The surgical procedures for implant applications on the lateralupper areas depend on sinus pneumatization and availability of the residual bone. In these cases, autologous bone grafting remains the gold standard. Nevertheless, because of the morbidity associated to the donor site and the post-surgical complications, several alternative bone substitutes have been introduced, which, however, imply additional costs and show limited osteoinductive properties. Such limitations can be compensated with new regeneration strategies for biological and mechanical tissue restoration, a subject which has been addressed by tissue engineering in recent years. The authors present a new therapeutic option for implant application in the upper maxilla with bone availability less than 4 mm by using 3D scaffolds obtained from antigen-free porcine cartilage in the fit-lock technique. A longitudinal study on 18 consecutive cases was performed, with a 95.2% success rate one year after the implant. The advantages of this new technique are: 1)Functional and anatomical recovery of the maxillary antrum, 2) Immediate application of the implants; 3) Reduction of surgical times; 4) Absence of patient morbidity; 5)Local anesthesia; 6) Use of implants with a diameter > 4 mm.

Los procedimientos quirurgicos para la aplicacion de los implantes en los sectores latero superiores, estan condicionadas por la neumatizacion del seno y la disponibilidad del hueso residual. En estos casos el injerto de hueso autologo permanece como la mejor opcion, pero a causa de la morbilidad asociada al sitio donante y a las complicaciones post quirurgicas, se pusieron a disposicion diversas alternativas de sustitutos oseos, que implican sin embargo un aumento de los costos economicos y con limitadas propiedades osteoinductivas. Tales defectos pueden ser compensados con nuevas estrategias de regeneracion biologica y mecanica de los tejidos a los cuales fue dirigida la ingenieria biologica y mecanica en los ultimos anos. Se presenta una nueva posibilidad terapeutica en la aplicacion de los implantes en el maxilar superior con disponibilidad osea inferior a los 4 mm, mediante la utilizacion de andamios 3D confeccionados en cartilago de cerdo libre de antigenos obtenido segun la tecnica Fit-Lock. Se realizo un estudio longitudinal en 18 casos consecutivos evidenciando al cabo de un ano de la carga implantologica, un exito del 95,2%. Las ventajas en esta nueva tecnica son: 1)La recuperacion funcional y anatomica del antro del maxilar 2).La aplicacion inmediata de los implantes; 3)Reduccion de los tiempos quirurgicos; 4) Ausencia de morbilidad para el paciente; 5) Uso de anestesia local; 6)Uso de implantes con diametros superiores a los 4 mm.

The implant-supported rehabilitation of posterosuperior sectors may be sometimes conditioned by the pneumatization of the para-nasal sinuses, which decreases the possibility of implant placement when the bone height is ≤ 4 mm. (prerequisite for primary stabilization). Sinus lift surgery with simultaneous application of implants is the procedure which provides the best chance of success compared to the application of the filling material only. There are many surgical techniques which combine autogenous bone grafting (ilium crest, calvaria, fibula) with implant placement. The objective of this report is to present a new technique which aims to minimize invasive bone grafting and patient morbidity. The authors performed a longitudinal study on 21 cases with a 94.5% success rate, exemplified by one clinical case. The advantages of this technique are: 1) Functional and anatomical recovery of the jaw cavity. 2) Simultaneous application of implants when the bone is ≤ 4mm. 3) Reduction of surgical times. 4) Reduced patient morbidity. 5) Local anesthesia.

La rehabilitacion implanto soportada de los sectores posterosuperiores resulta, a veces, condicionada por la neumatizacion del seno maxilar, reduciendo la posibilidad de la aplicacion de los implantes cuando la disponibilidad osea es inferior a los 4 mm. (Condicion Limite para la estabilidad primaria). El levantamiento del seno maxilar y la aplicacion simultanea de los implantes es con seguridad la condicion que mejor garantiza el exito, respecto a la sola aplicacion del material de relleno. Muchas son las tecnicas quirurgicas desarrolladas en la utililizacion del hueso autologo (cresta iliaca, calota craneana, perone) y la aplicacion de los implantes. En este articulo se presenta una nueva tecnica para reducir al minimo la invasividad de la toma del material oseo de injerto autologo y la morbilidad del paciente. Se ha realizado un estudio longitudinal sobre 21 casos consecutivos, mostrando un exito del 94,5%. Las ventajas de esta tecnica son: 1) Recuperacion funcional y anatomica del seno maxilar. 2) Aplicacion inmediata de los implantes con un espesor residuo de hueso de piso de seno menor a los 4 mm. 3) Reduccion de los tiempos quirurgicos. 4) Menor Morbilidad del paciente. 5) Anestesia loco regional.

