Impact of Prolonged Continuous Ketamine Infusions in Critically Ill Children: A Prospective Cohort Study.

BACKGROUND: Ketamine has been considered as an adjunct for children who do not reach their predefined target sedation depth. However, there is limited evidence regarding the use of ketamine as a prolonged infusion (i.e., >24 hours) in the pediatric intensive care unit (PICU). OBJECTIVE: We sought to evaluate the safety and effectiveness of continuous ketamine infusion for >24 hours in mechanically ventilated children. METHODS: We conducted a prospective cohort study in a tertiary PICU from January 2020 to December 2022. The primary outcome was the incidence of adverse events (AEs) after ketamine initiation. The secondary outcome included assessing the median proportion of time the patient spent on the Richmond Agitation-Sedation Scale (RASS) goal after ketamine infusion. Patients were also divided into two groups based on the sedative regimen, ketamine-based or non-ketamine-based, to assess the incidence of delirium. RESULTS: A total of 269 patients were enrolled: 73 in the ketamine group and 196 in the non-ketamine group. The median infusion rate of ketamine was 1.4 mg/kg/h. Delirium occurred in 16 (22%) patients with ketamine and 15 (7.6%) patients without ketamine (p = 0.006). After adjusting for covariates, logistic regression showed that delirium was associated with comorbidities (odds ratio [OR] 4.2), neurodevelopmental delay (OR 0.23), fentanyl use (OR 7.35), and ketamine use (OR 4.17). Thirty-one (42%) of the patients experienced at least one AE following ketamine infusion. Other AEs likely related to ketamine were hypertension (n = 4), hypersecretion (n = 14), tachycardia (n = 6), and nystagmus (n = 2). There were no significant changes in hemodynamic variables 24 h after the initiation of ketamine. Regarding the secondary outcomes, patients were at their goal RASS level for a median of 76% (range 68-80.5%) of the time in the 24 hours before ketamine initiation, compared with 84% (range 74.5-90%) of the time during the 24 h after ketamine initiation (p < 0.001). The infusion rate of ketamine did not significantly affect concomitant analgesic and sedative infusions. The ketamine group experienced a longer duration of mechanical ventilation and a longer length of stay in the PICU and hospital than the non-ketamine group. CONCLUSION: The use of ketamine infusion in PICU patients may be associated with an increased rate of adverse events, especially delirium. High-quality studies are needed before ketamine can be broadly recommended or adopted earlier in the sedation protocol.

Assessing the quality of constructed technosols enabled holistic monitoring of ecological restoration.

The soil quality index (SQI) serves as a general ecological restoration indicator, however, statistics approaches that accurately assess the minimum data set (MDS) for SQI remain susceptible. The present study aims to evaluate the short-term reclamation results at the Ferro-Carvão stream and propose a system for ecological restoration monitoring, by selecting influential attributes and indexing soil quality. We hypothesized that the reclamation activities at the Ferro-Carvão stream, referred to as the "Marco zero" (MZ) area, can bring its soil quality to levels comparable to those of the native area. We collected soil samples at 0-20 and 20-40 cm depths from transects of MZ and reference sites (R1 and R2). Principal component analysis showed the MDS for each soil depth. Permutational analysis of variance, in conjunction with Nonmetric Multidimensional Scaling, exposed relationships between transects of areas. An additive non-linear factorial algorithm allowed SQI assessment. The results indicated a similar soil quality between transects of areas at 0-20 cm depth, whereas a dissimilarity at 20-40 cm. To sum up, reclamation activities allowed MZ-constructed Technosol to present a soil quality similar to native areas. The soil quality assessment at both depths offered insights into reclamation activities' immediate and long-term impacts on the Ferro-Carvão stream. This robust framework effectively monitors ecological restoration progress and guides future efforts in post-mining and post-dam collapse sites.

Soils under seal carcasses with varying degrees of decomposition: oasis of nutrients and vegetation in Antarctica.

Areas of high concentration of seal carcasses have been observed in localized areas of James Ross Island, Antarctica. Such carcasses show an unusual vegetation development, in a semi-arid area with bare soils under intense winds, high salinity and sandy texture. We investigated carcasses of seals around a lake in James Ross Island, with four different stages of decomposition, with three replicates: Seal (S01), with recently mummified carcasses; S02, with partially degraded carcasses; S03, with broken carcasses with partially degraded exposed bones, and S04, with completely broken, scattered skeletons. The vegetation showed a maximum degree of development in carcasses at stages S02 and S03, with the environment between the skin and the skeleton as the preferred place for vegetation establishment. The chemical alteration was greater with increasing carcass decomposition but reduced with the spreading and final decomposition of the bones, with anomalous values observed only in the vicinity of the carcasses. It is concluded that the presence of carcasses of seals, concentrated in wet places, even in a semi-desert climate, represent important oases of nutrients, with a combination of physical and chemical effects throughout the decomposition process that favor plant establishment and succession.

