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1.
Artigo em Inglês | MEDLINE | ID: mdl-33819324

RESUMO

Numerous surgical techniques for root coverage have been suggested with different degrees of success, as assessed by the proportion of complete root coverage. Mandibular incisors, teeth with a high frequency of gingival recession defects (GRDs), were associated with the least favorable outcomes due to unfavorable anatomical conditions. In the present series of three cases, a modified version of the free gingival graft technique for the purpose of root coverage at mandibular incisors is illustrated. The purpose of the modification of the original technique was to achieve improved blood supply from the recipient site to the graft, with the ultimate aim of enhancing predictability and outcomes of the procedure. In all included cases, complete or almost complete root coverage was achieved at challenging GRDs in the mandibular incisor area.


Assuntos
Retração Gengival , Procedimentos Cirúrgicos Bucais , Tecido Conjuntivo , Gengiva , Retração Gengival/cirurgia , Humanos , Incisivo/cirurgia , Retalhos Cirúrgicos , Raiz Dentária , Resultado do Tratamento
2.
PLoS One ; 16(1): e0245111, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411801

RESUMO

The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.

3.
Clin Oral Implants Res ; 32(3): 314-323, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33340414

RESUMO

OBJECTIVES: The aim of the present study was to evaluate whether clinical findings at implant sites are relevant as screening tests for a history of marginal bone loss. MATERIAL AND METHODS: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically (probing pocket depth (PPD), bleeding on probing (BoP)) and radiographically. A history of bone loss was confirmed through baseline documentation. Diagnostic accuracy was evaluated through receiver operating characteristic curves and multi-level regression analyses. Results were expressed as sensitivity/specificity, area under the curve, and odds ratios. RESULTS: While the sensitivity of PPD in regard to bone loss was low, specificity was generally high. Multi-level modeling revealed that each additional millimeter of PPD corresponded to an additional bone loss of 0.30 mm (95% CI 0.27; 0.33). The sensitivity of BOP in regard to bone loss >2 mm was 80.9% (95% CI 73.9; 86.7), while the specificity was 42.2% (95% CI 39.6; 44.8). CONCLUSIONS: Clinical parameters at implant sites obtained at a single time point were associated with a history of marginal bone loss. While BoP demonstrated a high level of sensitivity, the sensitivity of PPD was generally low. The present data suggest that BoP is a relevant screening test for history of bone loss.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Perda do Osso Alveolar/diagnóstico por imagem , Implantes Dentários/efeitos adversos , Humanos
4.
Clin Oral Implants Res ; 32(3): 297-313, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33340418

RESUMO

OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (a) a history of peri-implant bone loss and (b) the presence of peri-implantitis. MATERIAL & METHODS: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). RESULTS: Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC = 0.96; 95% CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥ 1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC = 0.80; 95% CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss > 0.5 mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss > 2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm (AUC = 0.93; 95% CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥ 1 site & bone level ≥ 3 mm & PPD ≥ 6 mm) was low. CONCLUSIONS: The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥ 2 mm.


Assuntos
Implantes Dentários , Peri-Implantite , Implantes Dentários/efeitos adversos , Humanos , Peri-Implantite/diagnóstico por imagem , Índice Periodontal , Periodontia , Supuração
5.
Clin Oral Implants Res ; 31(11): 1072-1077, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32870513

RESUMO

OBJECTIVES: The aim of the present prospective study was to assess the risk for disease recurrence following surgical therapy of peri-implantitis. MATERIAL & METHODS: 73 patients (130 implants) treated surgically for peri-implantitis were examined at 1 and 5 years after therapy. The primary outcome was recurrence/progression of disease defined as any of the following events: (a) bone loss >1.0 mm, (b) surgical retreatment, (c) implant removal/loss after year 1. Patient- and implant-related parameters as well as 1-year outcomes were evaluated as potential predictors through multiple logistic regression analysis. RESULTS: 57 implants (44%) displayed recurrence/progression of peri-implantitis during follow-up. Among these, 27 implants were removed. Residual deep probing pocket depth (≥6 mm; odds ratio 7.4; 95% confidence interval 2.8-19.3) and reduced marginal bone level (OR 1.4; 95%CI 1.1-1.7) at 1 year after surgery constituted risk factors for recurrence/progression of disease. Furthermore, implants with modified surfaces were at higher risk than implants with non-modified surfaces (OR 5.1; 95%CI 1.6-16.5). CONCLUSION: Implants with (a) residual deep probing pocket depth, (b) reduced marginal bone level, or (c) modified surfaces following surgical therapy of peri-implantitis present with increased risk for recurrence/progression.

