Publications by authors named "Antonio Barone"

171 Publications

Early treatment with dexamethasone intravitreal implants in diabetic macular edema: Naïve versus refractory patients.

Eur J Ophthalmol 2021 Jun 12:11206721211024804. Epub 2021 Jun 12.

Department of Ophthalmology, Ospedali Riuniti, University of Foggia, Foggia, Italy.

Purpose: To assess the efficacy and safety of dexamethasone 0.7 mg implants (DEX-I) in patients with diabetic macular edema (DME) either naïve to therapy or refractory to anti-VEGF treatment, in a single-center, real-world setting.

Methods: Patients diagnosed with DME and treated with DEX-I were retrospectively enrolled in the study and split in two groups: naïve (Group 1,  = 64) and refractory (Group 2,  = 64) to treatment. Patients were evaluated at baseline, at 1 month, and every 3 months after each DEX-I implant. Main outcome measures were change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to follow-up visits.

Results: Significant improvements in BCVA were observed in treatment-naïve patients at 6 months following the first and second DEX-I injection ( = 0.0023 and  = 0.0063, respectively), with significant reductions in mean CMT at 6 months after all DEX implants. In treatment-refractory patients, mean CMT was significantly reduced from baseline to 6 months ( < 0.05) after all DEX-I injections, although no changes were observed in BCVA.

Conclusions: DEX-I improved visual acuity and macular edema mostly in treatment-naïve patients, suggesting DEX-I may be a viable first-line treatment option in DME.
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http://dx.doi.org/10.1177/11206721211024804DOI Listing
June 2021

Dexamethasone intravitreal implant in patients with cataract and naïve diabetic macular edema.

Eur J Ophthalmol 2021 Mar 23:11206721211004395. Epub 2021 Mar 23.

Department of Ophthalmology, University of Foggia, Foggia, Italy.

Purpose: To assess the feasibility and clinical effectiveness of dexamethasone intravitreal implant 0.7 mg (IDI) administered in diabetic patients to prevent the worsening of macular edema.

Methods: Forty eyes of 40 consecutive patients with naïve macular edema secondary to diabetes mellitus who were treated with IDI administered preoperative (Group A: 20 patients) or IDI administered immediately after cataract surgery (Group B: 20 patients). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes were evaluated at baseline and at postoperative time points.

Results: Follow-up study was 20 weeks. In Group A and B, mean BCVA improved significantly at all post-surgery time points ( < 0.05). In Group A and B, mean CMT decreased significantly at 16 weeks ( = 0.02 and  = 0.004, respectively). At week 20, CMT failed to reach statistical significance in both groups ( = 0.5, group A and  = 0.15, group B). No statistical differences were noted between groups in term of BCVA (with the exception of week 4 for the presence of cataract in Group A), CMT and IOP.

Conclusions: The use of intravitreal dexamethasone implant 1 month prior to scheduled cataract extraction or at the time of phacoemulsification appears to be safe and effective for at least 16 weeks after surgery.
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http://dx.doi.org/10.1177/11206721211004395DOI Listing
March 2021

Autotransplantation of Two Immature Third Molars with the Use of L-PRF.

Case Rep Dent 2021 2;2021:6672711. Epub 2021 Jan 2.

Department of Surgical, Medical, Molecular and of Critical Area Pathologies, Complex Operative Unit of Stomatology and Oral Surgery, University-Hospital of Pisa, University of Pisa, 56126 Pisa, Italy.

Tooth autotransplantation is a procedure which provides the extraction of an erupted or impacted tooth and its repositioning to another site in the oral cavity. This Case Report describes a successful case of two autotransplantations of open-apex mandibular third molars in place of the hopeless first mandibular molars with the use of L-PRF in a growing patient. A 15-year-old male patient was referred to the Dental Clinic for the extractions of the two hopeless mandibular first molars. Autotransplantation was considered the best treatment option for both sites 36 and 46, because the presence of two impacted mandibular third molars (38 and 48) with an incomplete root formation. Teeth 36 and 46 were extracted and replaced with teeth 38 and 48. The patient had an uneventful healing. At follow-up visits, the two autotransplanted teeth showed physiologic mobility, absence of inflammation and discomfort, and absence of infection; probing depth values were within normal range, and the vitality tests were positive. After 2 years, the teeth in position 36 and 46 showed absence of infection and mobility, and positive pulp vitality tests and the radiographic examinations exhibited closure of the root apices as well as absence of any periapical radiolucency or root resorption. Tooth autotransplantation is a good treatment option in case of tooth loss offering an alternative to traditional or implant-supported prosthesis especially for growing patients.
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http://dx.doi.org/10.1155/2021/6672711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801052PMC
January 2021

Maxillary sinus augmentation with three different biomaterials: Histological, histomorphometric, clinical, and patient-reported outcomes from a randomized controlled trial.

Clin Implant Dent Relat Res 2021 Feb 8;23(1):86-95. Epub 2020 Dec 8.

Formerly, Unit of Oral Surgery and Implantology, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.

Background: Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior-upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used.

Methods: Twenty-four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient-reported outcome measures.

Results: Although the percentage of new bone was not statistically different between the three groups (P = .191), the percentages of residual biomaterial was significantly higher (P < .000) and nonmineralized tissue significantly lower (P < .000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P < .0005). The rest of the secondary outcomes were not significantly different between the groups.

Conclusion: MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes.
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http://dx.doi.org/10.1111/cid.12964DOI Listing
February 2021

Impact of Concave/Convergent vs Parallel/ Divergent Implant Transmucosal Profiles on Hard and Soft Peri-implant Tissues: A Systematic Review with Meta-Analyses.