Glacier fluctuations and a proglacial evolution in King George Bay (King George Island), Antarctica, since 1980 decade.

This study aims to investigate the glacier shrinkage and recent proglacial environment in King George Bay, Antarctica, since 1988 in response to climate change. Remote sensing data (SPOT, Sentinel, Landsat and Planet Scope images) were applied to glacial landforms and ice-marginal fluctuations mapping. Annual mean near-surface air temperature reanalysis solutions from ERA-Interim were analyzed. Moraines and glaciofluvial landforms were identified. The Ana Northern Glacier has the highest retreat value (3.64 km) (and area loss of 31%) in response to higher depth in frontal ice-margin and reveal ocean-glacier linkages. The Ana South Glacier changed from a tidewater glacier to land-terminating after 1995, and had an outline minimum elevation variation of 89 meters, a shrinkage of 0.63 km, and a new proglacial subaerial sector. The Ana South Glacier foreland had recessional moraines (probably formed between 1995 and 2022), lagoons, and lakes. There are many flutings in low-relief environments. The 1980-1989, 1990-1999, 2000-2009, 2010-2019 anomaly plots concerning to the 1980-2019 average for atmospheric temperature, are shown to be a driver of the local glacial trends.

Ornithogenesis and soil-landscape interplays at northern Harmony Point, Nelson Island, Maritime Antarctica.

Understanding the influence of soil-forming factors and processes in ornithogenic soils is important to predict impacts of climate change on Antarctic ecosystems. Herein, we analyzed the soil-landscape interplays and development of ornithogenic soils at Harmony Point (HP), Nelson Island. We collected, described, and classified 24 soil profiles, combined with vegetation and landforms descriptions. Geoprocessing techniques were employed for mapping. Soil physical, chemical, geochemical, and mineralogical analyses were applied. Patterned ground, "Ornithogenic"/Typic Gelorthent, and moss carpets were the dominant landform, soil and vegetation classes, respectively. Soils from rocky outcrops were more structured, acidic, with higher organic carbon, organometallic complexes, and secondary phosphate minerals, due to former bird influence. Soils from cryoplanated platforms presented higher water pH, base saturation, clay content, and secondary silicate minerals. Soils from marine terraces presented high exchangeable bases, phosphorous, and amorphous phosphate minerals. Soil chemical weathering is enhanced by ornithogenesis and widespread in HP. Besides ornithogenesis, organic matter accumulation, cryoturbation, and cryoclastic processes are also important to pedogenesis of ornithogenic soils. The soils of the cryoplanated platforms exhibited a gradient of pedogenetic development corresponding to increasing biota influence and distance from glacier. In contrast, soils of rocky outcrops were more developed even close to the glacier, due to ornithogenesis.

Digitally Guided Lateral Sinus Floor Elevation With Simultaneous Implant Placement: 3 Case Reports With Technical Considerations.

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.

Digitally-Guided Lateral Sinus Floor Elevation with Simultaneous Implant Placement: Three Case Reports with Technical Considerations.

INTRODUCTION: A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla.  Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon design and locate the window after the flap is reflected based upon the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardship in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring a LSFE simultaneous to implant placement, a maxillary sinus surgical guide (MSSG) has been tested and reported to be the amiable method to be utilized as a conjunct, to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. CASE SERIES: This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus, as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated base on 3D software. During the surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. CONCLUSION: This technique makes the sinus window opening procedure simple and predictable, reduces surgical time as well as the risk of complications, and allows the placement of the implant in the ideal 3D position.

Effects of crown contour on artificial biofilm removal efficacy with interdental cleaning aids: An in vitro study.

