Giambattista Ravera

Systemic linoleic and γ-linolenic acid therapy in dry eye syndrome with an inflammatory component

Purpose. To evaluate the efficacy and anti-inflammatory activity of systemic linoleic (LA) and &ggr;-linolenic acid (GLA), which decrease chronic inflammation in rheumatoid arthritis, on the ocular surface of patients with keratoconjunctivitis sicca. Methods. In a randomized clinical trial, 26 patients with aqueous-deficient keratoconjunctivitis sicca were consecutively selected from patients presenting to Department of Neurosciences, Ophthalmology and Genetics, University of Genoa. The diagnosis was based on dry eye symptom survey score, Schirmer-1 test values, positive vital staining with lissamine green, and fluorescein break-up time (FBUT). All patients had ocular surface inflammation based on HLA-DR expression, a major histocompatibility class II antigen, on epithelial bulbar conjunctiva samples. The subjects were randomly divided into two groups of 13 patients each. The study group received tablets containing LA (28.5 mg) and GLA (15 mg) twice daily for 45 days and used tears; the control group received a tear substitute and a placebo tablet for 45 days. Results. Statistically significant changes in symptoms (p < 0.005), lissamine green staining (p < 0.005), and ocular surface inflammation (p < 0.05) occurred in the study group compared with controls. HLA-DR expression varied from 58.5 ± 14.1% positive conjunctival cells to 41.3 ± 18.9% in the treated group and from 61.4 ± 21.9% to 58.0 ± 13.3% in the controls. No statistically significant difference between groups was found for FBUT and the Schirmer-1 test. Conclusions. Therapy with LA and GLA and tear substitutes reduces ocular surface inflammation and improves dry eye symptoms. Long-term studies are needed to confirm the role of this new therapy for keratoconjunctivitis sicca.

Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage

OBJECTIVES This retrospective study investigated the clinical effectiveness over up to 8 years of parallel-sided and of tapered glass-fiber posts, in combination with either hybrid composite or dual-cure composite resin core material, in endodontically treated, maxillary anterior teeth covered with full-ceramic crowns. METHODS The study population comprised 192 patients and 526 endodontically treated teeth, with various degrees of hard-tissue loss, restored by the post-and-core technique. Four groups were defined based on post shape and core build-up materials, and within each group post-and-core restorations were assigned randomly with respect to root morphology. Inclusion criteria were symptom-free endodontic therapy, root-canal treatment with a minimum apical seal of 4mm, application of rubber dam, need for post-and-core complex because of coronal tooth loss, and tooth with at least one residual coronal wall. Survival rate of the post-and-core restorations was determined using Kaplan-Meier statistical analysis. RESULTS The restorations were examined clinically and radiologically; mean observation period was 5.3 years. The overall survival rate of glass-fiber post-and-core restorations was 98.5%. The survival rate for parallel-sided posts was 98.6% and for tapered posts was 96.8%. Survival rates for core build-up materials were 100% for dual-cure composite and 96.8% for hybrid light-cure composite. CONCLUSIONS For both glass-fiber post designs and for both core build-up materials, clinical performance was satisfactory. Survival was higher for teeth retaining four and three coronal walls.

Immediate function with fixed implant-supported maxillary dentures: A 12-month pilot study

