An Evaluation of Autologous Fat Injection as a Treatment for Velopharyngeal Insufficiency: A Review and Integrated Data Analysis.

BACKGROUND: Velopharyngeal insufficiency (VPI) is a condition characterized by incomplete separation of the oral and nasal cavities during speech production, thereby leading to speech abnormalities and audible nasal emissions. Subsequently, this adversely impacts communication and potentially interpersonal social interactions. Autologous fat grafting (AFG) to the velopharynx, a minimally invasive technique, aims to improve oronasal separation by providing bulk and advancing the posterior pharyngeal wall toward the soft palate. Despite its potential, the relative novelty of AFG in treating VPI has resulted in reporting of inconsistent indications, varied surgical techniques, and mixed outcomes across existing literature. METHODS: This systemic review examined the evidence of AFG for VPI treatment over the past decade (2013-2023). A thorough search across five electronic databases yielded 233 studies, with 20 meeting the inclusion criteria (e.g., utilized fat injection as their selected VPI treatment, conducted study in human subjects, did not perform additional surgical procedure at time of fat injection). Selected studies encompassed patient and surgical intervention characteristics, perceptual speech assessment (PSA) scores, gap sizes, nasalance measurements, and complications. RESULTS: The majority of patients had a prior cleft palate diagnosis (78.2%), in which nasoendoscopy was the prevalent method for visualizing the velopharyngeal port defect. Fat harvesting predominantly occurred from the abdomen (64.3%), with an average injection volume of 6.3 mL across studies. PSA and subjective gap size scores were consistently higher preoperatively than postoperatively. PSA score analysis from seven studies revealed significant and sustained improvements postoperatively. Gap size score analysis from four studies demonstrated similar preoperative and postoperative differences. Complications were reported in 17 studies, yielding a 2.7% summative complication rate among 594 cases. CONCLUSIONS: Autologous fat grafting has emerged as a minimally invasive, safe, and effective treatment for mild to moderate VPI. However, challenges remain because of variability in patient selection criteria, diagnostic modalities, and outcome measurements. This review underscores the need for randomized control trials to directly compare AFG with standard-of-care surgical interventions, providing more conclusive evidence of its clinical efficacy.

Mandibular Contouring in Subjects With Class II or Class III Dentofacial Deformities and Treatment Needs.

Facial contouring relates to hard and soft structures that make up the face. Skeletal class II and III subjects present bone structure and position changes, significantly impacting the soft tissues. This study aims to analyze the morphology of the mandible at mandibular ramus and angle level in subjects with skeletal facial deformity class II and III who are candidates for orthognathic surgery and to define implications in facial contour. A cross-sectional study used cone beam computed tomography to compare the mandibular contour (mandibular angle and ramus region) in orthognathic surgery candidates. One hundred sixty orthognathic surgery candidates were analyzed, ranging in age from 18 to 58 years (31.29 ± 11.97). Regarding the skeletal class, 95 (59.37%) were skeletal class II, and 65 (40.62%) were skeletal class III. Class II subjects had a larger antegonial notch than class III subjects. Concerning the mandibular contour, class II subjects presented less vertical distance than class III subjects, but both presented similar gonial angles. Concerning the ideas to assess the need for mandibular contouring surgery, the 2 proposals to determine the need for mandibular contouring surgery in class II and III subjects present a similar distribution. The mandibular notch is an objective element and is commonly present in subjects with a class II facial pattern; this element can be used in contour analysis to define expected facial characteristics, including the patient's facial sex, in the decision of surgical techniques for lower facial contour augmentation or reduction.

Translational Experimental Basis of Indirect Adenosine Receptor Agonist Stimulation for Bone Regeneration: A Review.

