Comparison of two early loading protocols in full arch reconstructions in the edentulous maxilla using the Cresco prosthetic system: a three-arm parallel group randomized-controlled trial

Objectives: Appraise the feasibility of interchanging conventional components of a fixed dental prosthesis (FDP) with those of Cresco in two different early loading protocols. Material and methods: In five centers patients with an edentulous, fully healed maxilla were recruited to partake in a three‐arm blinded randomized‐controlled trial (RCT). Each patient received 5/6 implants using a single‐stage surgery approach to support a 10/12‐unit FDP. The implants used were SLA solid screw two‐part implants. In test groups 1 and 2 components from Cresco were used and the implants loaded 10 days or 6–8 weeks post‐implant placement. Group 3 received their FDP fabricated with conventional components 6–8 weeks post‐implant placement. Patients were followed up 3 years. Results: Of 36 patients, 30 remained after 3 years. The adjusted means and ranges of changes in crestal bone levels were ?0.65, ?0.5 and ?0.4 mm in groups 1, 2 and 3, respectively. The change from baseline was statistically significant in all treatment groups. Adjusting for the difference in implant depth, there was an expected additional change in bone level of ?0.29 mm by each 1 mm the implant was placed deeper. There was no significant difference between the 6‐8 weeks post‐implant placement loading Cresco group vs. the control group or between the two Cresco groups. Conclusions: The vertical placement has more effect on bone loss than the fabrication technique used for the suprastructure and whether the implants were loaded after 10 days vs. 6–8 weeks. To cite this article :
Jokstad A, Ellner S, Gussgard A. Comparison of two early loading protocols in full arch reconstructions in the edentulous maxilla using the Cresco prosthetic system: a three‐arm parallel group randomized‐controlled trial.
Clin. Oral Impl. Res. 22 , 2011; 455–463.
doi: 10.1111/j.1600‐0501.2010.02156.x     

Patients' satisfaction after surgical facial reconstruction or after rehabilitation with maxillofacial prosthesis

The matching of the aesthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive. Because of this, the objective of the present article was to evaluate patient's satisfaction rating after surgical facial reconstruction or rehabilitation with oral and maxillofacial prosthesis, by means of reviewing the literature.     

Histomorphometric and fluorescence microscopic analysis of bone remodelling after installation of implants using an osteotome technique

The influence of the osteotome technique on the osseointegration of rough-surfaced stepped cylinder implants (Frialit)-2) was compared to conventional preparation of the implant site in an animal model. A total of 104 implants were placed into the distal femoral condyle of 52 New Zealand white rabbits. This region contains sufficient trabecular bone for implant placement. The implant site was prepared either by the osteotome technique or by conventional technique with drills as a control group. During the healing period polychromatic fluorescence labelling was performed with four different fluorescent dyes. After 2, 4 and 8 weeks, the implants were removed with the surrounding bone. The sample preparation was done using the 'sawing and grinding' technique. Ground sections 100 microm thick were used for fluorescence microscopic analysis; 30- microm-thick ground sections were examined histomorphometrically. After 2 weeks the bone-to-implant contact ratio was 55.0 +/- 7.1% for the osteotome technique and 29.2 +/- 4.8% for the control group (P < 0.0005). After 4 weeks, the bone-to-implant contact ratio was still significantly better for the osteotome technique (bone-to-implant contact ratio osteotome technique 71.1 +/- 7.2%, bone-to-implant contact ratio control 59.0 +/- 6.3%, P = 0.003). Eight weeks after implant placement the bone-to-implant contact ratio was still better for the osteotome technique compared to the conventional implant placement. However it was no longer statistically significant. The qualitative fluorescence microscopic examination showed an earlier and stronger signal for the osteotome technique than the control group. With the latter, the zone of mineralization moved slowly towards the implant surface. Implant sites prepared by the osteotome technique showed a pronounced signal in the whole compressed area already by the second day. In conclusion, the osteotome technique increases new bone formation and leads to an enhanced osseointegration of dental implants in trabecular bone. However, more experimental trials have to be carried out on higher mammals that show a metabolic rate of bone that is more comparable to humans.     

Is there a relationship between juvenile idiopathic arthritis and periodontitis?

AIM: The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years). MATERIAL AND METHODS: In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M. RESULTS: JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP> or =5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019). CONCLUSION: After adjustment for microbial plaque, JIA is not a risk factor for periodontitis.     

