Prosthesis Complications Research Articles

Troubleshooting recalcitrant tracheoesophageal prosthesis site leak with internal mammary artery perforator flap: a case report

BackgroundAn enlarged tracheoesophageal puncture (TEP) site is a grave complication of voice prosthesis rehabilitation.Case presentationWe report a case of periprosthetic leakage with an enlarged tracheoesophageal fistula causing aspiration, not responding to conservative management and primary closure. Internal mammary artery perforator (IMAP) flap was subsequently used in the management. The flap was successfully taken up at the recipient site with no leak post-operatively as confirmed by barium swallow, thereby preventing further aspiration.ConclusionThough minor degrees of TEP leak usually respond to conservative management, the recalcitrant ones require active intervention which one should be aware of.

Evaluation of microleakage and push-out bond strength of various composite resins for sealing the screw-access channel in implant-supported restorations

Statement of problemMicroleakage and loss of the composite resin sealing the screw-access channel are frequent complications of screw-retained implant-supported prostheses. How the screw-access channel should be best restored to reduce such complications is unclear. PurposeThe purpose of this in vitro study was to evaluate the microleakage and bond strength of 3 types of composite resins (flowable, packable, and bulk-fill) with or without a bonding agent treatment to seal the screw-access channel of 2 types of restorative materials (zirconia and Co-Cr alloy) with or without thermocycling. Material and methodsIn total, 240 yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) specimens (IPS e.max ZirCAD) and 240 Co-Cr alloy (Vera PDS) specimens were prepared with a Ø3×3-mm cylindrical cavity at the center to simulate the screw-access channel. Three types of composite resins (flowable, packable, and bulk-fill resin) (Filtek Z350 XT Flowable Restorative, Filtek Z350 XT Universal Restorative, and Filtek One Bulk Fill Restorative) were applied to restore the access channel of the zirconia and Co-Cr specimens with or without a bonding agent (Single Bond Universal Adhesive). Microleakage and push-out bond strength were determined and compared by dividing the specimens into experimental groups with or without thermocycling (1000 times with 30 seconds at 5 ±2 °C and 55 ±2 °C). The results were analyzed by using a 1-way ANOVA and 4-way ANOVA. Adjustment for multiple comparisons was made with the Tukey Honestly Significant Difference (HSD) test. ResultsThe specimens subjected to thermocycling showed a lower bond strength (P<.001) and higher microleakage (P<.001) than specimens stored in a constant-temperature water bath. Specimens treated with bonding agents showed a higher bond strength (P<.001) and lower microleakage (P<.001) than specimens not treated with a bonding agent. Higher bond strengths were observed in the order of bulk-fill resin, packable resin, and flowable resin (P<.001). Packable resin showed higher microleakage than flowable resin and bulk-fill resin (P<.05). No significant difference in microleakage was found between the flowable resin and bulk-fill resin (P>.05). ConclusionsHigher bond strengths were observed in the order of bulk-fill resin, packable resin, and flowable resin. Less microleakage was observed in the flowable resin and bulk-fill resin than in the packable composite resin. Bonding agent treatment was effective in increasing bond strength and decreasing microleakage. Zirconia and Co-Cr showed a bond strength similar to that of composite resins, but zirconia showed higher microleakage than Co-Cr. Restoring the screw-access channel with the bulk-fill resin should increase bond strength and reduce microleakage.

Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study.

Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables. To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants. The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition). Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months. The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.

Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant–Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study

