Hepatic intra-arterial versus intravenous fotemustine in patients with liver metastases from uveal melanoma (EORTC 18021): a multicentric randomized trial

Despite an improved antitumor efficacy as noticed by an enhanced response rate and an improved progression-free survival, the hepatic intra-arterial fotemustine did not increase the overall survival of uveal melanoma patients with liver metastases only. We propose to consider intrahepatic treatment as an experimental approac

Enhancement of electroporation facilitated immunogene therapy via T-reg depletion

Regulatory T cells (T-regs) can negatively impact tumor antigen-specific immune responses after infiltration into tumor tissue. However, depletion of T-regs can facilitate enhanced anti-tumor responses, thus augmenting the potential for immunotherapies. Here we focus on treating a highly aggressive form of cancer using a murine melanoma model with a poor prognosis. We utilize a combination of T-reg depletion and immunotherapy plasmid DNA delivered into the B16F10 melanoma tumor model via electroporation. Plasmids encoding murine granulocyte macrophage colony-stimulating factor and human B71 were transfected with electroporation into the tumor and transient elimination of T-regs was achieved with CD25-depleting antibodies (PC61). The combinational treatment effectively depleted T-regs compared to the untreated tumor and significantly reduced lung metastases. The combination treatment was not effective in increasing the survival, but only effective in suppression of metastases. These results indicate the potential for combining T-reg depletion with immunotherapy-based gene electrotransfer to decrease systemic metastasis and potentially enhance survival

Self-assessed neurological disturbances after surgical removal of impacted lower third molar: a pragmatic prospective study on 423 surgical extractions in 247 consecutive patients

OBJECTIVES: The aim of this study was to assess the combined role of current radiographic risk indicators and patient age in predicting lower lip sensitivity disturbances after surgical removal of impacted lower third molars. The question was which combinations indicate low or high risk. MATERIALS AND METHODS: A prospective study was implemented involving 247 consecutive outpatients who underwent 423 surgical extractions. The predictor variables were patient age and risk indicators observed on panoramic radiographs. The outcome variable was the incidence of self-assessed lip sensitivity alterations. The extractions were subdivided into four groups according to the predictors. RESULTS: Two hundred forty-five teeth were extracted in patients younger than 25 years and 178 in patients 25 years old or older; radiographic risk indicators were associated with 226 out of 423 teeth (53.43%). No permanent neurological damage was observed. Transient lip sensitivity alterations were observed in five cases (1.18%; 95% confidence interval\u2009=\u20090.4 to 2.7%), all in the older group with radiographic risk indicators. CONCLUSIONS: The data indicate a low overall incidence of transient lip sensitivity impairment that occurred only in the presence of radiographic risk indicators in patients aged 65\u200925 years. CLINICAL RELEVANCE: Informed consent should include the possibility of inferior alveolar nerve injury in mature patients with radiographic risk indicators. Prophylactic removal of impacted teeth with radiographic signs of risk may be indicated when the patient is not yet aged 25 years

A radiation free alternative to CBCT volumetric rendering for soft tissue evaluation

Objective: The aim of the present study is to evaluate whether a “radiation free” method using 3D facial scan can replace Cone Beam Computed Tomography (CBCT) volumetric rendering of soft tissue of the patient to assess maxillofacial surgery outcomes and compare the reference points and angular measurements of patient facial soft tissue. Material and Methods: Facial soft tissue scan of the patient’s face, before and after orthognathic surgery and a CBCT of the skull for volumetric rendering of soft tissues were carried out. The 3D acquisitions were processed using Planmeca ProMax 3D ProFace® software (Planmeca USA, Inc.; Roselle, Illinois, USA). The participant were positioned in a natural position during the skull scannering. Three sagittal angular measurements were performed (Tr-NA, Tr-N-Pg, Ss-N-Pg) and two verticals (Go-N-Me, Tr-Or-Pg) on facial soft tissue scan and on the patient’s 3D soft tissue CBCT volumetric rendering. Results: A certain correspondence has been demonstrated between the measurements obtained on the Proface and those on the CBCT. Conclusion: A radiation free method was to be considered an important diagnostic tool that works in conditions of not subjecting the patient to harmful ionizing radiation and it was therefore particularly suitable for growing subjects. The soft tissue analysis based on the realistic facial scan has shown sufficient reliability and reproducibility even if further studies are needed to confirm the research result

Immediate Nonocclusal Versus Early Loading of Dental Implants in Partially Edentulous Patients – —15-year Follow-up of a Multicentre Randomised Controlled Trial

