Evaluation of Retention and Attachment Wear of CAD/CAM Versus Conventional Implant-Assisted Overdenture Frameworks.

Previous studies have demonstrated problems with implant-supported overdenture attachments, such as denture base fracture and retention loss of the attachment's nylon insert. In this study, three implants were surgically inserted at the anterior mandibular region of 16 completely edentulous men (mean age: 50 years), divided into two groups depending on the received mandibular complete overdenture: a conventional metal-reinforced framework with prefabricated metal housing (Group I) or a CAD/CAM metal-reinforced framework with custom metal housing (Group II). At 3 months (prostheses loading), 6 months, and 12 months after implant placement, the retention of the mandibular dentures and wear of O-ring attachments were evaluated. Data were collected, tabulated, and statistically analyzed using Student t test. Statistically significant differences were found between the two groups and within the same groups during the evaluation period (P < .05). Attachment housing incorporated within a CAD/CAM implant overdenture can be a better alternative to the manufacturer's metal housing, as it diminishes retention loss and attachment wear over time, thus increasing patient satisfaction and chewing efficiency.

The Egyptian Association of Vascular Biology and Atherosclerosis (EAVA) Perspectives on the Usage of Inclisiran.

BACKGROUND: Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in Egypt, up to 71% of female participants had dyslipidemia. Control of LDL-c levels and thus improvement of hyperlipidemia is quite often very difficult. With the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, the decrease of significant cardiac adverse events, the patient control rate, and the death rate have all been improved. Inhibition of the formation of PCSK9 through inclisiran, which is a novel method of reducing LDL-c and is only given twice per year, seems alluring. After revision of published data, we analyzed the potential advantages of the use of inclisiran. CONCLUSION: The Egyptian Association for Vascular Biology and Atherosclerosis (EAVA) analyzed the data necessary for obtaining clear indications for the usage of inclisiran. We propose the addition of inclisiran to statins with or without ezetimibe for patients with documented atherosclerotic cardiovascular disease (ASCVD) or similar risk, familial hypercholesterolemia (FH) with another major risk factor, and very high and high risk diabetes mellitus, who did not reach LDL-c goals and/or with true statin intolerance. Inclisiran is also recommended as upfront therapy, with triple combination, in extreme risk subjects such as those with post acute coronary syndromes (ACS).

Polyetheretherketone custom CAD-CAM splint for treatment of periodontally affected mobile anterior teeth.

This technique describes the use of a polyetheretherketone (PEEK) splint to support mobile anterior teeth. The lingual surfaces were first scanned, and the splint was then digitally designed, fabricated, and delivered.

Egyptian Atherosclerosis and Vascular Biology Association Consensus on the Use of Sodium Glucose Cotransporter-2 Inhibitors in Heart Failure with Reduced Ejection Fraction.

Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances in treatment, the prognosis remains poor. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease HF events by 27-39% in high-risk patients with type 2 diabetes mellitus (T2DM). Moreover, the DAPA-HF and EMPEROR-Reduced studies randomized patients with HF with reduced ejection fraction (HFrEF) with or without diabetes mellitus to receive guideline-directed medical therapy versus guideline-directed medical therapy plus an SGLT-2 inhibitor. Both studies showed the benefits of SGLT-2 inhibitors. In addition, SGLT-2 inhibitors have shown improvement according to the EMPEROR-Preserved study of HF with preserved ejection fraction (HFpEF). Therefore, a panel of cardiology experts from the Egyptian Atherosclerosis and Vascular Biology Association (EAVA) revised the literature for SGLT-2 inhibitors in HF, along with the recommended indications and contraindications, and this article presents their consensus on the topic. The panel concluded that SGLT-2 inhibitors have significantly benefited patients with chronic HFrEF, as indicated through the DAPA-HF and EMPEROR-Reduced trials. The panel recommended early use of dapagliflozin 10 mg or empagliflozin 10 mg in patients with symptomatic chronic HFrEF, whether diabetic or non-diabetic, to ameliorate HF hospitalization rate, mortality, symptoms, and decline in renal function.

Effect of dynamic cyclic loading on screw loosening of retightened versus new abutment screw in both narrow and standard implants (in-vitro study).

BACKGROUND: The purpose of this in-vitro study was to evaluate the effect of dynamic cyclic loading on screw loosening of retightened abutment screw versus new abutment screw in both narrow and standard implants. METHODS: Separate acrylic resin blocks containing implant assembly (fixture, abutment, abutment screw, metal tube capping the abutment). Samples were divided into two main groups according to the diameter of implant: group 1 (GI 4.5-mm diameter) and group 2 (GII 3-mm diameter). Each group is subdivided into two subgroups according to the suggested option to manage screw loosening either by retightening (GIA, GIIA) or using new screws (GIB, GIIB). One hundred thousand cycles of eccentric dynamic cyclic loading (DCL) were applied before and after retightening or replacing the screw; then, removal torque loss (RTL) ratio was calculated, tabulated, and analyzed by t-student, ANOVA, pair wise Tukey's tests. RESULTS: There were differences between GI and GII regarding the incidence of screw loosening process. Removal torque loss ratio was higher in GIB and GIIB where the old abutment screws were replaced by new screws for both standard implants (SIs) and narrow diameter implants (NDIs). There was significant effect of retightening and replacing the abutment screws after exposure to DCL. CONCLUSIONS: Within the limitations of this in-vitro study, it can be conclude that screw loosening process occurred in both SIs and NDIs but with higher values in NDIs. It is better to retighten the screw of NDIs and SIs than replacing it with a new screw.

