgical approach for soft tissue augmentation around loaded dental implants in the partially or totally edentulous maxilla. Four patients presenting eight maxillary implants with a buccal peri-implant soft tissue deficiency received a laterally rotated flap. A buccal mesial and apical recipient area was created around each implant, and a pediculated keratinized graft was rotated 90° from the distopalatal and positioned and sutured on the peri-implant buccal aspect. All implants treated showed a gain in buccal clinical peri-implant attachment (1.37 ± 0.44 mm) and buccal soft tissue levels (2.06 ± 1.40 mm) and interproximal soft tissue levels (1 ± 0.75 mm). The technique provided quality soft tissue with a gain in soft tissue thickness (3.06 ± 0.68 mm) and keratinized wide tissue (4.69 ± 0.80 mm) with minimal morbidity (1575 ± 549.67 mg of ibuprofen) and maintenance of prosthetic loading. Peri-implant soft tissue stability was maintained for 13.5 ± 1.87 months. Laterally rotated flap can be applied and provide clinical benefits to compromised implants due to the presence of buccal peri-implant soft tissue deficiency. Further studies are required to confirm these preliminary results.

Immediate Post-Extraction Short Implant Placement with Immediate Loading and without Extraction of an Impacted Maxillary Canine: Two Case Reports.

For the treatment of impacted maxillary canines, traction associated with a complete orthodontic treatment is the first choice in young patients. However, in adults, this treatment has a worse prognosis. The surgical extraction of the impacted tooth can result in a series of complications and a compromised alveolar bone integrity, which may lead to the requirement of a bone regeneration/grafting procedure to replace the canine with a dental implant. These case reports aimed to describe an alternative treatment procedure to the surgical extraction of impacted maxillary canines in adults. Following clinical and computerized tomography-scan (CT-Scan) examination, the possibility of maintaining the impacted canine in its position and replacing the temporary canine present in its place with a dental implant was planned. A short dental implant with an immediate provisional crown was placed, without contacting the impacted canine. At 3 months follow-up, a definitive metal-ceramic restoration was placed. Follow-up visits were performed periodically. The implant site showed a physiological soft tissue color and firmness, no marginal bone loss, no infection or inflammation, and an adequate aesthetic result in all follow-up visits. These results suggest that the treatment carried out is a valid option to rehabilitate with an osseointegrated short implant area where a canine is included, as long as there is a sufficient amount of the remaining bone.

Clinical and Immunological Factors That Distinguish COVID-19 From Pandemic Influenza A(H1N1).

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although COVID-19 has been extensively characterized clinically, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, and a histological pattern of alveolar pneumonia in pandemic influenza A(H1N1) patients. Conversely, dry cough, gastrointestinal symptoms and interstitial lung pathology were observed in COVID-19 cases. Pandemic influenza A(H1N1) was characterized by higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163. Meanwhile, COVID-19 displayed an immune profile distinguished by increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1ß, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3. Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against pandemic influenza A(H1N1). Furthermore, we demonstrated the diagnostic potential of some clinical and immune factors to differentiate both diseases. These findings might be relevant for the ongoing and future influenza seasons in the Northern Hemisphere, which are historically unique due to their convergence with the COVID-19 pandemic.

Non-Incised Papilla Surgical Approach and Leukocyte Platelet-Rich Fibrin in Periodontal Reconstruction of Deep Intrabony Defects: A Case Series.

We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.

Connective Tissue Grafts with Nonincised Papillae Surgical Approach for Periodontal Reconstruction in Noncontained Defects.

This case report presents the preliminary results of combining a modification of the nonincised papillae surgical approach (NIPSA), attempting to improve outcomes in the treatment of teeth with advanced periodontal support loss. The modification added a connective tissue graft (CTG) in the buccal aspect of these unfavorable cases caused by deep buccal bone dehiscence, soft tissue deficiencies, or tooth malposition (especially when positioned outside the bony contour). Deep, intrabony, noncontained defects affecting the maxillary incisors were treated in four patients. At the 1-year follow-up, all cases showed an improvement in the marginal soft tissue with considerable reductions in periodontal pocket depth and gains in clinical attachment. NIPSA plus CTG seem to improve clinical outcomes in deep, noncontained intrabony defects.

Peripheral Giant Cell Granuloma Associated With Periodontal Intrabony Defect.

