Publications by authors named "Francesca Vailati"

34 Publications

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study.

Int J Prosthodont 2021 Apr 16. Epub 2021 Apr 16.

Purpose: To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique.

Materials And Methods: Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS).

Results: A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2).

Conclusion: Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.
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http://dx.doi.org/10.11607/ijp.7248DOI Listing
April 2021

Blood stream infections during the first wave of COVID-19. A short microbiological retrospective picture at Papa Giovanni XXIII Hospital, Bergamo, Italy.

New Microbiol 2021 Jan;44(1):51-58

Microbiology and Virology Laboratory, Azienda Socio-Sanitaria Territoriale (ASST) "Papa Giovanni XXIII," Bergamo, Italy.

This paper aims to describe the etiology of bloodstream infections in COVID-19, Papa Giovanni XXIII Hospital, Bergamo, Italy. Two periods were evaluated: February 22-May 21, 2019/2020. We considered: the number of patients and blood culture sets, species of isolates (bacteria, specifically those indicated by EARS criteria; CoNS; Candida albicans) and their antibiotic sensitivity. In 2020 Escherichia coli and Carbapenemase-producing Klebsiella pneumoniae disappeared. Candida albicans and MDR Pseudomonas aeruginosa, Enterococcus faecium and Acinetobacter baumannii were largely present. The analysis shows: 1. BSIs number was the same; 2. In the first month of the COVID-19 period, BSIs were uncommon; 3. Microbial etiologies were different; 4. MDR isolates were less common.
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January 2021

Retrospective clinical study of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions following the "3-step technique". Part 1: 6-year survival rates and technical outcomes of the restorations.

Int J Prosthodont 2021 Mar 18. Epub 2021 Mar 18.

Purpose: To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition.

Materials And Methods: For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05.

Results: A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003).

Conclusion: Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.
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http://dx.doi.org/10.11607/ijp.7294DOI Listing
March 2021

Rapid identification of non-tuberculous mycobacteria with MALDI-TOF mass spectrometry.

Infez Med 2021 Mar;29(1):79-84

Microbiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.

Rapid and accurate identification of non-tuberculous mycobacteria (NTM) is important for a prompt start to antibiotic therapy. The aim of this study was to obtain accurate identification of NTM quickly by analyzing the performance of the MALDI-TOF mass spectrometry (MS) system VITEK® MS in identifying various NTM species from solid medium and MGIT 960 liquid medium. The study was performed in two phases: preliminary and perspective. Overall, 41/42 species and 33/34 species were correctly identified from the MGIT medium in the preliminary and perspective phases, respectively. The VITEK® MS system includes in its database part of the mycobacteria from the Mycobacterium fortuitum complex but is unable to discriminate among the various species belonging to the complex. Although the VITEK® MS system does not have the protein spectrum of Mycobacterium chimaera, it is not able to distinguish between Mycobacterium chimaera and Mycobacterium intracellulare. Since the VITEK® MS includes the separate protein spectrum of both M. chelonae and M. abscessus, it can discriminate between the two microorganisms. Thanks to these studies we show that the VITEK® MS system is a reliable method for identification of NTMs directly from MGIT liquid medium, instead of the use of solid media.
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March 2021

EasyPrimer: user-friendly tool for pan-PCR/HRM primers design. Development of an HRM protocol on wzi gene for fast Klebsiella pneumoniae typing.

Sci Rep 2020 Jan 28;10(1):1307. Epub 2020 Jan 28.

Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Milan, 20157, Italy.

