Immediate Loading Of Implants Research Articles

Immediate loading of implants for maxillary congenital lateral deficiency

Immediate loading of implants for maxillary congenital lateral deficiency

Effect of Densah Burs on Primary and Secondary Stability of Immediately Loaded Implants in Addition to Crestal Bone Loss and Gingival Probing Depth - An Evaluative Study.

Osseodensification (OD) compaction increases primary stability by leaving the residual bone particles in the osteotomy site, which in turn act as an autograft. [ 1 ] Condensing the bone trabeculae through OD has demonstrated to have a potentiating influence on secondary stability. [ 2 ]. A split-mouth study was conducted in 40 patients to determine the effect of OD on implant success rate in terms of primary and secondary stability in situations including immediate loading of implants placed in low-density bone, which was tested using resonance frequency analysis (RFA) at the interval of 0, 6 th month. In order to assess the implant success rate, gingival probing depth and crestal bone loss (CBL) around the implant were also assessed at baseline and 6 months. With respect to primary stability, at baseline, the mean RFA of Densah burs is 71.6 ± 9.5 and of conventional drills is 67.6 ± 10.4. The mean stability of Densah burs is significantly higher than conventional drills, both at baseline and after 6 months as well. CBL, at baseline, the mean CBL of Densah burs is 0.58 ± 0.11 and of conventional drills is 0.64 ± 0.12. The mean CBL of Densah burs is significantly lower than that of conventional drills for both. The implant stability values found in the present study were remarkable when compared between OD and conventional osteotomy techniques. Decreased loss of bone at the crest probing depth also aided in the increased success rate.

Порівняльний аналіз стану опорних тканин при використанні різних ортопедичних конструкцій для негайного навантаження на дентальних імплантатах при втраті зубів на одній із щелеп

Abstract. The use of fixed prosthetic structures supported by implants in case of partial or complete tooth loss remains relevant. Thanks to the use of intraoral welding of temporary prosthesis elements, the method of manufacturing temporary prosthetic structures has been integrated into the practice of prosthetic dentistry, which allows them to be fixed during dental implantation surgery. The aim of the study is to compare the condition of supporting tissues when using different orthopedic structures for immediate loading on dental implants in case of partial or complete loss of teeth in one of the jaws. For the comparative evaluation of different orthopedic structures on implants for immediate loading, temporary structures made of polymethyl methacrylate, composite structures reinforced with metal beams using intraoral welding, acrylic structures with dentures reinforced with a cast beam were selected. Computed tomography and orthopantomography were used to assess the condition of the bone tissue before implantation, 3 days and 1, 6, months after implantation. The study resulted in the following conclusions. Restoration of complete tooth loss in one of the jaws with fixed orthopedic composite structures reinforced with metal beams using intraoral welding is a promising method that allows to reduce the time of patient rehabilitation, the number of surgical stages and the trauma of the surgical stage of treatment. In this regard, soft and bone tissue trophism is less disturbed, which affects the subsequent osseointegration and functioning of implants. At the same time, the risks of bone resorption are minimized. Clinical evaluation of the tissues around the implants and X-ray analysis of the bone in patients with acrylic structures with set teeth reinforced with cast metal beams showed almost similar results. However, the technique involves additional surgical intervention, which negatively affects the trophism and healing of soft and bone tissues, increases the risk of complications, and extends the rehabilitation period. The use of temporary structures made of polymethyl methacrylate is less appropriate due to their less stable fixation, which can lead to inflammation of the soft tissues surrounding the implants and bone resorption. Key words: fixed structures, occlusal relations of the jaws, digital technologies, dental implantation.

