Prosthetic aspects and patient satisfaction with two-implant-retained mandibular overdentures: a 10-year randomized clinical study

PURPOSE: This study aimed to compare the prosthetic aspects and patient satisfaction with prosthetic care in two-implant-retained mandibular overdentures, whether implants were splinted with a bar or left with magnets or ball attachments. MATERIALS AND METHODS: Thirty-six completely edentulous patients had two Br?nemark implants placed in the mandibular canine area. A randomized procedure allocated patients into three groups of equal size, each with a different attachment system: bars, magnets, or balls. Prosthesis retention and mechanical as well as soft tissue complications were recorded in addition to patient satisfaction. A linear mixed model was fitted with attachment type and time as classification variables and adjusted by Turkey's multiple range test. RESULTS: Ball-retained overdentures showed at year 10 the greatest vertical retention force (1,327 g), followed by bars (1,067 g) and magnets (219 g). In the ball group, need for tightening of abutment screws was the most common mechanical complication; in the magnet and bar groups, respectively, the most common complications were wear and corrosion, and the need for clip activation. Prosthesis stability and chewing comfort for the overdenture were rated significantly lower for the magnet group compared to the ball and bar groups. Prosthesis stability of the maxillary denture was rated significantly lower in the bar group compared to ball and magnet groups. CONCLUSION: The ball group scored best in relation to retention of the overdenture, soft tissue complications, and patient satisfaction at year 10. The bar group scored lower for comfort and stability of the maxillary denture. Magnets offered patients the least comfort.     

The prevalence of non-syndromic orofacial clefts and associated congenital heart diseases of a tertiary hospital in Riyadh,Saudi Arabia

BackgroundOrofacial clefts are considered one of the most common birth defects and are frequently associated with other malformations. Congenital heart disease is one of the most prevalent congenital malformation.ObjectiveTo investigate the prevalence of congenital heart diseases associated with non-syndromic orofacial clefts in the Saudi population.MethodsElectronic files of non-syndromic orofacial cleft patients who visited the Oral and Maxillofacial Surgery Department in King Abdulaziz Medical City of Riyadh, Saudi Arabia from January 2015 to December 2018 were retrospectively reviewed. Data were recorded in an excel sheet and analyzed using SPSS via frequency tests.ResultsIn the cleft children identified, the prevalence of non-syndromic orofacial clefts was (77%). Orofacial clefts showed a male predominance (62%). The most common orofacial phenotype was unilateral cleft lip and palate (34%). The prevalence of associated congenital malformations with orofacial clefts was (41%). The most prevalent congenital malformation was congenital heart disease (35%), mainly found in unilateral cleft lip and palate patients (33%). The prevalence of associated congenital heart disease with orofacial clefts was (19%). The most frequent type of congenital heart disease was atrial septal defect (37%).ConclusionThis study highlights the recognition of the associated congenital heart disease with non-syndromic orofacial cleft patients. Global screening protocols designed for newborns with non-syndromic orofacial cleft are needed to eliminate late diagnosis of critical congenital heart diseases which might present operative risks of anesthesia and/or surgical procedures.     

Clinical experience of levetiracetam monotherapy for adults with epilepsy: 1-year follow-up study.

We identified 46 patients with a history of partial seizures, with and without secondarily generalization, who received levetiracetam (LEV) (Keppra) monotherapy. Patients began LEV either as first line therapy (n=11) or were converted to LEV monotherapy (n=35) after failing prior antiepileptic medications (AEDs). Patients were followed up to 12 months after LEV started. The majority of these patients were able to continue on LEV and a small number of patients discontinued LEV secondary to lack of efficacy. One third of the non-seizure free group at 6 months of follow-up had worse seizure control at 12 months and two thirds had the same or better seizure control. Our 1-year follow-up data of LEV as monotherapy suggests that LEV can be effective and well tolerated in adults with either new or difficult to control epilepsy. A prospective, large, long-term double-blind study is needed to confirm this finding.     

