Breast cancer time to treatment in Martinique: predictive factors and effect on survival.

BACKGROUND: Martinique is the second French Region with the lowest physician-to-population ratio, which may affect waiting times for access to care. OBJECTIVES: To assess (i) factors influencing waiting times from diagnosis to cancer-related treatments in breast cancer women in Martinique, and (ii) the impact of waiting times on patients' survival. STUDY DESIGN: Retrospective observational study. METHODS: Data on women diagnosed with invasive breast cancer between 1st January 2013 and 31st December 2017 and initially treated by surgery were extracted from the Martinique population-based registry. A cox model was performed to find predictive factors for waiting times. A log-rank test was used to compare time-to-treatment between groups. RESULTS: In total, 713 patients were included (mean age: 58 ± 13). Median time from diagnosis to surgery was 40 [25-60] days. Age at diagnosis was found to predict variations in waiting times. Patients > 75 had longer waiting time to surgery than those < 40 or [40-50] (P = 0.016 and P < 0.001, respectively). Women with a time-to-treatment ≥ 4 months had a significant lower survival (P < 0.01). CONCLUSIONS: Specific interventions are needed to improve waiting time from diagnosis to initial treatment, as they are longer than recommended and affect survival time.

Tempo de tratamento ortodôntico com aparelhos autoligados: revisão de literatura

Introdução: Atualmente, braquetes autoligados têm sido sugeridos para reduzir o tempo de tratamento na Ortodontia. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura acerca do tempo de tratamento com esses braquetes, em comparação com outros braquetes e tratamentos sugeridos. Revisão de literatura: Foi realizada pesquisa bibliográfica de caráter descritivo, que compreendeu o levantamento de referencial teórico na base de dados eletrônica Medline ­ PubMed. A seleção de artigos foi feita a partir dos títulos e resumos e a revisão compreendeu 4 artigos publicados na língua inglesa no período de 2019 a 2023. Conclusão: Há uma escassez de estudos clínicos envolvendo essa temática e o tratamento ortodôntico com aparelhos autoligados parece apresentar menor tempo de tratamento em comparação com aparelhos fixos tradicionais. No entanto, os estudos não mostraram diferenças estatisticamente significativas na redução desse tempo. Pode-se sugerir que mais estudos clínicos sejam conduzidos no intuito de elucidar essa questão.

Introduction: Currently, self-ligating brackets have been suggested to reduce treatment time in Orthodontics. Objective: Therefore, the present study aimed to review the literature about the treatment time with these brackets, in comparison with other brackets and suggested treatments. Literature review: Descriptive bibliographical research was carried out, which included the survey of theoretical references in the electronic database Medline ­ PubMed. The selection of articles was made based on titles and abstracts and the review comprised 4 articles published in the English language from 2019 to 2023. Conclusion: there is a shortage of clinical studies involving this topic and orthodontic treatment with self-ligating appliances seems to present shorter treatment time compared to traditional fixed appliances. However, the studies did not show statistically significant differences in reducing this time. It can be suggested that more clinical studies be conducted to elucidate this issue.

Retrasos en el diagnóstico y tratamiento del cáncer de mama en Medellín, Colombia / Delays in the diagnosis and treatment of breast cancer in Medellín, Colombia

Resumen OBJETIVO: Determinar los retrasos en el diagnóstico y tratamiento de pacientes con cáncer de mama atendidas en Medellín, Colombia, y describir sus características sociodemográficas y clínicas. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional y analítico de corte transversal efectuado en mujeres con cáncer de mama del registro personal de un cirujano. Se consideró retrasos en el paciente, proveedor y total, definidos como el tiempo trascurrido mayor a 90, 30 y 30 días, respectivamente; se recopilaron los datos demográficos, clínicos y paraclínicos. Para el análisis se utilizó estadística descriptiva. RESULTADOS: Se estudiaron 331 mujeres de las que 98.6% contaba con aseguramiento en salud; el 80.1% (n= 265) tuvieron retraso total del tratamiento, el 76.1% (n = 270) tuvo demora del paciente y el 78% (n = 277) demora del proveedor. En el análisis bivariado se establecieron asociaciones significativas entre un retraso total y el pertenecer al régimen subsidiado (OR = 1.17; IC95%: 1.06-1.29; p = 0.008). CONCLUSIÓN: En la muestra estudiada se encontraron retrasos importantes debidos a la responsabilidad de la paciente y el proveedor, y un retraso total del tratamiento asociado de forma significativa con pertenecer al régimen subsidiado.

