Search

Background: This study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS)., Methods: This is a multi-centre, randomised trial, enrolling adults with moderate to severe ARDS secondary to community-acquired pneumonia. Patients were randomised to a driving pressure-limiting strategy or low PEEP strategy based on a PEEP:FiO 2 table. All patients received volume assist-control mode until day 3 or when considered ready for spontaneous modes of ventilation. The primary outcome was ventilator-free days within 28 days. Secondary outcomes were in-hospital and intensive care unit mortality at 90 days., Results: The trial was stopped because of recruitment fatigue after 214 patients were randomised. In total, 198 patients (n=96 intervention group, n=102 control group) were available for analysis (median age 63 yr, [interquartile range 47-73 yr]; 36% were women). The mean difference in driving pressure up to day 3 between the intervention and control groups was -0.7 cm H 2 O (95% confidence interval -1.4 to -0.1 cm H 2 O). Mean ventilator-free days were 6 (sd 9) in the driving pressure-limiting strategy group and 7 (9) in the control group (proportional odds ratio 0.72, 95% confidence interval 0.39-1.32; P=0.28). There were no significant differences regarding secondary outcomes., Conclusions: In patients with moderate to severe ARDS secondary to community-acquired pneumonia, a driving pressure-limiting strategy did not increase the number of ventilator-free days compared with a standard low PEEP strategy within 28 days., Clinical Trial Registration: NCT04972318., Competing Interests: Declaration of interest The authors declare that they have no conflicts of interest., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare the accuracy of zygomatic implant placement using a dynamic computer-assisted implant surgery system (D-CAIS) versus the traditional freehand approach., Methods: An experimental in vitro study was conducted using 10 stereolithographic models randomized to two groups: D-CAIS (test group) and freehand placement (control group). A single zygomatic implant was placed on each side of the models. The accuracy of implant placement was assessed by superimposing the actual postoperative implant position, obtained via cone-beam computed tomography (CBCT), with the virtual preoperative surgical plan from the preoperative CBCT. Additionally, the operated side and surgery duration were recorded. Descriptive statistics and bivariate analyses were performed to evaluate the data., Results: The D-CAIS group demonstrated significantly greater accuracy across most outcome variables. Reductions in angular (MD = -5.33°; 95 %CI: -7.37 to -3.29; p < 0.001), coronal global (MD = -2.26 mm; 95 %CI: -2.97 to -1.55; p < 0.001), coronal horizontal 2D (MD = -1.96 mm; 95 %CI: -2.60 to -1.32; p < 0.001) and apical global deviations (MD = -3.37 mm; 95 %CI: -4.36 to -2.38; p < 0.001) were observed. Accuracy in the freehand group varied significantly between operated sides. However, the surgical procedures in the D-CAIS group were significantly longer (MD = 11.90 mins; 95 %CI: 9.37 to 14.44; p < 0.001)., Conclusions: D-CAIS navigation systems offer significantly greater accuracy in zygomatic implant placement compared to the traditional freehand technique. Additionally, D-CAIS systems may minimize discrepancies in accuracy between operated sides, though their use is associated with an increase in the duration of surgery., Clinical Significance: D-CAIS navigation systems improve the accuracy of zygomatic implant placement. However, an increase in the duration of surgery is to be expected., Competing Interests: Declaration of competing interest This study was conducted with the support of a zygomatic implant donation from Straumann (Straumann®, Basel, Switzerland), and non-financial aid from Bonemodels (Castellón de la Plana, Spain). Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France), and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain) Dentaid SL (Cerdanyola del Vallés, Spain) and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK). Dr. Octavi Camps-Font reports grants and non-financial support from Inibsa Dental (Lliçà de Vall, Spain) and Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, and Avinent SLU outside the submitted work. The remaining authors report no conflicts of interest., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background and Aims: Nutritional status has a great impact on the prognosis of maintenance hemodialysis patients. Therefore, its management should be a priority, and risk screening frequent and easily implemented, based on the biochemical and clinical routine parameters already available, when the use of more comprehensive tools is not possible. Many tools fit these simple criteria, namely the modified creatinine index, geriatric nutritional risk index, and simple protein energy wasting score. These scores are associated with mortality and morbidity risk in hemodialysis patients. This study aims to confirm that these scores are significantly associated with all-cause mortality and to compare them with malnutrition inflammation score., Methods: Historical cohort study of hemodialysis patients from 25 outpatient clinics. The nutritional and inflammation status was assessed at baseline with malnutrition-inflammation score, geriatric nutritional risk index, modified creatinine index, and simple protein-energy wasting score. Univariable and multivariable Cox additive regression models were used to analyse data. Partial likelihood ratio tests to compare the performance of non-nested Cox models were used., Results: We analysed 2322 patients, 59 % males, 31.7 % diabetic, with a median age of 70 years (P 25  = 60, P 75  = 79), during a median follow-up period of 45 months (P 25  = 31; P 75  = 45). All-cause mortality was observed in 778 patients (33.5 %). The median of the modified creatinine index was 19.9 mg/kg/day (P 25  = 18.6, P 75  = 23.2), and a higher index value was observed for the surviving patients (p < 0.001). Regarding geriatric nutritional risk score, a median of 106.6 (P 25  = 99.4, P 75  = 114.2) was observed, being significantly higher in the survival group (p < 0.001). Simple protein-energy wasting score lower values were more frequent in the group of deceased patients (p < 0.001). For the malnutrition-inflammation score the median was 6 (P 25  = 4, P 75  = 8), and 50.6 % of the patients had a score ≥6, with higher scores being more frequent in the deceased group (p < 0.001). Partial likelihood ratio tests showed that the malnutrition-inflammation score only fitted better than the model including simple protein-energy wasting score. All scores had a good discriminative performance with Harrell's C-statistic ranging from 0.71 to 0.73. Malnutrition-inflammation score and modified creatinine index models attained the highest values., Conclusion: All the tools were significantly associated with mortality. The geriatric nutritional risk index was the score that performed most similarly to the malnutrition-inflammation score., (Copyright © 2025 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement., Methods: A total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters., Results: Global entry deviations were not significantly different between the two techniques (p = 0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p < 0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001)., Conclusions: dCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time., Clinical Significance: dCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Markus Neuschitzer, Jorge Toledano-Serrabona, Javier Bara-Casaus, and Adrià Jorba-Garcia declare that they have no competing interests. - Rui Figueiredo reports grants, personal fees and non-financial support from MozoGrau (Valladolid, Spain), Dentaid SL (Cerdanyola del Vallès, Spain), Inibsa Dental (Lliçà de Vall, Spain) and Avinent SA (Santpedor, Spain), grants from Mundipharma Research (Cambridge, UK), and personal fees from BioHorizons Iberica (Madrid, Spain), Dentsply implants Iberia (Barcelona, Spain), Septodont SAS (Saint-Maur-des-Fossés, France) and Araguaney Dental (Barcelona, Spain) outside the submitted work. In addition, he has participated as an investigator in clinical trials sponsored by Geistlich (Wolhusen, Switzerland). - Eduard Valmaseda-Castellón reports personal fees and non-financial support from MozoGrau (Valladolid, Spain). He is the Director of the Avinent-University of Barcelona research agreement (Càtedra UB-Avinent), with Avinent (Santpedor, Spain), and has received personal fees from BioHorizons Ibérica (Madrid, Spain), Inibsa Dental (Lliça de Vall, Spain) and Dentsply implants Iberia (Barcelona, Spain) outside the submitted work. In addition, he has participated as an investigator in clinical trials sponsored by Mundipharma (Cambridge, UK) and Geistlich (Wolhusen, Switzerland)., (Copyright © 2024. Published by Elsevier Ltd.)

