Short implants (<8mm) versus longer implants (≥8mm) with lateral sinus floor augmentation in posterior atrophic maxilla: A meta-analysis of RCT`s in humans.

BACKGROUND: One of the greatest challenges that dentists face today is to rehabilitate severe atrophied alveolar ridges in partially and completely edentulous patients with implants. Despite the high survival rate of implants placed next to sinus elevation, this technique presents complications that can be avoided by placing short implants, an option that also presents high survival rates. For this reason, the aim of this study is to compare the survival rate, marginal bone loss and complications associated with short implants (<8 mm) versus longer implants (≥8mm) placed with lateral sinus floor elevation in posterior atrophic maxillae. MATERIAL AND METHODS: A literature search was conducted by two independent reviewers in the PubMed/Medline (National Library of Medicine, Washington, DC) electronic database for articles published from January 2007 to July 2018. Seven qualified articles were selected for the meta-analysis. RESULTS: The test for overall effect did not find statistical significance in the survival rates, overall complications, intra-operative complications, post-operative complications and prosthetic complications. However, the test showed statistically significant differences in biological complications in favor of standard implants, and marginal bone loss between control and test groups in favor of short implants (<8mm) was found. CONCLUSIONS: Within the limitations of the present study, prosthetic rehabilitations with short implants (<8mm) in posterior maxilla is a reliable treatment option as an alternative to lateral wall sinus floor augmentation.

Osseoinductive elements around immediate implants for better osteointegration: a pilot study in foxhound dogs.

OBJECTIVE: The aim of this study was to evaluate the effects on osseointegration of topical applications of melatonin vs. vitamin D over surfaces of immediate implants. MATERIALS AND METHODS: Mandibular premolar distal roots (P2 , P3 , P4 ) were extracted bilaterally from six American Foxhound dogs. Three conical immediate implants were randomly placed bilaterally in each mandible. Three randomized groups were created: melatonin 5% test group (MI), vitamin D 10% test group (DI), and Control group implants (CI). Block sections were obtained after 12 weeks and processed for mineralized ground sectioning. Bone-to-implant contact (total BIC), new bone formation (NBF), inter-thread bone (ITB), and histological linear measurements (HLM) were assessed. RESULTS: At 12 weeks, all implants were clinically stable and histologically osseointegrated. Total BIC values were 49.20 ± 3.26 for the MI group, 49.86 ± 1.89 for DI group and 45.78 ± 4.21 for the CI group (P < 0.018) with statistically significant difference between the three groups. BIC percentage were 42.44 ± 2.18 for MI, 44.56 ± 1.08 for DI, and 41.95 ± 3.34 for CI groups respectively (P > 0.05). Inter-thread bone formation values were MI 17.56 ± 2.01, for DI 19.87 ± 0.92, and CI 14.56 ± 1.24 (P > 0.05). Statistically significant differences in peri-implant new bone formation were found between the three groups: MI 28.76 ± 1.98, DI 32.56 ± 1.11 and CI 25.43 ± 4.67, respectively (P < 0.045). Linear measurements showed that the MI group showed significantly less lingual crestal bone loss (CBL) (MI 0.59 ± 0.71), compared to DI (0.91 ± 1.21) and CI (0.93 ± 1.21) (P < 0.042), and less lingual peri-implant mucosa (PIM) (MI 3.11 ± 1.34),(DI 3.25 ± 0.18 compared with CI 3.54 ± 1.81 (P = 0.429). Linear measurements of buccal CBL showed significantly less buccal bone loss in test DI (0.36 ± 0.12) than CI (1.34 ± 1.23) and MI (1.11 ± 1.38) (P = 0.078). CONCLUSIONS: Within the limitations of this animal study, topical applications of 5% Melatonin or 10% vitamin D improved bone formation around implants placed immediately after extraction and helped to reduce CBL after 12 weeks osseointegration.

Do topical applications of bisphosphonates improve bone formation in oral implantology? A systematic review.

BACKGROUND: The aim of this systematic literature review was to evaluate the feasibility of topical bisphosphonate application for preserving/enhancing alveolar bone in oral implantology. MATERIAL AND METHODS: An electronic search was conducted in the PubMed/Medline, EMBASE, Scopus, Web of knowledge, and Google-Scholar databases for articles dated from January 2000 to December 2016. Two reviewers assessed the quality of the studies independently. RESULTS: A total of 154 abstracts were identified, of which 18 potentially relevant articles were selected; a final total of nine papers were included for analysis. Comparison of the findings of the selected studies was made difficult by the heterogeneity of the articles, all of them animal research papers that showed heterogeneity in the methodologies used and a high or moderate risk of bias. CONCLUSIONS: The topical application of bisphosphonate solution would appear to favor new bone formation in alveolar defects, and boosts the regenerative capacities of biomaterials resulting in increased bone density.

