RESUMEN
The placement of implants in the posterior maxillary area is considered a reliable procedure, offering recognized rehabilitative advantages. The aim of this study was to evaluate the performance of dental implants placed in the sinus floor augmented with a block autograft by comparing the outcomes over 5 years with those of dental implants positioned in non-augmented bone. This retrospective cohort study included 16 patients who had undergone prosthetic rehabilitation supported by dental implants between 2000 and 2006. One implant per patient was included and assigned to one of two predictor groups: grafted versus ungrafted maxillary sinus. Changes in marginal bone level (MBL) and apical bone level (ABL) over time, at 1, 3, and 5 years, were the primary outcome variables. Appropriate pair-wise comparison tests were performed. No significant differences were seen with regard to ABLs and among times between the grafted group (nine implants) and the ungrafted group (seven implants). Significant marginal bone resorption was found over time, primarily at the buccal aspect, in both study groups. The bone surrounding the apex of dental implants appeared stable after sinus augmentation in the grafted area. The behaviour of the two groups with regard to loss of MBLs over time was very similar.
Asunto(s)
Remodelación Ósea , Implantación Dental Endoósea , Implantes Dentales , Seno Maxilar/cirugía , Adulto , Trasplante Óseo , Retención de Prótesis Dentales , Fracaso de la Restauración Dental , Femenino , Humanos , Masculino , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/patología , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del TratamientoRESUMEN
A document by the B. Ramazzini College of University Teachers of Occupational Medicine of the Italian Society of Occupational Health and Industrial Hygiene (S.I.M.L.I.I). The aim of this document was to compare the professional competence, training profile and core curricula of the three main specialization courses in the Public Health postgraduate medical area, i.e., Occupational Medicine, Hygiene and Preventive Medicine, and Forensic Medicine, such as contained in the Ministerial Decree (D.M) of 1 August 2005. We set out to identify, using clear and objective criteria, the knowledge and skills that specialists in Hygiene or Forensic Medicine must develop, in accordance with Art. 38 of the new Italian law on safety ahd health at work (D.Lgs 81/2008), in order to be authorized to perform occupational health activities as "Competent Physicians" (CP). The comparison revealed significant differences in structure and content among the three courses. In particular, compared to the course in Occupational Medicine, the courses in Hygiene and in Forensic Medicine both lack clinical training, including diagnostic and therapeutic skills, risk-oriented occupational health activities, biological monitoring, assessment of individual susceptibility, and clinical or instrumental procedures to prevent and detect occupational diseases. Furthermore, the specialization course in Hygiene lacks any training regarding the criteria and methods for assessing the individual worker's fitness for work, while the course in Forensic Medicine lacks any training in occupational risk assessment and management. From this comparison, a list was derived of the education and training debits that specialists in Hygiene or Forensic Medicine should cover (credits) in order to be authorized to perform CP activities as indicated by the new law. A core curriculum is proposed here, based on the corresponding credits, for use as a reference.
Asunto(s)
Curriculum/normas , Educación de Postgrado en Medicina/legislación & jurisprudencia , Salud Pública/educación , Escuelas de Salud Pública/legislación & jurisprudencia , Universidades/legislación & jurisprudencia , Competencia Clínica/normas , Educación de Postgrado en Medicina/normas , Medicina Legal/educación , Humanos , Higiene/educación , Medicina del Trabajo/educación , Medicina Preventiva/educación , Escuelas de Salud Pública/normas , Universidades/normasRESUMEN
The aim of the present retrospective chart review was to determine the relationship between nonvascularized osseous graft remodeling and the three-dimensional (3D) features of grafts and recipient sites, the anatomical recipient regions and different graft sources. 32 iliac crest or chin grafts were onlay-positioned in the mandible or maxilla of 14 patients. CT scans, taken before implant positioning and after 1 year, revealed a mean volume resorption of 35-51%. For iliac crest grafts, the average resorption was 42% when the onlay was positioned in the anterior maxilla and 59% when it was positioned in the posterior mandible. Spearman correlation and 3D interpolation analysis revealed, for both iliac crest groups, a moderate or advanced remodeling pattern depending on 3D features, namely graft thickness and shape, basal bone volume of recipient site, and the basal bone/graft volume ratio of the recipient site. No statistically significant differences were found between the recipient and donor site groups. Retrospective analysis of the data indicates that iliac crest grafts, onlay-positioned on adequate basal bone volume, may register a reduced volume remodeling when shaped thick in the anterior maxilla or rounded and convex, on the external surface, in the posterior mandible.
Asunto(s)
Aumento de la Cresta Alveolar , Densidad Ósea , Remodelación Ósea , Trasplante Óseo/patología , Implantación Dental Endoósea , Adulto , Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar/métodos , Mentón/cirugía , Femenino , Humanos , Ilion/cirugía , Masculino , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/cirugía , Enfermedades Maxilares/diagnóstico por imagen , Enfermedades Maxilares/cirugía , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
The aim of the present survey was to assess neurosensory disturbances and/or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line.
Asunto(s)
Traumatismos del Nervio Craneal/etiología , Hipoestesia/etiología , Mandíbula/cirugía , Complicaciones Posoperatorias , Recolección de Tejidos y Órganos/efectos adversos , Traumatismos del Nervio Trigémino , Adulto , Trasplante Óseo/efectos adversos , Trasplante Óseo/métodos , Distribución de Chi-Cuadrado , Mentón/inervación , Diente Canino/lesiones , Diente Canino/inervación , Pulpa Dental/lesiones , Pulpa Dental/inervación , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Osteotomía/métodos , Estadísticas no Paramétricas , Recolección de Tejidos y Órganos/métodos , Trasplante AutólogoRESUMEN
Of various proposed alternatives to autogenous bone, a synthetic, degradable copolymer of PLA-GLA and dextrane seems to be a promising biomaterial for maxillary sinus lift. Consecutive partially edentulous patients showing severe monolateral posterior maxillary atrophy were treated via sinus lift using PLA-GLA-dextrane copolymer as the sole filler. Delayed implant positioning was performed and cores of regenerated tissues and native bone controls were retrieved and evaluated by light and electron microscopy, histomorphometry, microhardness and qualitative X-ray analysis. Seven sinuses in 7 patients were augmented with PLA-GLA-dextrane copolymer. Six to nine months after the copolymer 'graft', 17 bone cores were retrieved: all histological sections contained newly synthesized, mineralized material and new bone in various stages of development. Histomorphometry revealed average Trabecular Bone Volume (TBV) values ranging from 51% (6 months) to 77% (9 months). Backscattered scanning electron microscopy (BSE) in experimental and control samples confirmed histology findings. Microhardness values suggested newly formed bone at nine months was not as hard as native bone. Ca and P content was similar in 9-month regenerated and native bone. Seventeen implants were inserted in the second stage of surgery: resulting Implant Success (SR) and Cumulative Success (CSR) up to 3 years were 100% following Albrektssons criteria. Sinus lift augmentation using PLA-GLA-dextrane copolymer as the sole filler resulted in uneventful surgeries. New bone formation was evident histologically and its maturation was still in progress after 9 months. Successful, staged implant positioning was achieved in regenerated tissue.