Abstract OBJECTIVE: To determine the existence of delays in the diagnosis and treatment of breast cancer in women treated in Medellin (Colombia), to explore the associated factors, and to describe sociodemographic and clinical characteristics. MATERIALS AND METHODS: Retrospective, observational and analytical cross-sectional study of 331 women with breast cancer in Medellin (Colombia) in the personal record of a surgeon. Delays in the patient, provider and total were considered, defined as the time elapsed greater than 90 days, 30 days and 30 days, respectively; Demographic, clinical, and paraclinical data were collected and analyzed using descriptive statistics. RESULTS: 98.6% of the women had health insurance; 80.1% (n= 265) presented total treatment delay, 76.1% (N= 270) had patient delay, and 78% (n=277) provider delay; In the bivariate analysis, significant associations were established between total delay and belonging to the subsidized regimen (OR= 1.17; 95% CI 1.06-1.29; p= 0.008). CONCLUSION: Among the patients studied, important delays were found due to the responsibility of the patient and the provider, and a total delay to treatment significantly associated with belonging to the subsidized regimen.

Tiempo de ventilación mecánica invasiva y lesión renal aguda en pacientes críticos / Invasive Mechanical Ventilation Time and Acute Kidney Injury in Critically Ill Patients

Introducción: La evidencia científica vincula el uso de la ventilación mecánica invasiva con una mayor probabilidad de desarrollar lesión renal aguda, pero la falta de consenso sobre esta asociación no es infrecuente. Objetivo: Identificar la relación entre tiempos de ventilación mecánica y la aparición y gravedad de la lesión renal aguda. Métodos: Cohorte histórica realizada en una Unidad de Cuidados Intensivos del Distrito Federal, Brasil, entre 2016 y 2018. La población fue compuesta por 387 pacientes, pero la muestra consistió en 52 pacientes que necesitaron ventilación mecánica invasiva durante una semana y dos. El registro de los datos se realizó en un cuestionario estructurado compuesto por variables de identificación, datos clínicos, variables hemodinámicas y parámetros de laboratorio. Para los análisis de asociación se utilizaron las pruebas de Chi-cuadrado, Exacta de Fisher y Mann-Whitney. Los resultados con p < 0,05 se consideraron significativos. Resultados: La lesión renal aguda de diferentes severidades predominó en más de la mitad de los pacientes (55,80 por ciento), siendo el estadio 2 más prevalente (aproximadamente 30 por ciento ). Los pacientes que permanecieron en ventilación mecánica durante una semana o dos mostraron una disminución del riesgo de lesión renal aguda (OR 0,85; IC del 95 por ciento: 0,72 a 0,99, p = 0,038) y OR 0,77; IC 95 por ciento 0.63-0.94, p = 0,010, respectivamente). Conclusión: La lesión renal aguda de diferentes severidades estuvo presente en pacientes con ventilación mecánica invasiva. Sin embargo, el tiempo de ventilación mecánica solo no fue determinante de lesión renal aguda(AU)

Introduction: Scientific evidence associates the use of invasive mechanical ventilation with a higher probability of developing acute kidney injury, but the lack of consensus on this association is not uncommon. Objective: To identify the relationship between mechanical ventilation times and the onset and severity of acute kidney injury. Methods: Historical cohort carried out, between 2016 and 2018, in an intensive care unit of the Federal District, Brazil. The population consisted of 387 patients, but the sample consisted of 52 patients who required invasive mechanical ventilation for one week and two. The data were recorded with a structured questionnaire composed of identification variables, clinical data, hemodynamic variables and laboratory parameters. Chi-square, Fisher's exact and Mann-Whitney tests were used for the association analysis. Results with P < 0.05 were considered significant. Results: Acute kidney injury of different severity degrees predominated in more than half of the patients (55.80 percent), stage 2 being the most prevalent (approximately 30 percent). Patients who remained on mechanical ventilation for a week or two showed a decreased risk for acute kidney injury (OR: 0.85, 95 percent CI: 0.72-0.99, P = 0.038 and OR: 0.77, 95 percent CI: 0.63-0.94, P = 0.010, respectively). Conclusion: Acute kidney injury of different severity degrees was present in patients with invasive mechanical ventilation. However, the time of mechanical ventilation alone was not a determinant of acute kidney injury(AU)

Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia selectiva y ortodoncia: distancia y tiempo en que se logra realizar un desplazamiento. Revisión bibliografica / Corticotomia seletiva e ortodontia: distância e tempo em que um deslocamento é alcançado. Revisão bibliográfica

La corticotomía se define como una osteotomía, en la cual, se corta el hueso cortical, perforando o alterando mecánicamente de una manera quirúrgica controlada y al mismo tiempo penetrando mínimamente en la mé-dula ósea para acelerar el movimiento dental ortodóntico en respuesta a una demanda de los pacientes en cuanto a la efectividad del tratamiento y al rápido movimiento de cada zona. Objetivo: mediante una revisión bibliográfica, determinar la distancia y tiempo en que se logra realizar un desplazamiento o movimiento orto-dóntico después de haber realizado una corticotomía selectiva. Para la búsqueda, se utilizaron Plataformas como Pubmed, Scielo, Science Direct y Google Scholar, en las que se empleó palabras claves como distan-cia, tiempo, corticotomía selectiva y tratamiento de ortodoncia y se buscaron artículos publicados entre el 2001 y 2017. Resultados: se obtuvo que los movimientos se realizan en un periodo de 4 meses, respecto a la distancia y se observó que se logra desplazar un promedio de 3.5mm. Conclusiones: en pacientes adultos, ha aumentado la exigencia sobre reducir tiempos de tratamiento, la ortodoncia facilitada por corticotomía con-sigue llevar a cabo un tratamiento exitoso y disminuir los tiempos de tratamiento. Sin embargo, la evidencia es escasa, pues está basada principalmente en reportes de casos, por lo cual se requiere mayor investigación acerca de este procedimiento.

Corticotomy is defined as an osteotomy, in which the cortical bone is cut, perforated or mechanically altered in a controlled surgical way and at the same time minimally penetrating the bone marrow to accelerate orthodon-tic dental movement in response to a demand for patients regarding the effectiveness of the treatment and the rapid movement of each zone. Objective: by means of a bibliographic review, determine the distance and time in which an orthodontic movement is achieved after having performed a selective corticotomy. For the search, Platforms such as Pubmed, Scielo, Science Direct and Google Scholar were used, in which keywords such as distance, time, selective corticotomy and orthodontic treatment were used and articles published between 2001 and 2017 were searched. Results: It was obtained that the movements are carried out in a period of 4 months, with respect to the distance and it was observed that an average of 3.5mm can be moved. Conclu-sions: in adult patients, the demand for reducing treatment times has increased; orthodontics facilitated by corticotomy achieves successful treatment and decreases treatment times. However, the evidence is scarce, since it is mainly based on case reports, so more research is required about this procedure.

A corticotomia é definida como uma osteotomia, na qual o osso cortical é cortado, perfurado ou alterado mecanicamente de maneira cirúrgica controlada mais penetração mínima na medula óssea para acelerar o movimento dentário ortodôntico em resposta a uma demanda por pacientes quanto à eficiência do tratamento e ao movimento rápido de cada zona. Objetivo: por meio de uma revisão bibliográfica, determinar a distância e o tempo em que um movimento ou deslocamento ortodôntico é alcançado após a realização de uma cortico-tomia seletiva. MATERIAL Y MÉTODOS: Para a pesquisa, foram utilizadas plataformas como Pubmed, Scielo, Science Direct e Google Scholar, nas quais foram utilizadas palavras-chave como distância, tempo, corticoto-mia seletiva e tratamento ortodôntico e foram pesquisados artigos publicados entre 2001 e 2017. Resultados: se observou que os movimentos são realizados em um período de 4 meses, em relação à distância obser-vou-se que uma média de 3,5 mm pode ser movimentada. Conclusões: em pacientes adultos, a demanda por redução do tempo de tratamento aumentou, a ortodontia facilitada pela corticotomia consegue o sucesso do tratamento e diminui o tempo de tratamento. No entanto, as evidências são escassas, uma vez que se baseiam principalmente em relatos de casos, sendo necessárias mais pesquisas sobre esse procedimento.

Interferon-based Simeprevir Therapy for Pediatric Patients with Chronic Hepatitis C Viral Infection.

Interferon-based simeprevir therapy showed high efficacy and tolerability in children with genotype 1 hepatitis C virus infection. While direct-acting antivirals (DAAs) therapy are undergoing study in children, this regimen is considered an available therapeutic option for selected patients in countries where DAAs have not yet been approved.