Maxillary Rehabilitation using the All-on-Four Technique and Computer-Guided Surgery: A Case Report

The aim of this study was to evaluate the clinical and radiographic outcomes of the All-on-4 technique in fully edentu-lous maxilla using R2GATE software for flapless, computer-guided surgery and immediate loading. Ten adult patients with fully edentulous maxilla, aged between 35 and 60 years, were included in the study between April 2021 and April 2022. The surgical procedure was performed under local anesthesia and followed the All-on-4 approach with immediate loading of implants using a screw-retained provisional acrylic resin prosthesis on the same day. Final prosthesis was de-livered four months after the surgery. Clinical and radiographic outcomes were evaluated at four- and twelve-months post-operation. The study reported a 95% implant survival rate using the All-on-4 technique. The mean marginal bone level was recorded at 0.35 mm and 0.66 mm during the 4 and 12-month follow-up periods, respectively. Fixed provi-sional prosthesis fracture, abutment, and prosthesis screw loosening were the most frequent mechanical complications reported. Within the limitations of this study, the use of computer-guided surgery in the All-on-4 technique seemed to be a promising treatment option with high implant survival rates that may help reduce post-surgical discomfort and me-chanical complications in the rehabilitation of the edentulous maxilla.

Immediate Loading of Implants with Fixed Rehabilitations in Geriatric Edentulous Patients; Biological Complications.

This study aimed to report the outcomes of the immediate loading of implants with fixed rehabilitations in edentulous geriatric patients. Edentulous geriatric patients were diagnosed with an oral examination, radiographic evaluation, and intermaxillary relations and treated with fixed rehabilitation over several implants. After immediate surgery, the implants were immediately loaded with a fully fixed prosthesis. Twenty-four patients (20 females and 4 males) were treated using a total 210 implants. All patients (100%) had a previous history of periodontitis. Eleven patients (45.8%) were smokers. Eleven patients (45.8%) suffered from chronic medical diseases (i.e., diabetes, cardiovascular diseases). The study's clinical follow-up period extended for three years, during which thirty-three fixed prostheses were installed over the implants in 24 patients. The average marginal bone loss measured was 1.33 ± 0.17 mm. The success rate of the implants and prosthodontics being placed in this study yielded 98.5% and 97%, respectively. One patient (4.2%) showed some kind of technical complications. Eleven patients (45.8%) showed mucositis, and 25 implants (11.9%) in 10 patients (41.7%) were associated with peri-implantitis. This study shows that the treatment of edentulous geriatric patients by immediate loading of implants with fixed rehabilitations is a clinically successful protocol but with a high prevalence of peri-implant diseases.

Success rate of immediately loaded implants in the posterior zone.

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

CLINICAL EFFECTIVENESS OF GUIDED IMPLANT SURGERY IN PATIENTS WITH FULLY EDENTULOUS PATIENTS ATROPHY OF THE LOWER JAW

Objectives: The aim of this study was to evaluate the results of mandibular prosthetics based on 6 implants placed with guided surgery and immediate loading in patients with a completely edentulous mandible. Materials and Methods: 52 patients participated in this study, referred in need of full arch implant-supported reconstructions in mandible. Jaw bones patients were diagnosed with cone beam computerized tomography. Patients were evaluated according to the results of computed tomography (CT). Computer software was used to create virtual templates for 3Diagnosys, an implant treatment. Surgical guided were made for ostectomy and for implant position using a 3D printer (Stratasys. Implants were placed flapless implantation metho through the sleeves of the surgical template tightening torque of 35–45 Ncm. Patients received 312 implants (64 UV functionalised short (≤6 mm) implants, 248 standard implants) 52 implant-supported prosthesis. The following parameters were assessed: implant success, prosthetics survival and changes in peri-implant marginal bone level (MBL), probe depth (PPD), and probe bleeding (BOP). Results: After 3 months loss of the marginal bone of 0.7 ± 0.35 mm (MBL), after 12 months of observation, there was a slight loss of the marginal bone over time 1.2 ± 0.38 mm (MBL), 1,47 ± 0.42. mm (MBL), after 5 years of observation. After 5 years of observation, the average PPD was 2.42 ± 0.47 mm, the average BOP was 1.32 ± 0.85. Of the 312 implants, 3 failed to osseointegrate, 5 implants failed (peri-implantitis) after 5 years. No serious prosthetic complications have been reported. After 5 years, the effectiveness of implants was 97.4%. Conclusion: Computer-guided implant surgery and immediate loading of implants in patients with insufficient lower jaw and completely edentulous is a predictable and effective method with a minimum rehabilitation period.