PURPOSE. To compare peri-implant bone and soft-tissue levels at immediately non-oc-clusally loaded versus non-submerged early-loaded implants in partially edentulous patients 15 years after loading. MATERIALS AND METHODS. Fifty-two patients from five Italian private practices were randomised, 25 to immediate loading and 27 to early loading. To be immediately loaded, single full Osseotite implants had to be inserted with a torque of at least 30 Ncm, and splinted implants with a torque of at least 20 Ncm. Immediately loaded implants were provided with non-occluding temporary restorations within 48 hours, which were brought into full occlusion after 2 months. In the early loading group, implants were loaded after 2 months. Definitive restorations were provided 8 months after implant placement in both groups. Outcome measures were prosthesis failures, implant failures and complica-tions, recorded by non-blinded assessors, and peri-implant bone and soft-tissue levels, as evaluated by blinded assessors. RESULTS. Fifty implants were loaded immediately and 54 early. Twelve patients with 24 implants dropped out from the immediate group versus 11 patients with 22 implants from the early loaded group, but all remaining patients were followed up for at least 15 years after loading. One single implant with its provisional crowns and one definitive prothesis failed in the immediate loading group. Seven patients with immediately loaded and two with early loaded implants reported complications. There were no statistically significant differences between groups in terms of implant failures (Fisher’s exact test P = 0.481; diff. =-0.04, 95% CI:-0.16 to 0.08), prosthesis failures (Fisher’s exact test P = 0.226; diff. =-0.08, 95% CI:-0.21 to 0.06), or complications (Fisher’s exact test P = 0.066; diff. =-0.22, 95% CI:-0.41 to 0.01). There were also no statistically significant differences in peri-implant bone (diff. = 0.28 mm, 95%CI:-0.35 to 0.91; P = 0.368) or soft-tissue level changes (diff. = 0.34 mm, 95%CI:-0.32 to 1.00; P = 0.292) between the two groups. Specifically, after 15 years immediately loaded patients had lost an average of 1.75 mm, and early loaded patients an average of 1.44 mm of peri-implant marginal bone. CONCLUSIONS. The long-term prognosis of prostheses supported by both immediately and early-loaded implants seems favourable

Residual Bone Height and New Bone Formation after Maxillary Sinus Augmentation Procedure Using Biomaterials: A Network Meta-Analysis of Clinical Trials

Background. Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). Methods. PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). Results. A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. Conclusion. There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .)

Multi-layer technique (Mlt) with porcine collagenated cortical bone lamina for bone regeneration procedures and immediate post-extraction implantation in the esthetic area : A retrospective case series with a mean follow-up of 5 years

Background: Augmentation of the edentulous atrophic anterior region is a challenging situation. The purpose of this article was to evaluate the effectiveness of a collagenated cortical bone lamina of porcine origin for horizontal ridge augmentation in patients with inadequate alveolar ridge width undergoing immediate post-extraction implantation in the anterior sites, and to report on implant survival rates/complications. Materials and methods: The cases were extracted electronically from a large database according to these specific inclusion criteria: patients with inadequate alveolar ridge width in the anterior maxilla or mandible, who underwent immediate post-extraction implant placement and simultaneous alveolar bone reconstruction using xenogeneic cortical bone lamina. An additional layer of palatal connective tissue graft was inserted between lamina and the vestibular mucosa, for improving soft tissue healing. A collagenated bone substitute was additionally placed in the gap between the lamina and implant surface in all patients. The main outcomes were implant survival and complications. Results: Forty-nine patients with 65 implants were included. Patients’ mean age at the time of implant surgery was 60.0 ± 13.6 years. The mean follow-up was 60.5 ± 26.6 months after implant placement. The implant survival was 100%. Four postoperative complications occurred in four patients. No specific factor was found to be associated with complication occurrence. Conclusion: The use of collagenated cortical bone lamina can be considered as a successful option for alveolar reconstruction in immediate post-extraction implant insertion procedures in anterior regions with inadequate alveolar ridge width

Healing of post-extraction sockets filled with anorganic bovine bone and covered with a xenogeneic collagen matrix. Radiological 2D and 3D results of a pilot study to assess dimensional stability

Analysis of short-term results regarding dimensional stability of post-extraction sockets managed via a preservation protocol using deproteinized bovine bone matrix and a xenogeneic collagen matrix. Materials and methods Fifteen patients needing extraction of one single-rooted premolar tooth were treated in a pilot study. Five patients were treated in each centre. After tooth extraction, sockets were filled with anorganic bovine bone matrix and covered with a xenogeneic collagen matrix. Six months later, implants were placed. Dimensional changes in the treated sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Results After six months of healing, the vertical reduction of the grafted sites was 0.31 ± 0.24 mm (p < 0.001). Volumetric analysis of superimposed models showed an average palatal-lingual contraction of 0.33 ± 0.51 mm3 (p = 0.02). At the vestibular level, the average contraction was found to be 0.8 ± 0.3 mm3 (p < 0.001). Finally, the analysis of linear variations in the treated sites on a single sagittal section at the crystal level, and at 3 and 7 mm apically respect to the crest, both towards the vestibule and palate, generally showed more marked resorption at the crestal level compared to apical measurements. Conclusion: The clinical protocol herein employed for socket preservation showed a positive effect in preventing the physiological post-extraction remodeling

COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses

Objective: To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol. Sources and Methods: Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed. Conclusion: The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications