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Mohammed M Mehanna,1,2 Amina Tarek Mneimneh,2 Souraya Domiati,3 Ahmed N Allam4 1Department of Industrial Pharmacy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; 2Department of Pharmaceutical Technology, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon; 3Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon; 4Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, EgyptCorrespondence: Mohammed M MehannaDepartment of Pharmaceutical Technology, Faculty of Pharmacy, Beirut Arab University, Beirut, LebanonTel +961 71708661Email mmhanna@bau.edu.lbBackground: Gastric ulcer is a prevalent disease with various etiologies, including non-steroidal anti-inflammatory drugs and alcohol consumption. This study aimed to explore the dual gastric protection effect of tadalafil and limonene as a self-nanoemulsifying system (SNES)-based orodispersible tablets.Methods: Tadalafil-loaded limonene-based SNES was prepared, and the optimum formula was characterized in terms of particle size (PS), polydispersity index (PDI), and zeta potential (ZP) then loaded on various porous carriers to formulate lyophilized orodispersible tablets (ODTs). The ODTs were evaluated via determining hardness, friability, content uniformity, wetting, and disintegration time. The selected ODT was examined for its gastric ulcer protective effect against alcohol-induced ulcers in rat model. Ulcer score and ulcer index were computed for rats stomachs that were inspected macroscopically and histopathologically.Results: The prepared SNES had droplet size of 104 nm, polydispersity index of 0.2, and zeta potential of − 15.4 mV. From the different ODTs formulated, the formula with superior wetting time: 23.67 s, outstanding disintegration time: 28 s, accepted hardness value: 3.11 kg/cm2 and friability: 0.6% was designated. A significant gastroprotective effect of the unloaded and tadalafil-loaded ODTs was recognized compared to the omeprazole pre-treated group. Moreover, the histopathological analysis displayed very mild inflammation in the limonene-based ODTs group and intact structure in the tadalafil-loaded pre-treated animals.Conclusion: Limonene gastroprotective effect functioned along with tadalafil in the form of SNES-incorporated ODTs could serve as a promising revenue for better efficacy in gastric ulcer prevention.Keywords: gastric ulcer, gastroprotection, limonene, orodispersible tablets, self-nanoemulsifying system, tadalafil

Souraya Domiati,1 Mohammed Mehanna,2,3 Hanan Ragab,4 Hania Nakkash Chmaisse,1 Ahmed El Mallah5 1Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon; 2Department of Pharmaceutical Technology, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon; 3Department of Industrial Pharmacy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; 4Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; 5Department of Pharmacology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt Purpose: Although nonsteroidal anti-inflammatory drugs are widely used to treat a variety of disorders, their administration is associated with gastrointestinal side effects, acute kidney injury and liver enzymes’ elevation. Accordingly, researchers are encouraged to create novel agents with better safety profile. The aim of the current study was to evaluate the chronic efficacy and safety profile of two compounds previously proven to have acceptable acute anti-inflammatory and analgesic activities.Materials and methods: Doses were determined through formalin-induced mice paw edema-based dose–response curves. Granuloma weight was used to assess the chronic effect of the investigated compounds as compared to the vehicle and diclofenac representing the positive and the negative controls, respectively. Mice kidneys, livers and stomachs were histologically examined. Moreover, troponin I, alanine aminotransferase, aspartate aminotransferase, serum creatinine and blood urea nitrogen levels were measured. Results: The results highlight that the granulomas and exudates developed in mice after 7 days of treatment, with compound I and compound II were significantly lower than that of the negative control group. Moreover, compound I showed significantly better anti-inflammatory effect than diclofenac. Troponin level was undetected in all groups. Histopathological examination of the stomach revealed normal mucosa for both tested compounds and controls. Likewise, kidneys showed neither significant histologic alteration nor biomarkers increase as compared to the control over both 7- and 30-day treatment periods. Mice that received the tested compounds or diclofenac exhibited transient liver damage specifically; congestion, vacuolization, necrosis and inflammation after 7 days of treatment which decreased significantly after 30 days of treatment as emphasized by the Suzuki score and biomarker levels. Conclusion: Since the tested compounds, specifically compound I, presented a satisfactory chronic safety profile as well as anti-inflammatory effect, it is worth conducting further molecular pharmacological, toxicological and bioavailability studies to elucidate the efficacy of these potential anti-inflammatory bipyrazole compounds. Keywords: peptic ulcer, hepatic injury, kidney injury, nonsteroidal anti-inflammatory drugs, pyrazole, histology

Background: Medication non-adherence is a significant barrier to optimal treatment goals. The study explores the association between subjective well-being (SWB) and medication adherence among Lebanese individuals with multiple chronic diseases and identifies additional factors that may influence adherence in this population., Methods: An exploratory, cross-sectional study was conducted for three months at six community pharmacies. Adherence was assessed using the Adherence to Refills and Medication Scale Arabic Lebanese Version (ARMS-A). The SWB was measured using the Arabic Scale of Happiness (ASH), Love of Life Scale (LLS), Arab Hope Scale (AHS), and Satisfaction with Life Scale (SWLS). Spearmen's Rho correlation analyzed the association between ARMS-A and SWB constructs. Binary logistic regression identified predictors of adherence among individuals with chronic diseases and on multiple chronic medications., Results: Of 400 participants, 106 (26.5 %) with a 95 % CI, 0.22-0.31, were adherent. Lower medication adherence (reflected in higher ARMS-A scores) was associated with lower SWB ( p  = 0.01). Multivariate analysis showed that lower education (OR = 2.21, 95 % CI, 1.01-4.81), lack of a specific diet (OR = 1.64, 95 % CI, 1.01-2.69), and frequent hospital and/or emergency visits (OR = 3.29, 95 % CI, 1.75-6.17 for 2 visits; OR = 2.71, 95 % CI, 1.43-5.14 for ≥3 visits) significantly increased the odds of non-adherence to chronic treatment. However, higher income (OR = 0.06, 95 % CI, 0.01-0.38), healthcare provider occupation (OR = 0.42, 95 % CI, 0.21-0.48), and having diabetes mellitus (OR = 0.59, 95 % CI, 0.36-0.96) correlated with better adherence., Conclusion: A significant portion of participants failed to adhere to their prescribed chronic medications, influenced by multicomplex socioeconomic, psychological, and health-related factors. These findings demonstrate the need for culturally-tailored, pharmacist-led interventions to improve medication adherence and overall health outcomes., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

Quinone-containing compounds have risen as promising anti-inflammatory targets; however, very little research has been directed to investigate their potentials. Accordingly, the current study aimed to design and synthesize group of quinones bearing different substituents to investigate the effect of these functionalities on the anti-inflammatory activities of this important scaffold. The choice of these substituents was carefully done, varying from a directly attached heterocyclic ring to different aromatic moieties linked through a nitrogen spacer. Both in vitro and in vivo anti-inflammatory activities of the synthesized compounds were assessed relative to the positive standards: celecoxib and indomethacin. The in vitro enzymatic and transcription inhibitory actions of all the synthesized compounds were tested against cyclooxygenase-2 (COX-2), cyclooxygenase-1 (COX-1), and 5-lipoxygenase (LOX) and the in vivo gene expression of Interleukin-1, interleukin 10, and Tumor Necrosis Factor-α (TNF-α) were determined. The IC 50 against COX-1 and COX-2 enzymes obtained by the immunoassay test revealed promising activities of sixteen compounds with selectivity indices higher than 100-fold COX-2 selectivity. Out of those, four compounds revealed selectivity indices comparable to celecoxib as a reference drug. Furthermore, all the tested compounds inhibited LOX with an IC 50 in the range of 1.59-3.11 µM superior to that of the reference drug used; zileuton (IC 50  = 3.50 µM). Consequently, these results highlight the promising LOX inhibitory activity of the tested compounds. The obtained in vivo paw edema results showed high inhibitory percentage for the compounds 9a, 9b, and 11a with the significant lower TNF-α relative mRNA expression for compounds 5a, 5d, 9a, 9b, 12d, and 12e. Finally, in silico docking of the most active compounds (5b, 5d, 9a, 9b) against COX2 enzymes presented an acceptable justification of the obtained in vitro inhibitory activities. As a conclusion, Compounds 5b, 5d, 9a, 9b, and 11b showed promising results and thus deserves further investigation., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: Concerns about the side effects of available coronavirus disease (COVID-19) vaccines have posed a significant barrier to vaccination in several countries. Accordingly, the current study aimed to assess the acceptability of COVID-19 vaccination and its predictors among the Lebanese population., Methods: A cross-sectional study was conducted in February 2021 among Lebanese adults from the 5 main Lebanese districts. The questionnaire included demographic data, questions about COVID-19 experience, COVID-19 anxiety syndrome scale, and attitudes regarding the COVID-19 vaccine. Data were analyzed on SPSS, version 23. Statistical significance was considered at a P value ≤ 0.05 with a 95% CI., Results: Of 811 participants, 45.4% (95% CI: 41.9-48.9) accepted taking the COVID-19 vaccine. Choices were negatively affected by concerns about the side effects of the vaccine and positively affected by anxiety and seeking COVID-19 news very closely. Moreover, if the COVID-19 vaccination was a requirement for traveling, participants would be more willing to get the vaccine., Conclusions: Since 54.7% of the studied Lebanese adults were either unwilling or undecided to get the vaccine and COVID-19 news was retrieved mainly from the Ministry of Public Health online site and the local news, the existing targeted campaign should be enforced toward encouraging vaccination to reach herd immunity against COVID-19 and revealing the safety of the vaccines.