Int J Prosthodont 2020 Sep/Oct;33(5):553-564

Purpose: To systematically review the literature comparing marginal bone loss (MBL) and pink esthetic scores of implants with convergent or concave transmucosal profiles vs divergent or parallel profiles.

Materials And Methods: A PICO question was defined, and an electronic search was carried out in the MEDLINE/PubMed and Cochrane Oral Health Group databases. Studies documenting type of transmucosal profile (either tissue-level profiles or abutments) and soft and/or hard tissue outcomes of implants were considered eligible. Studies were selected on the basis of the inclusion criteria and quality assessments. A meta-analysis with subgroup analyses was performed.

Results: Five papers fulfilled the inclusion criteria, and four were eligible for meta-analysis. Significantly less MBL was found in concave/convergent groups, with a mean difference of 0.772 (95% confidence interval [CI]: 0.450 to 1.095; P < .001). In the subgroup analyses for platform-switching and platform-matching connections, a significant effect in favor of concave/convergent was detected, with a standardized difference in means of 1.135 (95% CI: 0.688 to 1.583, P < .001) when platform switching was considered. No significant effects were found for platform-matching connections.

Conclusion: Within the limitations of this review, it is suggested that concave/convergent implant transmucosal profiles result in less MBL. No statistically significant results were obtained for soft tissue-related outcomes or for the platform-matching connection subgroup.
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http://dx.doi.org/10.11607/ijp.6726DOI Listing
September 2020

A perspective on dental activity during COVID-19: The Italian survey.

Oral Dis 2021 Apr 15;27 Suppl 3:694-702. Epub 2020 Sep 15.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: During the months of March and April 2020, Italy saw an exponential outbreak of COVID-19 epidemic. Dental practitioners were particularly limited in their routine activity, and the sole performance of urgent treatments was strongly encouraged during the peak of the epidemic. A survey among dental professionals was performed between 6th and 13th of April, in order to evaluate the status of dental practice during COVID-19 in Italy.

Materials And Methods: An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic.

Results: The survey was completed by 3,254 respondents and, according to the results obtained, dental activity was reduced by the 95% and limited to urgent treatments. The majority of the surveyed dentists employed additional personal protective equipment compared to normal routine, although in a non-negligible number of cases difficulty in retrieving the necessary equipment was reported.

Conclusions: The survey provided a snapshot of dental activity during the SARS-CoV-2 outbreak. Overall, following the peak of the epidemic, it is probable that dental activities will undergo some relevant changes prior to fully restart.
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http://dx.doi.org/10.1111/odi.13606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436518PMC
April 2021

Non-impacted tooth extractions and antibiotic treatment: A RCT study.

Oral Dis 2021 May 4;27(4):1042-1051. Epub 2020 Sep 4.

University of Pisa - Department of Surgical, Medical, Molecular and Critical Area Pathology, University-Hospital of Pisa, Pisa, Italy.

Objectives: A controlled, single-blind, randomized clinical trial was performed to evaluate usefulness of antibiotics in preventing pain and complications after tooth extractions and benefits of probiotics in reducing gastro-intestinal symptoms associated with antibiotic therapy.

Materials And Methods: A total of 159 patients were enrolled in this trial. After tooth extractions, patients were allocated to one of the groups: group 1 received postoperatively amoxicillin + clavulanic acid; group 2 received the same antibiotic therapy with an adjunctive probiotic treatment; and group 3 received neither antibiotics nor probiotics. Follow-up visits were planned at 7, 14, and 21 days after tooth extractions (T1, T2, and T3), and parameters assessed were pain, presence of abscess, edema, fever, alveolitis, trismus, pain, difficulty in daily routine activities, and gastro-intestinal symptoms.

Results: The number of patients reporting pain at T1 was significantly higher in the control group when compared to group 2 (p = .016), while no difference for pain intensity was observed between groups. No surgical site infection was observed in any of the groups. Intestinal symptoms seemed to be tackled by probiotic administration.

Conclusions: Pain was the most important symptom in the control group. Antibiotics were not necessary after non-impacted tooth extractions, and probiotics can reduce gastro-intestinal symptoms associated with antibiotics.
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http://dx.doi.org/10.1111/odi.13607DOI Listing
May 2021

Influence of implant mucosal thickness on early bone loss: a systematic review with meta-analysis.

J Periodontal Implant Sci 2020 Aug 23;50(4):209-225. Epub 2020 Jun 23.

Unit of Oral Surgery, Department of Surgical, Medical, Molecular and Critical Needs Pathologies, University of Pisa, Pisa, Italy.

Purpose: Marginal bone loss (MBL) is an important clinical issue in implant therapy. One feature that has been cited as a contributing factor to this bone loss is peri-implant mucosal thickness. Therefore, in this report, we conducted a systematic review of the literature comparing bone remodeling around implants placed in areas with thick (≥2-mm) vs. thin (<2-mm) mucosa.

Methods: A PICO question was defined. Manual and electronic searches were performed of the MEDLINE/PubMed and Cochrane Oral Health Group databases. The inclusion criteria were prospective studies that documented soft tissue thickness with direct intraoperative measurements and that included at least 1 year of follow-up. When possible, a meta-analysis was performed for both the overall and subgroup analyses.

Results: Thirteen papers fulfilled the inclusion criteria. A meta-analysis of 7 randomized clinical trials was conducted. Significantly less bone loss was found around implants with thick mucosa than around those with thin mucosa (difference, -0.53 mm; <0.0001). Subgroups were analyzed regarding the apico-coronal positioning, the use of platform-matched vs. platform-switched (PS) connections, and the use of cement-retained vs. screw-retained prostheses. In these analyses, thick mucosa was found to be associated with significantly less MBL than thin mucosa (<0.0001). Among non-matching (PS) connections and screw-retained prostheses, bone levels were not affected by mucosal thickness.

