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Background: COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV)., Methods: Patients with COVID-19 pneumonia admitted up to May 28 th , 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan., Results: Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes., Conclusions: Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related disease (COVID-19) is an infectious disease characterized by systemic inflammation, which might enhance baseline thrombotic risk, especially in hospitalized patients. Little is, however, known about predictors of thrombotic complications in patients with COVID-19., Methods: We prospectively followed up 180 hospitalized COVID-19 patients. Demographics, clinical and laboratory features at presentation and past medical history were tested as predictors of the first thrombotic complication through multivariate Cox regression analysis and a categorical score generated based on the results., Results: Sixty-four thromboses were recorded in 54 patients, of whom seven with thrombosis on admission and 47 with thrombosis during hospitalization. Patients with thrombosis were mainly Caucasian and diabetic, had marked baseline signs of inflammation and organ damage, lower PaO2/FiO2 ratio, higher D-dimer levels and history of major hemorrhages. The latter three variables were independently associated to thrombotic complications and concurred to a 0-5 score, which accounted for 80% of the total sample variability. Patients with three or more points of the newly generated score were at higher risk for thrombotic complications (HR=4.9, P<0.001). Patients with thrombotic complications were more likely to be admitted to intensive care and/or to die (HR=1.9, P=0.036). Five of 180 patients were diagnosed with disseminated intravascular coagulation and three of them died. Eleven minor and no major bleeding events were observed., Conclusions: Patients with COVID-19 are at increased risk for thrombosis and might be stratified on admission based on lower Pao2/FiO2 ratio, higher D-dimer levels and history of major hemorrhages.

Background: The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit during a pandemic., Methods: In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure =10 cm H2O, FiO2=0.6, daily treatment duration: 4×3h-cycles) and respiratory physiotherapy including pronation outside the Intensive Care Unit were followed-up., Results: Of 90 acute respiratory distress syndrome (ARDS) patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the Intensive Care Unit and with a median (interquartile) follow-up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (P=0.033). No safety issues were observed., Conclusions: Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the Intensive Care Unit setting during the pandemic.

Aim: The purpose of this study was to evaluate the effect of ceramic surface polishing procedure on the early dental biofilm formation on zirconium ceramics., Methods: Twenty samples (discs shape) of tetragonal zirconium polycrystal stabilized with yttrium ceramics (Y-TZP) for LAVA system were fabricated (5 mm diameter and 1.5 mm thickness). Two patients with high level of dental hygiene were selected for this study. Oral devices covering the crowns of the upper premolars and molars were fabricated for each participant. Glazed and polished samples of Y-TZP ceramics were fixed on the vestibular and palatal zones of the devices. After 20 min (8 samples) and 1 h (8 samples) in the oral environment, the samples were removed and analyzed in a scanning electron microscope. The surface topographies of 4 ceramic samples (2 glazed and 2 polished) were analyzed (control group: without exposition in oral environment)., Results: The glazed samples showed a more irregular surface than polished samples. Deposition of granular aggregates was verified on all the samples in the two times of the study analyzed. This granular material coated more intensely on irregular areas, and its thickness increased after 1 h. No difference was observed as to bacterial morphology in any time of the study. Cocci and rods-shaped prevailed., Conclusions: Glazed surfaces presented larger tendency to dental biofilm accumulation.

The rehabilitation of the mandible after ablation cancer surgery is a challenge. Furthermore, osteodistraction in the microvascular fibula flap makes it difficult to predict adequate bone lengthening. The aim of this article is to evaluate a protocol used to manufacture templates for measuring osteodistraction, in terms of force vectors and definitive height. An accurate prosthetic wax-up with guide pins measuring the quantity of bone lengthening must be performed to manufacture the template. This device may be used to establish the end of the osteo-distraction in respect to the vertical dimension of the definitive occlusion.

Hygienic home care maintenance for patients who have received a maxillofacial prosthesis is very important in order to secure a long-term success of a facial rehabilitation. Craniofacial implant therapy requires a specific protocol to care for the peri-implant tissues and material used for the prosthesis. This article presents the maintenance and care protocol for proper follow-up management of a maxillofacial ear prosthesis. Home care methods for the prosthesis hygiene are described, including: the insertion and the disconnection of the ear prosthesis, hygiene of the bar abutments before and after postdefinitive connection to the craniofacial fixtures, washing of the device, professional follow-up.

