This study evaluated 290 tapered, oxidized titanium implants placed in compromised bone in 126 patients over 3 years. The implants had a 99.3% survival rate after 3 years of loading. Marginal bone levels around the implants remained stable over the 3-year period. By using a customized osteotomy technique that minimized bone removal and tapered implants with an oxidized surface, the implants provided reliable support for fixed dental prostheses in grafted and ungrafted compromised bone.
This document describes a study that evaluated marginal periimplant tissue stability after buccal defect regeneration using porous titanium granules. Twenty patients received dental implants where buccal bone defects were present. Porous titanium granules were used to fill the defects. Clinical and radiographic evaluations were performed at 2, 4, and 6 months to assess gingival index, mucosal level, papilla index, probing depth, and bone levels/density. The results found stable clinical measurements except for minor changes in mucosal level and papilla at 4 months. Radiographic parameters showed insignificant bone level changes over time. The conclusion was that porous titanium granules can effectively augment osseous defects for dental implants.
jornal club on Tissue Engineering for Lateral Ridge Augmentation withRecombi...Shilpa Shiv
JC on Tissue Engineering for Lateral Ridge Augmentation withRecombinant Human Bone Morphogenetic Protein 2Combination Therapy: A Case Report. IJPRD 2015.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
JOURNAL CLUB ON THE OUTCOME OF ORAL IMPLANTS PLACED IN BONE WITH LIMITED BU...Shilpa Shiv
This document summarizes a study that evaluated the outcomes of oral implants placed in bone with limited bucco-oral dimensions over a 3-year period. 100 implants were placed in 28 patients. The study found that the implants had a 100% survival rate over 3 years and that the marginal bone levels around the implants remained stable. The results indicate that implants can successfully be placed in sites with up to 4.5mm of bucco-oral bone width without the need for bone grafting, providing patients maintain good oral hygiene.
1) Early crestal bone loss around dental implants is common, with an average of 0.9-1.6mm of bone loss in the first year after loading. Bone loss then slows significantly to around 0.05-0.13mm per year.
2) Factors that can contribute to early crestal bone loss include surgical trauma from heat generation during drilling, excessive pressure during implant placement, periosteal flap elevation, and occlusal overload especially in the first year as the bone adapts to loading.
3) Long-term maintenance of crestal bone is important for implant success and health of the surrounding soft tissues. Peri-implantitis can lead to bone loss but
Immediate implant placement following tooth extraction can help preserve alveolar bone and provide benefits like fewer treatment visits. However, it also carries risks like increased mucosal recession on the facial aspect due to normal bone resorption after extraction. For optimal esthetic outcomes with immediate implants, it is important to have adequate facial bone volume, perform bone grafting if needed, and consider the patient's gingival biotype and bone defect morphology. Careful case selection and experience with the technique are important to minimize esthetic complications.
This presentation has videos and more surgical aspects of recent advances in Implant dentistry.This is different from other presentations in this platform since it is stuffed with most recent articles and informations
Extraction and Immediate Implant Placement, and Provisionalization with two Y...Abu-Hussein Muhamad
Extraction and Immediate Implant Placement, and Provisionalization with two Years Follow-up: A Case Report. PDF
Abu-Hussein Muhamad, Bajali Musa, Abdulgani Azzaldeen
This document describes a study that evaluated marginal periimplant tissue stability after buccal defect regeneration using porous titanium granules. Twenty patients received dental implants where buccal bone defects were present. Porous titanium granules were used to fill the defects. Clinical and radiographic evaluations were performed at 2, 4, and 6 months to assess gingival index, mucosal level, papilla index, probing depth, and bone levels/density. The results found stable clinical measurements except for minor changes in mucosal level and papilla at 4 months. Radiographic parameters showed insignificant bone level changes over time. The conclusion was that porous titanium granules can effectively augment osseous defects for dental implants.
jornal club on Tissue Engineering for Lateral Ridge Augmentation withRecombi...Shilpa Shiv
JC on Tissue Engineering for Lateral Ridge Augmentation withRecombinant Human Bone Morphogenetic Protein 2Combination Therapy: A Case Report. IJPRD 2015.