Bone regeneration remains a significant clinical challenge, often necessitating surgical approaches when healing bone defects and fracture nonunions. Within this context, the modulation of adenosine signaling pathways has emerged as a promising therapeutic option, encouraging osteoblast activation and tempering osteoclast differentiation. A literature review of the PubMed database with relevant keywords was conducted. The search criteria involved in vitro or in vivo models, with clear methodological descriptions. Only studies that included the use of indirect adenosine agonists, looking at the effects of bone regeneration, were considered relevant according to the eligibility criteria. A total of 29 articles were identified which met the inclusion and exclusion criteria, and they were reviewed to highlight the preclinical translation of adenosine agonists. While preclinical studies demonstrate the therapeutic potential of adenosine signaling in bone regeneration, its clinical application remains unrealized, underscoring the need for further clinical trials. To date, only large, preclinical animal models using indirect adenosine agonists have been successful in stimulating bone regeneration. The adenosine receptors (A1, A2A, A2B, and A3) stimulate various pathways, inducing different cellular responses. Specifically, indirect adenosine agonists act to increase the extracellular concentration of adenosine, subsequently agonizing the respective adenosine receptors. The agonism of each receptor is dependent on its expression on the cell surface, the extracellular concentration of adenosine, and its affinity for adenosine. This comprehensive review analyzed the multitude of indirect agonists currently being studied preclinically for bone regeneration, discussing the mechanisms of each agonist, their cellular responses in vitro, and their effects on bone formation in vivo.

Effect of Surgical Instrumentation Variables on the Osseointegration of Narrow- and Wide-Diameter Short Implants.

PURPOSE: The aim of the present study was to systematically analyze how a multifactorial surgical instrumentation approach affects osseointegration on both narrow-diameter and wide-diameter short implants. MATERIALS AND METHODS: Twelve skeletally mature female sheep were used in the study along with 144 plateau-root-form healing chamber titanium (Ti-6Al-4V) implants (Bicon LLC, Boston, MA), evenly distributed between narrow (3.5 mm) and wide (6.0 mm) diameters. The presence or the absence of irrigation, different drilling speeds, and 2 time points quantifying bone-implant contact (BIC) and bone area fraction occupancy (BAFO) to evaluate the osteogenic parameters around the implants. RESULTS: There were no signs of inflammation, infection, or failure of the implants observed at either healing period. The narrow 3.5-mm implant, at 6 weeks, yielded significant differences in terms of BIC at a drilling speed of 50 rotations per minute (RPM), with higher values of the samples using irrigation (30.6 ± 6.1%) compared with those without (19.7 ± 6.1%). No statistical differences were detected for 500 and 1,000 RPM with or without irrigation. The wide 6-mm diameter implant showed differences with respect to drilling speed, 500 and 1,000 RPM, with higher values associated with samples subjected to irrigation. BAFO results, for both diameters, only detected statistical differences between the 2 times (3 vs 6 weeks); no statistical differences were detected when evaluating as a function of time, drilling speed, and irrigation. CONCLUSIONS: Surgical instrumentation variables (ie, drilling speed [RPM] and irrigation) yielded to be more of an effect for BIC at longer healing time (6 weeks) for the wider implants. Furthermore, deploying narrow or wide plateau-root-form implants, where conditions allow, has shown to be a safe alternative, considering the high BIC and BAFO values observed, independent of irrigation.

Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review.

PURPOSE: The aim was to determine the survival rate of dental implants installed in the posterior region of the maxilla after a graftless maxillary sinus lift via the lateral window approach and to identify the factors involved in the results. MATERIALS AND METHODS: A systematic search was done on MEDLINE, EMBASE, LILACS, Scopus, and Science Direct up to June 2016; additional studies were identified through an analysis of references. Primary studies in English, Spanish, Portuguese, and French were included; the selection and data extraction process was conducted by 2 investigators independently, and the methodological quality was evaluated by means of the Effective Public Health Practice Project's Quality Assessment Tool. RESULTS: The combined search identified 232 articles. After the selection process, 11 articles were identified, 9 of which were prospective and 2 were retrospective. In all of them, the graftless maxillary sinus lift was done with the immediate installation of the implant. All the studies included presented a low methodological quality. The mean survival rate of the implants was 97% with an average new intrasinus bone formation of 6.2 mm. CONCLUSION: This technique has a high implant survival although it is not possible to identify its correct indication and contraindication.

Nonthermal Atmospheric Pressure Plasma Treatment of Endosteal Implants for Osseointegration and Antimicrobial Efficacy: A Comprehensive Review.

The energy state of endosteal implants is dependent on the material, manufacturing technique, cleaning procedure, sterilization method, and surgical manipulation. An implant surface carrying a positive charge renders hydrophilic properties, thereby facilitating the absorption of vital plasma proteins crucial for osteogenic interactions. Techniques to control the surface charge involve processes like oxidation, chemical and topographical adjustments as well as the application of nonthermal plasma (NTP) treatment. NTP at atmospheric pressure and at room temperature can induce chemical and/or physical reactions that enhance wettability through surface energy changes. NTP has thus been used to modify the oxide layer of endosteal implants that interface with adjacent tissue cells and proteins. Results have indicated that if applied prior to implantation, NTP strengthens the interaction with surrounding hard tissue structures during the critical phases of early healing, thereby promoting rapid bone formation. Also, during this time period, NTP has been found to result in enhanced biomechanical fixation. As such, the application of NTP may serve as a practical and reliable method to improve healing outcomes. This review aims to provide an in-depth exploration of the parameters to be considered in the application of NTP on endosteal implants. In addition, the short- and long-term effects of NTP on osseointegration are addressed, as well as recent advances in the utilization of NTP in the treatment of periodontal disease.

An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement.

The temporomandibular joint (TMJ) is a complex structure in the cranio-maxillomandibular region. The pathological changes of the joint cause deficiencies at different levels, making its replacement necessary in some cases. The aim of this article is to analyze the current indications, treatment and criteria, and follow-up using a systematic review and case series. A systematic review was carried out, identifying the indications for the use of a customized TMJ prosthesis and evaluating criteria and validation in the international literature. After review and exclusion, 8 articles were included with a minimum follow-up of 12 months. The age of the subjects was between 18 and 47 years old. In 226 patients, 310 TMJ prostheses were installed, 168 bilaterally and 142 unilaterally. In most of the articles, a good condition in the follow-up was observed, with a reduction in pain and better conditions of mandibular movement and function. TMJ prosthesis and replacement is a protocolized, defined, stable, and predictable procedure. Indications and criteria must be evaluated by specialists and patients related to the pathology involved in TMJ deformity or degeneration. Randomized research with an accurate diagnosis and follow-up is necessary to obtain the best indication for this treatment.

TMJ Position in Symmetric Dentofacial Deformity.

The aim of this research was to analyze the facial class, presence of malocclusion, and the mandibular plane and to relate this to the mandibular condyle position. A cross-sectional study in subjects under analysis for orthognathic surgery was done. The mandibular plane, the gonial angle, and the molar class were included to compare the coronal and sagittal position of the condyle and the joint space observed in the CBCT. The measurements were obtained by the same observer at an interval of two weeks. In addition, the Spearman test was performed to determine the correlation using a p value < 0.05 to observe any significant differences. Eighty-nine male and female subjects (18 to 58 years old, 24.6 ± 10.5) were included. In the coronal section, subjects with CIII had a greater mediolateral distance (MLD, p = 0.0001) and greater vertical distance (SID, p = 0.0001) than subjects with CII. In terms of the skeletal class and the mandibular plane, it was observed that subjects in the CII group had a greater mandibular angle (open angle) (p = 0.04) than the CII group and was related to the anterior position of the condyle. The most anterior condylar position was observed in the CII group (p = 0.03), whereas a posterior condylar position was significant in CIII subjects (p = 0.03). We can conclude that the sagittal position of the TMJ was related to the mandibular plane and the skeletal class showing a higher mandibular angle and most anterior position of the condyle in CII subjects and a lower mandibular angle and most posterior position of the condyle in CIII subjects. The implications for surgical treatment have to be considered.

The Influence of Surface Treatment on Osseointegration of Endosteal Implants Presenting Decompressing Vertical Chambers: An In Vivo Study in Sheep.