Peri-implantitis is a common implant-supported prosthesis complication, and marginal bone loss affects the stress distribution in implant systems. This three-dimensional finite element analysis study investigated how bone loss affects the implant assembly; in particular, models including two implant systems with different connection systems (external or internal hexagon), abutment materials (titanium or zirconia), and bone loss levels (0, 1.5, 3, or 5 mm) were created. We observed that the maximum von Mises stress distinctly increased in the groups with bone loss over 1.5 mm compared to the group without bone loss, regardless of the connection system or abutment material used. Moreover, the screw stress patterns with bone loss progression were determined more by the connection systems than by the abutment materials, and the magnitude of the stress on the fixture was affected by the connection systems with a similar pattern. The highest stress on the screw with the external hexagon connection system increased over 25% when bone loss increased from 3 to 5 mm, exceeding the yield strength of the titanium alloy (Ti–6Al–4V) when 5 mm bone loss exists; clinically, this situation may result in screw loosening or fracture. The highest stress on the fixture, exceeding the yield strength of pure titanium, was noted with the internal hexagon connection system and 1.5 mm bone loss. Titanium and zirconia abutments—both of which are clinically durable—presented similar screw and fixture stress patterns. Therefore, clinicians should pay more attention to maintaining the peri-implant bone to achieve the long-term stability of the implant-supported prosthesis.

REVIEW OF THE COMPLICATIONS IN PROSTHESIS MAKING &amp; SERVICING

Prostheses are intended to restore the human body's appearance and return some functions lost due to the loss of limbs. The prosthesis industry exists for this purpose, as well as the servicing of the prostheses. However, there are complications in the design and installation of prostheses, as well as servicing them. Prosthesis usage is subjected to the specific circumstances of the recipient and is dependent on medical coverage for long-term servicing. The relatively low number of cases involving prostheses compared to other medical cases and the circumstantial differences between these cases prevent in-depth and comprehensive studies of the industry, preventing the establishment of standardized best practices. Despite this, research and development of improvements for recipients' problems continue, utilizing the latest technologies to address technical complications. This article consolidates the present-day complications of prosthesis making and servicing.

Survival rate and complication-free survival rate of implant-retained prostheses in the oral rehabilitation of patients with head and neck cancer: A retrospective evaluation of a cohort from a regional service

Statement of problemLiterature reporting on the prosthetic survival and complications of implant-retained prostheses in patients with head and neck cancer is sparse. PurposeThe purpose of this retrospective study was to present the survival rates and complication-free survival rates of both fixed and removable implant-retained oral prostheses in patients with head and neck cancer while also reporting on the frequency and causes of failure and complications for each prosthesis type. Material and methodsA retrospective analysis of the prosthetic survival rates and complication-free survival rates of implant-retained oral prostheses and the frequency and causes of failure and complications in patients with head and neck cancer treated in a regional unit from 2012 to 2017 was performed. Differences in categorical and continuous data were assessed for statistical significance by using the Pearson chi-squared test, Fisher exact test, t test, and analysis of variance as appropriate. Cox proportional hazard regression models were fitted to evaluate the association between prostheses type, clinical and medical factors, and the outcomes of survival and complication-free survival. Descriptive statistics were used to analyze the frequency and type of prosthetic complications. ResultsThe sample was composed of 153 patients diagnosed with head and neck cancer who had completed implant-retained prosthodontic rehabilitation and had been provided with 221 prostheses. The 5-year survival rate was 87% for maxillary fixed prostheses, 79% for mandibular fixed, 66% for maxillary removable, and 50% for mandibular removable. Hazard ratios were calculated showing that the 5-year survival rate of a mandibular removable prosthesis (HR=5.1; 95% CI 1.60-16.25) (P=.006) was greater than that of a maxillary fixed prosthesis (HR=1.0). The 5-year complication-free survival rate was highest for mandibular fixed prostheses (62%), followed by maxillary fixed (58%), maxillary removable (36%), and mandibular removable prostheses (29%). Hazard ratios showed that the 5-year survival rate of maxillary removable (HR=1.91; 95% CI 1.01-3.66) (P=.048) and mandibular removable prosthesis (HR=2.29; 95% CI 1.23-4.25) (P=.009) was greater than that of a maxillary fixed prosthesis (HR=1.0). Variables of radiotherapy, grafting, age, and sex and their influence on the survival rate and complication-free survival rate were assessed but were not statistically significant. ConclusionsThis evaluation indicated that fixed implant-retained prostheses had a higher 5-year survival rate and 5-year complication-free survival rate than removable implant-retained prostheses in patients with head and neck cancer.

Long-term clinical and radiographic outcomes of total shoulder arthroplasty in patients under age 60 years.

