Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial ...role in reducing disability in order to reintroduce patients in the community.
The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit.
Cross-sectional observational study.
Inpatients Rehabilitation Unit.
Post-acute COVID-19 patients.
Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2.
We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients.
This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.
Objectives
To compare gingival tissue healing at surgically manipulated periodontal sites and at sites receiving implants and healing abutments with machined (MS) vs laser‐microtextured (LMS) surface ...placed with one‐stage protocol.
Material and Methods
Twenty‐four non‐smoking patients each received two implants with one‐stage protocol in a split‐mouth design on the same jaw. In each patient, one implant with a MS collar and one immediate healing abutment with a MS, and one implant with a LMS collar and one immediate healing abutment with a LMS were used. Soft tissues healing at surgically manipulated periodontal tissues (T+) and at non‐surgically manipulated periodontal tissues (T‐) at MS implant sites and at LMS implant sites were compared by means of clinical and biochemical parameters at baseline and at 1–2–3–4–6–8 and 12 weeks.
Results
PD and BoP mean values were statistically higher in MS than LMS implant sites (p<0.05). During early healing phase (1–4 weeks), MS and LMS peri‐implant tissues and periodontal tissues at T(+) showed no statistically significant difference in crevicular fluid volume changes (p>0.05). Between 6 and 12 weeks, compared with T(+), no statistically significant difference in crevicular fluid volume and IL‐6 and IL‐1β concentrations was noted in LMS implant sites (p>0.05), while statistically significantly higher mean values were noted in MS implant sites (p<0.05).
Conclusions
Compared with T(+) and T(‐), both MS and LMS implant sites presented a higher pro‐inflammatory state in the early phase after surgery (1–4 weeks). At 12 weeks, only MS implant sites kept a higher pro‐inflammatory state, while at LMS implant sites, it becomes similar to T(+) and T(‐).
Aim: The aim of the present study was to compare the direct and indirect cytotoxicity of a porcine dried acellular dermal matrix (PDADM) versus a porcine hydrated acellular dermal matrix (PHADM) in ...vitro. Both are used for periodontal and peri-implant soft tissue regeneration. Materials and methods: Two standard direct cytotoxicity tests—namely, the Trypan exclusion method (TEM) and the reagent WST-1 test (4-3-4-iodophenyl-2-4-nitrophenyl-2H-5-tetrazolio-1,3-benzol-desulphonated)—were performed using human primary mesenchymal stem cells (HPMSCs) seeded directly onto a PDADM and PHADM after seven days. Two standard indirect cytotoxicity tests—namely, lactate dehydrogenase (LTT) and MTT (3-4,5-dimethyl-2-thiazolyl-2,5-diphenyl-2H-tetrazoliumbromide)—were performed using HPMSCs cultivated in eluates from the matrices incubated for 0.16 h (10 min), 1 h, and 24 h in a serum-free cell culture medium. Results: The WST and the TEM tests revealed significantly lower direct cytotoxicity values of HPMSCs on the PHADM compared with the PDADM. The indirect cytotoxicity levels were low for both the PHADM and PDADM, peaking in short-term eluates and decreasing with longer incubation times. However, they were lower for the PHADM with a statistically significant difference (p < 0.005). Conclusions: The results of the current study demonstrated a different biologic behavior between the PHADM and the PDADM, with the hydrated form showing a lower direct and indirect cytotoxicity.
Background
Repeated removal and replacement of healing abutments result in frequent injuries to the soft tissues.
Purpose
The purpose of this study was to evaluate the effect of ...disconnection/reconnection of laser microgrooved vs. machined healing and prosthetic abutments on clinical periodontal parameters, marginal bone levels, and proinflammatory cytokine levels around dental implants.