Quantitative Validation of the n-Butanol Sniffin’ Sticks Threshold Pens

Odorant pens are used by medical practitioners and researchers to assess olfactory dysfunction. Despite their routine use, there are currently no data on the gas-phase odorant concentrations released from the pen tips or whether these concentrations scale linearly with the aqueous-phase concentrations inside the pens. The commercially available Sniffin’ Sticks odor threshold test containing n-butanol was chosen for evaluation. The gas-phase concentration of n-butanol at the tip of each pen was measured directly in a new set of pens via proton-transfer-reaction mass spectrometry (PTR-MS). Measurements were additionally made on the same pens after 6 months and two older pen sets, namely a 3-year-old (used) and 4-year-old (new) set. Furthermore, application-related tests were made to determine the performance of the pens during routine use and under stress. These data demonstrate that the gas-phase n-butanol concentrations of the threshold pens are linear over the entire set, both for brand-new pens and 6 months later; this reflects the expected performance that was previously only assumed. Furthermore, the application–simulation tests demonstrated a good performance of the pens when used according to their intended protocol. Measurements of the older pen sets suggest that storage conditions are more critical than usage for pen stability. The present findings confirm that the n-butanol odorant pens are an appropriate tool for threshold testing, provided they are stored and handled correctly.

Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures

This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging.     

Transkutane Vagusnervstimulation

Background

Approximately 20-40?% of epilepsy patients show drug resistance and a large number of patients under antiepileptic therapy suffer from side effects including cognitive disorders and depression. Transcutaneous vagus nerve stimulation (t-VNS) can be used for these patients as a supplementary treatment to resection epilepsy surgery.

Aim

The main aims of this investigation were to test the safety, tolerability and practicality of t-VNS in epilepsy patients.

Material and methods

For the proof of concept trial ten patients with pharmacoresistant epilepsy (eight with focal and two with generalized epilepsy) were recruited. For admission to the study a minimum frequency of four seizures per month was necessary. The medication dosage was kept constant in the baseline and in the total treatment phase. The auricular branch of the vagus nerve (ABVN) of the left ear was stimulated. The stimulation pulses were biphasic with a frequency of 10/s and a pulse width of 300 µs. After an initial training period the stimulation was carried out in the morning, midday and evening for 1 h each over a period of 9 months. The subjectively experienced frequency of seizures, continuous video EEG (electroencephalogram) long-term conduction carried out 4 times for 1 week each and cognitive and functional alterations were considered to be end point parameters.

Results

The total treatment period of 9 months was completed by seven patients. Of these seven patients five showed a reduction in the frequency of seizures during the 9-month treatment period and two reported an increase in seizures. In two patients the seizure frequency was reduced by 45 % and 48 % in a comparison between baseline and end of treatment. In two further patients contradictions arose between the subjective report on seizure frequency and the objectively quantified frequency in the video EEG. For one patient the interictal epileptic EEG activity was continually reduced during the course of the 9-month period.

Conclusion

The t-VNS procedure represents a procedure which is well tolerated and practical for long-term treatment.     

Rupture of the spleen following thoracoscopic spine surgery in a patient with chronic pancreatitis

Purpose

To highlight the perioperative risk of intracapsular haematoma of the spleen or splenic ruptures during thoracoscopic spine surgery in patients with chronic pancreatitis.

Methods

A 38-year-old patient with an L1 burst fracture (AO A3.3) underwent a standard thoracoscopic corpectomy and replacement of the vertebral body with an extendable vertebral body replacement 10 days after posterior instrumentation of T12–L2. In patients history chronic abusive alcoholism with related diseases such as pancreatitis, followed by hemipancreatectomy was found. Six hours after the surgery, the patient became hemodynamically unstable. An emergency CT scan revealed a splenic rupture. Emergent splenectomy was performed.

Results

After surgical treatment of the L1 burst fracture, a rupture of the spleen was detected. An immediate splenectomy was performed. At the 18-month follow-up, an unchanged stable position of the cage was observed on CT.

Conclusions

Due to its proximity to the thoracolumbar junction, the spleen is vulnerable to injury during spine surgery. If the patient has undergone previous intra-abdominal operations or chronic inflammation of the pancreas is found, special care of the spleen during the operation is necessary.

     

Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial

Background  

Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF.