Phalangeal microgeodic syndrome: case report of a young woman treated with pentoxifylline.

Phalangeal microgeodic syndrome (PMS) is a rare osteolytic disorder of unknown etiology that typically affects children up to 15 years old during colder months. Transient peripheral circulatory impairment probably underlines its pathogenesis. Conservative treatment with eviction of cold exposure is often successful. We report the case of a young woman presenting with joint pain in her feet, along with toe discoloration and redness, where a diagnosis of PMS was established based on magnetic resonance imaging findings and exclusion of other differential diagnostic entities. Pharmacological treatment was deemed necessary for symptomatic relief, but a trial of calcium channel blocker (CCB) was not tolerated by the patient. The patient was then started on pentoxifylline, with significant clinical improvement.

Volumetric analysis on the use of customized healing abutments with or without connective tissue graft at flapless maxillary immediate implant placement: A randomized clinical trial.

OBJECTIVES: To evaluate buccal volume change after using a customized healing abutment with or without connective tissue grafts (CTG) in flapless maxillary immediate implant placement (IIP). MATERIALS AND METHODS: The present study was designed as a randomized clinical trial (RCT). Patients treated with flapless maxillary IIP were allocated into two groups, both receiving a customized healing abutment, and additionally, the test group received a CTG. A cone-beam computerized tomography (CBCT) allowed to access the initial buccal bone thickness (BT). Digital impressions were taken prior to extractions (T0), 1 month (T1), 4 months (T2), and 12 months (T3) after implant insertion and superimposed with computer software allowing to compute variables related to buccal volume variation (BVv) and total volume variation (TVv) (ClinicalTrials.gov: NCT05060055). RESULTS: Thirty-two patients (mean age 48 ± 11 years), sixteen in each group, were evaluated after a 12-month period. After 1 year of treatment, no significant differences were found between groups, although in participants with BT ≤1 mm, control and test groups showed a BVv of -14.18 ± 3.49% and -8.30 ± 3.78%, respectively (p = .033). Regarding mucosa height variation variables, the control group showed approximately the triple vertical recession in both papillae. CONCLUSIONS: The placement of a CTG was not capable of completely maintaining the initial peri-implant tissue architecture, although in thin-bone phenotypes, less dimensional changes are expected when a CTG was used.

RS3PE syndrome: Autoinflammatory features of a rare disorder.

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome was first described by McCarty in 1985 and is characterized by pitting oedema and an acute symmetrical synovitis of small joints. Self-directed inflammation in autoimmune disorders is caused by an abnormal activation of the adaptive immune system, while in autoinflammatory disorders, it is due to aberrant activation of the innate immune system without autoantibodies or autoreactive T cells. The role of autoimmunity in the pathogenesis of RS3PE syndrome is suggested by possible associations with some autoimmune diseases and human leukocyte antigen (HLA) haplotypes. However, several other features point to a possible role of autoinflammation in RS3PE syndrome. In this review, the relative contributions of both innate and adaptive immune systems to the pathogenesis of RS3PE syndrome are discussed.

Periimplant bone changes in different abutment heights and insertion timing in posterior mandibular areas: Three-year results from a randomized prospective clinical trial.

AIM: To compare the influence of the abutment height and its insertion timing on the marginal bone change (MBC) variation of implants placed at posterior mandibular partial edentulous areas in a medium follow-up period. MATERIAL AND METHODS: This randomized clinical trial (RCT) comprised a sample of patients with posterior mandibular edentulous areas, treated with at least two implants and distributed into three groups: implants connected to a 2 mm height abutment during the surgical stage (Group A); implants connected to a 1 mm height abutment during the surgical stage (Group B); and implants connected to a 2 mm height abutment after 2 months (Group C). Clinical and radiographic measurements were performed during a 36-month period (T4). The MBC was set as the main variable in study. Statistical significance was set at 0.05. RESULTS: A total of 29 subjects and 59 implants were enrolled in this study. A mean MBC of 0.35 ± 0.46 mm, 0.60 ± 0.81 mm, and 0.71 ± 0.90 mm was computed for groups A, B and C, respectively, at T4. Significant differences were found between groups A and C in terms of MBC variation after 3 years of treatment (p = .048). Multiple linear regression analysis showed a significant influence of the first-year MBC and the abutment insertion timing has independent predictor variables for the MBC assessed at T4. CONCLUSION: The installation of 2-mm prosthetic abutments, at the time of implant placement, in areas with limited keratinized mucosa presents as a favorable treatment option in terms of periimplant marginal bone maintenance.

IgG4-related disease: How to place it in the spectrum of immune-mediated and rheumatologic disorders?