Material and methods
Twenty-four patients each received 2 implants with one-stage protocol in a split-mouth design on the same jaw. In each patient, one healing and prosthetic abutments with a laser microgrooved surface (LMS group) and one healing and prosthetic abutments with machined surface (MS group) were used. Four months following implant placement (T0), the healing abutments were disconnnected and reconnected three times to carry out the impression procedures and metal framework try-in. Four weeks later (T1), definitive prosthetic abutments were installated with screw-retained crowns. Modified plaque index (mPI), modified gingival index (mGI) bleeding on probing (BOP), and probing depth (PD) were recorded at T0 and T1. At the same time points, samples for immunological analyses were taken from the sulcus around each implant. Peri-implant crevicular fluid (PICF) samples were analyzed for interleukin-1beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor (TNF)-α levels using the ELISA kit.
Results
At T0 and T1, mPI and mGI showed no statistical difference between the two groups, while higher PD and BoP values were noted for the MS group (
P
< 0.05). The mean PICF volume and mean concentrations of IL-1β, IL-6, and (TNF)-α in the LMS group were statistically less than those in the MS group (
P
< 0.05). In addition, comparison of IL-6 and IL-1β mean concentrations at T0 and T1 in the MS group showed a statistically significant increase (
p
< 0.05) over time, which was not noted for the LMS.
Conclusion
Disconnection/reconnection of healing and prosthetic abutments with a laser-microgrooved surface resulted in less inflammatory molecular response compared with conventional machined ones.
Trial registration
ClinicalTrials.gov
NCT04415801
, registered 03/06/2020
The most used types of retention of implant-supported prostheses are screw-retained or cement-retained restorations. The advantages and disadvantages of both have been identified by various authors ...over the years. However, cement-retained implant crowns and fixed partial dentures are among the most used types of restorations in implant prostheses, due to their aesthetic and clinical advantages. When cemented prostheses are made on implants, the problem of cement residues is important and often associated with biological implant pathologies. The objective of this research was to establish to what extent the techniques to reduce excess cement really affect the volume of cement residues.
This review was written following the PRISMA statement; a detailed search was carried out in three different electronic databases-PubMed, Scopus, and Cochrane Library. The inclusion criteria were prospective clinical studies, with at least 10 participants per group, and with at least 6 months of the follow-up period.
There have been many proposals for techniques supposed to reduce the amount of excess cement in the peri-implant sulcus and on the prosthetic components, but of these, which are exceptional in their in vitro capabilities, very few have been clinically validated, and this represents the real limitation and a great lack of knowledge regarding this topic. Three articles met the inclusion criteria, which were analyzed and compared, to obtain the information necessary for the purposes of the systematic review.
Extraoral cementation can reduce the excess cement, which, after a normal excess removal procedure, is, nevertheless, of such size that it does not affect the possibility of peri-implant pathologies developing. All these studies concluded that a small amount of cement residue is found in the gingival sulcus, and using eugenol-free oxide cements, the residues were only deposited on the metal surfaces, with a better peri-implant tissues health.
Despite the limitations of this study, it was possible to carefully analyze these characteristics and obtain valuable suggestions for daily clinical practice. Resinous cements are considered, due to the free monomers present in them, toxic for the soft tissues. The provisional zinc-oxide cements, also eugenol-free, represent the ideal choice. The different grades of retentive forces provided by these cements do not seem to have clinical effects on the decementation of restorations.
The aim of this retrospective study was to analyze peri-implant marginal bone loss levels/rates and peri-implant sulcular fluid levels/rates of metalloproteinase-8 in three timeframes (6 months ...post-surgery-restoration delivery (T0)-and 6 (T6) and 24 (T24)-months post-loading) and to evaluate if there is a correlation between peri-implant sulcular fluid levels of metalloproteinase-8 and peri-implant marginal bone loss progression.
Two cohorts of patients undergoing implant surgery between January 2017 and January 2019 were selected in this retrospective study. A total of 39 patients received 39 implants with a laser-microtextured collar surface, and 41 subjects received 41 implants with a machined/smooth surface. For each patient, periapical radiographs and a software package were used to measure marginal bone loss rates. Implant fluid samples were analyzed by an enzyme-linked immunosorbent assay (ELISA) test. The modified plaque index, probing depth, and bleeding on probing were also recorded.