The extrinsic and intrinsic coloration of maxillo-facial silicone elastomers has always been a challenge for the clinician in order to obtain a perfect, durable integration with the surrounding skin tissues. This preliminary report describes the method for obtaining good aestethetic results for maxillo-facial prosthesis. This study shows the aesthetic results of a new silicone for the laboratory technique of creating color of the basis for a maxillo-facial prosthesis, with a good matching with human skin. The technique is useful for the direct extrinsic coloration of the surface onto the skin of the patient by means of the RTV version of the same silicone. The technological properties of this material also make it easy to reproduce the emerging profile of the prosthesis from the human skin, avoiding anaesthetic overcounturings. The 12 month follow-up shows excellent and stable aesthetic results, which are not influenced by home care procedures and by the weathering effect on color and on physical properties.

Hybrid prosthesis supported by natural teeth (overdenture) is widely used in clinical practice and should be executed whenever the clinical conditions suggest it. Through a critical review of the literature, the anatomical, functional, psychological and clinical advantages are emphasized. Among the first ones, the prophylaxis of residual anatomical components, due to the limitation of bone resorption, and the preservation of sensorial proprioception are relevant. Important advantages are also represented by a better crown-root ratio of residual teeth supporting overdenture, with the consequent improvement of the longitudinal prognosis of such teeth. The greater retention and stability of overdenture in comparison with complete denture greatly improve the masticatory efficacy. The psychological advantages resulting from the dental anchorage, which allows the patient to be more confident in social life, are also relevant. Finally, when the dental support is lost, converting overdenture into complete denture is simple and quick, and makes easier the longitudinal clinical maintenance of the denture.

The recording of maxillo-mandibular relationships using Gothic arch assembly in dentulous subjects is useful not only in prosthetic rehabilitation, but also in the analysis of mandibular range of motion on patients with temporomandibular disorders. The traditional methodology to assemble Gothic arch plate is too long and elaborate, so it is remitted to the laboratory. This study describes a quick and simplified technique utilizing photopolymerizing resins which can be used by the dentist in his own office, in order to permit a greater use in the clinical practice.

Objective: Various dental procedures can generate thermal increase in the dental pulp, in particular if they are incorrectly conducted. In literature the pulp cells are considered very heat sensitive. In this study the symptomatological response of patients during and after thermal administration to the dental crown has been recorded. The analysis of the symptomatology was used as an indication for the definition of the threshold of thermal damage., Experimental Design: Twelve healthy teeth of four patients programmed for extraction were subdivided into six couples of homologous teeth. One tooth out of each couple was used for the immediate in vivo recording of the symptoms; the other, once extracted, was used to determine the thermal increase applied through the insertion of a thermocouple sensor. In each couple of teeth the thermal stimulus was equal., Results: The average thermal increase was 11.2 degrees C. Pain starts at temperatures ranging from 39.5 to 50.4 degrees C with an average of 44.6 degrees C. This agrees with classical physiological data which reports the threshold of pain at 45 degrees C., Conclusions: The threshold of pain registered suggests that at temperatures below 44.6 degrees C damage to the dental pulp is improbable, at least in healthy teeth. The limit of 45 degrees C appears, therefore, to be a probable safe threshold, contrary to what is reported in literature.

Background: Complete dentures in elderly patients often present a large build-up of dental calcolus. In order to avoid this leading to the onset of mycosis or other infections of the oral cavity, all the dental calcolus must be removed during check-ups., Methods: In order to analyse the consequences of removing the dental calcolus by mechanical means on the resin of the dentures, a polymethylmetacrylate (PMMA) plate was treated with a ultrasonic scaler, with rotating silicone points and with tungsten carbide burrs mounted on a straight hand-grip. The specimens were observed under a light stereomicroscope and their surface was analysed using a surface roughness tester. Observation under the stereomicroscope showed that in all cases the smooth surface of the resin is damaged and modified., Results: The analysis using the surface roughness tester revealed that only very limited quantities of resin are removed whatever the method. Using the lateral edge of the ultrasonic scaler tip and the rotating silicone points mounted on a hand-grip were the techniques that gave the best results, causing the least abrasions., Conclusions: The results obtained show that after removing the dental calcolus with the instruments tested, the dentures need to be polished in order to prevent the roughness and irregularities caused by the instruments from favouring plaque retention and the consequent reformation of dental calcolus.