Conclusions: Soft tissue thickness was found to be correlated with MBL except in cases of PS connections used on implants with thin tissues and screw-retained prostheses. Mucosal thickness did not affect implant survival or the occurrence of biological or aesthetic complications.

Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084598.
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http://dx.doi.org/10.5051/jpis.1904440222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443387PMC
August 2020

Implant Placement in Patients under Treatment with Rivaroxaban: A Retrospective Clinical Study.

Int J Environ Res Public Health 2020 06 26;17(12). Epub 2020 Jun 26.

Department of Surgical, Medical, Molecular and of Critical Area Pathologies, Complex Operative Unit of Stomatology and Oral Surgery, University-Hospital of Pisa, University of Pisa, 56126 Pisa, Italy.

The management of patients under treatment with Direct Oral Anticoagulants (DOACs) has led clinicians to deal with two clinical issues, such as the hemorrhagic risk in case of non-interruption or the risk of thromboembolism in case of suspension of the treatment. The primary aim of this retrospective study was to evaluate the incidence of perioperative bleeding events and healing complications in patients who were under treatment with Rivaroxaban and who received dental implants and immediate prosthetic restoration. Patients treated with Rivaroxaban (Xarelto 20 mg daily) and who needed implant rehabilitation were selected. Four to six implants were placed in mandibular healed sites or fresh extraction sockets. All patients, in agreement with their physicians, interrupted the medication for 24 h and received implants and immediate restorations. Twelve patients and 57 implants were analyzed in the study. No major postoperative bleeding events were reported. Three patients (25%) presented slight immediate postoperative bleeding controlled with compression only. The implant and prosthetic survival rate were both 100% after 1 year. Within the limitations of this study, multiple implant placement with an immediate loading can be performed without any significant complication with a 24 h discontinuation of Rivaroxaban, in conjunction with the patient's physician.
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http://dx.doi.org/10.3390/ijerph17124607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345116PMC
June 2020

Application of IBM Watson to Support Literature Reviews: A Preliminary Experience in Restorative Dentistry.

Stud Health Technol Inform 2020 Jun;270:1201-1202

Università degli Studi di Trieste, Trieste, Italy.

Literature reviews are crucial in the choice of the best personalized material type and restauration type in restorative dentistry. We developed an IBM-Watson based system to support literature search for restorative dentistry, and compared its results to a literature search performed by a trained professional. We found that our system could assist the researcher in performing a literature review, but the grounding semantic model needs to be refined in order to provide more extensive results.
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http://dx.doi.org/10.3233/SHTI200362DOI Listing
June 2020

Prevalence of multidrug-resistant tuberculosis in Latin America and the Caribbean: a systematic review and meta-analysis.

Trop Med Int Health 2020 09 30;25(9):1065-1078. Epub 2020 Jun 30.

School of Medicine, University of São Paulo, São Paulo, Brazil.

Objectives: To evaluate the prevalence of multidrug-resistant tuberculosis (MDR-TB) in individuals living in Latin America and the Caribbean (LAC).

Methods: We searched the MEDLINE, Embase and Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) databases until 08 August 2019 for all studies on the subject, without time or language restrictions. Original studies reporting the prevalence of infection with Mycobacterium tuberculosis resistant to isoniazid and rifampicin simultaneously (MDR) in LAC, the prevalence of resistance in cases with no previous treatment (new cases) and the prevalence of resistance in previously treated cases were selected. Considering the expected heterogeneity between studies, all analyses were performed using the random effects model, and heterogeneity was assessed using the I statistic.

Results: We included 91 studies from 16 countries. The estimated overall prevalence was 13.0% (95% CI 12.0-14.0%), and the heterogeneity between studies was substantial (I  = 96.1%). In the subgroup analyses, it was observed that the prevalence of MDR-TB among new cases was 7.0% (95% CI 6.0-7.0%) and in previously treated cases was 26.0% (95% CI 24.0-28.0%).

Conclusions: This review highlights multidrug resistance to antituberculosis drugs in LAC, indicating that prevention strategies have not been effective. Government institutions should invest heavily in strategies for early diagnosis and the rapid availability of effective treatments and prioritise adequate protection for health professionals. In addition, screening programmes should be adopted to prevent secondary cases.
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http://dx.doi.org/10.1111/tmi.13453DOI Listing
September 2020

Tissue level implants in healthy versus medically compromised patients: a cohort comparative study.

Minerva Stomatol 2020 Oct 14;69(5):295-301. Epub 2020 May 14.

Unit of Stomatology and Oral Surgery, Department of Surgical, Medical, Molecular and Critical Needs Pathologies, University Hospital of Pisa, University of Pisa, Pisa Italy.

Background: Dental implants placed in medically compromised patients have predictable outcomes and a high rate of survival, compared to those placed in healthy patients. The aims of this study were to observe and compare implant survival/success rates and soft tissue response to tissue-level implants placed in healthy and medically compromised patients with a 1-year follow-up.

Methods: Seventy-two patients, 36 healthy patients (20 females and 16 males) and 36 medically compromised patients (18 females and 18 males) affected by cardiovascular diseases (arrythmia, hypertension, atrial fibrillation, bypass and pacemaker surgery), depression, endocrine metabolic diseases (hypercholesterolemia, type II diabetes, Hashimoto's thyroiditis), gastrointestinal diseases (gastritis, hiatal hernia, gastric ulcers), asthma, osteoporosis or glaucoma received one tissue-level implant. Measurements for primary and secondary outcomes were collected immediately after implant placement and at 1 year from implant insertion.