INTRODUCTION: The peripheral giant cell granuloma (PGCG) is associated with periodontal bony lesions in several situations and excision results in a soft papilla defect and an intrabony defect without soft tissue protection. CASE PRESENTATION: A PGCG associated with loss of periodontal support is described. Following the lesion excision, a specific flap design outlining a surgical papilla in the adjacent area was proposed. The aim of this flap design was to obtain an optimal condition for periodontal regeneration, to treat the lesion excision associated with soft tissue defect, and to avoid a second surgical area. Complete periodontal defect resolution without soft tissue contraction or lesion recurrence was obtained at 2-year follow-up. CONCLUSION: Early diagnosis and treatment are essential to prevent greater loss of periodontal attachment.

Endogenous stimulation is responsible for the high frequency of IL-17A-producing neutrophils in patients with rheumatoid arthritis.

BACKGROUND: Neutrophils play an important role in the pathogenesis of rheumatoid arthritis (RA). It has recently been reported that in addition to T helper (Th) 17 cells, other cells, including neutrophils, produce IL-17A, an important inflammatory cytokine involved in the pathogenesis of RA. The purpose of this study was to examine the presence of interleukin 17A-producing neutrophils in patients with RA. METHODS: We performed a cross-sectional study including 106 patients with RA and 56 healthy individuals. Whole peripheral blood cells were analyzed by flow cytometry to identify CD66b+ CD177+ IL-17A+ neutrophils and CD3+ CD4+ IL-17A+ T cells. Serum levels of IL-17A and IL-6 were measured by means of cytometry bead array (CBA). In purified neutrophils, mRNA levels of IL-17 and RORγ were measured by RT-PCR. In addition, purified neutrophils from patients and healthy controls were stimulated with the cytokines IL-6 and IL-23 to evaluate differences in their capacity to produce IL-17A. RESULTS: Neutrophils from RA patients expressed IL-17 and RORγ mRNA. Consequently, these cells also expressed IL-17A. Serum IL-17A levels but not Th17 cell numbers were increased in RA patients. Neutrophils positive for cytoplasmic IL-17A were more abundant in patients with RA (mean 1.2 ± 3.18%) than in healthy individuals (mean 0.07 ± 0.1%) (p < 0.0001). Although increased IL-17A+ neutrophil numbers were present in RA patients regardless of disease activity (mean 6.5 ± 5.14%), they were more frequent in patients with a more recent diagnosis (mean time after disease onset 3.5 ± 4.24 years). IL-6 and IL-23 induced the expression of RORγ but failed to induce IL-17A expression by neutrophils from RA patients and healthy individuals after a 3 h stimulation. CONCLUSION: IL-17A-producing neutrophils are increased in some RA patients, which are not related to disease activity but have an increased frequency in patients with recent-onset disease. This finding suggests that IL-17A-producing neutrophils play an early role in the development of RA.

Supra-alveolar attachment gain in the treatment of combined intra-suprabony periodontal defects by non-incised papillae surgical approach.

AIM: To assess the effectiveness of non-incised papillae surgical approach (NIPSA) in periodontal reconstructive surgery of combined intra-suprabony defects. MATERIALS AND METHODS: Patients with deep periodontal defects treated with NIPSA (n = 20) were analysed. Defects were treated with enamel matrix derivative plus xenograft. Clinical outcomes were assessed before surgery and at 12 months. Wound closure was assessed one week post-surgery. Supra-alveolar attachment gain (SUPRA-AG) was recorded at 12 months post-surgery. RESULTS: Non-incised papillae surgical approach showed significant improvements in clinical attachment gain (5.9 ± 2.38 mm; p < 0.001), recession reduction (0.25 ± 0.44; p < 0.05) and tip of the papillae coronal displacement (0.4 ± 0.5; p < 0.05). It also showed complete wound closure of the apical mucosal incision in the 85% of the cases, with no interproximal tissue necrosis. SUPRA-AG (1.9 ± 1.74) showed a positive tendency, associated with complete intrabony defect resolution. CONCLUSIONS: Non-incised papillae surgical approach promoted primary intention healing, wound stability and space provision for optimal periodontal reconstruction, preserving supra-alveolar soft tissue integrity.

Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non-incised papillae surgical approach (NIPSA): A retrospective cohort study.

BACKGROUND: The objective of this study was to compare a minimally-invasive surgical technique (MIST) and a non-incised papilla surgical approach (NIPSA) in periodontal reconstructive surgery of deep intraosseous defects. METHODS: Data on 30 patients with a deep intraosseous defect treated with MIST (n = 15) or NIPSA (n = 15) were analyzed retrospectively. All patients met the same inclusion criteria and were treated following the same protocol, except for the surgical management of soft tissue (MIST versus NIPSA). Clinical parameters at baseline and at 1-year post-surgery, early healing at 1 week, and postoperative pain were assessed. RESULTS: NIPSA and MIST resulted in significant clinical attachment gain (CAG) (P < 0.001) and probing depth reduction (PDr) (P < 0.001) at 1-year post-surgery. However, NIPSA resulted in significantly lower recession of the tip of the interdental papilla compared with MIST (P < 0.001). Smoking negatively influenced early healing in both techniques (P < 0.05). CONCLUSIONS: NIPSA and MIST both resulted in significant improvements in clinical parameters. NIPSA showed significant soft tissue preservation. NIPSA may represent a promising papillae preservation technique in the treatment of intraosseous periodontal defects.