Infective endocarditis (IE) is a complex and potentially life-threatening condition characterized by infection of the heart's endocardial surface, often leading to systemic complications. Historically recognized as a distinct pathological entity, IE has been associated with a wide range of bacterial pathogens, with Bartonella species emerging as a notable cause in recent years. Among these, Bartonella quintana is a rare but significant etiological agent, particularly in cases of culture-negative endocarditis. The management of Bartonella -induced IE remains challenging due to the evolving understanding of its pathophysiology and the need for tailored therapeutic strategies. We present a unique case of a patient with B. quintana IE, remarkable for its simultaneous involvement of three cardiac valves - mitral, tricuspid, and aortic - each exhibiting vegetations. This multisite valvular involvement is an uncommon and distinctive feature, underscoring the aggressive nature of the infection. Notably, the patient's initial presentation was a massive ischemic stroke in the territory of the middle cerebral artery, an atypical manifestation of IE that highlights the potential for cardioembolic complications as the first clinical sign. Further evaluation revealed additional systemic embolization, including septic emboli to the spleen, further complicating the clinical picture. This case underscores the importance of considering IE in patients presenting with embolic stroke, even in the absence of classic symptoms such as fever or heart failure. It also emphasizes the need for a high index of suspicion for Bartonella species in culture-negative endocarditis, particularly in cases with multisite valvular involvement and systemic embolic phenomena. Early diagnosis and targeted treatment are critical to improving outcomes in this rare but devastating condition., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Santos et al.)

Background: Activated phosphoinositide 3-kinase (PI3K) δ Syndrome (APDS) is an ultra-rare, potentially life-threatening disease that lacks approved treatments in Spain. This study aimed to apply Multi-Criteria Decision Analysis (MCDA) to assess the value of the first pharmacological treatment for APDS in Spain., Methods: A multidisciplinary group of 8 experts evaluated the selective PI3Kδ inhibitor leniolisib against Standard of Care (SoC). An MCDA framework tailored for Orphan Drugs (ODs), consisting of 5 comparative and 2 quantitative non-comparative criteria, was used. Re-scoring followed a group discussion., Results: Leniolisib scored higher than SoC in all criteria, including efficacy and safety. It was deemed highly valuable as the first disease-modifying treatment, with a positive therapeutic impact and potential to improve patients' quality of life. Additionally, leniolisib may lead to cost savings. The supporting data was considered of high quality., Conclusion: Based on MCDA methodology and stakeholder experience in APDS management, leniolisib is seen as a value-added treatment option compared to SoC in Spain., Competing Interests: Conflict of interest: RA, CA, LIG, AH, ON, CP, CR-G, and JLT have received honoraria from Pharming for their participation in this study. KHH and RF are employees of Pharming. AG is an employee of Omakase Consulting, which received funding from Pharming for the development and performance of this study and the elaboration of the manuscript. None of the authors have received honoraria for the review of the manuscript., (© 2025 The Authors.)

