Clinical decision-making for immediate restoration of terminal dentition: determination and transfer of jaw relations

This is a report of the carotid occlusion and shunt times utilized to perform carotid endarterectomy (CEA) with primary closure, patch reconstruction, and interposition bypass grafting. The times needed for two ancillary procedures, inversion plication repair of the endarterectomy-produced common carotid step and eversion plication shortening of the endarterectomized internal carotid artery, are also reported. Over 15 years, 1,326 primary CEAs were performed. In 144 (10.9%) of these a shunt was utilized. Reconstruction was by primary closure in 137 (10.3%); patching in 1,171 (88.3%), of which 903 (77.1%) were with autologous vein, 241 (20.6%) with Dacron, and 27 (2.3%) with polytetrafluoroethylene (PTFE); and interposition bypass grafting with reversed saphenous vein in 18 (1.4%). The carotid occlusion times for nonshunted CEAs, the shunt times, the occlusion times for arteriotomy and shunt placement and for shunt removal and closure, and the total operative times were prospectively recorded. Common carotid steps >2 mm were reconstructed in 92 (6.9%) of CEAs. The internal carotid was shortened in 63 (4.8%) CEAs. Both ancillary procedures were performed in 19 (1.4%) CEAs. The occlusion and total shunt times for all CEAs was 27.4 ± 6.7 min (m +1 s.d.). The mean shunt time plus two short occlusion times were 5 to 6 minutes longer than the mean occlusion times for nonshunted CEAs. The carotid occlusion time was 20.9 ±5.2 minutes for primary closure and 27.4 ±6.3 minutes for patch reconstruction (31% longer). The occlusion and shunt times for CEAs with each of the three patch materials were essentially identical. The occlusion times for patched CEAs without and with step reconstruction were 27.1 ±6.2 and 31.5 ±6.0 minutes, respectively (16% longer), and without and with shortening, 27.8 ±6.1 and 29.4 ±8.0 minutes, respectively (6% longer). Arteriotomy length correlated with occlusion and shunt times (p<0.001 for slope, r=0.41). The total operative time was 70.6 ±8.3 minutes for all CEAs. Perioperative stroke was not associated with occlusion time or shunt use. Patch reconstruction adds approximately 6 to 7 minutes to carotid occlusion time and total shunt time when compared with primary closure. Common carotid step repair adds approximately 4 minutes and internal carotid shortening 2 minutes to occlusion and shunt times. The increased occlusion times necessary for patch angioplasty and ancillary reconstructive procedures are relatively short and do not predispose patients to increased risk of perioperative stroke.

A functional speech impression used to fabricate a maxillary speech prosthesis for a partial glossectomy patient

The survival rate, marginal bone loss and soft tissue health of the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients has not been reported in the clinical research. This retrospective study aimed to evaluate the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients after 1-8 years of follow-up. A retrospective study was conducted based on the medical records of 33 patients who received all-on-four or six treatments from April 2014 to May 2020. Four radiographic examinations [immediate postoperative (T0), definitive restorations (T1), 1-3 years after prosthetic restorations (T2), and more than 3 years after prosthetic restorations (T3)] were obtained to evaluate vertical bone height (VBH). We also calculated the survival rate and examined the condition of soft tissue with this implant system in edentulous or terminal dentition patients. Three-level linear model analyses were used to explore potential risk factors for VBH changes on the mesial and distal sides. The generalized linear model was used to analyze the influencing factors of BOP and plaque. A total of 218 implants were included in this study. The cumulative survival rate of the implants was 97.25% before the definitive prosthesis, 96.33% within 3 years of follow-up and 95.32% after more than 3 years of follow-up. The mean ± standard deviation (SD) bone losses of the VBH were 0.27 ± 0.05 mm (T1-T3) on the mesial side and 0.49 ± 0.06 mm (T1-T3) on the distal side. During 1-8 years of follow-up, the height and angle of the abutment (p < 0.001), the mandible implant site (p < 0.001), the length of the implant (p = 0.014 < 0.05) and age (p = 0.029 < 0.05) showed statistically significant effects on vertical mesial bone height (VMBH) and vertical distal bone height (VDBH). The risk of BOP among participants who brushed three times a day was lower than those who brushed less than three times. The plaque risk of short abutment height was higher than the long abutment. The current study showed that the Ankylos implants with the balanced base abutments in all-on-four or six implants treatment is a viable and predictable option with a high survival rate and low marginal bone loss in edentulous or terminal dentition patients. VBH around the implants was strongly associated with the mandible implant site, abutment height and angle, the length of the implant and age. Moreover, teeth-brushing times and abutment height significantly affect soft tissue health.

Finger amputation is one of the most common types of amputation. Prosthesis with adequate suspension, user-friendly design, and an aesthetic appearance can be effective in the rehabilitation of these patients. The aim of this technical note was to propose a technique for fabrication of finger prosthesis with a new suspension approach for such patients. To design and accurately fabricate the socket of finger prosthesis, the socket was reduced by 2 mm less than the original value, and a central tunnel with 4 mm width and depth with length matching the distance between the end of the stump and the nail section was provided, so that the silicone material extended to the stump to provide appreciable suspension. This study demonstrated the design and fabrication of a silicone finger prosthesis. It also showed silicone finger prosthesis with acceptable suspension, a user-friendly and light design, and a cosmetic appearance constructed for a patient with finger amputation. Patients with finger amputation usually use prostheses with a simple suspension technique, but evidence suggests that the residuum of these patients experience atrophy and subsequently loss of appropriate suspension. Therefore, this study was required to provide an alternative suspension method in patients with finger amputations.

This narrative review explores available information on the process for prosthesis design and factors influencing prosthesis design decision making, to support prosthesis user's participation in shared decision making about lower-limb prosthesis design. The prosthesis design process involves the fabrication of a first prosthesis and/or adjustments to a prosthesis throughout the life of the prosthesis user. Factors that influence prosthesis design decisions are extensive and may be specific to the individual prosthesis user, to prosthesis design options, the available resources, and/or the environment. This review offers foundational information for a prosthesis user's participation in shared decision making for prosthesis design, including the process of prosthesis design and factors influencing prosthesis design decisions. Future research is needed to further describe the timing of prosthesis design decisions, prosthesis design changes over time, and the role of physical and life changes of a prosthesis user on prosthesis design decisions.

A prosthesis fabrication technique for the edentulous maxillary resection patient

Occlusally oriented impressions for large maxillary stomas

Good intra-operative anaesthesia is more than an 'airway, breathing, circulation, drugs with a three, two and a one'.

To demonstrate the implementation of a digital workflow for the rehabilitation of a terminal dentition patient with complete-arch implant-supported prostheses. A virtual patient-oriented workflow can facilitate interdisciplinary treatment planning, improving the synergism between surgical and prosthetic procedures. Digital technologies assisted the acquisition of prosthetic information and optimized dental implant placement, provisional restoration fabrication, and delivery of definitive prostheses. Digital processing methods enable the integration of cutting-edge technological innovations, with fundamental prosthetic and surgical principles, to build individualized workflows for immediate implant placement and loading, aiming to provide improved patient care in comprehensive rehabilitation. To ensure predictable outcomes, a thorough diagnosis and data collection are needed for selecting the appropriate digital workflow, based on the latest scientific evidence. For patients with terminal dentition, clinicians can integrate artificial intelligence (AI) driven applications to form a comprehensive treatment plan. The virtual treatment plan can then be transferred to clinical practice, enabling surgical and prosthetic interventions for complete-arch, immediate implant placement and loading through a digital workflow.

Digital Workflow in Implant Treatment Planning For Terminal Dentition Patients.

This report describes a step-by-step staged digital protocol for the terminal dentition patient using a Provi-guide. This protocol will improve implant placement accuracy, shorten treatment time, and assure an implant-supported fixed complete denture immediately loaded after extraction of the remaining terminal dentition and complete edentulism. The novelty of the Provi-guide technique described is that it serves 2 objectives: (1) a nonlimiting surgical guide, and (2) a fixed interim prosthesis. Implants placed in the described digital stagged protocol can serve both the interim and the final prosthesis.

To present a digital workflow for rehabilitating terminal dentition patients with complete arch maxillary (FP-2) and mandibular (FP-3) implant-supported restorations through a staged approach. Staging extractions in these patients offers a valuable treatment option, allowing patients to retain fixed prostheses throughout the treatment. In this way, both function and esthetics can be evaluated, without relying on transitional complete dentures or the need for immediate implant placement and loading. Interim fixed restorations, such as tripod prostheses, can assist in the preservation of soft tissue anatomy and increase patient comfort, compared to removable prostheses. Prosthetic-driven implant placement and loading can be facilitated by implementing a stackable surgical template system. To overcome the challenges of digital implant position acquisition in edentulous areas, a dual-purpose implant scan body system can be implemented. Finally, monolithic zirconia titanium-supported prostheses are delivered to meet both esthetic and mechanical requirements.

PURPOSETo integrate extra-oral facial scanning information with CAD/CAM complete dentures to immediately rehabilitate terminal dentition.MATERIALS AND METHODSTen patients with terminal dentition scheduled for total extraction and immediate denture placement were recruited for this study. The patients were submitted to a facial scanning procedure using the in-office PritiMirror scanner with bite registration records in-situ. Definitive stone cast models and bite records were subsequently submitted to a lab scanning procedure using the lab scanner (iSeries DWOS; Dental Wings). The scanned models were used to create a virtual teeth setup of a complete denture. Using the intra-oral bite records as a reference, the virtual setup was incorporated in the facial scan thereby facilitating a virtual clinical evaluation (teeth try-in) phase. After applying necessary adjustments, the virtual setup was submitted to a CAM procedure where a 5-axis industrial milling machine (M7 CNC; Darton AG General) was used to fabricate a full-milled PMMA immediate provisional prosthesis.RESULTSTotal extractions were performed, the dentures were immediately inserted, and subjective clinical fit was evaluated. The immediate provisional prostheses were inserted and clinical fit, occlusion/articulation, and esthetics were subjectively assessed; the results were deemed satisfactory. All provisional prostheses remained three months in function with no notable technical complications.CONCLUSIONTen patients with terminal dentition were treated using a complete digital approach to fabricate complete dentures using CAD/CAM technology. The proposed technique has the potential to accelerate the rehabilitation procedure starting from immediate denture to final implant-supported prosthesis leading to more predictable functional and aesthetics outcomes.

This paper has three principal aims. It firstly provides some theoretical background on the key current research issues and challenges in regard to industrial relations in multinational companies. It then presents a concise review of scholarship to date on industrial relations in multinational companies using INTREPID ( Investigation of Transnationals’ Employment Practices: an International Database) data. Finally, the paper identifies some of the main industrial relations issues that remain to be addressed, in effect charting a form of research agenda for future work using the INTREPID data, with particular focus on the potential contribution from ‘late joiners’ to the INTREPID project.

Background: The ankle (talocrural) joint is composed of a superior mortise, formed by the weight-bearing inferior surface of the tibia and the two malleoli, which receive the trochlea of the talus. The ankle joint is maintained medially by a strong, medial (deltoid) ligament, and a much weaker lateral ligament. On rocky surfaces, the natural ankle will initiate ground contact with reduced dorsiflexion to provide a relatively flatter foot. Patients wearing prosthesis attempt to replicate this strategy but are unable to mimic the ankle angle to match the terrian, presumably due to the reduced range of motion available from the ankle and foot. Therefore, the desing of a prosthetic foot and ankle mechanism with expanded ranges of ankle motion presents an opportunity to restore vital functions among amputees using lower limb prosthesis and this forms the bases of this study. This design and fabrication of a below-knee prosthesis followed standard protocols in prosthetics and orthotics with the inclusion of ankle joint. Objectives: The aim of the study is to make accurate and proper assessments/measurements of the amputee which will help to design and fabricate different components of the prosthesis, including the devised ankle joint, then assemble the components and fit the below-knee prosthesis on the amputee in other to achieve a better ambulation and rehabilitation of the amputee. Materials and method: The methods followed in the fabrication of the device include: Assessment, Impression/measurement taking, Modification, Lamination of test/check socket, Lamination of a new positive cast/model, Formation of liners/inserts, Lamination of a definitive socket, Attachment of socket to pylon and ankle joint (bench alignment), Prosthesis finishing, Amputee’s training and follow-up. The below-knee prosthesis consists of a socket, metal pylon and ankle joint component, padding/suspension materials, screws, bolts and nuts. The materials used for fabricating these components and the below knee prosthesis as a whole included: Plaster of Paris (POP) bandage and powder, Plastic polymer laminate, Reinforcement textile, Padding/suspension materials, Metals, Cosmetic finishing materials, and Adhesives. Results: The ankle joint in the design resulted in minimal energy expenditure, no pain, improved number of steps and strides per minute by the amputee than the use of the conventional prosthesis. From a paired t-test conducted for the improved and conventional prostheses in steps and strides, there was significant difference between the improved and the conventional prostheses at 5% level (p value