6.
Clin Oral Implants Res ; 31(10): 1002-1009, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32794289

RESUMO

OBJECTIVES: The aim was to evaluate the overall occurrence and potential clustering of biological and technical complications in implant dentistry. MATERIAL AND METHODS: 596 patients provided with implant-supported reconstructions were evaluated for the occurrence of (a) technical complications, (b) peri-implantitis and (c) implant loss during a period of 9 years. Time and type of event were scored, and potential risk factors were explored through parametric modelling of survival and hazards. Clustering of complications was assessed at the patient level, and patient satisfaction was evaluated by questionnaire completed at the 9-year examination. RESULTS: 42% of patients were affected by technical and/or biological complications during the 9-year observation period. Extent of therapy (Hazard Ratio 2.5: patients with partial jaw restorations; HR 3.9: patients with full jaw restorations) and a history of periodontitis (HR 1.6) were identified as risk factors. While technical complications occurred mostly as isolated events, 41% of subjects identified with peri-implantitis and 52% of subjects with implant loss also presented with other complications. The hazard for technical complications and implant loss peaked at 0.7 years and 0.2 years, respectively, while the hazard for peri-implantitis was consistent throughout the observation period. The overall proportion of satisfied patients at 9 years was high (95%), and only minor differences between individuals with and without complications were noted. CONCLUSIONS: Complications following implant-supported restorative therapy were common findings. Extent of therapy and periodontitis were identified as risk factors. While technical complications occurred in an isolated pattern, peri-implantitis and implant loss demonstrated clustering with other types of complications.


Assuntos
Perda do Osso Alveolar , Implantes Dentários/efeitos adversos , Peri-Implantite/epidemiologia , Peri-Implantite/etiologia , Periodontite , Análise por Conglomerados , Prótese Dentária Fixada por Implante/efeitos adversos , Humanos
7.
JAMA Netw Open ; 3(6): e205323, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32585017

RESUMO

Importance: Severe early onset fetal growth restriction caused by placental dysfunction leads to high rates of perinatal mortality and neonatal morbidity. The phosphodiesterase 5 inhibitor, sildenafil, inhibits cyclic guanosine monophosphate hydrolysis, thereby activating the effects of nitric oxide, and might improve uteroplacental function and subsequent perinatal outcomes. Objective: To determine whether sildenafil reduces perinatal mortality or major morbidity. Design, Setting, and Participants: This placebo-controlled randomized clinical trial was conducted at 10 tertiary referral centers and 1 general hospital in the Netherlands from January 20, 2015, to July 16, 2018. Participants included pregnant women between 20 and 30 weeks of gestation with severe fetal growth restriction, defined as fetal abdominal circumference below the third percentile or estimated fetal weight below the fifth percentile combined with Dopplers measurements outside reference ranges or a maternal hypertensive disorder. The trial was stopped early owing to safety concerns on July 19, 2018, whereas benefit on the primary outcome was unlikely. Data were analyzed from January 20, 2015, to January 18, 2019. The prespecified primary analysis was an intention-to-treat analysis including all randomized participants. Interventions: Participants were randomized to sildenafil, 25 mg, 3 times a day vs placebo. Main Outcomes and Measures: The primary outcome was a composite of perinatal mortality or major neonatal morbidity until hospital discharge. Results: Out of 360 planned participants, a total of 216 pregnant women were included, with 108 women randomized to sildenafil (median gestational age at randomization, 24 weeks 5 days [interquartile range, 23 weeks 3 days to 25 weeks 5 days]; mean [SD] estimated fetal weight, 458 [160] g) and 108 women randomized to placebo (median gestational age, 25 weeks 0 days [interquartile range, 22 weeks 5 days to 26 weeks 3 days]; mean [SD] estimated fetal weight, 464 [186] g). In July 2018, the trial was halted owing to concerns that sildenafil may cause neonatal pulmonary hypertension, whereas benefit on the primary outcome was unlikely. The primary outcome, perinatal mortality or major neonatal morbidity, occurred in the offspring of 65 participants (60.2%) allocated to sildenafil vs 58 participants (54.2%) allocated to placebo (relative risk, 1.11; 95% CI, 0.88-1.40; P = .38). Pulmonary hypertension, a predefined outcome important for monitoring safety, occurred in 16 neonates (18.8%) in the sildenafil group vs 4 neonates (5.1%) in the placebo group (relative risk, 3.67; 95% CI, 1.28-10.51; P = .008). Conclusions and Relevance: These findings suggest that antenatal maternal sildenafil administration for severe early onset fetal growth restriction did not reduce the risk of perinatal mortality or major neonatal morbidity. The results suggest that sildenafil may increase the risk of neonatal pulmonary hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT02277132.


