Impact of digital technologies on implant surgery in fully edentulous patients: A scoping review.

BACKGROUND: For over three decades, digital technologies have been used in Implant Dentistry, beginning with the introduction of planning software for Static Computer-Assisted Implant Surgery (S-CAIS). During this time, this field has witnessed the emergence of diverse methodologies and a proliferation of technological advancements. Today, S-CAIS is a widely adopted procedure for the placement of dental implants in both partially and fully edentulous patients, with Dynamic Computer-Assisted Surgery (D-CAIS) and Robotic-Assisted Implant Surgery (RAIS) rapidly gaining attention among dental professionals. The continuous advancements in this arena are not merely indicative of technological progress; they represent a steadfast dedication to refining precision, enhancing efficiency, and fostering innovation with the goal of optimizing patient outcomes in dental implantology. AIMS: The purpose of the following review is to meticulously examine the spectrum of digital technologies available and to describe their protocols, advantages, and shortcomings as well as to evaluate their accuracy in implant surgery in patients with complete edentulism. MATERIALS AND METHODS: A scoping review was performed following the Joanna Briggs Institute (JBI) protocols, leveraging the population, concept, and context (PCC) framework to construct the research question and determine the inclusion and exclusion criteria. RESULTS: Two hundred and sixty-seven records were identified for screening. After applying all the screening criteria, 41 articles were included for review and qualitative data analysis. DISCUSSION: S-CAIS, D-CAIS, and RAIS were identified as the main technologies for computer assisted implant surgery. Their applications, characteristics, protocols and levels of accuracy were compared and described. CONCLUSION: Taking into consideration the limitations of this study, S-CAIS appears to be the most applied and validated technology in implant surgery for fully edentulous patients followed by D-CAIS and RAIS being these last two promising initiatives in the field. Despite having similar levels of accuracy, the overall comparison showed a slightly higher values in RAIS followed by D-CAIS and S-CAIS.

Influence of scanning protocol on the accuracy of complete-arch digital implant scans: An in vitro study.

OBJECTIVE: This in-vitro study assessed the influence of two intraoral scanning (IOS) protocols on the accuracy (trueness and precision) of digital scans performed in edentulous arches. METHODS: Twenty-two abutment-level master casts of edentulous arches with at least four implants were scanned repeatedly five times, each with two different scanning protocols. Protocol A (IOS-A) consisted of scanning the edentulous arch before inserting the implant scan bodies, followed by their insertion and its subsequent digital acquisition. Protocol B (IOS-B) consisted of scanning the edentulous arch with the scan bodies inserted from the outset. A reference scan from each edentulous cast was obtained using a laboratory scanner. Trueness and precision were calculated using the spatial fit analysis, cross-arch distance, and virtual Sheffield test. Statistical analysis was performed using generalized estimating equations (GEEs). Statistical significance was set at α = .05. RESULTS: In the spatial fit test, the precision of average 3D distances was 45 µm (±23 µm) with protocol IOS-A and 25 µm (±10 µm) for IOS-B (p < .001), and the trueness of average 3D distances was 44 µm (±24 µm) with protocol IOS-A and 24 µm (±7 µm) for IOS-B (p < .001). Cross-arch distance precision was 59 µm (±53 µm) for IOS-A and 41 µm (±43 µm) for IOS-B (p = .0035), and trueness was 64 µm (±47 µm) for IOS-A and 50 µm (±40 µm) for IOS-B (p = .0021). Virtual Sheffield precision was 286 µm (±198 µm) for IOS-A and 146 µm (±92 µm) for IOS-B (p < .001), and trueness was 228 µm (±171 µm) for IOS-A and 139 µm (±92 µm) for IOS-B (p < .001). CONCLUSIONS: The IOS-B protocol demonstrated significantly superior accuracy. Placement of scan bodies before scanning the edentulous arch is recommended to improve the accuracy of complete-arch intraoral scanning.

Distribution of Antibiotic Resistance in a Mixed-Use Watershed and the Impact of Wastewater Treatment Plants on Antibiotic Resistance in Surface Water.

