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Despite the common belief that the granting of a patent is a neutral act, patent protection is intended to encourage technological innovations that are acceptable from an ethical point of view: in fact, both international and supranational legislation exclude from patentability inventions whose commercial exploitation would be contrary to ordre public, a notion that certainly encompasses also the prevention of serious damage to the environment. However, the provisions excluding the patentability of inventions whose commercial exploitation is contrary to ordre public (and in particular to environmental ordre public) have rarely been applied in Europe. After outlining the reasons why ordre public exceptions have had very limited application in Europe so far, the paper offers a new perspective through which such exceptions should be interpreted and suggests how patent offices can play a new and more decisive role in promoting environmentally sustainable innovation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate and analyze the effects of different prosthetic protocols under different loading and occlusal conditions on the survival rates of single implants immediately placed into fresh extraction sockets of maxillary or mandibular premolars with single-stage surgery. Materials and Methods: Patients needing replacement of a single premolar in the maxilla or mandible were included and randomly divided into three groups based on the different loading protocols: group 1 = healing abutment; group 2 = provisional crown left out of occlusion without functional loading; and group 3 = provisional crown in functional occlusion in maximum intercuspation without contact in excursions. The hypothesis was that single implants inserted into fresh extraction sockets and immediately connected to a temporary crown under functional loading would demonstrate survival rates comparable to single implants placed in the same conditions connected to a healing abutment or to an immediate temporary crown left out of occlusion. Results: A total of 112 patients were treated, and 126 implants were placed (92 in the maxilla and 34 in the mandible). After a mean follow-up of 2.5 years (range 1 to 5 years), there were no failures in groups 1 or 2. Two implants failed in group 3 (one in the maxilla, one in the mandible). The cumulative survival rate was 98.5% across all groups, with 100% in groups 1 and 2 and 95% in group 3. Statistical analysis showed that group 3 displayed a survival rate comparable to groups 1 and 2 (P = .08). Conclusion: Within the limitations of this study, no significant differences were found in terms of implant survival rates between implants inserted into fresh extraction sockets without loading vs with immediate nonfunctional or functional loading. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of different healing abutment designs in compensating for the buccolingual volumetric tissue change that occurs following flapless single-tooth immediate extraction placement in the molar area. Materials and Methods: Patients in need of extraction and replacement of a first or second molar in the mandible or maxilla were consecutively recruited. Immediately after extraction and implant placement, an abutment was connected. Five different types of abutments were randomly selected to be used for each case. The study population was divided into five categories according to abutment design: 5-mm diameter healing abutment (group 1); 6-mm diameter healing abutment (group 2); 7.5-mm diameter healing abutment (group 3); provisional restoration (group 4); and customized healing abutment (group 5). The buccopalatal dimension (BPD) was measured on the study casts at 1, 3, and 5 mm apical to the free gingival margin, and horizontal volumetric changes were compared between baseline and 2, 4, and 6 months. Results: A total of 267 implants were inserted in 246 patients. The breakdown of placed implants for each group was as follows: 67 implants in group 1; 64 in group 2; 71 in group 3; 33 in group 4; and 32 in group 5. Changes in the mean horizontal ridge dimension were as follows. After 6 months in group 1, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 4.21 ± 0.158, 3.38 ± 0. 178 and 2.35 ± 0.178 mm. In group 2, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 3.16 ± 0.198, 2.56 ± 0.198, and 1.62 ± 0.198 mm. In group 3, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 2.53 ± 0.138, 2.16 ± 0.144, and 1.56 ± 0.144 mm. In group 4, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 1.11 ± 0.179, 1.23 ± 0.179, and 1.12 ± 0.179 mm. In group 5, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 0.25 ± 0.225, 0.30 ± 0.225, and 0.19 ± 0.225 mm. Mixed-effect regression and post hoc means comparisons were used to model the impact of the restoration technique, height of measurement, and time on BPD using a significance reference level of .05. Statistical analysis showed that the type of abutment, the height of measurement, and the time significantly influenced the BPD and that there were complex interaction effects between these variables. Conclusion: The observed volumetric soft tissue changes in the 6-month short-term follow-up appeared to vary based on the use of different healing abutment sizes that were connected to implants placed immediately after tooth extraction in the molar area. In particular, the use of a customized healing abutment resulted in preservation of the original horizontal dimension of the molar soft tissue. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the survival and success rate of and the incidence of complications affecting implants inserted and immediately loaded in sites where an impacted tooth was present in the maxilla. Materials and methods: A total of 10 patients were treated and 14 implants were inserted, 4 in healed sites and 10 in extraction sites. The implant site preparation started in the crestal bone and continued in the enamel and dentine of the impacted tooth. The radiographic depth of implant penetration into the impacted tooth, peri-implant soft tissue and hard tissue condition at the 1-year follow-up and the last follow-up appointment, marginal bone loss at the 1-year follow-up and the last follow-up appointment, and the final aesthetic result were evaluated. Results: The implants healed uneventfully with an adequate hard and soft tissue response and no adverse clinical or radiographic signs or symptoms. They were in function for a minimum of 3 and a maximum of 11 years (mean 7.2 years). Conclusion: Although further studies with a larger sample size are required to validate this unconventional approach, it can be considered a valuable clinical option to replace teeth in an area of impaction. [ABSTRACT FROM AUTHOR]

This article aims to evaluate the effect of anatomically designed, single-unit provisional restorations on soft tissue preservation following immediate implant placement. Patients in need of a single-tooth replacement in the esthetic area were recruited for this study. An immediate provisional restoration with a transmucosal area anatomically designed to support the soft tissue was used for every patient. The horizontal volumetric tissue changes and the presence and amount of vertical recession were measured at baseline (T0) and after 1 month (T1), 3 months (T2), and 6 months (T3). Sixty-three patients received 66 implants that were placed into fresh extraction sites. The average follow-up time was 48 months (range: 24 to 60 months). All implant restorations were successful, and the cumulative implant survival rate and success of restorations was 100%. After 6 months, the mean horizontal ridge measured midbuccally had increased by 0.10 ± 0.10 mm at 1 mm from the free gingival margin, had decreased by 0.09 ± 0.10 mm at 3 mm, and had decreased by 0.20 ± 0.10 mm at 5 mm. In addition, the mean recession at the midbuccal surfaces was 0.04 ± 0.37 mm. Measurements were made clinically and compared to measurements made on the casts. According to the results of this study, the use of customized anatomically designed immediate provisional restorations following single-tooth extraction and immediate implant placement appeared to minimize the loss of tissue volume that results from postextraction bone remodeling, thus optimizing the final esthetic result. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate the cumulative survival rate and marginal bone loss (MBL) of extra-short (5- and 6-mm-long) and short (6.5-mm-long) implants inserted into severely atrophic, partially edentulous posterior maxillae and mandibles that were immediately restored with provisional fixed dental prostheses. Materials and Methods: Between October 2013 and December 2017, partially edentulous patients with severe vertical bone atrophy in the posterior area in need of replacement of premolars and/or molars with fixed prostheses were enrolled in the study. Analysis of cumulative survival rate and MBL was determined with respect to implant length at the longest, biannual follow-up period (38 ± 10 months; range: 25 to 48 months). Results: Fifty-five patients were included in the study. A total of 62 extra-short (5 and 6 mm), 15 short (6.5 mm), and 69 standard-length (≥ 10 mm) implants were immediately placed and loaded. Cumulative survival rates were similar for all implants (99.3%). One mandibular extra-short implant failed and was removed but was replaced 2 months later with another implant of the same length and diameter and successfully reloaded. Implant length did not impart any significant differences in MBL, though the presence or absence of platform switching was influential. Conclusion: The cumulative survival rate and MBL reported in this study encourage the use of short and extra-short implants to immediately restore with fixed prostheses partially edentulous patients with severe vertical bone atrophy in posterior areas. Thus, it could be an alternative treatment to vertical bone augmentation. [ABSTRACT FROM AUTHOR]

Background and Objectives: The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with SilverbackTM TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA). Materials and Methods: The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated. Results: All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12–48), with improvement in pain and functional scores, without major surgical complications and/or infections. Conclusions: Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot. [ABSTRACT FROM AUTHOR]