PURPOSE: To qualitatively and quantitatively evaluate histologic osseointegration parameters of implants designed with decompressing vertical chambers between the threads with two different surface treatments (TiO2 blasting + maleic acid vs TiO2 blasting + maleic + HCl) in a large translational animal model at 3 and 6 weeks in vivo. MATERIALS AND METHODS: Nine female sheep were used, and 72 implants with trapezoidal threads and decompressing vertical chambers of 0.6 mm in diameter and 0.2 mm in depth were placed in the ilium crest. After 3 and 6 weeks, the animals were euthanized, and biomechanical and histomophometric analyses were performed. RESULTS: Survey histologic evaluation indicated intimate contact between the bone and the implants independent of surface treatment at both times in vivo. Bone formation at both time points depicted an intramembranous-type healing pattern between the implant threads. The mean removal torque values for all groups showed a relative increase in removal torque from 3 to 6 weeks. In terms of bone area fraction occupancy analysis, significant differences were found at 6 weeks between surface treatments (P = .046), where the experimental surface yielded higher degrees of bone area fraction occupancy. CONCLUSION: Conical implants with decompressing vertical chambers between threads presented similar osseointegration parameters regarding bone-toimplant contact and torque-out test values irrespective of surface treatment. However, shifting from a minimally rough to a moderately rough surface (experimental surface with supplemental acid-etching) resulted in significantly improved bone area fraction occupancy at 6 weeks.

Comparison of Surface Treatments of Endosteal Implants in Ovariectomized Rabbits.

PURPOSE: The aim of this work was to evaluate osseointegration of endosteal implants with two different surface treatments at early stages (~3 weeks) in the tibia of healthy and ovariectomized rabbits. MATERIALS AND METHODS: The study comprised 10 adult New Zealand female rabbits (Oryctolagus cuniculus; 6 months and 3.0 ± 0.5 kg). Five animals were subjected to bilateral ovariectomy to mimic osteoporotic-like conditions, and the remaining rabbits (n = 5) served as the healthy control group. After 3 months, specimens from the ovariectomized and control groups were subject to implant placement in both tibiae, using two different types of surface treatment. A total of 36 implants were placed, n = 18 acid-etched and n = 18 anodized. After 3 weeks, euthanasia of the animals was performed, and samples were obtained for processing. Bone-to-implant contact and bone area fraction occupancy were quantified to evaluate the osseointegration parameters around the implant surface and within the thread area, respectively, and nanoindentation tests were performed to determine elastic modulus and hardness of the new bone. Both analyses were performed on the entire implant (total), as well as individually within the cortical and bone marrow cavity area. RESULTS: All animals were evaluated with no signs of infection or postoperative complications. The total bone-to-implant contact and bone area fraction occupancy results, independent of surface treatment, yielded significant differences between the ovariectomized and control groups (P = .002 and P < .001, respectively). In the marrow cavity, analyzing the surface treatments independently as a function of bone condition, the only differences detected were in the anodized treatment (P = .04). Regarding the elastic modulus, differences were detected only with the anodized implants between the ovariectomized and control groups (P = .015). CONCLUSION: At 3 weeks after implant placement, there were better osseointegration values of the implants in the healthy control group compared with the ovariectomized group independent of surface treatment. Also, specifically in the medullary region of the rabbit tibia, the acid-etched implants had more uniform osseointegration values in conditions of low-quality bone in comparison to the anodized implants, histomorphometrically and biomechanically.

Osseodensification Versus Subtractive Drilling Techniques in Bone Healing and Implant Osseointegration: Ex Vivo Histomorphologic/Histomorphometric Analysis in a Low-Density Bone Ovine Model.

PURPOSE: The aim of this study was to qualitatively and quantitatively assess the effect of osteotomy preparation by conventional, subtractive, or osseodensification instrumentation on osteotomies, treated with or without endosteal implants, and healing capacity. MATERIALS AND METHODS: Seven sheep were used, and 56 osteotomies were made in the left and right ilium of the sheep (n = 8/sheep [4 per side/time point (3 and 6 weeks)]). Two different instrumentation techniques were used: (1) conventional/regular drilling in a three-step series of a 2-mm pilot and 3.2-mm and 3.8-mm twist drills and (2) osseodensification drilling with a Densah Bur 2.0-mm pilot and 2.8-mm and 3.8-mm multi-fluted tapered burs. Drilling was performed at 1,100 rpm with saline irrigation. RESULTS: Qualitative histomorphometric evaluation of the osteotomies after 3 and 6 weeks did not indicate any healing impairment due to the instrumentation. In all samples, histologic examination suggested bone remodeling and growth (empty and treated with an implant), irrespective of preparation technique. Osteotomies prepared using the osseodensification instrumentation showed the existence of bone chips autografted into the trabecular spaces along the length of the osteotomy wall. CONCLUSION: The osseodensification group yielded higher osseointegration rates, as distinguished through qualitative assessment, bone-to-implant contact, and bone-area-fraction occupancy, indicating an increased osteogenic potential in osteotomies prepared using the osseodensification technique.