Suicide attempters in Abu Dhabi: Is criminal prosecution associated with patients’ guardedness?

The objective of this study was to examine the relationship between legal status and guardedness in patients who attempted suicide in Abu Dhabi, United Arab Emirates. The consultation-liaison team assessed 355 patients admitted for suicidal/self-injurious behavior, recording their guardedness before knowing whether they were legally charged. Patients who were legally charged for the suicidal act (n?=?139) were 1.6 times (p?=?.03) more guarded in volunteering information than patients who were not legally charged. Legally charging suicide attempters might have a negative impact on risk assessment and psychiatric care.     

Deep Belief Networks for Quantitative Analysis of a Gold Immunochromatographic Strip

Gold immunochromatographic strip (GICS) has become a popular membrane-based diagnostic tool in a variety of settings due to its sensitivity, simplicity and rapidness. This paper aimed to develop a framework of automatic image inspection to further improve the sensitivity as well as the quantitative performance of the GICS systems. As one of the latest methodologies in machine learning, the deep belief network (DBN) is applied, for the first time, to quantitative analysis of GICS images with hope to segment the test and control lines with a high accuracy. It is remarkable that the exploited DBN is capable of simultaneously learning three proposed features including intensity, distance and difference to distinguish the test and control lines from the region of interest that are obtained by preprocessing the GICS images. Several indices are proposed to evaluate the proposed method. The experiment results show the feasibility and effectiveness of the DBN in the sense that it provides a robust image processing methodology for quantitative analysis of GICS.     

Microbiological and clinical outcomes and patient satisfaction for two treatment options in the edentulous lower jaw after 10 years of function

BACKGROUND: Long-term data on microbiological and clinical outcome as well as on patient satisfaction after implant therapy in the edentulous mandible are limited. Especially comparisons between fixed full prostheses (FFPs) and overdentures (ODs), or between anchoring systems for the latter are scarce. AIM: This study aimed to evaluate both of these parameters at the 10-year follow-up in a group of fully edentulous patients rehabilitated via an OD or a FFP (the latter to allow inter-group comparison). MATERIAL AND METHODS: A total of 37 fully edentulous patients (25 ODs, 12 FFPs, age at implant installation ranged from 36 to 85 years) participated in this study. All subjects received their implants (Branemark System, Nobel Biocare AB, Gothenburg, Sweden) 10 years previously. For the ODs different attachment systems (bar, magnets, ball) had been applied that allowed a further intra-group comparison. At the follow-up visit, 10 years after the abutment insertion, a series of periodontal parameters were recorded, long-cone radiographs were taken and subgingival plaque samples were collected for analysis using checkerboard DNA-DNA hybridization. The clinical and radiographic data were recorded at abutment connection and after 1 and 10 years. RESULTS: After 10 years of loading, mean plaque and bleeding indices and changes in attachment or marginal bone level were not significantly different, neither between the OD and FFP group, nor within the OD group. The marginal bone loss between abutment connection and year 10 was 0.86 and 0.73 mm for OD and FFP groups, respectively. The subgingival microbiota at implant sites from all (sub)-groups was comparable, with low numbers of DNA counts (+/-10 x 10(5)) but high detection frequencies of Actinobacillus actinomycetemcomitans (>90%), Porphyromonas gingivalis (>85%) and Tannerella forsythensis (30%). The composition of the subgingival microbiota was influenced by probing depth and bleeding tendency. Patient satisfaction was very high for both types of prosthetic rehabilitation. The FFP group scored only slightly better for chewing comfort and general satisfaction. CONCLUSION: These data indicate that from the clinical and microbiological standpoint, as well as patient satisfaction, both an OD and a FFP offer a favourable long-term outcome.     

A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome

PURPOSE: This randomized controlled clinical trial aimed to evaluate the efficacy of splinted implants versus unsplinted implants in overdenture therapy over a 10-year period. MATERIALS AND METHODS: The study sample comprised 36 completely edentulous patients, 17 men and 19 women (mean age 63.7 years). In each patient, 2 implants (Br?nemark System, Nobel Biocare, G?teborg, Sweden) were placed in the interforaminal area. Three to 5 months after placement, they were connected to standard abutments. The patients were then rehabilitated with ball-retained overdentures, magnet-retained overdentures, or bar-retained overdentures (the control group). Patients were followed for 4, 12, 60, and 120 months post-abutment connection. Group means as well as linear regression models were fitted with attachment type and time as classification variables and corrected for simultaneous testing (Tukey). RESULTS: After 10 years, 9 patients had died and 1 was severely ill. Over 10 years, no implants failed. Mean Plaque Index, Bleeding Index, change in attachment level, Periotest values, and marginal bone level at the end of the follow-up period were not significantly different among the groups. DISCUSSION: The annual marginal bone loss, excluding the first months of remodeling, was comparable with that found around healthy natural teeth. CONCLUSION: The fact that no implants failed and that overall marginal bone loss after the first year of bone remodeling was limited suggested that implants in a 2-implant mandibular overdenture concept have an excellent prognosis in this patient population, irrespective of the attachment system used.     

Improvement in seizure control and quality of life in medically refractory epilepsy patients converted from polypharmacy to monotherapy

In a retrospective chart review, we identified 35 patients with medically refractory epilepsy (MRE) who had been converted from polypharmacy to monotherapy and maintained on monotherapy for at least 12 months. None of the 35 patients had worsening of their seizure frequency after the conversion to monotherapy. Fourteen of the 35 patients (40%) became seizure-free. Nine of 35 patients (26%) had a 50% reduction in seizure frequency. Five of 35 patients (14%) had a 75% reduction in seizure frequency. Twenty-eight (80%) of 35 patients participated in a quality-of-life questionnaire. Quality of life was rated as better on monotherapy as compared with polypharmacy in a number of domains: memory loss, concern over medication long-term effects, difficulty in taking the medications, trouble with leisure time activities, and overall state of health. This improvement reached statistical significance. Conversion to monotherapy in patients with MRE may be successful in achieving a reduction in seizure frequency and an improvement in quality-of-life parameters. A prospective, randomized trial is necessary to validate these findings.     

Prognostic value of the consistency of lateralizing ictal features and ictal EEG in patients undergoing temporal lobectomy for refractory complex partial seizures.

PURPOSE: Ictal and postictal clinical manifestations have lateralizing value in the presurgical evaluation of intractable seizures. The consistency and frequency of these signs during seizures and the associated implications for postoperative seizure outcome are unknown. METHODS: The videotaped complex partial seizures of 49 patients with known postoperative outcomes greater than 2 years after temporal lobectomy were blindly reviewed for: (1) unilateral hand posturing (UHP), (2) unilateral hand automatism (UHA), (3) forced and nonforced head turning (HT), and (4) postictal dysphasia (PID). The presence and laterality of each assessable sign were recorded. Data were analyzed as follows: (1) the prevalence of each sign in patients with Engel class 1 and Engel class 2-4, and (2) the postsurgical outcome when the sign was present in more than or less than 50% of the seizures for each patient. We reviewed patients' presurgical work-up, specifically ictal EEG and MRI. RESULTS: The prevalence of UHP, UHA, HT, and PID was similar for Engel class 1 and Engel class 2-4 patients. Engel class 1 outcome when UHP, UHA, HT, and PID were present for greater than 50% of seizures was no different compared to when these signs were present for less than 50% of seizures. Patients who had concordant ictal EEG and MRI abnormalities had the best postsurgical outcome. CONCLUSIONS: The consistency and frequency of ictal manifestations in the presurgical evaluation of complex partial seizures does not predict seizure outcome. The presence of any specific lateralizing sign need not be present in every complex partial seizure for the sign to hold predictive value. Concordant ictal EEG and MRI abnormalities are still the best predictors of outcome.