Replacing amalgam with a high-viscosity glass-ionomer in restoring primary teeth: A cost-effectiveness study in Brasilia, Brazil.

OBJECTIVES: When planning primary oral health care services the cost implications of adopting new intervention practices are important, especially in resource-strapped countries. Although on a trajectory to be phased-out, amalgam remains the standard of care in many countries. METHODS: Adopting a government perspective, this study compared the costs of performing amalgam and ART/high-viscosity glass-ionomer cement (HVGIC) restorations and the consequences of failed restorations over 3 years in suburban Brasilia, Brazil. Cost data were collected prospectively; cost estimates were developed for the study sample and a projection of 1000 single- and 1000 multiple-surface restorations per group. Probabilistic sensitivity analysis was conducted in TreeAge Pro. RESULTS: Results were mixed. For single-surface restorations, ART/HVGIC will cost US$51 per failure prevented, while for multiple-surface restorations, ART/HVGIC was cost-effective with a savings of US$11 compared to amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost-effective 49.2% of the time compared to HVGIC at 50.6% of the time at a willingness to pay threshold of US$237 per failure prevented. Personnel accounted for more than half the cost burden for both methods; instruments and supplies accounted for about one third. The per restoration cost to replace amalgam with HVGIC ranges from US$1 to a savings of US$0.84. CONCLUSION: Replacing amalgam with a high-viscosity glass-ionomer as part of the ART method comes at a minimal increase in cost for governments. Increasing the number of restorations seems to diminish the cost burden. CLINICAL SIGNIFICANCE: ART/HVGIC could be considered a viable alternative to amalgam in primary teeth.

Prescripción de antibioticoterapia por vía parenteral en un servicio de cirugía general de Santiago de Cuba / Parenteral antibiotic therapy prescription in a general surgery service of Santiago de Cuba

Se realizó un estudio analítico y transversal, del tipo indicación-prescripción de medicamentos, de 254 pacientes atendidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero a mayo de 2016, con vistas a analizar la prescripción de antibióticos de administración parenteral por parte del personal médico de esta área. En la serie las infecciones resultaron más frecuentes en el sexo masculino (53,1 por ciento y en los grupos etarios de 45 a 64 años (42,1 por ciento). Asímismo, predominó el criterio de aplicar terapia antimicrobiana empírica (71,7 por ciento) y en general, las indicaciones correspondieron a la amikacina 144 (25,2 por ciento), 121 al metronidazol (21,2 por ciento) y 118 a la penicilina cristalina (20,7 por ciento); por otra parte, los gérmenes patógenos más aislados en el Servicio fueron la Escherichia coli, la Klebsiella, el enterobacter y el estafilococo coagulasa positivo.

An analytic and cross-sectional study, of the indication-prescription medications type, of 315 patients assisted in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January to May, 2016, aimed at analyzing the prescription of parenteral antibiotics on the part of the medical staff of this area. In the series the infections were most frequent in the male sex (53,1 percent) and in the 45 to 64 years group (42,1 percent). Also, the criterion of applying antimicrobians empirically prevailed (71,7 percent) and in general, indications corresponded to amikacin 144 (25,2 percent), 121 to metronidazole (21,2 percent), and 118 to crystalline penicillin (20,7 percent); on the other hand, the most isolated pathogens in the Service were Escherichia coli, Klebsiella, enterobacter and positive coagulase staphylococcus.

Nasoenteral tube: factors associated with delay between indication and use in emergency services / Sonda Nasogástrica: factores asociados al delay entre indicación y uso en Servicio de Urgencia / Sonda Nasoenteral: fatores associados ao delay entre indicação e uso em Emergência

ABSTRACT Objective: to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. Method: A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. Results: the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. Conclusion: the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

RESUMEN Objetivo: conocer el tiempo entre indicación y uso de sonda nasogástrica (SNG) y factores asociados a demoras. Método: cohorte prospectivo que observó adultos en Servicio de Urgencia brasileño, desde indicación hasta uso de la SNG, evaluándose variables clínicas del proceso de trabajo. Se adoptó modelo de Ecuaciones de Estimación Generalizada para identificar factores asociados a demoras en cada etapa del proceso. Resultados: el tiempo entre indicación y uso de SNG fue 573 (IQR=360α1093) minutos, en 150 inserciones de SNG. Las inserciones en pacientes que no la utilizaban previamente, demoras en rutina de atención médica, de nutrición y enfermería, uso de ventilación mecánica, noradrenalina y ayuno, constituyeron factores de demora hasta uso de la sonda. Conclusión: el tiempo entre indicación y uso de SNG fue elevado, superando las 10 horas en mitad de los casos. Factores relacionados a condiciones clínicas del paciente y a gestión de atención contribuyeron a las demoras.

RESUMO Objetivo: conhecer o tempo entre indicação e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Método: coorte prospectiva que acompanhou adultos de uma Emergência brasileira, desde a indicação ao uso da SNE, avaliando-se variáveis clínicas e do processo de trabalho. Adotou-se o modelo de Equações de Estimações Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicação e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 inserções de SNE. Inserções em pacientes que anteriormente não a utilizavam, retardos na rotina assistencial médica, da nutrição e enfermagem, uso de ventilação mecânica, noradrenalina e jejum foram fatores para maior tempo até o uso da sonda. Conclusão: o tempo entre indicação e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas do paciente e à gestão da assistência contribuiriam para atrasos.

Assistência ao paciente com síndrome coronariana aguda segundo indicadores de qualidade / La atención al paciente con síndrome coronario agudo según los indicadores de calidad / Health care for patients with acute coronary syndrome according to quality indicators

RESUMO Objetivo: avaliar a assistência intra-hospitalar ao paciente com Síndrome Coronariana Aguda segundo indicadores de qualidade. Método: longitudinal, quantitativo, realizado entre novembro de 2012 e março de 2013 com 94 pacientes, por meio de entrevistas e prontuários. Resultados: 39,4% tiveram angina instável, 60,6% infarto do miocárdio, sendo 34% com supra de ST. Tiveram óbito pacientes com escore de TIMI e GRACE superiores a 4 e 140 (p<0,05). A admissão em unidade de cuidados intensivos foi 2,1%, avaliação da fração de ejeção do ventrículo esquerdo em 83,0%, AAS em 24 horas de admissão em 77,8%, estatinas em 72,7%, inibidor da enzima conversora de angiotensina em 62,8%, aconselhamento antitabágico 53,3% e reperfusão oportuna 62,5%. Submeteram-se a estratégia invasiva em 24h 12,0% e, acima de 72h, 50,0%. O tempo porta-ECG foi de 68,3±104,3 min e porta-balão de 122±54,5 min. Conclusão: são necessários protocolos assistenciais para uniformização da prática e melhora destes indicadores.

RESUMEN Objetivo: evaluar la atención en el hospital para los pacientes con síndrome coronario agudo según los indicadores de calidad. Método: estudio cuantitativo longitudinal realizado entre noviembre de 2012 y marzo de 2013 con 94 pacientes a través de entrevistas y registros médicos. Resultados: el 39,4% tenían angina inestable, el 60,6% tenían infarto de miocardio y el 34% con elevación del ST. Los pacientes con puntuación TIMI y GRACE superior a 4 y 140 (p <0,05) murieron. Ingreso en la unidad de cuidados intensivos fue de 2,1%, la evaluación de la fracción de eyección ventricular izquierda en el 83,0%, la aspirina dentro de las 24 horas de ingreso en el 77,8%, estatinas en el 72,7%, la enzima convertidora de la angiotensina en un 62,8%, consejería anti-tabaco a 53,3% y la reperfusión oportuna en el 62,5%. El total de 12,0% de los pacientes fueron sometidos a la estrategia invasiva dentro de las 24 horas, y el 50,0% por encima de las 72 horas. El tiempo puerta ECG fue de 68,3 ± 104,3 min y puerta-balón de 122 ± 54,5 min. Conclusión: los protocolos de atención son necesarios para la normalización de la práctica y mejorar estos indicadores.

ABSTRACT Objective: to assess in-hospital care for patients with Acute Coronary Syndrome according to quality indicators. Method: a longitudinal quantitative study was performed between November 2012 and March 2013 with 94 patients, including interviews and medical records. Results: a total of 39.4% of patients had unstable angina and 60.6% had myocardial infarction, of which 34% had ST segment elevation. Patients with TIMI and GRACE scores higher than four and 140 (p<0.05) respectively died. Admission to the intensive care unit totaled 2.1%; assessment of left ventricular (LV) ejection fraction, 83.0%; ASA within 24 hours of admission, 77.8%; statins, 72.7%; angiotensin-converting enzyme inhibitor, 62.8%; anti-smoking counseling, 53.3%; and timely reperfusion, 62.5%. Of all participants, 12.0% underwent an invasive strategy in 24h and 50.0% in 72h. Door-to-ECG time was 68.3±104.3 min and door-to-balloon time, 122±54.5 min. Conclusions: health care protocols are required to standardize practice and improve these indicators.

