Initial U.S. pilot study: palatal implants for the treatment of snoring.

OBJECTIVE: To assess efficacy of polyethylene terephthalate (PET) implants in the soft palate for the treatment of socially significant snoring. DESIGN: A prospective, interventional case series. SETTING: Hospital-based multi-specialty clinic. PATIENTS: Twenty-five consecutive patients with socially significant snoring without history of obstructive sleep apnea. INTERVENTION: Three PET implants were inserted into the soft palate of each patient (Pillar procedure, Restore Medical, Inc., St. Paul, Minnesota). MAIN OUTCOME MEASURE: Change in snoring severity measured by the bed partner using a 10-centimeter visual analog scale (VAS) where 0 = "no snoring noise" and 10 = "extreme snoring noise causing (the bed partner) to leave the bedroom." RESULTS: Ninety-day follow-up data was collected for 21 patients. Four patients had incomplete follow-up. Snoring VAS rated by the bed partner had a baseline mean value of 8.5 +/- 1.4, which decreased to 5.0 +/- 2.1 at 30 days and to 4.4 +/- 2.5 at 90 days (P < 0.001). All patients tolerated the procedure well and no procedure-related complications were observed. Two implants partially extruded in 1 patient within the 90-day follow-up period, for an implant partial extrusion rate of 2.7% (2/75 implants) and patient partial extrusion rate of 4% (1/25 patients). At 90 days, 75% of patients and 90% of their bed partners recommended the procedure. CONCLUSIONS: In this case series, PET implants into the soft palate significantly reduced snoring with few extrusions and no complications. Controlled studies are needed to confirm effectiveness and to refine patient selection criteria. EBM rating: C-4.     

Ten-year follow-up of critically ill patients undergoing heart transplantation.

BACKGROUND: The long-term result following heart transplantation appears very good despite complications of coronary atherosclerosis and cancer. Critically ill patients supported with mechanical devices remain a growing and difficult group in which long-term results need to be defined. The objective of this study was to review the 10-year follow-up of critically ill patients who underwent heart transplantation after support with mechanical devices. METHODS: We retrospectively analyzed all patients who underwent heart transplantation from 1986 to 1999 at the Montreal Heart Institute. RESULTS: Twenty-two patients (22/199, 11%) underwent heart transplantation after support with intra-aortic balloon pumps (n = 17) and total artificial hearts (n = 5). One hundred seventy-seven patients (177/199, 89%) underwent heart transplantation without pre-operative mechanical assistance. Patients with pre-operative mechanical assistance were younger (41 +/- 12 vs 48 +/- 10 years old, p = 0. 002), underwent a shorter waiting time to transplantation (2 +/- 2 vs 19 +/- 27 weeks, p = 0.004), and donor hearts had longer ischemic time (166 +/- 63 vs 137 +/- 49 minutes, p = 0.002) compared with patients without pre-operative mechanical assistance. One-month, 1-, 5-, and 10-year survival averaged 86% +/- 7%, 67% +/- 10%, 67% +/- 10%, and 59% +/- 12%, respectively, in patients with pre-operative mechanical assistance compared with 95% +/- 2%, 88% +/- 2%, 81% +/- 3%, and 74% +/- 4%, respectively, in patients without assistance, a significant difference (p = 0.04) that is mainly related to higher operative mortality in the former group. Although, we found no difference between the 2 groups in the 10-year freedom rate from acute rejection, infection, cancer, and coronary atherosclerosis, sepsis was the cause of 4 early deaths among patients with pre-operative mechanical assistance. CONCLUSION: Early and long-term survival was significantly decreased in critically ill patients with pre-operative mechanical assistance compared with other patients without pre-operative assistance. Sepsis is a dominant threat among patients who underwent heart transplantation with pre-operative mechanical assistance, and the lower survival is due mainly to the increased early mortality.     

Additional palatal implants for refractory snoring.