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that results from massive expansion of polyclonal IgG4-switched B and/or plasma cells. It can virtually affect all organs and its diagnosis relies on clinical, serological and histopathological criteria. The role of autoimmunity and adaptive immune system in IgG4-RD is reflected in plasmablast differentiation, germinal center formation and IgG4 production induced by CD4+ cells expressing CD40 ligand. IgG4-RD has been considered to be a Th2/Treg-driven disorder, but follicular helper T cells are important in driving the IgG subclass switch. Prompt clinical responses to rituximab, human leukocyte antigen (HLA) associations and the presence of autoantibodies also point to the importance of adaptive immune system. However, innate immunity may induce storiform fibrosis through T-cell independent responses as a consequence of toll-like receptors activation by microbe-and damage-associated molecular patterns, while macrophages and basophils also appear to have a significant role in IgG4-RD pathogenesis. Allergic mechanisms may drive IgG4-RD, but only a subgroup has elevated IgE serum levels and peripheral eosinophilia. Finally, the 2012 revised Chapel Hill Consensus Conference nomenclature pointed IgG4-RD as a cause of large-vessel vasculitis. This review aims to discuss how to place IgG4-RD in the spectrum of immune-mediated and rheumatologic disorders.

New insights in cryoglobulinemic vasculitis.

Cryoglobulins are antibodies that precipitate at low temperatures and dissolve after rewarming. Cryoglobulinemia refers to the presence of circulating cryoglobulins and generally leads to a systemic inflammatory syndrome characterized by fatigue, arthralgia, purpura, ulcers, neuropathy and/or glomerulonephritis. The disease mainly involves small to medium-sized blood vessels and causes vasculitis due to cryoglobulin-containing immune complexes. Cryoglobulinemia is classified into three types (I, II and III) on the basis of immunoglobulin composition. Predisposing conditions include lymphoproliferative, autoimmune diseases and hepatitis C virus infection. The diagnosis of cryoglobulinemic syndrome is predominantly based on the presence of clinical features and laboratorial demonstration of serum cryoglobulins. The treatment strategy depends on the cause of cryoglobulinemia. For patients with chronic HCV infection, antiviral therapy is indicated. Immunosuppressive or immunomodulatory therapy, including steroids, plasmapheresis and cytotoxic agents, is reserved for organ-threatening manifestations. In this review, we discuss the main clinical presentations, diagnostic approach and treatment options.

Influence of the abutment height and connection timing in early peri-implant marginal bone changes: A prospective randomized clinical trial.

AIM: The aim of this study was to compare the influence of the abutment height and insertion timing on early marginal bone loss (MBL) in posterior mandibular partial implant-supported restorations. MATERIAL AND METHODS: The study was planned as a prospective, randomized, controlled parallel group including subjects in need of at least two implants for the restoration of an edentulous posterior mandibular area. The patients were allocated into Groups A (implants immediately connected to 2-mm height abutments), B (immediately connected 1-mm height abutments), and C (2-mm abutments were inserted in a second-stage surgery). Each subject was placed in a 1-year follow-up program, including examination assessment of various soft tissue and bone-level parameters. RESULTS: A total of thirty-three patients, including sixty-eight implants, were enrolled in this study. One implant was lost on group C after the first month of healing. A mean MBL change of 0.719 ± 0.361, 0.651 ± 0.379, and 0.754 ± 0.672 mm was computed for groups A, B, and C, respectively, with no significant differences found. The early MBL at T1 was an independent predictor variable for the marginal bone alterations that were assessed at T3 (p < 0.001). CONCLUSION: The first-month MBL variation is a predictor factor of the bone alterations that might occur after 1 year of treatment. The early connection of final prosthetic abutments with distinct heights does not seem to reduce the 1-year MBL rate when compared with traditional treatment protocols.

The influence of customized abutments and custom metal abutments on the presence of the interproximal papilla at implants inserted in single-unit gaps: a 1-year prospective clinical study.