Effect of supplemental acid-etching on the early stages of osseointegration: A preclinical model.

PURPOSE: To evaluate the effect of two surface modifications on early osseointegration parameters of conical implants in a translational pre-clinical model. MATERIALS AND METHODS: Conical implants with progressive trapezoidal threads and healing chambers were evaluated consisting of two different surface conditions: 1) Implacil surface (IMP Sur), and 2) Implacil surface + Supplemental Acid-etching (IMP Sur + AE). Surface characterization comprised of the evaluation of roughness parameters (Sa, Sq and Sdr), surface energy and contact angle. Subsequently, implants were installed in the ilium crest of nine female sheep (weighing ~65 kg). Torque out, histological and histomorphometric analyses were conducted after 3 and 6 weeks in-vivo. The percentage of bone to implant contact (%BIC) and bone area fraction occupancy within implant threads (%BAFO) were quantified, and the results were analyzed using a general linear mixed model analysis as function of surface treatment and time in-vivo. RESULTS: Supplemental acid etching significantly increased Sa and Sq roughness parameters without compromising the surface energy or contact angle, and no significant differences with respect to Sdr. Torque-out testing yielded significantly higher values for IMP Sur + AE in comparison to the IMP Sur at 3- (62.78 ± 15 and 33.49 ± 15 N.cm, respectively) and 6-weeks (60.74 ± 15 and 39.80 ± 15 N.cm, respectively). Histological analyses depicted similar osseointegration features for both surfaces, where an intramembranous-type healing pattern was observed. At histomorphometric analyses, IMP Sur + AE implants yielded higher values of BIC in comparison to IMP Sur at 3- (40.48 ± 38 and 27.98 ± 38%, respectively) and 6-weeks (45.86 ± 38 and 34.46 ± 38%, respectively). Both groups exhibited a significant increase in %BAFO from 3 (~35%) to 6 weeks (~44%), with no significant differences between surface treatments. CONCLUSION: Supplemental acid-etching and its interplay with implant thread design, positively influenced the BIC and torque-out resistance at early stages of osseointegration.

Growth and metabolic responses to methyl viologen (1,1'-dimethyl - 4,4'-bipyridinium dichloride) on Chlorella vulgaris.

Aquatic environments are especially susceptible to being contaminated by pesticides used in agricultural fields. Methyl viologen (MV) is an herbicide with high effectiveness for the control of unwanted land plants; however, it also has a high toxicity towards the algae in the aquatic environment. The objective of this work was to describe the effect of MV on photosynthetic metabolism and its relationship with respiration, growth and the content of photosynthetic pigments of Chlorella vulgaris. The cultures of C. vulgaris were exposed for 72 h at different concentrations of methyl viologen. The results show that growth, pigment content and metabolic activity decrease as the concentration of MV increases. Analysis of the photochemical activity indicates that MV produces an inhibition of electron transport between quinone A and quinone B of photosystem II. The inhibition of photosynthetic electron transport is directly related to the reduction of metabolic activity and cell growth. The results found in this research show that methyl viologen can be a toxic pollutant for primary producers in aquatic environments.

Ratification of IATSIC/WHO's guidelines for essential trauma care assessment in the South American region.

