Immediate implant placement and loading in the esthetic area when the buccal socket wall is significantly damaged.

OBJECTIVES: Recent clinical recommendations contraindicate immediate implant placement when the socket buccal bone plate is significantly damaged. The connective tissue graft (CTG) is increasingly being used in implant therapy and can replace periodontal defects lacking bone wall in periodontal regenerative surgery. Therefore, CTG could be used to allow immediate implant placement and loading even when the buccal socket wall is damaged, facilitating graft material stability. CLINICAL CONSIDERATIONS: In the first case, deep bone dehiscence was caused by a vertical root fracture. In the second case, a big bone fenestration was caused by a chronic endodontic periapical lesion. Both cases were treated with immediate implant placement and loading. A buccal CTG was used to compensate for the lack of bone and allow stabilization of the particulate xenograft in the gap between the implant and the damaged buccal socket wall. In both cases, a provisional screw-retained crown was immediately delivered, and the definitive layered zirconia crown was delivered after 3 months. Esthetic results and patient satisfaction monitored for 1 year after loading proved to be encouraging. CONCLUSIONS: Although further investigations with longer follow-up are required, the approach is likely to yield good results after 1 year of loading. CLINICAL SIGNIFICANCE: The purpose of this report is to show a surgical approach that seems to be able to overcome the contraindication of the quoted consensus report, which allows for good esthetic results and patient satisfaction even when the buccal bone wall of the extraction socket has been more than 50% compromised, allowing treatment time and cost reduction.

Effects of 6 Single-File Systems on Dentinal Crack Formation.

INTRODUCTION: The purpose of this study was to compare the formation of microcracks after canal preparation performed with different single-file systems as One Shape (Micro-Mega, Besancon, Cedex, France), F6 SkyTaper (Komet Italia Srl, Milan, Italy), HyFlex EDM (Coltene/Whaledent AG, Altstatten, Switzerland), WaveOne (Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (VDW, Munich, Germany), and WaveOne Gold (Dentsply Maillefer). METHODS: Eighty-four human extracted mandibular central incisors (40-60 y) were selected and divided into 6 experimental groups (n = 12 teeth) and a control group (unprepared teeth): One Shape (group 1), F6 SkyTaper (group 2), HyFlex EDM (group 3), WaveOne (group 4), Reciproc (group 5), and WaveOne Gold (group 6). Roots were then sectioned at 3, 6, and 9 mm from the apex, and the surface was observed under a stereomicroscope. Data were analyzed using logistic regression (P < .05). RESULTS: No cracks were observed in the control group. All the systems tested caused cracks, mainly in the apical section (3 mm). HyFlex EDM (33.3%) and WaveOne Gold (58.3%) showed fewer microcracks than other experimental groups (P < .01); however, no significant difference was found between them in crack formation (P > .05). There was no difference among the other experimental groups (P > .05). CONCLUSIONS: All the instruments tested created dentinal cracks. Within the limitations of this study, the flexibility of nickel-titanium instruments because of heat treatment seems to have a significant influence on dentinal crack formation. HyFlex EDM and WaveOne Gold caused less microcracks than the other instruments tested.

Beta-adrenergic antagonists improve oxygen saturation in acute pulmonary edema: a case series in the prehospital setting.

The use of beta-adrenergic antagonists in acute heart failure is controversial. In this case series, we report the use of intravenous atenolol, a short-acting cardioselective beta-adrenergic antagonist, to treat acute pulmonary edema in the prehospital setting. Four patients with a documented history of cardiac disease and one patient with unknown cardiac issues experienced severe respiratory distress and presented with pulmonary edema; the local emergency medical service was utilized. In all of the patients, the saturation of peripheral oxygen (SpO2) was severely low, and the patients were rapidly treated with oxygen, diuretics, morphine, and nitrates. However, only a small increase in oxygen saturation was observed. Intravenous atenolol was administered and led to a dramatic increase in SpO2. In our case series, we observed the positive effect of early treatment with short-acting beta-adrenergic antagonists on the recovery of rapid oxygen delivery in severely hypoxemic patients.