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Cristina Bucchi,1,2 Massimo del Fabbro,3,4 Alain Arias,2 Ramón Fuentes,2 José Manuel Mendes,5 Marie Ordonneau,6 Valérie Orti,7 María-Cristina Manzanares-Céspedes6 1PhD Program in Medicine and Translational Research, Universitat de Barcelona, Barcelona, Spain; 2Department of Integral Adults Dentistry, Research Centre for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile; 3Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; 4IRCCS Orthopedic Institute Galeazzi, Milan, Italy; 5CESPU, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Dental Sciences, Portugal; 6Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; 7Department of Periodontology, Dental School, University of Montpellier, Montpellier, France Purpose: Bone graft materials can be obtained from the patient’s own body (autologous graft), animals (xenograft), human cadavers (allograft) and synthetic materials (alloplastic bone graft). Patients may have ethical, religious or medical concerns about the origin of bone grafts, which could lead them to reject the use of certain types of bone graft in their treatments. The aim of this multicenter study, which surveyed patients from five university clinics in Portugal, France, Italy, Spain and Chile, was to analyze patients’ opinions regarding the source of bone grafts. Patients and methods: A survey composed of ten questions was translated into local languages and validated. Patients were asked about the degree of acceptance/rejection of each graft and the reasons for rejection. A chi-squared test was used to analyze statistically significant differences. Results: Three hundred thirty patients were surveyed. The grafts that elicited the highest percentage of refusal were allograft (40.4%), autologous bone graft from an extraoral donor site (34%) and xenograft (32.7%). The grafts with the lowest rate of refusal were alloplastic (6.3%) and autologous bone grafts from an intraoral donor site (24.5%). The main reason for autologous bone rejection was the fear of pain and discomfort, for xenograft it was the fear of disease transmission and the rejection of use of animals for human benefit, and for allograft it was ethical/moral motivations and the fear of disease transmission. Religious affiliation influenced patient’s preferences. Conclusion: The origin of bone grafts is still conflictive for a high percentage of patients. Keywords: survey, patient’s concerns, bone graft materials, animal products, tissue donation

Background: Haptics-enhanced virtual reality (VR-haptic) simulation in dental education has evolved considerably during the past decade, representing a promising resource of simulation-based training opportunities to support conventional practice. We aim to summarize current literature on the applications of VR-haptics in learning, practicing, and teaching dental education., Methods: A literature search was performed using PubMed, focusing on research articles published between January 2010 and January 2024. Out of the 667 articles that matched the search terms (dentistry, education, haptic, teaching, training, virtual reality), 105 were screened, and 42 were eligible for full-text reading and utilization. Findings from an ongoing educator survey on the use of VR-haptics in dental education have also been provided., Results: VR-haptic simulation has been shown to have a supportive role in dental simulation practice. Despite training within a digital world, hand skill transfer to the real world has been demonstrated, which affords educators more flexibility in how to train their students before and during traditional preclinical and clinical practical education. The individualized VR-haptic training and feedback help students in mastering essential working techniques, while also increasing engagement and motivation., Conclusions: VR-haptics-supported dental education can help students effectively address challenges during their preclinical and clinical training, as well as in their subsequent careers, and it may help mitigate some weaknesses of the current educational system. Validation is a key factor for the acceptance of VR-haptic simulators; thus, further research and verification are needed before VR-haptics could be considered a primary hand skill development method of learning in dental education. VR-haptic simulation may in the future be used as an assessment tool for the students' and clinicians' credentialing process., (© 2024 The Author(s). Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

Background: Viscosupplementation consists of intraarticular hyaluronic acid injections applied to treat pain and improve joint mobility. The objective of the study was to analyze the improvement of the range of mobility of the first metatarsophalangeal joint with a single dose of cross-linked hyaluronic acid., Methods: Ten fresh frozen specimens of feet sectioned below the knee were selected. Before and after the infiltration procedure, the range of flexion was calculated for all specimen's metatarsophalangeal joints. To detect complications due to the procedure, five feet were dissected and five were sectioned with a diamond saw., Results: The range of the first metatarsophalangeal joint flexion differences between the preoperative and the postoperative period was as follows: (1) 47° (range, 37-51.5) to 58° (range, 49-69.5) degrees of loaded dorsiflexion ( p > 0.006); (2) 41° (range, 40-51.5) to 58° (range, 52.5-66.5) degrees of unloaded dorsiflexion ( p > 0.009); and (3) 14° (range, 10.5-24.25) to 16° (range, 14.25-28.5) degrees of unloaded plantarflexion ( p > 0.083). No injuries of anatomical structures were observed either by anatomical dissection or in the anatomical sections., Conclusions: The results obtained in this viscosupplementation study demonstrate the improvement of the range of mobility of the first metatarsophalangeal joint without evidence of extravasation and lesions of the periarticular anatomical structures.

Two cases of calcified bone and dental tissue integration with titanium implants are presented, along with a review of the literature on their experimental and clinical implications. First, histological analyses of a titanium implant extracted from a patient with iimplant disease revealed the integration of both dental and bone tissue on the implant's surface. Secondly, a biocompatibility study in an animal model documented two implants in contact with tooth roots. Samples from both animal and human models demonstrated simultaneous osseointegration and dental tissue neoformation, with the latter attributed to the activity of cementoblasts. The literature review confirms the formation of cementum around dental implants in contact with teeth. Certain clinical reports have proposed the insertion of implants into bone sites containing impacted teeth as a conservative treatment alternative, avoiding the need for tooth extraction surgery and demonstrating the successful integration of teeth, bone, and dental implants. Furthermore, the documented natural formation of periodontal tissues around dental implants provided a foundation for tissue engineering studies aimed at realizing implant-bone relationships similar to those of natural bone-tooth structures. The primary challenges remain the long-term preservation of periodontal-like tissue formed on implants and the imparting of functional proprioceptive properties.

Oral rehabilitation with dental implants has resulted in high success rates. However, some complications have been described, such as the loss of the prosthetic screw. Some manufacturers sell screws with different coatings to avoid screw loosening, but even these types of screws can come loose. We aimed to investigate the screw coatings that can be applied during a dental appointment to avoid screw loosening. Following PRISMA Guidelines, we searched PubMed/Medline, Embase and Web of Science for studies published up to January 2024. All studies of single dental implant crowns, in which the prosthetic screw was coated with a lubricant and the preload and/or the removal torque value (RTV) was recorded, were analyzed. We excluded studies applying the finite element method (FEM) as well as studies without a control group. The risk of bias was assessed with a tool developed by our research group. Of the 1959 records identified, 19 were selected. Ten studies were considered to have a low risk of bias, and nine were considered to have a medium risk of bias. The coatings tested were adhesives, saliva, chlorhexidine, Vaseline, silicone gel, Polytetrafluoroethylene (PTFE) tape, blood, fluoride, Listerine ® Mouthwash and normal saline. The preload, the RTV with and without cyclic loading and the percentage of RTV loss were recorded. Some coatings show promise, although there is no clear evidence that any option is superior in minimizing screw loosening.

