M. Del Fabbro

Relation between serum creatinine and body mass index in elite athletes of different sport disciplines

Objectives: To document the relation between serum creatinine concentration and body mass index in elite athletes from five different sports, and to study potential differences among athletes performing different sports with different features and requirements. Methods: Before the start of the competitive season, serum creatinine was measured in 151 elite athletes from five different sports: rugby (n  =  44), soccer (n  =  27), alpine skiing (n  =  34), sailing (n  =  22), cycling (n  =  24). Pearson’s correlation analysis was used to evaluate the relation between serum creatinine and body mass index (BMI). Analysis of variance and unpaired Student’s t test were used to compare creatinine concentration and BMI in different sport disciplines. Results: In the whole group of athletes, a positive correlation between serum creatinine and BMI was found (r  =  0.48, p<0.001). Significant differences in creatinine concentration and BMI were found between athletes competing in different sports: their mean (SD) values were respectively 1.31 (0.12) mg/dl and 28.83 (2.41) for rugby players, 1.27 mg/dl (0.10) and 23.10 (1.01) for soccer players, 1.15 (0.11) mg/dl and 25.8 (1.50) for skiers, 1.08 (0.11) mg/dl and 26.93 (2.36) for sailors, and 0.91 (0.07)mg/dl and 21.33 (1.21) for cyclists. Conclusions: There is a correlation between creatinine concentration and BMI in elite athletes competing in different sports characterised by different kinds of training, competitive season, and involvement of aerobic and anaerobic metabolism. Interpretation of creatinine concentrations in male athletes should consider professional status as well as the specific sport performed. All athletes should be monitored with consecutive creatinine assessments, using as the baseline the concentration determined before the start of training and the competitive season, but taking into consideration the specific sport performed and the BMI until equations that include creatinine and factors that affect its concentration are used.

Clinical evaluation of an implant maintenance protocol for the prevention of peri‐implant diseases in patients treated with immediately loaded full‐arch rehabilitations

OBJECTIVE The aim of this prospective study was to assess the outcomes of an implant maintenance protocol for implants supporting a full-arch rehabilitation. MATERIALS AND METHODS Sixty-one patients (28 women and 33 men) treated with immediately loaded full-arch rehabilitation, both mandibular and maxillary, supported by a combination of two tilted and two axial implants, were included in the study. Patients were scheduled for follow-up visits every 6 months for +2 years, then yearly up to 4 years. Each patient received professional oral hygiene treatment and detailed oral hygiene instructions. During each visit, modified plaque index, bleeding index and probing depth were assessed. The presence of peri-implant tissue inflammation was also evaluated. RESULTS Mean observation time, considering both mandible and maxilla, was 18.3 months ranging from 6 months to 5 years. Both plaque and bleeding indexes frequency decreased over time. Probing depth was stable (2.46 ± 0.5 mm at 4 years). Only three implants were lost due to peri-implantitis (1.4% at 12 months), whereas the incidence of peri-implant mucositis was less than 10% in each considered period. CONCLUSIONS The adoption of a systematic hygienic protocol is effective in keeping low the incidence of peri-implant mucositis as well as in controlling plaque accumulation and clinical attachment loss.

Is autologous platelet concentrate beneficial for post-extraction socket healing? A systematic review

The aim of this systematic review was to assess if the use of autologous platelet concentrates may be beneficial to the healing of extraction sockets. Medline, Embase and Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Hand searching of the relevant journals and of the bibliographies of reviews was also performed. Prospective comparative studies evaluating the effect of a platelet concentrate on fresh extraction sockets were included. Outcome variables related to hard and soft tissue healing, aesthetics and postoperative discomfort were considered. A methodological study quality assessment was made. The initial search yielded 425 articles, eight were finally included. 207 tooth extractions (104 tests and 103 controls) in 115 patients were evaluated. The articles provided a broad range of variable outcomes to assess the regenerative potential of platelet concentrate and its possible benefits to the treatment. Favourable effects on hard and soft tissue healing and postoperative discomfort reduction were often reported. A large heterogeneity was found regarding study design, sample size, surgical techniques and methods for preparing platelet concentrates. Standardization of experimental design is needed in order to detect the true effect of platelet concentrates in regenerative procedures of extraction sockets.