Propranolol is the first-line drug for managing migraine attacks. D-limonene is a citrus oil known for its neuroprotective mechanism. Thus, the current work aims to design a thermo-responsive intranasal limonene-based microemulsion mucoadhesive nanogel to improve propranolol efficacy. Microemulsion was fabricated using limonene and Gelucire ® as the oily phase, Labrasol ® , Labrafil ® , and deionized water as the aqueous phase, and was characterized regarding its physicochemical features. The microemulsion was loaded in thermo-responsive nanogel and evaluated regarding its physical and chemical properties, in vitro release, and ex vivo permeability through sheep nasal tissues. Its safety profile was assessed via histopathological examination, and its capability to deliver propranolol effectively to rats' brains was examined using brain biodistribution analysis. Limonene-based microemulsion was of 133.7 ± 0.513 nm diametric size with unimodal size distribution and spheroidal shape. The nanogel showed ideal characteristics with good mucoadhesive properties and in vitro controlled release with 1.43-fold enhancement in ex vivo nasal permeability compared with the control gel. Furthermore, it displayed a safe profile as elucidated by the nasal histopathological features. The nanogel was able to improve propranolol brain availability with C max 970.3 ± 43.94 ng/g significantly higher than the control group (277.7 ± 29.71 ng/g) and with 382.4 % relative central availability, which confirms its potential for migraine management.

Background: Medication waste is a public health problem affecting developed and developing countries. In Lebanon, a developing country in the Middle East, efforts are being deployed in hospitals but not in the community., Objective: This study aimed to validate a questionnaire to explore the knowledge, attitude, and practice (KAP) towards the disposal of unused and expired medicines among the Lebanese population and then identify the factors associated with these variables comparatively between the general population and healthcare professionals., Methods: A cross-sectional study was conducted among the general Lebanese population in May-June 2022 using a standardized questionnaire. The validity and reliability of the KAP scales were assessed, then a thorough statistical analysis was done to explore the factors associated with these scales., Results: The KAP scales generated by this study were valid and reliable. Using these scales, 24.5%, 22.6%, and 21% of participants demonstrated proper knowledge, attitude, and practice, respectively. Higher knowledge scores were significantly associated with female gender (Beta = 0.97), a high monthly income (Beta = 1.68), a secondary (Beta = 6.11) or university (Beta = 6.80) education level, and postgraduate education (Beta = 7.13). However, older age (Beta = - 0.06) and a low monthly income (Beta = - 3.06) were significantly associated with lower knowledge scores. A higher knowledge score (Beta = 0.06) was significantly associated with a more positive attitude regarding unused or expired medication disposal. Being a healthcare professional (Beta = 0.72) was significantly associated with a higher practice score, while being a female (Beta = - 0.32) and living in a rural area (Beta = - 0.37) were significantly associated with lower practice scores., Conclusion: This study validated KAP scales regarding medication waste in Lebanon and showed low KAP scores in the majority of respondents. Factors associated with higher KAP scores in various aspects of medication disposal, including gender, age, education level, and profession (healthcare professionals), suggest the need to consider those when implementing targeted corrective measures. Although further studies are required to confirm our findings, this study could be the ground for a medication waste management national strategy in Lebanon., (© 2022. The Author(s).)

Purpose: Tadalafil's exact analgesic mechanism is still unclear. The current study aimed to elucidate this mechanism in an inflammatory pain model., Methods: Computer-assisted simulation docking experiments were carried out to assess the binding of tadalafil to different ligands. The anti-inflammatory and analgesic effects of tadalafil were evaluated using formalin-induced paw edema and a von Frey filament test, respectively. The plantar paw of the mice was then dissected to quantify iNOS, nNOS, COX-2, TNFα, IL1, and IL10 gene expression levels using a real-time polymerase chain reaction. iNOS, TNFα, and COX-2 inhibition was reassessed in vitro using the ELISA technique. One-way analysis of variance followed by post hoc Tukey test or t -test was used to compare the means., Results: Docking analysis showed a superior binding score of tadalafil to COX-2, iNOS, IL-1, and TNF-α compared to that of indomethacin and morphine and a similar binding score to nNOS and IL-10 relative to that of indomethacin. In the in vivo study, tadalafil, after an hour of formalin administration, inhibited significantly paw edema, similar to indomethacin. Furthermore, it significantly increased the withdrawal force in the von Frey filament test as compared to the negative control, which was similar to the effect observed with indomethacin and morphine. The RT-PCR revealed that tadalafil reduced significantly the iNOS, COX-2, and TNF-α gene expressions but had no effect on nNOS, IL 1, and IL10. In vitro ELISA tests confirmed the inhibition of iNOS, COX-2, and TNF-α., Conclusion: Tadalafil probably exerts its analgesic effect through the simultaneous inhibition of iNOS, COX-2, and TNF-α, which is not the case with other nonsteroidal anti-inflammatory drugs. Nevertheless, further studies are required to confirm its mechanism., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Background: The rapid global development of the pharmacy profession has led pharmacists to enter the cosmetic industry by administering injectable dermal fillers (DFs) to those in need. However, there is no clear indication that the Lebanese pharmacists are familiar with these procedures or are willing to do so., Objectives: We aimed to investigate the Lebanese community pharmacists' knowledge about DFs and their willingness to administer them., Methods: A self-administered questionnaire was sent to 461 randomly selected pharmacists who agreed to participate in the study after a phone call. A scoring system for the knowledge about DFs was employed., Results: Only 31.4 % of participants reported formal education as the source of knowledge about DFs, and 3.7 % of them reported practicing them on patients. The mean score of knowledge was 5.9 ± 2.5 (out of 14). High level of knowledge was observed in only 25 % of the participants, where females, older and experienced pharmacists, and those working in Beirut region were more significantly knowledgeable. Around 67 % of participants were willing to be trained in this field to expand their field of practice and improve their income., Conclusions: Lebanese community pharmacists are not yet ready for this new dimension in the career. Legislative procedures, training, licensing, and developed pharmacy curriculum must precede the practice of DFs by pharmacists in Lebanon., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Non-steroidal anti-inflammatory drugs (NSAIDs) represent the foundation of pain management caused by inflammatory disorders. Nevertheless, their oral administration induces several side effects exemplified by gastric ulceration, thus, delivering NSAIDs via skin has become an attractive alternative. Herein, microemulsion-based hydrogel (MBH), proliposomal, and cubosomal gels were fabricated, loaded with diclofenac, and physicochemically characterized. The size, charge, surface morphology, and the state of diclofenac within the reconstituted gels were also addressed. The ex-vivo permeation study using Franz cells was performed via the rat abdominal skin. The formulations were assessed in-vivo on mice skin for their irritation effect and their anti-nociceptive efficacy through tail-flick test. Biosafety study of the optimal gel was also pointed out. The gels and their dispersion forms displayed accepted physicochemical properties. Diclofenac was released in a prolonged manner from the prepared gels. MBH revealed a significantly higher skin permeation and the foremost results regarding in-vivo assessment where no skin irritation or altered histopathological features were observed. MBH further induced a significant anti-nociceptive effect during the tail-flick test with a lower tendency to evoke systemic toxicity. Therefore, limonene-containing microemulsion hydrogel is a promising lipid-based vehicle to treat pain with superior safety and therapeutic efficacy., (Copyright © 2022. Published by Elsevier B.V.)

Since both morphine and tadalafil have been proven to exert some of their analgesic activity through modulation of the NO-cGMP pathway, the aim of the current study is to evaluate the pharmacologic interaction between tadalafil and morphine to decrease the dose of morphine and subsequently its side effects. The assessment was carried out through isobolographic analysis relative to ED 50 s of both morphine and tadalafil obtained by tail-flick test on BALB/c mice. Morphine and tadalafil ED 50 s calculated from the dose-response curves were 8303 and 2080 μg/kg, respectively. The experimental ED 50 values of morphine and tadalafil in their mixture were 4800 and 1210 μg/kg, respectively. Those results showed an additive interaction between morphine and tadalafil presented by a total fraction value for the mixture of 1160 μg/kg. This outcome can be interpreted by the fact that both drugs share common pathways, namely, NO-cGMP and opioid receptors. As a conclusion, the morphine and tadalafil combination showed an additive effect against acute pain, which is mediated through the central nervous system, thus providing a rationale for combining them to decrease morphine dose and thus minimizing its side effects.

Objectives: Distinct measures were adopted in Lebanon to prohibit the spreading of SARS-CoV-2. These actions provide positive results only if the population chooses to be compliant. Aim: Accordingly, this study aimed to reflect the Lebanese population adherence by determining their level of knowledge and practice during this pandemic. Method: A cross-sectional online survey was performed in April 2020. It involved 410 volunteers from the main 5 Lebanese districts. The questionnaire was divided into 3 parts; sociodemographic, knowledge, and practice. A score was calculated out of 18 points to evaluate the knowledge of the respondents. The last 8 questions reflected the participants' precautionary methods during the pandemic. Descriptive statistics and one-way analysis of variance tests were conducted using SPSS version 20. Results: The overall correct rate of the knowledge questionnaire was 75%. Survey completers of extreme age groups (under 18 and >44), elementary education level, and medical occupation displayed the least level of knowledge compared to other groups ( p < 0.05). Most of the participants showed proactive practices to protect themselves against COVID-19. They covered their mouths (81.2%), threw the used tissues (93.7%), and washed their hands (66.6%) after sneezing or coughing. Moreover, they wore face masks if they were sick (59%) or in a crowded place (79.3%). Concerning Hydroxychloroquine, 10% claimed that they would take it if they have COVID-19 symptoms. Conclusion: This survey sheds the light on the fact that one mandatory measure does not fit all the population; there must be a specialized method of prevention for each profession, age group, and area of the country to prevent the outbreak of COVID-19., (Copyright © 2020 Domiati, Itani and Itani.)

Background To follow international standards, the Lebanese Order of Pharmacists would like to start to implement the medication therapy management in community pharmacies. Objective The objective of this study is to evaluate community pharmacists' knowledge of and readiness for medication therapy management. Setting Community pharmacists from all Lebanese regions. Method A cross-sectional observational descriptive study was conducted. Pharmacists at their workplace completed self-administered anonymous standardized questionnaires between June and December 2016, with no compensation in return. Statistical analysis was conducted using bi-variate and multi-variable methods. Main outcome measure The major dependent variable of interest was the willingness to engage in medication therapy management activities. Results While only 376 (46%) of the interviewed pharmacists declared to be familiar with this concept, the majority of interviewed pharmacists 646 (78.8%) agreed on the importance of patient-centered care. Although this service will not be remunerated at this stage, 529 (64.5%) were willing to attend advanced training sessions to become actively engaged in medication therapy management, particularly those who had adequate workflow, staff and time at their workplace (aOR = 1.51; p = 0.045) and those agreeing to review a patient's medication profile and provide interventions as part of their role (aOR = 6.10; p < 0.001). Conclusion Lebanese pharmacists have adequate knowledge and a positive attitude towards medication therapy management services implementation; however, barriers could arise such as inadequate time, workflow and physical space. Efforts should be exerted by the Lebanese Order of Pharmacist to extend the role of the pharmacist and its positive effect on patient outcome.