We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The rat has long served as a valuable animal model in implant dentistry and orthopedics, particularly in studying the interactions between biomaterials and bone tissue. The rat's tibia is frequently chosen due to its easy surgical access through thin tissue layers (skin and muscle) and the flattened shape of its medial face, facilitating the surgical insertion of intraosseous devices. Additionally, this model enables the induction of specific diseases, mimicking various clinical conditions to assess biological responses to different implant conditions like geometry, surface texture, or biological cues. However, despite its robust cortical structure, certain intraosseous devices may require adaptations in design and size for successful implantation. Therefore, establishing standardized surgical methods for manipulating both soft and hard tissues in the implantation region is essential for ensuring proper implant or screw device placement, particularly in fields like implant dentistry and orthopedics. This study included eighty Sprague Dawley rats divided into two groups based on their respective diseases: Group 1 with osteoporosis and Group 2 with Type 2 Diabetes. Implantations were performed at 4 weeks and 12 weeks, with the same surgeon following a consistent surgical technique. A positive biological response was observed, indicating complete osseointegration of all implants placed. These results validate the success of the surgical protocol, which can be replicated for other studies and serve as a benchmark for the biomaterials community. Notably, osseointegration values remained stable at both 4 weeks and 12 weeks for both disease models, demonstrating a durable integration of the implant over time and emphasizing the establishment of an intimate bone connection as early as 4 weeks.

Turner Syndrome (TS) is a rare genetic disorder that affects females when one of the X chromosomes is partially or completely missing. Due to high genetic and phenotypic variability, TS diagnosis is challenging and is often delayed until adolescence, resulting in poor clinical management. Numerous oral, dental and craniofacial anomalies have been associated with TS, yet a comprehensive description is still lacking. This study addresses this gap through a detailed analysis of oral health and craniofacial characteristics in a cohort of 15 females with TS and their first-degree relatives. Subjects with TS ranged from 3 to 48 years old, none showed evidence of periodontal disease and only the youngest was in mixed dentition. Using the Multifunction System, we identified an aggregation of multiple signs and symptoms in each TS subject, including tooth anomalies (supernumerary molars, agenesis, microdontia, enamel defects, alterations in eruption patterns -advanced and delayed for chronological age-, crowding, rotations and transpositions), malocclusion (class II/1 and II/2) and Class II facial profile, while relatives exhibited fewer manifestations. The early detection of these signs and symptoms is crucial for appropriate referral and the optimal clinical management of TS, especially during the critical period of 9 to 10 years when congenital dental anomalies appear. The use of an established taxonomy to describe these phenotypic features is essential for early detection. Multidisciplinary teams are required to ensure holistic care management in rare diseases like TS.

This study aimed to evaluate the effect of two coating materials, a silicone sealing gel and a polytetrafluoroethylene (PTFE) tape, on the screw preload and removal torque value (RTV) to develop strategies to prevent prosthetic screw loosening. We examined 45 complexes comprising an implant, abutment, and prosthetic screw, of which 15 samples were uncoated, 15 were coated with GapSeal ® (Hager & Werken GmbH & Co., Duisburg, Germany), and 15 were coated with PTFE tape (MIARCO ® , Valencia, Spain). The screws were tightened to register the preload and then untightened to register the RTV. The preload values showed a statistically significant difference only in the PTFE group, suggesting that this lubricant negatively affects the preload. The RTVs showed statistically significant differences among all groups, with the GapSeal ® group and PTFE group showing the highest and lowest values, respectively. It can be concluded that the application of the PTFE tape on the screw significantly reduced the preload and RTV. The silicone sealing gel did not affect the preload but increased the RTV. Therefore, the use of GapSeal ® should be considered to prevent prosthetic screw loosening, while the use of PTFE tape should be avoided.

