1-year Success Rate Research Articles

Monolithic Polymer-Infiltrated Ceramic Network CAD/CAM Single Crowns: Three-Year Mid-Term Results of a Prospective Clinical Study

To evaluate the clinical outcomes of monolithic CAD/CAM-fabricated polymer-infiltrated ceramic network (PICN) single crowns (SC) after 3 years. A total of 34 patients who received 76 single crowns were included in this cohort study. Full-coverage crown preparation with reduced thickness (1.0 to 1.5 mm) was applied. All monolithic PICN SCs (VITA Enamic) were manufactured using a CAD/CAM system and adhesively seated. Clinical follow-up evaluations were performed at 6, 12, 24, and 36 months after insertion using modified United States Public Health Service (USPHS) criteria. Kaplan-Meier survival and success methods were applied to calculate absolute and relative failures. To determine effects of time and restoration, a mixed logit model was adjusted for the modified USPHS criteria (P < .05). PICN SCs revealed an estimated Kaplan-Meier survival rate of 93.9% after 3 years. Four clinically unacceptable fractures occurred, which resulted in replacement of the affected SCs. Neither secondary caries nor debonding were recorded. The 3-year Kaplan-Meier success rate was 92.7%. Significant increases in marginal discoloration (P = .0002) and surface roughness (P < .0001) were noted over time. Color match, anatomical form, and marginal adaptation remained favorable over the given observation period. PICN CAD/CAM crowns with reduced thickness showed acceptable survival and success rates over a service time of 36 months. However, extended clinical follow-up periods are needed to evaluate the long-term performance.

A comparison of the 1-year surgical outcomes of ab externo trabeculotomy and microhook ab interno trabeculotomy using propensity score analysis

ObjectiveTo compare the 1-year outcomes of trabeculotomy ab externo (ab externo TLO) and trabeculotomy ab interno using a microhook (ab interno TLO) for glaucoma patients using propensity score analysis.Methods and...

Contemporary management of refractory pediatric glaucoma

The management of pediatric glaucoma poses a unique challenge in terms of maintaining lifelong vision and combating an aggressive scarring response from surgery. Contemporary literature regarding the surgical management of children with pediatric glaucoma who fail, or are at a high risk of failure, from conventional surgery is limited. The aim of this review is to highlight recent developments in relation to the current opinion regarding the management of children with refractory pediatric glaucoma. Some studies have reported impressive success rates with circumferential trabeculotomy, even in eyes with previous failed surgery. Early results of deep sclerectomy in populations which may not respond well to conventional angle surgery are encouraging but data is limited for the pediatric age group. In compliant patients in whom multiple postoperative examinations under anesthesia are possible, trabeculectomy remains an effective procedure. Multiple recent studies have demonstrated that glaucoma drainage device (GDD) surgery is associated with 5-year success rates of over 70% in primary childhood glaucomas. Glaucoma drainage device surgery is likely to remain a mainstay of surgical management for refractory glaucoma in older children. More prospective data are needed on the success of circumferential trabeculotomy, deep sclerectomy and micropulse laser in pediatric eyes with previous failed surgery. VIDEO ABSTRACT: http://links.lww.com/COOP/A34.

Immediate and 1-year success rate of type 2 endoleak treatment using three-dimensional image fusion guidance