OBJECTIVES: To evaluate the efficacy of various interdental cleaning aids for artificial biofilm removal on different implant-supported crown designs. METHODS: Mandibular models with missing first molar were fabricated and installed with single implant analogs and loaded with crowns of different designs (concave, straight, and convex). Artificial biofilm was made with occlusion spray. Thirty volunteers (periodontists, dental hygienists, and laypersons) were asked to clean the interproximal areas. The crowns were unscrewed and photographed in a standardized setting. The outcome was measured by the cleaning ratio which represents the cleaned surfaces in relation to the area of the tested surface. RESULTS: A significant difference in favor of concave crown (p < .001) on the basal surface was cleaned by all tools, except the water flosser. There was evidence of an overall effect of "cleaning tool," "surface," and "crown design" (p < .0001) except for the "participant" factor. The mean cleaning ratio for each cleaning tool and overall combined surfaces were (in%): dental floss: 43.02 ± 23.93, superfloss: 42.51 ± 25.92, electric interspace brush: 36.21 ± 18.78, interdental brush: 29.10 ± 15.95, and electric water flosser: 9.72 ± 8.14. Dental floss and superfloss were significantly better (p < .05) than other tools in removing plaque. CONCLUSIONS: Concave crown contour had the greatest artificial biofilm removal, followed by straight and convex crowns at the basal surface. Dental floss and superfloss were the most effective interdental cleaning devices for artificial biofilm removal. None of the tested cleaning devices were able to completely remove the artificial biofilm from the interproximal/basal surfaces.

Ultrasound insonation angle and scanning imaging modes for imaging dental implant structures: A benchtop study.

INTRODUCTION: High frequency ultrasound has shown as a promising imaging modality to evaluate peri-implant tissues. It is not known if the ultrasound imaging settings might influence ultrasound's ability to differentiate implant structures. The aim of this benchtop study was to evaluate the dependence of ultrasound on imaging angles and modes to measure implant geometry-related parameters. METHODS: A clinical ultrasound scanner (ZS3, Mindray) with an intraoral probe (L30-8) offering combinations of harmonic and compound imaging modes was employed for imaging 16 abutments and 4 implants. The samples were mounted to a micro-positioning system in a water tank, which allowed a range of -30 to 30-degree imaging angles in 5-degree increment between the probe and samples. The abutment angle, implant thread pitch and depth were measured on ultrasound, compared to the reference readings. The errors were computed as a function of the image angles and modes. All samples were replicated 3 times for 3 image modes and 11 image angles, thus resulting in 2,340 images. RESULTS: The mean errors of ultrasound to estimate 16 abutment angles, compared to the reference values, were between -1.8 to 2.7 degrees. The root mean squared error (RMSE) ranged from 1.5 to 4.6 degrees. Ultrasound significantly overestimated the thread pitch by 26.1 µm to 36.2 µm. The error in thread depth measurements were in a range of -50.5 µm to 39.6 µm, respectively. The RMSE of thread pitch and depth of the tested 4 implants was in a range of 34.7 to 56.9 µm and 51.0 to 101.8 µm, respectively. In most samples, these errors were independent of the image angle and modes. CONCLUSIONS: Within the limitations of this study, high-frequency ultrasound was feasible in imaging abutments and implant fixtures independent of scanning angle within ±30° of normal incidence and for compounding and non-compounding-based imaging modes.

Retrospective Outcomes of Horizontal Guided Bone Regeneration at Partially Edentulous Sites with a Facially Oriented Crestal Incision (FOCIS) Design.

This retrospective study aimed to describe the facially oriented crestal incision (FOCIS) and assess the incidence of flap dehiscence and its efficacy in simultaneous and staged guided bone regeneration (GBR) procedures. The data of 41 patients treated with FOCIS GBR were analyzed. The primary outcome analyzed was the rate of initial wound closure. Secondary outcomes were related clinical parameters, including mean resolution of dehiscences and fenestrations, crestal buccal bone thickness (BBT), and bone width (BW) increase. A total of 53 implants were placed. The initial wound closure rate was 92.7% (38/41) and 94.3% (50/53) at the patient and implant levels, respectively. The complete dehiscence resolution rate was 79.31%, and the mean dehiscence reduction was 3.12 ± 2.46 mm (95% CI: 2.19 to 4.06 mm). BBT had a mean increase of 1.22 ± 1.07 mm (95% CI: 0.86 to 1.59 mm), and the final BBT was an average of 1.56 ± 0.79 mm (95% CI: 1.32 to 1.80 mm). Lastly, BW increase averaged 3.38 ± 1.49 mm (95% CI: 2.58 to 4.17 mm) for the staged cases. Utilizing FOCIS at partially edentulous sites can help achieve and maintain wound closure in horizontal GBR procedures.

The Prosthetic-Biologic Connection and Its Influence on Peri-implant Health: An Overview of the Current Evidence.

Prosthetic design is a critical step in implant treatment planning that must synchronize with implant positioning to promote a state of peri-implant health. Improperly designed prostheses may not only hinder patient (or professional) hygiene measures but also impact the ability of clinicians to examine the peri-implant supporting tissues for diagnostic purposes. The purpose of this review was to discuss the current state of the evidence surrounding prosthetic factors associated with peri-implant diseases. Following the chronologic order of implant treatment, key prosthetic variables were discussed in relation to peri-implant disease pathogenesis. Specific concepts including the impact of implant spatial positioning, abutment height, residual cement, and implant splinting were found to be associated with peri-implant disease pathogenesis. Excessive occlusal forces were found to play a role in susceptibility to prosthetic complications with limited evidence to suggest a role in peri-implant disease progression. An intimate prosthetic-biologic connection exists, which must be respected to promote an environment for long-term peri-implant stability and health.

Evaluation of the degradation of two bioabsorbable interference screws: an in-vivo study in sheep.

PURPOSE: To evaluate in-vivo degradation of two bioabsorbable interference screws. METHODS: Twenty-two crossbred Santa Inês ewes were used. A poly-DL-lactide (PDLLA) screw (70%/30%) was inserted in the right pelvic limb, and a PDLLA screw (70%) + ß-tri-calcium phosphate (ß-TCP) (30%) in the left pelvic limb. Animals were euthanized at one, four, seven and a half and 18 months after surgery. Plain radiography, computed tomography (CT), microCT, and histological analysis were accomplished. RESULTS: PDLLA screw was hypodense at all evaluation moments, but with progressive density increase along the central axis, whereas PDLLA/ß-TCP was initially hyperdense and progressively lost this characteristic. No adverse reactions were observed on histological evaluation. CONCLUSIONS: The inclusion of ß-TCP favors screw degradation since the PDLLA/ß-TCP screws evidenced a more intense degradation process than the PDLLA screws at the last evaluation. PDLLA screws showed higher bone production, evident around the screw thread, inside the lateral perforations, and in the central canal, whereas the PDLLA/ß-TCP screws presented less bone tissue at the implantation site.

Influence of the Near-Cortical Over-Drilling Technique on the Mechanical Behaviour of Locking Plate Constructs Applied in Maned Wolf's Femur.

OBJECTIVE: The aim of this study was to evaluate the influence of near-cortical over-drilling holes on the mechanical behaviour of locking plate constructs applied in maned wolf's femur by using mechanical testing and finite element method (FEM). STUDY DESIGN: Seven pairs of adult maned wolves (Chrysocyon brachyurus) femur bones were randomly distributed into four groups. In all groups, a 3.5 mm locking compression plate, designed with 12 combi-holes and one locked, was applied to the lateral surface of the femur. G1 (n = 4) received bicortical locking screws placed in holes 1, 3, 5, 8, 10 and 12. In G2 (n = 5), the plate was applied as used in G1, but the application of the locked screws involved the near-cortical over-drilling technique. In G3 (n = 4), the plate was applied as used in G2, but the size of the near-cortical over-drilling was larger. The combi-holes 6 and 7 were maintained over a 10 mm fracture gap without screws. All constructs were tested for failure in the axial load. The axial load was applied eccentrically to the femoral head. RESULTS: Statistical differences were observed in the maximum load with G3 > G1 and G3 > G2, and in the deflection with G2 > G1 and G2 > G3. The FEM showed the lowest total displacement of the bone-plate constructs as well as of the plate in G1 compared with G2 and G3. CONCLUSION: The near-cortical over-drilling technique used in unstable fractures induced in the maned wolf's femur showed by static axial compression test that maximum load and deflection are dependent on drill hole size induced in the near-cortex. Based on FEM, the lowest total displacement of the bone-plate constructs was observed in Group 1.

Treatment efficacy of gingival recession defects associated with non-carious cervical lesions: a systematic review.

PURPOSE: This systematic review aimed to compare the efficacy, defined in terms of the mean percentage of root coverage (mRC), of surgical treatment approaches combined with adhesive restorations of non-carious cervical lesions (NCCLs) to that of root coverage alone in patients with a single gingival recession (GR) and NCCL. METHODS: A literature search was conducted to identify longitudinal studies reporting the mRC following treatment for the correction of GR defects associated with NCCLs using a combination of surgical and restorative techniques in systemically and periodontally healthy patients. RESULTS: The search resulted in the retrieval of 12,409 records. Seven publications met the inclusion criteria for the qualitative synthesis of data. The mRCs ranged from 69% to 97%. In the medium term, the gingival margin position was more stable when a connective tissue graft (CTG) was used, independently of whether restoration of teeth with NCCLs was performed. CONCLUSIONS: The strength of the evidence was limited by methodological heterogeneity in terms of study design as well as the unit and period of analysis, which precluded a meta-analysis. Although no definitive conclusion could be drawn due to the lack of sufficient evidence to estimate the effectiveness of the interventions, CTG-based procedures contributed to gingival margin stability regardless of the performance of restoration to treat NCCLs.

Three-Dimensional Volumetric Analysis of the Palatal Donor Site Following Soft Tissue Harvesting.

Autogenous soft tissue grafting is a commonly performed procedure in periodontal and implant surgery. Reharvesting a connective tissue graft (CTG) from the same palatal donor site is often required, but little is known about the volumetric changes that occur after harvesting a free gingival graft and how long the palatal mucosa takes to regain its original form and thickness. This study evaluated the volumetric changes that occur at the palatal donor site after harvesting a soft tissue graft with a noninvasive digital technology. Nineteen patients needing a CTG for a single site were enrolled. Intraoral digital scans of the palatal donor sites were obtained at baseline and at 1, 3, 6, and 12 months. The digital scans were imported and analyzed with an imaging software to evaluate volumetric changes. Average volume losses of 5.82 ± 2.63 mm3 and 11.03 ± 5.47 mm3 were observed after 1 and 3 months, respectively. Only minor changes were observed at 6 and 12 months. Linear dimensional changes at 5 and 7 mm from the gingival margin were substantially higher than the changes at 3 mm for the 1- and 3-month interval comparisons compared to baseline. Graft dimension was associated with volume loss at 1 and 3 months (P < .01). After palatal harvesting, the donor site undergoes volumetric changes, mostly during the first 3 months, and is attenuated thereafter.

Prognostic factors associated with implant loss, disease progression or favorable outcomes after peri-implantitis surgical therapy.

BACKGROUND: The treatment of the peri-implantitis remains complex and challenging with no consensus on which is the best treatment approach. PURPOSE: To examine the key local and systemic factors associated with implant loss, disease progression, or favorable outcomes after surgical peri-implantitis therapy. MATERIALS AND METHODS: Records of patients treated for peri-implantitis were screened. Patient-, implant- and surgery-related variables on and prior to the day of the surgery were collected (T0: time of peri-implantitis treatment). If the treated implant was still in function when the data was collected, the patient invited to participate for a recall study visit (T1, longest follow-up after treatment). Impacts of the variables on the implant survival, success, and peri-implant bone change after treatment were investigated. RESULTS: Eighty patients with 121 implants with a mean follow-up of 42.6 ± 26.3 months were included. A total of 22 implants (18.2%) were removed during the follow-up period. When relative bone loss (%) was in range 25%-50%, risk for implant removal increased 15 times compared to lower bone loss <25% (OR = 15.2; CI: 2.06-112.7; p = 0.008). Similarly, relative bone loss of >50% increased 20 times the risk of implant failure compared to the <25% (OR = 20.2; CI: 2.42-169.6; p = 0.006). For post-treatment success rate, history of periodontitis significantly increased the risk of unsuccess treatment (OR = 3.07; p = 0.04) after resective surgery). CONCLUSION: Severe bone loss (>50%) poses significantly higher risk of treatment failure.

Acid sulfate soils from Antarctica: genesis and properties along a climatic gradient.

Sulfurization is a pedogenic process that involves pyrite oxidation and strong soil acidification, accounting for the formation of acid sulfate soils. In Antarctica, acid sulfate soils are related to specific parent materials, such as sulfide-bearing andesites in Maritime Antarctica and pyritized sedimentary rocks in James Ross Archipelago. The hypothesis is that the acid sulfate soils of these regions vary according with a climate gradient. The reviewing of current data showed that the acid sulfate soils of warmer and wetter Maritime Antarctica have a greater weathering degree, higher acidity, leaching, phosphorus adsorption capacity, structural development, and well-crystallized iron oxides and kaolinite formation. On the other hand, the sulfurization at the drier region of James Ross Archipelago is counterbalanced by the semiaridity, resulting in lower acidity and higher base contents combined with little morphological and mineralogical evolution besides presence of weatherable minerals in the clay fraction. The sulfurization process interplays with other pedogenic processes, such as the phosphatization in Maritime Antarctica and salinization in James Ross Archipelago. Higher temperatures and soil moisture enhance the pedogenesis, showing that even the Antarctic sulfate soils, which originated from specific parent materials, have their development and characteristics controlled by a clear climatic gradient.