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) base...Shilpa Shiv
Journal club on Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile, JCP 2015
JOURNAL CLUB ON THE OUTCOME OF ORAL IMPLANTS PLACED IN BONE WITH LIMITED BU...Shilpa Shiv
This document summarizes a study that evaluated the outcomes of oral implants placed in bone with limited bucco-oral dimensions over a 3-year period. 100 implants were placed in 28 patients. The study found that the implants had a 100% survival rate over 3 years and that the marginal bone levels around the implants remained stable. The results indicate that implants can successfully be placed in sites with up to 4.5mm of bucco-oral bone width without the need for bone grafting, providing patients maintain good oral hygiene.
1) Early crestal bone loss around dental implants is common, with an average of 0.9-1.6mm of bone loss in the first year after loading. Bone loss then slows significantly to around 0.05-0.13mm per year.
2) Factors that can contribute to early crestal bone loss include surgical trauma from heat generation during drilling, excessive pressure during implant placement, periosteal flap elevation, and occlusal overload especially in the first year as the bone adapts to loading.
3) Long-term maintenance of crestal bone is important for implant success and health of the surrounding soft tissues. Peri-implantitis can lead to bone loss but
Immediate implant placement following tooth extraction can help preserve alveolar bone and provide benefits like fewer treatment visits. However, it also carries risks like increased mucosal recession on the facial aspect due to normal bone resorption after extraction. For optimal esthetic outcomes with immediate implants, it is important to have adequate facial bone volume, perform bone grafting if needed, and consider the patient's gingival biotype and bone defect morphology. Careful case selection and experience with the technique are important to minimize esthetic complications.
This presentation has videos and more surgical aspects of recent advances in Implant dentistry.This is different from other presentations in this platform since it is stuffed with most recent articles and informations
Extraction and Immediate Implant Placement, and Provisionalization with two Y...Abu-Hussein Muhamad
Extraction and Immediate Implant Placement, and Provisionalization with two Years Follow-up: A Case Report. PDF
Abu-Hussein Muhamad, Bajali Musa, Abdulgani Azzaldeen
This randomized controlled study compared clinical outcomes of flapless implant surgery to traditional flap implant placement. 24 patients received implants in the maxillary anterior or premolar region, with 12 receiving flapless implants and 12 receiving traditional flap implants. Both groups had high success rates of around 92% after 15 months. The flapless group had slightly higher plaque scores initially but scores were similar after 15 months. The flapless group experienced less loss of keratinized gingiva. While both groups reported satisfaction, the flapless approach may provide benefits such as reduced treatment time and discomfort. Larger studies are still needed to confirm these results.
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
This study evaluated the differences in histological findings and stability between platform-switched implants and flat-to-flat interfaces. 26 patients received 43 implants, with some receiving a platform-switched abutment and others a flat-to-flat healing abutment. Biopsies at 3 months found no significant inflammatory cell infiltrate for either group. ISQ measurements also found no significant differences in stability between the groups over 3 months. The study concluded that platform-switching seems reliable for one-stage procedures and maintains stability comparable to flat-to-flat interfaces.
The Christensen prosthesis system is used to treat temporomandibular joint (TMJ) disorders through either hemiarthroplasty or total joint replacement. Studies have found that the Christensen fossa-eminence prosthesis for hemiarthroplasty provides better results than the total joint replacement. Additionally, customized total joint prostheses like the TMJ Concepts system lead to improved outcomes over the off-the-shelf Christensen prosthesis in terms of incisal opening, pain, function, and diet. The Christensen prosthesis can also effectively treat rheumatoid-induced TMJ disorders, improving pain, function, and satisfaction for most patients.
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
immediate vs delayed implant placement in anterior single tooth extraction.rakhi chaudhry
This study compared immediate versus delayed dental implant placement in 124 patients requiring single tooth extractions. Immediate implants placed at the time of extraction required bone augmentation more often than implants placed 12 weeks later (72% vs 43.9%). Delayed implants were less likely to have wound failures and exhibited better soft tissue outcomes. Based on the need for more frequent bone grafting and poorer aesthetic results, the study concludes delayed implant placement may be preferable to immediate placement in the aesthetic zone.
Journal club on Surgical treatment of periiMplantitis using a bone substitute...Shilpa Shiv
This study evaluated the 5-year outcomes of surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane. 38 patients with peri-implantitis were treated with either a bone substitute alone or with a membrane. At 5 years, clinical improvements from treatment were maintained, including reduced bleeding and probing depths. Radiographic bone fill increased by 1.1-1.3 mm with no significant difference between treatment groups. Strict post-surgical plaque control was important for successful treatment outcomes. The membrane did not provide additional benefit to bone fill.
This document summarizes two clinical cases where minimally invasive antral membrane balloon elevation was used to perform sinus lift procedures for single tooth implant placement in the posterior maxilla with reduced bone height. In both cases, the procedure allowed for sufficient bone augmentation to subsequently place dental implants. The procedure was found to be a relatively simple and safe method for rehabilitation of missing teeth in the challenging posterior maxilla, avoiding the need for more invasive sinus lift surgeries.
- Immediate loading of dental implants began in the 1960s and involves placing a provisional or definitive restoration on implants on the same day as surgery or within 2 weeks.
- Studies have shown immediate loading can achieve high success rates in the anterior mandible with 4 or more implants supporting a fixed bridge or 2 or more implants supporting an overdenture.
- Immediate loading may stimulate bone formation and increase bone-implant contact compared to conventional loading after 3-6 months of healing. However, risks are higher with immediate loading and patient factors like bruxism or smoking can affect outcomes.
Osseodensification is a novel bone preservation technique that uses specially designed densifying burs to compress and densify bone at the implant site rather than removing it. This increases primary stability and bone density compared to conventional drilling. The densifying burs cut bone in one direction and densify it in the other, creating an autografted layer along the osteotomy walls. Studies have found osseodensification enhances implant stability, reduces treatment time, and facilitates placement in low-density bone or ridge expansion. However, it is an expensive technique that requires specialized burs and training.
This finite element analysis compared the stress distribution of two implant-supported prosthesis systems - one with implants placed in a straight line (straight system) and one with angled implants creating an offset (angled system). Both systems had three implants supporting a metal-ceramic prosthesis in the posterior mandible. Vertical and horizontal loads were applied. The results found that the peak stresses occurred at the neck of the mesial implant in the straight system and the distal implant in the angled system, but the values were similar between systems. There was no significant difference found in stress concentration between the two systems.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
Immediate Placement and Provisionalization of Maxillary Posterior Single Impl...Abu-Hussein Muhamad
Functional immediate load is the most recent concept. This describes a load, within physiological limits, applied to implants before the osseo-integration process is completed. One of the treatment options offered to patients requiring replacement of one or more teeth is the use of prostheses supported by implants. Patients nowadays demand greater aesthetic and functional restorations; therefore, the clinician tries to reduce implant load time. All this leads to the implementation of several modifications to the conventional surgical and prosthetic protocol leading to a reduction in the load time of the implant. This is a case report of the immediate loading of posterior implant.
This case report describes immediate placement of a dental implant in the socket of an extracted fractured maxillary incisor tooth. The tooth was extracted atraumatically without flap reflection and the implant was immediately placed, achieving primary stability. A provisional restoration was placed for temporization. At the 4 month follow-up, an impression was made and a definitive restoration placed. The patient exhibited no clinical or radiographic complications after 1 year of follow-up, demonstrating that immediate implant placement can preserve hard and soft tissues while providing immediate esthetics, function, and comfort.
This case series evaluated a protocol for selecting the implant diameter during immediate implant placement in fresh extraction sockets. 20 patients received immediate implants in the maxillary anterior region. Implant diameter was selected based on preoperative CBCT measurements to maintain a 3mm gap between the implant and buccal bone wall. Autogenous bone graft was used to fill the gap. Postoperative CBCTs found no significant changes in socket dimensions and minimal buccal bone resorption up to a mean follow up of 35 months, indicating the protocol helped preserve buccal bone stability.