Introduction: The lack of academic agreement in the practical or clinical use of declarative knowledge can generate unnecessary confusion and miscommunication. The concept Centric Occlusion (CO) is part of the body of declarative knowledge in dentistry, but its definition remains unclear., Objective: To ascertain the CO concept in articles published in dental journals as a study case for the dentistry "corpus" of declarative knowledge., Methodology: The alternative definitions of CO used by the GPT (Glossary of Prosthodontic Terms) from 1956-1977, 'CO as a synonym for maximum intercuspal contact (MIC)', or by the GPT from 1987-2017, 'CO may or may not coincide with MIC', were searched in the articles. The association between the CO definition used and variables such as article aims, journal scope and authors specialty was assessed., Results: Eight hundred and twelve articles were analysed. The widespread use of CO as synonym of MIC was the main finding and was significantly associated to the Orthodontics field. The CO definition according to the GPT 1987-2017 was less frequently observed but appeared in all dentistry fields, showing a significant association with the Oral Rehabilitation field. The difficulty of incorporating the current definition of CO (by GPT) into the main clinical discussions was evidenced all the long of the review process., Conclusion: The lack of consensus in the concept use was confirmed by the present study case, showing the influence of specific fields in Oral Health declarative knowledge. This methodology can provide a tool to the academy to assess controversial terms or concepts in Oral Health education, thus facilitating the critical and reflexive learning by students., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30-60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage., Material and Methods: A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group., Results: Our study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis., Conclusion: The primary and secondary outcomes of our study were not achieved. Therefore, more meta-analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Interpersonal violence results in injuries that frequently affect oral, head and neck structures, the treatment of which must be carried out by Oral health practitioners with sufficient training to detect the problem and manage the victim's lesions and need for referral. The objective of this study is to know the academic preparation that Spanish dentistry students receive in learning outcomes related to interpersonal violence during undergraduate academic training., Materials and Methods: A survey was conducted through an online form with 9 questions (Survey Monkey platform). The link was sent by email to the deans of the 23 Spanish universities (public and private) offering dentistry degrees. The analysis of the results was carried out using Fisher's test and a chi-squared test., Results: 95.63% of the deans (n = 22) responded. 85.7% of the universities report to carry on training in violence, according with Spanish legislation. Currently 33.3% dedicate less than 5 h to this training, whereas in the future study plans only 19% would dedicate less than 5 h to these learning outcomes. 85.7% of the respondents agree in consider this training as mandatory. The subjects in which learning outcomes on interpersonal violence were reported to be included were: legal and forensic dentistry (78%), psychology (55%), medical ethics (33.3%), paediatric dentistry (39%), surgery (5.5%) and 22% respondents cited other specialties. In future curricula, the competence areas in which such training is proposed to be imparted are: legal and forensic dentistry (80.9%), psychology and medical ethics (57.1%), paediatric dentistry (38.1%), surgery (14.2%) and in 23.8% also in other specialties. Significant differences were found between public and private universities only in the number of hours that would be dedicated to interpersonal violence learning outcomes in the future., Conclusions: Interpersonal violence encompasses situations of abuse and neglect inflicted to different patients (women, children, elderly) that are perceived both by Oral Health students and practitioners to require a comprehensive training. Most of the respondent deans consider that in the future curricula both the hours and areas that teach interpersonal violence learning outcomes must be increased. To respond to victim's need for help and care, the future requirements for the Oral health workforce education must encompass interprofessional undergraduate as well as postgraduate training in interpersonal violence., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Dental fluorosis affects the quality of life. A cross-sectional, observational study was conducted in a community affected by endemic fluorosis for several generations with a conserved biological and social environment. The study included patients from the rural population of Anantapur, India. The Dean index (DI) and the Thylstrup and Fejerskov Index (TFI) were used for fluorosis classification. Additionally, water samples were collected for fluoride analysis, taken from the patients' living areas. The statistical association between the variables was analyzed. In total, 785 patients between 10 and 60 years old were included in the study (58.7% women and 41.3% men). Fluorosis signs were found in 94.6% of patients examined using the DI and 94.4% using the TFI. Moderate-severe dental fluorosis was observed in 62.8% by DI and 73.1% by TFI consuming untreated water with up to 2.9 ppm of fluoride. Furthermore, moderate-severe dental fluorosis was observed in 33.2% by DI and 39.9% by TFI consuming water with ≤1.5 ppm of fluoride. The high prevalence of moderate-severe dental fluorosis in patients consuming water with a low fluoride concentration suggests that other factors are involved. Biological susceptibility change could play an essential role in the severity of dental fluorosis in populations exposed for several generations, affecting its actual and future quality of life.

Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal phalanx after percutaneous adductor tendon release (PATR). To date, no study addresses this issue. Eleven cadaveric fresh-frozen below-the-knee cadaveric lower limbs with associated hallux valgus deformity were used. These specimens were subjected to a constant abduction force after PATR. HV and intermetatarsal angles showed statistically significant differences when comparing the preoperative and postoperative periods. PATR showed to be a reliable technique as the adductor tendon was completely released in 9 cases, and 75% released in the remaining 2 feet. The study supports that PATR provides powerful and quantifiable correction of HV deformity and can be accurately performed percutaneously., (Copyright © 2021 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The state of alarm due to Covid-19 pandemic in Spain stopped all educational and most university research activities. The Spanish Anatomical Society (SAE) Consensus Expert Group on Body Donations piloted a study based on a questionnaire to know the status of body donations and dissection activities during the lockdown, as well as the future implications of Covid-19 pandemic for body donation programs and anatomy teaching. The questionnaire results show that Spanish Universities refused body donations and stopped all dissection research and teaching. The Covid-19 expected influence on anatomy teaching was referred to the increase in teaching workforce and resources required to apply the new safety measures to future practical activities, as well as to prepare and adapt teaching material for online-only programs. The application of reinforced safety measures was expected to be perceived by the respondent's students as a gain in teaching quality, while the transformation of the anatomy courses in online-only programs will be perceived as a quality decrease. The respondent's concerns about future institutional implications of the pandemic were related to increased costs of the adaptation of the facilities and the reinforced preventive measures, as well as the eventual decrease in donations. The complete lockdown applied to dissection rooms was not justified by scientific evidence and represented a break of the confidence deposed in the institutions by the donors. A consensus is required for the adoption of a renewed, comprehensive protocol for present and future body donations including the evidence Covid-19 pandemic has contributed to create., (© 2021 The Authors. Anatomical Sciences Education published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

Background: This study aimed to evaluate the area of dentin growth in rabbit incisors after pulp capping with plasma rich in growth factors (PRGF) compared with mineral trioxide aggregate (MTA) by fluorescence., Methods: twenty-seven upper and lower incisors of rabbits were divided into 4 groups: poor PRGF (F1) ( n = 9 teeth), rich PRGF (F2) ( n = 8 teeth), ProRoot MTA (positive control, n = 5 teeth), and untreated (NC) (negative control, n = 5). Fluorochrome markers were injected 24 h before surgery and the day before euthanasia, 28 days after the vital pulp therapy (VPT). Two transverse cuts were performed to every tooth: the first cut (A), 1 mm incisal to the gingival margin, and the second cut (B), 5 mm apical to the first cut. The sections were assessed with histomorphometric evaluation by fluorescence microscopy, comparing the dentin area between fluorescence marks and the total mineralized area., Results: The higher percentage of dentin growth was observed in the F2 group (B = 63.25%, A = 36.52%), followed by F1 (B = 57.63%, A = 30,12%) and MTA (B = 38.64%, A = 15.74%). The group with lowest percentage of dentin growth was the NC group (B = 29.22%, A = 7.82%). Significant difference ( p < 0.05) was found between F2 group and MTA, also statistically significant difference has been observed comparing dentin growth areas of NC group with F1 and F2 groups., Conclusions: The application of PRGF rich and poor fraction as a pulp capping material stimulated dentin formation more intensively than MTA and NC.