PurposeTo retrospectively assess immediate and 1-year success rate of type 2 endoleak (T2E) treatment with ethylene-vinyl-alcohol-polymer using three-dimensional (3D) image fusion guidance with cone beam computed tomography via trans-arterial embolization (TAE) or direct percutaneous sac injection (DPSI). Materials and methodsA total of 37 patients with T2E who were treated either using TAE (34/37; 92%) or DPSI (9/37; 8%) were included. There were 34 men and 3 women with a mean age of 86±9 (SD) years (range: 67–104years). Mean aneurysm diameter was 67±14 (SD) mm (range: 42–101mm) at pre-procedure evaluation. Immediate success was complete embolization of the sac and feeding artery. 1-year success was reduction or stability of the aneurysmal sac diameter based on pre-procedure and 12-month follow-up examinations. Safety (treatment-related complications), patient demographics, duration of procedure and contrast volume were reported. ResultsImmediate and 1-year successful outcomes were reported in 94% (n=32) and 88% (n=28) of patients after TAE and 100% (n=9) and 89% (n=8) after DPSI. T2E treatments were immediately successful for 95% of the procedures (41/43) and for 88% (36/41) at 1year. Overall, T2E treatment was effective in 33 patients (89%). No major complications occurred. Mean procedure time and contrast volume were significantly different between the 2 techniques with respectively 87±16 (SD) min (range: 65–120min) and 75±26 (SD) mL (range: 40–130mL) for TAE and 32±10 (SD) min (range: 20–50min) (P<0.01) and 6±6 (SD) mL (range: 2–22mL) (P<0.01) for DPSI. Mean aneurysm diameter at 1-year was 68±17 (SD) mm (range: 43–101mm). No significant differences in the pre-procedure sac diameter were found at long-term follow-up between patients without T2E and those with persistent T2E (P=0.1) in the successful embolization group (n=33). ConclusionTAE or DPSI treatments of T2E with ethylene-vinyl-alcohol-polymer using 3D-image fusion guidance were immediately successful for 95% of the procedures and remained effective for 88%. Longer follow-up is necessary to assess sac stability in the case of persistent endoleak.

Five- and 10-Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors.

Endoscopic dacryocystorhinostomy (eDCR) is the preferred approach for nasolacrimal duct obstruction, yet quality data on long-term outcomes is lacking. A retrospective study in a single, academic institution. To assess the 5- and 10-year success rates of eDCR, and its associated risks. All eDCRs conducted at Kaplan Medical Center between the years 2002-2017 were included. For long-term follow-up analysis, two subgroups with a minimum of documented 5- and 10-year follow-up after surgery were defined. Surgical success was defined by both anatomical (observed patent lacrimal flow) and functional (symptomatic relief) success. Data was collected from the hospital's electronic medical records and was completed by phone interviews. Pre-, intra-, and postoperative variables were collected and stratified by multivariate analysis. After exclusions, 321, 168, and 65 patients were included for immediate, 5- and 10-year outcome analysis, respectively. Overall success rates were 92.5%, 86.3%, and 80%, respectively. The anatomical success rates were 93.8%, 89.9%, and 86.1%, respectively. Multivariate analysis revealed that older age (P < .001, P = .001) previous smoking (P = .043, P = .037), and postoperative complains of epiphora (even when a successful irrigation was observed, P < .001, P = .01) were all associated with eDCR failure 5 and 10 years following surgery. Male gender was also associated with eDCR failure (5 years, P = .045; 10 years, P = .063). Despite decreased rates over time, eDCR is beneficial for the majority of patients also at 10 years following surgery. Older age, smoking, postoperative epiphora, and male gender are related to long-term failure and should be discussed with the patients before surgery. 3b Laryngoscope, 131:10-16, 2021.

Percutaneous ethanol injection efficacy in the treatment of benign thyroid nodules. Ten-year follow-up of 254 patients

Introduction and aim: Although percutaneous ethanol sclerotherapy for the treatment of benign thyroid nodules (PEI) has been used for more than 30 years, there are only two studies in thyroid cysts (THCY) and 2 in autonomously functioning nodule (AFN) in which the mean follow-up reaches at least five years, while in the event of non-autonomously functioning solid nodules (NAS), there is not any study with at least 5-year mean follow-up. Our study focuses on the long-term efficacy of PEI in benign thyroid nodules. Method: We analyzed the long-term success of PEI in 254 patients treated for more than 10 years. The success was defined as 50% or greater reduction in nodule volume. In addition, the patient had to remain euthyroid without thyrostatic therapy in AFN. Results: The 10-year success rate was 79.4%, 37.1% and 69.4% in THCY, AFN and NAS, respectively. In 23.3% of unsuccessful PEIs, the failure could be revealed only after 5 years of follow-up. The mean nodule volume at 10-year follow-up related to the initial size was 29.8%, 39.6% and 48.9% in THCY, NAS and AFN, respectively. In THCY, PEI proved to be significantly more effective in older patients while other parameters (size of the nodule, amount of the injected alcohol and the ratio of these) did not correlate significantly with the success rate. Conclusions: Our study which presents the longest follow-up in all 3 types of benign thyroid nodules confirms that PEI has a minimal role in AFN, is recommendable in THCY and might have a role in NAS. The success rate decreases over time which emphasizes the importance of the long-term follow-up in the judgement of PEI. Orv Hetil. 2020; 161(6): 224-231.

Trabeculotomy versus combined trabeculotomy–trabeculectomy for primary congenital glaucoma: study protocol of a randomised controlled trial

IntroductionTrabeculotomy and combined trabeculotomy–trabeculectomy (CTT) are major surgical options for primary congenital glaucoma (PCG). However, it is unclear which of these two surgical procedures should be recommended as the optimum...

Three-year clinical performance of monolithic and partially veneered zirconia ceramic fixed partial dentures.

To compare the 3-year survival and success rates of monolithic (M) and partially veneered (PV) zirconia-fixed partial dentures (FPDs). Sixty-seven FPDs (n = 33 M-FPDs; n = 34 PV-FPDs) were placed in 51 patients (n = 23 males; mean age 61.5 years) and clinically followed up 1 week, 6 months, and then yearly after placement. One hundred per cent (100%) of M-FPDs and 70% of PV-FPDs were located in the posterior region. Ninety-two per cent (92%) of M-FPDs had three units, whereas 50% of PV-FPDs had more than three units. A facial veneer was present in 73% of the PV-FPDs units. Survival and success were calculated using the Kaplan-Meier method and compared using the log-rank test (α = .05). The mean observation period was 3.5 years for M-FPDs and 3.1 years for PV-FPDs. Most complications associated with FPDs were biological in nature. Ceramic defects occurred exclusively among PV-FPDs. Three-year survival was 96.7% for M-FPDs and 93.8% for PV-FPDs (P = .064). Three-year success was 93.8% for M-FPDs and 81.7% for PV-FPDs (P = .039). The use of both M-FPDs and PV-FPDs yielded clinically successful results over a mean period of 3 years. By using monolithic or facially veneered zirconia, ceramic FPDs could be fabricated which showed only a minimum of technical complications over the period of investigation without sacrificing adequate esthetics.

Long-term obstructive sleep apnea therapy: a 10-year follow-up of mandibular advancement device and continuous positive airway pressure

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, commonly managed by either continuous positive airway pressure (CPAP) or a mandibular advancement device (MAD). Long-term follow-up and comparison regarding efficacy of these therapies is scarce. In this study the results of treatment, patient adherence, and satisfaction over a 10-year follow-up of these therapies are reported. This is a longitudinal follow-up study taken from a subset of patients initially enrolled in a randomized controlled clinical trial of 103 patients with OSA (51 and 52 patients randomized for MAD and CPAP, respectively). After a 10-year follow-up period, 14 patients using MAD and 17 patients using CPAP could be evaluated for this longitudinal follow-up study. Data were analyzed at baseline, after 3 months and at 1-, 2-, and 10-year follow-up. All 31 patients with OSA underwent polysomnography and self-reported measurements. Polysomnography results showed a favorable outcome of both therapies at 10-year follow-up. At baseline, included patients in both groups did not significantly differ in apnea-hypopnea index (AHI) values. At 10-year follow-up, both the MAD and CPAP groups showed a significant reduction in AHI. At baseline the mean AHI in the MAD group was 31.7 ± 20.6 events/h whereas in the CPAP group it was 49.2 ± 26.1 events/h. At 10-year follow-up the mean AHI in the MAD group was 9.9 ± 10.3 events/h and in the CPAP group it was 3.4 ± 5.4 events/h. Both therapies resulted in a substantial improvement in self-reported neurobehavioral outcomes at 10-year follow-up. Both CPAP and MAD therapy demonstrate good and stable treatment effects after a 10-year follow-up period. Therefore, when indicated, both therapies are appropriate modalities for the long-term management of OSA. Registry: Netherlands Trial Register; Name: Management of the Obstructive Sleep Apnea-Hypopnea Syndrome: Oral Appliance versus Continuous Positive Airway Pressure Therapy; Identifier: NL75; URL: https://www.trialregister.nl/trial/75.

Reduction of radiation and contrast agent exposure in a cryoballoon ablation procedure with integration of electromagnetic mapping and intracardiac echocardiography: a single center experience.

Pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) is routinely guided by fluoroscopy and utilizes contrast injection to ensure catheter positioning and pulmonary vein occlusion. Non-fluoroscopic imaging techniques including electromagnetic mapping (EM) and intracardiac echocardiography (ICE) have demonstrated reduced fluoroscopy times and contrast exposure. Utilization of color flow Doppler to evaluate vein occlusion with the balloon has not been evaluated as an alternative to contrast injection. In this study we evaluate the effectiveness of cryoablation guided by EM and ICE along with color Doppler to achieve PVI. We designed a retrospective cohort study comparing patients who were treated before and after implementation of EM (Carto 3, Biosense Webster) and ICE during CBA (AF Solutions, Medtronic). We analyzed patients receiving CBA with fluoroscopy plus EM and ICE (group 2; N = 24) versus fluoroscopy alone (group 1; N = 25). Procedural success was defined as freedom from atrial fibrillation or other atrial arrhythmias at 1year post ablation. Primary outcomes were radiation time and contrast exposure. Procedural success was achieved in all cases. Total fluoroscopy time was reduced from 22.4 ± 9.8min to 8.9 ± 5.1min (P < 0.001) in patients receiving CBA guided by EM and ICE. Furthermore, exposure to contrast media was significantly lower at 75.4 ± 24.1ml and 16.5 ± 21.1ml (P ≤ 0.001) in group 1 and group 2, respectively. Neither the number of required cryotherapy treatments nor procedure duration was negatively impacted by the implementation of non-fluoroscopic techniques. The 1-year success rate was identical between both groups at 72% and 79%. There was no difference in complication rates. This single-center cohort study demonstrates that CBA guided by EM and ICE can markedly reduce radiation and contrast exposure with excellent rates of acute PVI. This technique may be particularly effective in patients sensitive to intravenous contrast exposure.

The Long-Term Outcome of Customized EVAR Follow-Up Primarily Based on Ultrasound AAA Diameters

Introduction - Previous studies have suggested that yearly contrast-enhanced CT (CTA) follow-up after EVAR of AAA may be unnecessary and could have negative effects. The objective was to study the long-term outcome of a personalized follow-up program after infrarenal EVAR based on frequent ultrasound AAA diameter measurements for low-risk patients. Methods - All consecutive patients followed-up locally for at least one year after infrarenal EVAR between 2010 and 2015 were included. Pre-, intra-, and post-operative data was retrospectively reviewed. Follow-up included CTA at 1 month post-EVAR in all patients. Depending on this CTA, the patients were divided into 2 groups, ultrasound-based and CTA-based follow-up. When the CTA was uneventful and the patient was considered anatomically at low risk of developing AAA-related adverse events by the operator, the follow-up continued with only ultrasound assessing AAA diameter at 1, 2, 3 and every 5 years postoperatively (group A). When expansion was suspected or ultrasound was inconclusive, CTA was performed. Patients not fulfilling the criteria for group A were followed with yearly 3-phase-CTAs (group B). Crossing-over between groups was permitted. Late re-interventions were analysed by intention-to-treat based on allocation to group A or B. Values are presented as median (IQR) or absolute numbers (%) if not stated otherwise. Non-parametric and log-rank tests were used for comparisons. Results - 204 patients (176 male, age 72 (67-77), 20 ruptured AAAs) with an AAA diameter of 58 (48-66) mm were included. 180 (88 %) were allocated into follow-up in group A and 24 (12%) in group B. Median follow-up time was 36 (24-59) months, during which 78 additional CTAs (0.42/person) were performed in group A and 6 crossovers occurred between the groups. Five year primary and primary assisted success was 83±6% and 95±2% for group A and 59±17% and 91±6% for group B, respectively (p= 0.005 for primary and p= 0.222 for primary assisted success). Primary failures were detected after 22 (12-36) months. 15 late aneurysm-related re-interventions were performed in 12 patients at a median of 40 (27-60) months postoperatively (9 in group A and 6 in group B). In group A, 7 re-interventions were expansion-related (6 detected on ultrasound follow-up and 1 after unrelated abdominal CT-scan) and 2 were after symptomatic lower limb ischemia. All late re-interventions in group B were performed following findings on follow-up imaging due to AAA enlargement or failing sealing zones without expansion. Five-year late re-intervention-free survival was 95±2 % and 85± 8% for groups A and B, respectively (p=0.010). Five-year survival was 81±4% and 75±16% for group A and B, respectively, with no verified aneurysm-related deaths. Conclusion - A customized follow-up program after infrarenal EVAR based on ultrasound AAA diameter measurements in low-risk patients seems to be effective in maintaining a very high 5-year clinical success rate. Ultrasound can be used for the majority of patients. However, yearly CTA is still necessary for high-risk patients. Longer follow-up is needed to determine the ideal frequency of imaging in the long-term.