We aimed to characterize the long-term clinical and radiographic outcomes of total shoulder arthroplasty (TSA) in patients aged < 60 years. We hypothesized meaningful improvements in shoulder functionality and pain with TSA and an acceptably low rate of prosthesis complications and revisions. This was a retrospective cohort study of 29 patients (34 shoulders) undergoing TSA before age 60 years with a minimum follow-up period of 10 years. Shoulder range of motion, functionality (American Shoulder and Elbow Surgeons and Simple Shoulder Test scores), and pain (visual analog scale score) were evaluated. Radiographs were assessed for lateral humeral offset, the acromiohumeral interval, and glenoid loosening. The mean age of the patients was 54.4±5.5 years (range, 35.5-59.8 years), with a mean follow-up period of 16.1±4.5 years (range, 10.0-26.1 years). In patients aged < 60 years, TSA significantly improved forward elevation (from 119°±26° to 146°±21°, P=.0002), external rotation (from 21°±25° to 52°±15°, P=.0001), and internal rotation (from L5 to L1, P=.002). Additionally, TSA significantly increased American Shoulder and Elbow Surgeons scores (from 32±20 to 64±27, P=.0008) and Simple Shoulder Test scores (from 3±2 to 7±4, P=.0004) and reduced visual analog scale pain scores (from 7±3 to 3±3, P=.0001). Radiographically, there was no significant difference in mean lateral humeral offset (13±6 mm vs. 10±12 mm, P=.472) or the mean acromiohumeral interval (20±4.2 mm vs. 16±6 mm, P=.061) between immediate postoperative and final follow-up radiographs. Radiographic evidence of glenoid loosening was noted in 2 patients. Complications occurred in 6 patients (17.6%), all of which were cases of aseptic glenoid loosening. Ultimately, 4 patients underwent conversion to a reverse TSA and 2 underwent arthroscopic glenoid removal. The rate of prosthesis survivorship was 97.1% (95% confidence interval [CI], 91.4%-100%) at 10 years, 85.4% (95% CI, 73.7%-97.2%) at 15 years, and 80.1% (95% CI, 65.1%-98.4%) at 20 years. TSA consistently improved shoulder functionality and reduced pain while limiting the need for further revisions. These findings suggest that TSA is a viable treatment option for glenohumeral arthritis in younger patients.

The Causal Relationship Between Rheumatoid Arthritis and Mechanical Complications of Prosthesis After Arthroplasty: A Two-Sample Mendelian Randomization Study.

The causal effects of rheumatoid arthritis (RA) on complications of arthroplasty are yet to be established. This study was the first to explore the causal effect of RA on mechanical complications of prosthesis through two-sample Mendelian randomization (MR). In the MR analysis, RA was selected as the exposure in this study while single-nucleotide polymorphisms (SNPs) from a genome-wide association study (GWAS) were selected as the instrumental variables (IVs). Summary statistics data on mechanical complications of prosthesis was extracted from publicly available GWAS data, including 463,010 European descent individuals. MR analysis was performed using the standard inverse variance weighted method (IVW). Furthermore, other methods (MR Egger, weighted median, simple mode, and weighted mode) were also done to verify the results. Finally, the sensitivity analysis was executed. Results of the standard IVW showed that RA possibly increases the risk of mechanical complications of prosthesis [OR = 1.000255; 95% CI = (1.0001035, 1.000406); p = 9.69 × 10 −4 ]. This outcome was also verified by other methods including weighted median [OR = 1.000285; 95% CI = (1.0001032, 1.000466); p = 1.41 × 10−3], simple mode [OR = 1.000446; 95% CI = (1.0001116, 1.000781); p = 1.04 × 10−2], and weighted mode [OR = 1.000285; 95% CI = (1.0001032, 1.000466); p = 2.29 × 10−3]. No heterogeneity and directional pleiotropy was observed upon sensitivity analysis, indicating the stability and reliability of the result. In summary, the present study showed that RA potentially increases the risks of complications of prosthesis, which might provide guidance in arthroplasty on RA patients.

Evaluation of Gram Positive and Gram Negative Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis

ABSTRACT Introduction Infection is the most feared complication of inflatable penile prosthesis (IPP), often necessitating complete removal. Late infection after IPP insertion is thought to be due to the slow formation of a biofilm. Understanding and preventing biofilm formation would be a breakthrough in preventing IPP infections. Objective We aimed to develop an in vitro model to compare formation and growth of biofilms on penile implants by bacteria commonly associated with infection. Methods Sterile IPPs (Coloplast Titan) were cut into rings and incubated with S. epidermidis, S. aureus, P. aeruginosa, or K. pneumoniae cultures in tryptic soy broth (TSB) for a 4 h attachment period, and then in only TSB for 120 h. We utilized a published and validated method to measure biofilm mass. Rings were then dipped in deionized water to wash off additional bacteria and either fixed with ethanol (EtOH) or not treated further (no fix). Fixing was employed to preserve biofilm on the rings that otherwise may have been lost during crystal violet staining. Biofilm formation was measured with a spectrophotometer (OD570) after crystal violet staining. Results All bacteria formed substantial biofilm on implant rings as measured by OD570. As expected, the gram-negative bacteria, P. aeruginosa and K. pneumoniae produced significantly more biofilm than the gram-positive S. epidermidis and S. aureus. Interestingly, P. aeruginosa formed the most biofilm by at least a factor of 6 in both testing conditions. The ethanol fixing condition produced more consistent results for the crystal violet assay. Conclusions Our novel in vitro model of biofilm formation of penile implants can be used in future studies to evaluate the effect of different antibiotic dips and anti-infective capacity of pre-coated implants against different bacteria. Our findings suggest gram-negative bacteria form faster and a greater quantity of biofilm on penile implants as compared to gram-positives. P. aeruginosa displayed the strongest predilection to form biofilm on implants compared to all other bacteria studied, and could be investigated as a specific target to reduce delayed post-operative IPP infections. Disclosure Yes, this is sponsored by industry/sponsor: Coloplast Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific

New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

ABSTRACT Introduction Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. Registered Nurse First Assistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant. Objective Comparing the influence of different assistants on perioperative complications of Inflatable Penile Prosthesis Methods Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. A logistic regression model was used to identify predictors of complications. Student's T test was used to examine for differences in total OR time between different assistants. Results A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 – 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs 72.9 ± 35.5 min, p&amp;lt;0.01). Patient factors including new IPP, BMI&amp;gt;30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 – 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively. Conclusions Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Factors that Influence the Clinical Longevity of Ceramic Unit Restoration: A Scoping Review

Statement of Problem: Ceramic restorations can be essential in dental rehabilitation aesthetic and functional, but its longevity and treatment plan need to be good settled down. Different material options, manufacturing techniques and protocols are available. It is important to map the literature to know the state of the art about of clinical failures related to these fixed prostheses.&#x0D; Purpose: Evaluate the rate of survival of single restorations (crowns and ceramic veneers) as well as identify the types of clinical complications reported.&#x0D; Material and methods: A scoping review was conducted from the MEDLINE/Pubmed, Embase, Scopus, Web of Science and Cochrane Library. A search of all published literature until June 2021 was based on the following keywords: ('dental crown' OR 'ceramic veneer' OR 'porcelain veneer' OR 'dental veneer' OR 'dental porcelain') AND ('survival rate' OR 'ceramic restoration failure' OR 'prosthesis complication' OR complication).&#x0D; Results: The most reported biological complications were need for treatment endodontic and detachment. The complications and technical failures involved, mainly, fractures and cracks in ceramics. There were also cases of pigmentation marginal.&#x0D; Conclusion: The survival rate of single ceramic restorations is high. The main factors influencing restoration failures are bruxism, operator inexperience and inadequate cementation.

