Long-term clinical evaluation of 211 two-unit cantilevered resin-bonded fixed partial dentures

Objectives

This retrospective study aims to evaluate the long term clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) relating to their retention, success and survival rate.

Materials and methods

Prostheses that were placed at least four years previously were clinically reviewed to evaluate retention, success and survival rate. Additional information was also collected, including patient's gender, age and satisfaction on their prosthesis, operator's experience, prosthesis service life, root canal therapy if performed, abutment mobility, bone support, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of proximal axial contacts adjacent to the prosthesis. The date of any debonding with subsequent treatment was also recorded.

Results

A total of 211 two-unit RBFPDs were placed in 153 patients, with a mean service life of 113.2 ± 33.5 months. Twenty-eight prostheses debonded, resulting in a retention rate of 86.7 percent, and another five teeth were extracted with the prostheses, resulting in a success rate of 84.4 percent. 90.0 percent prostheses were functioning (survival rate) by means of rebonding at the time of review. The location of the replaced tooth had a significant effect on the retention of RBFPDs with posterior RBFPDs lower than anterior (p = 0.020). Kaplan–Meier analysis revealed 5-, 10- and 15-year cumulative probability of surviving was 0.97, 0.91 and 0.84, respectively.

Conclusions

211 two-unit RBFPDs were observed to have a success, retention and survival rate of 84.4, 86.7 and 90.0 percent, respectively, with a mean service life of 9.4 years.

Clinical Significance

Based on the clinical results, two-unit RBFPD are shown to be a durable prosthesis over the long term with high patient satisfaction. The posterior prostheses, particularly in the lower arch appeared to have a higher failure rate, and improved design features should be considered.     

Gastric Ischemic Conditioning Prior to Esophagectomy Is Associated with Decreased Stricture Rate and Overall Anastomotic Complications

Background

Gastric ischemic conditioning prior to esophagectomy can increase neovascularization of the new conduit. Prior studies of ischemic conditioning have only investigated reductions in anastomotic leaks. Our aim was to analyze the association between gastric conditioning and all anastomotic outcomes as well as overall morbidity in our cohort of esophagectomy patients.

Methods

We performed a retrospective review of patients undergoing esophagectomy from 2010 to 2015 in a National Cancer Institute designated center. Ischemic conditioning (IC) was performed on morbidly obese patients, those with cardiovascular disease or uncontrolled diabetes, and those requiring feeding jejunostomy and active tobacco users. IC consisted of transection of the short gastric vessels and ligation of the left gastric vessels. Primary outcomes consisted of all postoperative anastomotic complications. Secondary outcomes were overall morbidity.

Results

Two-hundred and seven esophagectomies were performed with an average follow-up of 19 months. Thirty-eight patients (18.4%) underwent conditioning (IC). This group was similar to patients not conditioned (NIC) in age, preoperative pathology, and surgical approach. Five patients in the ischemic conditioning group (13.2%) and 57 patients (33.7%) in the NIC experienced anastomotic complications (p =?0.011). Ischemic conditioning significantly reduced the postoperative stricture rate fourfold (5.3 vs. 20.7% p?=?0.02). IC patients experienced significantly fewer complications overall (36.8 vs. 56.2% p?=?0.03).

Conclusions

Gastric ischemic conditioning is associated with fewer overall anastomotic complications, fewer strictures, and less morbidity. Randomized studies may determine optimal selection criteria to determine whom best benefits from ischemic conditioning.