STATEMENT OF PROBLEM Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable procedure. There is little long-term data available on similar treatments in the edentulous maxilla. PURPOSE The purpose of this study was to evaluate the 12-month implant survival after immediate loading of 4 to 6 implants with fixed screw-retained prostheses in edentulous maxillae. MATERIAL AND METHODS Twenty-one patients, edentulous or with remaining teeth to be extracted in the maxilla, received 4 to 6 implants (n=111). The patients were restored with screw-retained fixed provisional prostheses supported by palladium-alloy frameworks within 24 hours after surgery. Insertion torques for implants were at least 40 Ncm. Implants, grouped as tapered or cylindrical screws, were placed in healed bone or extraction sockets. Implants were also classified as either vertical or off-angle. Definitive prostheses were placed after a mean healing time of 18 weeks. Radiographic examinations were made at the time of placement of provisional prostheses and 12 months later. Between-groups bone resorption was compared using 2-way ANOVA (alpha=.05). RESULTS The mean follow-up time for all of the patients was 20 months (range, 13 to 28 months). The cumulative implant survival rate at the 12-month follow-up visits (after surgery) was 92.8%; the prostheses survival rate was 100%. No significant differences were found between the survival of tapered or cylindrical screw-type implants placed in postextraction sockets versus those in healed edentulous sites or between vertical and off-angle placed implants. Eight implants failed during the first 3 months, 5 of which were the most distal implants. The mean reduction in marginal bone height over the 12-month observation period was 0.84 mm (CI 95%; 0.68-0.99 mm). CONCLUSIONS In this study with 12-month follow-up, 4 to 6 implants were sufficient to successfully support fixed implant screw-retained prostheses in the edentulous maxillae of 21 patients.

Tilted Implants in the Immediate Loading Rehabilitation of the Maxilla: A Systematic Review

Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

Vascular Permeability, Blood Pressure, and Organ Damage in Primary Hypertension

Sub-clinical organ damage is a strong independent predictor of cardiovascular mortality in primary hypertension, and its changes over time parallel those in risk of cardiovascular events. A better understanding of the pathogenetic mechanisms underlying the development of target organ damage may help us devise more effective therapeutic strategies. We therefore investigated the relationship between the presence of organ damage and some of its potential determinants, such as blood pressure severity and early atherosclerotic abnormalities. Thirty-seven untreated, non-diabetic hypertensive patients were enrolled. Target organ damage was assessed by albuminuria and left ventricular mass index; systemic vascular permeability was evaluated by transcapillary escape rate of albumin (TERalb); and blood pressure was measured by 24-h ambulatory blood pressure monitoring. The albumin-to-creatinine ratio and left ventricular mass index were directly related to TERalb (r=0.48, p=0.003 and r=0.39, p<0.020, respectively) and 24-h systolic blood pressure values (r=0.54, p<0.001; r=0.60, p<0.001). The simultaneous occurrence of increased blood pressure load and TERalb was associated with higher left ventricular mass index values (p=0.012) and entailed an increased risk of having at least one sign of damage (χ2=17.4; p<0.001). Logistic regression analysis showed that the risk of presenting at least one sign of organ damage increased more than ten-fold when TERalb was above the median and more than five-fold with each 10 mmHg increase in 24-h systolic blood pressure. Blood pressure load and vascular permeability are potentially modifiable factors that are independently associated with the occurrence of sub-clinical signs of renal and cardiac damage in hypertensive patients.

Epilepsy associated with infantile hemiparesis: predictors of long-term evolution

To study the evolution of epilepsy associated with infantile hemiparesis (IH) in relation to age and identification of factors predictive of pharmacoresistance. Thirty-four children with epilepsy and associated IH were followed for a period of 13 years and 3 months (range 5-19 years). All the patients underwent clinical evaluation and EEG, CT and/or MRI. Disease course was evaluated from the time of diagnosis of epilepsy to end of follow-up by differentiating the cases with severe pharmacoresistance from those with favourable outcome. Several possible prognostic factors were identified predicting evolution toward intractable epilepsy. Univariate statistical analysis by calculating odds ratio (OR) with 95% confidence interval (CI) and multivariate analysis by logistic regression were performed. Eleven cases presented severe epilepsy evolving toward pharmacoresistance; duration of epilepsy was always longer than 8 years. Twenty-three cases (seven with severe epilepsy and 16 with mild epilepsy) evolved toward remission; in these patients epilepsy duration was shorter (2-7 years) and a complete remission was obtained within 12 years of age. Significant prognostic factors associated with pharmacoresistance included: non-vascular causes, cortical lesions, mixed and frequent seizures during the first two years of epilepsy. Our results show that surgical treatment could be considered in cases with unfavourable prognostis factors.