This document proposes a concept called "Build-A-Brain" where parents could customize their newborn's brain by selecting different brain modules or regions to maximize the child's success. The proposal discusses how parents could pay to assemble a brain with modules like the best hippocampus for memory to help their child become a successful doctor. However, there may be ethical concerns about designing children's abilities and widening socioeconomic gaps. The document also suggests the possibility of "customizing" one's brain as an adult through surgery to gain new skills or prevent genetic diseases.
El documento resume el periodo presidencial de Gustavo Díaz Ordaz en México, caracterizado por el uso de la violencia para someter a la disidencia, la represión de opositores políticos y el crecimiento económico. Aunque el país creció un 7% anualmente durante su mandato, su sexenio también estuvo marcado por la sangrienta represión del movimiento estudiantil de 1968. El documento también destaca el auge de la literatura mexicana y la adopción de nuevas tendencias culturales como el movimiento hippie durante esta
This randomized controlled study compared clinical outcomes of flapless implant surgery to traditional flap implant placement. 24 patients received implants in the maxillary anterior or premolar region, with 12 receiving flapless implants and 12 receiving traditional flap implants. Both groups had high success rates of around 92% after 15 months. The flapless group had slightly higher plaque scores initially but scores were similar after 15 months. The flapless group experienced less loss of keratinized gingiva. While both groups reported satisfaction, the flapless approach may provide benefits such as reduced treatment time and discomfort. Larger studies are still needed to confirm these results.
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
This study evaluated the differences in histological findings and stability between platform-switched implants and flat-to-flat interfaces. 26 patients received 43 implants, with some receiving a platform-switched abutment and others a flat-to-flat healing abutment. Biopsies at 3 months found no significant inflammatory cell infiltrate for either group. ISQ measurements also found no significant differences in stability between the groups over 3 months. The study concluded that platform-switching seems reliable for one-stage procedures and maintains stability comparable to flat-to-flat interfaces.
The Christensen prosthesis system is used to treat temporomandibular joint (TMJ) disorders through either hemiarthroplasty or total joint replacement. Studies have found that the Christensen fossa-eminence prosthesis for hemiarthroplasty provides better results than the total joint replacement. Additionally, customized total joint prostheses like the TMJ Concepts system lead to improved outcomes over the off-the-shelf Christensen prosthesis in terms of incisal opening, pain, function, and diet. The Christensen prosthesis can also effectively treat rheumatoid-induced TMJ disorders, improving pain, function, and satisfaction for most patients.
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
immediate vs delayed implant placement in anterior single tooth extraction.rakhi chaudhry
This study compared immediate versus delayed dental implant placement in 124 patients requiring single tooth extractions. Immediate implants placed at the time of extraction required bone augmentation more often than implants placed 12 weeks later (72% vs 43.9%). Delayed implants were less likely to have wound failures and exhibited better soft tissue outcomes. Based on the need for more frequent bone grafting and poorer aesthetic results, the study concludes delayed implant placement may be preferable to immediate placement in the aesthetic zone.
Journal club on Surgical treatment of periiMplantitis using a bone substitute...Shilpa Shiv
This study evaluated the 5-year outcomes of surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane. 38 patients with peri-implantitis were treated with either a bone substitute alone or with a membrane. At 5 years, clinical improvements from treatment were maintained, including reduced bleeding and probing depths. Radiographic bone fill increased by 1.1-1.3 mm with no significant difference between treatment groups. Strict post-surgical plaque control was important for successful treatment outcomes. The membrane did not provide additional benefit to bone fill.
This document summarizes two clinical cases where minimally invasive antral membrane balloon elevation was used to perform sinus lift procedures for single tooth implant placement in the posterior maxilla with reduced bone height. In both cases, the procedure allowed for sufficient bone augmentation to subsequently place dental implants. The procedure was found to be a relatively simple and safe method for rehabilitation of missing teeth in the challenging posterior maxilla, avoiding the need for more invasive sinus lift surgeries.
- Immediate loading of dental implants began in the 1960s and involves placing a provisional or definitive restoration on implants on the same day as surgery or within 2 weeks.