The aquatic environment has been recognized as a source of antibiotic resistance (AR) that factors into the One Health approach to combat AR. To provide much needed data on AR in the environment, a comprehensive survey of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and antibiotic residues was conducted in a mixed-use watershed and wastewater treatment plants (WWTPs) within the watershed to evaluate these contaminants in surface water. A culture-based approach was used to determine prevalence and diversity of ARB in surface water. Low levels of AR Salmonella (9.6%) and Escherichia coli (6.5%) were detected, while all Enterococcus were resistant to at least one tested antibiotic. Fewer than 20% of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (17.3%) and carbapenem-resistant Enterobacteriaceae (CRE) (7.7%) were recovered. Six ARGs were detected using qPCR, primarily the erythromycin-resistance gene, ermB. Of the 26 antibiotics measured, almost all water samples (98.7%) had detectable levels of antibiotics. Analysis of wastewater samples from three WWTPs showed that WWTPs did not completely remove AR contaminants. ARGs and antibiotics were detected in all the WWTP effluent discharges, indicating that WWTPs are the source of AR contaminants in receiving water. However, no significant difference in ARGs and antibiotics between the upstream and downstream water suggests that there are other sources of AR contamination. The widespread occurrence and abundance of medically important antibiotics, bacteria resistant to antibiotics used for human and veterinary purposes, and the genes associated with resistance to these antibiotics, may potentially pose risks to the local populations exposed to these water sources.

Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation.

INTRODUCTION: Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods. METHODS: This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05. RESULTS: Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration ( P =0.525) and time-to-radiographic healing ( P =0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2, P =0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54), P <0.05], and infection rates were similar. Both interventions significantly improved ( P ≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up. CONCLUSION: Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO. LEVEL OF EVIDENCE: Level III.

Advances in Nonsurgical Periocular Rejuvenation.

Nonsurgical periocular rejuvenation presents varied options to the practitioner. The most common current inject modalities for rejuvenation include hyaluronic acid (HA), platelet-rich plasma (PRP), calcium hydroxyapatite, and poly-L-lactic acid. This article provides a summary of recent publications regarding each injectable as well as the description of pertinent periocular anatomy. The modern injector should possess an understanding of each modality for a safe and rejuvenated result.

Digital verification and correction of digital intraoral scans for fixed implant rehabilitation of edentulous arches: A dental technique.

A method is described for the verification and correction of a digital scan of a complete arch implant-supported prosthesis for a completely edentulous patient. The technique provides an efficient way to integrate a highly accurate and precise scan of an implant index cast with a digital intraoral implant scan by using a computer-aided design and computer-aided manufacturing (CAD-CAM) software program. This method allows dental professionals to validate and, if necessary, correct the implant positions in the scan without the need for a conventional impression.

Serial magnetic resonance imaging of splenomegaly in the Trypanosoma brucei infected mouse.

Splenomegaly, an enlargement of the spleen, is a known clinical sign of the parasitic disease, human African trypanosomiasis. This study follows the development of splenomegaly in a group of mice over multiple infection points, using a non-invasive imaging modality, magnetic resonance imaging (MRI). CD-1 mice infected with GVR35 T.b. brucei demonstrated a significant increase in spleen size from day 7 post-infection, with changes in the spleen tracked in individual animals over five time points. At the final time point, the mean spleen weight calculated using the spleen volume from the MR images was compared with the post-mortem gross spleen weight. No significant difference was detected between the two methods (1.62 ± 0.06g using MRI and 1.51 ± 0.04g gross weight, p = 0.554). Haematology and histological analysis were also performed, giving additional insight into splenomegaly for the GVR35 strain of infection. The study demonstrates that MRI is a useful tool when examining changes in organ volume throughout HAT infection and may be applicable in the investigation of a range of conditions where changes in organ volume occur and MRI has not been used previously.

Effects of argon plasma and aging on the mechanical properties and phase transformation of 3Y-TZP zirconia.