OBJECTIVES: To assess and compare the papilla presence mesially and distally to dental implants restored with customized abutments and custom metal abutments in the anterior maxilla. MATERIAL AND METHODS: Thirty-eight patients receiving 38 single-tooth implants, restored with 26 customized abutments and 12 custom metal abutments in the anterior maxillary region were enrolled in this study. The cases where did not existed contact point were excluded. Presence/absence of the interproximal papilla, inter-tooth-implant distance (ITD) and distance from the base of the contact point to dental crest bone of adjacent tooth (CPB) were accessed. Global P-values were determined for changes in CPB and papilla score over time (P < 0.05). RESULTS: Thirty-six patients with 36 implants were available for the 12-month follow-up. The abutments and reconstruction survival rate was 100% with no fracture or crown loss. A mean mesial CPB of 5.71 ± 1.54 mm and distal CPB of 4.01 ± 1.73 mm were assessed in the customized abutment group for an overall mean papilla presence of 1.69 ± 0.46. A mean mesial CPB of 5.41 ± 1.31 mm and distal CPB of 4.77 ± 1.21 mm were assessed in the control group for an overall mean papilla presence of 1.08 ± 0.65. CONCLUSIONS: The restoration of single-implants using computer-assisted design/computer-assisted manufacturing abutments appears to help maintaining a regular papillary filling although the variations of the implant positioning or the restoration/teeth relation.

Statistical analysis of teeth autotransplantation in Portugal's region of Chaves.

AIM: The aim of this study was to evaluate the success rate of 33 transplanted teeth in a northern population of Portugal. METHODS: The mean follow-up period was 7 years, ranging from 6 months to 20 years. RESULTS: Six teeth (18%) were rated as unsuccessful, 52% of the donor teeth were transplanted to receptor alveolus after immediate exodontia and 24% were transplanted to receptor alveolus surgically prepared. From the total number of cases, 64% had open root apex at the time of the transplantation and, in the latest control, of all teeth root development was over in 55%. Teeth ankylosis was present in 38% of all cases and 58% of all 33 transplants presented pulpar vitality. Data shows that, in males, teeth transplanted into natural alveolus were non-ankylosed, with normal color and vital teeth with incomplete root development at the time of the surgery. All cumulative curves obtained showed no statistical significance, mainly due to the low number of unsuccessful teeth autotransplantations. Orthodontic treatment performed after tooth autotransplantation showed success in 15% of all cases. CONCLUSION: Data reconfirms that autotransplantation of teeth is, in selected patients, the best option to replace a missing tooth in young patients.

The Use of Tissue Grafts Associated with Immediate Implant Placement to Achieve Better Peri-Implant Stability and Efficacy: A Systematic Review and Meta-Analysis.

Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: "For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p < 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).

System interoperability and data linkage in the era of health information management: A bibliometric analysis.

Background: Across the world, health data generation is growing exponentially. The continuous rise of new and diversified technology to obtain and handle health data places health information management and governance under pressure. Lack of data linkage and interoperability between systems undermines best efforts to optimise integrated health information technology solutions. Objective: This research aimed to provide a bibliometric overview of the role of interoperability and linkage in health data management and governance. Method: Data were acquired by entering selected search queries into Google Scholar, PubMed, and Web of Science databases and bibliometric data obtained were then imported to Endnote and checked for duplicates. The refined data were exported to Excel, where several levels of filtration were applied to obtain the final sample. These sample data were analysed using Microsoft Excel (Microsoft Corporation, Washington, USA), WORDSTAT (Provalis Research, Montreal, Canada) and VOSviewer software (Leiden University, Leiden, Netherlands). Results: The literature sample was retrieved from 3799 unique results and consisted of 63 articles, present in 45 different publications, both evaluated by two specific in-house global impact rankings. Through VOSviewer, three main clusters were identified: (i) e-health information stakeholder needs; (ii) e-health information quality assessment; and (iii) e-health information technological governance trends. A residual correlation between interoperability and linkage studies in the sample was also found. Conclusion: Assessing stakeholders' needs is crucial for establishing an efficient and effective health information system. Further and diversified research is needed to assess the integrated placement of interoperability and linkage in health information management and governance. Implications: This research has provided valuable managerial and theoretical contributions to optimise system interoperability and data linkage within health information research and information technology solutions.

Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. DATA SOURCE: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, 'In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?' The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. CONCLUSION: This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Comparative Clinical Behavior of Zirconia versus Titanium Dental Implants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. Methods: This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran's Q-test and Higgins' I2 statistic. Results: Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference (p > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 (p > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr (p > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) (p < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months (p < 0.001). Conclusions: The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up.

Panniculitis: A Cardinal Sign of Autoinflammation.

Panniculitis was first described in the nineteenth century and is characterized by inflammation of the subcutaneous fat. It may be categorized in septal or lobular subtypes, but other histopathological features (e.g., presence of vasculitis, nature of inflammatory infiltrates, characteristics of fat necrosis) are also important for diagnostic purposes. Clinically, panniculitis is characterized by the presence of subcutaneous nodules, and both ulcerative and nonulcerative clinical subtypes have been proposed. In this review, we aimed to describe the occurrence of panniculitis in autoinflammatory disorders (AIDs) and related diseases. Among monogenic AIDs, panniculitis is common in IFN-mediated disorders. Panniculitis is a distinctive feature in proteasome-associated autoinflammatory syndromes (PRAAS), including chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome and Nakajo-Nishimura syndrome. On the other hand, erythema nodosum corresponds to the most common clinical form of panniculitis and is common in polygenic AIDs, such as Behçet's syndrome, inflammatory bowel disease, and sarcoidosis. Cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia are rare disorders that may also present with inflammation of the subcutaneous fat. Therefore, panniculitis can identify a specific subgroup of patients with AIDs and may potentially be regarded as a cardinal sign of autoinflammation.

The Influence of History of Severe Periodontitis on Estimated Long-Term Marginal Bone Loss around Implants Restored with Fixed Segmented Full-Arch Rehabilitation.

The aim of this study was to analyze the long-term marginal bone level (MBL) of implants supporting fixed full-arch restoration in patients who had previously lost their dentition due to severe periodontitis. This retrospective study included 35 patients in whom 342 implants with internal tapered conical connections were placed. MBL was analyzed radiographically over time and a long-term estimation of MBL was calculated. A mixed linear model with abutment height, graft, diameter and location (maxilla/mandible) as factors and gender, age, implant length and prosthetic variables as covariates was used to evaluate the influence on MBL. MBL in these patients showed an estimator of predictions at 4108 days after loading of -0.307 mm, SE = 0.042. Only 0.15% of implants were radiographically affected with MBL of 3 mm or more. The mixed linear model results showed a main effect of the type of opposing dentition, gender, implant diameter, and abutment height. Particularly, an abutment height of 1 mm had associated larger MBL than the remaining heights. Thus, it can be concluded that dental implants restored with fixed segmented full-arch rehabilitation in patients with a history of severe periodontal disease do not suffer important marginal bone loss if some specific factors are considered, mainly the use of long transmucosal abutments (≥2 mm).

Histologic Osseointegration Level Comparing Titanium and Zirconia Dental Implants: Meta-analysis of Preclinical Studies.

Purpose: To assess the literature comparing histologic levels of osseointegration for titanium vs zirconia dental implants. Materials and Methods: This systematic review was conducted following the PRISMA guidelines and was registered in PROSPERO (CRD42021236781). Electronic and manual searches were carried out through the PubMed/MEDLINE, PubMed Central, and Embase databases with a platform-specific search strategy combining controlled terms (MeSH and Emtree) and text words. The articles were selected by two independent investigators who evaluated the articles based on the criteria for eligibility. Results: A total of 17 articles were included. All were preclinical studies. The populations included dogs (27.55%), minipigs (14.28%), rats (14.28%), and rabbits (43.89%); and the implantation site varied among the mandible (36.82%), maxilla (9.04%), tibia (17.64%), skull (10.70%), and femur (25.80%). A total of 370 titanium (Ti) implants and 537 zirconia (Zr) implants were evaluated. The average osseointegration (% bone-to-implant contact) for Zr was 55.51% (17.6% to 89.09%), and for Ti was 58.50% (23.2% to 87.85%). There was no statistical difference between studies at the 2-month follow-up (P = .672), but this difference was significant at 1 and 3 months (P < .001). Conclusions: Within the limitations of this review, Zr implants had a similar level of osseointegration compared to Ti implants. Nonetheless, because these findings are based on preclinical research, all data must be carefully examined.

Aesthetic and radiographic outcomes using the root membrane technique in immediate adjacent implant placement: A retrospective clinical study with a 5- to 9-year follow-up.