In this longitudinal study the authors analyse the acid-basal characteristics in vitro of seven cements used in dentistry for a period of three weeks. The cements tested were subdivided into three groups based on their composition, whereas Life was presented separately since it is generally used as a sub-base for fillings in conservative treatment. All the materials studied alter the pH of the matter in which they are imbedded. Life and Tempbond present the highest and lowest pH values recorded during the study in vitro. The authors discuss the biological implications of these results.

The aim of this study is the evaluation of pulpal blood flow effect on the thermal levels measured at the pulpodentin junction in human anesthetized premolars. The value have been recorded as discrepancies between peak temperatures caused by a thermal stimulus applied on the same tooth in two different conditions: with and without pulpal blood supply. Thermal stimuli ranged from 3 to 9 degrees C on a total of twelve teeth giving a mean peak difference of 1.3 degrees C. This result has been interpreted as the effect of thermal dissipation produced by pulpal blood flow. The small magnitude of the value suggests, however, that anesthetized pulp fails to protect itself from injurious heat by increasing pulpal blood flow.

The authors examine the detail reproduction capacity and surface roughness of 11 commercially available materials [6 plasters (stones?), 2 epoxy resins and 3 polyurethane resins] indicated for the construction of working models with individually extractable dies. The study was performed in vitro according to the method outlined by the ADA in specification no. 19 relating to materials for elastomeric imprints. This specification describes the use of a steel test-block with which it is possible to prepare a master imprint in polyvinylsiloxane. This imprint allows the grooves of the test-block to be reproduced in the form of angular crest which represent the details to be reproduced. Both the master imprint and the samples to be tested were prepared according to the manufactures instructions. The study was performed in three stages: macroscopic analysis, microscopic analysis, profilometric analysis. The macroscopic analysis did not show any differences between the different materials tested. The microscopic analysis showed that when enlarged 40 times the resins revealed a smoother surface than the plasters. The surface quality of plasters was improved by using a hardening solution recommended by the manufacturer as an alternative to water, or by using spacer paint. The plaster materials gave excellent angular definition contrary to the epoxy and polyurethane resins. The use, where advised, of the hardening solution as an alternative to water did not alter this parameter. The electronic profilometer used for the profilometric analysis comprised a diamond sensor which, when run along the surface, recorded all roughness, translating it into chart form.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-curing resins enable the operator to prepare directly temporary prosthesis on single crown abutments. However such a technique may involve the danger of an inflammation of the pulp, due to the exothermic polymerization reaction of self-curing resins. The Authors suggest experimentally assessing the thermic increase during the polymerization reaction of seven different resins. Moreover they want to estimate the influence of the ratio monomer-polymer on the thermic curve of such reactions.

Self-curing resins are generally used to directly temporary prostheses on the crown abutments. This technique enables the operator to obtain a better marginal adaptation of the temporary prosthesis. The risk of such a procedure is the inflammation of the pulp due to the exothermic polymerization reaction of self-curing resins. The authors suggest experimentally evaluating the rate of thermic increase within the pulp cavity of an extracted tooth while directly relining a temporary crown.

The adhesive properties and dimensional stability of four canal sealers, introduced under vacuum in glass pipettes, into teeth subsequently given performing classic endocanalar sealing were assessed after hours and after 60 days. A scal without ZOE proved most satisfactory.

Electromyography has been used to analyse the myoelectric activity of the masticatory muscles in 130 dysfunctional patients in comparison with normal subjects. Of the muscles examined, those presenting greater basal tension were also identified. Myoelectric activity proved greater, at postural values, in dysfunctional patients; by contrast, subjects without craniomandibular symptomatology presented normally low initial values. As for the analysis of the muscular group presenting greater tension, analysis of the results did not produce statistically significant percentages pointing to the prevalence of one muscular group over another.