The reinforcement of acrylic denture base remains problematic. Acrylic prosthesis fractures are commonly observed in prosthodontic practice and have not been reliably resolved. This study compared the resistance to masticatory force of acrylic bases of removable complete conventional prosthesis in 3D upper models. Forty acrylic base test specimens containing two types of reinforcement meshes (20 with glass fiber meshes (FIBER-FORCE ® - Synca, Bio Composants Médicaux TM , Tullins, France), 20 with metal meshes (DENTAURUM ® -Ispringen, Germany)), 20 with a conventional PMMA acrylic base (LUCITONE 199 ® -Dentsply Sirona, York, PA, USA), and 20 using a permanent soft reline material (MOLLOPLAST-B ® -DETAX GmbH & Co. KG, Ettlingen, Germany) were tested-a total of 80 specimens. Half of the specimens were made for a low alveolar ridge and half for a high alveolar ridge. The data were analysed using one-way analysis of variance and Student's t -test for independent test specimens. In the high-alveolar-ridge group, the prosthesis reinforced with the glass fiber mesh was the most resistant to fracture, while in the low-alveolar-ridge group, the non-reinforced prosthesis showed the highest resistance masticatory force. Prostheses with the permanent soft reline material showed the lowest resistance to fracture in both high and low-alveolar-ridge groups. The results show that the selection of the right reinforcement material for each clinical case, based on the height of the alveolar ridge, may help to prevent prosthesis fractures.

Objective: To evaluate the association between prematurity (by the gestational week [gw]) and ADHD during childhood. Method: Observational, matched cohort study using data from children born in a tertiary-level hospital (Hospital Universitari Vall d'Hebron, Catalonia, Spain) during 1995-2007 and data from the Information System for the Development of Research in Primary Health Care (SIDIAP database, Catalonia, Spain). Results: Prevalence of ADHD increases as gestational age decreases, 12.7% for those born ≤28 gw, compared to 3.2% for those born after the 37 gw. The risk of developing ADHD in the non-premature children tends to increase as the gw decreases (35-36 gw, hazard ratio [HR] = 1.70, 95% confidence interval [CI] [1.19, 2.44]; 33-34 gw, HR = 3.38, 95% CI [2.08, 5.50]; 29-32 gw, HR = 2.37, 95% CI [1.54, 3.63]; and ≤28 gw, HR = 5.57, 95% CI [2.49, 12.46]) Conclusion: Being born preterm is associated with a risk of developing ADHD, also in late preterm children (35-36 gw). Attention when taking care of these infants regarding their mental health must be made.

High prevalence of placental-derived complications, such as preeclampsia and intrauterine growth restriction, has been reported in women with breast cancer (BC) treated with chemotherapy during pregnancy (PBC-CHT)., Aim: To ascertain whether PBC-CHT is associated with an imbalance of angiogenic factors, surrogate markers for placental insufficiency, that could explain perinatal outcomes., Methods: Prospective study between 2012 and 2016 in a single institution. Soluble fms-like tyrosine kinase (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) in maternal blood were assessed throughout pregnancy in 12 women with BC and 215 controls., Results: Cancer patients were treated with doxorubicin-based regimes and with taxanes. Ten PBC-CHT (83%) developed obstetrical complications. At the end of the third trimester, significantly higher levels of sFlt-1; sFlt-1/PGF ratio, and sEng levels were observed in BC women as compared to controls. Moreover; there was a significant correlation between plasma levels of sFlt-1 and the number of chemotherapy cycles administered. Besides, more chemotherapy cycles correlated with lower birthweight and head circumference at birth., Conclusions: Women with BC treated during pregnancy showed an antiangiogenic state compatible with placental insufficiency. Angiogenic factors could be useful in the clinical obstetric management of these patients; although further studies will be required to guide clinical decision-making.

Bone is a complex hierarchical material that can be characterized from the microscale to macroscale. This work demonstrates the application of an enhanced homogenization methodology to the multiscale structural analysis of a femoral bone. The use of this homogenization technique allows to remove subjectivity and reduce the computational cost associated with the iterative process of creating a heterogeneous mesh. Thus, it allows to create simpler homogenized meshes with its mechanical properties defined using information directly from the mesh source: the medical images. Therefore, this methodology is capable to accurately predict bone mechanical behavior in a fraction of the time required by classical approaches. The results show that using the homogenization technique, despite the differences between the used homogeneous and heterogeneous meshes, its mechanical behavior is similar. The proposed homogenization technique is useful for a multiscale modelling and it is computationally efficient.

Previous studies have proposed that our ability to produce and use stone tools was the primary selective pressure explaining the evolution of the human hand. Derived traits in humans include a robust first metacarpal and longer thumbs relative to the other fingers. Along with other anatomical peculiarities, humans can exert forceful precision and have powerful grips, and can resist loads during tool production and use. Despite this biomechanical explanation for the morphology of the human hand, limited work has been done on the soft tissue and, therefore, the relationship between the hand bones and the muscles most heavily relied upon during tool-related behaviours still requires thorough investigation. For this purpose, we have dissected 23 forearms and hands of fresh human cadavers of known sex and age at death, and dissected all the muscles attached at the first metacarpal (the first dorsal interosseous, opponens pollicis, and abductor pollicis longus muscles). Variations in physiological cross-sectional area, muscle mass, and fibre length were compared with metacarpal anatomy. In no case bone traits were a significant predictor of muscle features. In contrast, sex and age predicted muscle architecture in several cases, thus substantially affecting the functional analysis based on linear measurements of this bone. The data, therefore, failed to provide a deductive framework for predicting muscle recruitment based on measurements of bone from the fossil record.

Aim: This case report demonstrates a positive outcome of the adjuvant use of fragile fracture (FF), which is a technique used to harvest dental pulp stem cells (DPSCs), and platelet-rich plasma (PRP) in a mandibular premolar (tooth 44) with a completely formed root that was transplanted into a surgically created socket and which maintained pulp vitality and function., Summary: After virtual surgical planning, a 3D tooth replica of tooth 44 was fabricated. A surgical socket was created in the position of tooth 14; then, tooth 44 was extracted and the root dentine was abraded using a turbine diamond bur 3 mm from the apex until a circular groove was prepared around the outer circumference of the root; and then, an FF was performed without damaging the pulp tissue. PRP was placed in the socket, after which the donor tooth was inserted in the recipient area. At 2 weeks post-treatment, orthodontic traction was applied. At 3-year follow-up, the tooth had adequate alignment and was asymptomatic. Response to pulp testing was positive, and the presence of pulp canal obliteration was observed as a sign of pulpal healing., Key Learning Points: Autotransplantation is a good alternative for replacing missing teeth, with repair of tissues and pulp revascularization. Revascularization of an autotransplanted mature tooth using the fragile fracture technique and PRP scaffold is a feasible option and might have positive effects on the long-term outcome of the procedure. Including completely formed teeth as donors in autotransplantation, maintaining vitality and their functions is an option that warrants further study., (© 2019 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Purpose: Ankle lateral collateral ligament complex has been the focus of multiple studies. However, there are no specific descriptions of how these ligaments are connected to each other as part of the same complex. The aim of this study was to describe in detail the components of the lateral collateral ligament complex-ATFL and CFL-and determine its anatomical relationships., Methods: An anatomical study was performed in 32 fresh-frozen below-the-knee ankle specimens. A plane-per-plane anatomical dissection was performed. Overdissecting the area just distal to the inferior ATFL fascicle was avoided to not alter the original morphology of the ligaments and the connecting fibers between them. The characteristics of the ATFL and CFL, as well as any connecting fibers between them were recorded. Measures were obtained in plantar and dorsal flexion, and by two different observers., Results: The ATFL was observed as a two-fascicle ligament in all the specimens. The superior ATFL fascicle was observed intra-articular in the ankle, in contrast to the inferior fascicle. The mean distance measured between superior ATFL fascicle insertions increases in plantar flexion (median 19.2 mm in plantar flexion, and 12.6 mm in dorsal flexion, p < 0.001), while the same measures observed in the inferior ATFL fascicle does not vary (median 10.6 mm in plantar flexion, and 10.6 mm in dorsal flexion, n.s.). The inferior ATFL fascicle was observed with a common fibular origin with the CFL. The CFL distance between insertions does not vary with ankle movement (median 20.1 mm in plantar flexion, and 19.9 mm in dorsal flexion, n.s.). The inferior ATFL fascicle and the CFL were connected by arciform fibers, that were observed as an intrinsic reinforcement of the subtalar joint capsule., Conclusion: The superior fascicle of the ATFL is a distinct anatomical structure, whereas the inferior ATFL fascicle and the CFL share some features being both isometric ligaments, having a common fibular insertion, and being connected by arciform fibers, and forming a functional and anatomical entity, that has been named the lateral fibulotalocalcaneal ligament (LFTCL) complex. The clinical relevance of this study is that the superior fascicle of the ATFL is anatomical and functionally a distinct structure from the inferior ATFL fascicle. The superior ATFL fascicle is an intra-articular ligament, that will most probably not be able to heal after a rupture, and a microinstability of the ankle is developed. However, when the LFTCL complex is injured, classical ankle instability resulted. In addition, because of the presence of LFTCL complex, excellent results are observed when an isolated repair of the ATFL is performed even when an injury of both the ATFL and CFL exists.

Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself., Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage., Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees., Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO., Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

The purpose of the present work was to evaluate in vivo different antimicrobial therapies to eradicate osteomyelitis created in the femoral head of New Zealand rabbits. Five phosphate-based cements were evaluated: calcium phosphate cements (CPC) and calcium phosphate foams (CPF), both in their pristine form and loaded with doxycycline hyclate, and an intrinsic antimicrobial magnesium phosphate cement (MPC; not loaded with an antibiotic). The cements were implanted in a bone previously infected with Staphylococcus aureus to discern the effects of the type of antibiotic administration (systemic vs. local), porosity (microporosity, i.e. <5 μm vs. macroporosity, i.e. >5 μm) and type of antimicrobial mechanism (release of antibiotic vs. intrinsic antimicrobial activity) on the improvement of the health state of the infected animals. A new method was developed, with a more comprehensive composite score that integrates 5 parameters of bone infection, 4 parameters of bone structural integrity and 4 parameters of bone regeneration. This method was used to evaluate the health state of the infected animals, both before and after osteomyelitis treatment. The results showed that the composite score allows to discern statistically significant differences between treatments that individual evaluations were not able to identify. Despite none of the therapies completely eradicated the infection, it was observed that macroporous materials (CPF and CPFd, the latter loaded with doxycycline hyclate) and intrinsic antimicrobial MPC allowed a better containment of the osteomyelitis. This study provides novel insights to understand the effect of different antimicrobial therapies in vivo, and a promising comprehensive methodology to evaluate the health state of the animals was developed. We expect that the implementation of such methodology could improve the criteria to select a proper antimicrobial therapy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to systematically evaluate the available literature on minimally invasive surgical (MIS) treatment for hallux valgus and to provide an overview of the different surgical techniques., Methods: A systematic review of the literature available in MEDLINE, EMBASE, and the Cochrane database was performed including studies from January 2001 to 1 January 2018. The radiological outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA)), complication rates, and clinical outcome scores were evaluated. The MINORS scale was used to assess the methodological quality of included articles., Results: Of 278 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 2279 procedures in 1762 patients. The surgical techniques were divided into five categories: the Bosch technique, MIS Chevron-Akin, Reverdin-Isham procedure, Endolog system, and techniques involving distal soft tissue release and fixation. Results regarding radiological correction, clinical outcomes, and complication rate varied widely., Conclusions: The studies included were of too little level of evidence to allow for data pooling or meta-analysis. There were too few studies on each surgical technique category to assess whether one is more effective than the rest. However, there is some evidence that the Chevron and Akin showed the most potential for improvement of the HVA and the Endolog for the IMA. An overall complication rate of 13% was obtained among all included studies. Appropriately powered randomized controlled trials, utilizing validated outcome measures, blinded assessors, and long-term follow up are needed to assess the efficacy of MIS techniques.

Purpose: Bone tissue is a dynamic tissue, possessing different functional requirements at different scales. This layered organization indicates the existence of a hierarchical structure, which can be characterized to distinguish macro-scale from micro-scale levels. Structurally, both scales can be linked by the use of classic multiscale homogenization techniques. Since in bone tissue each micro-scale domain is distinct form its neighbour, applying a classic multiscale homogenization technique to a complete bone structure could represent an inadmissible computational cost. Thus, this work proposes a homogenization methodology that is computationally efficient, presenting a reduced computational cost, and is capable to define the homogenized microscale mechanical properties of the trabecular bone highly heterogeneous medium., Methods: The methodology uses the fabric tensor concept in order to define the material principal directions. Then, using an anisotropic phenomenological law for bone tissue correlating the local apparent density with directional elasticity moduli, the anisotropic homogenized material properties of the micro-scale patch are fully defined. To validate the developed methodology, several numerical tests were performed, measuring the sensitivity of the technique to changes in the micro-patch size and preferential orientation., Results: The results show that the developed technique is robust and capable to provide a consistent material homogenization. Additionally, the technique was combined with two discrete numerical techniques: the finite element method and radial point interpolation meshless method., Conclusions: Structural analyses were performed using real trabecular patches, showing that the proposed methodology is capable to accurately predict the micro-scale patch mechanical behavior in a fraction of the time required by classic homogenization techniques.