To evaluate the flexural strength (FS) and flexural modulus (FM) of a commercial 3Y-TZ0P ceramic after artificial aging and either without or with two application times of non-thermal plasma treatments (NTP). In addition, changes in crystalline phase transformation and surface nano-topography after NTP application, during different aging periods, were evaluated. Ninety 3Y-TZP bars (45x4x3 mm) were made for FS and FM testing, and assigned to nine groups (n=10): no NTP/no aging (Control); no NTP/4h aging; no NTP/30h aging; 10s NTP/no aging; 10s NTP/4h aging; 10s NTP/30h aging; 60s NTP/no aging; 60s NTP/4h aging and 60s NTP/30h aging. Artificial accelerated aging was simulated using an autoclave (134º C at 2 bar) for up to 30h. FS and FM were assessed using a universal testing machine and data analyzed using a ANOVA and Tukey test (α=0.05). The volume change in zirconia monoclinic phase (MPV) was evaluated using X-ray diffraction and surface nano-topography was assessed using atomic force microscopy (baseline until 30h-aging). NTP application did not influence the FS and FM of zirconia. Compared to the Control (no NTP/no aging), the FS of zirconia samples treated for 30 hours in autoclave ("no NTP/30h aging" group) increased. Artificial aging for 30 hours significantly increased the FM of zirconia, regardless of NTP application. MPV tended to increase following the increase in aging time, which might result in the surface irregularities observed at 30h-aging. NTP did not alter the zirconia properties tested, but 30h-aging can change the zirconia FS, FM and MPV.

Effects of argon plasma and aging on the mechanical properties and phase transformation of 3Y-TZP zirconia

Abstract To evaluate the flexural strength (FS) and flexural modulus (FM) of a commercial 3Y-TZ0P ceramic after artificial aging and either without or with two application times of non-thermal plasma treatments (NTP). In addition, changes in crystalline phase transformation and surface nano-topography after NTP application, during different aging periods, were evaluated. Ninety 3Y-TZP bars (45x4x3 mm) were made for FS and FM testing, and assigned to nine groups (n=10): no NTP/no aging (Control); no NTP/4h aging; no NTP/30h aging; 10s NTP/no aging; 10s NTP/4h aging; 10s NTP/30h aging; 60s NTP/no aging; 60s NTP/4h aging and 60s NTP/30h aging. Artificial accelerated aging was simulated using an autoclave (134º C at 2 bar) for up to 30h. FS and FM were assessed using a universal testing machine and data analyzed using a ANOVA and Tukey test (α=0.05). The volume change in zirconia monoclinic phase (MPV) was evaluated using X-ray diffraction and surface nano-topography was assessed using atomic force microscopy (baseline until 30h-aging). NTP application did not influence the FS and FM of zirconia. Compared to the Control (no NTP/no aging), the FS of zirconia samples treated for 30 hours in autoclave ("no NTP/30h aging" group) increased. Artificial aging for 30 hours significantly increased the FM of zirconia, regardless of NTP application. MPV tended to increase following the increase in aging time, which might result in the surface irregularities observed at 30h-aging. NTP did not alter the zirconia properties tested, but 30h-aging can change the zirconia FS, FM and MPV.

Resumo Avaliar a resistência à flexão (FS) e o módulo de flexão (FM) de uma cerâmica comercial 3Y-TZP após envelhecimento artificial, e com ou sem dois tempos de aplicação de plasma não térmico (NTP). Além disso, a transformação de fase cristalina e a nano-topografia de superfície após a aplicação de NTP, durante diferentes períodos de envelhecimento, foram avaliadas. Noventa barras 3Y-TZP (45x4x3 mm) foram feitas para testes de FS e FM, e distribuídas em nove grupos (n=10): sem NTP/sem envelhecimento (Controle); sem NTP/4h de envelhecimento; sem NTP/30h de envelhecimento; 10sNTP/sem envelhecimento; 10sNTP/4h; 10sNTP/30h; 60sNTP/sem envelhecimento; 60sNTP/4h e 60sNTP/30h. O envelhecimento artificial acelerado foi simulado em autoclave (134º C a 2 bar) por até 30 horas. FS e FM foram avaliados em máquina de ensaio universal e os dados analisados ​​pela ANOVA e teste de Tukey (α = 0,05). A mudança de volume da fase monoclínica de zircônia (MPV) foi avaliada usando difração de raios-X e nano-topografia de superfície foi avaliada utilizando microscopia de força atômica (baseline até 30h). A aplicação do NTP não influenciou a FS e FM da zircônia. Comparado ao Controle ("sem NTP/sem envelhecimento"), a FS das amostras de zircônia tratadas por 30 horas em autoclave ("sem NTP/30h de envelhecimento") aumentou. O envelhecimento artificial por 30 horas aumentou significativamente a FM da zircônia, independente do tempo de aplicação do NTP. O MPV tendeu a aumentar em função do aumento do tempo de envelhecimento para todos os grupos, que pode ter resultado nas irregularidades superficiais observadas com 30 horas de envelhecimento. O NTP não afetou as propriedades da zircônia testadas, mas o envelhecimento por 30 horas pode alterar a FS, FM e MPV da zircônia.