Clinical evaluation of chairside-fabricated partial crowns composed of zirconia-reinforced lithium silicate ceramics: 3-year results of a prospective practice-based study.

Prospective practice-based clinical evaluation of chairside fabricated monolithic partial crowns composed of zirconia-containing lithium silicate (ZLS) ceramic material. Between October 2013 and September 2014, 71 patients were restored with 92 partial crowns on vital or sufficiently endodontically treated teeth. The monolithic restorations were fabricated chairside (Cerec SW 4.2/Cerec MC XL) from a glaze-fired ZLS ceramic material (Celtra Duo, Dentsply Sirona, Bensheim, Germany). Adhesive cementation was performed using the total-etch technique with one of two dual-curing composite materials. Modified United States Public Health Service parameters were evaluated annually; moreover, the parameters "time-dependent survival" (in situ criterion) and "success rates" (event-free restorations) were evaluated according to Kaplan-Meier analysis. Sixty-nine patients with 17 premolar and 71 molar partial crowns attended annual follow-up examinations (observational period: 36.0 ± 5.7 months). Two complete failures were recorded and were caused by a tooth fracture (at 30 months) and a restoration fracture (at 38 months), (3-year survival rate: 99%; 95% confidence interval (CI 95%): [0.97;1]). One clinical intervention was necessary (endodontic treatment) to maintain function (3-year success rate: 98%; (CI95%: [0.95:1]). Chairside-fabricated ZLS partial crowns show a good initial clinical performance. However, to further evaluate this new material, clinical data from studies with longer observational periods are required. Based on this mid-term evaluation, ZLS ceramics appear to be a promising alternative material for the chairside fabrication of adhesively luted monolithic posterior restorations with a low risk of material-related complications.

P983Long-standing persistent atrial fibrillation: what can we achieve with ablation?

Abstract Introduction Atrial fibrillation (AF) ablation presents suboptimal results in patients (pts) with persistent long-lasting forms (LSPAF, AF ≥12 months). Recently, the STAR AF-II trial has shown that in these pts complex additional strategies do not improve success compared to only performing pulmonary vein isolation (PVI). Objectives To evaluate the success of AF ablation, particularly in long-standing persistent AF Methods Single-center prospective study of pts with AF submitted to ablation. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional ablation strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (&gt;30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF in our population and with pts included in STAR-II AF trial. Results 620 patients were submitted to AF ablation, 67% male, 58±12 years, including 78 pts (13%) with LSPAF - pts with paroxysmal and persistent short duration AF represented 61% and 26% of the population. In LSPAF, VPI was performed with irrigated catheter (N=33), PVAC (N=44) or nMARQ (N=1), complemented by CTI ablation in 15, linear left atrial lesions in 3, ablation of areas of low voltage in 3 and elimination of fractionated electrograms in 1 patient. With a median follow-up of 426 days (94–989), the 3-year success rate after a single procedure was 53% in LSPAF, lower than that observed in patients with paroxysmal AF (69%) or short-duration persistent AF (61%) - LogRank P=0.002. The risk of arrhythmias was double in LSPAF vs paroxysmal AF (HR: 2.0; P=0.001). However, after an average of 1.2 procedures/patient, the success rate in LSPAF was 80% at 3 years, comparable to that observed for other types of AF (Log Rank 2.5, p=0.29). Effectively, the long-term success rate of our LSPAF pts treated with PVI and very selective additional strategies was higher than that observed in the STAR-II AF pts treated with PVI and indiscriminate complex ablations (80% vs. 69%, t-test p&lt;0.001, with similar mean follow-up). Conclusions AF ablation is more effective if it is performed earlier in the natural history of the disease. However, even in LSPAF, high success rates are achieved through PVI-based ablation strategies, although more procedures are required.

The Clinical Performance of Narrow Diameter Implants Versus Regular Diameter Implants: A Meta-Analysis.

The purpose of this study is to analyze 1- and 3-year clinical performances of narrow diameter implants (NDIs) versus regular diameter implants (RDIs). A search of electronic databases and a manual search was performed for the time period January 2000 to April 2018. A meta-regression was used to evaluate the effects of the "fixed effects" model on the implant survival rates, prosthesis success rates and marginal bone loss (MBL) with follow-up time of 1 year and 3 years. Of the 11 studies included, the overall combined 1-year implant survival rates were 98.14% for NDIs and 98.20% for RDIs. The overall combined 3-year implant survival rates were 98.71% for NDIs and 98.84% for RDIs. The corresponding values for 1-year prosthesis success rates were 96.94% for NDIs and 99.25% for RDIs. The corresponding values for 3-year prosthesis success rates were 89.25% for NDIs and 96.55% for RDIs. The meta-regression showed no significant differences between NDIs and RDIs regarding implant survival rates, prosthesis success rates, and MBL in 1-year and 3-year follow-up (P > .05). The results of this meta-analysis concluded that the implant diameter did not affect its survival rates, prosthesis success rates, and MBL in 1 and 3 years. The use of NDIs instead of bone augmentation procedures with RDIs did not affect its survival rates, prosthesis success rates, and MBL in the short-term and middle-term. However, more high-quality randomized controlled trials and long follow-up studies are needed on this topic.

Clinical outcomes of catheter ablation of paroxysmal atrial fibrillation in very young population compared to older population: a prospective study

BackgroundData on procedural characteristics and clinical outcome of catheter ablation of atrial fibrillation (AF) in adults younger than 35 years has not been sufficiently addressed. The aim is to assess procedural characteristics and clinical outcome of catheter ablation of paroxysmal atrial fibrillation in young adults in comparison to older adults.ResultsSeventy-six consecutive patients with symptomatic paroxysmal AF underwent pulmonary vein isolation (PVI) at Ain Shams University Hospitals from 2013 till 2016. They were divided into the two groups, young population group (mean age 31.6 ± 4.2 years, 77% men) and older population group (mean age 49 ± 8.4 years, 74% men). Clinical data before and during the procedure were recorded. Follow-up was based on outpatient visits including 24 h Holter, ECG at 3, 6, and, 12 months post single ablation procedure. Recurrence was defined as any AF/atrial tachycardia episode > 30 s following a 3-month blanking period. Body mass index, CHA2DS2-VASc score, and left atrial volume were higher in the older population group [P values 0.019, < 0.001, and 0.001, respectively]. The presence of low-voltage areas was found only in 22% of the older population group and not in the younger group [P 0.02]. All patients were followed up for 1 year; 1-year arrhythmia-free survival after a single procedure was 83.3% (25/30) and 78.3% (36/46) in the older group [P 0.75]. No complications were recorded in both groups. Redo AF ablation were done for four patients in the old group and one patient in the young group.ConclusionsCatheter ablation of AF in very young adults is associated with higher 1-year success rates but comparable to success rates in older populations. AF ablation for PAF is effective in very young adults.

Factors influencing the long-term prognosis of root tip resected teeth.

Introduction: The aim of the study was to investigate possible predictive factors influencing the long-term success of root tip resection.Methods: The retrospective study included 216 patients (♂ 111, ♀ 106, median age 43.3 years). A total of 261 root tip resections were performed on these patients between 1989 and 2012. In addition to determining the success rates 5 and 10 years postoperatively, the factors gender, age, tooth type, use of bone replacement material and preoperative periodontal tooth status were examined with regard to their significance for the long-term prognosis of root tip resected teeth. Results: The evaluation showed an average success rate of 63.6% for all included teeth over the entire observation period (tooth at least one year postoperatively still in situ). The 5-year success rate was 78.2%, the 10-year success rate 63.1%. A dependence of the success rates on the tooth type could not be evaluated. However, the examination showed a clear dependence of the success on the age of the patients. Root tip resections in patients in the age group 60 years and older had significantly worse success rates compared to the age groups 20 to 39 years and 40 to 59 years. The prognosis was also significantly better for patients in the age group 20 to 39 years than for patients in the age group 40 to 59 years. Periodontally compromised teeth showed only a tendency for a poorer prognosis than periodontally healthy teeth. With regard to sex and intraoperative filling of the resection defect with bone replacement material, no differences in the success rates were found.Conclusions: A root tip resection is a good option, largely independent of the type of tooth, to preserve a tooth in the medium to long term after unsuccessful endodontic treatment. However, a revision of the endodontic treatment or even an extraction with subsequent implantation should always be considered as an alternative, especially with increasing age.