High marginal bone rates at T24 were strongly associated with elevated rates between T0 and T6. The levels of metalloproteinase-8 were significantly more elevated around implants with marginal bone loss, in relation to implants without marginal bone loss. Marginal bone loss (MBL) rates at 24 months were associated with initial bone loss rates and initial levels of metalloproteinase-8.
Peri-implant marginal bone loss progression is statistically correlated to peri-implant sulcular fluid levels of metalloproteinase-8. Moreover, the initial high levels of marginal bone loss and metalloproteinase-8 can be considered as indicators of the subsequent progression of peri-implant MBL: implants with increased marginal bone loss rates and metalloproteinase-8 levels at 6 months after loading are likely to achieve additional marginal bone loss values.
Aim
To compare the clinical and radiographic conditions and the expression of pro‐inflammatory cytokines in peri‐implant crevicular fluid (PICF) at two‐piece/bone level (TP/BL) versus ...one‐piece/tissue level (OP/TL) single implants with a laser‐microgrooved collar after at least 5 years of loading.
Materials and Methods
In total, 20 single TP/BL implants and 20 contralateral OP/TL implants, both with a laser‐microgrooved collar surface, in 20 systemically and periodontally healthy subjects (12 males and 8 females, between the age of 36 and 64 mean age of 49.7 ± 12.3 years), were examined. Levels of IL‐1β, IL‐1RA, IL‐6, IL‐8, IL‐17, b‐FGF, G‐CSF, GM‐CSF, IFN, MIP‐1β, TNF‐α, and VEGF were assessed in PICF using the Bio‐Plex 200 Suspension Array System. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and gingival recession (REC) were recorded. Radiographic crestal bone levels (CBL) were assessed at the mesial and distal aspects of the implant sites.
Results
The mean PI, PD, BOP, and REC values had no significant differences in either group. A higher mean value of CBL with statistical difference was detected for TP/BL compared with OP/TL implants. The levels of IL‐1β, IL‐6, IL‐8, GM‐CSF, and MIP‐1β and TNF‐α were higher at TP/BL implants than at OP/TL implants. However, only IL‐1β, IL‐6, and TNF‐α values presented significant differences between the groups.
Conclusions
Although after 5 years of loading single TP/BL and OP/TL implants with a laser‐microgrooved collar surface presented similar good clinical conditions, a higher proinflammatory state and higher crestal bone loss were detected for TP/BL implants.
The aim of the current study was to retrospectively investigate the prevalence of peri-implant mucositis (PIM) and peri-implantitis (P) in a long-term follow-up (≥20 years) of implants with the same ...body design and body surface but different collar surfaces with laser-microtextured grooves (LMGSs) vs. no laser-microtextured grooves (no-LMGSs) in private practice patients. Furthermore, several patient-related, implant-related, site-, surgical-, and prosthesis-related potential disease risk factors were analyzed. A chart review of patients receiving at least one pair of implants (one with an LMGS and the other without LMGS) in the period 1993-2002 was used. Chi-square analysis was used to determine if a statistically significant difference between the investigated variables and PIM/P was present. Possible risk factors were statistically evaluated by a binary logistic regression analysis. A total of 362 patients with 901 implant-supported restorations (438 with LMGS and 463 no-LMGS) were included in the study. The cumulative survival rates of implants at 5, 10, 15, and 20 years were 98.1%, 97.4%, 95.4%, and 89.8%, respectively, for the LMGS group, and 93.2%, 91.6%, 89.5%, and 78.3% for the no-LMGS group. The difference was statistically significant at all timepoints (
< 0.05). In total, at the end of the follow-up period, 45.7% of patients and 39.8% of implants presented PIM, and 15.6% of patients and 14% of implants presented P. A total of 164 LMGS implants (37.4%) and 195 no-LMGS implants (42.1%) presented peri-implant mucositis, while 28 (6.3%) of LMGS implants and 98 (21.1%) no-LMGS implants demonstrated peri-implantitis. Differences between LMGS implants and no-LMGS implants were statistically significant (
< 0.05). The binary logistic regression identified collar surface, cigarette smoking, histories of treated periodontitis, and lack of peri-implant maintenance as risk factors for P. After at least 20 years of function in patients followed privately, LMGS implants compared to no-LMGS implants presented a statistically and significantly lower incidence of P. Implant collar surface, cigarette smoking, previously treated periodontitis, and lack of peri-implant maintenance are factors with significant association to P.