Results: Three were failed and two were survived out of a total of 72 implants. Among healthy patients, two implants failed while one was classified as survived; among Medically compromised patients one implant failed and another one was classified as survived. No statistically significant difference was found between the two groups in terms of success rate or survival rate. No statistically significant differences between the two groups' marginal bone level was observed. In healthy patients a mean loss of keratinized tissue (-0.1±0.6 mm) was reported, while in medically compromised patients a mean gain was reported (+0.5±0.8 mm).

Conclusions: In terms of success, failure and survival rates, tissue level implants placed in healthy and in medically compromised individuals showed no short-term (1 year) differences.
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http://dx.doi.org/10.23736/S0026-4970.20.04359-9DOI Listing
October 2020

Extension implants in the atrophic posterior maxilla: 1-year results of a retrospective case-series.

J Dent Sci 2020 Mar 6;15(1):9-13. Epub 2020 Jan 6.

Department of Multidisciplinary Regenerative Research, "Guglielmo Marconi University", Rome, Italy.

Background/purpose: Blade implants account for one of the most debated dental implants design in scientific literature. They have been reconsidered by clinicians since their re-classification by Food and Drug Administration in 2014.

Materials And Methods: The present study aimed to evaluate the outcome of newly manufactured extension implants in the treatment of moderate atrophic posterior maxillae. All the patients enrolled in the present retrospective case series study showed a moderate bone atrophy in the posterior maxilla with a maximum residual height ranging between 4 mm and 8 mm. Implants were inserted with the aid of an electro-magnetic device, and then they covered with screws and left healing. Three months after, implants were exposed and loaded.

Results: Difference between the marginal bone level at the 3-month evaluation (5.57 ± 0.67 mm) and that at baseline (5.67 ± 0.55 mm) appeared to be not significant (p-value = 0.63). At the 12-month evaluation, the marginal bone level (4.95 ± 0.45 mm) underwent significant decrease respect to baseline value as proven by significant change at marginal bone level (-0.62 ± 0.51 mm with a p-value = 0.01).

Conclusion: The results of the present study suggested a positive 12-month outcome for extension implants in the rehabilitation of the moderate atrophic maxilla, without the need of extensive reconstructive surgeries and grafting procedures.
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http://dx.doi.org/10.1016/j.jds.2018.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109493PMC
March 2020

Potential short-term outcome of an uncontrolled COVID-19 epidemic in Lombardy, Italy, February to March 2020.

Euro Surveill 2020 03;25(12)

These authors are joint senior authors and contributed equally to this work.

Sustained coronavirus disease (COVID-19) transmission is ongoing in Italy, with 7,375 reported cases and 366 deaths by 8 March 2020. We provide a model-based evaluation of patient records from Lombardy, predicting the impact of an uncontrolled epidemic on the healthcare system. It has the potential to cause more than 250,039 (95% credible interval (CrI): 147,717-459,890) cases within 3 weeks, including 37,194 (95% CrI: 22,250-67,632) patients requiring intensive care. Aggressive containment strategies are required.
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http://dx.doi.org/10.2807/1560-7917.ES.2020.25.12.2000293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118340PMC
March 2020

Jawbone remodeling: a conceptual study based on Synchrotron High-resolution Tomography.

Sci Rep 2020 03 2;10(1):3777. Epub 2020 Mar 2.

Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.

One of the most important aspects of bone remodeling is the constant turnover mainly driven by the mechanical loading stimulus. The remodeling process produces changes not only in the bone microarchitecture but also in the density distribution of the mineralized matrix - i.e. in calcium concentrations- and in the osteocyte lacunar network. Synchrotron radiation-based X-ray microtomography (microCT) has proven to be an efficient technique, capable to achieve the analysis of 3D bone architecture and of local mineralization at different hierarchical length scales, including the imaging of the lacuno-canalicular network. In the present study, we used microCT within a conceptual study of jawbone remodeling, demonstratively focusing the investigation in two critical contexts, namely in the peri-dental and the peri-implant tissues. The microCT analysis showed that a relevant inhomogeneity was clearly present in both peri-dental and peri-implant biopsies, not only in terms of microarchitecture and mineralization degree, but also considering the lacunar network, i.e. size and numerical density of the osteocyte lacunae. The correlated histological results obtained on the same samples confirmed these observations, also adding information related to non-mineralized tissues. Despite its demonstrative nature, it was concluded that the proposed method was powerful in studying jawbone remodeling because it revealed a direct correlation of its rate with the lacunar density, as achieved by the analysis of the osteocyte lacunar network, and an inverse correlation with the local bone mineral density, as revealed with the Roschger approach.
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http://dx.doi.org/10.1038/s41598-020-60718-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052147PMC
March 2020

Antibiotic's effectiveness after erupted tooth extractions: A retrospective study.

Oral Dis 2020 Jul 23;26(5):967-973. Epub 2020 Mar 23.

Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", School of Dentistry, University of Salerno, Salerno, Italy.

Objective: The purpose of this retrospective study was to assess the influence of antibiotics on the development of alveolitis after tooth extractions.

Materials And Methods: The study population consisted of patients who had erupted tooth extractions in 3 centers. The patients' medical records were collected for several parameters. Moreover, use of antibiotics was evaluated. The primary outcome was the development of alveolitis during the postoperative period. The secondary outcome measure was the possible associations between alveolitis and other patients' characteristics.

Results: A total of 1579 patient charts were screened. The patients enrolled in the study were 418 (159 males and 259 females). Alveolitis was reported for 12 extraction sites (2.87%). Six were in the group of patients that received antibiotics (2.14% out of 280 patients treated with antibiotics), and six were in the group of patients that did not receive antibiotics (4.35% out of 138 patients not receiving antibiotics). None of patient-level parameters showed any significant association with the development of alveolitis.

