Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality

Objectives

To compare subjective and objective outcomes of complete dentures fabricated with standard clinical protocols, but omitted selected steps during the laboratory phase.

Materials and methods

Forty-three edentulous patients (mean age 58.1 years, SD 9.9, range 35–78), were consecutively recruited and randomly assigned to one of four groups according to selected variations of laboratory steps: Group 1 (n = 10), omission of secondary casts obtained from impressions in border moulded custom trays; Group 2 (n = 10), omission of secondary casts and face-bow articulator mounting; Group 3 (n = 10), omission of face-bow mounting; Group 4 (n = 13), no steps omitted (control). Clinical procedures for all groups were identical, and performed by senior dental students under supervision of prosthodontists, all of whom were blinded to the Group. At 1-, 4- and 12-weeks after delivery, patients rated their overall satisfaction, as well as a range of functional factors using visual analogue scales. An independent blinded prosthodontist similarly rated four domains of denture quality at the 1-week follow-up.

Results

No significant differences were noted among the groups in all aspects of patients’ assessments at all the time points (P > 0.1). There were no significant differences in prosthodontists’ ratings of denture quality in any of the domains examined (P > 0.1).

Conclusion

Selected omissions of steps (face-bow mounting and/or secondary casts) during the laboratory phase of complete denture fabrication has only a minor role, if any, in subjective and objective outcomes, contrasting with the common belief that such omissions will adversely affect outcomes.

Clinical significance

General practitioners provide most complete dentures. Many do not follow all the procedures they were taught at dental school. Our finding that omitting frequently advocated steps made no difference to patient satisfaction or to denture quality suggests that cost-effectiveness through simplifications be considered in practice and in education.     

A Novel Monthly Dosing Regimen of Risedronate for the Treatment of Postmenopausal Osteoporosis: 2-Year Data

This 2-year trial evaluated the efficacy and tolerability of a monthly oral regimen of risedronate. Postmenopausal women with osteoporosis were randomly assigned to double-blind treatment with risedronate 75 mg on 2 consecutive days each month (2CDM) or 5 mg daily. The primary end point was the percentage change from baseline in lumbar spine bone mineral density (BMD) at 12 months. Secondary end points included the change in BMD of the lumbar spine and proximal femur and in bone turnover markers as well as the number of subjects with at least one new vertebral fracture over 24 months. Among 1,229 patients who were randomized and received at least one dose of risedronate, lumbar spine BMD was increased in both treatment groups: mean percentage change from baseline was 4.2 ± 0.19 and 4.3 ± 0.19 % in the 75 mg 2CDM and 5 mg daily groups, respectively, at month 24. The treatment difference was 0.17 (95 % confidence interval ?0.35 to 0.68). There were no statistically significant differences between treatment groups on any secondary efficacy parameters. Both treatment regimens were well tolerated. Risedronate 75 mg 2CDM was noninferior in BMD efficacy and did not show a difference in tolerability compared to 5 mg daily after 24 months of treatment in women with postmenopausal osteoporosis. This monthly regimen may provide a more convenient dosing schedule to some patients with postmenopausal osteoporosis.     

Pediatric Single‐Lumen Cannula Venovenous Extracorporeal Membrane Oxygenation: A French Center Experience

Single‐lumen cannula venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a special extracorporeal life support (ECLS) technique used for neonatal and pediatric refractory hypoxemia. This is an alternative flow rate ECLS that consists of successive clamping on the drainage and the injection lines. Currently, the Armand‐Trousseau's pediatric intensive care unit remains the only pediatric ECMO center proposing this partial assistance. This article details a technical note and a retrospective analysis of our experience in refractory hypoxemia. The retrospective study, from 2007 to 2011, included all pediatric and neonatal patients treated by single‐lumen cannula VV ECMO. The study was focused on pre‐ECMO patient characteristics and complications during ECMO course. During the last 5 years, 67 pediatric patients were assisted by this single‐lumen cannula VV ECMO. Sixty‐one patients (91%) were newborns. Thirty‐nine patients presented with meconium aspiration syndrome (58%), which was the most frequent etiology. Before cannulation, mean oxygenation index (OI) was 32 ± 11, alveolar‐arterial oxygen difference was 604 ± 47 mm Hg, and partial pressure arterial oxygen/fraction inspired oxygen ratio was 59.2 ± 35.8. Forty‐eight patients (72%) presented pulmonary hypertension, and 66 patients were treated by nitric oxide (98%). Fifty patients (75%) were treated by vasopressors or inotropic drugs. Average duration of ECMO was 13.2 ± 7.8 days. There were forty‐six survivors (69%). The worst prognosis was for respiratory syncytial virus pneumonia. Complications like acute renal injury and hematologic and transfusion acts were not so different than those observed in classical ECMO techniques. Nevertheless, 19 patients presented a stroke (28% of the overall population), but this high rate did not seem to be due to the ECLS technique used. Single‐lumen cannula VV ECMO is a partial and efficient ECMO support. Our experience shows that this technique is as efficient and less invasive than two cannulas ECMO. The single‐lumen cannula VV ECMO is a simple and safe ECLS support used for neonatal or pediatric refractory hypoxemia. Because this is a partial assistance, it is a promising ECLS support.     

Treatment of frozen shoulder with subcutaneous TNF-alpha blockade compared with local glucocorticoid injection: a randomised pilot study

We compared the effect of subcutaneous adalimumab injections with intraarticular glucocorticoid injections on frozen shoulder of 18 patients with unilateral joint involvement. Ten patients were randomised to subcutaneous injections with adalimumab and eight to intraarticular glucocorticoid injections administered every other week for a total of three administrations. The evaluation included validated scores. No effect of subcutaneous injections of adalimumab on frozen shoulder symptoms was demonstrated.