In this work we present EasyPrimer, a user-friendly online tool developed to assist pan-PCR and High Resolution Melting (HRM) primer design. The tool finds the most suitable regions for primer design in a gene alignment and returns a clear graphical representation of their positions on the consensus sequence. EasyPrimer is particularly useful in difficult contexts, e.g. on gene alignments of hundreds of sequences and/or on highly variable genes. HRM analysis is an emerging method for fast and cost saving bacterial typing and an HRM scheme of six primer pairs on five Multi-Locus Sequence Type (MLST) genes is already available for Klebsiella pneumoniae. We validated the tool designing a scheme of two HRM primer pairs on the hypervariable gene wzi of Klebsiella pneumoniae and compared the two schemes. The wzi scheme resulted to have a discriminatory power comparable to the HRM MLST scheme, using only one third of primer pairs. Then we successfully used the wzi HRM primer scheme to reconstruct a Klebsiella pneumoniae nosocomial outbreak in few hours. The use of hypervariable genes reduces the number of HRM primer pairs required for bacterial typing allowing to perform cost saving, large-scale surveillance programs.
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http://dx.doi.org/10.1038/s41598-020-57742-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987216PMC
January 2020

Utility of routine evaluation of sterility of cellular therapy products with or without extensive manipulation: Best practices and clinical significance.

Cytotherapy 2018 02 12;20(2):262-270. Epub 2017 Dec 12.

Centre of Cellular Therapy "G. Lanzani", Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.

Background: We analyzed the results of routine sterility testing performed in our center over the last 10 years, in the context both hematopoietic stem cell transplantation (HSCT) and Advanced Therapeutic Medicinal Products (ATMPs).

Methods: For sterility tests 14-day cultures were performed in culture media detecting aerobic and anaerobic microorganisms.

Results: In this study, 22/1643 (1.3%) of apheretic products for autologous or allogeneic HSCT were contaminated, whereas 14/73 bone marrow (BM) harvests (17.8%) were positive. In 22 cases, the contaminated HSCs were infused to patients, but there was no evidence of any adverse impact of contamination on the hematologic engraftment or on infections. Indeed none of the five positive hemocultures detected in patients following infusion could be linked to the contaminated stem cell product. Our Cell Factory also generated 286 ATMPs in good manufacturing practice (GMP) conditions since 2007 and all final products were sterile. In three cases of mesenchymal stromal cell expansions, the starting BM harvests were contaminated, but the cell products at the end of expansion were sterile, presumably thanks to the presence of an antibiotic in the culture medium.

Discussion: The decreased rate of contamination of cell harvests observed with time suggests that routine sterility testing and communication of the results to the collecting centers may improve clinical practices. Furthermore, we recommend the use of antibiotics in the medium for ATMP expansion, to decrease the likelihood of expanding microorganisms within clean rooms. Finally we discuss the costs of sterility testing of ATMPs by GMP-approved external laboratories.
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http://dx.doi.org/10.1016/j.jcyt.2017.11.009DOI Listing
February 2018

Treatment planning of adhesive additive rehabilitations: the progressive wax-up of the three-step technique.

Int J Esthet Dent Autumn 2016;11(3):356-77

A full-mouth rehabilitation should be correctly planned from the start by using a diagnostic wax-up to reduce the potential for remakes, increased chair time, and laboratory costs. However, determining the clinical validity of an extensive wax-up can be complicated for clinicians who lack the experience of full-mouth rehabilitations. The three-step technique is a simplified approach that has been developed to facilitate the clinician's task. By following this technique, the diagnostic wax-up is progressively developed to the final outcome through the interaction between patient, clinician, and laboratory technician. This article provides guidelines aimed at helping clinicians and laboratory technicians to become more proactive in the treatment planning of full-mouth rehabilitations, by starting from the three major parameters of incisal edge position, occlusal plane position, and the vertical dimension of occlusion.
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January 2017

Four-unit fixed dental prostheses replacing the maxillary incisors supported by two narrow-diameter implants - a five-year case series.

Clin Oral Implants Res 2017 Jul 21;28(7):887-892. Epub 2016 Jun 21.

Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.

Objectives: (1) To determine the survival rate of 10 four-unit fixed dental prostheses (FDPs) replacing the four maxillary incisors, supported by 20 narrow-diameter implants (NDIs), (2) to assess the incidence of mechanical and biological complications, and (3) to evaluate bone level changes longitudinally after final FDP insertion.

Materials And Methods: Ten patients (six women, four men), mean age 49.4 ± 12.6 years, were treated with a four-unit anterior maxillary FDP (six screw-retained; four cemented). Biological parameters, eventual technical complications, radiographic measurements, and study casts were assessed at 1 (baseline), 3, and 5 years after implant placement. A multilevel logistic regression test was performed on clinical parameters and bone level changes (significance level P < 0.05).

Results: The 5-year implant and FDP survival rate was 100%. Mean modified plaque index (mPI) values were 0.03 and 0.02 at 3 and 5 years, significantly lower when compared to mPI (0.11 ± 0.31) at 1 year. Mean modified sulcus bleeding index (mSBI) was 0.08, 0.08, and 0.15 over time. Probing depth (PD) values were 1.57, 1.64, and 2.03 mm. Statistically significant differences were found between 1 vs. 5 year (P = 0.0003) and 3 vs. 5 year (P = 0.001). Keratinized mucosa (3.65 mm) remained stable during observation period. DIB mean values were 2.01 ± 0.34, 2.13 ± 0.13, and 2.17 ± 0.38 mm. Patient satisfaction based on visual analog scale revealed favorable fulfillment of overall treatment and esthetic expectations.

Conclusions: Two NDIs supporting a four-unit FDP to replace the four missing maxillary incisors may be considered a predictable treatment modality.
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http://dx.doi.org/10.1111/clr.12895DOI Listing
July 2017

CAD/CAM monolithic restorations and full-mouth adhesive rehabilitation to restore a patient with a past history of bulimia: the modified three-step technique.

Int J Esthet Dent 2016 ;11(1):36-56

Due to an increasing awareness about dental erosion, many clinicians would like to propose treatments even at the initial stages of the disease. However, when the loss of tooth structure is visible only to the professional eye, and it has not affected the esthetics of the smile, affected patients do not usually accept a full-mouth rehabilitation. Reducing the cost of the therapy, simplifying the clinical steps, and proposing noninvasive adhesive techniques may promote patient acceptance. In this article, the treatment of an ex-bulimic patient is illustrated. A modified approach of the three-step technique was followed. The patient completed the therapy in five short visits, including the initial one. No tooth preparation was required, no anesthesia was delivered, and the overall (clinical and laboratory) costs were kept low. At the end of the treatment, the patient was very satisfied from a biologic and functional point of view.
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June 2016

Malpositioned implants in the anterior maxilla: a novel restorative approach to reestablish peri-implant tissue health and acceptable esthetics. Part II: Case report and discussion.

Int J Esthet Dent 2015 ;10(4):522-32

This two-part case presentation describes the prosthetic challenge of managing complications in a 50-year-old female patient after inadequate esthetic risk assessment, treatment planning, and implant placement in the anterior maxilla. In Part I, the clinical situation was described, and different restorative solutions were proposed to correct the extreme facial inclination of the implants, excluding major surgical procedures, namely implant removal. In Part II, different prosthetic options are discussed, and the final treatment is revealed. A noninvasive treatment protocol was applied to transform a severely compromised postsurgical situation into an esthetically acceptable result. An unconventional prosthesis design was implemented, including the use of ceramic veneers bonded to the CAD/CAM-generated screw-retained zirconia- based fixed dental prosthesis (FDP), to correct major axis-related problems and spatial discrepancies.
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February 2016

Asaia lannensis bacteremia in a 'needle freak' patient.

Future Microbiol 2016 17;11(1):23-9. Epub 2015 Dec 17.

Virology & Microbiology Laboratory - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

The genus Asaia has gained much interest lately owing to constant new species discoveries and its role as a potential opportunistic pathogen to humans. Here we describe a transient bacteremia due to Asaia lannensis in a patient with a psychiatric disorder (compulsive self-injection of different substances). Common phenotypic methods of identification failed to identify this organism, and only restriction fragment lenght polymorphism of PCR-amplified 16S rRNA gene allowed for proper identification. The isolate was highly resistant to most antibiotics. The paper also discusses the currently available medical literature, acknowledges the potential problems linked to the isolation of these strains and proposes an approach to species identification that can be applied in a clinical microbiology laboratory.
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http://dx.doi.org/10.2217/fmb.15.126DOI Listing
October 2016

Malpositioned implants in the anterior maxilla: a novel restorative approach to reestablish peri-implant tissue health and acceptable esthetics. Part I. Case presentation and treatment options.