Influence of different treatment techniques and clinical factors over the intrafraction variation on lung stereotactic body radiotherapy.

PURPOSE: In the present study we compared three different Stereotactic body radiation therapy (SBRT) treatment delivery techniques in terms of treatment time (TT) and their relation with intrafraction variation (IFV). Besides that, we analyzed if different clinical factors could have an influence on IFV. Finally, we appreciated the soundness of our margins. MATERIALS AND METHODS: Forty-five patients undergoing SBRT for stage I lung cancer or lung metastases up to 5 cm were included in the study. All underwent 4DCT scan to create an internal target volume (ITV) and a 5 mm margin was added to establish the planning target volume (PTV). Cone-beam CTs (CBCTs) were acquired before and after each treatment to quantify the IFV. Three different treatment delivery techniques were employed: fixed fields (FF), dynamically collimated arcs (AA) or a combination of both (FA). We studied if TT was different among these modalities of SBRT and whether TT and IFV were correlated. Clinical data related to patients and tumors were recorded as potential influential factors over the IFV. RESULTS: A total of 52 lesions and 147 fractions were analyzed. Mean IFV for x-, y- and z-axis were 1 ± 1.16 mm, 1.29 ± 1.38 mm and 1.17 ± 1.08 mm, respectively. Displacements were encompassed by the 5 mm margin in 96.1 % of fractions. TT was significantly longer in FF therapy (24.76 ± 5.4 min), when compared with AA (15.30 ± 3.68 min) or FA (17.79 ± 3.52 min) (p < 0.001). Unexpectedly, IFV did not change significantly between them (p = 0.471). Age (p = 0.003) and left vs. right location (p = 0.005) were related to 3D shift ≥2 mm. In the multivariate analysis only age showed a significant impact on the IFV (OR = 1.07, p = 0.007). CONCLUSIONS: The choice of AA, FF or FA does not impact on IFV although FF treatment takes significantly longer treatment time. Our immobilization device offers enough accuracy and the 5 mm margin may be considered acceptable as it accounts for more than 95 % of tumor shifts. Age is the only clinical factor that influenced IFV significantly in our analysis.

Implantes transalveolares imediatos / Transaveolar immediat implants

Os implantes dentários imediatos são, por definição, aqueles instalados no mesmo ato cirúrgico de exodontias dos elementos dentários a serem substituídos pela implantação. Como vantagens desse tipo de técnica, podemos citar: altas taxas de sucesso (aproximadamente 95% dos casos), proporciona a redução de etapas cirúrgicas, com possibilidades reabilitadoras mais rápidas - notadamente em áreas de grande relevância estética - além de, com um sítio dentário ainda residente, -alvéolo dentário com a morfologia muito próxima da original - permitir reestruturar características teciduais muito próximas das presentes quando na dentição natural. Por outro lado, outros fatores sugerem uma análise inicial bem criteriosa, podendo, por vezes, limitar ou mesmo contra-indicar a aplicação da técnica de implantação imediata : a qualidade e quantidade óssea da região a ser implantada, a qual incidirá diretamente sobre a presença ou ausência de estabilidade primária do implante, a necessidade de cirurgia periodontal prévia, ou mesmo a morfologia residual do alvéolo dentário, que, dependendo do formato da raiz (raízes com lacerações, alvéolos com septos, entre outros)limitará o posicionamento adequado do implante

The immediate implants are, as definition, those that are positioned in the course of surgical extraction of the tooth to be replaced. The advantages of this technique are: high success rates of implantation procedures (approximately 95% of the cases), ashortening of treatment time (without a second surgical procedure), besides, the preservation of the extraction socket walls (required for implant installation) permitting maintaining tecidual aspects to a morphology pretty close to the original form. However, there are another factors that suggest a criterious initial analysis that can determine the indication or the contraindication of the technique: the bone quality and quantity (direct factors of influence in the primary stability), the necessity of a previous periodontal approach, or even the extraction socket morphology, which root anatomy can limit a ideal positioning of the implant