OBJECTIVE: To evaluate safety and efficacy of additional palatal implants for snoring treatment. STUDY DESIGN AND SETTING: A prospective case series at two clinical sites in an office setting. Patients who did not have an acceptable reduction in snoring intensity after an initial 3 implant procedure received additional implants. Bed partners rated snoring intensity on a 10 cm visual analog scale (VAS) at baseline and 90 days postprocedure. RESULTS: Snoring intensity VAS decreased significantly from 6.4 +/- 2.3 to 4.6 +/- 2.9 (P < 0.01) for patients who received an additional fourth implant, and to 4.1 +/- 2.8 after the 5th implant (P<0.01). Epworth sleepiness scale scores also decreased significantly for patients who received additional fourth or fifth implants. There were no adverse events. CONCLUSIONS: Additional palatal implants for snoring treatment were safe and effective in this case series. SIGNIFICANCE: Additional implants may offer relief for snorers not responding to the initial 3 implant procedure.     

The effect of skin surface warming on pre-operative anxiety in neurosurgery patients

Skin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery. We randomly allocated 80 patients to four groups in the pre-operative holding area. Treatment was applied for 30-45 min with (1) passive insulation and placebo; (2) passive insulation and intravenous midazolam (30 microg.kg-1); (3) warming with forced-air and placebo; and (4) warming with forced-air and intravenous midazolam (30 microg.kg-1). Thermal comfort levels (VAS 0-100 mm) and anxiety levels (VAS 0-100 mm, Spielberger State-Trait Anxiety Inventory) were assessed twice: before the designated treatment was started and before induction of anaesthesia. In the midazolam and the midazolam/warming groups, anxiety VAS and Spielberger state anxiety scores decreased by -19 (95% CI: -29 to -9, p<0.01) and -10 (95% CI: -14 to -6, p<0.01), respectively. In the warming and the combined groups, thermal VAS increased by +26 (95% CI: 17-34, p<0.01). Pre-operative warming did not reduce anxiety VAS (p=0.11) or Spielberger state anxiety (p=0.19). The results of our study indicate that pre-operative warming can be recommended solely to improve thermal comfort, not to replace anxiolytic premedication regimens.     

口腔种植修复治疗牙列缺损的效果

目的 探究口腔种植修复在牙列缺损治疗中的应用效果。方法 选取2020年1月-2021年9月于 我院进行牙列缺损治疗的50例患者作为研究对象，采用随机数字表法分为对比组及试验组，各25例。对 比组实施常规修复术治疗，试验组实施口腔种植修复术治疗。比较两组修复效果、修复后语言能力、咀 嚼功能、稳定性、牙齿舒适度以及不良反应发生率。结果 试验组治疗总有效率高于对比组，差异有统计 学意义（P＜0.05）；试验组语言能力、咀嚼功能、稳定性以及牙齿舒适度评分均高于对比组，差异有统 计学意义（P＜0.05）；试验组不良反应发生率低于对比组，差异有统计学意义（P＜0.05）。结论 采取 口腔种植修复方式能提升牙列缺损患者的临床效果，相较于常规修复术治疗方式，患者的不良反应发生 率更低。     

Superior sealing effect of hydroxyapatite in porous-coated implants: experimental studies on the migration of polyethylene particles around stable and unstable implants in dogs

Background Migration of wear debris to the periprosthetic bone is a major cause of osteolysis and implant failure. Both closed-pore porous coatings and hydroxyapatite (HA) coatings have been claimed to prevent the migration of wear debris. We investigated whether HA could augment the sealing effect of a porous coating under both stable and unstable conditions.

Methods We inserted porous-surfaced knee implants, with and without HA coating, in 16 dogs, according to a paired, randomized study design. 8 dogs had 2 implants inserted into each knee using a stable implant device and 8 dogs received 1 implant in each knee using a micro-motion (500 μm) implant device. Implants had a periimplant gap of 0.75 mm. We then injected polyethylene (PE) particles or a control solution into the knee joints on a weekly basis.

Results After 16 weeks, the rating of particles around stable implants was reduced by the HA coating from a median value of 2 (1-4) to 1 (0-1) (p = 0.01) and during micromotion from 3 (2-4) to 1 (0-3) (p = 0.002). HA-coated implants had superior bone ongrowth during stable and unstable conditions. We found no difference in bone ongrowth between PE-exposed and vehicle-exposed implants.

Interpretation Compared to a pure plasma-sprayed porous coating, a layer of HA coating provides better bone ongrowth and protects the bone-implant interface against the migration of wear debris under both stable and unstable conditions.     

Influence of premature exposure of implants on early crestal bone loss: an experimental study in dogs.

OBJECTIVE: Several studies have reported on spontaneous early exposure of submerged implants, suggesting that exposed implants have greater bone loss than nonexposed implants. The purpose of this study was to compare the effects of implant-abutment connections and partial implant exposure on crestal bone loss around submerged implants. STUDY DESIGN: Bilateral, edentulated, flat alveolar ridges were created in the mandible of 6 mongrel dogs. After 3 months of healing, 2 fixtures were placed on each side of the mandible following a commonly accepted 2-stage surgical protocol. The fixtures on each side were randomly assigned to 1 of 2 procedures. In the first, a cover screw was connected to the fixture, and the incised gingiva was partially removed to expose the cover screw (partially exposed group). In the second, a healing abutment was connected to the fixture so that the coronal portion of the abutment remained exposed to the oral cavity (abutment-connected group). After 8 weeks, micro-computed tomography (micro-CT) at the implantation site was performed to measure the bone height in the peri-implant bone. Data were analyzed by Wilcoxon's signed rank test. RESULTS: The average bone height was greater for the abutment-connected fixture (9.8 +/- 0.5 mm) than for the partially exposed fixture (9.3 +/- 0.5 mm; P < .05). CONCLUSION: These results suggest that when implant exposure is detected, the placement of healing abutments may help limit bone loss around the submerged implants.     

Cardiac transplantation for cardiomyopathy and ischemic heart disease: differences in outcome up to 10 years.

BACKGROUND: Ischemic heart disease (IHD) and cardiomyopathy (CM) are the most common indications for heart transplantation. The aim of this study was to investigate the difference in clinical outcome between these two groups. METHODS: At our institution between 1987 and 1998 transplantation was performed in 133 patients with IHD and 87 with CM. Follow-up was complete for all patients (mean 87 months). RESULTS: Mean age at time of surgery was 51 +/- 5 years for IHD versus 39 +/- 9 years for CM recipients (p = 0.02). There was no difference in donor age, donor gender, or pre-operative hemodynamics between the two groups. The operative mortality was 11.2% in IHD recipients and 10.6% in CM recipients (p = 0.9). No differences were observed in intra-cardiac pressures or incidence of renal dysfunction, infection, or malignancy between the two groups. The incidence of peripheral vascular incidents was significantly higher for IHD recipients (13% vs 3%, p = 0.02). At 10 years, the incidence of coronary artery disease was 35% and 9%, respectively (p = 0.02). Mean NYHA status was 2.0 +/- 0.3 and 1.1 +/- 0.2 for IHD and CM recipients, respectively (p = 0.013). The actuarial survival at 1, 5, and 10 years was 77%, 62%, and 39% for IHD recipients compared with 85%, 82%, and 80% for CM recipients (p = 0.7, p < 0.0001 and p < 0.0001, respectively). CONCLUSION: After heart transplantation, medium- and long-term outcome is significantly better for CM than IHD recipients. In view of limited donor availability, it is appropriate to explore more vigorously alternative treatments for patients with severe ischemic left ventricular dysfunction.     