Conclusion: In conclusion, this study showed that the use of antibiotics after erupted tooth extractions is not useful in preventing alveolitis. Larger, prospective, and randomized studies are needed before incorporating these findings into the daily clinical practice.
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http://dx.doi.org/10.1111/odi.13297DOI Listing
July 2020

Standard vs customized healing abutments with simultaneous bone grafting for tissue changes around immediate implants. 1-year outcomes from a randomized clinical trial.

Clin Implant Dent Relat Res 2020 Feb 3;22(1):42-53. Epub 2019 Dec 3.

Unit of Implantology, Department of Surgical, Medical and Molecular Pathology, University of Pisa, University-Hospital of Pisa, Pisa, Italy.

Background: Immediate implants have shown risks of esthetic complications. The hypothesis was that a customized healing abutment could improve the peri-implant tissue healing.

Purpose: To evaluate and compare the soft and hard tissue healing around immediate implants that received bone grafting and a customized vs a standard healing abutment.

Materials And Methods: Patients, who required tooth extraction and who received an immediate implant (with an alloplastic graft material) were randomly assigned to a customized or a standard healing abutment group. Clinical and radiographic examinations were taken at baseline, at 4 and 12 months.

Results: Twenty-five patients out of 61 were excluded from the study because unsuitable for immediate implantation. In total, 36 patients were randomized in the two groups. There were 17 females and 19 males (age range 23-77). No prosthetic or implant failure was registered during the study period. The Papilla Index was significantly higher in the customized than in the standard group at 4 and 12 months (P = .0002). The bone loss at mesial sites was significantly higher in the control than in the test group (P = .0014).

Conclusion: The customized healing abutment group showed the most favorable outcomes (in terms of PI and MBL) in case of immediate implant that received a peri-implant bone grafting procedure.
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http://dx.doi.org/10.1111/cid.12871DOI Listing
February 2020

28th Annual Scientific Meeting of the European Association for Osseointegration, 26-28 September 2019.

Clin Oral Implants Res 2019 09;30 Suppl 19:3-549

Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Medicine, Unit of Oral Surgery and Implantology, University of Geneva, Switzerland.

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http://dx.doi.org/10.1111/clr.2_13508DOI Listing
September 2019

Calvarial Model of Bone Augmentation in Rabbit for Assessment of Bone Growth and Neovascularization in Bone Substitution Materials.

J Vis Exp 2019 08 13(150). Epub 2019 Aug 13.

Division of Fixed Prosthodontics and Biomaterials, Biomaterials Laboratory, University of Geneva, University Clinic of Dental Medicine;

The basic principle of the rabbit calvarial model is to grow new bone tissue vertically on top of the cortical part of the skull. This model allows assessment of bone substitution materials for oral and craniofacial bone regeneration in terms of bone growth and neovascularization support. Once animals are anesthetized and ventilated (endotracheal intubation), four cylinders made of polyether ether ketone (PEEK) are screwed onto the skull, on both sides of the median and coronal sutures. Five intramedullary holes are drilled within the bone area delimited by each cylinder, allowing influx of bone marrow cells. The material samples are placed into the cylinders which are then closed. Finally, the surgical site is sutured, and animals are awaken. Bone growth may be assessed on live animals by using microtomography. Once animals are euthanized, bone growth and neovascularization may be evaluated by using microtomography, immune-histology and immunofluorescence. As the evaluation of a material requires maximum standardization and calibration, the calvarial model appears ideal. Access is very easy, calibration and standardization are facilitated by the use of defined cylinders and four samples may be assessed simultaneously. Furthermore, live tomography may be used and ultimately a large decrease in animals to be euthanized may be anticipated.
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http://dx.doi.org/10.3791/59976DOI Listing
August 2019

Twelve-year longitudinal clinical evaluation of bonded indirect composite resin inlays.

Quintessence Int 2019 ;50(6):448-454

Objective: This prospective clinical study evaluated the clinical performance of one-, two- and multi-surface composite resin inlays over a 12-year period on premolars and molars.

Method And Materials: One clinician placed 113 indirect composite resin inlays (Signum, Heraeus Kulzer) in 30 patients that were bonded using a three-step bonding system and composite resin luting cement. Evaluations were made at 3 and 12 years by another clinician who was not involved in the placement of the restorations, using the modified US Public Health Service (USPHS) criteria. Data were analyzed using a nonparametric statistical test (Mann-Whitney U test) followed by Bonferroni correction (alpha = .05).

Results: Fourteen patients could not be followed, yielding to the follow-up of 99 restorations. After 12 years, compared to the 3-year follow-up, tooth integrity, secondary caries, and sensitivity criteria showed significant change, while other parameters did not show significant difference (P > .05). Parameters such as loss of marginal integrity, loss of restoration integrity, loss of surface polish, and secondary caries received more frequently delta scores. At the 3-year follow-up, the clinical performance of one- or two-surface inlays did not show significant difference from multi-surface ones (P = .6317), but at the 12-year follow-up, the results were more favorable for multi-surface inlays. Overall, the failure rate at 12 years was 12%.

Conclusions: Adhesively bonded indirect composite resin inlays showed acceptable long-term clinical results in terms of function, but surface and margin characteristics changed over time.
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http://dx.doi.org/10.3290/j.qi.a42477DOI Listing
November 2019

Medication-Related Osteonecrosis of the Jaw: The Use of Leukocyte-Platelet-Rich Fibrin as an Adjunct in the Treatment.