Evaluating the Frequency of Implant-Supported Fixed Prosthesis Complications in Yazd Dental School in 2020

Introduction: Evaluating the frequency of complications in implant supported prosthesis such as screw loosening and porcelain fracture is important for prevention and management of these problems. The purpose of this study was to evaluate the frequency of implant-supported fixed prosthesis complications in Yazd dental school in 2020. Methods: In this descriptive cross-sectional study, the patients treated with fixed implant-supported restorations in prosthodontic Department of Yazd Dental School, which at least 1 year passed from loading were recalled and examined by census sampling. Prosthetic complications, including porcelain chipping, open proximal contacts, screw loosening and repeated decementation was registered after inspection. The data were analyzed by SPSS 16 software and Chi-square and Fisher's exact tests. Prosthetic problems including porcelain pallor, open proximal contact, loosening of the abutment screw, and repeated loss of cement were recorded after examination and observation. Results: In 130 examined prosthesis, repeated decementation (8.5%), porcelain fracture (6.2%), open proximal contact (2.3%) and screw loosening (3.07%) was observed. Frequency of prosthetic complications according to sex, age, duration of implant loading and implant location were not statistically significant (p &gt;0.05). Frequency of repeated decementation was associated with prosthetic units and number of supporting implants (p &lt;0.05). Conclusion: Repeated decementation was the most frequent complication. Frequency of complications was not related to sex, age, duration of implant loading and implant location. Frequency of complications in single and multiunit prosthesis was different.

Prevalence and treatment rate of osteoporosis in patients undergoing total knee and hip arthroplasty: a systematic review and meta-analysis.

Due to age and gender, patients awaiting total knee or hip arthroplasty (TKA/THA) are at a higher risk of osteoporosis. In joint arthroplasty, low bone mineral density (BMD) is a risk factor for implant osseointegration, durability, and prosthesis complications. This study aims to investigate the prevalence and treatment rate of osteoporosis in patients undergoing total joint arthroplasty (TJA). We applied a comprehensive literature search through PubMed, Cochrane Library, and EMBASE from inception to July 10, 2021, for studies investigating the prevalence and treatment rate of osteoporosis in TJA patients. The aggregated prevalence was calculated with the random-effects model, and the heterogeneity between studies was checked by Cochran's Q test and quantified by the I2 statistic. We performed subgroup analyses and meta-regression analyses to determine the source of heterogeneity. Publication bias was assessed by a funnel plot and verified by Egger's test. Anti-osteoporosis treatment for TJA patients was described qualitatively and quantitatively. Of 4561 citations identified by the search strategy, 11 studies including 3462 patients were eligible for inclusion. The pooled prevalence of osteoporosis and osteopenia in TJA patients was 24.8% (95%CI: 14.1-37.2%) and 38.5% (95%CI: 29.3-48.0%), respectively. The prevalence of osteoporosis/osteopenia in TJA patients was 64.0% (95%CI: 45.8-80.3%). In terms of gender, the pooled prevalence of osteoporosis in males, females, and postmenopausal females were 5.5% (95%CI: 1.5-11.4%), 29.0% (95%CI: 18.3-41.1%), and 38.3% (95%CI: 13.2-67.1%), respectively. The treatment rate of osteoporosis in TJA patients was 32.9% (95%CI: 15.2-53.1%) by a random-effects model. Osteoporosis is highly prevalent in patients undergoing TJA, especially in postmenopausal females. However, the treatment rate of osteoporosis is low. Considering the possibility of surgical complications, clinicians should strengthen their awareness of pre-operative BMD assessment and manage osteoporosis in high-risk patients.

A better way to... manage late presenting complications of temporomandibular joint prostheses

<b>Introduction</b>: Within our centre, Temporomandibular joint (TMJ) prostheses have been provided in varying materials and designs over the years. Various patients have re-presented with various late complications of such surgery including limited mouth opening, facial pain, swelling, malocclusion and malpositioned components. This case series aims to discuss and illustrate the multidisciplinary approach to assessment, planning, and surgery for this cohort of patients. <b>Methods</b>: A Retrospective review of late TMJ protheses complications presenting within our centre has been undertaken. This includes multiple patient cases, with photographs, detailing the MDT planning, surgery and outcomes. <b>Results</b>: The most common presentation was pain and limited mouth opening or ankylosis. A total of twelve cases are included. Five cases were related to full metal prosthesis. Malposition of the condylar element was found in six other cases. Malocclusion was present in three cases. Some cases benefited from the removal of the joint alone, others a simultaneous further joint replacement and some with concurrent orthognathic surgery. Outcomes show reduction in pain and improvement in opening most notably. <b>Conclusions</b>: This case series evidences that complications of TMJ prostheses can present late and that such surgery carries many and significant risks. It highlights the adopted multidisciplinary team approach ensures that prostheses are appropriately designed and positioned correctly, whilst simultaneously addressing any gross occlusal abnormalities.

