Single posterior implant-supported restorations fabricated using a scannable healing abutment versus a conventional scan body: A randomized controlled trial.

STATEMENT OF PROBLEM: The use of a scannable healing abutment is a convenient option for fabricating implant-supported restorations (ISRs) with a digital workflow; however, clinical studies evaluating prosthetic efficacy are lacking. PURPOSE: The purpose of this randomized controlled trial was to investigate the prosthetic efficacy of definitive posterior single ISRs fabricated after scanning using a scannable healing abutment-scan peg (SHA-SP) in comparison with a conventional scan body (CSB). The time for data acquisition, quality of proximal and occlusal contacts, and relative occlusal force of ISRs were measured. MATERIAL AND METHODS: Twenty-four participants eligible for single ISRs to replace the mandibular first molar with adjacent and antagonist teeth present were randomly allocated to either a study group (n=12) receiving ISRs after intraoral scanning using an SHA-SP or a control group (n=12) receiving ISRs after intraoral scanning using CSB. During the surgical procedure, a prefabricated contoured scannable healing abutment was screwed to the implant in the SHA-SP group, while a custom-made healing abutment was used in the CSB group. After a healing period of 3 months, an intraoral scan was made, and the duration of data acquisition was recorded. The ISRs were milled from zirconia and evaluated for the quality of proximal and occlusal contacts using dental floss and shim stock, respectively. The relative occlusal forces of the ISRs and their contralateral natural teeth were measured using a digital occlusal analyzer. Statistical analysis was done using an independent sample t test for quantitative variables and a Pearson chi-squared test for qualitative variables between the tested groups (α=.05). RESULTS: The direct digital workflow using SHA-SP was statistically less time consuming than the CSB (P<.001). The 2 groups were statistically similar regarding the quality of the proximal contacts (P=.281) or occlusal contacts (P=.307) and the relative occlusal forces of ISRs (P=.315). The relative occlusal forces of the ISRs in both groups were significantly lower than those of their contralateral natural teeth (P<.001). CONCLUSIONS: Direct digital workflow using SHA-SP was more rapid, saving clinical chairside time, and produced proximal and occlusal contacts of comparable quality with those obtained with CSB. The relative occlusal forces of ISRs in both workflows were lower than their contralateral natural teeth.

The precision of two alternative indirect workflows for digital model production: an illusion or a possibility?

OBJECTIVE: Despite the clear drive from both research and clinical dentistry toward digital transformation, there are limitations to implementing intra-oral scanning (IOS) into daily dental practice. This study aimed to compare the precision of digital models obtained from two alternative indirect workflows to direct IOS. MATERIAL AND METHODS: Two indirect digital workflows were evaluated in this study. In the IOS group (direct), IOS directly obtained digital impressions of participants' upper and lower dental arches, while in the Scan Impression (Scan Imp) group (indirect), a desktop scanner scanned silicone-based impressions of upper and lower whole arches that were taken with plastic trays. In the cone-beam computed tomography impression (CBCT Imp) group (indirect), a CBCT machine scanned the silicone-based impressions. Then, the precision of the entire arch and individual teeth for all digital impressions was virtually quantified. Following superimposition, differences between standard tessellation language (STL) files obtained from both-direct and indirect-methods were evaluated by color-mapping and measuring the surface distance between superimposed STL files. Furthermore, 18 linear measurements were taken from each digital model. ANOVA with repeated measures, Pearson coefficient, and intraclass correlation coefficient were used for intergroup comparisons. RESULTS: The digital models obtained from the two indirect workflows differed from the IOS in some dental and intra-arch measurements but were considered clinically acceptable. Ranked against IOS, CBCT Imp models had greater precision, followed by Scan Imp. CONCLUSION: Digital models obtained from two indirect, alternative workflows, desktop, and CBCT scanning of impression, have clinically acceptable accuracy and reliability of tooth size and intra-arch measurements, providing the use of proper methodologies. CLINICAL RELEVANCE: There are some limitations to implementing IOS in daily clinical practice. However, several alternative digital model production techniques might provide an affordable solution. Although they may insignificantly differ in accuracy, all can be applied clinically.

Outcomes of bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with two prosthetic techniques: A 1-year randomized clinical trial.

STATEMENT OF PROBLEM: Providing a definitive restoration with an emergence profile matching that of the contralateral or extracted tooth should result in an esthetic peri-implant soft tissue contour. Whether a custom healing abutment improves the outcome of a bio-copied definitive restoration compared with a stock abutment is unclear. PURPOSE: The purpose of this 1-year randomized clinical trial was to evaluate the peri-implant soft and hard tissues related to bio-esthetic single implant-supported restorations having a contralateral tooth-matching restorative emergence profile after peri-implant soft tissue conditioning with either custom or stock healing abutment for patients indicated for immediate implant placement. MATERIAL AND METHODS: Twenty-four participants indicated for immediate implant placement in the maxillary esthetic zone received bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with either a custom healing abutment (n=12) or a stock healing abutment (n=12). The pink and white esthetic score (PES-WES) was evaluated 6 and 12 months after implant placement. Peri-implant bone changes were measured with cone beam computed tomography (CBCT) scans at the same intervals. RESULTS: The PES-WES showed significant difference between the 2 groups at 6 and 12 months. The CBCT scans did not show significant difference between the 2 groups. CONCLUSIONS: The use of the bio-esthetic concept for immediate single implant placement achieved successful esthetic restorations after conditioning the peri-implant tissues using either custom or stock healing abutments. However, the use of custom healing abutments was associated with higher PES-WES values in comparison with the use of stock healing abutments.

Exploiting itraconazole-loaded nanomixed micelles in coated capsules as efficient colon-targeted delivery system for improved antifungal and potential anticancer efficacy.

Chronic Inflammatory bowel diseases are usually accompanied by opportunistic colonic fungal infections. Itraconazole (ITZ), is a highly lipophilic broad-spectrum antifungal drug that is superiorly effective against several fungal species. Box-Behnken design was adopted to design ITZ-nanomixed micelles (ITZ-NMMs), aiming to enhance ITZ solubility, using various concentrations of Pluronic® L121, Cremophor EL, and with either sodium-deoxycholate or Pluronic® F68 through thin film hydration technique. Optimized formula composed of 90 % Pl-L121, 9.1% Cremophor EL, 3.127 % ITZ concentration and SDC as the hydrophilic surfactant and its particle size, Polydispersity index, zeta potential, entrapment efficiency, and release extent after 3 h were found to be 17.82 ± 0.189 nm, 0.26 ± 0.014, -6.72 ± 0.725 mV, 66 ± 7.4%, and 96.3 ± 7.22%, respectively. In vitro ITZ release study implied the ability of optimal ITZ-NMMs to enhance ITZ solubility in comparison to ITZ suspension. Also, augmented anti-fungal and anti-cancer activities were proven as ITZ-NMMs IC50 was 16.5 times that of pure ITZ. Afterwards, lyophilized optimal ITZ-NMMs formula was loaded into Eudragit S100-coated capsules where in vitro release and in vivo X-ray imaging ensured protection of ITZ release in either the stomach or intestine and targeting it to the colon. Such results suggested promising ITZ-NMMs system, capable of enhancing ITZ solubility in the intended target site, therefore, can be used not only in the treatment of colon fungal infections but also augments colon cancer therapy.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Positional transfer accuracy of titanium base implant abutment provided by two different scan body designs: an invitro study.

BACKGROUND: The variabilities in design and material of scan bodies have a major role in the positional transfer accuracy of implants. The purpose of this invitro study was to compare the 3D transfer accuracy (trueness and precision) of titanium base (TB) abutment position provided by 2 different scan bodies: one-piece scan body (SB) in comparison to two-piece healing abutment and scan peg (HA-SP). METHODS: A maxillary model with a dummy implant in the 2nd premolar (Proactive Tapered Implant; Neoss) was 3D printed and TB (Ti Neolink Mono; Neoss) was tightened on the implant and scanned by using a laboratory scanner (inEos X5; Dentsply Sirona) (reference scan). An SB (Elos Medtech) and an HA-SP (Neoss) were subsequently connected to the implant and were scanned 10 times each by using the same scanner (test scans). All the scans were exported as STL files and imported into CAD software where the TBs were formed. Test scans were superimposed on reference scans for transfer accuracy analysis using 3D metrology software (GOM Inspect; GOM GmbH) in terms of angular deviation in vertical and horizontal directions, linear deviation in each XYZ axis of TBs and total linear deviation in all axes. Statistical analysis was done using independent sample t test. When Levene's test for equality of variances was significant, Welch's t-test was used. (P value < 0.05) RESULTS: Significant differences were found amongst the tested groups in both angular and linear deviation in terms of trueness with less deviation values for the SB group (P < 0.001). For the precision, significant differences were found amongst the tested groups in angular deviation in vertical direction with less deviation value for the SB group compared to HA-SP group (P < 0.001). However, no significant difference was found between the tested groups regarding the angular deviation in horizontal direction (P = 1.000). Moreover, significant differences were found amongst the tested groups in linear deviations with less linear deviations in XYZ axes for SB compared to HA-SP group (P = 0.020, < 0.001, = 0.010 respectively). CONCLUSIONS: SB showed less angular and linear deviation values in the 3D positional transfer of TB than HA-SP indicating higher degree of accuracy of SB.

CAD-CAM custom healing abutments: A dental technique.

Custom healing abutments are important in establishing optimal esthetics for prosthesis-driven, implant-supported restorations. This report demonstrates a technique for constructing a custom healing abutment with computer-aided design and computer-aided manufacturing to save chairside time and provide predictable results.

Fabrication of a CAD-CAM custom healing abutment guided by a conventional dental radiograph for delayed loaded dental implants: A dental technique.

This article describes a technique for fabricating a custom anatomic healing abutment for delayed loaded implants by using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology from a polymethyl methacrylate (PMMA) blank. The dimensions of the custom healing abutment are measured from a conventional dental radiograph and diagnostic casts. The healing abutment is used in the second surgical stage to guide soft tissue healing. The resulting soft tissue contour guides the design of the mucosal part of the custom implant abutment.

Screening and identification of gut anaerobes (Bacteroidetes) from human diabetic stool samples with and without retinopathy in comparison to control subjects.

Studies have reported a reciprocal interaction between metabolic disorders and the human gut microbial composition. However, more information is still needed concerning the gut microbiome related to metabolic disorders such as Diabetes. The aim of the present study was to reveal whether stool samples collected from normal individuals and from diabetic subjects with or without retinopathy differ in their gut microbial composition. Data showed higher Bacteroides ratio in diabetic groups gut composition with no significant difference of bacterial strains in diabetic subjects with or without retinopathy compared to lean (control) individuals gut microbiota. These findings indicated that the gut microbiota is altered in accordance to the presence of metabolic disorders. However, further studies have to be elaborated in terms of gut microbial composition with diabetes.

Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

BACKGROUND: Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. METHODS: Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. RESULTS: Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. CONCLUSIONS: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03526731 - on 16 May 2018.

Freeze-Dried Self-Nanoemulsifying Self-Nanosuspension (SNESNS): a New Approach for the Preparation of a Highly Drug-Loaded Dosage Form.

Febuxostat suffers from relatively low bioavailability owing to the poor drug solubility and hepatic first-pass effect. This study aimed to prepare highly drug-loaded self-nanoemulsifying self-nanosuspension systems (SNESNS). SNESNS were designed to improve febuxostat's oral bioavailability by enhancing its solubility. Different oil and surfactant/co-surfactant mixtures were used for the preparation of SNESNS. The prepared SNESNS were estimated for their particle size, in vitro drug release and transmission electron microscopy (TEM). Results revealed that the oil mixture of Capryol™ 90:Miglyol® 812 (1:1 w/w) with surfactant/co-surfactant mixture of Cremophor® RH 40/Transcutol® HP loaded with drug in 4-fold greater concentration than its saturated solubility resulted in the formation of SNESNS by dilution under the effect of magnetic stirring. SNESNS were freeze-dried using trehalose as a cryoprotectant. TEM images and the bimodal particle size curve confirmed the formation of the biphasic nanosystems after dilution (nanoemulsion and nanosuspension). Higher Cmax and AUC0-48 values compared to those of the market product Feburic® tablets confirmed the success of the SNESNS as a promising carrier for drugs suffering from poor water solubility like febuxostat.

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study.

BACKGROUND: Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations. METHODS: 64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase. RESULTS: Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile. CONCLUSION: Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase. TRIAL REGISTRATION: Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.

Development of novel amisulpride-loaded liquid self-nanoemulsifying drug delivery systems via dual tackling of its solubility and intestinal permeability.

OBJECTIVE: The aim of the current investigation was at enhancing the oral biopharmaceutical behavior; solubility and intestinal permeability of amisulpride (AMS) via development of liquid self-nanoemulsifying drug delivery systems (L-SNEDDS) containing bioenhancing excipients. METHODS: The components of L-SNEDDS were identified via solubility studies and emulsification efficiency tests, and ternary phase diagrams were constructed to identify the efficient self-emulsification regions. The formulated systems were assessed for their thermodynamic stability, globule size, self-emulsification time, optical clarity and in vitro drug release. Ex vivo evaluation using non-everted gut sac technique was adopted for uncovering the permeability enhancing effect of the formulated systems. RESULTS: The optimum formulations were composed of different ratios of Capryol™ 90 as an oil phase, Cremophor® RH40 as a surfactant, and Transcutol® HP as a co-surfactant. All tested formulations were thermodynamically stable with globule sizes ranging from 13.74 to 29.19 nm and emulsification time not exceeding 1 min, indicating the formation of homogenous stable nanoemulsions. In vitro drug release showed significant enhancement from L-SNEDDS formulations compared to aqueous drug suspension. Optimized L-SNEDDS showed significantly higher intestinal permeation compared to plain drug solution with nearly 1.6-2.9 folds increase in the apparent permeability coefficient as demonstrated by the ex vivo studies. CONCLUSIONS: The present study proved that AMS could be successfully incorporated into L-SNEDDS for improved dissolution and intestinal permeation leading to enhanced oral delivery.

Development of novel amisulpride-loaded solid self-nanoemulsifying tablets: preparation and pharmacokinetic evaluation in rabbits.

OBJECTIVE: The current investigation is focused on the formulation and in vivo evaluation of optimized solid self-nanoemulsifying drug delivery systems (S-SNEDDS) of amisulpride (AMS) for improving its oral dissolution and bioavailability. METHODS: Liquid SNEDDS (L-SNEDDS) composed of Capryol™ 90 (oil), Cremophor® RH40 (surfactant), and Transcutol® HP (co-surfactant) were transformed to solid systems via physical adsorption onto magnesium aluminometasilicate (Neusilin US2). Micromeretic studies and solid-state characterization of formulated S-SNEDDS were carried out, followed by tableting, tablet evaluation, and pharmacokinetic studies in rabbits. RESULTS: Micromeretic properties and solid-state characterization proved satisfactory flow properties with AMS present in a completely amorphous state. Formulated self-nanoemulsifying tablets revealed significant improvement in AMS dissolution compared with either directly compressed or commercial AMS tablets. In vivo pharmacokinetic study in rabbits emphasized significant improvements in tmax, AUC(0-12), and AUC(0-∞) at p < .05 with 1.26-folds improvement in relative bioavailability from the optimized self-nanoemulsifying tablets compared with the commercial product. CONCLUSIONS: S-SNEDDS can be a very useful approach for providing patient acceptable dosage forms with improved oral dissolution and biovailability.

Nanoparticles as tool for enhanced ophthalmic delivery of vancomycin: a multidistrict-based microbiological study, solid lipid nanoparticles formulation and evaluation.

CONTEXT: A microbiological multidistrict-based survey from different Egyptian governorates was conducted to determine the most prevalent causative agents of ocular infections in the Egyptian population. Antibiotic sensitivity testing was then performed to identify the most potent antimicrobial agent. Vancomycin (VCM) proved the highest activity against gram-positive Staphylococcus bacteria, which are the most commonly isolated causative agents of ocular infection. However, topically applied VCM suffers from poor ocular bioavailability because of its high molecular weight and hydrophilicity. OBJECTIVE: The aim of the present study was to develop VCM-loaded solid lipid nanoparticles (SLNs) using water-in-oil-in-water (W/O/W) double emulsion, solvent evaporation technique to enhance ocular penetration and prolong ophthalmic residence of VCM. METHOD: Two consecutive full factorial designs (2(4) followed by 3(2)) were adopted to study the effect of different formulation and process parameters on SLN formulation. The lipid type and structure, polyvinyl alcohol (PVA) molecular weight and concentration, sonication time, as well as lipid:drug ratio were studied as independent variables. The formulated SLN formulae were evaluated for encapsulation efficiency (EE%), particle size (PS), and zeta potential as dependent variables. RESULTS: The statistically-optimized SLN formula (1:1 ratio of glyceryltripalmitate:VCM with 1% low molecular weight PVA and 1 min sonication time) had average PS of 277.25 nm, zeta potential of -20.45, and 19.99% drug encapsulation. Scanning and transmission electron micrographs showed well-defined, spherical, homogenously distributed particles. CONCLUSION: The present study suggests that VCM incorporation into SLNs is successfully achievable; however, further studies with different nanoencapsulation materials and techniques would be valuable for improving VCM encapsulation.

Acceleration of Alveolar Ridge Augmentation Using a Low Dose of Recombinant Human Bone Morphogenetic Protein-2 Loaded on a Resorbable Bioactive Ceramic.

PURPOSE: The aim of the present study was to evaluate the effect of a porous silica-calcium phosphate composite (SCPC50) loaded with and without recombinant human bone morphogenetic protein-2 (rhBMP-2) on alveolar ridge augmentation in saddle-type defects. MATERIALS AND METHODS: Micro-granules of SCPC50 resorbable bioactive ceramic were coated with rhBMP-2 10 mg and then implanted into a saddle-type defect (12 × 7 mm) in a dog mandible and covered with a collagen membrane. Control groups included defects grafted with SCPC50 granules without rhBMP-2 and un-grafted defects. Bone healing was evaluated at 8 and 16 weeks using histologic and histomorphometric techniques. The increase in bone height and total defect fill were assessed for each specimen using the ImageJ 1.46 program. The release kinetics of rhBMP-2 was determined in vitro. The height of the bone in the grafted defects and the total defect fill were statistically analyzed. RESULTS: SCPC50 enhanced alveolar ridge augmentation as indicated by the increased vertical bone height, bone surface area, and bone volume after 16 weeks. SCPC50-rhBMP-2 provided a sustained release profile of a low effective dose (BMP-2 4.6 ± 1.34 pg/mL per hour) during the 1- to 21-day period. The slow rate of release of rhBMP-2 from SCPC50 accelerated synchronized complete bone regeneration and graft material resorption in 8 weeks. Successful rapid reconstruction of the alveolar ridge by SCPC50 and SCPC50-rhBMP-2 occurred without any adverse excessive bone formation, inflammation, or fluid-filled voids. CONCLUSIONS: Results of this study suggest that SCPC50 is an effective graft material to preserve the alveolar ridge after tooth extraction. Coating SCPC50-rhBMP-2 further accelerated bone regeneration and a considerable increase in vertical bone height. These findings make SCPC50 the primary choice as a carrier for rhBMP-2. SCPC50-rhBMP-2 can serve as an alternative to autologous bone grafting.

Novel delivery approach for ketotifen fumarate: dissofilms formulation using 3² experimental design: in vitro/in vivo evaluation.

Orally dissolving films (dissofilms) have gained increasing popularity and attention due to their ease of administration and avoidance of first pass metabolism. Ketotifen fumarate (KF) bioavailability is reported to be only ~ 50% due to hepatic first-pass metabolism. Aiming to surmount this drawback and improve patients' compliance, a 3(2) full factorial design was applied to formulate KF Orodispersible films, and to investigate the effects and interactions of the concentrations of the novel film former; Lycoat NG73® and the film modifier; maltodextrin (MDX) on the characteristics of the films prepared using solvent casting technique. The dissofilms were thoroughly evaluated regarding their weight uniformity, content uniformity, moisture uptake, in vivo mouth dissolving time (MDT) and their thermal behavior via differential scanning calorimetry. Statistical analysis revealed the significant influence of Lycoat NG73® concentration on percent elongation, percent KF dissolved after 5 min, and in vivo MDT, while MDX concentration had significant effect only on percent elongation. Further, storage of the optimal selected formula (15% Lycoat NG73 and 0% MDX) at 40 °C/75% relative humidity for 12 weeks caused no significant change in appearance, KF content or drug dissolution profile. Pharmacokinetic study revealed that the orally dissolving films showed significantly higher absorption extent than the reference marketed product, while no significant difference was observed for Cmax.

Piezosurgical Buccal Plate Repositioning Technique: A Modified Surgical Approach for the Horizontal Augmentation of Atrophied Mandibles.