Background: Little is known about the effect of non-nutritive sucking habits (pacifier and digital sucking) in the prevalence of molar Class in mixed dentition. The aim of this study was determinate the relation between non-nutritive sucking habits, and Angle´s molar Class, in the horizontal plane, and it´s relation with gender. A convenience sample of 326 children with ages between 6 and 12 years was selected from three schools of Oporto., Material and Methods: To collect the epidemiologic data, was used a method recommended by the WHO. An indirect questionnaire about the medical history, dental habits, was used. It was adapted from Sanchez-Molins and validated by Clinical Dental III of Integrated Dental University Institute Health Sciences, Gandra, Portugal., Results: In this study, 326 infants were examined in order to determine the prevalence of non-nutritive sucking habits. Only 45 observed children did not mentioned any kind of non-nutritive sucking habit; the remaining 281 children mentioned at least one potential bad habit. Children with non-nutritive sucking habits show a higher molar Class II percentage in females, while molar Class III is more frequent among males compared with children with no sucking habits., Conclusions: Children with non-nutritive sucking habits, presented a higher-Class II prevalence with statistically significance. It was detected a direct relationship between Angle´s molar Class and gender. Key words: Finger sucking, pacifier sucking, Angle Class malocclusion., Competing Interests: Conflict of interest statement: The author declare that there are no conflicts of interest.

Introduction: Operative correction of symptomatic bunionette by means of minimally invasive (MI) osteotomies of the 5th metatarsal (M5) has gained popularity. This study aims to investigate the safe zones of commonly used techniques and the risk of injury to neurological structures., Materials and Methods: Ten human fresh frozen cadaveric feet were dissected and branches of the sural nerve were identified. A frontal section of the feet was performed at the site of the skin incision described for M5 MI osteotomies (corresponding to distal and mid diaphyseal osteotomies). The location of the lateral dorsal cutaneous nerve (LDCN) of the sural nerve or its branches was documented using a goniometer and o'clock references placed on the frontal section of the M5., Results: The LDCN showed variations in the distribution of its branches, forming the dorsolateral branch - a single terminal branch for the 5th toe - in 6/10 cases or two terminal branches - the dorsolateral and dorsomedial - in 4/10. At the point of osteotomies, the dorsolateral branch was identified at a mean of 22.7° from the extensor tendon around the M5 circumference and in all cases between 12 and 2 o'clock in a right foot or 10 o'clock to 12 o'clock in a left., Conclusion: The studied M5 osteotomies can place the dorsolateral branch of the fifth toe at risk and safe zones lie between 10 o'clock to 2 o'clock in any foot laterality. If these landmarks are considered, the risk of nerve damage is minimized when performing MI osteotomies of the M5., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The coexistence of deformity of the nail bed and subungual exostosis (SE) is a frequent finding in podiatric practice in the fourth and fifth decades of life. However, it has been described by other specialists as being an uncommon osteocartilaginous tumor most prevalent during the second and third decades of life. This study attempts to determine the causes of this discrepancy., Methods: Two authors independently conducted a systematic bibliographic review in multiple databases, podiatry sources and others, and key words were chosen to achieve a broad search strategy. Studies reporting on epidemiology and treatment of SE lesions in lower extremities in ten or more patients were selected. Initially, 197 articles were identified through database screening, with 23 meeting all inclusion and exclusion criteria. Seven articles with the ages of all of the patients were included in the analysis of age data. A comparison was then made between the diagnostic criteria for the selected 23 articles., Results: Model results reveal that, although there are some significant differences between individual studies, the main factor tested (patient's age) was clearly significant ( F 1,5.2 = 78.12, P < .001), showing that studies coming from the podiatry speciality were conducted on individuals with a mean age of 37 years higher than in studies from other specialties. Clinical and radiologic characteristics and treatment described in the podiatry literature also contrast with those in other specialties., Conclusions: The SE described by podiatrists, in accordance with the parameters of true exostosis, is different from Dupuytren's SE and should be considered as a different pathologic entity. The authors are working on its histologic identification.

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.

Background: The purpose of this study is to describe a simple and reproducible method to localize the neurological structures at risk and to describe a safe zone for hallux minimally invasive surgery (MIS) procedures., Methods: Ten fresh-frozen cadaveric feet were dissected to identify the dorsomedial digital nerve (DMDN) and the dorsolateral digital nerve (DLDN) of the first toe. Axial sections were performed at the sites of metatarsal osteotomies. We documented the position of the nerves with respect to the extensor hallucis longus (EHL) tendon using a clock method superimposed on the axial section RESULTS: The DMDN was found at an average of 26.2° medial to the medial border of the EHL tendon. (SD 11.26, range 14.5-45.5), whereas the average distance of the DLDN was 32.3° lateral to the medial border of the EHL tendon. (SD 6.29, range 13.5-40)., Conclusions: Using the clock method the DMDN and DLDN were found consistently between 10 o'clock and 2 o'clock in either right and left feet. The clock method may facilitate avoiding the area where these nerves are located serving as a valuable tool in minimally invasive foot surgery., (Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Periodontal diseases, such as chronic periodontitis, share common inflammatory risk factors with other systemic and chronic inflammatory disorders. Mucosal tissues, such as oral epithelia, are exposed to environmental stressors, such as tobacco and oral bacteria, that might be involved in promoting a systemic inflammatory state. Conversely, chronic disorders can also affect oral health. This review will summarize recent evidence for the interrelationship between chronic periodontitis and other prevalent chronic diseases such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. The association with pregnancy is also included due to possible obstetric complications. We will focus on inflammatory cytokines such as TNF-alpha, IL-1, and IL-6, because they have been shown to be increased in patients with chronic periodontitis, in patients with chronic systemic diseases, and in patients with both chronic periodontitis and other chronic diseases. Therefore, an imbalance towards a proinflammatory immune response could underline a bidirectional link between chronic periodontitis and other chronic diseases. Finally, we highlight that a close coordination between dental and other health professionals could promote oral health and prevent or ameliorate other chronic diseases.

Background: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments., Material and Methods: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces., Results: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03., Conclusions: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments.

Objectives: Aim of this study was to develop a finite element model of the forces that patients with rapid maxillary expansion bear and to validate it by a mechanical test., Methods: Computer-aided design models of the metallic screw and polymeric splint were modelled and discretized. Two forces were generated and considered independently: F1 at the temporary molar (2.5 N) and F2 at the permanent molar (2.5 N). The results of the finite element analysis were used to define the strain values which the anterior and posterior arms of the rapid maxillary expansion appliance bore as a linear function of F1-F2 by calculating the strain-force coefficient δ ij . Two strain gauge rosettes were attached to an appliance which was placed in an XY motorized stage to reproduce the same forces used in the finite element analysis. Once the system was validated, the matrix was inverted to determine forces F1 and F2 that a group of 40 patients underwent (median age 8.33 years, standard deviation 1.86 years) for 75 days, using their strain values. The parents of the patients activated a quarter turn (0.20 mm) twice a day until 50% transversal overcorrection was achieved., Results: Finite element analysis showed that the effects of the forces on stress at the location of the arms were notably different. There was a satisfactory correlation between finite element analysis predictions and in vitro values. Dissipation of F1 and F2 in patients was predicted to be 62.5 and 80%, respectively, after 75 days of retention., Conclusion: These results back the finite element analysis model for force prediction.

Escherichia coli early-onset sepsis (EOS) is an important cause of mortality and morbidity in neonates, especially in preterm and very low birth weight (VLBW) newborns. The aim of our study was to evaluate potential changes in the clinical and microbiological characteristics of E. coli EOS in our setting. Epidemiological, clinical, and microbiological data from all neonates with proven E. coli EOS from January 1994 to December 2014 were retrospectively collected in a single tertiary care hospital in Barcelona (Spain). Seventy-eight E. coli EOS cases were analyzed. A slight increase in the incidence of E. coli EOS was observed during the study period. VLBW newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased E. coli EOS diagnosis, mainly in the term newborn group. There was an increase in resistant E. coli strains causing EOS, with especially high resistance to ampicillin and gentamicin (92.8 and 28.6%, respectively). Nonetheless, resistant strains were not associated with poorer clinical outcomes., Conclusions: There is an urgent need to reconsider the empirical therapy used in neonatal EOS, particularly in VLBW newborns. What is Known: • E. coli early-onset sepsis (EOS) and E. coli resistant strains have been described as overall stable but increasing in VLBW neonates (< 1.500 g) in previous studies. What is New: • Our study shows an increasing incidence of E. coli EOS in all age groups, overruling group B Streptoccocus for the last 10 years. E. coli resistant strains also increased equally in all age groups, with high resistance rates to our first line antibiotics (ampicillin and gentamicin). • Empiric antibiotic therapy of EOS, mainly in VLBW newborns, should be adapted to this new scenario.

Introduction: Regenerative endodontic procedures (REP) are a promising alternative for necrotic immature teeth in adolescents and children, but very little evidence is available on this alternative in long-lasting necrotic teeth with open apices in adults. REPs are designed to replace damaged structures of the pulp-dentin complex, but no regeneration has been obtained in any of the cases described in necrotic immature permanent teeth with apical periodontitis with histologic results. The results are limited to periapical tissue repair with increasing root length, thickening of the root walls, and apical closure in young patients. In this series of cases, we report on the outcomes of the adjuvant use of autologous platelet-rich plasma (PRP) in endodontic therapy in adults by monitoring periapical tissue healing with periodic periapical radiographs and cone-beam computed tomographic scanning., Methods: Three teeth with apical periodontitis and open apices in 3 different patients from 21 to 35 years-old were evaluated. An REP was performed with the adjuvant use of PRP., Results: At controls, complete disappearance of the radiolucent lesions and the presence of calcified structures forming bridges occupying the pulp lumen were observed but not an ostensible thickening of root walls with a regeneration of pulp-dentin complex., Conclusions: The repair of periapical tissues with REPs of open apex teeth with apical periodontitis and in nonsurgical endodontic retreatment appears to be feasible in adults, but no regeneration was obtained in any of the present cases. The use of PRP may be a good choice as an autologous matrix because of its stability and induction; it contains growth factors and bioactive molecules like transforming growth factor beta, bone morphogenic proteins, insulinlike growth factors, and angiogenetic growth factors, which stimulate collagen production, angiogenesis, and cell differentiation. Anti-inflammatory and antibacterial properties have also been reported for this preparation, which are involved in all processes of repair., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Vascular staining techniques have been used to describe the vascular structures of several anatomic areas. However, few reports have described this procedure in the head and neck region. This paper describes a head and neck vascular labeling procedure, and describes some of the technical complications that may occur., Material and Methods: Fifteen specimen cadaver heads were prepared. After drying the vascular system, the internal carotid arteries were ligated and a solution with latex and a gelling agent was injected into the internal carotid arteries and external jugular veins. Two different colors were employed to differentiate arteries from veins. A total of 60ml latex was injected into each blood vessel. Subsequently, the specimens were refrigerated at 5°C for a minimum of 24 hours. Finally, a dissection was performed to identify the venous and arterial systems of the maxillofacial region., Results: In most specimens, correct identification of the vascular structures (lingual artery, pterigoyd plexus, and the major palatal arteries, among others) was possible. However, in three heads a major technical problem occurred (the latex remained liquid), making the dissection unfeasible. Other minor complications such as latex obstruction due to the presence of atheromas were found in two further specimens., Conclusions: The vascular labeling technique is a predictable, effective and simple method for analyzing the vascular system of the maxillofacial area in cadaveric studies, including vessels of reduced diameter or with an intraosseous course. This procedure can be especially useful to teach vascular anatomy to dental students and postgraduate residents. Key words: Blood vessels, vascular casting, vascular labeling, head and neck arteries, carotid arteries, jugular veins., Competing Interests: Conflict of interest statement:The remaining authors do not have any conflicts of interest to declare.

Purpose: Sinus floor augmentation is a common procedure in implant dentistry. However, several intraoperative complications can occur during this procedure, such as bleeding from the lateral wall of the maxillary sinus. The aim of this study was to describe the vascular structures of the lateral wall of the maxillary sinus using a vascular labeling technique., Materials and Methods: Ten cadaveric specimens were prepared by the vascular labeling technique. Liquid latex was injected into the large vessels of the head, and the lateral wall of the maxillary sinus was exposed by dissection. The diameter of the vessels and their distance from the alveolar ridge (AR) were recorded., Results: Blood vessels could be observed in all the dissected specimens (100%). The mean distance from the lower edge of the blood vessels to the AR was 18.5 mm (SD 3.31 mm)., Conclusions: The vascular labeling technique detects maxillary sinus vessels in a predictable and effective way. These structures are clinically relevant because they are located in the area where the lateral window is usually created in sinus augmentation procedures and can cause profuse bleeding.