J Craniofac Surg 2019 Jun;30(4):1095-1101

Unit of Oral Surgery and Implantology, Service of Maxillofacial and Buccal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Medication-related osteonecrosis of the jaw are bone exposures in the maxillofacial region that does not heal after 8 weeks from the observation of a health care provider in patients with history of the intake of antiresorptive agents and no previous irradiation of the craniofacial region. Initially attributed only to the intake of bisphosphonates they have later been associated also with the intake of other classes of antiresorptive medications.This retrospective study analyzed records from patients with documented medication-related osteonecrosis of the jaws treated in our unit. Clinical data, comorbidities and concurrent medications, treatment outcome information such us number of repeated treatments needed, antibiotic used, type of treatment adopted were recorded. Baseline demographics for the included records of 15 patients (mean age: 64 years) revealed a treatment success rate of 73.3% (mean observation period: 42.2 months), failure rate of 26.6%, dental extraction trigger rate of 33.3%, and a spontaneous trigger rate of 40%.Zolendronate and denosumav were the medications most frequently associated with the upset of medication-related osteonecrosis of the jaw (60% of the sample). In 8 cases out of the 11 that were successful, the surgical treatment had to be repeated more than once. Leukocyte-platelet-rich fibrin led to the resolution of 11 of the 14 cases in which it was used.
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http://dx.doi.org/10.1097/SCS.0000000000005475DOI Listing
June 2019

A methodological approach to standardize and control the quality of the position and alignment of lamina implants on two-dimensional radiographs.

Oral Radiol 2020 07 4;36(3):288-306. Epub 2019 Feb 4.

Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80100, Naples, Italy.

Objectives: We sought to validate a new method to detect the degree of correlation between simulated and real tilted blade implants as they appear on a single two-dimensional radiograph.

Methods: The angular correction factor (CF^) was defined as the coupling of two subsequent angle transformations, a set of five angular values describing the theoretical radiographic appearance of the blade implant: (1) three consecutive rotations about the axes of the blade ([Formula: see text], θ, and ψ, standing for pitch, roll, and yaw, respectively) to represent the polarization directions; (2) a two-dimensional projection defined by two angles (λ and [Formula: see text], respectively, longitude and latitude) to represent the vector of the X-ray beam intersecting the detector plate. Data of patients who received fixed prostheses supported by blade-form implants were employed to calculate a dimensional correction factor (CF°), a specific length through the major axis. The simulation of a distorted radiograph of a blade positioned in space was compared with the real radiograph. Differences in the angular measurements served as an initial test to assess the effectiveness of the method.

Results: In the acquired sets of periapical radiographs, mean misalignments of + 3.58° in longitude and - 0.04° in latitude were registered. The following variations were detected during the accuracy testing: the absolute error was 0.1 ± 7.5° for angle [Formula: see text]; 2.4 ± 6.7° for angle θ; - 1.0 ± 3.7° for angle ψ; 4.5 ± 8.6° for angle λ; and 2.0 ± 9.3° for angle [Formula: see text]. The linear dependence between CF° and CF^ was estimated by a robust linear regression: slope + 0.991, intercept + 0.007, and adjusted R 0.992.

Conclusions: This a posteriori analysis introduces the explicit trigonometric equations of the theoretical standard (CF^) used to describe the blade implant radiographic position and misalignment on two-dimensional radiographs.
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http://dx.doi.org/10.1007/s11282-019-00374-5DOI Listing
July 2020

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study.

J Oral Maxillofac Surg 2019 Feb 4;77(2):289-298. Epub 2018 Oct 4.

Chairman and Professor, Unit of Oral Surgery and Implantology, Department of Oral and Maxillofacial Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland.

Purpose: The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique.

Materials And Methods: Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7 mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4 months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3 years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated.

Results: All patients reported postoperative paresthesia that resolved over a period of 2 months after the augmentation procedure. The mean vertical bone gain was 5.6 mm after 4 months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06 ± 0.37 mm 3 years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39 ± 0.36 mm.

Conclusion: The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.
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http://dx.doi.org/10.1016/j.joms.2018.09.031DOI Listing
February 2019

Seroprevalence of hepatitis E in adults in Brazil: a systematic review and meta-analysis.

Infect Dis Poverty 2019 Jan 16;8(1). Epub 2019 Jan 16.

School of Medicine, USP, São Paulo, SP, Brazil.

Background: Hepatitis E virus (HEV) is a member of the Hepeviridae family; it has four main genotypes and one serotype. While genotypes 1 and 2 cause epidemic hepatitis and are transmitted via water and the fecal-oral route, genotypes 3 and 4 are zoonotic. In the various seroprevalence studies of hepatitis E in Brazil, the numbers reported vary widely and are difficult to interpret. The aim of this study was to analyze existing seroprevalence studies of hepatitis E in adults in Brazil.

Main Text: We searched the PubMed, Latin American and Caribbean Health Sciences and Embase databases for studies published from inception to May 12, 2018 concerning infection by HEV in Brazil without time period or language restrictions. We included studies that presented data concerning hepatitis E seroprevalence in adults in Brazil, had a sample size ≥50 patients and whose method used for the detection of anti-HEV was standardized and commercialized. We also evaluated the quality of the articles using a list of criteria that totalized 9 items. Of the 20 studies ultimately analyzed, 10 (50%) were from the southeast region of Brazil, 3 (15%) were from the central-west region, 3 (15%) were from the northern region, 2 (10%) were from the northeast region and 2 (10%) were from the southern region. Regarding the quality evaluation of the studies, the mean score was 5.6 (range: 4-8). The estimated overall seroprevalence of HEV infection in the adult population was 6.0% (95% CI: 5.0-7.0); in subgroup analyses, we observed that the prevalence of anti-HEV antibodies in blood donors was 7.0% (95% CI: 5.0-8.0), whereas in the general population, it was 3.0% (95% CI: 2.0-4.0).

