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The term "buccal implant position" is commonly used but lacks a precise definition and missing a reference point. Considering its major impact on peri-implantitis and esthetic failures the purpose of this study was to find a correlation between bucco-palatal implant positioning and the midfacial soft tissue level of implant crowns using newly defined Emergence-points.Patients with unilateral single-tooth implant crowns in the region of the central or lateral maxillary incisor were included in this study. Digital intraoral scans were superimposed over a scan of the master cast or the original digital data set and analyzed in a computer planning program. In relation to the corresponding natural tooth, an ideal Emergence-point (ESeventy-three patients met the inclusion criteria. AD ranged from 0 to 3.5 mm (AD = 0.87 ± 1.01), SIP from 0.2 to 5.1 mm (AD = 2.66 ± 1.64). Statistical analysis showed a significant inverse correlation between AD and SIP (ρ = -.55, p .001). VIP, the implant inclination, time span since implant insertion, and phenotype revealed no significant correlation to AD.The more palatal the implant was positioned, the less AD was observed. The position of the implant shoulder should preferably be planned more than 2 mm behind the ideal E-point. This E-point can be used for implant planning as it defines the ideal crown length for prospective planning.

The aim of this pilot exploratory cohort study was to assess the value of buccal augmentation in immediate implant placement and immediate restoration of anterior teeth in maxillae with missing buccal lamellar bone with regard to esthetic parameters, as well as soft and hard tissue level changes.This study compared three groups of 10 patients each with immediate implant placement and immediate restoration in the anterior maxilla: (1) patients with partially to totally missing buccal bone with simultaneous augmentation with bovine collagen (test group augmented [TGA]); (2) patients with partially to totally missing buccal bone without augmentation (test group nonaugmented [TNA]); and (3) patients with intact buccal lamellar bone (control group [CG]). The pink esthetic score (PES) and the course of the peri-implant bone level after 1, 3, and 12 months were used as assessment criteria.After 12 months, the PES in the TGA was assessed as being better than it was preoperatively (mean ± SD: 8 ± 3.09 vs 9.25 ± 3.01, respectively, P = .8243), while it remained almost identical in the other two groups (TNA = 8.75 ± 2.7 vs 8.6 ± 3.3, P = .4098; CG = 10.6 ± 2.41 vs 10.6 ± 2.22, P = .7085). A significant difference among the PES values of the three groups was not observed at any point in time (preoperative: P = .118, 12 months: P = .383). In total, the TNA and CG showed an improvement in 3 out of 7 parameters of the PES after 12 months, while this was the case in 5 out of 7 parameters in the TGA. No significant difference among the three groups could be seen at any time point regarding peri-implant bone level. In the CG and TGA patients, a nonsignificant improvement in peri-implant bone level was seen after 12 months (respectively: 1.6 mm to 0.99 mm; P = .08068; 1.89 mm to 1.73 mm; P = .5866). In contrast, TNA patients showed a nonsignificant deterioration vs the postoperative situation (1.16 mm to 1.45 mm; P = .08208).Within the limitations of this pilot study, it can be concluded that a missing buccal lamellar bone appears to be no contraindication for immediate implant placement and immediate restoration, provided the baseline esthetic situation is accepted. As compared to the nonaugmented defect group or the group with intact lamellar bone, neither the esthetic nor the radiologic results could be improved significantly by augmentation with bovine collagen.

Zusammenfassung Hintergrund Trotz Brandschutzmaßnahmen und Aufklärung erleiden ca. 0,5 Millionen Menschen pro Jahr in Deutschland Verbrennungen. Im Jahr 2018 mussten fast 2000 Schwerstbrandverletzte in deutschen Verbrennungszentren behandelt werden. Brandverletzungen stellen eine schwerwiegende Erkrankung mit hoher Mortalität und langfristigen Folgen für den Patienten dar. Methodik und Ergebnisse Ziel dieses Übersichtsartikels ist es, eine Zusammenfassung der derzeit gültigen Leitlinie zur Behandlung von Verbrennungen im Erwachsenenalter (https://www.awmf.org/leitlinien/detail/ll/044–001.html) zu präsentieren, wobei der Fokus auf folgenden Aspekten liegt: 1. der Akutbehandlung der Brandwunde am Unfallort, 2. der Entscheidungsfindung zur Verlegung in ein Brandverletztenzentrum, 3. der chirurgischen Wundversorgung mit Debridement und Hauttransplantation und 4. der Nachsorge. Die S2k-Leitlinie basiert auf aktueller Literatur und dem Konsens von 11 an der Behandlung Brandverletzter beteiligter Fachgesellschaften. Zusammenfassung Dieser Übersichtsartikel enthält gewichtete Empfehlungen zur Behandlung von Brandwunden erwachsener Patienten in Deutschland. Der Artikel soll Ärzten und medizinischem Personal in der Akutsituation vor Ort und in der Klinik die Entscheidung über die notwendige Behandlung erleichtern. Hiermit soll die Behandlungsqualität für Patienten verbessert werden.

The relatively narrow spectrum of chemical elements within the microbial 'biochemical palate' limits the reach of biotechnology, because several added-value compounds can only be produced with traditional organic chemistry. Synthetic biology offers enabling tools to tackle this issue by facilitating 'biologization' of non-canonical chemical atoms. The interplay between xenobiology and synthetic metabolism multiplies routes for incorporating nonbiological atoms into engineered microbes. In this review, we survey natural assimilation routes for elements beyond the essential biology atoms [i.e., carbon (C), hydrogen (H), nitrogen (N), oxygen (O), phosphorus (P), and sulfur (S)], discussing how these mechanisms could be repurposed for biotechnology. Furthermore, we propose a computational framework to identify chemical elements amenable to biologization, ranking reactions suitable to build synthetic metabolism. When combined and deployed in robust microbial hosts, these approaches will offer sustainable alternatives for smart chemical production.

Objectives The aim of the present systematic literature review was to determine whether long-term treatment results with single-tooth implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL). Material and methods Electronic and manual searches were performed to identify studies reporting on long-term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single-tooth implants in the aesthetic zone using defined placement and loading protocols. Comparative trials were subjected to meta-analyses whilst data from single-arm studies were pooled to evaluate differences between timing protocols. Results A total of 7 controlled trials were considered for meta-analyses: immediate loading was compared to delayed loading in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences. Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling. No impact of the one abutment - one time concept, flap design and simultaneous bone or soft tissue augmentation could be established. Conclusions Insufficient data are available for meta-analytic comparison of all combinations of implant placement and loading protocols.

Background Immediate implant placement in the presence of intact extraction alveoli has frequently been reported, while hardly any reports on immediate implant placement in missing buccal bone can be found in literature. Objectives This pilot study evaluates esthetic outcome and soft and hard tissue level changes of immediate implant placement with immediate provisionalization in patients with partially/completely missing buccal bone without any further augmentation procedure in the maxillary anterior zone. Material and methods Twelve patients (TG) with partially to completely missing buccal bone designated for extraction and flapless immediate implant insertion in the anterior zone of the maxilla were included. Patients randomly selected out of a larger group of patients with immediate implants with intact alveoli served as controls (CG). Immediate provisionalization was done without any further augmentation of the alveolar ridge. Marginal hard and soft tissue levels, PES, and implant success were evaluated during a 1-year observation period. Results The defect of the buccal alveolar bone was 4.96 mm (min., 2.26 mm; max., 9.68 mm) and the mean mesio-distal extension 4.25 mm (min., 3.2 mm; max., 5.91 mm). Preoperative PES differed significantly between TG (9.68) and CG (12.25) and improved in TG postoperatively with no significant difference to CG after 1 year (TG, 10.91; CG, 11.3). The buccal soft tissue level remained almost unchanged over the observation period (TG preop, 0.86 mm ± 0.90 mm; 1 year, 0.91 mm ± 0.96 mm; CG preop, 0.98 mm ± 0.87 mm; 1 year, 0.98 mm ± 0.87 mm and did not show any correlation with either the mesial/distal bone level or the initial buccal vertical defect at any point of time. Conclusions These clinical results provide evidence that immediate implant placement without additional augmentation, but with immediate provisionalization might be a viable treatment alternative even with missing buccal plate in the esthetic maxillary zone.

Thomas Urquhart (1611–1660), celebrated for his English translation of Rabelais’ Gargantua et Pantagruel, has earned some notoriety for his eccentric, putatively incomprehensible early book on trig...