BACKGROUND: The purpose of the present study was to evaluate the usefulness of the International Association for Trauma Surgery and Intensive Care (IATSIC)/World Health Organization (WHO)'s Guidelines for Essential Trauma Care (EsTC Guidelines) in providing an internationally applicable and standardized template to assess trauma care capabilities in the South American Region. METHODS: Field assessment was conducted in seven provinces (urban and rural, pop. 2,239,509) and 24 facilities (5 large hospitals (LH); 15 small hospitals (SH); 4 basic hospitals (BH)) in Ecuador using EsTC criteria. A total of 260 individual items in Human Resources (HR- availability, clinical knowledge, skills) and physical resources (PR) were evaluated via inspection, review of local statistics, and administrative and staff interviews. EsTC was evaluated on a scale as follows: 0 (absent); 1(inadequate; < 50%); 2 (partly adequate > 50%); 3 (adequate-100%). RESULTS: 210,045 Emergency Department (ED) visits and 61,365 (29%) ED trauma visits were recorded (incidence rate 2,740/100,000 population). Deficits were noted in prehospital trauma care (inadequate coordination, communication), education and training (ATLS < 30%, TNCC 0%), facility based trauma care (poor physical resources [PR] and human resources [HR]), and quality assurance (1/27 hospitals). CONCLUSIONS: The IATSIC/WHO EsTC Guidelines provide a simple and useful template to assess trauma care capability in variable facilities and international settings, and they could serve as a valuable tool for trauma system development. Endorsement of EsTC Guidelines by the Panamerican Health Organization and lead trauma societies (the Panamerican Trauma Society) should be considered.

Morphological Analysis of the Human Maxillary Sinus Using Three-Dimensional Printing.

BACKGROUND: The maxillary sinus (MS) is described as a pyramid-shaped cavity of the maxilla. AIM: The aim of this research is to present a strategy for morphological analysis of the MS using three-dimensional (3D) printing acquired through cone-beam computed tomography images. MATERIAL AND METHODS: A cross-sectional exploratory, single-blind study was conducted, including 24 subjects. MSs were reconstructed, and 3D virtual modeling was done bilaterally, obtaining 48 physical models generated on a 3D printer. The statistical analysis used tests of normality and tests using a value of P < 0.05 to establish statistical significance. RESULTS: The mean of the MS volume was 15.38 cm3 (±6.83 cm3). The minimum volume was 5.4 cm3 and the maximum was 30.8 cm3. In a bilateral comparison of the right and left volume of the same individual, there were no significant differences (P = 0.353). In relation to the morphology of the MSs, the most prevalent was pyramidal with a square base with a prevalence of 66.7%. Related to gender, significant differences were observed only for the left volume (P = 0.009), with the mean volume being significantly greater in the men (19.69 cm3) than in the women (12.28 cm3). CONCLUSION: 3D printing of the MS permitted the more precise observation of anatomical features that cannot be seen on a 2D screen. A classification is presented that allows an analysis of sinus morphology, although it is necessary to conduct studies with larger samples to obtain more conclusive results.

Toma de decisiones de encomienda y evaluación de las actividades profesionales confiables en la educación médica basada en competencias: una revisión de alcance y análisis temático / Entrustment decision-making and evaluation of entrustable professional activities in the competency- based medical education: a scoping review and thematic analysis

Introducción: La evaluación de las actividades profesionales confiables implica que el tutor tome decisiones de encomienda que posibiliten el desarrollo de competencias adecuadas de los futuros especialistas. Objetivo. El objetivo es conocer los componentes que sustentan la toma de decisiones de encomienda como herramienta de evaluación efectiva, segura y eficaz de las actividades profesionales confiables en la educación médica basada en competencias. Materiales y métodos: Se realizó una revisión sistemática en las bases de datos PubMed, BIREME-BVS y Web of Science. Se procedió al análisis y síntesis de los artículos, de acuerdo con la metodología JBI para las revisiones de alcance; el análisis se profundizó en otros artículos de revistas especializadas y citas bibliográficas relacionadas; y el manuscrito final se efectuó con base en las recomendaciones PRISMA-ScR. Resultados: La toma de decisiones de encomienda se centra en la relación tutor-estudiante, con base principalmente en la proactividad, la integridad, la capacidad y la humildad del estudiante, que confluyen en la confianza del tutor para sobrepasar la ‘zona de desarrollo próximo’ y alcanzar un siguiente nivel. Aunque eso signifique un determinado riesgo inicial sobre la seguridad de la atención médica, permite gradualmente generar la autonomía del estudiante. Conclusiones: No cabe duda de que la toma de decisiones de encomienda se basa en la confianza, la encomienda, la supervisión y la autonomía. Una escala retrospectiva-prospectiva que incluya la confianza-encomienda-supervisión-autonomía permite una adecuada evaluación de las actividades profesionales confiables y, por ende, la evaluación de las competencias.(AU)