Immediately loaded full arch implant rehabilitation and oral health-related quality of life: A retrospective cohort study from primary dental care.

This study evaluates patient-centered outcomes in patients undergoing full-arch rehabilitation, with immediate loading of implants. Using the Oral Health Impact Profile questionnaire pre-and post-treatment, it assesses the hypothesis that immediate full arch loading significantly improves quality of life. A dataset was defined as: 20 consecutive patients from a research database who had undergone IFAL surgery (maxilla, mandible, or both) and definitive restoration by a single clinician, and completed the OHIP-14 questionnaire prior to treatment and after restoration. Pre (T0 ) and post (T1 ) treatment questionnaires were analyzed from 20 consecutive patients in whom a total of 160 implants were placed. The mean T0 score was 26.7, and mean T1 score 4.6. Differences were statistically significant (p = 0.00008). Greatest improvements were seen in psychological discomfort and disability, and pain. Worsening quality of life was shown by questions relating to speech in six patients and taste in three patients. This study demonstrates that overall IFAL significantly improves tooth-related quality of life. It suggests reasons for patients to seek treatment while providing evidence to manage expectations, such as possible implications on speech, thus supporting informed consent of future patients in a primary care setting.

Delayed and Immediately Loaded Implants Placed in Fresh Extraction Socket - A Clinical and Radiological Study.

To present the outcomes of immediately loaded single implants placed in the anterior region compared to conventional protocol. 10 patients requiring single anterior tooth extraction was randomised either into immediate or delayed loaded group. Implants were positioned immediately after extraction and prosthesis was providing for the immediately loaded group. The cases were followed up for a period of 9 months at regular 3-month interval after the placement of definitive crowns. The parameters taken were probing depth, pain score and crestal marginal bone loss. A total of 10 AD1N-Touareg Spiral tapered Implant with spiral tap, 5 immediately loaded and 5 delayed loaded were evaluated. For immediate loaded cases, there was 0.93 ± 0.04 mm bone lost after 3 months, 1.26 ± 0.21 mm after 6 months and 1.72 ± 0.13 mm after 9 months. For delayed loading, there was 0.90 ± 0.02 mm bone lost after 3 months, 1.26 ± 0.15 mm after 6 months and 1.80 ± 0.07 mm after 9 months. Pain and probing depth showed gradual reduction in both the groups during the course of treatment. In the present study, the success rate and radiographic results of immediate loading of implants in freshly extracted sockets in the anterior region where comparable to those obtained from delayed groups.

5- to 15-Year Survival of Immediately Loaded Implants in Fully Edentulous Maxillae: A Multilevel Analysis in a Retrospective Cohort Study.

Although immediate-loading implant (ILI) treatment is a general treatment strategy for fully edentulous maxillae, long-term evidence is required. The purpose of this study was to evaluate the long-term clinical results of, and risk factors for, ILI treatment in fully edentulous maxillae. ILI treatments of maxillae using 526 implants in 117 patients were reviewed retrospectively. The longest and mean observation periods were 15 years and 9.2 years, respectively. Kaplan-Meier survival curve analysis, log-rank tests, and multilevel mixed-effects parametric survival analysis were used for statistical analyses. Overall, 38 of 526 implants failed in 23 patients, and the estimated 15-year cumulative implant-level and patient-level survival rates were 90.7% and 73.7%, respectively. The cumulative implant survival rate was significantly higher in female patients than in male patients. Sex, implant length, and implant diameter were significantly associated with implant survival. ILI treatment of completely edentulous maxillae demonstrated viable long-term clinical outcomes. Male sex, shorter implant length, and narrow implant diameter negatively affected implant survival. Int J Oral Maxillofac Implants 2023;38:516-522. doi: 10.11607/jomi.10310.

Digital implant placement accuracy: a clinical study on a fully-guided flapless single-unit immediate-loading protocol

AimsThe primary aim of the present study was to measure the discrepancy between the virtual and the actual position of the single-unit implants placed via a digitally-designed fully-guided surgical template using a flapless surgical technique. Prefabricated provisional restorations and periodontal factors were evaluated after the immediate loading of implants and 3 months after the surgery, respectively.Materials and methodsFourteen implants in nine patients were virtually planned after importing intraoral scans and cone-beam computed tomography (CBCT) records into 3D planning software. Accordingly, fully-guided surgical templates, customized abutments, and provisional restorations were designed and fabricated. The implant position after the surgery was compared with its virtual counterpart in terms of angular and apical linear deviations. Implants were immediately loaded after the surgery, and the occlusal level of the delivered provisional restorations was compared with their designed positions. Early implant failure, bleeding on probing, and peri-implant pockets were documented on the 3-month follow-up.ResultsA mean angular deviation of 5.07 ± 2.06° and a mean apical linear deviation of 1.74 ± 0.63 mm resulted. Two out of 14 implants failed within the first 3 months of the surgery, and the occlusal level difference was calculated for nine prefabricated provisional restorations.ConclusionsDIONAVI protocol has been evaluated regarding its accuracy, and an estimation of the expected deviation is presented to the clinicians using this protocol. However, before widespread use, immediate-loading protocols and provisional restorations must be studied further.Trial registrationIRCT, IRCT20211208053334N1. Registered 6 August 2022.

Matrix Metalloproteinase-8 Levels in Peri-Miniscrew Crevicular Fluid During Immediate and Delayed Orthodontic Loading--A Split-Mouth Study.

Purpose: To compare the matrix metalloproteinase-8 (MMP-8) levels in the peri-miniscrew implant crevicular fluid (PMCF) of immediate-loaded and delayed-loaded miniscrew implants at different time intervals. Materials and Methods: Titanium orthodontic miniscrews were placed bilaterally in the attached gingiva of 15 patients between the maxillary second premolar and maxillary first molar for en masse retraction. This split-mouth study was designed to have an immediate-loaded miniscrew on one side and a delayed-loaded miniscrew on the other side that was loaded 8 days after miniscrew placement. PMCF was collected from the mesiobuccal aspects of the immediate-loaded implants at 24 hours, 8 days, and 28 days after loading, and from the delayed-loaded miniscrew implants at 24 hours and 8 days before loading and 24 hours and 28 days after loading. An enzyme-linked immunosorbent assay kit was used to assess MMP-8 levels in the PMCF samples. Unpaired t test, ANOVA F-test, and Tukey post hoc test were used to evaluate data at the P < .05 level. Results: Although there were slight alterations in the MMP-8 levels in the PMCF over time, there was no statistically significant difference in the MMP-8 levels between groups. There was a statistically significant decrease in the levels of MMP-8 between 24 hours after miniscrew placement and 28 days after loading on the delayed-loaded side (P < .05). Conclusion: The MMP-8 levels did not vary much between immediate-loaded and delayed-loaded miniscrew implants as a result of the force application. However, there was no significant difference between immediate loading and delayed loading in terms of biologic response to mechanical stress. The increase in MMP-8 levels after 24 hours post-miniscrew insertion, as well as the subsequent gradual reduction over the course of the study period in both immediate and delayed groups after loading, is probably due to the bone adapting to stimuli.

Immediate Loading of Dental Implants with Fixed Prosthodontic Constructions-Advantages and Methods

“Immediate loading of implants” implies loading of implants after extraction of a tooth. The goal of our study was to observe the loss of keratinized gums and bone tissue in the region surrounding the alveolar ridge after tooth extraction, and to compare it to the immediate loading of dental implants with the same indicator. Recently, immediate implant placement after the extraction of a tooth with early loading has become more common. The advantages of this procedure include fewer surgical interventions, reduction in overall treatment time, reduced soft and hard tissue loss, and psychological satisfaction for the patient. This study shows the advantages and methods for immediate implant placement with immediate provisional restorations.