Int J Esthet Dent 2015 ;10(3):368-73

This two-part case presentation describes the prosthetic challenge of managing complications after inadequate esthetic risk assessment, treatment planning, and implant positioning in the anterior maxilla. Here, the case report of a 50-year-old woman, referred after inappropriate execution of immediate implant placement, is presented. Different restorative treatment alternatives are proposed, excluding major surgical procedures. In the next part of the article, the advantages and shortcomings of the various prosthetic options will be discussed and the selected treatment revealed. The aim of this part of the article is to illustrate the importance of treatment planning, emphasizing that the correction of esthetic implant failures consistently leads to compromised results when compared to what could have been achieved first time round.
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December 2015

Direct identification of microorganisms from positive blood cultures using the lysis-filtration technique and matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS): a multicentre study.

New Microbiol 2015 Apr 29;38(2):245-50. Epub 2015 Apr 29.

Microbiology Laboratories of AO "Papa Giovanni XXIII" (formerly "Ospedali Riuniti di Bergamo"), Bergamo.

Microbial identification from blood cultures is essential to institute optimal antibiotic therapy and improve survival possibilities. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been successfully applied to identify bacteria and yeasts from positive blood cultures broths. The aim of this multicentre study was to evaluate the reliability of the lysis-filtration technique associated with MALDI-TOF MS to directly identify microorganisms from 765 positive blood cultures collected in six Italian hospitals. Overall, 675/765 (78.1%) blood isolates were correctly identified at the species level, with significant differences between Gram-negative and Gram-positive bacteria (92.6%, and 69.8%, respectively). Some difficulties arise in identifying Streptococcus pneumoniae, Staphylococcus aureus, yeasts and anaerobes. The lysis-filtration protocol is a suitable procedure in terms of performance in identifying microorganisms, but it is quite expensive and technically time-consuming since the time of filtration is not regular for all the samples. The application of the MALDI-TOF MS technique to the direct microbial identification from positive blood cultures is a very promising approach, even if more experience must be gained to minimize errors and costs.
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April 2015

Viridans Group Streptococci clinical isolates: MALDI-TOF mass spectrometry versus gene sequence-based identification.

PLoS One 2015 17;10(3):e0120502. Epub 2015 Mar 17.

Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Rome, Italy.

Viridans Group Streptococci (VGS) species-level identification is fundamental for patients management. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been used for VGS identification but discrimination within the Mitis group resulted difficult. In this study, VGS identifications with two MALDI-TOF instruments, the Biotyper (Bruker) and the VITEK MS (bioMérieux) have been compared to those derived from tuf, soda and rpoB genes sequencing. VGS isolates were clustered and a dendrogram constructed using the Biotyper 3.0 software (Bruker). RpoB gene sequencing resulted the most sensitive and specific molecular method for S. pneumonia identification and was used as reference method. The sensitivity and the specificity of the VITEK MS in S. pneumonia identification were 100%, while the Biotyper resulted less specific (92.4%). In non pneumococcal VGS strains, the group-level correlation between rpoB and the Biotyper was 100%, while the species-level correlation was 61% after database upgrading (than 37% before upgrading). The group-level correlation between rpoB and the VITEK MS was 100%, while the species-level correlation was 36% and increases at 69% if isolates identified as S. mitis/S. oralis are included. The less accurate performance of the VITEK MS in VGS identification within the Mitis group was due to the inability to discriminate between S. mitis and S. oralis. Conversely, the Biotyper, after the release of the upgraded database, was able to discriminate between the two species. In the dendrogram, VGS strains from the same group were grouped into the same cluster and had a good correspondence with the gene-based clustering reported by other authors, thus confirming the validity of the upgraded version of the database. Data from this study demonstrated that MALDI-TOF technique can represent a rapid and cost saving method for VGS identification even within the Mitis group but improvements of spectra database are still recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120502PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362942PMC
December 2015

Full-mouth adhesive rehabilitation in a case of amelogenesis imperfecta: a 5-year follow-up case report.