Intravesical reservoir erosion as a late complication of a 3-piece inflatable penile prosthesis: ectopic placement in a high-subrectus space: a rare case report

Background: Inflatable penile prosthesis (IPP) is the mainstream treatment of refractory erectile dysfunction (ED). Usually, Space of Retzius (SOR) is the usual IPP reservoir placement space, however, more concerns regarding this space complication have emerged due to its anatomical proximity to some major structures. Intravesical reservoir erosion is the most common reported reservoir complication. Hematuria is the main presentation, sometimes, dysuria and urinary tract infection take place. We present a case of late intravesical reservoir erosion after 3 years of IPP implantation. Methods: Revision surgery was made including placement of AMS Conceal® reservoir in an ectopic high-subrectus space and anterior to transversalis fascia, contralaterally. Results: Recently, ectopic placement has gained popularity among implanters due to its safety and efficacy. Specifically, submuscular space placement, after inventing the lock-out valve to avoid undesirable auto-inflation due to the high back-pressure. Conclusion: Ectopic placement utilizes more choices in cases like hostile pelvis for implanting a 3-piece IPP instead of a malleable prosthesis. Ectopic placement is safe and highly acceptable between high-volume implanters, which may prime a new era of reservoir placement.

Study of Management of Prosthetic Complications of Implant-Supported Fixed Restorations

During the rehabilitation of a patient by fixed supra-implant prosthesis, the practitioner can be confronted with many complications both mechanical, biological, aesthetic, or even functional. The practitioner must be able to handle the situation, otherwise, it would be a fault. the aim of this article is to assess the different complications of the supra-implant prosthesis and to identify the best way to deal with them.

Implant Supported Full-Arch Zirconia-Based Restorations Manufactured (CAD/CAM) From Monolithic Zirconium Dioxide:6-Year Eight-Year Results Prospective Clinical Study

Purpose: To evaluate the survival of implants, the success of prosthetics of implant-supported reconstructions based on monolithic zirconium dioxide, functioning up to 5 years. Materials and Methods: In this study 87 patients were participated referred in need of full arch implant-supported reconstructions in maxilla, mandible or both. All patients underwent a thorough clinical examination according to a generally accepted scheme. After the diagnostic workup was completed, a treatment plan was developed by using a cone beam computed tomography and software system. Using surgical guides 46 patients' dental implants were installed. Postoperative clinical and radiological monitoring was regularly conducted, and criteria for thesuccess of implantation and success of prosthetics of implant-supported reconstructions were evaluated 642 implants (6 to 8 dental implants in the edentulous arches) were installed for monolithic zirconia full arch reconstructions.prosthodontic treatment was performed 3 to 6 months after implants healing time. Digitaltechnologies were included in the work flow with the laboratory scanning of the master casts andCAD/CAM manufacturing software. The monolithic zirconia block were milled using CAD/CAM software according to the manufacturer‘s specifications and then a monolithic zirconia restorations sintering. Outcome measures were: Implant success; prosthesis success; complications and marginal bone levels. Results: No intra-operative or immediate post-operative complications were noted. During a 3-year observation fracture of the monolithic zirconia or any other mechanical complications of prostheses, no registered, screws fractured in 3 prosthesis was observed over the 3-year study period. Conclusion: Our studies have shown good aesthetic, functional and mechanical properties of monolithic zirconia restorations and fewer complications

Effects of neoadjuvant chemotherapy combined with customized tumor-type total knee arthroplasty on immune function and limb function in the treatment of malignant bone tumors around the knee joint

Objectives:To explore the effects of neoadjuvant chemotherapy combined with customized tumor-type total knee arthroplasty (TKA) on immune function and limb function in the treatment of malignant bone tumors around the knee joint.Methods:Sixty-one patients with malignant bone tumors around the knee joint treated in Sichuan Provincial Orthopedics Hospital from February 2018 to February 2020 were retrospectively enrolled and divided into two groups according to treatment methods. The differences in immune function indexes before and after treatment were compared between the two groups. And their postoperative complications were recorded.Results:Before treatment, no significant difference can be observed in the comparison, values between the two groups (P>0.05); After treatment, the levels in Group-A were higher than before treatment (P<0.05), but the levels were not different from those before treatment (P>0.05). In contrast, the levels in Group-B were higher than before treatment and higher than that in Group-A, while the level of CD8+ was lower than before treatment and lower than that in Group-A (P<0.05). At six months postoperatively, no significant difference was observed in the excellent and good rate of limb function between the two groups (P>0.05). There were no differences in the incidence of postoperative prosthesis complications and the incidence of adverse chemotherapy reactions between the two groups (P>0.05)Conclusion:Neoadjuvant chemotherapy combined with customized tumor-type TKA for knee malignant bone tumors is an excellent safety treatment for malignant bone tumors around the knee joint, boasting a variety of benefits, such as significantly ameliorating the immune function of patients and promoting the recovery of limb function, which is worthy of clinical application.

A comparison of marginal bone loss, survival rate, and prosthetic complications in implant-supported splinted and nonsplinted restorations: A systematic review and meta-analysis.

To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). The PROSPERO registry, which keeps track of prospective systematic reviews, also received this paper (CRD42021229477). An electronic search was done in PubMed, the Cochrane Central Trials Register, Scopus, Science Direct, and Google Scholar searches were carried out. The search was limited to articles published in English and covered the period from January 2010 to August 2020. To conduct the meta analysis, researchers employed methodologies such as continuous measurement and odds ratios. For both qualitative and quantitative analysis, 19 scientific studies were chosen. 3682 implants were placed in 2099 patients with a mean age of 59 years (splinted, 2529; non-splinted, 1153); the mean age was not provided in 5 trials. For splinted restorations, there were statistically significant differences in MBL, indicating the former has less MBL than for NSR. Splinted restorations had much greater survival rates than NSR, according to a qualitative study. Rest prosthesis complications with or without splinting were essentially the same. Splinted implant restorations lost less bone than non-splinted implant restorations, according to this meta analysis. This was particularly true for posterior restorations. Lower implant failure was associated with splinted restorations. Restorations with and without splinting had the same level of prosthetic problems.

Is there a real difference between modular stems and monoblock implants in THA? A revision and comparison of tribological, clinical and radiological outcomes

Background. Total hip arthroplasty represents one of the most practiced intervention in orthopaedic surgery. In order to increase the durability of implants, several options have been proposed over the years. Probably one of the most important aspects for this purpose is the adequate restoration of the offset, limb length and femoral neck version. The appearance of modularity in implants seems to be the best help for orthopaedists to achieve these goals. However, in view of these advantages, some specific complications of modular prostheses have been reported, including increased release of metal particles from wear, fretting, implant failure and secondary osteolysis. Aim. The aim of this study was to conduct a systematic review of the studies in the literature in order to compare modular implants with monolithic implants from a tribological, clinical and radiographic point of view and to establish specific indications or contraindications. Methods. We set specific and clear inclusion criteria and selected 11 studies from a collection of more than 150 studies found in the principle scientific databases. We analysed the studies by dividing them by categories of outcomes and assessing any differences between them. Findings. No significant differences were found in almost any of the outcomes examined. The only different trend was shown in the blood and urinary concentration of metal ions resulting from corrosion, which was increased in modular prostheses. However, this difference was not reflected in a cross-evaluation with clinical and radiographic outcomes. Conclusions. The literature is poor in valid scientific evidence that compares the two groups of patients. There is no unanimous opinion on any evaluable outcome. Further RCTs and meta-analyses on this much debated topic are needed.