The goal of the study is to evaluate if the use of rotary nickel-titanium (RNT) instruments, as Hedstroem files, is safe. Twelve twisted files (TF) RNT instruments size 06-25 were selected and randomly divided in 2 groups of 6 instruments each. Group A (new instruments) were used as control. Group B (test) instruments were clinically used only as Hedstroem files in a canal that had been previously instrumented to the working length with other 06-25 RNT instruments. Group B instruments were used only in the straight portion of the canal (1 minute at 1000 rpm). A cyclic fatigue test was performed for each instrument of groups. Data were statistically analyzed (Student's t-test). Results showed no significant difference (P > 0.05) between groups A and B. Data confirmed that the use of TF instruments as Hedstroem files is a safe procedure. Cross section images and volumes of the same instrument, before and after cyclic fatigue testing, have been obtained by means of microtomographic analysis to evaluate possible microstructure alterations.

Scopo dello studio è valutare se l'utilizzo degli strumenti rotanti nichel titanio come Hedstroem file è sicuro. Dodici twisted files (TF), dimensioni 06-25, sono stati selezionati e suddivisi random in 2 gruppi di 6 strumenti ciascuno. Il gruppo A (strumenti nuovi) composto da strumenti utilizzati come controllo. Il gruppo B (test) composto da strumenti utilizzati, clinicamente solo come Hedstroem file in un canale, in precedenza strumentato fino alla lunghezza di lavoro con altri strumenti rotanti 06-25. Gli strumenti del gruppo B sono stati utilizzati soltanto nella porzione rettilinea del canale (1 minuto a 1000 rpm). È stato eseguito un test di fatica ciclica sugli strumenti dei due gruppi. I dati sono stati analizzati statisticamente (Student's t-test). I risultati non mostrano differenze statisticamente significative (P > 0,05) tra i due gruppi. I dati raccolti hanno confermato che l'utilizzo dei TF come Hedstroem file rappresenta una procedura sicura. Tramite analisi microtomografica sono state ottenute delle immagini di sezioni e volumi dello stesso strumento, prima e dopo l'applicazione di fatica ciclica, per valutare eventuali alterazioni microstrutturali.

The aim of this study was to identify the most effective disinfection protocol to reduce the presence of Legionella pneumophila in the water system of two Italian hospitals. From 2004 to 2009, 271 samplings of hot water were carried out in 11 hospital units to detect the presence of L. pneumophila. Additionally, water samples collected from one boiler outlet and the hot water recirculation were tested. From 2004 to 2009, L. pneumophila was present in 37% of the samples. Of these, 68.3% and 18.8% were positive for serogroups 2-14 and 1, respectively. Furthermore, 12.9% of the samples were positive for both serogroups. Finally, a maximal count of 10(4) CFU/L was measured in the most distal sites. To reduce L. pneumophila colonization, a two-year long hyperchlorination (2004-2006) was carried out. Moreover, from June 2005 until now, continuous maintenance of boilers and tanks, substitution of the shower heads and increase of the boiler outlet temperature to 60 ºC were performed. All these treatments led to a marked reduction of L. pneumophila colonization in the short but not in the medium-long term. Only the use of chlorine dioxide led, after four years, to a reduction of the loads of L. pneumophila to values below 100 CFU/L. However, in the distal sites a persistent degree of colonization (maximum value 700 CFU/L, average 600 CFU/L) was observed probably due to the presence of L. pneumophila in the stagnant water in dead legs. In conclusion, data show that long-term chlorination of hot water sources together with carefully aimed maintenance of water pipes can lead to an effective reduction of L. pneumophila concentration in hospital water systems.

In questo studio si è cercato di identificare il protocollo di disinfezione più efficace per il contenimento della presenza di Legionella pneumophila nel sistema idrico di due ospedali italiani. Dal 2004 al 2009 abbiamo eseguito 271 campionamenti d'acqua calda da 11 reparti per verificare la presenza di L. pneumophila. Inoltre abbiamo controllato l'acqua in mandata della caldaia e quella proveniente dal ricircolo. Il 37% dei campioni è risultato positivo a L. pneumophila (18.8% sierogruppo 1, 68.3% sierogruppi 2-14, 12.9% entrambi), con valori anche di 10(4) UFC/L nei punti più distali. Al fine di contenere la carica di Legionella sono stati fatti diversi interventi, quali iperclorazione shock (20042006), pulizia e manutenzione di caldaie e serbatoi (in continuo), sostituzione delle bocchette delle docce, aumento della temperatura a 60 ºC in mandata (da giugno 2005). Tutti questi interventi hanno dato buon esito a breve ma non nel medio-lungo termine. Solo l'utilizzo del biossido di cloro ha portato, a distanza di quattro anni, a un contenimento delle cariche a valori inferiori a 100 UFC/L, seppure sia necessario evidenziare ancora una colonizzazione (valore massimo 700 UFC/L, average 600 UFC/L) nei reparti più distali, probabilmente a causa della presenza di acqua stagnante nei rami morti del circuito idrico.