Conclusions: The results of this systematic review indicate that there should be national investment in the prevention of hepatitis E virus infection in Brazil, including the implementation of improvements in basic sanitation and guidance regarding the appropriate handling of animal waste and the optimal cooking of vegetables, meat and their derivatives.
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http://dx.doi.org/10.1186/s40249-018-0514-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334402PMC
January 2019

Nonsurgical Treatment of Peri-implantitis Without Eliminating Granulation Tissue: A 3-Year Study.

Implant Dent 2019 Feb;28(1):4-10

Full Professor, Department of Surgical, Medical, Molecular and Critical Area Pathology, University-Hospital at Pisa, University of Pisa, Italy.

Objectives: The purpose of this study was to evaluate a nonsurgical approach toward peri-implantitis by means of mechanical debridement and local detoxification leaving granulation tissue into the peri-implant pockets.

Materials And Methods: An analysis was performed on the outcomes of 2 nonsurgical protocols: mechanical debridement plus chemical detoxification with 0.2% chlorhexidine and chlortetracycline hydrochloride (test), and mechanical debridement alone (control). Measures were collected at baseline, 3, 24, and 36 months after treatment.

Results: Seventy-five implants with peri-implantitis were included. At a 36-month evaluation, mean pocket probing depth was 3.15 ± 0.32 mm for the test group and 5.97 ± 0.90 mm for the control group, the difference being significant. An improvement of marginal bone level was recorded for the test group, whether the control group showed a further marginal bone loss. Treatment success was 100% in the test group and 31.4% in the control group.

Conclusion: Nonsurgical implant debridement alone seemed not efficient in the treatment of peri-implantitis. Further longitudinal studies are required to evaluate the efficacy of mechanical debridement with chemical detoxification and removal of granulation tissues against mechanical debridement with chemical detoxification alone.
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http://dx.doi.org/10.1097/ID.0000000000000832DOI Listing
February 2019

Clinical outcomes of implants placed in ridge-preserved versus nonpreserved sites: A 4-year randomized clinical trial.

Clin Implant Dent Relat Res 2018 Dec 11;20(6):906-914. Epub 2018 Oct 11.

Department of Surgery, Unit of Oral Surgery and Implantology, University-Hospital at Geneva, School of Dental Medicine, Geneva, Switzerland.

Background: Consistent bone changes occur after tooth removal, often compromising the success of implants placed within the socket left to natural healing The long-term effect of ridge preservation on implant outcomes is still unclear.

Purpose: The aim of the study was to assess success and survival rates of implants placed in extraction sockets, with spontaneous healing, or grafted with cortical porcine bone, or collagenated corticocancellous porcine bone.

Materials And Methods: Ninety patients in need for a single premolar/molar tooth extraction and an implant treatment were selected for the present study. Patients were randomly distributed among 3 groups: sites that healed naturally (ctrl), or sites that received ridge preservation with either cortical (cort) or collagenated corticocancellous porcine bone (coll). Three months after, all the experimental sites were reentered to insert implants. Marginal bone levels were recorded; soft tissues were analyzed and summarized with the Pink Esthetic Score (PES). Forty-two patients out of 90 (initial cohort study) completed the entire follow-up of 4 years.

Results: Cumulative survival and success rates for all implants were 100% at a 4-year evaluation. Mean marginal bone loss (MBL) was 1.14 ± 0.23 mm in the cort group, 1.13 ± 0.29 mm in the coll group, and 1.92 ± 0.07 mm in the ctrl group. There were no significant differences between the 2 grafting materials but MBL was significantly greater in the nongrafted sites (P value < .001). The PES resulted significantly better (9.42 ± 0.75) for the cort group than for the coll group (8.53 ± 1.18) and ctrl group (6.07 ± 1.89) at 4-year evaluation.

Conclusions: Ridge preservation was more effective than natural healing in preserving marginal bone and in achieving better esthetic outcomes around implants 4 years after placement. The cortical porcine bone showed better clinical outcomes than collagenated corticocancellous porcine bone.
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http://dx.doi.org/10.1111/cid.12682DOI Listing
December 2018

A novel approach to treat gingival recession and non-caries cervical lesion combined defects: Restoration guided creeping attachment (RGCA) technique. A case report.

Quintessence Int 2018 ;49(6):445-450

Gingival recessions have multifactorial etiology and are often associated with non-caries cervical lesions. Different surgical techniques have been proposed over the years for their treatment, according to the severity of the recession. A novel technique, called restoration guided creeping attachment (RGCA), for the treatment of combined gingival recession and non-caries cervical lesion is presented. RGCA aims at treating Miller class I and II recessions using a specifically designed composite restoration and a minimally invasive approach. A clinical case describing the technique and forming the basis for further studies is presented. Although the results obtained are encouraging, a wider number of patients and longer follow-ups are needed to assess the reliability of this technique.
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http://dx.doi.org/10.3290/j.qi.a40254DOI Listing
March 2019

Oral health-related quality of life and clinical outcomes of immediately or delayed loaded implants in the rehabilitation of edentulous jaws: a retrospective comparative study.

Minerva Stomatol 2018 Oct 16;67(5):189-195. Epub 2018 Apr 16.

Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, Versilia General Hospital, Lido di Camaiore, Lucca, Italy.

Background: Patient-centered outcomes are being given great attention by the dental scientific community. The Oral Health Impact Profile -14 questionnaire (OHIP-14) has been introduced to address patients' success criteria when describing the impact of oral rehabilitations on quality of life (OHrQoL).

Methods: Thirty-five patients wearing a full-arch implant-prosthesis being in place between 4 and 6 years before this analysis were considered eligible and then enrolled in the present retrospective study. According to their prosthetic anamnesis, two groups were defined: delayed loading group (IL-group) and immediate loading group (IL-group). At the moment of analysis, clinical and radiographic parameters were collected, and patients were asked to complete the Oral Health Impact Profile -14 questionnaire (OHIP-14) in order to measure their OHrQoL.

