Alessandro Mangano

Prospective clinical evaluation of 1920 Morse taper connection implants: results after 4 years of functional loading

PURPOSEnThis study evaluated the survival rate and the clinical, radiographic and prosthetic success of 1920 Morse taper connection implants.nnnMATERIAL AND METHODSnOne thousand nine hundred and twenty Morse taper connection implants were inserted in 689 consecutive patients, from January 2003 until December 2006. Implants were clinically and radiographically evaluated at 12, 24, 36 and 48 months after insertion (mean follow-up per implant: 25.42 months). Modified plaque index (mPI), modified sulcus bleeding index, probing depth (PD) and the distance between implant shoulder and first crestal bone-implant contact (DIB) were measured in mm. Success criteria included the absence of suppuration and clinically detectable implant mobility, PD<5 mm, DIB<1.5 mm after 12 months of functional loading and not exceeding 0.2 mm for each following year, the absence of recurrent prosthetic complications at the implant-abutment interface. Prosthetic restorations were fixed partial prostheses (364 units), single crowns (SCs: 307 units), fixed full-arch prostheses (53 units) and overdentures (67 units).nnnRESULTSnThe overall cumulative implant survival rate was 97.56% (96.12% in the maxilla and 98.91% in the mandible). The cumulative implant success rate was 96.61% (95.25% in the maxilla and 98.64% in the mandible). Only a few prosthetic complications were reported (0.65% of loosening at implant-abutment interface in SCs).nnnCONCLUSIONnThe use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches. The absence of an implant-abutment interface (microgap) is associated with minimal crestal bone loss. The high mechanical stability significantly reduces prosthetic complications.

The use of propofol and remifentanil for the anaesthetic management of a super-obese patient.

Morbid obesity is defined as body mass index (BMI) >u200a35u2003kg.m−2, and super‐obesity as BMI >u200a55u2003kg.m−2. We report the case of a 290‐kg super‐obese patient scheduled for open bariatric surgery. A propofol‐remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. Servins weight correction formula was used for propofol. Arterial blood samples were taken at fixed time points to assess the predictive performance of the TCI system. A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol‐remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index‐guided propofol‐remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery.

Dipyrone Increases the Blood Flow of Arterial Dorsal Skin Flaps: Are Prospective Studies Always Properly Designed?

We read with interest the article published by Gulmez et al. [1]. While the authors are to be commended for their goal of conducting a prospective, randomized, double-blind trial about the effect of dipyrone on blood flow and necrosis (i.e., flap survival), there are several issues with respect to the design of the study and the statistical analysis used. With respect to study design, the major issue is that there is no reference to any sample size calculation. In fact, in order for a particular finding to be claimed as significant (or not), the study must have enough power. In this particular case, the expected change in blood flow should be stated and from that the sample size should be calculated (e.g., considering the ‘‘standard’’ a error of 0.05 and a power of 0.8). Moreover, there is no reference to the randomization method. Another critical point we want to bring up is the statistical analysis used. The authors state that ‘‘Student’s ttest at a p level of significance less than 0.05 was used to compare the percentage of necrotic area and blood flow changes from baseline for each time point measure.’’ This may not be the correct way to go. Are all the variables normally distributed? If not, nonparametric tests should be used. Moreover, this study involves both tests between groups and tests within the same individuals (i.e., repeated measurements on blood flow and fraction of necrosis). Therefore, close attention should be paid to whether use of a t test for unpaired or paired data is appropriate and, similarly, to the use of either a Wilcoxon rank-sum test or signed-rank test. While this study is extremely interesting for plastic surgeons, appropriate statistical analysis of data from trials is crucial for adequate conclusions. In addition, we have recently shown that the anesthetic technique used affects regional blood flow in spine surgery [2]. Because most patients undergoing plastic surgery procedures are under general anesthesia, it would be interesting to investigate the effect of different anesthetic techniques on flap vascularization and viability. We hope our suggestions will be useful to other authors who will be involved in similar studies in the future.