Comparative assessment of two-phase class II treatment with Activator or Bionator followed by fixed appliances: A retrospective controlled before-and-after study

AIM

Two-phase treatment for children with Class II malocclusion with several functional appliances is still performed by many orthodontists, while the Activator and the Bionator appliances are two of the most popular ones. Aim of this study was to compare the skeletal and dentoalveolar effects of treatment with these two appliances.

METHODS

Class II children treated with Activator or Bionator in the first phase, followed by a phase of fixed appliances were included. Skeletal and dentoalveolar parameters were assessed from lateral cephalograms and analysed with linear regressions at 5%.

RESULTS

A total of 89 patients (mean age 10.0 years; 47% female) were included. During the first phase, Bionator increased less the SNB (difference in mean treatment-induced changes [MD] -0.7°; 95% confidence interval [CI] -1.3 to -0.2°; P=0.01) and decreased less the ANB angle (MD 0.6°; 95% CI 0 to 1.1°; P=0.03) compared to Activator. Activator slightly increased the facial axis and Bionator reduced it (MD -1.6°; 95% CI -2.3 to -0.8°; P<0.001). Compared to Activator, the Bionator retroclined more the upper incisors (MD -2.4°; 95% CI -4.6 to -0.2°; P=0.03) and increased more the interincisal angle (MD 2.9°; 95% CI 0.5 to 5.4°; P=0.02). After the second phase (6.2 years after baseline), the only differences were a reduced facial axis (MD -1.3°; 95% CI -2.2 to -0.3°; P=0.008) and an increased maxillary rotation (MD 0.9°; 95% CI 0 to 1.8°; P=0.04) with Bionator compared to Activator.

CONCLUSION

Similar dentoalveolar effects were seen overall with two-phase treatment with either appliance, with Bionator being associated with more vertical increase compared to Activator.

COVID-19 in Systemic Lupus Erythematosus patients treated with belimumab: a retrospective clinical study

BACKGROUND

Routine use of immunosuppressive agents in systemic lupus erythematosus (SLE) patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) potentially increases the risk of adverse outcomes. belimumab, a monoclonal antibody for the treatment of SLE, remains untested for its specific impact on coronavirus disease 2019 (COVID-19) symptoms in these patients. Here, this research investigated the effect of belimumab on COVID-19 symptoms in SLE patients infected with SARS-CoV-2.

METHODS

This study enrolled SLE patients who underwent treatment with belimumab. After thorough screening based on the inclusion and exclusion criteria, data pertaining to COVID-19 for both the participants and their cohabitants were obtained through telephone follow-up. The potential impact of belimumab on COVID-19 was evaluated by comparing COVID-19 symptoms and medication use across various groups to investigate the association between belimumab treatment and COVID-19 in SLE.

RESULTS

This study involved 123 SLE patients, of whom 89.4% tested positive for SARS-CoV-2. Among cohabitants of SLE patients, the SARS-CoV-2 positive rate was 87.2% (p = 0.543). Patients treated with belimumab exhibited a lower incidence of multiple COVID-19 symptoms than their cohabitating counterparts (p < 0.001). This protective effect was found to be partially related to the time of last belimumab administration. Among those with COVID-19, 30 patients opted to discontinue their anti-SLE drugs, and among them, 53% chose to discontinue belimumab. Discontinuing drugs did not increase the risk of hospitalization due to SARS-CoV-2 infection.

CONCLUSION

This study concluded that treatment with belimumab did not increase susceptibility to COVID-19 and beneficially alleviated the symptoms of COVID-19.

Difference in marginal bone loss around implants between short implant-supported partial fixed prostheses with and without cantilever: a retrospective clinical study

PURPOSE

To investigate the influence of cantilever prosthetic arm on the marginal bone loss (MBL) over time around dental implants supporting short fixed partial dentures (FPDs), in a record-based retrospective study.

METHODS

All cases of 3-unit implant-supported FPDs, supported by 2-3 implants, from the database of cases treated at one specialist clinic were considered for inclusion. Only implants with a minimum of 36 months of radiological follow-up were considered. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built.

RESULTS

One-hundred-thirty-nine patients (64 men, 75 women) with 164 3-unit implant-supported FPDs (333 implants supporting non-cantilevered FPDs, 94 supporting cantilevered FPDs) were included in the study. The patients were followed up clinically and radiographically for a mean of 154.1 ± 78.0 (min-max, 37.3-364.6) and 132.9 ± 77.3 months (min-max, 36.8-329.9), respectively. The total number of marginal bone level double measurements (mesial and distal sides of each implant) was 2909. FPDs with cantilever presented an estimated greater MBL over time compared to FPDs without cantilever. Bruxism, sex (women), implant (modified) surface, and (poor) bone quality were also associated with higher MBL over time.

CONCLUSIONS

The use of a cantilever extension is suggested to negatively affect the bone marginal level over time around implants supporting 3-unit FPDs. Due to the small difference of the estimated MBL over long periods of follow-up between the groups, it is a matter of debate if the observed negative effect may be of clinical significance.