The aim of this retrospective study was to investigate the relationship between the amount of early bone remodeling, the marginal bone loss (MBL) progression, and the peri-implant sulcular fluid ...concentration of active metalloproteinase-8 (a-MMP-8) and the incidence of peri-implantitis (P) over 5 years of implant function. It has been documented that dental implants with a high degree of early marginal bone loss (MBL) are likely to achieve additional increased MBL during function. Moreover, it has been speculated that early increased MBL might be a predictive factor for the subsequent onset of peri-implant inflammatory diseases. Clinical and radiographic data at implant placement (T0) and restoration delivery (TR) at 6 months (T1), 2 years (T2), and 5 years (T5) post-loading were retrospectively collected. MBL levels/rates (MBLr) and peri-implant sulcular fluid levels/rates of a-MMP-8 were assessed at TR, T1, T2, and T5. Implants were divided into two groups: group 1 with peri-implantitis (P+) and group 2 without peri-implantitis (P−). A multi-level simple binary logistic regression, using generalized estimation equations (GEEs), was implemented to assess the association between each independent variable and P+. A receiver operating characteristics (ROC) curve was used to evaluate an optimal cutoff point for T1 MBL degree and a-MMP-8 level to discriminate between P+ and P− implants. A total of 80 patients who had received 80 implants between them (39 implants with a laser-microtextured collar surface (LMS) and 41 implants with a machined collar surface (MS)) were included. Periapical radiographs and a software package were used to measure MBL rates. Peri-implant sulcular implant fluid samples were analyzed by a chairside mouth-rinse test (ImplantSafe®) in combination with a digital reader (ORALyzer®). Twenty-four implants (six with an LMS and eighteen with an MS) were classified as P+. No statistically significant association was found between the amount of early bone remodeling, MBL progression, and MBLr and the incidence of peri-implantitis. Implants with a-MMP-8 levels >15.3 ng/mL at T1 presented a significantly higher probability of P+. The amount of early marginal bone remodeling cannot be considered as an indicator of the subsequent onset of P, whereas high a-MMP-8 levels 6 months after loading could have a distinct ability to predict P.
AimTo compare the clinical and radiographic conditions and the expression of pro‐inflammatory cytokines in peri‐implant crevicular fluid (PICF) at two‐piece/bone level (TP/BL) versus one‐piece/tissue ...level (OP/TL) single implants with a laser‐microgrooved collar after at least 5 years of loading.Materials and MethodsIn total, 20 single TP/BL implants and 20 contralateral OP/TL implants, both with a laser‐microgrooved collar surface, in 20 systemically and periodontally healthy subjects (12 males and 8 females, between the age of 36 and 64 mean age of 49.7 ± 12.3 years), were examined. Levels of IL‐1β, IL‐1RA, IL‐6, IL‐8, IL‐17, b‐FGF, G‐CSF, GM‐CSF, IFN, MIP‐1β, TNF‐α, and VEGF were assessed in PICF using the Bio‐Plex 200 Suspension Array System. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and gingival recession (REC) were recorded. Radiographic crestal bone levels (CBL) were assessed at the mesial and distal aspects of the implant sites.ResultsThe mean PI, PD, BOP, and REC values had no significant differences in either group. A higher mean value of CBL with statistical difference was detected for TP/BL compared with OP/TL implants. The levels of IL‐1β, IL‐6, IL‐8, GM‐CSF, and MIP‐1β and TNF‐α were higher at TP/BL implants than at OP/TL implants. However, only IL‐1β, IL‐6, and TNF‐α values presented significant differences between the groups.ConclusionsAlthough after 5 years of loading single TP/BL and OP/TL implants with a laser‐microgrooved collar surface presented similar good clinical conditions, a higher proinflammatory state and higher crestal bone loss were detected for TP/BL implants.
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