Introduction: Third molar removal is one of the most common surgical procedures in dentistry. Therefore, it is important to evaluate the learning curve of dentists undergoing surgical training. Thus, the aims of this study were to assess the performance of oral surgery residents in third molar extractions based on operative time and the occurrence of incidents/complications, and to determine which variables are associated with surgical difficulty., Material and Methods: A prospective cohort study was carried out in adults requiring an impacted lower third molar extraction. All procedures were performed by residents of a master's degree in Oral Surgery and Implantology. The outcome variables were operative time and surgeon-reported difficulty. A descriptive, bivariate and multivariate analysis was performed., Results: One hundred and 74 patients were operated on by six students. Similar performance was observed among the surgeons. Although a significant improvement in operative time was seen after 10 cases, a non-significant decreasing trend of incidents was also found. The multivariate analysis revealed an association between difficulty with crown/root sectioning and impaction against the second molar., Conclusions: At least 10 lower impacted third molar extractions performed by postgraduate students with experience in tooth extractions are required to improve the operative time. Incidents seem to decrease slightly with the number of procedures performed. Surgical difficulty seems to be related to the need for crown/tooth sectioning and greater impaction against the second molar. Further studies are required to confirm these findings., (© 2025 The Author(s). European Journal of Dental Education published by John Wiley & Sons Ltd.)

Purpose: The available scientific evidence on the effectiveness of the surgical treatment of peri-implantitis is limited. The aim of this study was to assess the risk of recurrence or disease progression in patients with peri-implantitis that underwent surgical treatment., Materials and Methods: A retrospective cohort study was carried out in patients subjected to peri-implant surgery between 2015 and 2021, and with a minimum follow-up of 12 months. Data were analyzed using simple binary logistic regression models at patient level and generalized estimation equations at implant level., Results: A total of 34 patients and 103 implants were analyzed (70 undergoing resective techniques and 33 regenerative procedures). Fifteen patients (44.12%) experienced peri-implantitis recurrence and one patient (2.9%) lost one implant. No differences were found between the surgical techniques (p = 0.56). A history of periodontitis (ORa = 4.62; 95%CI: 1.14 to 18.75; p = 0.032), maxillary location (ORa = 9.69; 95%CI: 1.81 to 51.87; p = 0.008) and two implants treated per procedure (ORa = 31.68; 95%CI: 3.91 to 256.54; p = 0.001) were seen to increase the risk of recurrence., Conclusions: Almost half of all patients (44%) undergoing surgical treatment of periimplantitis will present disease progression or recurrence. This risk seems to be higher in patients with several treated implants, with a history of periodontal disease, or when the maxilla is involved.

Objective: This study aimed to evaluate the efficacy and safety of a digitally guided dual technique during esthetic crown lengthening surgery. In addition, patient satisfaction and patient-reported outcomes were assessed., Materials and Methods: A prospective case series study was conducted. Cone-beam computed tomography and intraoral scans were used to design surgical guides, which were manufactured via 3D printing. The primary outcome was surgical accuracy, assessed by measuring the distance between the planned and final gingival margin positions using overlapping intraoral scans. Secondary outcomes included clinical crown length, gingival margin stability, pain, and patient satisfaction. Statistical analyses were performed using multilevel linear regression models, with significance set at p < 0.05., Results: Ten participants (87 teeth) were treated without complications. The mean duration of surgery was 66.5 min. The overall absolute deviation was 0.56 mm (95% CI: 0.48 to 0.65) at 6 months postoperatively. Clinical crown length increased significantly from baseline to the end of surgery (p < 0.001), with minimal reduction at 6 months (p = 0.479). Patient-reported outcomes indicated mild postoperative pain and high satisfaction with esthetic results., Conclusions: The digitally guided dual technique for esthetic crown lengthening surgery is safe and effective, providing highly accurate outcomes. The technique also results in excellent patient satisfaction., Clinical Significance: The use of digitally guided dual techniques for ACL surgery enhances precision and safety, leading to highly accurate outcomes and improved patient satisfaction. This approach could be beneficial in clinical settings to ensure better esthetic and functional results., (© 2025 The Author(s). Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Background: The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, due to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate the impact of visually assessed liver steatosis in grafts donated following brainstem (DBD) versus circulatory death (DCD)., Methods: NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data and adjusted regression models with interaction terms to compare the impact of visually assessed donor graft steatosis on transplant outcome., Results: 9217 recipients of deceased donor grafts were included (DBD = 7349; DCD = 1868). Multivariable cox regression revealed that the negative impact on graft survival was significantly different in DCD and DBD livers (interaction P = 0.011 and P = 0.043). The largest impact was in DCD livers (moderate steatosis: aHR = 1.851, 1.296-2.645, P = 0.001 and aHR = 5.426; severe steatosis: 1.723-17.090, P = 0.004). Visually assessed steatosis did not predict longer-term graft survival in the DBD cohort., Conclusion: The impact of visually assessed steatosis on post-transplant outcome is far greater in DCD grafts, despite an identical method of steatosis assessment. This highlights novel therapeutics should be considered for steatotic DCD grafts to allow this growing sector of the donor pool to be safely utilised., Competing Interests: Conflicts of interest None declared., (Crown Copyright © 2025. Published by Elsevier Ltd. All rights reserved.)

Object pose estimation is essential for computer vision applications such as quality inspection, robotic bin picking, and warehouse logistics. However, this task often requires expensive equipment such as 3D cameras or Lidar sensors, as well as significant computational resources. Many state-of-the-art methods for 6D pose estimation depend on deep neural networks, which are computationally demanding and require GPUs for real-time performance. Moreover, they usually involve the collection and labeling of large training datasets, which is costly and time-consuming. In this study, we propose a template-based matching algorithm that utilizes a novel perceptual hashing method for binary images, enabling fast and robust pose estimation. This approach allows the automatic preselection of a subset of templates, significantly reducing inference time while maintaining similar accuracy. Our solution runs efficiently on multiple devices without GPU support, offering reduced runtime and high accuracy on cost-effective hardware. We benchmarked our proposed approach on a body-in-white automotive part and a widely used publicly available dataset. Our set of experiments on a synthetically generated dataset reveals a trade-off between accuracy and computation time superior to a previous work on the same automotive-production use case. Additionally, our algorithm efficiently utilizes all CPU cores and includes adjustable parameters for balancing computation time and accuracy, making it suitable for a wide range of applications where hardware cost and power efficiency are critical. For instance, with a rotation step of 10° in the template database, we achieve an average rotation error of 10 ° , matching the template quantization level, and an average translation error of 14% of the object's size, with an average processing time of 0.3 s per image on a small form-factor NVIDIA AGX Orin device. We also evaluate robustness under partial occlusions (up to 10% occlusion) and noisy inputs (signal-to-noise ratios [SNRs] up to 10 dB), with only minor losses in accuracy. Additionally, we compare our method to state-of-the-art deep learning models on a public dataset. Although our algorithm does not outperform them in absolute accuracy, it provides a more favorable trade-off between accuracy and processing time, which is especially relevant to applications using resource-constrained devices., Competing Interests: Authors JA-M and VM were employed by Mercedes-Benz AG. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Araya-Martinez, Matthiesen, Bøgh, Lambrecht and Pimentel de Figueiredo.)

Objectives: To systematically review published evidence on cancer drug wastage and the effectiveness of mitigation methods., Methods: Search keywords for Scopus, PubMed, and EMBASE were developed using the Pearl Growing technique. Relevant articles were identified in a 2-step process: first, based on titles/abstracts, then on full article reviews. Among the identified English peer-reviewed articles, those considering adults ≥18 years and relevant cancer drug wastage outcomes were included. Key concepts and measures for drug wastage and its mitigation were tabulated. Trends in publication numbers were analyzed using Mann-Kendall tests. Costs were converted first to 2024 local currencies using country-wise consumer price indexes and then to 2024 USD using exchange rates., Results: Among 6298 unique articles, 94 met the inclusion criteria. Seventy-four (79%) of these were published since 2015, highlighting increasing attention to cancer drug wastage. Twenty-three articles (24%) explicitly reported drug wastage amounts, whereas 52 articles (55%) considered the mitigation methods. Most articles focused on high-income countries (n = 67), single-hospital settings (n = 45), and retrospective study designs (n = 55). Wastage mitigation techniques included vial sharing (n = 21), dose rounding (n = 17), closed-system transfer device (n = 9), centralized drug preparation (n = 7), and vial size optimization (n = 7). A trend toward higher median wastage cost was evident in US settings ($135.35/patient-month) compared with other countries ($37.71/patient-month), whereas mitigation methods across countries were not statistically significant., Conclusions: High cancer drug costs highlight the importance of minimizing drug wastage to reduce healthcare expenditure. Our review demonstrates that wastage varies by healthcare setting and mitigation technique. Future studies would benefit from reporting standards for cancer drug wastage that include reporting wastage (both in mg and cost, preferably in terms of purchase power parity), as well as cohort size, considered vial sizes, considered dosages, and used mitigation methods separately for each drug. This approach would account for variability in cancer drug wastage and help identify optimal mitigation practices tailored to the health system context., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2025. Published by Elsevier Inc.)

Real-time surgical navigation systems (dynamic computer-aided surgery, d-CAIS) and static guided surgery (static computer-aided surgery, s-CAIS) have been shown to enhance the accuracy of zygomatic implant (ZI) placement. The objective of this systematic review was to evaluate and compare the accuracy and risk of complications associated with d-CAIS and s-CAIS in ZI placement. A systematic review of published studies involving more than 4 patients was conducted to assess and compare the accuracy of d-CAIS and s-CAIS in zygomatic implant placement. Only one study included freehand ZI placement as a control. The primary outcomes measured were the accuracy of implant placement relative to preoperative planning, with a secondary focus on evaluating any potential complications. Out of 903 screened studies, 14 met the inclusion criteria. Freehand zygomatic implant placement was used as a control in only 1 study. The results revealed a mean apex deviation of 2.07 mm (95% CI: 2.01 to 2.13; I 2  = 83.14%) for d-CAIS, 1.29 mm (95% CI: 1.15 to 1.43; I 2  = 94.5%) for s-CAIS, and 4.98 mm (95% CI: 3.59 to 6.37; I 2  = not assessable) for freehand placement. Reported complications included mucositis, reversible bilateral sinusitis, oroantral fistula, unspecified reversible postoperative complications, and fracture of the anterior wall of the zygoma. Both CAIS systems demonstrated high accuracy and safety in ZI placement, with a nearly 99% success rate at 6 months of follow-up. These findings suggest that both d-CAIS and s-CAIS are reliable methods for improving the precision and reducing the risks associated with ZI procedures., Competing Interests: Declaration of competing interest The authors declare no conflict of interest related to this article. However, the authors would like to state the following conflicts outside the submitted work: Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France), and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Inibsa Dental (Lliçà de Vall, Spain) Dentaid SL (Cerdanyola del Vallés, Spain) and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico City, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK). The remaining authors report no conflicts of interest. Dr. Octavi Camps-Font reports grants and non-financial support from Inibsa Dental (Lliçà de Vall, Spain) and Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare, and Avinent SLU outside the submitted work., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To assess the safety and accuracy of static computer assisted corticotomy surgery (sCACS) in comparison with freehand piezocision., Materials and Methods: A randomized in vitro study was conducted. A total of 260 interradicular corticotomies were performed in 20 identical printed models. sCACS was performed in half of the models, while the rest underwent freehand localized decortication. Accuracy was measured in the three spatial axes by overlapping the digital planning with a previous cone-beam computed tomography (CBCT) scan of the patient and a postoperative CBCT of the models. Safety was determined as the number of damaged root surfaces. Descriptive and bivariate analyses were performed., Results: Freehand corticotomies increased the likelihood of iatrogenic root damage 2.21-fold (95%CI: 1.30 to 3.77; p = 0.004). Both groups showed some degree of deviation compared to digital planning. Nevertheless, the accuracy of sCACS was significantly greater in sagittal (B = -0.21 mm, 95%CI: -0.29 to -0.12; p < 0.001), axial (B = -0.32 mm, 95%CI: -0.48 to -0.18; p < 0.001) and angular deviation (B = -2.02º; 95%CI: -2.37 to -1.66; p < 0.001) compared to freehand surgery, with the exception of depth., Conclusions: The precision and safety of sCACS are greater than the freehand technique., Clinical Relevance: Corticotomies are performed in crowded areas where there is usually space limitation. Clinicians should consider the systematic use of surgical guides, since minimal deviations can cause iatrogenic root damage in areas where malocclusions are present., Competing Interests: Declarations. Ethics approval: This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Hospital Odontològic Universitat de Barcelona (Comitè d’Ètica i Investigació amb Medicaments) (protocol number 18/30). Consent to participate: Written informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The agonal phase can vary following treatment withdrawal in donor after circulatory death (DCD). There is little evidence to support when procurement teams should stand down in relation to donor time to death (TTD). We assessed what impact TTD had on outcomes following DCD liver transplantation., Methods: Data were extracted from the UK Transplant Registry on DCD liver transplant recipients from 2006 to 2021. TTD was the time from withdrawal of life-sustaining treatment to asystole, and functional warm ischemia time was the time from donor systolic blood pressure and/or oxygen saturation falling below 50 mm Hg and 70%, respectively, to aortic perfusion. The primary endpoint was 1-y graft survival. Potential predictors were fitted into Cox proportional hazards models. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome., Results: One thousand five hundred fifty-eight recipients of a DCD liver graft were included. Median TTD in the entire cohort was 13 min (interquartile range, 9-17 min). Restricted cubic splines revealed that the risk of graft loss was significantly greater when TTD ≤14 min. After 14 min, there was no impact on graft loss. Prolonged hepatectomy time was significantly associated with graft loss (hazard ratio, 1.87; 95% confidence interval, 1.23-2.83; P  = 0.003); however, functional warm ischemia time had no impact (hazard ratio, 1.00; 95% confidence interval, 0.44-2.27; P  > 0.9)., Conclusions: A very short TTD was associated with increased risk of graft loss, possibly because of such donors being more unstable and/or experiencing brain stem death as well as circulatory death. Expanding the stand down times may increase the utilization of donor livers without significantly impairing graft outcome., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background Patients with neuromyelitis optica spectrum disorder (NMOSD) are often seropositive for antibodies against aquaporin-4 (AQP4). The importance of MRI monitoring in this disease requires evaluation. Purpose To profile MRI features from a large international cohort with AQP4 immunoglobulin G (IgG)-seropositive NMOSD (from the Parallel MRI in NMOSD [PAMRINO] study) and to evaluate and confirm existing knowledge regarding the incidence, location, and longitudinal development of characteristic lesions in the central nervous system associated with AQP4-IgG-seropositive NMOSD. Materials and Methods In this retrospective study (from August 2016 to January 2019), MRI and clinical data were collected from 17 NMOSD expert sites in 11 countries across four continents. Clinical features and lesions identified at cross-sectional and longitudinal MRI were assessed. No formal statistical tests were used to compare observations; however, means, SDs, and 95% CIs are reported when evaluating lesion frequencies. Results Available T1-weighted and T2-weighted MRI scans in patients with AQP4-IgG-seropositive NMOSD ( n = 525) were read. Among the 525 patients, 320 underwent cerebral MRI examinations with T2-weighted hyperintense cerebral (264 of 320; 82.5%), cerebellar (44 of 320; 13.8%), and brainstem (158 of 321 [49.2%], including one lesion observed at cervical spinal cord [SC] MRI) lesions. Lesions in the optic nerves, analyzed from 152 MRI examinations, were mainly found in the central (81 of 92; 88%) and posterior (79 of 92; 86%) sections (bilaterally in 39 of 92; 42%). Longitudinally extensive transverse myelitis was the predominant SC lesion pattern (upper compartment from 322 MRI examinations, 133 of 210 [63.3%]; and lower compartment from 301 MRI examinations, 149 of 212 [70.3%]). However, nonlongitudinal extensive transverse myelitis lesions were also observed frequently (105 of 210; 50.0%) in the cervical SC. Clinical data ( n = 349; mean age, 44 years ± 14 [SD]; 202 female patients) and acute lesions at contrast-enhanced (CE) MRI ( n = 58, performed within 30 days of the last attack) were evaluated. CE lesions were detected in the cerebrum (eight of 13; 62%), optic nerves (14 of 19; 74%), or chiasm (three of four; 75%) within 15 days of any relapse. In the upper SC (29 of 44; 66%), CE lesions were frequently observed up to 20 days after a clinical myelitis event. Conclusion A high incidence of abnormal brain MRI examinations and nonlongitudinal extensive SC lesions was found in patients in PAMRINO with AQP4-IgG-seropositive NMOSD. © RSNA, 2024 Supplemental material is available for this article.