PURPOSE: To demonstrate a modified surgical approach for horizontal ridge augmentation that allows for safe manipulation and predictable management of the buccal plate and avoids creation of a secondary surgical site. MATERIALS AND METHODS: This pilot randomized controlled clinical trial included 24 patients who required horizontal alveolar ridge augmentation. Patients were assigned to one of the three groups: Group A was treated with the buccal plate repositioning (BPR) technique and grafted with silica calcium phosphate nanocomposite (SCPC) graft, group B was similarly managed and grafted using demineralized freeze-dried bone allograft (DFDBA), and group C was augmented using mandibular ramus autogenous bone block graft (ABBG). The primary outcome was the coronal crest width, which was measured at 6 months using CBCT. RESULTS: The BPR technique resulted in horizontal augmentation with a mean of 4.30 ± 0.94 mm for group A, showing no significant difference from either group B (4.98 ± 1.13 mm) or group C (3.68 ± 0.27 mm). All augmented ridges allowed for successful implant placement with good primary stability. CONCLUSIONS: The BPR technique resulted in horizontal bone gain in extremely narrow alveolar ridges. It allowed for implant placement in a vascular cancellous bed protected by intact cortical plate. Different types of bone grafts, whether alloplast or allograft, resulted in successful augmentation comparable to that gained from autogenous block grafting.

Effect of curfew from the COVID-19 pandemic on amblyopia treatment in children in Saudi Arabia.

Background: Amblyopia was defined as a reduction in the best-corrected visual acuity in one or both eyes with the presence of amblyogenic factors. Objective: The aim of this work was to investigate the effect of curfews resulting from the COVID-19 pandemic on amblyopia treatment in children. Design: A prospective longitudinal study. Methods: The study was conducted in pediatric ophthalmology clinics at a tertiary hospital in Riyadh, Saudi Arabia. Children aged 3-9 years who underwent amblyopia treatment from September 2020 to May 2021 were recruited. Visual acuity data were collected from the subjects' record files for the first visits prior to the curfew and from the clinics for the second visits after the curfew had ended. Results: A total of 97 children with amblyopia (strabismic, anisometropic, mixed, and visual deprivation) were included. In all, 15 children did not attend the clinic for follow-up visits after the outbreak of COVID-19. The follow-up visits for most of the participants took place 4-5 months after the first visit. No significant difference in visual acuity in the amblyopic eye was found between the first and second visits (p > 0.05). No significant correlation was noted between the baseline difference in visual acuity at the first and second visits and the duration of the amblyopia treatment between the two visits. The adjusted model shows a variation of 0.18% according to the duration between the two visits. Conclusion: The findings showed no significant difference in visual acuity in amblyopic eyes between the first and second visits (before and after the COVID-19 curfew), although visual acuity was clinically improved.

Fabrication and optimization of itraconazole-loaded zein-based nanoparticles in coated capsules as a promising colon-targeting approach pursuing opportunistic fungal infections.

Itraconazole (ITZ), a broad-spectrum antifungal drug, was formulated into colon-targeting system aiming to treat opportunistic colonic fungal infections that commonly infect chronic inflammatory bowel diseases (IBD) patients due to immunosuppressive therapy. Antisolvent precipitation technique was employed to formulate ITZ-loaded zein nanoparticles (ITZ-ZNPs) using various zein: drug and aqueous:organic phase ratios. Central composite face-centered design (CCFD) was used for statistical analysis and optimization. The optimized formulation was composed of 5.5:1 zein:drug ratio and 9.5:1 aqueous:organic phase ratio with its observed particle size, polydispersity index, zeta potential, and entrapment efficiency of 208 ± 4.29 nm, 0.35 ± 0.04, 35.7 ± 1.65 mV, and 66.78 ± 3.89%, respectively. ITZ-ZNPs were imaged by TEM that revealed spherical core-shell structure, and DSC proved ITZ transformation from crystalline to amorphous form. FT-IR showed coupling of zein NH group with ITZ carbonyl group without affecting ITZ antifungal activity as confirmed by antifungal activity test that showed enhanced activity of ITZ-ZNPs over the pure drug. Histopathological examination and cytotoxicity tests ensured biosafety and tolerance of ITZ-ZNPs to the colon tissue. The optimized formulation was then loaded into Eudragit S100-coated capsules and both in vitro release and in vivo X-ray imaging confirmed the success of such coated capsules in protecting ITZ from the release in stomach and intestine while targeting ITZ to the colon. The study proved that ITZ-ZNPs is promising and safe nanoparticulate system that can protect ITZ throughout the GIT and targeting its release to the colon with effectual focused local action for the treatment of colon fungal infections.