- Studies have shown immediate loading can achieve high success rates in the anterior mandible with 4 or more implants supporting a fixed bridge or 2 or more implants supporting an overdenture.
- Immediate loading may stimulate bone formation and increase bone-implant contact compared to conventional loading after 3-6 months of healing. However, risks are higher with immediate loading and patient factors like bruxism or smoking can affect outcomes.
Osseodensification is a novel bone preservation technique that uses specially designed densifying burs to compress and densify bone at the implant site rather than removing it. This increases primary stability and bone density compared to conventional drilling. The densifying burs cut bone in one direction and densify it in the other, creating an autografted layer along the osteotomy walls. Studies have found osseodensification enhances implant stability, reduces treatment time, and facilitates placement in low-density bone or ridge expansion. However, it is an expensive technique that requires specialized burs and training.
This finite element analysis compared the stress distribution of two implant-supported prosthesis systems - one with implants placed in a straight line (straight system) and one with angled implants creating an offset (angled system). Both systems had three implants supporting a metal-ceramic prosthesis in the posterior mandible. Vertical and horizontal loads were applied. The results found that the peak stresses occurred at the neck of the mesial implant in the straight system and the distal implant in the angled system, but the values were similar between systems. There was no significant difference found in stress concentration between the two systems.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
Immediate Placement and Provisionalization of Maxillary Posterior Single Impl...Abu-Hussein Muhamad
Functional immediate load is the most recent concept. This describes a load, within physiological limits, applied to implants before the osseo-integration process is completed. One of the treatment options offered to patients requiring replacement of one or more teeth is the use of prostheses supported by implants. Patients nowadays demand greater aesthetic and functional restorations; therefore, the clinician tries to reduce implant load time. All this leads to the implementation of several modifications to the conventional surgical and prosthetic protocol leading to a reduction in the load time of the implant. This is a case report of the immediate loading of posterior implant.
This case report describes immediate placement of a dental implant in the socket of an extracted fractured maxillary incisor tooth. The tooth was extracted atraumatically without flap reflection and the implant was immediately placed, achieving primary stability. A provisional restoration was placed for temporization. At the 4 month follow-up, an impression was made and a definitive restoration placed. The patient exhibited no clinical or radiographic complications after 1 year of follow-up, demonstrating that immediate implant placement can preserve hard and soft tissues while providing immediate esthetics, function, and comfort.
This case series evaluated a protocol for selecting the implant diameter during immediate implant placement in fresh extraction sockets. 20 patients received immediate implants in the maxillary anterior region. Implant diameter was selected based on preoperative CBCT measurements to maintain a 3mm gap between the implant and buccal bone wall. Autogenous bone graft was used to fill the gap. Postoperative CBCTs found no significant changes in socket dimensions and minimal buccal bone resorption up to a mean follow up of 35 months, indicating the protocol helped preserve buccal bone stability.
This document proposes a concept called "Build-A-Brain" where parents could customize their newborn's brain by selecting different brain modules or regions to maximize the child's success. The proposal discusses how parents could pay to assemble a brain with modules like the best hippocampus for memory to help their child become a successful doctor. However, there may be ethical concerns about designing children's abilities and widening socioeconomic gaps. The document also suggests the possibility of "customizing" one's brain as an adult through surgery to gain new skills or prevent genetic diseases.
El documento resume el periodo presidencial de Gustavo Díaz Ordaz en México, caracterizado por el uso de la violencia para someter a la disidencia, la represión de opositores políticos y el crecimiento económico. Aunque el país creció un 7% anualmente durante su mandato, su sexenio también estuvo marcado por la sangrienta represión del movimiento estudiantil de 1968. El documento también destaca el auge de la literatura mexicana y la adopción de nuevas tendencias culturales como el movimiento hippie durante esta
El documento describe la transición de México hacia el neoliberalismo en las décadas de 1970 y 1980. La crisis económica llevó a considerar alternativas como el neoliberalismo. Surgen rivalidades entre obreros y empresarios sobre qué opción es mejor. Aunque Javier Paniagua trata de atraer a ambos sectores, Miguel de la Madrid es elegido candidato presidencial del PRI en 1982, indicando que adoptarían el modelo neoliberal. Mientras, la oposición gana terreno electoral. En 1988, Cuauhtémoc Cárdenas se postula
Brasil es oficialmente la República Federativa de Brasil, el quinto país más grande del mundo ubicado en América del Sur. Está compuesto por 26 estados y tiene una gran diversidad de climas, flora, fauna y cultura. Algunos de los principales lugares turísticos de Brasil incluyen el Cristo Redentor, el Pan de Azúcar y las cataratas del Iguazú.
Este documento describe la transición de México hacia el neoliberalismo bajo el gobierno de José López Portillo y Miguel de la Madrid en los años 1970 y 1980. Discute las tensiones entre los sectores obrero y empresarial durante esta transición, y cómo el candidato presidencial Miguel de la Madrid representaba el proyecto neoliberal sobre las preferencias de la CTM. También describe el surgimiento de partidos de oposición como el PRD y su candidato Cuauhtémoc Cárdenas, y las elecciones presidenciales fraudulentas de 1988 que llevaron a Carlos
El documento resume la historia de Lamborghini desde 1965 hasta la actualidad, destacando sus obras maestras como el Gallardo, Veneno, Reventon y Murciélago. También menciona el Museo Lamborghini y los propietarios de la marca a través de la historia, desde su fundador Ferruccio Lamborghini hasta los dueños actuales.
De la arquitectura del computador encontraremos la unidad de control que se divide en unidad de control cableada y la unidad de control microprogramada. y la unidad de almacenamiento externo
El documento describe los avances tecnológicos en la telefonía celular, incluyendo el desarrollo de pantallas táctiles como la del iPhone y su adopción por otras empresas. También describe una nueva tecnología israelí llamada StoreDot que puede cargar un teléfono completamente en menos de un minuto usando nuevos materiales de batería y reacciones moleculares.
A group of former students visited their retired professor and discussed stresses in their lives and careers. The professor served them hot chocolate with cups of varying quality and expense. He noted that the nice cups were taken, leaving the plain ones, and used this as an analogy to explain that they focus too much on external factors like jobs and money rather than enjoying life itself. The professor's message was that our circumstances don't define our quality of life and we should make the most of what we have.
This document outlines initiatives undertaken from 2009-2012 by a cluster of schools to improve indigenous students' math skills. It established an indigenous education officer role and provided cultural training for teachers. Schools held math camps for indigenous students and projects where curriculum leaders mentored teachers. Assessment data showed most students improved their understanding of math concepts after participating in the initiatives.
Este documento presenta una guía de laboratorio sobre el sistema digestivo monogástrico y poligástrico. El objetivo general es identificar las formas y funciones de los órganos digestivos en monogástricos y poligástricos. Los objetivos específicos son localizar y reconocer las estructuras de estos sistemas digestivos, incluyendo la boca, esófago, estómagos, intestinos y ano, así como conocer las funciones de los cuatro tipos de estómagos en los rumiantes. El procedimiento incluye identificar
Dokumen tersebut membahas kriteria-kriteria yang harus dipenuhi oleh waralaba agar berhasil, di antaranya usaha franchisor harus terbukti sukses, memiliki keunikan seperti metode operasi atau resep rahasia, adanya prototype usaha yang sukses, mudah distandarisasi dan diajarkan, serta menguntungkan bagi franchisee. Kriteria-kriteria ini penting untuk memastikan waralaba dapat berjalan dengan baik.
Este documento describe dos actividades de aprendizaje. La Actividad 1 incluye 5 tareas relacionadas con resumir y analizar contenidos de 3 unidades, identificar aspectos positivos y negativos de protagonistas sociales, y analizar el cambio social y su impacto en la educación. La Actividad 2 implica leer un artículo sobre sociología de la educación y participar en un foro de discusión sobre fundamentos de la filosofía y sociología de la educación, considerando criterios y fechas establecidas.