Technical complications with tooth-supported fixed dental prostheses (FDPs) of different span lengths: an up to 15-year retrospective study

BACKGROUNDS

Long-span dental bridges may cause excessive load on abutment teeth and the periodontal area, which may lead to bridge fractures or periodontal problems. However, some reports have revealed that short- and long-span bridges can provide a similar prognosis. This clinical study aimed to investigate the technical complications associated with fixed dental prostheses (FDPs) of different span lengths.

METHODS

All patients with previously cemented FDPs were clinically examined during their follow-up visits. Several data related to FDPs were registered, such as design, material type, location, and type of complication. The main clinical factors analyzed were technical complications. Life table survival analyses were performed to calculate the cumulative survival rate of FDPs when technical complications were detected.

RESULTS

The study examined 229 patients with a total number of 258 prostheses and an average of 98 months of follow-up. Seventy-four prostheses suffered from technical complications, and the most common complication was ceramic fracture or chipping (n = 66), while loss of retention occurred in 11 prostheses. The long-term evaluation of long-span prostheses revealed a significantly higher technical complication rate compared to short-span prostheses (P = ,003). The cumulative survival rate for short-span FDPs was 91% in year 5, 68% in year 10, and 34% in year 15. For long-span FDPs, the cumulative survival rate was 85% in year 5, 50% in year 10, and 18% in year 15.

CONCLUSION

Long-span prostheses (5 units or more) can be associated with a higher technical complication rate compared to short-span prostheses after long-term evaluation.

Marginal bone loss around dental implants: comparison between diabetic and non-diabetic patients-a retrospective clinical study

OBJECTIVES

The aim of the present retrospective study was to compare the marginal bone loss (MBL) around dental implants in a group of diabetic patients in relation to a matched group of non-diabetic patients.

MATERIALS AND METHODS

The present dental record-based retrospective study included patients selected from individuals treated with dental implants at one specialist clinic in Malmö, Sweden. Patients were excluded if they had history of periodontitis and/or were treated for periodontal disease. The study group included 710 implants installed in 180 patients (mean age 60.3±13.0 years), 349 implants in 90 diabetic (21 T1DM and 69 T2DM patients), and 361 implants in 90 non-diabetic patients.

RESULTS

The results suggested that jaw (greater MBL in the maxilla), diabetes (greater MBL for diabetic patients, and worse for T1DM patients), bruxism (greater MBL for bruxers), and smoking (greater MBL for smokers and former smokers) had a statistically significant influence on MBL over time.

CONCLUSIONS

Patients with diabetes have an estimated greater MBL over time compared to non-diabetic patients. The difference was greater in patients with diabetes type 1 compared to patients with diabetes type 2. Bruxism, smoking, and implant location (maxilla) were also associated with a higher loss of marginal bone around implants over time.

CLINICAL RELEVANCE

Awareness of the possible influence of diabetes on the long-term outcomes of dental implant treatment is important, in order to be able to minimize the possibility of a high MBL with time, which can eventually lead to the loss of the implant.

A retrospective clinical study

PURPOSE

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge.

METHODS

From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure.

RESULTS

A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation.

CONCLUSIONS

Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

Retrospective Clinical Study of Marginal Bone Level Changes with Two Different Screw-Implant Types: Comparison Between Tissue Level (TE) and Bone Level (BL) Implant

AIM

The objective of this retrospective cohort study was to compare the amount of marginal bone loss (MBL) in a bone-level and a soft-tissue-level implant system, both of which have similar intra-bony shape and surface composition. A subgroup analysis was done to compare the amount of MBL of each implant type in relation to the different vertical placement within the respective groups of implants.

MATERIALS AND METHODS

Records of all patients who underwent implantation for replacement of teeth using comparable bone level (BL) and soft tissue level implants (TE) from 1st January 2006 to 31st December 2009 were scrutinized. Initial depth of implant placement (IDIP) was measured for all implants. Marginal bone loss was measured in patients whose records were available at time point corresponding to 12, 24 and 36 months post insertion.

RESULTS

Out of a total of 384 implants, 337 implants were included for study. The mean MBL for the BL implants were 0.3, 0.38, 0.48 and for TE implant were 0.6, 0.54 and 0.93 for time periods 12, 24 and 36 months respectively. Although there was no statistically significant difference between the two groups at time periods at 6-12 months, in later time periods, there was a slightly greater amount of MBL around TE implants as compared to BL implants (p < 0.001). When comparing the IDIP and MBL in the same implant type, there was a statistically significant (p < 0.001) positive correlation between the depth of implant placement and the amount of MBL, with deeper placed implants having more bone loss.

CONCLUSION

Within the limitations of this retrospective cohort study design, one can conclude that BL implants had statistically significant lesser MBL as compared to TE in time periods above 12 months. Although the difference is statistically significant, the difference may not be clinically significant. The IDIP had an influence on the amount of MBL, with deeper placed implants and screw structure of the implant placed below the bone, having more MBL in the period of study.

Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit

BACKGROUND

With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia (VAP) has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children.

METHODS

From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children's Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed.

RESULTS

A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli (G(-)) were the most (65.55%), followed by fungi (21.01%) and gram-positive cocci (G(+), 13.45%). Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G(-) and G(+) to antibiotics were serious. Most of G(-) was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G(+) to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G(-), and their multiple drug-resistances were serious.

CONCLUSION

In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.