Assuntos
Peso ao Nascer , Término Precoce de Ensaios Clínicos , Retardo do Crescimento Fetal/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Doenças Placentárias/tratamento farmacológico , Citrato de Sildenafila/uso terapêutico , Adulto , Método Duplo-Cego , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Hipertensão Pulmonar/induzido quimicamente , Recém-Nascido , Doenças do Recém-Nascido/induzido quimicamente , Doenças do Recém-Nascido/prevenção & controle , Análise de Intenção de Tratamento , Masculino , Artéria Cerebral Média/fisiologia , Mortalidade Perinatal , Inibidores da Fosfodiesterase 5/efeitos adversos , Doenças Placentárias/fisiopatologia , Pré-Eclâmpsia/etiologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Fluxo Pulsátil , Citrato de Sildenafila/efeitos adversos , Artérias Umbilicais/fisiologia
8.
FASEB J ; 34(7): 9664-9677, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32502311

RESUMO

Antenatal glucocorticoid therapy reduces mortality in the preterm infant, but evidence suggests off-target adverse effects on the developing cardiovascular system. Whether deleterious effects are direct on the offspring or secondary to alterations in uteroplacental physiology is unclear. Here, we isolated direct effects of glucocorticoids using the chicken embryo, a model system in which the effects on the developing heart and circulation of therapy can be investigated, independent of effects on the mother and/or the placenta. Fertilized chicken eggs were incubated and divided randomly into control (C) or dexamethasone (Dex) treatment at day 14 out of the 21-day incubation period. Combining functional experiments at the isolated organ, cellular and molecular levels, embryos were then studied close to term. Chicken embryos exposed to dexamethasone were growth restricted and showed systolic and diastolic dysfunction, with an increase in cardiomyocyte volume but decreased cardiomyocyte nuclear density in the left ventricle. Underlying mechanisms included a premature switch from tissue accretion to differentiation, increased oxidative stress, and activated signaling of cellular senescence. These findings, therefore, demonstrate that dexamethasone treatment can have direct detrimental off-target effects on the cardiovascular system in the developing embryo, which are independent of effects on the mother and/or placenta.

9.
J Clin Periodontol ; 47 Suppl 22: 155-175, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31889320

RESUMO

OBJECTIVES: To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis. METHODS: Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate. RESULTS: As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS-1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise versus full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups. CONCLUSIONS: Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887.

10.
Clin Oral Implants Res ; 31(2): 192-200, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31838762

RESUMO

OBJECTIVE: To examine the progression of experimental peri-implantitis around different implants placed in augmented and pristine sites. MATERIALS AND METHODS: Six labrador dogs were used. Three months after tooth extraction, four implants with different surface modifications were installed on each side of the mandible. A standard osteotomy was applied on one side, while on the contralateral side the osteotomy was modified, resulting in a gap between the implant and the bone wall. The gap was filled with a bone substitute and covered by a resorbable membrane. Three months after implant installation, implants were exposed and healing abutments were connected. Two months later, oral hygiene procedures were abandoned and a cotton ligature was placed in a submarginal position around the neck of all implants and kept in place for 4 weeks. Following ligature removal, plaque formation continued for 6 months (spontaneous progression period). Radiographs were obtained throughout the experiment, and biopsies were collected and prepared for histological evaluation at the end of the spontaneous progression period. RESULTS: Differences in bone loss during the spontaneous progression period between pristine and augmented sites were small. The size and vertical dimension of the peri-implantitis lesion were larger at augmented than at pristine sites. Implants with non-modified surfaces exhibited smaller amounts of bone loss and smaller dimensions of peri-implantitis lesions than implants with modified surfaces. CONCLUSION: Small differences in spontaneous progression of peri-implantitis were detected between pristine and augmented sites. Implants with modified surfaces exhibited more bone loss and larger lesions than implants with non-modified surfaces, irrespective of the type of surrounding bone.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Animais , Planejamento de Prótese Dentária , Cães , Propriedades de Superfície
11.
Ultraschall Med ; 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31476786