Success and Complication Rates of Root-Filled Teeth Restored with Zirconia Posts: A Critical Review.

To study the complication and success rates of root-filled teeth restored with zirconia posts in a critical review. An electronic literature search in the MEDLINE, Cochrane Library, Ovid-EMBASE, and Chinese National Knowledge Infrastructure (CNKI) databases was undertaken in December 2018. Other databases were also searched for gray literature, and the electronic search was complemented by a manual search in the related reviews and references of full-text articles. Initial screening of the titles and abstracts of eligible studies was conducted by two independent reviewers in duplicate. Complication and success rates were extracted from the included studies and then pooled using a random- or fixed-effects model. Poisson regression was used to study the effect of core materials (resin vs composite). Among 431 screened articles, 2 prospective and 3 retrospective studies met the eligibility criteria and were included. The pooled data showed that zirconia posts had a favorable 3-year success rate of 97.4% (95% confidence interval [CI] 95.7% to 98.8%). The estimated 3-year catastrophic complication (ie, tooth extraction) rate was 0.09% (95% CI 0% to 1.67%), and the estimated 3-year noncatastrophic complication rates were 0.24% (95% CI 0% to 1.16%) for post complications, 0.78% (95% CI 0% to 4.29%) for crown complications, and 0.03% (95% CI 0% to 0.63%) for endodontic failures. Based on the limited number of clinical cohort studies, zirconia posts appear to be suitable for use in post-and-core systems. However, the studies included in this critical review had a relatively high risk of bias, and further well-designed clinical studies, especially long-term randomized controlled trials, are required to confirm these findings.

Effect of peroral endoscopic myotomy in geriatric patients: a propensity score matching study.

Peroral endoscopic myotomy (POEM) is a safe and effective approach for achalasia. However, the safety, feasibility, perioperative and long-term efficacy in treating geriatric patients has not been well evaluated. Data of 2367 patients diagnosed with achalasia and treated with POEM in the Endoscopy Center, Zhongshan Hospital, Fudan University from August 2010 to December 2017 were retrospectively reviewed. Last follow-up was in December 2018. Propensity score matching based on baseline characteristics was used to adjust for confounding. With a caliper of 0.01 in propensity scoring, 139 patients aged ≥ 65years were matched at a 1:2 ratio with 275 patients aged < 65years. Perioperative complications and long-term outcomes were compared between the two groups. After propensity score matching, the two groups had similar baseline clinical characteristics and distribution of propensity scores. The mean age was 70.22years in geriatric patients and 42.02 in younger patients. Technical failure occurred in one geriatric and one non-geriatric patients (p = 0.485). The procedural time in geriatric patients was similar to younger patients [50 (interquartile range (IQR) 36-76) vs. 50 (IQR 36-70) min, p = 0.398]. There were also no significant differences in major perioperative adverse events (2.88% vs. 2.18%, p = 0.663) and hospitalization length (median 3 vs. 3days, p = 0.488). During a median follow-up period of 41months (IQR 26-60), mean decrease in Eckardt score and pressure of the LES were 6.63 and 11.9mmHg in geriatric patients, which were similar to the change in non-geriatric patients (6.49 and 11.6mmHg, p = 0.652 and 0.872, respectively). Clinical reflux occurred in 23.53% geriatric patients and 21.59% non-geriatric patients (p = 0.724). 5-year success rate of 92.94% was achieved in geriatric patients and 92.61% in younger patients (log-rank p = 0.737). POEM is a safe and reliable treatment in geriatric achalasia patients with confirmed short-term and long-term efficacy compared with those in non-geriatric patients.

Combining Intraoral and Face Scans for the Design and Fabrication of Computer-Assisted Design/Computer-Assisted Manufacturing (CAD/CAM) Polyether-Ether-Ketone (PEEK) Implant-Supported Bars for Maxillary Overdentures.