Immediate Implants, Immediate Loading, and Milled Double Bar Prosthesis (Titanium, Biohpp): A Case Report

Abstract To rehabilitate lower arch by placing immediate implants and immediate milled provisionals and provide double bar prosthesis for the long-term survival of implants. Full-mouth rehabilitation by integrating cone-beam computed tomography data three-dimensional printing technology helps in precise placement and predictable outcomes to the longevity of implants. Six immediate implants were placed in the lower arch using digitally guided surgery. Computer-aided design-computer-aided manufacture milled temporary prosthesis was also given within 24 h of the surgery. After allowing for osseointegration, the final prosthesis was made up of materials such as titanium (primary bar), PEEK (secondary bar), and high-impact polymer composite crowns. Splinting all the implants together with such framework designs reduces the loads on implants and addition of two bars produces a dampening effect and helps long-term survival of the same. Strategies used to preserve alveolar bone and soft tissue by immediate implant placement in fresh extraction sockets shorten the treatment span. Immediate loading of implants using temporary prosthesis can be done after attaining adequate primary stability. This case has a follow-up of 6 years. The milled double bars made out of titanium and BioHPP h provide dampening effect and thus long-term survival of the implant.

Full-mouth rehabilitation of upper and lower jaws with computer-guided flapless surgery and immediate loading of implants inserted and mastication analysis

ABSTRACT Although a number of approaches to implant-supported restoration of severely atrophic maxillae and mandibles have been developed, most of these treatments are expensive and protracted. An exception is the concept, which uses only guided implant surgeries and immediate loading with a hybrid, screw-retained provisional prosthesis delivered on implant placement, followed by a definitive hybrid prosthesis later. The present article describes full-arch rehabilitations using implant-supported prostheses and analyzes the functional efficacy of the treatment done by mastication analysis. This innovative technique allows for full-arch implant-supported prosthesis without the need for any bone grafting procedures even in atrophic situations and immediate function. In this technique, four or six or more implants are placed in the jaws, immediately loaded with temporalization, and put into function.

Immediate Loading of Dental Implants with Fixed Prosthodontic Constructions Advantages and Methods

“Immediate loading of implants” implies loading of implants after extraction of a tooth. The goal of our study was to observe the loss of keratinized gums and bone tissue in the region surrounding the alveolar ridge after tooth extraction, and to compare it to the immediate loading of dental implants with the same indicator. Recently, immediate implant placement after the extraction of a tooth with early loading has become more common. The advantages of this procedure include fewer surgical interventions, reduction in overall treatment time, reduced soft and hard tissue loss, and psychological satisfaction for the patient. This study shows the advantages and methods for immediate implant placement with immediate provisional restorations.

Використання лазерного зварювання під час негайної реабілітації стоматологічних пацієнтів при повній відсутності зубів

Necessary to take into account the effect of occlusal and non-axial loading in orthopedic treatment and rehabilitation of patients with edentulous jaws with implant-supported structures. Immediate stabilization, which achieved by intraoral welding, increases the posebility of success of implant osseointegration, and using immediate loading even in cases of bone atrophy for allows implants to be stabilized. The presented review of scientific literature on the use of laser welding in dentistry, the features of the application and the practical feasibility of immediate loading when splinting implants using intraoral welding. Many authors have investigated the use and effect of the parameters of a pulsed solid-state Nd:YAG laser for Ti and dental alloys. Scientists have proven the safety and effectiveness of using a dental Nd:YAG laser for welding metals directly in the oral cavity. The main risk for immediate loading implants is bone overload in the implants area during the first postoperative weeks, which can lead to their disintegration. Splinting prevent micro-displacement, distributes forces across multiple implants and shows highly effective immediate loading protocols. The expediency of immediate loading and the use of implant splinting with the intraoral welding prevents possible implant tilt and overload. The problem of using the method of immediate loading of implants with intraoral welding in dental orthopedic treatment has not been finally solved, and the well-known developments of the authors require further research and improvement.