Results: Independent t-test showed total OHIP-14 scores to be not significantly different between groups; however, the domains "functional limitation" and "physical disability" resulted significantly higher in patients within the DL-group. On the contrary, social disability was higher in the IL-group. When the comparison was performed taking sex into account, no significant differences between groups were highlighted. Instead, the stratification for years of follow-up led to significant evidences. When the follow-up was shorter (less-than-5 years), the functional limitation reported scores were higher.

Conclusions: Within the limitations of this study, the analysis supports the absence of significant differences between immediate loading and delayed loading full-arch protocol in term of clinical, radiological parameters and OHrQoL.
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http://dx.doi.org/10.23736/S0026-4970.18.04134-1DOI Listing
October 2018

Longitudinal analysis on the effect of insertion torque on delayed single implants: A 3-year randomized clinical study.

Clin Implant Dent Relat Res 2018 Jun 23;20(3):322-332. Epub 2018 Jan 23.

Unit of Oral Surgery and Implantology, University-Hospital at Geneva, Department of Surgery, School of Dental Medicine, Geneva, Switzerland.

Background: Implant stability is commonly related to insertion torque. Recently, it has been suggested that higher insertion torque may lead to greater bone resorption.

Purpose: The aim of the present randomized clinical study was to evaluate the role of different insertion torque values in terms of implant success, marginal bone loss, and facial soft tissues recession.

Materials And Methods: Patients requiring a single dental implant were recruited and randomized to receive one of two implants with the same macro-geometry but different cutting designs. First group consists of a 90 degrees cutting groove know as self-tapping implant, and the second group known as Blossom™ cutting groove. (Intra-Lock, Boca Raton, Florida). The insertion torque (IT) was assessed and two groups followed: high-IT (≥50 Ncm) group and regular-IT (<50 Ncm) group. After 3 months, all the implants were restored. At baseline, buccal bone thickness (BBT) was recorded. During the 3-year survey, the following outcomes had been registered: implant failures and success, radiographic marginal bone level around dental implant (MBL) and facial soft tissue level (FSTL).

Results: A hundred and sixteen implants were placed in healed sites. The overall survival rate after 3 years was 96.5%. The Cumulative Success Rate was 91.3% for the High IT group and 98.2% for the Regular IT group. The mean marginal bone loss and facial soft tissue recession, at a 3-year evaluation, were significantly greater for the High-IT group and in the mandible than that reached in the Regular-IT group and in the maxilla.

Conclusion: Present findings showed that implants placed with higher insertion torque in mandible led to greater bone resorption and mucosal recession than that registered for implants placed with a regular IT. Moreover, sites with a thick buccal bone wall (≥1 mm) showed smaller recession at the facial soft tissue level after 3 years.
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http://dx.doi.org/10.1111/cid.12586DOI Listing
June 2018

The rs738409 polymorphism of the PNPLA3 gene is associated with hepatic steatosis and fibrosis in Brazilian patients with chronic hepatitis C.

BMC Infect Dis 2017 12 19;17(1):780. Epub 2017 Dec 19.

Medical Research Laboratory for Virus (Laboratório de Investigação Médica por Vírus - LIM47) of the Clinics Hospital, School of Medicine, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil.

Background: Prospective studies have shown that 80% of acute hepatitis C virus (HCV) cases progress to chronic infection; approximately 10-20% of patients with these conditions will develop liver cirrhosis within 2 to 3 decades, and 1-5% will develop liver cancer. Some studies have indicated that the rs738409 polymorphism of the PNPLA3 gene is associated with steatosis and the progression of advanced fibrosis. This study assessed the contribution of the PNPLA3 rs738409 polymorphism with regard to the steatosis and degree of liver fibrosis in Brazilian patients diagnosed with chronic hepatitis C.

Methods: A total of 290 patients were evaluated at the Clinics Hospital of the School of Medicine, University of São Paulo, between 2010 and 2015. The inclusion criteria were age ≥ 18 years and positive anti-HCV antibody and HCV RNA tests. The participants were evaluated based on medical consultation, blood tests, and liver biopsies conducted before specific antiviral therapies were applied. The associations between the rs738409 PNPLA3 gene polymorphism and steatosis and advanced fibrosis were tested under a recessive inheritance model using logistic regression analysis, including age, gender, BMI, ethnicity/color, HOMA-IR, alcohol intake, HCV genotype 3, and the rs58542926 TM6SF2 gene polymorphism as covariates.

Results: The mean age of the patients was 54.9 years old (range, 28 to 82 years), and 124 (42.8%) patients were male; 226 (77.9%) were white, 43 (14.8%) were pardo, and 21 (7.2%) were black Brazilians. Of the patients included in this study, 133 (45.9%) presented with the CC genotype, 63 (21.7%) with the CG genotype, and 94 (32.4%) with the GG genotype of the PNPLA3 gene I148M variant. We observed that the associations between PNPLA3 rs738409 GG genotype and steatosis was significant (OR: 2.16; 95% CI 1.26-3.72). The same genotype was associated to advanced fibrosis too (OR:2.64; 95% CI 1.26-5.53).

Conclusions: Associations between the rs738409 polymorphism of the PNPLA3 gene genotype GG and hepatic steatosis and advanced fibrosis were observed. Studies are still needed to clarify the influence of these polymorphisms on hepatic steatosis and degree of fibrosis among individuals diagnosed with chronic hepatitis C.
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http://dx.doi.org/10.1186/s12879-017-2887-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735770PMC
December 2017