口腔正畸联合种植牙修复治疗牙缺失伴牙槽骨缺损的临床效果

目的 分析口腔正畸联合种植牙修复治疗牙缺失伴牙槽骨缺损的临床效果。方法 选择我院口腔 科2018年1月-2020年3月收治的80例牙缺失伴牙槽骨缺损患者为研究对象，随机分为对照组和试验组，每 组40例。对照组给予种植牙修复治疗，试验组给予口腔正畸联合种植牙修复治疗，比较两组口腔功能恢 复情况、种植体留存情况、并发症发生情况及治疗满意度。结果 试验组咀嚼频率、美观度、舒适度、 语言功能评分均高于对照组，差异有统计学意义（P＜0.05）；试验组种植体留存率为97.50%，高于对 照组的77.50%，差异有统计学意义（P＜0.05）；试验组并发症发生率为2.50%，低于对照组的17.50%， 差异有统计学意义（P＜0.05）；试验组治疗满意度为95.00%，高于对照组的77.50%，差异有统计学意义 （P＜0.05）。结论 口腔正畸联合种植牙修复治疗牙缺失伴牙槽骨缺损的临床效果良好，可改善患者的口 腔功能，提高种植体留存率，且并发症发生几率较小，患者满意度较高。     

Biological and mechanical characteristics of the interface between a new swelling anchor and bone.

We recently evaluated the peak pullout loads for anchors made from our new copolymeric swelling-type material compared with anchors made of a nonswelling material. In vitro and in vivo peak pullout loads of these anchors were evaluated after different intervals of implantation in the lateral femoral condyles of New Zealand White rabbits. Scanning electron microscopy and energy dispersive x-ray analyses were additionally performed on selected retrieved samples after pullout to examine the characteristics of bone attachment to the implant. The mean peak pullout load was greater for the swelling anchors than for the nonswelling anchors after 48 hours in vitro (46.0 +/- 15.8 compared with 10.8 +/- 9.1 N, p = 0.0541). After 2 weeks in vivo, it was significantly greater for the swelling anchors than for the nonswelling controls (177.7 +/- 41.3 compared with 53.7 +/- 17.5 N, p = 0.0024). The peak pullout load was also greater for the swelling anchors after 8 weeks in vivo; however, this difference was less pronounced than at 2 weeks (101.8 +/- 35.0 compared with 58.9 +/- 9.7 N, p = 0.0508). Furthermore, the swelling implants tended to induce bone deposition at the bone-implant interface. Results from this investigation reveal that the new family of dynamic implants has potential for applications requiring fixation to cancellous or osteoporotic bone.     

Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Randomized, double-blinded, placebo-controlled, clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN AND SETTING: Sixty-two non-obese adults with history of snoring, daytime sleepiness, and mild/moderate OSAHS, were randomized to receive palatal implants (n = 31) or placebo procedure (n = 31). Complete follow-up including quality of life (QOL, SF-36), snoring visual analog scale (VAS), and Epworth Sleepiness Scale (ESS) data were obtained in 62 patients. Seven patients refused follow-up polysomnography for a total of 55 patients (29 implant and 26 placebo). RESULTS: The treatment group (change in score of -7.9 +/- 7.7) was significantly improved compared with the placebo group (change in score of 0.9 +/- 4.3) for apnea/hypopnea index (AHI) (P < 0.0001), QOL, SF-36 (P < 0.0001), snoring VAS (P < 0.0001), and ESS (P = 0.0002). CONCLUSIONS: Palatal implants improve AHI, QOL, snoring intensity, and daytime sleepiness for selected patients with mild/moderate OSAHS.     

A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants

Many surgical procedures use metal implants in bone. The clinical results depend on the strength of the bone holding these implants. Our objective was to show that a drug released from the implant surface can improve parameters reflecting the quality or amount of this bone. Sixteen patients received paired dental titanium implants in the maxilla, in a randomized, double-blinded fashion. One implant in each pair was coated with a thin fibrinogen layer containing 2 bisphosphonates. The other implant was untreated. Fixation was evaluated by measurement of resonance frequency (implant stability quotient; ISQ) serving as a proxy for stiffness of the implant-bone construct. Increase in ISQ at 6months of follow-up was the primary variable. None of the patients had any complications. The resonance frequency increased 6.9 ISQ units more for the coated implants (p=0.0001; Cohen's d=1.3). The average difference in increase in ISQ, and the effect size, suggested a clinically relevant improvement. X-ray showed less bone resorption at the margin of the implant both at 2months (p=0.012) and at 6months (p=0.012). In conclusion, a thin, bisphosphonate-eluting fibrinogen coating might improve the fixation of metal implants in human bone. This might lead to new possibilities for orthopedic surgery in osteoporotic bone and for dental implants.     