Este documento resume las enseñanzas de Jesús en Mateo 5:17-19 sobre la ley y cómo él vino no para abolirla sino para perfeccionarla. Señala que la ley, Jesús y el Espíritu Santo forman parte del mismo plan de Dios y nos comunican la verdad central de la fe: que Dios está presente entre nosotros a través de la fe en Jesús y su Espíritu. Nos invita a reflexionar sobre cómo vemos y vivimos la ley de Dios y qué podemos aprender de los que la consideran irrelevante.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1) A 10-year prospective study evaluated 121 oxidized titanium implants in 46 patients. 2) After 10 years, the survival rate was 99.2% with only 1 implant failing. 3) Marginal bone loss averaged 0.7 mm over 10 years, with 11.3% of implants showing over 2 mm of bone loss and 4.7% over 3 mm of bone loss. 4) Implants with over 3 mm bone loss showed bleeding and pus on probing, indicating peri-implantitis.
Immediate Implants Placed Into Infected Sockets: Clinical Update with 3-Year ...Abu-Hussein Muhamad
Dental implants can be placed immediately into healthy extraction sites with high success and survival rates. It has been suggested, however, that immediate placement of implants into infected extraction sites is contraindicated due to the pathology interfering with osseointegration resulting in decreased implant survival and success With many potential implant sites presenting with a preexisting periapical or periodontal infection, treatment protocols have been advocated for immediate placement of implants in these infected sites. Advancements in surgical techniques and implant surface technology have made immediate placement of implants a more predictable and accepted treatment option; however, there is still debate about whether infected extraction sites should be used for immediate implant treatment approaches. The purpose of this clinical update is to report on the success and survival of implants placed immediately into infected extraction sites.
Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on Astra Tech Dental Implant System. It was sponsored by Biosys Company.
This document describes a technique for selectively intruding overerupted molars in adult patients using a combination of selective alveolar corticotomies and a modified full-coverage maxillary splint with nickel-titanium springs. Two case reports are presented where this approach successfully intruded overerupted maxillary molars within 2.5-4 months without side effects. The technique aims to take advantage of the regional acceleratory phenomenon caused by corticotomies to increase orthodontic treatment efficiency for adult patients who require molar intrusion.
Short Implants and their role in prosthetic replacement of missing toothSivaRaman Sms
This is an seminar on short implants related to implant dentistry .
This gives the insight on what has happened since the evolution of short implants and its role in implantology .Their role as replacement of missing tooth in the atrophied maxillary and mandibular posterior regions
simplified drilling technique does not decrease dental implant osseointegrationNeppoliyan S
This study evaluated the effects of a simplified drilling technique using fewer drills compared to a conventional technique using multiple increasing diameter drills on dental implant osseointegration. 72 implants were placed in dog tibias using both techniques and evaluated after 1, 3, and 5 weeks. The study found no significant differences in bone-to-implant contact percentage or bone area fraction between the techniques at any time point. Both techniques resulted in direct bone contact and new bone formation around the implants. The simplified technique using fewer drills did not decrease osseointegration compared to the conventional technique.
This document discusses the use of short implants for treating atrophic maxillae. It defines short implants as those less than 7mm in length and notes they offer advantages over traditional longer implants including requiring only a single surgery, shorter recovery time, and lower costs. The document presents two case studies where short implants were successfully used to treat bone resorption in the maxilla, with outcomes comparable to traditional longer implants. It concludes that short implants can yield results similar to conventional implants when the bone bed is properly prepared and splinted implants with canine guidance are used.
This study evaluated the healing of mandibular ramus bone block grafts used for alveolar ridge augmentation before implant placement through clinical, histological, and histomorphometric analysis. Bone blocks were harvested from the mandibular ramus in 15 patients and grafted to maxillary defects. After 3-9 months of healing, implants were placed and bone samples were taken. Histological analysis found signs of active remodeling but also substantial amounts of non-vital bone and generally weak neo-vascularization, suggesting that most osteocytes in the grafted bone do not survive and neo-vascularization of non-vital grafted bone is difficult. The outcomes suggest grafted bone undergoes slow remodeling into new vital bone.
Clinical assessment
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Clinical assessment
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Clinical assessment
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Clinical assessment
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Clinical assessment
Radiographs every 2-3 years
This study placed 2,261 implants in 467 patients using angled abutments ranging from 0 to 45 degrees. Over an average observation period of 28.8 months, the estimated 5-year survival rate was greater than 98.6%. Statistical analysis showed no significant difference in survival rates between implants with abutments angled 0-15 degrees and 20-45 degrees. Good esthetic and functional outcomes were observed.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
Amato2019immediate loading of implant insertred throughMohamed Elsayed
This case series evaluated the survival rate and complications of immediately loading dental implants inserted through impacted teeth in the anterior maxilla or mandible. Seven patients received a total of 11 implants, which were immediately inserted using piezosurgery to drill through the impacted teeth. All implants integrated successfully without complications and were followed for 5-7 years. The results suggest this unconventional approach may be a viable option to avoid invasive procedures for removing impacted teeth. However, more studies are needed to validate this technique.
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This case report describes the immediate placement of a dental implant into a fresh extraction socket. A 53-year-old patient had a fractured maxillary lateral incisor extracted. The socket was prepared and a dental implant was immediately placed. Four months later, an impression was taken and a definitive crown placed. The patient exhibited no clinical or radiographic complications over two years of follow-up. Immediate implant placement and provisionalization preserved the hard and soft tissues and provided the patient with immediate aesthetics, function, and comfort.
Reconstruction of a facial defect is a complex modality either surgically or prosthetically, depending on the site, size, etiology, severity, age, and the patient’s expectation. The loss of an auricle, in the presence of an auditory canal, affects hearing, because the auricle gathers sound and directs it into the canal.
Surgical reconstruction is preferable but prosthetic approach may be necessary in some circumstances such as the presence of complex or large defects, requirement of the recurrence control, local or general contraindications of surgery, damaged neighboring tissues due to the radiotherapy, general poor health, failed reconstructive attempts previously made, refusal of the surgery by the patient, high esthetic demands, the desire for a quick recovery and palliatively operated patients.
Nowadays, craniofacial implants are used to support and retain such prostheses. Studies have shown successful retention and stability of auricular prostheses anchored to the temporal bone with titanium implants.
This case report describes the successful treatment of a 59-year-old edentulous female patient with a two-implant overdenture. Two implants were placed in the mandible using a surgical guide. After osseointegration was confirmed, ball abutments were attached to the implants and connected to an overdenture with O-rings. The patient was able to eat with the new prosthesis. Follow-ups showed good outcomes with minor gingivitis resolved with education. The report concludes two-implant overdentures provide an affordable option for edentulous patients.
This document discusses the rehabilitation of the atrophic posterior maxilla using pterygoid implants. It provides background on the challenges of posterior maxillary rehabilitation and outlines treatment options like sinus lifts, short implants and tilted implants. It then focuses on the anatomy of the pterygoid region and classifications for pterygoid implants. The document details the surgical protocol for placing pterygoid implants using guides, angled abutments, impressions and final prosthesis placement. It concludes that pterygoid implants provide an alternative to maxillary reconstruction and avoid cantilevers while allowing for immediate loading.
Objective: The aims of this study isto evaluate the inter-premolar width changes in the mandible using three different commercial orthodontic arch wires. Subjects and methods: Thirty patients including both males and females have been allocated in this study. Three orthodontic wires including NiTi, copper NiTi, and Beta-Titanium wires had been used. A special observational technique including cbct had been used to make an evaluation for the inter-premolar width before and after the aligning stage. Results: The results showed a highly significant increase in post-treatment inter premolar width in CNA and NITI groups; compared to Cu NITI group; with highly significant statistical difference (p < 0.01 respectively). Conclusion: The present study showed that there is a high significant increase in the inter-premolar width in the mandible, when comparing the wires in the groups (NiTi, CNA, and copper niti). Also, the gender of the patient does not seem to have an impact of the gender on post-treatment efficacy of each wire.
Similar to Technique for Placement of Oxidized Titanium Implants by Oded Bahat (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com