Mastering of analytical methods for accurate quantitative determinations of enantiomeric excess is a crucial aspect in asymmetric catalysis, chiral synthesis, and pharmaceutical applications. In this context, the phenomenon of Self-Induced Diastereomeric Anisochronism (SIDA) can be exploited in NMR spectroscopy for accurate determinations of enantiomeric composition, without using a chiral auxiliary that could interfere with the spectroscopic investigation. This phenomenon can be particularly useful for improving the quantitative analysis of mixtures with low enantiomeric excesses, where direct integration of signals can be tricky. Here, we describe a novel analysis protocol to correctly determine the enantiomeric composition of scalemic mixtures and investigate the thermodynamic and stereochemical features at the basis of SIDA. Dipeptide derivatives were chosen as substrates for this study, given their central role in drug design. By integrating the experiments with a conformational stochastic search that includes entropic contributions, we provide valuable information on the dimerization thermodynamics, the nature of non-covalent interactions leading to self-association, and the differences in the chemical environment responsible for the anisochronism, highlighting the importance of different stereochemical arrangement and tight association for the distinction between homochiral and heterochiral adducts. An important role played by the counterion was pointed out by computational studies., (© 2024 The Author(s). Chemistry - A European Journal published by Wiley-VCH GmbH.)

Background: This study was carried out to determine the knowledge and attitudes of dental students at the University of Barcelona (Spain) concerning antiresorptive and antiangiogenic medications and their implications in dental treatment., Material and Methods: A cross-sectional study was conducted among dentistry students at the University of Barcelona using a 27-item questionnaire. This anonymous survey gathered demographic variables and assessed student interest in attending an educational session on oral pathology. Descriptive and bivariate analyses were performed following data collection., Results: A total of 105 students were surveyed. They all demonstrated awareness of antiresorptive medications, their pharmacokinetics and indications. Less than half, however, could identify drugs linked to osteonecrosis of the jaws (ONJ) or associated risk factors for oral complications. The students had a better understanding of antiresorptive drugs in comparison with antiangiogenic medications. Moreover, comparative analysis revealed that 5th year dental students had a higher level of knowledge of the dental implications of these drugs., Conclusions: This study shows that dental student knowledge of antiresorptive and antiangiogenic medications needs to be improved. The development of educational strategies to address the implications of these drugs in dental treatment is clearly indicated. Key words: Medication-Related Osteonecrosis, Antiresorptive Drugs, Antiangiogenic Therapy., Competing Interests: -Karla Fuentes-Cazar, Jorge Toledano-Serrabona and Fabio Alves declare that they have no competing interests. -Alba Sánchez-Torres reports personal fees from Unither Pharmaceuticals (Paris, France) and from Mundipharma Research (Cambridge, United Kingdom), both outside the submitted work. -Cosme Gay-Escoda reports personal fees from Unither Pharmaceuticals (Paris, France), from Mundipharma Research (Cambridge, United Kingdom) and Menarini Research (Florence, Italy), outside the submitted work -Rui Figueiredo reports grants, personal fees and non-financial support from MozoGrau (Valladolid, Spain), Dentaid SL (Cerdanyola del Vallès, Spain), Inibsa Dental (Lliçà de Vall, Spain) and Avinent SA (Santpedor, Spain), grants from Mundipharma Research (Cambridge, UK), and personal fees from BioHorizons Iberica (Madrid, Spain), Dentsply implants Iberia (Barcelona, Spain), Septodont SAS (Saint-Maur-des-Fossés, France) and Araguaney Dental (Barcelona, Spain) outside the submitted work. In addition, he has participated as an investigator in clinical trials sponsored by Geistlich (Wolhusen, Switzerland). -Eduard Valmaseda-Castellón reports personal fees and non-financial support from MozoGrau (Valladolid, Spain). He is the Director of the Avinent-University of Barcelona research agreement (Càtedra UB-Avinent), with Avinent (Santpedor, Spain), and has received personal fees from BioHorizons Ibérica (Madrid, Spain), Inibsa Dental (Lliça de Vall, Spain) and Dentsply implants Iberia (Barcelona, Spain) outside the submitted work. In addition, he has participated as an investigator in clinical trials sponsored by Mundipharma (Cambridge, UK) and Geistlich (Wolhusen, Switzerland)., (Copyright: © 2024 Medicina Oral S.L.)

Purpose: The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit., Methods: We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months., Results: Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction., Conclusion: There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP., (© 2024. The Author(s).)

Objectives: To compare miniscrew versus bone tracing registration methods on dental implant placement accuracy and time efficiency in edentulous jaws using a dynamic computer-assisted implant surgery (d-CAIS) system., Methods: Twelve fully edentulous maxillary models were allocated into two groups: miniscrew tracing (MST) group, where registration was performed by tracing four miniscrews; and bone tracing (BT) group, where registration was conducted by tracing maxillary bone fiducial landmarks. Six implants were placed on each model using the X-Guide® d-CAIS system. Pre- and postoperative cone-beam computed tomography (CBCT) scans were superimposed to evaluate implant placement accuracy. The time required for registration and the overall surgery time were also recorded., Results: Thirty-six implants were placed in each group. The MST group showed significantly lower mean angulation deviations (mean difference (MD): -3.33°; 95 % confidence interval (CI): -6.56 to -0.09); p = 0.044), 3D platform deviations (MD: -1.01 mm; 95 % CI: -1.74 to -0.29; p = 0.006), 2D platform deviations (MD: -0.97 mm; 95 % CI: -1.71 to -0.23; p = 0.010), and 3D apex deviations (MD: -1.18 mm; 95 % CI: -1.92 to -0.44; p = 0.002) versus the BT group. The overall surgery time was similar for both groups (MD: 6.10 min.; 95 % CI: -0.31 to 12.51; p = 0.06), though bone tracing required significantly more time compared with miniscrew registration (MD: 4.79 min.; 95 % CI: 2.96 to 6.62; p < 0.05)., Conclusions: Registration with MST increases the accuracy of implant placement with a d-CAIS system in edentulous jaws compared with the BT method, and slightly reduces the overall surgery time., Clinical Significance: Miniscrew tracing registration improves implant placement accuracy in comparison with bone tracing registration., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare that they have no known competing financial interests or personal relationships directly related with this study. However, they would like to declare the following interests outside the submitted work: Dr. Octavi Camps-Font reports grants and non-financial support from Avinent (Santpedor, Spain), and non-financial support from Nobel Biocare (Zürich, Switzerland) outside the submitted work. Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare (Zürich, Switzerland), personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare the accuracy and operative time of implant placement using a dynamic computer assisted implant surgery (dCAIS) system based on a cone beam computer tomography (CBCT) image, with and without superimposing a standard tessellation language (STL) file of an intraoral scan of the patient., Methods: Ten identical resin models simulating an upper maxilla with posterior edentulism were assigned to two groups. In the CBCT+STL group, a CBCT file and an intraoral STL file were superimposed and used for registration; in the CBCT group, registration was performed using CBCT images. Six implants were placed in each model using the Navident® dynamic navigation system. Anatomy registration was performed by tracing fiducial points on the CBCT or STL image, depending on the group. Preoperative and postoperative CBCT images were overlaid to assess implant placement accuracy., Results: Sixty implants were analyzed (30 implants in each group). 3D platform deviation was significantly lower (mean difference (MD): 0.17 mm; 95 % confidence interval (CI): 0.01 to 0.23; P = 0.039) in the CBCT+STL group (mean: 0.71 mm; standard deviation (SD): 0.29) than in the CBCT group (mean: 0.88 mm; SD: 0.39). The remaining accuracy outcome variables (angular deviation MD: -0.01; platform lateral deviation MD: 0.08 mm; apex global MD: 0.01 mm; apex depth MD: 0.33 mm) and surgery time (MD: 3.383 min.) were similar in both groups (p > 0.05)., Conclusions: The introduction of an intraoral scan (STL) seems to reduce deviations slightly in dental implant placement with dCAIS systems. However, the clinical repercussion of this improvement is questionable., Clinical Significance: Superimposing an intraoral scan on the CBCT image does not seem to increase the accuracy of dCAIS systems but can be useful when radiographic artifacts are present., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare no conflict of interest directly related with this study. However, the authors would like to state the following conflicts outside the submitted work: Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare (Zürich, Switzerland), personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Key Message: GPI anchor addition is important for JAGGER localization and in vivo function. Loss of correct GPI anchor addition in JAGGER, negatively affects its localization and function. In flowering plants, successful double fertilization requires the correct delivery of two sperm cells to the female gametophyte inside the ovule. The delivery of a single pair of sperm cells is achieved by the entrance of a single pollen tube into one female gametophyte. To prevent polyspermy, Arabidopsis ovules avoid the attraction of multiple pollen tubes to one ovule-polytubey block. In Arabidopsis jagger mutants, a significant number of ovules attract more than one pollen tube to an ovule due to an impairment in synergid degeneration. JAGGER encodes a putative arabinogalactan protein which is predicted to be anchored to the plasma membrane by a glycosylphosphatidylinositol (GPI) anchor. Here, we show that JAGGER fused to citrine yellow fluorescent protein (JAGGER-cYFP) is functional and localizes mostly to the periphery of ovule integuments and transmitting tract cells. We further investigated the importance of GPI-anchor addition domains for JAGGER localization and function. Different JAGGER proteins with deletions in predicted ω-site regions and GPI attachment signal domain, expected to compromise the addition of the GPI anchor, led to disruption of JAGGER localization in the cell periphery. All JAGGER proteins with disrupted localization were also not able to rescue the polytubey phenotype, pointing to the importance of GPI-anchor addition to in vivo function of the JAGGER protein., (© 2024. The Author(s).)