Transcapsular adenomectomy(Millin): a comparative study, extraperitoneal laparoscopy versus open surgery

OBJECTIVE: To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches. METHODS: From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and peri-operative parameters were considered in order to determine the learning curve. RESULTS: In terms of pre-operative parameters considered, the 2 study groups are comparable (p>0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6+/-419 ml, for Group B 687.5+/-298.6 ml (p=0.004). For all the other parameters no significant statistical differences were recorded (p>0.4). Mean operative time was 107.2+/-34.9 min in Group A, and 95.5+/-22.5 min in Group B. Mean adenoma weight in Group A was: 69,5+/-21.5 g, in Group B: 88.1+/-43.8 g. Mean haemoglobin levels in Group A was: 11.2+/-1.8 g/dl, Group B: 11.6+/-1.2 (10-13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385+/-36 mg in Group A, versus 430+/-108 mg in Group B. Mean catheterization time was 6.3+/-3.7 days in Group A, 5.6+/-1.1 days in Group B. The mean hospital stay was 7.8+/-4.1 days in Group A, and 7+/-1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time (p=0.01). The p-value for the other parameters was not significant (p>0.1). CONCLUSIONS: The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss.     

Prospective clinical evaluation of 201 direct laser metal forming implants: results from a 1-year multicenter study

This prospective clinical study evaluated the survival rate and the implant-crown success of 201 direct laser metal forming (DLMF) implants in different clinical applications, after short-term follow-up of functional loading. At the 1-year scheduled follow-up examination, several clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, exudation; absence of implant mobility; absence of continuous peri-implant radiolucency, DIB <1.5 mm; absence of prosthetic complications at the implant-abutment interface. A total of 201 implants (106 maxilla, 95 mandible) were inserted in 62 patients (39 males, 23 females; aged between 26 and 65 years) in eight different clinical centers. The sites included anterior (n = 79) and posterior (n = 122) implants. The overall implant survival rate was 99.5%, with one implant loss (maxilla: 99.0%, 1 implant failure; mandible: 100.0%, no implant failures). The mean DIB was 0.4 ± 0.2 mm. Among the survived implants (200), five did not fulfill the success criteria, giving an implant-crown success of 97.5%. This 1-year follow-up prospective clinical study gives evidence of very high survival (99.5%) and success (97.5%) rates using DLMF implants.     

A survey of patients with inflatable penile prostheses for satisfaction

PURPOSE: We assessed patient satisfaction with 3 types of penile prostheses, namely the AMS 700 Series(R), Mentor Alpha 1(R) and Mentor Alpha NB(R). MATERIALS AND METHODS: The subjects consisted of 330 patients selected by stratified, systematic random sampling from among 1,298 subjects undergoing virgin 3-piece inflatable penile implant surgeries performed by the same surgical team at 1 hospital between January 1992 and December 1998. Data were collected by computer assisted telephone interviewing with a survey developed by the authors. The survey consisted of 37 questions in 7 sections, including 1 demographic section and 6 patient satisfaction sections. RESULTS: Of the 330 patients selected 248 (75%) could be contacted. Of these, 199 (80%) responded to the full survey and the remaining 49 (20%) agreed to respond only to the question, "How satisfied are you with the prosthesis?" Of the 199 full responders 12 (6%) had AMS implants and 187 (94%) had Mentor implants. Of the 49 single question responders 5 (10%) had AMS implants and 44 (90%) had Mentor implants. Of the 248 patients the overall satisfaction rate was 69%. Although there was no significant difference at the 5% level in patient satisfaction by implant type, responses tended to favor the Alpha IPPs in terms of overall sexual satisfaction (p =0.058), natural feeling of the prosthesis (p =0.061), flaccid appearance of the penis when deflated (p =0.054), and education with demonstration of inflation and deflation (p =0.075). CONCLUSIONS: There was a high degree of overall patient satisfaction across implant types.     

Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants

INTRODUCTION: In view of the increase in the life expectancy of humans and in edentulism of the population above 50 years of age, in which the prevalence of osteoporosis is also higher, it is fundamental to better understand the effects of systemic bone mass loss on the healing process of dental implants and to determine the quality of the bone that surrounds them. The objective of the present study was to compare systemic osteoporosis (axial and femoral) and parameters of mandibular bone quality, and to evaluate osseointegration in postmenopausal women receiving dental implants. METHODS: The sample consisted of 39 women aged 48-70 years, 19 with a densitometric diagnosis of osteoporosis in the lumbar spine and femoral neck and 20 controls with a normal densitometric diagnosis. Bone mineral density was measured in the patients and controls by dual-energy X-ray absorptiometry. Eighty-two osseointegrated dental implants were placed in the mandible, 39 of them in the osteoporosis group and 43 in the control group. Mandibular bone quality was evaluated by classifying mandibular inferior cortical and trabecular bone on panoramic radiographs and by histomorphometric analysis of a mandibular bone biopsy. Osseointegration was analyzed after 9 months. RESULTS: No significant difference was observed between patients with osteoporosis and controls when comparing individuals with a normal cortex and those with a severely or moderately eroded cortex determined on panoramic radiographs, although patients with MEC/SEC had lower femoral neck BMD than those with NC (0.688 +/- 0.17 vs. 0.814+/- 0.144 g/cm2, P<0.012). Histomorphometric analysis also revealed no difference in the parameters of bone formation or resorption between the two groups. Implant failure was observed in only one case. CONCLUSION: We conclude that there is an association between low femoral neck BMD and poor mandibular bone quality as assessed by panoramic radiography. The loss of one implant (1.2%) is compatible with the literature and cannot be attributed to systemic osteoporosis.     

Improved Knee Flexion Following High-Flexion Total Knee Arthroplasty

ABSTRACT: BACKGROUND: The application of new techniques and materials in total knee arthroplasty (TKA) continue to be a primary focus in orthopedic surgery. The primary aim of the present study is to evaluate post TKA total range of motion (ROM) among a group of patients who received a gender specific (GS) high-flexion design modification implant compared to a control group of patients who received non-gender specific implants. Methods and Results: The control group was comprised of 39 subjects that were recruited pre-operatively and received the non-GS implant while the study group consisted of 39 patients who received GS implants. The study group yielded an improvement in mean post-operative ROM of 21degrees at 12 months, whereas the mean improvement in ROM among the control group was 11degrees. Thus, the study group had a 10degrees increased ROM improvement (91%) over the control group (p = 0.00060). In addition, 100% of the subjects with GS high-flexion implants achieved greater or equal ROM post-operatively compared to 82% for the control cohort. Lastly, women who exhibited greater pre-operative ROM and lower body mass index (BMI) were found to benefit the most with the GS prosthesis. CONCLUSIONS: Our study demonstrates that among subjects with a normal BMI, the GS high-flexion knee implant is associated with increased ROM as compared to the non-gender specific non-high-flexion implant designs.     

Vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement.

OBJECTIVE: The aim of this study was to evaluate the combined use of autogenous bone and platelet-enriched fibrin glue as grafting material for vertical alveolar ridge augmentation with simultaneous implant placement in a canine alveolar ridge defect model. STUDY DESIGN: In 6 mongrel dogs, bilateral vertical alveolar ridge defects were created in the mandible. After 3 months of healing, 2 dental implants were placed in each defect of the mandible, creating 6-mm supra-alveolar peri-implant defects. The 2 implants per defect were subjected to surgical treatments involving either a combination of autogenous bone grafts and platelet-enriched fibrin glue, or a conventional flap procedure only (control). After a healing period of 6 months, the dogs were humanely killed for histological and histometric analyses. RESULTS: Implant placement alone produced limited vertical alveolar height (0.6 +/- 0.4 mm). However, alveolar augmentation including a combination of autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement resulted in alveolar ridge augmentation amounting to 4.2 +/- 1.0 mm, comprising 63% of the defect height. New bone-implant contact was 40.5% in the defects treated with combined autogenous bone grafts and platelet-enriched fibrin glue, and was 48.4% in the resident bone; this difference was not statistically significant. CONCLUSION: The present study demonstrates that vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement might effectively increase vertical alveolar ridge height and allow for an acceptable level of osseointegration.     