Advances in Nonsurgical Periocular Rejuvenation.

Nonsurgical periocular rejuvenation presents varied options to the practitioner. The most common current inject modalities for rejuvenation include hyaluronic acid (HA), platelet-rich plasma (PRP), calcium hydroxyapatite, and poly-L-lactic acid. This article provides a summary of recent publications regarding each injectable as well as the description of pertinent periocular anatomy. The modern injector should possess an understanding of each modality for a safe and rejuvenated result.

Behavior of KCNQ Channels in Neural Plasticity and Motor Disorders.

The broad distribution of voltage-gated potassium channels (VGKCs) in the human body makes them a critical component for the study of physiological and pathological function. Within the KCNQ family of VGKCs, these aqueous conduits serve an array of critical roles in homeostasis, especially in neural tissue. Moreover, the greater emphasis on genomic identification in the past century has led to a growth in literature on the role of the ion channels in pathological disease as well. Despite this, there is a need to consolidate the updated findings regarding both the pharmacotherapeutic and pathological roles of KCNQ channels, especially regarding neural plasticity and motor disorders which have the largest body of literature on this channel. Specifically, KCNQ channels serve a remarkable role in modulating the synaptic efficiency required to create appropriate plasticity in the brain. This role can serve as a foundation for clinical approaches to chronic pain. Additionally, KCNQ channels in motor disorders have been utilized as a direction for contemporary pharmacotherapeutic developments due to the muscarinic properties of this channel. The aim of this study is to provide a contemporary review of the behavior of these channels in neural plasticity and motor disorders. Upon review, the behavior of these channels is largely dependent on the physiological role that KCNQ modulatory factors (i.e., pharmacotherapeutic options) serve in pathological diseases.

Environmental Fate of Cl-PFPECAs: Predicting the Formation of PFAS Transformation Products in New Jersey Soils.

Although next-generation per- and polyfluorinated substances (PFAS) were designed and implemented as safer and environmentally degradable alternatives to "forever" legacy PFAS, there is little evidence to support the actual transformation of these compounds and less evidence of the safety of transformed products in the environment. Multiple congeners of one such PFAS alternative, the chloro-perfluoropolyether carboxylates (Cl-PFPECAs), have been found in New Jersey soils surrounding a manufacturing facility. These compounds are ideal candidates for investigating environmental transformation due to the existence of potential reaction centers including a chlorinated carbon and ether linkages. Transformation products of the chemical structures of this class of compounds were predicted based on analogous PFAS transformation pathways documented in peer-reviewed literature. Potential reaction products were used as the basis for high-resolution mass-spectrometric suspect screening of the soils. Suspected transformation products of multiple congeners, the Cl-PFPECAs, including H-PFPECAs, epox-PFPECAs, and diOH-PFPECAs, were tentatively observed in these screenings. Although ether linkages have been hypothesized as potential reaction centers under environmental conditions, to date, no documentation of ether scission has been identified. Despite exhaustive scrutiny of the high-resolution data for our Cl-PFPECA-laden soils, we found no evidence of ether scission.

Digital articulation of a complete arch fixed implant prosthesis using the implant prosthetic connections: A dental technique.

A method for the digital articulation of complete arch digital implant scans using the implant abutment prosthetic interfaces is described. This technique provides an effective and efficient method for articulating digital scans without the need for matching soft tissue references or fiduciary markers. This allows for a streamlined workflow with fewer intraoral scans and can provide a precise replication of the intaglio surface and emergence profile of an existing restoration.

Digitally Fabricated Provisional Implant Restorations Prior to Implant Placement: A Clinical Case Series.

PURPOSE: To review the factors that affect the ability to deliver a CAD/CAM implant-supported provisional restoration designed from a virtually planned implant position prior to surgical placement with static computer-assisted implant surgery (sCAIS). MATERIALS AND METHODS: Data were collected on patients treated with single-tooth implant treatment in which CBCT was combined with intraoral scans and imported into a virtual implant planning software. A synchronization tool established the connection between the planning software and the CAD software, where a digital diagnostic tooth arrangement was performed to create the ideal tooth dimensions and mucosal architecture. The virtual implant planning was finalized, and the implant position was transferred to the CAD software, where a restoration was designed and fabricated. The sCAIS was performed, and the prefabricated custom restorations were delivered on the day of the surgery or following healing if delayed loading or submerged healing was required. Descriptive statistics and statistical comparison with two-proportion z test were performed. RESULTS: A total of 23 patients with 28 single-implant sites met the inclusion criteria and were included in the study. Nineteen customized healing abutments and 10 provisional crowns were designed and fabricated for a total of 29 restorations. Of the restorations, 23 were successfully delivered on the day of the surgical intervention. No statistical significance was found among the different variables compared. CONCLUSION: Custom prefabricated CAD/CAM restorations based on a virtually planned implant position can be successfully designed, fabricated, and delivered when used in combination with sCAIS.

A completely digital workflow for the transition from a failed dentition to interim complete-arch fixed implant-supported prostheses: A clinical report.

This clinical report describes a completely digital workflow for the rehabilitation of the maxillary and mandibular arches with implant-supported fixed interim prostheses. Computer-assisted implant planning was used to fabricate a multifunctional surgical template for the guided placement of transitional and endosteal dental implants. Advantages of this technique include the integration of a completely digital workflow into the production of a virtual diagnostic tooth arrangement for edentulous patients, the planning of implant placement as per a restorative-driven approach, and the delivery of implant-supported fixed interim prostheses.

A comparative retrospective study of different surgical guide designs for static computer-assisted implant surgery in posterior single edentulous sites.

AIM: The aim of this retrospective clinical study was to compare the accuracy of static Computer-assisted implant surgery (sCAIS) in posterior single edentulous patients using different surgical guide designs. MATERIALS AND METHODS: Thirty-seven partially edentulous patients with a total of 54 implants were included in the study. Seventeen implants were included in Group 1-Unbounded Tooth-Mucosa Supported; 18 implants in Group 2-Unbounded Tooth Supported; and 19 implants in Group 3 (Control)-Bounded Tooth Supported. All partially edentulous patients were treated with fully guided implant surgery using the corresponding surgical guide. Discrepancies between the pre-planned and post-operative implant position were evaluated. RESULTS: The mean angular deviation ± standard deviation (SD) was 2.91 ± 1.56°, 3.33 ± 1.72° and 2.25 ± 1.13° for Groups 1, 2, and 3, respectively. The mean ± SD 3D offset at base was 0.66 ± 0.29 mm, 0.77 ± 0.24 mm, and 0.49 ± 0.22 mm; and 3D offset at tip was 0.84 ± 0.45 mm, 1.07 ± 0.38 mm, and 0.75 ± 0.25 mm for Groups 1, 2, and 3, respectively. No statistically significant differences between groups were found for angular deviation. There were statistically significant differences between Groups 2 and 3 for 3D offset at base (p = .002) and 3D offset at tip (p = .010). CONCLUSIONS: Different surgical guide designs for posterior single edentulous areas appear to be associated with the accuracy level of sCAIS. In unbounded sites, having additional posterior attached soft tissue support is preferable.

Fellowship program directors and trainees across the United States find parental leave policies to be inconsistent, inaccessible, and inadequate.

INTRODUCTION: Determine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs. METHODS: We administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables. RESULTS: A total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5-10 weeks (156/426; 36.6%) or 11-15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents' sex, specialty, or subspecialty. DISCUSSION: Parental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.