COMPARISON OF DELAYED VERSUS IMMEDIATE LOADING OF DENTAL IMPLANTS IN PARTIALLY EDENTULOUS MANDIBULAR POSTERIOR REGION

Study Design: The patient’s desire to shorten the treatment time and to avoid an edentulous condition immediate loading of implants has emerged as an alternative approach as compare to delayed loading implants for replacing missing natural teeth. The aim of this study is to compare the effect of immediate and delayed loading of implants in partially edentulous mandibular posterior region and to analyze outcome of both techniques Objective: To compare and evaluate postoperative treatment outcome in mandibular posterior region clinically and radiographically. Method: This is a Randomized controlled study, consisting of 50 patients. They were divided in two groups. Group1 (Number of patients- 25, Delayed loading implant) and Group2 (Number of patients-25, Immediate loading implant). Soft tissue examination were measured by probing depth with William probe , Hard tissue were measured and compared using OPG/CBCT and IOPAR. Result: The difference in the bone loss between Group A and Group B was 0.02 mm. In respect to soft tissue healing of gingiva bucally, lingually and papilla the average score of mean modied sulcus bleeding index and mean modied plaque index was not more than 01, signifying mild inammation at the most. Primary stability increases in both the groups. In delayed group mean stability was 56 and in immediate group mean stability was 57 which was adequate at the time of surgery and during healing period. The mean bone healing score was higher in delayed group than that of immediate group but the difference failed to reach the level of statistical signicance. Conclusion: Our study concludes that whether it is immediate loading or delayed loading protocol, under appropriate circumstances, medical condition and maintenance of good oral hygiene provide similar success rate.

Immediate Loading of Implants Placed by Guided Surgery in Geriatric Edentulous Mandible Patients.

The aim of this study was to show the clinical outcomes of the immediate loading of implants inserted by guided surgery in edentulous mandible patients. Edentulous mandible patients were diagnosed with oral examination, cone beam computerized tomography and diagnostic casts for intermaxillary relations and treated with 8–10 implants for rehabilitation with guided surgery and immediate loading. After flapless surgery, implants were loaded with an immediate acrylic temporary prosthesis. After a period of six months, a ceramic definitive full-arch prosthesis was placed. A total of 22 patients (12 females and 10 males) were treated with 198 implants. Eleven patients (50%) had a previous history of periodontitis. Six patients (27.3%) were smokers. The follow-up was 84.2 ± 4.9 months. Clinical outcomes showed a global success rate of 97.5% of implants. Five implants were lost during the healing phase with provisional prosthesis. Twenty-two fixed full-arch rehabilitations were placed in the patients over the 193 remaining implants. Mean marginal bone loss was 1.44 mm ± 0.45 mm. Six patients (27.3%) showed some kind of mechanical prosthodontic complication. Eighteen (9.3%) of the 193 remaining implants were associated with peri-implantitis. The antecedents of peri-implantitis are critical elements for the survival of the implants. The loss of implants was significant in patients who smoked up to 10 cigarettes, compared to non-smokers. Peri-implantitis is one of the key elements in the long-term follow-up of implants and it was more manifest in smoking patients, and in those with a history of peri-implantitis. Marginal bone loss was more significant in smokers. Full-arch rehabilitation is presented as a predictable alternative with minor fatigue problems that are easily solvable.

A Radiographic and Clinical Comparison of Immediate vs. Early Loading (4 Weeks) of Implants with a New Thermo-Chemically Treated Surface: A Randomized Clinical Trial

Background: Implant dentistry has evolved over time, resulting in better treatment outcomes for both patients and clinicians. The aim of this trial was to test whether the immediate loading of implants with a platform-switching design influences the marginal bone level, compared to four-week loading, after one year of follow-up. Moreover, a comparison of clinical data regarding implant survival, implant stability, and patient-reported outcome measures (PROMs) was conducted. Methods: Klockner® VEGA® implants with a ContacTi® surface were placed in partially edentulous patients in the posterior areas. Group A received an immediately loaded prosthesis (one week) and Group B received an early-loaded prosthesis (four weeks). All abutments were placed at the time of surgery. Radiographic and clinical data were recorded. Results: Twenty-one patients were treated (35 implants). No implants were lost during the study. The final marginal bone level did not show differences between groups. The bone loss at 12 months at the implant level was 0.00 mm for both groups (median). The final implant quotient stability (ISQ) values did not differ between groups (median 73 and 70.25), nor did the other clinical parameters or PROMs. Conclusions: The results suggest that neither of the loading protocols with the implants used influenced the marginal bone level—not the osseointegration rate, clinical conditions, or PROMs.