Oral rehabilitation after treatment for head and neck malignancy

BACKGROUND: Advances in the management of oral malignancy have resulted in significant improvements in survival and functional outcome. Ablation of oral tissues and radiotherapy render many patients unable to wear conventional prostheses, and these patients are, thus, candidates for oral rehabilitation with osseointegrated implants. We aim to present outcomes and complications of such treatment over a 14-year period in a single unit. METHODS: Data were collected for 81 consecutive patients, most of whom had received microvascular free flap reconstruction after surgical ablation of oral squamous cell carcinoma. Three hundred eighty-six implants were placed after a delay of 12 months after surgery. Sixty-five percent of implants were placed in the anterior mandible. Radiotherapy was used in 47% of the patients, and hyperbaric oxygen treatment was routinely used in irradiated subjects during the latter half of the series. Retrospective analysis of implants and prostheses was made by use of case notes, radiographs, and a computerized database. RESULTS: Data are presented for 364 of the 386 implants in 77 of the 81 patients after a median follow-up of 4 years. Two hundred sixty-five (73%) of the implants were in function supporting prostheses, 56 (15%) had been lost, and 43 (12%) were present but not loaded (ie, "sleepers"). Implant loss seemed patient specific and was also correlated with host bone type. Thirteen percent of patients in whom implants were placed in the mandible lost at least one implant, and the equivalent values for the maxilla was 40%. Thirty-six percent of patients in whom implants were placed in bone graft or flap lost at least one implant. The effects of implant manufacture, dimensions, radiotherapy, and hyperbaric oxygen did not reach statistical significance in this series. Cases of a second primary malignancy were noteworthy; however, the impact of recurrence was minimized by the delay between resection and rehabilitation. Of the 42 fixed and 29 removable prostheses fitted, 12 (17%) failed. CONCLUSIONS: Implants placed in mandible were reliable, but failure rates in vascularized bone graft and maxilla were higher. Radiotherapy did not seem to prejudice implant survival, and hyperbaric oxygen had no demonstrable benefit in this series. Despite some persistent soft tissue problems and implant loss, most patients reached a successful prosthetic and functional outcome.     

Comparison of bench test evaluations of surgical skill with live operating performance assessments

BACKGROUND: Attempts at assessing surgical proficiency have generally used laboratory simulation to evaluate skill. The aim of this study was to compare technical ability as measured on a bench simulation with actual operative performance. STUDY DESIGN: Twenty-two general surgeons and trainees were recruited: consultants (n = 4), specialist registrars (n = 14), and senior house officers (n = 4). They were assessed while performing a saphenofemoral dissection on an anesthetized patient in the operating theater, and performing the same procedure on an inanimate model within the laboratory. The Objective Structured Assessment of Technical Skill method, consisting of a 7-parameter global rating (maximum score 35) and 17-point step-by-step checklist (maximum score 17) was used to measure performance in both environments. Face, content, and construct validity of the synthetic model were established as part of this study. RESULTS: There was a significant relationship between technical skill as measured on the bench test model and performance within the operating theater with respect to both global rating (Spearman correlation coefficient 0.824, p < 0.001; alpha coefficient 0.89) and checklist ratings (r = 0.514, p < 0.02; alpha coefficient 0.68) rating assessments. Global rating scores correlated with experience for both operative (r = 0.822, p < 0.001) and bench (r = 0.515, p < 0.05) settings. There was no difference in level of measured performance between operating theater and bench model (global rating mean 23.25 +/- 6.66 versus 23.75 +/- 5.62, respectively; paired t-test p = 0.559). CONCLUSIONS: Assessment of technical skill using inanimate procedural simulation translates to actual surgical performance within the operating theater. This further validates use of bench test evaluations to measure surgical technical ability.