Background: The removal of third molars (3Ms) is the most frequent surgical procedure in the field of Oral Surgery. As a result, the Spanish Society of Oral Surgery (SECIB) aims to create a Clinical Practice Guideline (CPG) that offers evidence-based recommendations for optimal clinical practice. Specifically, the CPG will focus on providing guidance regarding the indications and criteria for clinical and radiological diagnosis of patients with 3Ms., Material and Methods: This CPG was developed by the SECIB, following the methodological guidelines described in the methodological manual for the "Development of Clinical Practice Guidelines in the National Health System". Several PICO questions related to the diagnosis and indications for the extraction of 3Ms were formulated. The leading experts carried out the evaluation of the evidence and the formulation of specific recommendations., Results: A total of 17 PICO questions were evaluated, addressing the indications, prognosis, diagnosis, and cost-benefit relationship of 3M extraction., Conclusions: The present Clinical Practice Guideline provides evidence-based recommendations on the diagnosis and indications for 3M extraction. These evidence-based recommendations can assist healthcare professionals and the general population in making informed decisions regarding the management of 3Ms.

Objectives: This study aimed to compare the effect the radiographic marker registration (RMR) and markerless tracing registration (MTR) on implant placement accuracy using a dynamic computer-assisted implant surgery system (dCAIS). Additionally, this study aimed to assess the surgical time and whether the implant location influences the accuracy of the two registration methods., Methods: 136 dental implants were randomly allocated to the RMR or MTR group and were placed with a dCAIS in resin models. Preoperative and postoperative Cone Beam Computer Tomograms (CBCT) were overlaid and implant placement accuracy was assessed. Descriptive and multivariate analysis of the data was performed., Results: Significant differences (P < 0.001) were found for all accuracy variables except angular deviation (RMR:4.30° (SD:4.37°); MTR:3.89° (SD:3.32°)). The RMR had a mean 3D platform deviation of 1.53 mm (SD:0.98 mm) and mean apex 3D deviation of 1.63 mm (SD:1.05 mm) while the MTR had lower values (0.83 mm (SD:0.67 mm) and 1.07 mm (SD:0.86 mm), respectively). In the MTR group, implant placement in the anterior mandible was more accurate (p < 0.05). Additionally, MTR did not significantly increase the surgical time compared with RMR (P = 0.489)., Conclusions: MTR seems to increase the accuracy of implant placement using dCAIS in comparison with the RMR method, without increasing the surgical time. The operated area seems to be relevant and might influence the implant deviations., Clinical Significance: Considering the limitations of this in-vitro study, MTR seems to provide a higher accuracy in implant placement using dCAIS without increasing the surgical time. Furthermore, this method does not require radiographic markers and allows re-registration during surgery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships directly related with this study. However, they would like to declare the following interests outside the submitted work: Dr. Rui Figueiredo reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), non-financial support from Nobel Biocare (Zürich, Switzerland), personal fees from Geistlich Pharma AG (Wolhusen, Switzerland), BioHorizons Iberica (Madrid, Spain), Araguaney Dental (Barcelona, Spain), Septodont (Saint-Maur-des-fossés, France) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Figueiredo has also participated as a principal investigator in a randomized clinical trial sponsored by Mundipharma (Cambridge, UK) and in another clinical trial as a sub-investigator for Menarini Richerche (Florence, Italy). Dr. Eduard Valmaseda-Castellón reports grants, personal fees, and non-financial support from MozoGrau (Valladolid, Spain), Avinent (Santpedor, Spain), Inibsa Dental (Lliçà de Vall, Spain), Dentaid SL (Cerdanyola del Vallés, Spain), and personal fees from BioHorizons Iberica (Madrid, Spain) and Laboratorios Silanes (Mexico city, Mexico) outside the submitted work. Dr. Eduard Valmaseda-Castellón has also participated as a principal investigator in a randomized clinical trial sponsored by Geistlich Pharma AG (Wolhusen, Switzerland) and in another clinical trial as a sub-investigator for Mundipharma (Cambridge, UK)., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)