Nitric oxide has been proven to play an important role in nociception, accordingly, its promoters, phosphodiesterase inhibitors have been investigated as pain response modulators. Aiming to evaluate the central antinociceptive effect of tadalafil, a phosphodiesterase 5 inhibitor, and to determine its EC50, tail flick and hot plate tests were employed. On the other hand, tadalafil antinociceptive peripheral effect was assessed through acetic acid-induced writhing model. Formalin test was used to appraise both non-inflammatory and inflammatory pain responses. In order to elaborate the involvement of opioid receptors and nitric oxide/cyclic guanosine monophosphate/potassium-ATP pathway in tadalafil-induced analgesia, mice were pretreated with naloxone, l-nitro-arginine-methyl-ester (l-NAME), methylene blue, and glibenclamide. The results illustrated that tadalafil had a significant antinociceptive effect in the tail flick, hot plate, acetic acid-induced writhing and formalin tests indicating the involvement of peripheral and central analgesic mechanisms. Moreover, tadalafil mechanism of action involved several receptors and mediators, specifically NO/cGMP pathway and opioid receptors. In the formalin test, naloxone significantly blocked the effect of tadalafil in the first phase and partially in the second phase which is an inflammatory pain-dependent aspect. l-NAME, methylene blue and glibenclamide partially blocked the effect of tadalafil in the first phase and enhanced its effect in the second phase which is related to nitric oxide role in the inflammatory process. As a conclusion, tadalafil possesses a potential analgesic effect via the involvement of opioid and nitric oxide pathways., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Purpose: Non-steroidal anti-inflammatory drugs are associated with several side effects, such as gastrointestinal mucosal damage, renal toxicity, and cardiovascular side effects. Aiming to find a novel analgesic/anti-inflammatory drug with minimal side effects, the present study was designed to screen and evaluate some newly synthesized pyrazole derivatives., Method: Anti-inflammatory activity using carrageenan-induced rat paw edema and cotton-pellet-induced granuloma, COX-1/COX-2 selectivity using thin layer chromatography, and analgesic using hot plate and tail flick tests as well as ulcerogenic and renal side effects of the ten compounds were assessed., Results and Discussion: The results of the carrageenan-induced rat paw edema showed that the carboxyphenylhydrazone derivative (N9) was more potent than the chlorophenyl counterpart (N8) with a relative activity compared to celecoxib of 1.08 and -0.13, respectively, after 1 h. Even though this is true, N9 caused significant increase in the ulcer index, creatinine, and Blood Urea Nitrogen levels. The cotton granuloma test showed that the carboxyphenylhydrazone derivative (N7) was also more potent than its chlorophenyl counterpart (N6) with a relative activity compared to celecoxib of 1.13 and 0.86, respectively. Moreover, adding an acetyl not only increased the anti-inflammatory activity from a relative activity compared to celecoxib of 0.57-1.17 for the compounds X4 and N5, respectively, in the granuloma test, but also increased the selectivity toward COX-2 from 0.197 to 47.979., Conclusion: As a conclusion, from the ten compounds analyzed, N5 and N7 showed promising results as anti-inflammatory/analgesic agents with low ulcerogenicity and nephrotoxicity and thus should be further analyzed to determine the ED50 and other side effects.

In an attempt to improve patient satisfaction during the healing period after placement of implants, mini-transitional implants (MTIs) have been advocated to allow immediate use of temporary dentures and to prevent transmucosal loads over the definitive implants. Twelve edentulous patients received two screw implants each in the predetermined mandibular canine region. At the time of surgery, six patients had two MTIs placed medially to the permanent ones. The flap was repositioned allowing transmucosal penetration of MTIs. Patients left the operating room wearing their relined lower dentures. The results indicated that MTIs integrated sufficiently in bone, giving successful immediate support for the transitional prosthesis and allowing proper mucosal healing. Two of these transitional implants showed mobility three months after phase I surgery. After loading the final implants, patients who had MTI-supported dentures showed bone loss that was not significantly different from the control group.