To provide clinical information on overcorrection to be included in the initial digital setup to make clear aligner therapy (CAT) more efficient. Prescription data for 150 patients (80 women and 70 men; mean age 33.7 ± 12.7 years) treated successfully with CAT (F22 Aligners, Sweden & Martina, Due Carrare, Italy) and requiring only a single, minimal finishing phase were acquired retrospectively. The inclusion criteria were Class I dental malocclusion with only minimal crowding (≤3 mm), 12–20 aligner steps per arch, no use of auxiliaries or interarch elastics, and rotations ≤25° for round-shaped teeth. The prescribed and corrective movements to be achieved in the main and finishing treatment phases, respectively, were quantified by the dedicated clear aligner setup software. The magnitudes of inclination (buccal-lingual crown tipping), angulation (mesial-distal crown tipping), rotation, intrusion, and extrusion were extracted and analyzed by tooth type, maxilla and mandible, and both arches. Descriptive statistics, that is, mean, standard deviation, and percentage, were calculated for each movement investigated. Classification and regression trees (CART) were generated using the model-based recursive partitioning approach, and the corrective movements were correlated with respect to both the amount of the movements prescribed and the tooth type. Statistical significance was set at 5%. Inclination and rotation required the greatest correction, whereas angulation, intrusion, and extrusion required only minimal correction. Expressed as a percentage of prescribed movement, mean corrective movements were 20.5% for inclination, 14.5% angulation, 28.4% rotation, 11.7% extrusion, and 22% intrusion. According to CART, all corrective movements except extrusion depended on both tooth type and the magnitude of prescribed movement. To achieve more efficient CAT, approximately 20% overcorrection should be added to the initial planning phase when planning challenging movements such as inclination and rotation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the buccopalatal volumetric tissue change that occurs following flapless single-tooth immediate extraction placement in the esthetic area and to analyze the role of four different variables. Materials and Methods: Patients in need of a single-tooth replacement in the anterior maxillary or mandibular area (premolar to premolar) were recruited for the study. Patients were treated using four different therapeutic modalities: group 1 (healing abutment), group 2 (healing abutment + bone graft), group 3 (provisional restoration) and group 4 (provisional + bone graft). Alginate impressions were taken the day of implant insertion before tooth extraction (T0), at 1 month (T1), at 3 months (T2), and at 6 months (T3). Buccopalatal dimension (BPD) was measured on the study casts at 1, 3, and 5 mm apical to the free gingival margin and compared between T0 and T1 and T2 and T3. Results: Seventy-seven patients were included in the study, 29 men and 48 women with a mean age of 54 years (range: 24 to 76 years) and 80 implants were inserted. Thirteen implants were inserted in group 1, 13 in group 2, 20 in group 3, and 34 in group 4. The BPD contraction was more evident for group 1, smaller in group 2 and group 3, and minimal in group 4. Repeated measures analysis of variance (ANOVA) and post hoc tests were used. The data analyzed were considered statistically significant with a level of α = .05. The interaction effect P value was numerically zero. Conclusion: The results of this study seem to indicate that volumetric tissue changes after immediate extraction placement in the esthetic area can be minimized if a provisional is immediately connected and a bone graft is inserted simultaneously [ABSTRACT FROM AUTHOR]

Background: The criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th edition "with mixed features specifier" (DSM‐5 MFS) are considered controversial since they include only typical manic symptoms. By contrast, Koukopoulos developed an alternative model of mixed depression (MxD) focusing primarily on the excitatory component. Objective: To compare DSM‐5 MFS and Koukopoulos' MxD (KMxD) in terms of prevalence, associated clinical variables, and discriminative capacity for bipolar depression in patients with major depressive episode (MDE). Methods: A total of 300 patients with MDE—155 with major depressive disorder and 145 with bipolar disorder (BD)—were recruited. The discriminative capacity of DSM‐5 MFS and KMxD criteria for BD was estimated using the area under the curves of receiver operating characteristic (ROC_AUC). The clinical variables associated with these two diagnostic constructs were assessed by performing a logistic regression. Results: A total of 44 and 165 patients met the DSM‐5 MFS and KMxD criteria, respectively. The ROC_AUCs and their confidence intervals for BD according to DSM‐5 MFS and KMxD were 77.0% (72.0%‐82.1%) and 71.9% (66.2%‐77.7%), respectively. The optimal thresholds (combining sensitivity and specificity measures) for BD diagnosis were ≥1 (77%/68%) for DSM‐5 MFS and ≥3 symptoms (78%/66%) for KMxD. However, considering the DSM‐5 MFS cut‐off (≥3 symptoms), the specificity (97%) increased at the expense of sensitivity (26%). Conclusions: KMxD and DSM‐5‐MFS showed an overlapping discriminative capacity for bipolar depression. The current diagnostic threshold of DSM‐5 MFS did not prove to be very inclusive, if compared with the greater diagnostic sensitivity of KMxD, which also yielded better association with clinical variables related to mixedness. [ABSTRACT FROM AUTHOR]