PURPOSE: The root membrane technique was designed to preserve the buccal portion of the root in situ, preventing postextraction bundle bone loss and overlying soft tissue recession. Nevertheless, maintenance of the aesthetic gingival architecture around two or multiple adjacent implants, particularly in the anterior maxilla, remains a challenge, notably regarding the gingival contour and the interimplant papillae. The present study aimed to evaluate the clinical, aesthetic and radiographic outcomes for immediate adjacent implants placed using the root membrane technique in the anterior maxilla in a sample with a 5- to 9-year follow-up. MATERIALS AND METHODS: A retrospective clinical study was designed using the medical records of two private dental practices. A total of 40 patients who were treated using the root membrane technique for at least two adjacent implants and single-crown restorations between January 2010 and February 2019 were selected (100 implants). The clinical and radiographic data were analysed to assess implant survival/success, marginal bone loss and the pink aesthetic score. RESULTS: The cumulative survival rate after a mean follow-up period of 81.5 ± 30.5 months was 99.0% (implant-based) and 97.5% (patient-based), respectively. Between 1 and 5 years (n = 99), the mean marginal bone loss changed from 0.39 ± 0.07 mm to 0.36 ± 0.07 mm and subsequently to 0.37 ± 0.07 mm at the 7-year follow-up (n = 71) and 0.33 ± 0.07 mm at the 9-year follow-up (n = 14). The improvement from 1 year was significant at all the follow-up time points (P = 0.000). The mean global pink aesthetic score increased from baseline (11.33 ± 1.03) to 3 months after placement of the final restoration (11.73 ± 0.95) and the final observation (12.01 ± 0.87). This was a significant increase (P = 0.000 baseline to 3 months, 3 months to final observation and baseline to final observation). CONCLUSIONS: In this non-controlled retrospective study, adjacent implants placed using the root membrane technique achieved a satisfactory survival and success rate. The variation in marginal bone loss showed a significant positive trend from 1 year to 5 and 7 years. The overall pink aesthetic scores improved significantly between sequential observation periods. CONFLICT-OF-INTEREST STATEMENT: Dr Leitão-Almeida receives personal fees (for sponsored lectures) and non-financial support from MegaGen (Daegu, South Korea) outside of the submitted work; the other authors declare no conflicts of interests relating to this study.

A 3D Digital Analysis of the Hard Palate Wound Healing after Free Gingival Graft Harvest: A Pilot Study in the Short Term.

Purpose: Within this context, this pilot study aimed to evaluate the healing dynamics process of the hard palate after free gingival graft harvesting in the short term (3 months), utilizing digital imaging technology and tridimensional analysis software. Furthermore, assessing the results found to verify the existence of a relationship between gender or age with tissue loss. Materials and Methods: For connective-tissue harvesting, fifteen patients with gingival recessions type (RT) 1 and RT2 were selected. On the surgery day (before the procedure) and after three months, palatal impressions were taken in all patients, and cast models were done for posterior model scanning. The following variables were analyzed: mean thickness alterations (x¯ TA), maximum thickness loss (MTL), mean maximum thickness loss (x¯ MTL), and volume alterations (VA). A descriptive and bivariate analysis of the data was done. The data were submitted for statistical evaluation and were significant if p < 0.05. Results: Fifteen patients were analyzed, 11 females (73.3%) and four males (26.7%). The patients' average age was 28 ± 8.52 years (ranging between 16 and 48 years old). The palatal wound region's mean thickness and volume changes were −0.26 mm (±0.31) and 46.99 mm3 (±47.47 mm3) at three months. There was no statistically significant result correlating age/gender with any variable evaluated. Conclusions: Connective tissue graft harvesting promoted changes with a standard volume and thickness loss of palatal soft tissue. A 3D digital evaluation was a non-invasive method with a reproducible technique for measuring thickness or volume after connective tissue is collected. There was no relationship between age/gender and any variables analyzed.

Sinus Lift Associated with Leucocyte-Platelet-Rich Fibrin (Second Generation) for Bone Gain: A Systematic Review.

The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet-rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, "In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow-up (T)?" An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation.

Primary systemic vasculitides as the bridge in immune-mediated disorders: small vessels for autoimmunity, medium vessels for autoinflammation.

Vasculitides have been classically considered to be mostly of autoimmune origin, but the role of the innate immune system is being increasingly recognized among primary systemic vasculitides. For example, Behçet's syndrome (BS) shares more common features with autoinflammatory disorders (AIDs) than autoimmune diseases (ADs) and has recently been considered to be a polygenic AID by several authors, while others have classified it as a "mixed-pattern" disorder. This review aims to make a balance between autoinflammatory and autoimmune features of primary systemic vasculitides, including sex prevalence, association and/or familial aggregation with others AIDs or ADs, with human leukocyte antigen (HLA) system and/or disease-specific autoantibodies, type of cellular infiltration (neutrophilic or lymphocytic), clinical pattern (episodic or progressive), size of involved joints when articular involvement occurs, presence of lymphadenopathy or hypergammaglobulinemia, and therapeutic benefit of colchicine, IL-1 inhibitors and rituximab. Except for Henöch-Schonlein purpura, autoimmunity is usually predominant in small vessel vasculitides, where disease-specific autoantibodies are common. On the other hand, medium vessel and even variable vessel vasculitides such as BS often course with autoinflammatory features (e.g. increased levels of IL-1, neutrophilic infiltration) are often more obvious than those typical of autoimmunity. Therefore, it is possible that disorders like polyarteritis nodosa or Kawasaki disease may be considered as "mixed-pattern" diseases in the future. Finally, both the innate and adaptive immune systems can have significant roles in large vessel vasculitis.