Purpose To present a digital method that combines intraoral and face scanning for the computer-assisted design/computer-assisted manufacturing (CAD/CAM) fabrication of implant-supported bars for maxillary overdentures. Methods Over a 2-year period, all patients presenting to a private dental clinic with a removable complete denture in the maxilla, seeking rehabilitation with implants, were considered for inclusion in this study. Inclusion criteria were fully edentulous maxilla, functional problems with the preexisting denture, opposing dentition, and sufficient bone volume to insert four implants. Exclusion criteria were age < 55 years, need for bone augmentation, uncompensated diabetes mellitus, immunocompromised status, radio- and/or chemotherapy, and previous treatment with oral and/or intravenous aminobisphosphonates. All patients were rehabilitated with a maxillary overdenture supported by a CAD/CAM polyether-ether-ketone (PEEK) implant-supported bar. The outcomes of the study were the passive fit/adaptation of the bar, the 1-year implant survival, and the success rates of the implant-supported overdentures. Results 15 patients (6 males, 9 females; mean age 68.8 ± 4.7 years) received 60 implants and were rehabilitated with a maxillary overdenture supported by a PEEK bar, designed and milled from an intraoral digital impression. The intraoral scans were integrated with face scans, in order to design each bar with all available patient data (soft tissues, prosthesis, implants, and face) in the correct spatial position. When testing the 3D-printed resin bar, 12 bars out of 15 (80%) had a perfect passive adaptation and fit; in contrast, 3 out of 15 (20%) did not have a sufficient passive fit or adaptation. No implants were lost, for a 1-year survival of 100% (60/60 surviving implants). However, some complications (two fixtures with peri-implantitis in the same patient and two repaired overdentures in two different patients) occurred. This determined a 1-year success rate of 80% for the implant-supported overdenture. Conclusions In this study, the combination of intraoral and face scans allowed to successfully restore fully edentulous patients with maxillary overdentures supported by 4 implants and a CAD/CAM PEEK bar. Further studies are needed to confirm these outcomes.

Mechanical failure of articulating polymethylmethacrylate (PMMA) spacers in two-stage revision hip arthroplasty: the risk factors and the impact on interim function

BackgroundThis study aimed to investigate the risk factors for mechanical failure of cement spacers and the impact on hip function after two-stage exchange arthroplasty for periprosthetic joint infection (PJI).MethodsThirty-one patients (19 males and 12 females) with hip PJIs underwent resection arthroplasty and implantation of cement spacers from January 2014 to December 2015. Patients who encountered spacer-associated mechanical complications in the interim period (14 of 31) were compared with those without complications (17 of 31). Complications were defined as spacer dislocation, spacer fracture, spacer fracture with dislocation, and femoral fracture during or following spacer implantation. Hip functional outcome was assessed using the Harris hip score (HHS). Treatment success was defined according to the following criteria: (1) no symptoms or signs indicative of infection; (2) no PJI-related mortality; and (3) no subsequent surgical intervention for infection after reimplantation surgery. Multivariate logistic regression and Kaplan-Meier survival curves were used for analysis.ResultsFourteen patients (14/31 = 45%) suffered at least one spacer-related complication within the interim period. The development of spacer complications was associated with a younger age (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.83–1.00, p = 0.045) and chronic PJI (OR 14.7, 95% CI 1.19–182, p = 0.036). Patients with spacer complications also had a lower median HHS (37 vs. 60, p < 0.001) before reimplantation in comparison to those without spacer complications. After reimplantation, the two groups had a similar median HHS (90 vs. 89, p = 0.945). Two patients did not undergo reimplantation due to extensive comorbidities, and subsequently retained the antibiotic spacer for definitive treatment. The 2-year treatment success rate was 84.6% in the spacer-complication group and 87.5% in the non-spacer-complication group (p = 0.81).ConclusionThere was a high complication rate for articulating PMMA spacers during the interim period of two-stage revision total hip arthroplasty. A young age and chronic infection were the primary risk factors associated with mechanical complications. Patients at high risk of spacer-related mechanical complications should be advised accordingly by surgeons. Knowing the possible risk factors, surgeons should educate patients thoroughly to avoid spacer complications, thereby increasing patient satisfaction in the interim stage.Level of evidencePrognostic Level III.