Int J Esthet Dent 2015 ;10(1):12-31

Amelogenesis imperfecta (AI) is a hereditary disorder caused by mutations of genes primarily involved in the enamel formation. Several different types of AI have been identified, based on the phenotype and on the mode of inheritance. Regardless of the type, the dental treatment tends to be the same, favoring the complete removal of the compromised enamel late in the patient's life. With the new dentistry guidelines that orient clinicians towards minimal invasiveness, it should be mandatory to intercept patients affected by AI earlier, not only to protect the dentition from further degradation but also to help patients improve their self-esteem. This article examines the restorative dentistry performed on a 24-year-old Caucasian female suffering from the hypoplastic type of AI, using only adhesive procedures. Due to the complex needs of the patient, an interdisciplinary approach was followed, involving orthodontics, periodontics, and restorative dentistry. A full-mouth adhesive rehabilitation was achieved by means of direct composite restorations, veneer/onlays and facial/palatal veneers. No elective endodontic therapy was necessary for restorative purposes. The esthetics, mechanics, and biological success were achieved and maintained. The bond to the enamel did not show signs of degradation (eg, discoloration or infiltration) even after 5 years of function. This is encouraging as it shows that adhesive techniques may be a reliable approach even in the presence of a compromised enamel layer.
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December 2015

Full-mouth adhesive rehabilitation in case of severe dental erosion, a minimally invasive approach following the 3-step technique.

Eur J Esthet Dent 2013 ;8(3):358-75

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Geneva, Switzerland.

A full-mouth adhesive rehabilitation in case of severe dental erosion may present a challenge for both the clinician and the laboratory technician, not only for the multiple teeth to be restored, but also for their time schedule, difficult to be included in a busy agenda of a private practice. Thanks to the simplicity of the 3-step technique, full-mouth rehabilitations become easier to handle. In this article the treatment of a very compromised case of dental erosion (ACE class V) is illustrated, implementing only adhesive techniques. The very pleasing clinical outcome was the result of the esthetic, mechanic and most of all biological success achieved, confirming that minimally invasive dentistry should always be the driving motor of any rehabilitation, especially in patients who have already suffered from conspicuous tooth destruction.
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September 2013

Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.

BMC Infect Dis 2013 Mar 6;13:124. Epub 2013 Mar 6.

Department of Medical and Biological Sciences, University of Udine, Udine, Italy.

Background: Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections.

Methods: A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay.

Results: 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms.

Conclusions: These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance.
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http://dx.doi.org/10.1186/1471-2334-13-124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602654PMC
March 2013

Adhesively restored anterior maxillary dentitions affected by severe erosion: up to 6-year results of a prospective clinical study.

Eur J Esthet Dent 2013 ;8(4):506-30

Unlabelled: In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach.

Objectives: The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach.

Materials And Methods: Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed.

Results: After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%.

Conclusions: Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.
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April 2014

Palatal and facial veneers to treat severe dental erosion: a case report following the three-step technique and the sandwich approach.

Eur J Esthet Dent 2011 ;6(3):268-78

Department of Fixed Prosthodontics and Occlusion, University of Geneva, Geneva, Switzerland.

Minimally invasive principles should be the driving force behind rehabilitating young individuals affected by severe dental erosion. The maxillary anterior teeth of a patient, class ACE IV, has been treated following the most conservatory approach, the Sandwich Approach. These teeth, if restored by conventional dentistry (eg, crowns) would have required elective endodontic therapy and crown lengthening. To preserve the pulp vitality, six palatal resin composite veneers and four facial ceramic veneers were delivered instead with minimal, if any, removal of tooth structure. In this article, the details about the treatment are described.
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October 2011

Full-mouth minimally invasive adhesive rehabilitation to treat severe dental erosion: a case report.

J Adhes Dent 2012 Feb;14(1):83-92

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Switzerland.

Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success).
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http://dx.doi.org/10.3290/j.jad.a21852DOI Listing
February 2012

Bactericidal activity of oxacillin and glycopeptides against Staphylococcus aureus in patients with endocarditis: looking for a relationship between tolerance and outcome.