Egyptian Association of Vascular Biology and Atherosclerosis (EAVA) consensus on the usage of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

BACKGROUND: The current expert view of the PCSK9 inhibitors' use in Egypt is still ambiguous. MAIN BODY: Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has > 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications. CONCLUSION: We recommend the use of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolaemia patients with clinically diagnosed ASCVD, at very high cardiovascular risk.

Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndrome: final data of the nationwide cross-sectional 'CardioRisk' project.

BACKGROUND: Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). OBJECTIVE: Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. METHODS: From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. RESULTS: The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants. CONCLUSION: Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.

The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project.

BACKGROUND: Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt. METHODS: From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies. RESULTS: Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non-ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064). CONCLUSIONS: Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.

Effect of different angulations and collar lengths of conical hybrid implant abutment on screw loosening after dynamic cyclic loading.

BACKGROUND: The purpose of this in vitro study was to evaluate the effect of different angulations and collar lengths of the implant abutment on screw loosening by measuring removal torque value (RTV) before and after dynamic cyclic loading using digital torque gauge. METHODS: A total 90 sets of 4.5 mm diameter × 10 mm length bone level implants with conical hybrid connection were used. They were divided equally according to abutment angulation, into three groups: GI 0° abutment, GII 15° abutment, and GIII 25°. Each group was divided into two subgroups, 15 each, according to collar height: subgroup A (2 mm) and subgroup B (4 mm). Each implant and abutment assembly was positioned vertically in the center of the acrylic resin block using stainless steel cylindrical split mold. Initial analysis was made by abutment screw tightened with 30 Ncm torque twice with 10-min intervals using a digital torque gauge. RTV before and after cyclic loading of the abutment screws were measured in newton centimeter using digital torque gauge. One hundred thousand cycles of eccentric dynamic cyclic loading, at 130 N at a rate of 1 Hz, were applied 5 mm away from the central axis of the implant fixture. Percentage of removal torque loss (%RTL) before and after dynamic cyclic loading were calculated and statistically analyzed using the SPSS version 20. RESULTS: For GI, %initial RTL was 25.0 ± 1.5% and decreased significantly after loading (23.5 ± 2.3%). For GII, %initial RTL was 25.5 ± 1.4% and increased significantly after loading (33.4 ± 3.7%). For GIII, %initial RTL was 25.944 ± 1.2% and increased significantly after loading (40.1 ± 5.1%). There was significant effect on screw loosening for abutment angulations and collar lengths. CONCLUSION: Within the limitations of this study, results suggested that screw loosening increases with increasing abutment angulations and collar lengths after dynamic cyclic loading.

Implant-connected versus tooth-connected implant-supported partial dentures: 2-year clinical and radiographic comparative evaluation.

The purpose of this study was to clinically and radiographically compare implant-connected and tooth-connected implant-supported fixed-detachable mandibular partial dentures. Twenty partially edentulous patients (age range: 25 to 50 years) with mandibular Kennedy Class II configurations were equally divided into two groups receiving a three-unit, fixed-detachable, screw-retained partial denture. Group 1 comprised patients with unilateral missing mandibular molars and premolars. Two implants were placed at the mandibular first premolar and first molar areas. Group 2 comprised patients with missing mandibular molars and second premolars. An implant was placed at the mandibular first molar area, the first premolar was prepared, and a coping was cemented to the tooth with permanent cement. Each case was evaluated clinically and radiographically at baseline (partial denture insertion) and after 6, 12, and 24 months. Data were collected and statistically analyzed using repeated-measures one-way and two-way analysis of variance tests. There was no statistically significant difference between the two groups (P > .05). The implant-tooth-supported prosthesis provided an equally predictable treatment option compared to the totally implant-supported prosthesis in terms of implant survival and loss of marginal bone.

Paraoxonase-1 and oxidative status in common Mediterranean ß-thalassaemia mutations trait, and their relations to atherosclerosis.

AIMS: Investigation of paraoxonase-1 (PON1) activity with oxidative status parameters and the increased susceptibility to atherogenesis in ß-thalassaemia-trait (BTT) subjects. METHODS: Sixty BTT subjects and 20 age- and sex-matched healthy controls were enrolled in the study. Serum PON1, total antioxidant capacity (TAC), malondialdehyde (MDA) and carotid artery intima-media thickness (CIMT) were determined. Qualitative detection of ß-thalassaemia mutations was carried out. RESULTS: Serum PON1 activity and TAC were significantly lower in BTT subjects than in controls (p<0.001), while MDA and CIMT were significantly higher (p<0.001). In BTT subjects, TAC, MDA, and CIMT levels were significantly correlated with serum PON1 (r=0.945, -0.900, 0.940 and -0.922 respectively). Serum TAC and MDA were significantly correlated (r=-0.979). CONCLUSIONS: Oxidative stress is increased, while serum PON1 activity is decreased in BTT subjects. Decrease in PON1 activity is associated with the degree of oxidative stress, anaemia and increase in CIMT. Therefore, BTT subjects may be more prone to development of atherosclerosis.

Evaluation of the precision of three implant transfer impression techniques using two elastomeric impression materials.

A master cast representing a completely edentulous mandible was fabricated in polyurethane resin and had four implants secured to the anterior interforaminal area. Impressions were made using six technique-material combinations. Ten definitive casts were fabricated for each technique. Linear distances between implants were measured using a traveling microscope. There was no statistically significant difference between the direct unsplinted and splinted techniques (P > .05), while the indirect technique was statistically significantly different from the other two techniques (P < .05). There was no statistically significant difference between the two impression materials.