Quality of life after microscopic periradicular surgery using two different incision techniques: A randomized clinical study

AIM To monitor the quality of life of patients after periradicular surgery when two different flap designs were used. METHODOLOGY Forty patients with teeth having a periradicular lesion of endodontic origin were included according to specific selection criteria. Patients were randomly assigned to two groups. In one group a sulcular incision (SI) with complete papilla mobilization was made, and in the other group a papilla-base incision (PBI) was used. Periradicular surgery was performed using a surgical microscope. Parameters related to life quality were recorded daily in the first week post-surgery using a questionnaire. Pain was evaluated with a 0-100 visual analog scale (VAS). Other symptoms (swelling, bleeding and nausea), plus functions (chewing, speaking, sleeping, daily routine and work) were assessed using a five-point scale. Analgesic intake was recorded. Fishers test and unpaired t-test were used to assess the difference between groups. RESULTS The VAS score for pain, and the scores for swelling, chewing and phonetic impairment, peaked on days 1 and 2 postoperatively. A significant difference in favour of the PBI group was found for chewing and swelling in the first 4 days. Starting from day 3 post-surgery, the PBI group reported a significantly more rapid decrease in pain levels and analgesics use than the SI group (P < 0.05). The other parameters were similar in the two groups. CONCLUSIONS The papilla-base incision technique may be preferred as reduction of pain levels, swelling and drug intake were more rapid in the first week postoperatively compared with cases in which a sulcular incision was used.

Behaviour of reticulocyte counts and immature reticulocyte fraction during a competitive season in élite athletes of four different sports

The role of reticulocytes (Ret) in sports medicine became important when the count of immature erythrocytes has been introduced in protocols used and officially approved for antidoping purposes. The use of modern automated analysers, which allow the easy count and the description of characteristics of reticulocytes, increased the possible use of these parameters in sports medicine. We studied the behaviour of Ret and immature reticulocyte fraction (IRF) in top‐level athletes practising rugby, ski, soccer and cyclism, throughout a competitive season. We aimed at increasing the knowledge of physiological characteristics of these sportsmen and supplying valuable suggestions to trainers and sports physicians. We observed a stability of Ret counts, also during training and competitions, although some modifications, namely decrease during competitions periods in cyclists, and in rugby and soccer players, occurred. No significant correlation was found between Ret count and Hb in each sport discipline. IRF values tend to be high in athletes owing to continuous bone marrow stimulation linked to haemolysis, typical of sports activities. We confirm the validity of the use of Ret counts for antidoping purposes and also for evaluating health status and iron metabolism of sportsmen.

Evaluation of chlorhexidine 0.05% with the adjunct of fluoride 0.05% in the inhibition of plaque formation: A double blind, crossover, plaque regrowth study

OBJECTIVE The aim of this study was to evaluate the effect of mouthrinses containing 0.05% chlorhexidine + 0.05% fluoride solution on early dental plaque regrowth. MATERIALS AND METHODS Thirty periodontally healthy subjects were included in the study. A crossover 4-day plaque regrowth protocol was adopted. The test product was initially used in 15 patients, while a placebo was administered to the other 15 patients. Then, after a washout period, each patient used the other product. No other oral hygiene manoeuvre was allowed. Full-mouth plaque and bleeding scores (FMPS and FMBS) were evaluated at baseline and after 4 days. RESULTS All subjects completed the study. The mean age was 27 ± 8.4 years. Five patients were smokers with a mean daily consumption of 1 ± 2.5 cigarettes. FMPS at baseline was 8.0 ± 4.4 for control group and 7.9 ± 3.8 for test group, without significant difference. After the 4-day plaque regrowth the mean FMPS significantly increased to 31.9 ± 16.5 and 36.3 ± 16.1 for control and test group, respectively (no significant difference between the two groups). CONCLUSIONS The test product was safe and well tolerated by subjects. The similar outcomes of the two experimental groups suggest that the two products have an equivalent effect on early dental plaque regrowth. Studies with longer follow-up are needed to clarify whether there is a beneficial long-term effect of daily rinses with the tested solution.