Osseoinductive elements for promoting osseointegration around immediate implants: a pilot study in the foxhound dog.

OBJECTIVE: The aim of this study was to evaluate the effects of topical applications of melatonin over implant surfaces placed immediately after extraction by means of histological and histomorphometric analysis of peri-implant tissues. MATERIAL AND METHODS: Six American foxhound dogs were used in the study; mandibular premolar distal roots were extracted. Thirty-six immediate conical implants were randomly assigned to the distal site on each site of the mandible in three groups: (Group CI) 12 titanium implants alone; (Group MI) 12 titanium implants supplemented with melatonin; and (Group DI) 12 titanium implants supplemented with vitamin D (DI). Prior to implanting test, implants (MI) were submerged in melatonin 5% solution, and implants from (DI) group were submerged in vitamin D 10% solution. No treatment was applied at control implants. After 12 weeks, animals were sacrificed. Block sections were obtained and processed for mineralized ground sectioning. Bone-to-implant contact (total BIC), new bone formation (NBF), inter-thread bone (ITB) and histological linear measurements (HLM) were analyzed. RESULTS: At 12 weeks, all implants were clinically stable and histologically osseointegrated. Total BIC values were 48.36 ± 7.45* for the MI group and 44.82 ± 10.98 for the CI group (P = 0.035) with statistically significant difference between groups. BIC% were 41.36 ± 3.93 for MI and 41.34 ± 9.26 for CI (P > 0.05). Inter-thread bone formation values were MI 15.99 ± 2.43* and CI 14.79 ± 3.62 (P = 0.03), MI showing significantly better results. No statistically significant differences in peri-implant new bone formation could be found between the two groups: MI 25.37 ± 2.32, CI 26.55 ± 7.75 (P > 0.05). Linear measurements showed that the MI group showed significantly less lingual crestal bone loss (CBL) (MI 0.52 ± 0.74*, CI 0.92 ± 1.98) (P = 0.045) and less lingual peri-implant mucosa (PIM) (MI 3.13 ± 1.41*, CI 3.71 ± 1.81) (P = 0.042). No significant differences were observed in the buccal aspect. CONCLUSIONS: Within the limitations of this animal study, the topical application of melatonin improved bone formation around immediate implants and reduced lingual bone and lingual peri-implant mucosa, after 12 weeks of osseointegration.

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.

Customized birthweight standards for a Spanish population.

OBJECTIVE: To analyse the biological factors affecting birthweight and to derive customized birthweight standards for a Spanish population. METHODS: A retrospective cohort was created with all the singleton pregnancies delivered at term and free of pathology in our Institution. Birthweight was modeled by multiple linear regression from maternal (ethnic origin, maternal height, booking weight, smoking, and parity), and fetal (gender, gestational age) characteristics. RESULTS: In addition to gestational age and sex, height, booking weight, ethnic origin, parity, and smoking all have significant and independent effects on birthweight. Women from East-Asia, Morocco and South-America had newborns on average 83 g, 74 g and 95 g heavier than White-European Spanish women. The effect of smoking was found to be dose-related. CONCLUSION: We found the relative effect of the maternal and fetal characteristics to be very similar to that reported in previous studies. We report coefficients for ethnic groups that account for a sizeable proportion of the population composition of several European countries.

Association of smoking during pregnancy and fetal growth restriction: subgroups of higher susceptibility.

OBJECTIVE: To analyze the association between maternal smoking and fetal growth restriction, defined as a failure to achieve the growth potential, and to define subgroups of higher susceptibility for this association. STUDY DESIGN: A definition of growth restriction by customized birthweight standards applied to 13,661 non-malformed singleton deliveries. Customization was performed by maternal ethnic origin, height, booking weight, parity, gestational age at delivery and fetal gender. The adjusted risk of smoking for customized smallness-for-gestational age and the identification of subgroups with higher susceptibility were assessed by logistic regression. RESULTS: Overall, the adjusted odds ratio of smoking (all levels of exposure grouped) for the occurrence of growth restriction was 1.9 (95% confidence interval: 1.69-2.13). Smoking was etiologically responsible for 13.9% (95% confidence interval: 11.2-16.5) of the cases of growth restriction occurring in the population. Smoking resulted in an increasingly greater risk of growth restriction with progressive levels of cigarette consumption. The risk of smoking for fetal growth restriction was significantly greater in older women and those with a previous history of spontaneous preterm delivery. CONCLUSIONS: Smoking is associated with a higher risk for growth restriction. In addition, older pregnant women and those with a previous history of preterm delivery have an increased susceptibility.

Low-dose cyclosporine and mycophenolate mofetil in renal allograft recipients with suboptimal renal function.

BACKGROUND: Cyclosporine (CsA) nephrotoxicity can be identified by functional changes and chronic renal damage. CsA-associated renal fibrosis has been related to the overproduction of transforming growth factor (TGF)-beta1, a fibrogenic cytokine. Mycophenolate mofetil (MMF) may allow CsA dose reduction without increasing the risk of rejection. METHODS: We studied the impact of CsA dose reduction in association with MMF on renal function and TGF-beta1, production in 16 long-term renal allograft recipients with suspected CsA nephrotoxicity. Two grams/day of MMF were introduced, and CsA dose was reduced to reach whole-blood levels between 40 and 60 ng/ml within 1 month. CsA dose and levels, renal function parameters, and platelet-poor plasma TGF-beta1 levels were evaluated before and 6 months thereafter. RESULTS: MMF allowed a decrease in both the mean dose of CsA (3.8+/-1.35 vs. 2.2+/-0.73 mg/kg/day; P<0.01) and CsA levels (148+/-36 vs. 53+/-19 ng/ml; P<0.001). The reduction of CsA was associated with a decrement of serum creatinine levels (210+/-46 vs. 172+/-41 micromol/L; P<0.001) and an increase in both the glomerular filtration rate (32.9+/-12 vs. 39.1+/-14 ml/min/1.73 m2; P<0.02) and renal plasma flow (195+/-79 to 218.6+/-74.02 ml/min/1.73 m2; P<0.02). There was a reduction in plasma TGF-beta1 levels (4.6+/-4.2 vs. 2.0+/-1.4 ng/ml; P=0.003) and CsA levels correlated with TGF-beta1 (r=0.536, P=0.002). No rejection episodes occurred, and an improvement in both systolic (149+/-13 vs. 137+/-12 mmHg; P<0.01) and diastolic blood pressure (89+/-14 vs. 83+/-10 mmHg; P<0.04) were observed. CONCLUSIONS: These short-term results show that MMF introduction allows a CsA dose reduction, which improves renal function, reduces TGF-beta1 production, and improves the control of hypertension, without increasing the incidence of acute rejection.

Introduction of heteroatom-based substituents into 1,4-dihydropyridines by means of a halogen-mediated, oxidative protocol: diamination, sulfonylation, sulfinylation, bis-sulfanylation, and halo-phosphonylation processes

The natural tendency of 1,4-dihydropyridines to undergo "biomimetic" oxidation to afford pyridinium salts can be switched off and, through the use of reagents that interact electrophilically with the enamine moiety present in the heterocyclic system, it is possible to promote alternative oxidations. In this way, efficient regio- and stereocontrolled synthetic methods have been developed that lead to diversely substituted di- and tetrahydropyridines. These include iodoazidation, diamination, bis-sulfonamidation, sulfonylation, sulfinylation, thiocyanation, sulfanylation, bis-sulfanylation, and halo-phosphonylation processes.

Prevalence of human immunodeficiency virus in an infertile population.

OBJECTIVE: To assess the prevalence of human immunodeficiency virus (HIV) antibody in infertility. DESIGN: Prospective cross-sectional blind study. SETTING: An infertility clinic in Barcelona. PATIENTS: Three hundred thirty-five consecutive patients (308 infertile women and 27 spontaneous recurrent aborters) were seen between January 1989 and May 1990. MAIN OUTCOME MEASURE: Human immunodeficiency virus serostatus. RESULTS: The rate of seropositivity in the group of patients studied was 0.3% (95% confidence interval 0% to 0.9%). CONCLUSION: Further studies are desirable to establish the value of routine HIV testing in infertility patients as a population of women actively seeking pregnancy.

The prevalence of cocaine abuse during pregnancy in Barcelona.

The aim of our study was to determine the prevalence of cocaine abuse, by means of positive urine toxicology screens or targeted questionnaire, among women in labor at our hospital. The prospective study included 1773 women who delivered consecutively in our institution. All of them underwent a standardized questionnaire including drug use and demographic data. Urine samples were obtained during labor. Urine toxicology screens for cocaine and its metabolites, opiates, and ethanol were performed by enzyme multiplied immunoassay technique. Information was coded in order to maintain anonymity. Among the 1773 women in labor we screened, the mean age was 27.8 years and the overall prevalence of a positive questionnaire for cocaine was 0.3% and a positive urine toxicology was 0.8%. Results by drug and by demographic items are analysed. There was a substantial denial of cocaine use among the toxicologically positive patients, since only 43% of them referred its use at any time during pregnancy, in conclusion, the use of illicit drugs is common among pregnant women in our institution, but cocaine does not seem to be as prevalent as it is in the USA, while in the labor room most women with a positive test do not refer the use of the drug. Urine toxicology screening increases the rate of detection of substance abuse in this population of women. These studies are necessary to target educational programs among pregnant women.

Massive metastases from a lobular breast carcinoma from an unknown primary during pregnancy. A case report.

BACKGROUND: Carcinoma of the breast during pregnancy represents 2-5% of all breast cancers. The frequency and histopathologic spectrum of breast cancer are similar in pregnant and nonpregnant women. Infiltrating lobular carcinoma is one of the less understood types of breast cancer, and its metastatic pattern seems to be different from that of infiltrating ductal carcinoma. Breast neoplasms rarely present as cancer from an unknown primary site. CASE: A woman in the third trimester of pregnancy developed carcinoma massively metastatic to the bone marrow and liver from an unknown primary tumor. At 32 weeks' gestation a healthy male was delivered by cesarean section. The patient died 12 hours after delivery. The autopsy revealed an infiltrating lobular carcinoma, 1.5 cm, of the breast. CONCLUSION: Massive metastases from an occult lobular breast carcinoma in a pregnant woman are very rare. Diffuse metastatic spread, which often complicates or delays the diagnosis, is a characteristic pattern of infiltrating lobular carcinoma. Cancer from an unknown primary site during pregnancy is an exceptional finding. If a metastatic adenocarcinoma is diagnosed in a pregnant woman, a breast primary should be strongly suspected.

[Prevalence of bacterial vaginosis in an obstetric population of Barcelona]. / Prevalencia de vaginosis bacteriana en una población obstétrica de Barcelona.

OBJECTIVES: To investigate the prevalence and risk factors of bacterial vaginosis (BV) in a pregnant population of Barcelona (Spain). MATERIAL AND METHODS: 301 pregnant women controlled in the Hospital Clinic i Provincial (HCP) of Barcelona were enrolled in the study. Complete epidemiological information, and vaginal samples were available in 293 women. BV was diagnosed by Gram stain of vaginal smear (Nugent's criteria). RESULTS: BV was detected in 22 pregnant women (7.5%; 95% CI: 4.6-10.5%). There was no association between race, parity, education, marital status, smoking and drug use, and the presence of BV. Non-use of birth control method (72.3% vs 34.4%; p < 0.0001), presence of sexually transmitted diseases (STD) during pregnancy (22.7% vs 3.7%; p < 0.0001), HIV seropositivity (13.6% vs 2.9%; p = 0.041) and presence of symptoms of vaginitis (40.9% vs 13.3%; p = 0.009) were significantly associated with the presence of BV. CONCLUSIONS: The prevalence of BV in a pregnant population of Barcelona (Spain) is 7.5%. Further work is needed to evaluate the usefulness of BV as a prescreening marker for STD and HIV infection. The Gram stain provides an inexpensive, fast and easy method to diagnose BV, and may allow us to screen, treat and prevent the morbidity and mortality associated with it.

[Seroprevalence of toxoplasmosis in women of childbearing age, 1992-1999].

UNLABELLED: To determine the need of prenatal screening for toxoplasmosis in our hospital from a seroepidemiological point of view. PATIENTS AND METHODS: The prevalence of IgG anti-T. gondii was retrospectively analyzed in 7.090 women of childbearing age attended in the Hospital Clínic of Barcelona from February 1992 to April 1999. The association among the seroprevalence and the variables year, age, birthplace (province of Barcelona/other provinces) and place of residence (urban/rural) was analyzed. A decreasing trend was observed in the prevalence (p < 0.001), currently being < 40% in the average women between 15 and 45 years. Infection was also directly related to age of women (p < 0.001) and birthplace out of the province of Barcelona (p = 0.001). Habitat (rural or urban) was not associated with seroprevalence. Prenatal screening for toxoplasmosis is necessary due to the high rate of seronegative women exposed to infection and the evidence of a high number of primoinfections in the childbearing period.

[Analysis of a case of severe congenital toxoplasmosis]. / Análisis de un caso de toxoplasmosis congénita grave.

BACKGROUND: To describe a case of severe congenital toxoplasmosis because of inadequate surveillance of a seronegative pregnant woman and to evaluate the usefulness of different microbiological diagnostic methods after birth. METHODS: We applied serology, DNA amplification by one-tube semi-nested PCR, cell culture and mice inoculation analysis. RESULTS: Anti. T. gondii serology was useful for the diagnosis of congenital toxoplasmosis. PCR analysis of neonate cerebrospinal fluid and peripheral blood were positive, and yielded negative results after a few days of specific treatment. Cellular culture and mice inoculation yielded negative results. CONCLUSIONS: Our results suggest that serology and PCR are useful methods for the diagnosis of toxoplasmosis in newborns. Prenatal toxoplasmosis screening and suitable follow up of the seronegative pregnant women are necessary to prevent cases of severe infection in our area.

[Determinants of HIV mother-to-child transmission in Catalonia, Spain [1997-2001]: is it possible to eliminate it?]. / Determinantes de la transmisión vertical del VIH en Cataluña (1997-2001): ¿es posible su eliminación?

OBJECTIVES: To identify and describe the factors that have led to new cases of HIV infection through mother-to-child transmission since the introduction of antiretroviral therapy in HIV-seropositive pregnant women (1997-2001) in Catalonia. METHODS: Systematic review of cases identified in the pediatric services of all the hospitals in Catalonia. RESULTS: Twenty-eight cases of pediatric HIV infection were identified: 9, 9, 8, 2 and 0 per year of birth from 1997 to 2001, respectively. Of 16 mothers with a diagnosis of known HIV infection before or during pregnancy, nine underwent antiretroviral prophylaxis during pregnancy (compliance was good in five, unknown in one and poor in one) and seven did not undergo prophylaxis (six refused it and no information was available in one). Of 12 mothers diagnosed after delivery, pregnancy was not monitored in five and was little or well-monitored in the remaining seven. Of mothers with well-monitored pregnancy, a serological HIV test was not performed in six and was negative in the first trimester in one. CONCLUSIONS: Mother-to-child transmission of HIV has decreased in the last few years in Catalonia, but infections have sometimes occurred through poor implementation of preventive measures. Pregnant women should be offered an HIV diagnostic test not only in the first trimester but also at the end of pregnancy if HIV exposure is suspected. In women with unmonitored pregnancies, rapid diagnostic tests for HIV should be used in the delivery room.

Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction.

OBJECTIVES: To evaluate the characteristics and association with perinatal outcome of the aortic isthmus (AoI) circulation as assessed by Doppler imaging in preterm growth-restricted fetuses with placental insufficiency. METHODS: This was a prospective cross-sectional study. Fifty-one fetuses with intrauterine growth restriction (IUGR) and either an umbilical artery (UA) pulsatility index (PI) > 95(th) centile or a cerebroplacental ratio < 5(th) centile were examined at 24-36 weeks' gestation. AoI impedance indices (PI and resistance index) and absolute velocities (peak systolic (PSV), end-diastolic and time-averaged maximum (TAMXV) velocities), were measured in all cases and compared with reference ranges by gestational age. Furthermore, fetuses were stratified into two groups according to the direction of the diastolic blood flow in the AoI: those with antegrade flow (n = 41) and those with retrograde flow (n = 10). Clinical surveillance was based on gestational age and Doppler assessment of the UA, middle cerebral artery and ductus venosus (DV). Adverse perinatal outcome was defined as stillbirth, neonatal death and severe morbidity (respiratory distress syndrome, bronchopulmonary dysplasia, Grade III/IV intraventricular hemorrhage, necrotizing enterocolitis and a neonatal intensive care unit stay > 14 days). RESULTS: Adverse perinatal outcome was significantly associated with an increased AoI-PI (area under the curve 0.77; 95% CI, 0.63-0.92; P < 0.005). A significant correlation (P < 0.001) was found between retrograde blood flow in the AoI and adverse perinatal outcome, the overall perinatal mortality being higher in the retrograde group (70% vs. 4.8%, P < 0.001). In 4/5 (80%) fetuses the reversal of flow in the AoI preceded that in the DV by 24-48 h. AoI-PSV and AoI-TAMXV were < 5(th) centile in 40/51 (78%) and 48/51 (94%) cases, respectively, whereas AoI-PI was > 95(th) centile in 21/51 (41%) cases. CONCLUSIONS: Retrograde flow in the AoI in growth-restricted fetuses correlates strongly with adverse perinatal outcome. Absolute velocities in the AoI are decreased in growth-restricted fetuses. The data suggest a potential role for Doppler imaging of the AoI in the clinical surveillance of fetuses with severe IUGR, which should be confirmed in larger prospective studies.