Ann Clin Microbiol Antimicrob 2011 Jun 9;10:26. Epub 2011 Jun 9.

Section of Infectious Diseases, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.

Background: There is no clear relationship between in vitro bactericidal activity tests and clinical outcome. We studied bactericidal activity of oxacillin, vancomycin and teicoplanin against Staphylococcus aureus isolates in patients with endocarditis and then we sought to determine if there was a relationship between in vitro bactericidal activity and clinical outcome.

Methods: Minimal bacteriostatic and minimal bactericidal concentrations were determined for Staphylococcus aureus strains isolated from patients with endocarditis following standardized methods. Medical records were reviewed retrospectively to collect data on antimicrobial susceptibility at admission, antimicrobial therapy, need for surgery, embolic events and outcome.

Results And Discussion: Sixty-two Staphylococcus aureus strains were studied in 62 patients with endocarditis. Overall, 91.9% definite, 21% methicillin resistant and 72.6% cured. Surgery was performed in 32.3% and embolic events were documented in 64.5%. Tolerance to oxacillin and teicoplanin was more common than vancomycin tolerance among methicillin susceptible Staphylococcus aureus. Among methicillin resistant Staphylococcus aureus teicoplanin was shown to have a higher rate of tolerance than vancomycin. No statistically significant differences on clinical outcome between oxacillin tolerant and oxacillin non tolerant Staphylococcus aureus infections were observed. Tolerance to oxacillin did not adversely affect clinical outcomes of patients with methicillin susceptible Staphylococcus aureus endocarditis treated with a combination of antimicrobials including oxacillin. The cure rate was significantly lower among patients with methicillin resistant Staphylococcus aureus endocarditis.

Conclusions: In vitro bactericidal test results were not valid predictors of clinical outcome. Physicians need to use additional parameters when treating patients with staphylococcal endocarditis.
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http://dx.doi.org/10.1186/1476-0711-10-26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126696PMC
June 2011

Classification and treatment of the anterior maxillary dentition affected by dental erosion: the ACE classification.

Int J Periodontics Restorative Dent 2010 Dec;30(6):559-71

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Geneva, Switzerland.

Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality.
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December 2010

Development of a clinically validated bulk failure test for ceramic crowns.

J Prosthet Dent 2010 Oct;104(4):228-38

Department of Reconstructive Dentistry and Center for Biomaterials, University of Connecticut Health Center, Farmington, CT 06030-1615, USA.

Statement Of Problem: Traditional testing of ceramic crowns creates a stress state and damage modes that differ greatly from those seen clinically. There is a need to develop and communicate an in vitro testing protocol that is clinically valid.

Purpose: The purpose of this study was to develop an in vitro failure test for ceramic single-unit prostheses that duplicates the failure mechanism and stress state observed in clinically failed prostheses. This article first compares characteristics of traditional load-to-failure tests of ceramic crowns with the growing body of evidence regarding failure origins and stress states at failure from the examination of clinically failed crowns, finite element analysis (FEA), and data from clinical studies. Based on this analysis, an experimental technique was systematically developed and test materials were identified to recreate key aspects of clinical failure in vitro.

Material And Methods: One potential dentin analog material (an epoxy filled with woven glass fibers; NEMA grade G10) was evaluated for elastic modulus in blunt contact and for bond strength to resin cement as compared to hydrated dentin. Two bases with different elastic moduli (nickel chrome and resin-based composite) were tested for influence on failure loads. The influence of water during storage and loading (both monotonic and cyclic) was examined. Loading piston materials (G10, aluminum, stainless steel) and piston designs were varied to eliminate Hertzian cracking and to improve performance. Testing was extended from a monolayer ceramic (leucite-filled glass) to a bilayer ceramic system (glass-infiltrated alumina). The influence of cyclic rate on mean failure loads was examined (2 Hz, 10 Hz, 20 Hz) with the extremes compared statistically (t test; α=.05).

Results: Failure loads were highly influenced by base elastic modulus (t test; P<.001). Cyclic loading while in water significantly decreased mean failure loads (1-way ANOVA; P=.003) versus wet storage/dry cycling (350 N vs. 1270 N). G10 was not significantly different from hydrated dentin in terms of blunt contact elastic behavior or resin cement bond strength. Testing was successful with the bilayered ceramic, and the cycling rate altered mean failure loads only slightly (approximately 5%).

Conclusions: Test methods and materials were developed to validly simulate many aspects of clinical failure.
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http://dx.doi.org/10.1016/S0022-3913(10)60129-1DOI Listing
October 2010

Full-mouth adhesive rehabilitation of a severely eroded dentition: the three-step technique. Part 3.

Eur J Esthet Dent 2008 ;3(3):236-57

Dept of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Switzerland.

Dental erosion is a frequently underestimated pathology that nowadays affects an increasing number of younger individuals. Often the advanced tooth destruction is the result of not only a difficult initial diagnosis (e.g. multifactorial etiology of tooth wear), but also a lack of timely intervention. A clinical trial testing a fully adhesive approach for patients affected by severe dental erosion is underway at the School of Dental Medicine of the University of Geneva. All the patients are systematically and exclusively treated with adhesive techniques, using onlays in the posterior region and a combination of facially bonded porcelain restorations and indirect palatal resin composite restorations in the anterior maxillary region. To achieve maximum preservation of tooth structure and predict the most esthetic and functional outcome, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the dental technician to constantly interact during the planning and execution of a full-mouth adhesive rehabilitation. In this article, the third and last step of the three-step technique has been described in detail.
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August 2009

Full-mouth adhesive rehabilitation of a severely eroded dentition: the three-step technique. Part 2.

Eur J Esthet Dent 2008 ;3(2):128-46

Dept of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Switzerland.

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. The present article focuses on the second step, explaining all the laboratory and clinical steps necessary to restore the posterior quadrants with a defined occlusal scheme at an increased vertical dimension. A brief summary of the first step is also included.
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August 2009

Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores.

J Periodontol 2009 Jan;80(1):140-51

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Geneva, Switzerland.

Background: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters.

Methods: In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants.

Results: All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES.

Conclusions: This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.
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http://dx.doi.org/10.1902/jop.2009.080435DOI Listing
January 2009

Full-mouth adhesive rehabilitation of a severely eroded dentition: the three-step technique. Part 1.

Eur J Esthet Dent 2008 ;3(1):30-44

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Switzerland.

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been the recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. This article illustrates only the first step in detail, explaining all the clinical parameters that should be analyzed before initiating treatment.
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August 2009

Replacing four missing maxillary incisors with regular- or narrow-neck implants: analysis of treatment options.

Eur J Esthet Dent 2007 ;2(1):42-57

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Switzerland.

The restoration of the missing maxillary incisors is a complex and delicate treatment challenge. When implant therapy is used, proper treatment planning is critical, as selecting the proper number, location, and dimension of the implants is a difficult task. Thus, this article discusses the issues that must be addressed during diagnosis and treatment planning to achieve a predictable esthetic outcome when using implants to replace the maxillary incisors. The advantages and disadvantages of several implant-supported treatment options-using a combination of regular- and narrow-neck implants-are presented. Ultimately, the use of narrow-neck implants at the lateral incisor sites is presented as the best option for ensuring excellent esthetic outcomes, and the corresponding indications and contraindications are discussed. Further, all treatment options are ranked based on the predictability of their esthetic outcomes.
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September 2009

Severe attachment loss at the maxillary incisors: part 2.

Eur J Esthet Dent 2006 ;1(3):248-55

Department of Fixed Prosthodontics, School of Dental Medicine, University of Geneva, Geneva, Switzerland.

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of six treatment options using both conventional and implant therapy were presented. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.
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September 2009

Severe attachment loss at the maxillary incisors: part 1.

Eur J Esthet Dent 2006 Aug;1(2):166-76

Department of Fixed Prosthodontics, School of Dental Medicine, University of Geneva, Geneva, Switzerland.

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of six treatment options using both conventional and implant therapy are presented. In part 2, the treatment selected will be revealed and the rationale governing the decision will be discussed.
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August 2006