Introduction: The evaluation of entrustable professional activities implies that the tutor makes assignment decisions that enable the development of appropriate competencies of future specialists. Aim. The aim of this work is to recognize the components that support entrustment decision making as an effective, safe and efficient evaluation tool of entrustable professional activities, in competency-based medical education. Materials and methods: A systematic review was carried out in the PubMed, BIREME-BVS and Web of Science databases. The analysis and synthesis of the articles was carried out in accordance with the JBI methodology for scoping reviews; and was further conducted including other articles from specialized journals and related bibliographic citations. The final manuscript was prepared based on the PRISMA-ScR recommendations.Results: Entrustment decision-making focuses on the tutor-student relationship, based mainly on the student’s proactivity, integrity, ability and humility, which converge in the tutor’s confidence to surpass the ‘zone of proximal development’ and reach the next level. Although this means a certain initial risk to the safety of medical care, it gradually generates the student’s autonomy. Conclusions: There is no doubt that entrustment decision-making is based on trust, entrustment, supervision and autonomy. A retrospective-prospective scale that includes trust-entrustment-supervision-autonomy allows for an adequate evaluation of entrustable professional activities and, therefore, the evaluation of competencies.(AU)

Effect of Bimaxillary Orthognathic Surgery on Pharyngeal Airway Volume / Efecto de Cirugía Ortognática Bimaxilar en el Volumen de la Vía Aérea Faríngea

SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.

Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.

The 3 R's for Platelet-Rich Fibrin: A "Super" Tri-Dimensional Biomaterial for Contemporary Naturally-Guided Oro-Maxillo-Facial Soft and Hard Tissue Repair, Reconstruction and Regeneration.

Platelet-Rich fibrin (PRF) is a three-dimensional (3-D) autogenous biomaterial obtained via simple and rapid centrifugation from the patient's whole blood samples, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents. At the moment, it is safe to say that in oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-families) are receiving the most attention, essentially because of their simplicity, cost-effectiveness, and user-friendliness/malleability; they are a fairly new "revolutionary" step in second-generation therapies based on platelet concentration, indeed. Yet, the clinical effectiveness of such surgical adjuvants or regenerative platelet concentrate-based preparations continues to be highly debatable, primarily as a result of preparation protocol variability, limited evidence-based clinical literature, and/or poor understanding of bio-components and clinico-mechanical properties. To provide a practical update on the application of PRFs during oral surgery procedures, this critical review focuses on evidence obtained from human randomized and controlled clinical trials only. The aim is to serve the reader with current information on the clinical potential, limitations, challenges, and prospects of PRFs. Accordingly, reports often associate autologous PRFs with early bone formation and maturation; accelerated soft-tissue healing; and reduced post-surgical edema, pain, and discomfort. An advanced and original tool in regenerative dentistry, PRFs present a strong alternative and presumably cost-effective biomaterial for oro-maxillo-facial tissue (soft and hard) repair and regeneration. Yet, preparation protocols continue to be a source of confusion, thereby requiring revision and standardization. Moreover, to increase the validity, comprehension, and therapeutic potential of the reported findings or observations, a decent analysis of the mechanico-rheological properties, bio-components, and their bioactive function is eagerly needed and awaited; afterwards, the field can progress toward a brand-new era of "super" oro-dental biomaterials and bioscaffolds for use in oral and maxillofacial tissue repair and regeneration, and beyond.

Clinical and biological analysis in graftless maxillary sinus lift.

Maxillary sinus lift for dental implant installation is a well-known and versatile technique; new techniques are presented based on the physiology of intrasinus bone repair. The aim of this review was to determine the status of graftless maxillary sinus lift and analyze its foundations and results. A search was conducted of the literature between 1995 and 2015 in the Medline, ScienceDirect, and SciELO databases using the keywords "maxillary sinus lift," "blood clot," "graftless maxillary sinus augmentation," and "dental implant placement." Ten articles were selected for our analysis of this technique and its results. Despite the limited information, cases that were followed for at least six months and up to four years had a 90% success rate. Published techniques included a lateral window, elevation of the sinus membrane, drilling and dental implant installation, descent of the membrane with variations in the installation of the lateral wall access and suturing. The physiology behind this new bone formation response and the results of the present research were also discussed. We concluded that this is a promising and viable technique under certain inclusion criteria.