RESUMO

PURPOSE: To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS: Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS: We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION: Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.

12.
J Clin Periodontol ; 46 Suppl 21: 277-286, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31038223

RESUMO

BACKGROUND AND AIMS: Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects. MATERIAL AND METHODS: The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures. RESULTS: A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla. CONCLUSIONS: The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Processo Alveolar , Regeneração Óssea , Transplante Ósseo , Consenso , Implantação Dentária Endo-Óssea
13.
J Clin Periodontol ; 46(8): 872-879, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31077421

RESUMO

OBJECTIVE: The aim of the present study was to assess interventions and their consequences with regard to further bone loss at sites diagnosed with peri-implantitis. MATERIALS AND METHODS: In 2017, records of 70 patients diagnosed with moderate/severe peri-implantitis at ≥1 implant sites 4 years earlier were obtained. Changes of marginal bone levels during the study period assessed on radiographs and predictors of disease progression were identified by Cox regression and mixed linear modelling. Patient files were analysed for professional interventions related to the treatment of peri-implantitis. RESULTS: Mean bone loss (±SD) at implants diagnosed with moderate/severe peri-implantitis was 1.1 ± 2.0 mm over the observation period of 3.3 years. While non-surgical measures including submucosal and/or supra-mucosal cleaning of implants were provided to almost all patients, surgical treatment of peri-implantitis was limited to a subgroup (17 subjects). Surgically treated implant sites demonstrated a mean bone loss of 1.4 ± 2.4 mm prior to surgical intervention, while only minor changes (0.2 ± 1.0 mm) occurred after therapy. Clinical parameters (bleeding/suppuration on probing and probing depth) assessed at diagnosis were statistically significant predictors of disease progression. CONCLUSIONS: Non-surgical procedures were insufficient to prevent further bone loss at implant sites affected by moderate/severe peri-implantitis. Surgical treatment of peri-implantitis markedly diminished the progression of bone loss. Clinical assessments of bleeding on probing and probing depth at diagnosis predicted further bone loss.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Humanos , Índice Periodontal , Sistema de Registros , Estudos Retrospectivos
14.
J Endod ; 45(5): 532-537, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30857675

RESUMO

INTRODUCTION: The aim of the present study was to evaluate endodontic status and diagnosis of teeth before extraction and their impact on treatment planning and treatment outcomes of dental implant therapy. METHODS: Data were retrieved from patient files and radiographs of 596 Swedish individuals provided with implant therapy. Patients were categorized according to diagnosis in conjunction with tooth extraction as follows: PERIO (reason for extraction: periodontitis), CARIES (reason for extraction: caries, apical periodontitis, and/or root fracture), OTHER (reason for extraction: trauma and other), and MIX (a combination of these). Details on treatment planning (timing of implant installation and use of prophylactic antibiotics) and outcomes (early/late implant loss and peri-implantitis) were assessed from patient records or by clinical examination. Tooth status (endodontically treated: yes/no; apical lesion: yes/no) and diagnosis category were explored as independent parameters by logistic regression analyses. RESULTS: For the majority of patients (64%), tooth extraction was based on a caries or caries-related diagnosis. Fifty-one percent of all extracted teeth were endodontically treated. Every third tooth showed radiographic signs of an apical lesion. Immediate implant installation at such sites was less common. Endodontic status before extraction was not associated with the use of antibiotics or with treatment outcomes. The diagnosis category MIX was associated with early implant loss. PERIO was indicative of a higher risk for peri-implantitis. CONCLUSIONS: Endodontic status before extraction had a limited impact on treatment planning and was not associated with early/late implant loss or peri-implantitis. Immediate implant installation after tooth extraction was less commonly performed at sites with apical lesions.


Assuntos
Implantes Dentários , Peri-Implantite , Periodontite Periapical , Implantação Dentária Endo-Óssea , Humanos , Tratamento do Canal Radicular , Suécia
15.
J Clin Periodontol ; 46 Suppl 21: 340-356, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30667523

RESUMO

OBJECTIVES: The present systematic review aimed at evaluating the efficacy of reconstructive surgical therapy at peri-implantitis-related bone defects. METHODS: Studies reporting on outcomes of reconstructive surgery at peri-implantitis-related bone defects at 12 months were identified through an electronic search. Following data extraction, two different sets of meta-analyses were performed. Primarily, controlled studies were used to evaluate the potential benefit of reconstructive surgical therapy over controls. Secondly, overall outcome of reconstructive surgical therapy was assessed by comparing baseline values with outcomes at 12 months. Results were expressed as weighted mean differences (WMD) or risk ratios (RR). Heterogeneity was described by I2 and prediction intervals. RESULTS: The potential benefit of reconstructive techniques over control procedures was evaluated in three studies, representing a total of 116 implants. Altogether, 16 studies reported on the outcome of reconstructive measures at 12 months after surgery. The meta-analyses identified a larger improvement in marginal bone levels (MBL, WMD = 1.7 mm) and in defect fill (WMD = 57%) for test procedures, but found no differences for clinical measures (reduction of probing depth (PD) and bleeding on probing (BOP). Changes of clinical attachment and soft tissue levels were not considered. In terms of overall outcome, therapy resulted in improved MBL (WMD = 2.0 mm) and CAL (WMD = 1.8 mm), in recession (WMD = 0.7 mm), in reduced PD (WMD = 2.8 mm) and in reduced BOP (Implants: RR = 0.4/Sites: RR = 0.2). None of the included studies addressed patient-reported outcome measures. CONCLUSIONS: The available evidence on reconstructive therapy at peri-implantitis-related defects is limited by (a) the low number of controlled studies, (b) the lack of controlled studies for commonly used procedures, (c) the heterogeneity between studies and (d) the choice of outcome measures. A high variability for predicted outcomes at 12 months was noted. The interpretation of the demonstrated larger MBL gain for test procedures is difficult as graft material may not be distinguishable from newly formed bone. Potential aesthetic and patient-reported advantages remain to be demonstrated.


Assuntos
Implantes Dentários , Peri-Implantite , Procedimentos Cirúrgicos Reconstrutivos , Osso e Ossos , Estética Dentária , Humanos
16.
Obstet Gynecol ; 133(1): 129-136, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30531572

RESUMO

OBJECTIVE: To assess the effectiveness of amnioinfusion in women with second-trimester preterm prelabor rupture of membranes. METHODS: We performed a nationwide, multicenter, open-label, randomized controlled trial, the PPROM: Expectant Management versus Induction of Labor-III (PPROMEXIL-III) trial, in women with singleton pregnancies and preterm prelabor rupture of membranes at 16 0/7 to 24 0/7 weeks of gestation with oligohydramnios (single deepest pocket less than 20 mm). Participants were allocated to transabdominal amnioinfusion or no intervention in a one-to-one ratio by a web-based system. If the single deepest pocket was less than 20 mm on follow-up visits, amnioinfusion was repeated weekly until 28 0/7 weeks of gestation. The primary outcome was perinatal mortality. We needed 56 women to show a reduction in perinatal mortality from 70% to 35% (ß error 0.20, two-sided α error 0.05). RESULTS: Between June 15, 2012, and January 13, 2016, we randomized 28 women to amnioinfusion and 28 to no intervention. One woman was enrolled before the trial registration date (June 19, 2012). Perinatal mortality rates were 18 of 28 (64%) in the amnioinfusion group vs 21 of 28 (75%) in the no intervention group (relative risk 0.86, 95% CI 0.60-1.22, P=.39). CONCLUSION: In women with second-trimester preterm prelabor rupture of membranes and oligohydramnios, we found no reduction in perinatal mortality after amnioinfusion. CLINICAL TRIAL REGISTRATION: NTR Dutch Trial Register, NTR3492.


Assuntos
Líquido Amniótico , Ruptura Prematura de Membranas Fetais/terapia , Oligo-Hidrâmnio/terapia , Adulto , Feminino , Ruptura Prematura de Membranas Fetais/mortalidade , Idade Gestacional , Humanos , Recém-Nascido , Infusões Parenterais , Países Baixos , Oligo-Hidrâmnio/mortalidade , Assistência Perinatal , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Análise de Sobrevida , Resultado do Tratamento
17.
Clin Oral Implants Res ; 29 Suppl 18: 152-156, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30306685

RESUMO

OBJECTIVES: This publication reports the EAO Workshop group-2 discussions and consensus statements which provided the scientific evidence on the influence of biological parameters on implant-related clinical outcomes. MATERIAL AND METHODS: The first publication was a systematic review on the biological effects of abutment material on the stability of peri-implant marginal bone levels and the second, a critical narrative review on how peri-implant diagnostic parameters correspond with long-term implant survival and success. The group evaluated the content of both publications, made corrections and recommendations to the authors and agreed on the consensus statements, clinical recommendations and recommendations for future research, which are described in this consensus report. RESULTS: Tested abutment materials can be considered appropriate for clinical use according to the observation period studied (mean 3.5 years). Mean peri-implant bone loss and mean probing pocket depths are not adequate outcomes to study the prevalence of peri-implantitis, while the reporting of frequency distributions is considered more appropriate. CONCLUSIONS: Titanium is currently considered the standard of care as abutment material, although other materials may be more suitable for aesthetic locations. Peri-implantitis should be diagnosed through composite evaluations of peri-implant tissue inflammation and assessment of marginal bone loss with different thresholds.


Assuntos
Perda do Osso Alveolar/psicologia , Implantação Dentária Endo-Óssea , Perda do Osso Alveolar/etiologia , Processo Alveolar/patologia , Dente Suporte/efeitos adversos , Implantação Dentária Endo-Óssea/efeitos adversos , Implantação Dentária Endo-Óssea/métodos , Falha de Restauração Dentária , Humanos , Titânio/efeitos adversos , Titânio/uso terapêutico
18.
Clin Oral Implants Res ; 29 Suppl 18: 157-159, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30306692

RESUMO

OBJECTIVES: This publication reports the EAO Workshop group-2 and consensus plenary discussions and statements on a narrative review providing the background and possible facilities and importance of a dental implant register, to allow for a systematic follow-up of the clinical outcome of dental implant treatment in various clinical settings. It should be observed that the format of the review and the subsequent consensus report consciously departs from conventional consensus publications and reports. MATERIAL AND METHODS: The publication was a narrative review on the presence and significance of quality registers regarding select medical conditions and procedures. The group discussed and evaluated the publication and made corrections and recommendations to the authors and agreed on the statements and recommendations described in this consensus report. RESULTS: Possible registrations to be included in an implant register were discussed and agreed as a preliminary basis for further development, meaning that additional parameters be included or some be deleted. CONCLUSIONS: It was agreed to bring the idea of an implant quality register, including the presented results of discussions and proposals by the group- and plenary sessions, to the EAO Board for further discussion and decision.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Sistema de Registros , Implantação Dentária Endo-Óssea/normas , Implantação Dentária Endo-Óssea/estatística & dados numéricos , Implantes Dentários/normas , Implantes Dentários/estatística & dados numéricos , Humanos
19.
Hypertension ; 72(4): 971-978, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30354714

RESUMO

Integrating functional and molecular levels, we investigated the effects of maternal treatment with a xanthine oxidase inhibitor on the programming of cardiac dysfunction in adult offspring using an established rat model of hypoxic pregnancy. Female Wistar rats were divided into normoxic or hypoxic (13% O2) pregnancy±maternal allopurinol treatment (30 mg kg-1 d-1). At 4 months, hearts were isolated from 1 male per litter per outcome variable to determine cardiac function and responses to ischemia-reperfusion in a Langendorff preparation. Sympathetic dominance, perfusate CK (creatine kinase) and LDH (lactate dehydrogenase) and the cardiac protein expression of the ß1-adrenergic receptor, the M2 Ach receptor (muscarinic type-2 acetylcholine receptor), and the SERCA2a (sarcoplasmic reticulum Ca2+ ATPase 2a) were determined. Relative to controls, offspring from hypoxic pregnancy showed elevated left ventricular end diastolic pressure (+34.7%), enhanced contractility (dP/dtmax, +41.6%), reduced coronary flow rate (-21%) and an impaired recovery to ischemia-reperfusion (left ventricular diastolic pressure, area under the curve recovery -19.1%; all P<0.05). Increased sympathetic reactivity (heart rate, +755.5%; left ventricular diastolic pressure, +418.9%) contributed to the enhanced myocardial contractility ( P<0.05). Perfusate CK (+431%) and LDH (+251.3%) and the cardiac expression of SERCA2a (+71.4%) were also elevated ( P<0.05), further linking molecular markers of cardiac stress and injury to dysfunction. Maternal allopurinol restored all functional and molecular indices of cardiac pathology. The data support a link between xanthine oxidase-derived oxidative stress in hypoxic pregnancy and cardiac dysfunction in the adult offspring, providing a target for early intervention in the developmental programming of heart disease.


Assuntos
Alopurinol/farmacologia , Insuficiência Cardíaca , Hipóxia , Contração Miocárdica/fisiologia , Complicações na Gravidez , Sistema Nervoso Simpático , Animais , Inibidores Enzimáticos/farmacologia , Feminino , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/prevenção & controle , Testes de Função Cardíaca , Hipóxia/tratamento farmacológico , Hipóxia/metabolismo , Masculino , Estresse Oxidativo , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/metabolismo , Ratos , Receptor Muscarínico M2/metabolismo , Receptores Adrenérgicos beta/metabolismo , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/metabolismo , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologia , Xantina Oxidase/antagonistas & inibidores
20.
PLoS One ; 13(8): e0201063, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30138355

RESUMO

OBJECTIVE: To evaluate the long-term neurodevelopmental and behavioral outcome of antenatal allopurinol treatment during suspected fetal hypoxia. STUDY DESIGN: We studied children born from women who participated in a randomized double-blind placebo controlled multicenter study (ALLO-trial). Labouring women in whom the fetus was suspected to have fetal hypoxia were randomly allocated to receive allopurinol or placebo. At 5 years of age, the children were assessed with 2 parent reported questionnaires, the Ages and Stages Questionnaire (ASQ) and the Child Behavior Checklist (CBCL). A child was marked abnormal for ASQ if it scored below 2 standard deviation under the normative mean of a reference population in at least one domain. For CBCL, a score above the cut-off value (95th percentile for narrowband scale, 85th percentile for broadband scale) in at least one scale was marked as abnormal. RESULTS: We obtained data from 138 out of the original 222 mildly asphyxiated children included in the ALLO-trial (response rate 62%, allopurinol n = 73, placebo n = 65). At 5 years of age, the number of children that scored abnormal on the ASQ were 11 (15.1%) in the allopurinol group versus 11 (9.2%) in the placebo group (relative risk (RR) 1.64, 95% confidence interval (CI): 0.64 to 4.17, p = 0.30). On CBCL 21 children (30.4%) scored abnormal in de allopurinol group versus 12 children (20.0%) in the placebo group (RR 1.52, 95% CI: 0.82 to 2.83, p = 0.18). CONCLUSION: We found no proof that allopurinol administered to labouring women with suspected fetal hypoxia improved long-term developmental and behavioral outcome. These findings are limited due to the fact that the study was potentially underpowered. TRIAL REGISTRATION: NCT00189007 Dutch Trial Register NTR1383.


Assuntos
Alopurinol/administração & dosagem , Comportamento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/efeitos dos fármacos , Hipóxia Fetal/tratamento farmacológico , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/prevenção & controle , Pré-Escolar , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Método Duplo-Cego , Feminino , Hipóxia Fetal/complicações , Seguimentos , Depuradores de Radicais Livres/administração & dosagem , Humanos , Trabalho de Parto , Masculino , Gravidez
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