The Impact of Surgical Guide Fixation and Implant Location on Accuracy of Static Computer-Assisted Implant Surgery.

PURPOSE: To evaluate the accuracy of static computer-assisted implant surgery (sCAIS) for tooth-supported free-end dental implantation with the aid/and without the aid of fixation pins to secure the surgical template through comparison between planned, 3D printed guide position and placement implant position. MATERIALS AND METHODS: Thirty-two duplicated maxillary resin models were used in the present in vitro study. Digital planning was performed and fabrication of a surgical template that allowed implant placement on the distal extension edentulous site of the model (maxillary left side). A first optical scan was performed after fitting the surgical template on the model to assess the deviation at the surgical guide level. After placing implants in the model using the surgical guide, scan bodies were attached to the implants, and a second scan was performed to record the position of placed implants. The digital representations were later superimposed to the pre-operative scan and measurements of implant deviations were performed. Global (coronal and apical), horizontal (coronal and apical), depth and angular deviations were recorded between planned implant position, guide position, and placement implant position. Three-way ANOVA was used to compare implant location (#13, 14, and 15), fixation pin (with or without pin), and guide comparison (planned, guided, and placement). RESULTS: Final implant placement based on the digital plan and based on the 3D printed guide were very similar except for depth deviation. Use of fixation pin had a statistically significant effect on the depth and angular deviation. Overall, without fixation pins and based on guide versus placement, mean global coronal (0.88 ± 0.36 mm), horizontal coronal (0.55 ± 0.32 mm), and apical (1.44 ± 0.75 mm), and angular deviations (4.28 ± 2.01°) were similar to deviations with fixation pins: mean global coronal (0.88 ± 0.36 mm); horizontal coronal (0.67 ± 0.22 mm) and apical (1.60 ± 0.69 mm); and angular deviations (4.53 ± 2.04°). Horizontal apical without pins (1.63 ± 0.69 mm) and with fixation pins (1.72 ± 0.70 mm) was statistically significant (p = 0.044). Depth deviation without pins (-0.5 ± 0.5 mm) and with fixation pins (-0.16 ± 0.62 mm) was also statistically significant (p = 0.005). Further analysis demonstrated that the final sleeve position on the 3D printed guide was on average 0.5 mm more coronal than the digital plan. CONCLUSIONS: The use of surgical guides with or without fixation pins can provide clinically acceptable outcomes in terms of accuracy in implant position. There was a statistically significant difference in the accuracy of implant position when utilizing fixation pins only for horizontal apical and depth deviation. Additionally, a statistically significant difference between the planned and the 3D printed surgical guide when considering the sleeve position was detected.

Immediate Implant With Provisionalization and Soft Tissue Grafting After 4-Year Follow-Up.

INTRODUCTION: This paper presents a case report of immediate implant placement (IIP) with a provisionalization technique to restore function and esthetics with follow-up after 4 years. CASE PRESENTATION: Minimally traumatic extraction was performed with IIP, soft-tissue grafting, and immediate provisional crown. Six months after optimal healing, the patient was submitted to an esthetic restorative work through veneers in lithium disilicate. Fourteen-month and 4-year follow-up visits revealed stability of the peri-implant soft-tissues with peri-implant health status, with the evaluation of the pink and white esthetic score, yielding to mean scores, respectively, in 14 months of 11.62 ± 2.07 (pink esthetic score [PES]) and 18.25 ± 1.46 (PES/white esthetic score [WES]) and in 4 years of 11.0 ± 1.32 (PES) and 17.62 ± 0.65 (PES/WES). Intraoral digital radiographs showed minimal crestal bone level changes throughout the follow-up period. Thus, IIP is a sensitive technique procedure, and a 3D implant position is crucial for success. CONCLUSION: Immediate implant with grafting to fill the gap and soft tissue augmentation led to less horizontal changes and stable mucosal margin, and immediate provisionalization helped to maintain soft tissue architecture, and proper case selection is key for clinical success.

Autologous Platelet Concentrate of 2nd and 3rd generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews.

BACKGROUND: Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial. MATERIALS AND METHODS: An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes. RESULTS: Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed. CONCLUSIONS: This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.