Nonincised Papillae Surgical Approach (NIPSA) in Periodontal Regeneration: Preliminary Results of a Case Series.

A new surgical approach has been developed to optimize the preservation of the gingival margin and papillae when treating periodontal defects. The flap is raised by one mucosal incision far away from the marginal tissues. This case series reports on the effectiveness of a nonincised surgical approach (NIPSA) in conjunction with a hydroxyapatite-based graft biomaterial and enamel matrix derivative in treating intrabony defects. Ten defects in 10 patients were treated. The follow-up period ranged from 6 to 18 months (mean: 10.8 ± 4.7 months). Probing pocket depth was 9.6 ± 2.3 mm before surgery and 2.3 ± 0.5 mm postsurgery. Clinical attachment level (CAL) decreased from 10.4 ± 2.7 mm to 3.1 ± 0.87 mm postsurgery. The gingival papilla height, keratinized tissue width, and buccal gingival margin remained stable over time. No wound dehiscence was recorded. Mean Early Healing Index was 1.5 ± 0.7. Results show a substantial CAL gain, limited postsurgical shrinkage, minimal morbidity, and early healing.

Mejora de la gestión de las consultas externas hospitalarias mediante la cita automática directa de interconsultas / Improvement of the management of outpatient consultations by a direct automatic citation of interconsultations

Fundamentos: La demora originada para proporcionar una cita y la incertidumbre del tiempo previsto de espera, son causa de descontento en los pacientes. El objetivo de este trabajo fue mejorar la accesibilidad a la consulta de atención especializada en nuestra área de salud, disminuyendo el tiempo medio de espera y reducir el número de reclamaciones por este motivo. Métodos: Para medir la calidad del servicio prestado, se elaboraron 5 criterios que se evaluaron inicialmente mediante un corte transversal, en diciembre de 2015, en todos los pacientes pendientes de cita en el Área. Así mismo se cuantificaron las quejas y reclamaciones recogidas los 6 meses anteriores a esta fecha. Como intervención, se diseñó e implementó un nuevo circuito en el proceso interconsulta, protocolizando un sistema directo y automático de citación. Este sistema eliminaba además los pacientes sin cita, permitiendo la priorización en los casos preferentes. Al final de 2016 se realizó una nueva medición con la misma metodología. Para el análisis estadístico se han usado la t de Student y la Chi cuadrado. Resultados: En seis meses se redujo el número de pacientes sin cita de 4.726 a 0. El tiempo medio de espera en consultas externas pasó de 63 a 44,2 días. Los pacientes en espera de más de 50 días pasaron del 41,5% al 74,8%. El número de quejas y reclamaciones debidas a cita en consultas externas pasó de 161 a 80. Conclusiones: Ha mejorado la accesibilidad al disminuir el tiempo de espera media y se ha eliminado la lista de pacientes sin cita, si bien ha aumentado el número de pacientes pendientes de cita de más de 50 días. Se ha reducido a la mitad el número de quejas y reclamaciones

Background: The delay caused to provide an appointment and the uncertainty of the expected waiting time, are cause for discontent in the patients. The object of this work was to improve the accessibility to the consultation of specialized attention in our health area, decreasing the average waiting time and reduce the number of claims for this reason. Methods: To measure the quality of the service provided, 5 criteria were developed and evaluated, by means of a cross section, in December 2015 for all patients pending appointment in the Area. Likewise, the complaints and claims collected during the 6 months prior to this date were quantified. As an intervention, a new circuit was designed and implemented in the interconsultation process, protocolizing a direct and automatic citation system. This system also eliminated patients without an appointment, allowing prioritization in preferred cases. At the end of 2016, a new evaluation was made with the same methodology. For the statistical analysis, Student's t and Chi-square were used. Results: In six months the number of patients without appointment was reduced from 4726 to 0. The average waiting time for external consultations improved from 63 to 44.2 days. Patients waiting more than 50 days increased from 41.5% to 74.8%. The number of complaints and claims due to appointment in external consultations decreased from 161 to 80. Conclusions: Accessibility has improved by reducing the average waiting time and eliminating the list of patients without an appointment, although the number of patients pending appointments for more than 50 days has increased. The number of complaints and claims has been halved