Morphological features of the maxillary incisors roots and relationship with neighbouring anatomical structures: possible implications in endodontic surgery

The purpose of this study was to investigate the relationship between the root apex of the upper incisors and neighbouring anatomical structures as well as the morphology of the root-end foramen after apicoectomy. Fifty-seven patients requiring endodontic surgical treatment for a maxillary anterior root were enrolled. A preoperative diagnostic computed tomography (CT) scan was analysed to determine: the distance between the anterior wall of the nasopalatine duct and the central (CI-ND) incisor root 4mm from the apex; and the distance between the floor of the nasal cavity and the tip of either the central (CI-NF) or the lateral (LI-NF) incisor root. After apicoectomy, root-end foramen endoscopic pictures were taken in order to characterize their morphology. Fifty-nine central and 26 lateral incisors were evaluated. The average CI-ND was 4.71 ± 1.26 (SD) mm. The average CI-NF was 10.62 ± 2.25 mm. The average LI-NF was 13.05 ± 2.43 mm. The foramen shape after apicoectomy was ovoid to circular in about 90% of cases in both central and lateral incisors. A sound knowledge of the anatomical relationships at the surgical site is essential for the clinician to perform a safe endodontic surgical procedure.

Endodontic treatment of a geminated maxillary second molar using an endoscope as magnification device

AIM To describe endodontic treatment for a rare case of gemination. SUMMARY A case of complex endodontic treatment in a geminated tooth is presented. With the assistance of microinstruments and magnification devices, a geminated maxillary second molar was successfully treated. In such a case, ultrasonic tips and the use of an endoscope were essential to detect the peculiar anatomy of the tooth involved. KEY LEARNING POINTS Knowledge of anomalies concerning fused teeth is essential. Using an endoscope as a magnification device is useful during the inspection of pulp chambers. Ultrasonic tips are safe and useful to detect canal orifices.

Adjunctive glycine powder air-polishing for the treatment of peri-implant mucositis: an observational clinical trial.

OBJECTIVES The aim of this study was to make a comparative evaluation of professional oral hygiene with or without the adjunct of glycine air-powder system for the treatment of peri-implant mucositis. METHODS After the application of inclusion and exclusion criteria, patients were divided in two groups: in control group, patients were treated with professional oral hygiene manoeuvres (POH) while in the test group, glycine air-powder system (SGA) was adjuncted to professional oral hygiene. Probing depth (PD), bleeding index (BI) and plaque index (PI) were measured at baseline, and 3 and 6 months after the treatment. RESULTS A total of 30 patients (15 per group) were selected for the study. In POH e SGA group, PD was, 2.86 ± 0.37 and 3.00 ± 0.36 mm at baseline, 2.90 ± 0.53 and 2.62 ± 0.50 mm after 3 months, 2.96 ± 0.56 and 2.41 ± 0.54 mm after 6 months, respectively, significantly lower in SGA group in the last follow-up visit. In both groups, both PI and BI decreased over time. CONCLUSIONS The present reports showed that both techniques were useful for the treatment of peri-implant mucositis. In the test group (with glycine powder), a significant reduction of probing depth was observed.

Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation of the results. Ten consecutives cases with the occurrence of membrane perforation were included in this study. All were repaired with a flap of tissue removed from the palatine portion near to the surgical site. The technique is demonstrated through a clinical case. The results showed successful integration of 88.8% of the implants after 12 months from prosthesis installation. Histological evaluation of the samples showed that the use of nanocrystalized hydroxyapatite showed an adequate stimulation of boné neoformation within 6 months. Radiographic evaluation revealed a small apical implant bone loss, not compromising their anchorages and proservation. Thus, it can be concluded that the use of conjunctive technique with collected palate flap for sealing the perforation of the membrane of the sinus may have predictable result.