Background: The success of bone augmentation to a major degree depends on the biomechanics and biological conditions of the surrounding tissues. Therefore, an animal model is needed providing anatomical sites with similar mechanical pressures for comparing its influence on different biomaterials for bone regeneration. The present report describes the new bone formation associated to biomaterial in a bursa created in the epidural space, between dura mater and cranial calvaria, under the constant pressure of cerebrospinal fluid., Methods: Five adult California rabbits were used for the trial. In each animal, two bursae were created in the epidural spaces, in the anterior part of the skull, below both sides of the interfrontal suture. The spaces between dura mater and cranial calvaria were filled with in-situ hardening biphasic calcium phosphate containing hydroxyapatite and beta tricalcium-phosphate (BCP), in-situ hardening phase-pure beta-tricalcium phosphate (β-TCP) or without any biomaterials (sham). After 90 days, the animals were sacrificed, and the defect sites were extracted and processed for histomorphometric analysis by optical and backscattered electron microscopy., Results: The cranial epidural spaces created (n = 10) could be preserved by the application both BCP (n = 3) and β-TCP biomaterials (n = 3) in all experimental sites. The sites augmented with BCP showed less new bone formation but a trend to better volume preservation than the sites augmented with β-TCP. However, the bone in the BCP sites seemed to be more mature as indicated by the higher percentage of lamellar bone in the sites. In contrast, the created space could not be preserved, and new bone formation was scarce in the sham-operated sites (n = 4)., Conclusion: The experimental bursae created bilaterally in the epidural space allows comparing objectively bone formation in relation to biomaterials for bone regeneration under permanent physiological forces from cerebrospinal fluid pressure.

The delivery of osteogenic factors is a proven therapeutic strategy to promote bone regeneration. Bone morphogenetic proteins (BMPs) constitute a family of cytokines with well-known osteogenic and bone regenerative abilities. However, clinical uses of BMPs require high doses that have been associated with complications such as osteolysis, ectopic bone formation, or hematoma formation. In the present work, we sought to improve bone tissue engineering through an approach that combines the use of bone marrow-derived mesenchymal stem cells (BMMSCs), composite scaffolds, and osteoinductive agents. We employed a composite gelatin/CaSO4 scaffold that allows for an early expansion of seeded BMMSCs, which is followed by an increased level of osteogenic differentiation after 10 days in culture. Furthermore, this scaffold enhanced bone formation by BMMSCs in a mouse model of critical-sized calvarial defect. More importantly, our results demonstrate that ex vivo pretreatment of BMMSCs with low amounts of BMP-2 (2 nM) and Wnt3a (50 ng/mL) for 24 h cooperatively increases the expression of osteogenic markers in vitro and bone regeneration in the critical-sized calvarial defect mouse model. These data provide a strong rationale for the development of an ex vivo cooperative use of BMP-2 and Wnt3a. Osteogenic factor cooperation might be applied to reduce the required amount of growth factors while obtaining higher therapeutic effects.

Introduction: The aim of this study was to establish an accumulated strain pattern in different parts of rapid maxillary expansion appliances and relate them to different vertical growth patterns. A clinical study was conducted of 40 patients with posterior crossbite who required rapid palatal expansion., Methods: Patients (mean age, 8.48 years) were recruited and treated at the Dental Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Strain gauges were placed on the arms of the RME hyrax screw appliance to record deformation (strain) during the expansion and the retention phases for 75 days. A finite element model was used to place the gauge at the point where the strain was most expressed. The vertical coefficient of variation was used to classify the patients by their vertical growth pattern. P = 0.05 was considered to be statistically significant., Results: During the expansion phase, the highest values of accumulated strain were measured in the posterior part of the appliance for all facial biotypes, but these values passed to the anterior area at the end of the retention phase of the mesocephalic and brachycephalic patients. There was statistically significant difference in the strain of the posterior arms in accordance with the vertical growth pattern (P = 0.05) during the retention phase. At 75 days of retention, 61.25% of the arms had already begun to have strain dissipation., Conclusions: The accumulated strain pattern in the rapid maxillary expansion appliance can vary depending on the facial biotype. In the future, orthodontists should try to tailor the activation and retention protocol based on each patient's characteristics., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: This review attempts to organize the existing published literature regarding tooth movement in orthodontic treatment when low-level laser therapy (LLLT) is applied., Background Data: The literature discusses different methods that have been developed to motivate the remodeling and decrease the duration of orthodontic treatment. The application of LLLT has been introduced to favor the biomechanics of tooth movements. However there is disagreement between authors as to whether LLLT reduces orthodontic treatment time, and the parameters that are used vary., Materials and Methods: Studies in humans and animals in which LLLT was applied to increase the dental movement were reviewed. Three reviewers selected the articles. The resulting studies were analyzed according to the parameters used in the application of laser and existing changes clinically and histopathologically., Results: Out of 84 studies, 5 human studies were selected in which canine traction had been performed after removing a premolar, and 11 studies in rats were selected in which first premolar traction was realized. There were statistically significant changes in four human studies and eight animal studies., Conclusions: Varying the wavelength with a reasonable dose in the target zone leads to obtaining the desired biological effect and achieving a reduction of the orthodontic treatment time, although there are studies that do not demonstrate any benefit according to their values.

Objective: In the present study, it is describe the phenotypical analysis and the mutational screening, for genes PAX9 and MSX1, of six families affected by severe forms of tooth agenesis associated with other dental anomalies and systemic entities., Study Design: Six families affected by severe tooth agenesis associated with other dental anomalies and systemic entities were included. Oral exploration, radiological examination, medical antecedents consideration and mutational screening for PAX9 and MSX1 were carried out., Results: No mutations were discovered despite the fact that numerous teeth were missing. An important phenotypical variability was observed within the probands, not being possible to establish a parallelism with the patterns associated to previously described PAX9 and MSX1 mutations. CONCLUSIONS; These results bring us to conclude that probably other genes can determine phenotypical patterns of dental agenesis in the families studied, different than the ones described in the mutations of PAX9 and MSX1. Moreover, epigenetic factors can be involved, as those that can reduce gene dosage and other post-transcriptional modulation agents, causing dental agenesis associated or not with systemic anomalies.

Short Communication selected from the Oral Presentations of the 56th Congress of the Groupèment International pour la Recherche Scientifique en Stomatologie et Odontologie, Peñafiel (Portugal) May 2012. ";Prix du GIRSO"; 2012.